According to the National Institute of Mental Health, anxiety disorders affect more than 19% of adults within the US, in any given year . This means that one in five people in America are having to push through their daily activities such as performing at their job, completing school work, and maintaining relationships; all while trying to deal with anxiety-related issues.
These anxiety disorders can cause symptoms that make normal daily activities difficult, and so medications are sometimes used to help alleviate some of the symptoms.
Some of the first medications prescribed specifically were Benzodiazepines, which became available in the 1960s. While “Benzos” work quickly and effectively, they carry a (very) high risk of dependence, sedation, and tolerance buildup .
Many people are seeking alternatives to Benzodiazepines and similar medications to help with their anxiety symptoms and disorders, that don’t have the same risks of addiction & other side-effects. So here we are going to look at how anxiety medications work, what non-addictive anxiety medications exist on the market today, if there are any natural anxiety remedies and if any of these alternatives work as (or more) effectively than Benzodiazepines.
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Controlled Substances vs Non-controlled Substances for Anxiety
When we talk about “non-controlled” anxiety medications, we are referring to medications that do not carry the risk of dependence or addiction according to the U.S. Drug Enforcement Administration (DEA) .
Benzodiazepines, typically prescribed under the brand names Valium, Xanax, Restoril, Ativan and Klonopin, are the oldest and most well-known controlled substances for anxiety. While benzodiazepines have the advantage of working quickly, they carry a high risk of addiction.
That’s why it’s important for people suffering from anxiety to have alternatives to benzodiazepines.
Today, the commonly recommended first-line medications for anxiety are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
The main difference between SSRIs and SNRIs, compared to Benzodiazepines, is that SSRIs & SNRIs are shown to treat the source of the anxiety, whereas benzodiazepines typically only treat the symptoms.
How First-line Anxiety Medications Work
Benzodiazepines like Xanax work by decreasing abnormal excitement within the brain. They act on the brain and central nervous system (CNS) to produce a calming effect .
Xanax, specifically, slows down the movement of brain chemicals that may have become unbalanced, resulting in a reduction in nervous tension and anxiety. Xanax does this by boosting the effects of a natural chemical called gamma-aminobutyric acid (GABA), which is made in the brain .
Benzodiazepines typically act quickly within the body, taking effect within a few minutes to an hour after an oral dose. Benzodiazepines carry a (very) high risk of dependence, sedation, and tolerance buildup.
Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs originally developed to treat depression that have been shown to help reduce anxiety. SSRIs work by increasing the amount of serotonin in your brain, which has a mood-boosting effect. They are particularly effective in treating post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) . SSRIs include:
- Fluoxetine (Prozac)
- Escitalopram (Lexapro)
- Citalopram (Celexa)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
Importantly, SSRIs for anxiety have no addictive potential. They also have the added advantage of effectively treating depression, which commonly co-occurs with anxiety disorders .
The downside to SSRIs is that they take four to six weeks to build up in your system before you can feel the full effects. SSRIs can also cause uncomfortable withdrawal effects if you suddenly stop taking them; including vertigo, nausea or vomiting, chills, shock sensations or “brain zaps,” and visual disturbances . Around 30% to 50% of people experience mild side effects with SSRIs, but only about 19% discontinue the medication due to these effects .
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are better than SSRIs for disorders like generalized anxiety disorder and panic disorder. They are similar to SSRIs in that they boost serotonin, but they’re unique because they also regulate norepinephrine. Norepinephrine is a neurotransmitter related to alertness and concentration. Regulating both of these has an overall strong, positive effect on mood . SNRIs are available as:
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
SNRIs for anxiety are usually used after the failure of an SSRI, and like SSRIs they also have no addictive potential.
SNRIs have a delayed onset of action, usually taking at least two weeks to show their anti-anxiety effects . The side effects are reported to be similar to those of SSRIs, plus potentially fatigue, loss of appetite, and constipation . SNRIs can also cause withdrawal effects when you abruptly stop taking them, similar to those of SSRIs.
In some rare cases, as SNRIs focus on the neurotransmitter norepinephrine, which can have energizing effects, some have reported worse physical symptoms of anxiety after usage. This is not typical, however.
Are there other Non-Addictive Anxiety Medications?
While SSRIs and SNRIs have proven to be effective non-addictive alternatives to benzodiazepines for anxiety disorders, there are other non-addictive anxiety medications that carry little to no risk for abuse:
Azapirone drugs, like Buspirone (Buspar), act on the 5-HT1A receptor, a type of serotonin receptor. The non-addictive class of drugs for anxiety are similar to SSRIs in that sense (increasing chemical messengers involving serotonin).
Buspar, specifically, only targets one subtype of the serotonin receptor, so it only affects one specific area of the brain. SSRIs, in comparison, target more receptors so there are more side effects. Azapirones like Buspar also take around the same amount of time as an SSRI until effective .
Side effects of Azapirones can include:
- Sore throat
- Sleep problems
Beta blockers are typically prescribed for health conditions like high blood pressure, angina (chest pains), irregular heart rhythm (arrhythmia), and migraines.
It is now well-known that beta-blockers are (very commonly) used by performers to deal with performance anxiety . In fact, a 1987 survey by the International Conference of Symphony Orchestra Musicians, representing some of the largest orchestras in the U.S., found that 27 percent of their musicians were using beta-blockers for performance anxiety . Experts estimate that number is much higher today.
We experience the physical symptoms of performance anxiety because of the adrenaline pumping through our bloodstream and our heart working with greater force before a high-anxiety event.
By blocking the release of stress hormones, beta-blockers prevent the heart from going into overdrive, keeping blood pressure low, and performance anxiety symptoms at bay .
Some of the most common over the counter beta-blockers include:
Beta-blockers like Propranolol don’t do anything to change the chemical balance of your brain, so the side-effects are minimal but you can’t rely on beta blockers for long-term performance anxiety relief.
Calcium Channel Modulators
Calcium channel modulators (sometimes called calcium antagonists or calcium blockers) are medications used to lower blood pressure. They work by preventing calcium from entering the cells of the heart and arteries. Calcium causes the heart and arteries to squeeze (contract) more strongly. By blocking calcium, calcium channel modulators allow blood vessels to relax and open .
Some calcium channel modulators like Pregabalin (Lyrica) can also slow the heart rate, which can further lower blood pressure. Calcium blockers are also prescribed to relieve chest pain (angina), and sometimes to control an irregular heartbeat.
Calcium channel modulators are sometimes prescribed ‘off-label’ for anxiety and insomnia. The drug reduces the release of excitatory neurotransmitters like glutamate, which in turn give off a calming, and sometimes sleepy, effect .
According to a 2017 expert opinion piece pregabalin can even improve sleep problems, which are common in people with anxiety disorders, earlier than with the SSRIs or SNRIs .
Natural Remedies For Anxiety
With the potential risks and downsides of Benzodiazepines, as well as the risk of dependence when you take any drug habitually, it may be best to consider which natural anxiety remedies can provide the same benefits for anxiety as the drugs mentioned above.
Many foods, minerals and dietary supplements have similar properties to prescription anxiety medications, in terms of lowering the negative effects of stress and anxiety.
The major difference is that natural anxiety remedies are less likely to have detrimental side-effects, and carry a lower risk of dependence or addiction. They are also more widely available, as you do not need a prescription, and almost all are beneficial to your health in more areas than one .
Here are some notable natural remedies for anxiety that you can consider trying:
Silexan is a branded extract of lavender oil created by Wilmar Schwabe GmbH, a German pharmaceutical company. Schwabe pharmaceuticals claim that silexan is “introducing a new therapeutic alternative in the field of anxiety disorder treatment” .
At its core, Silexan is a standardized essential oil of L. angustifolia (lavender) flowers prepared by steam distillation .
Research involving Silexan is showing that “uniquely prepared, pharmaceutical quality lavender oil” (potent silexan) can improve symptoms of mild anxiety. Two recent studies found lavender oil capsules to be just as effective as commonly prescribed benzodiazepine Lorazepam and the antidepressant Paroxetine .
The anxiolytic (anti-anxiety) properties of lavender/silexan seemingly come from the antagonization of NMDA and GABA-related receptors in the central nervous system that influence muscle contraction, as well as inhibition of the serotonin transporter. In this way, the mechanism of action for Silexan seems to be similar to anxiolytic and antidepressant drugs like SSRIs and Benzodiazepines .
The major upside to lavender/silexan over other anti-anxiety medications is the almost complete lack of abuse potential in healthy recreational users of the lavender extract . Downsides can include the affectionately-titled “lavender burps” which are potential mild gastrointestinal issues, and recent studies showing that chemicals in lavender oil are potential endocrine disruptors with varying effects on receptors for two hormones — estrogen and androgen .
Gamma-Aminobutyric Acid, shortened to GABA, is a naturally-occurring amino acid that acts as a neurotransmitter within the body. GABA has been shown in numerous studies to have a calming effect, and GABA deficiency is believed to play a part in several anxiety disorders .
Studies that used GABA supplementation have found it may have a positive effect on stress and anxiety , which would help block the symptoms associated with anxiety in a similar way to benzodiazepines without the associated addiction risk.
L-theanine is an amino acid well known for its relaxing properties . Studies have shown that L-theanine may decrease the severity of stress-related symptoms in test subjects, while also increasing cognitive performance .
Taking L-theanine, therefore, may help people counteract the nerves that come with anxiety, while also providing better focus and clearer thought.
L-theanine can be taken in supplement form, and is also present in green, black and oolong teas, as well as some mushrooms.
Another natural amino acid, L-arginine effectively lowers blood pressure, and may provide relief from the symptoms of hypertension and even some forms of heart disease . L-arginine increases the release of nitric oxide in the blood, causing blood vessels to open which allows blood to flow more freely.
More research is necessary to show whether or not L-arginine also proves effective for anxiety in the same way as other anxiety medications do. But there is no addictive potential with L-arginine.
L-arginine can be found in supplement form, as well as found in red meat, dairy, poultry and fish.
Natural Anxiety Supplements
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Additionally, PerformZen contains L-theanine, theacrine, and Ginkgo Biloba, which are natural ingredients that promote calmness and provide a boost in clean energy.
So what is the best non-addictive anxiety medication or remedy?
If you’re currently living with anxiety, you’re not alone. Anxiety disorders are the most prevalent psychiatric disorder in the world, currently affecting over 40 million adults in the United States .
It is common for anxiety symptoms to interfere with your daily life and cause significant distress. If this is your current situation, consider reaching out to a mental health professional who can properly advise you about the right treatment that can reduce your symptoms and significantly improve your quality of life.
Your doctor may recommend one of the anxiety medications above, but if you are not comfortable using prescription medication with a high risk of addiction, talk with them about the alternatives listed here that are less risky and have less risk of dependence & addiction.
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