Non-Addictive Anxiety Medications: A Comprehensive Guide

What you will learn

• Non-addictive alternatives to commonly prescribed anxiety medications include SSRIs, beta blockers, and some antihistamines.
• These alternatives are usually not as fast-acting as benzodiazepines, but they can manage your symptoms with less risk.
• Supplementing your medication plan with at-home techniques can further improve anxiety symptom management.

Anxiety can be crushing. Those who seek medical treatment quickly learn that, despite advancements, no perfect treatment exists. In the worst-case scenario, clinically speaking, patients foster an addiction to the very thing meant to help them: medication.

Addiction to prescribed anxiety medications has become so prevalent that many people in need of professional treatment will hesitate. They may even forego medication altogether out of a fear of developing a dependence.

Thankfully, non-addictive anxiety medications are widely available. Understanding how they work, how they differ from addictive alternatives, and other key details will equip you for a safer and smarter path to stability.

Types of Non-Addictive Anxiety Medications

With or without a substantial risk of addiction, every medication that can potentially alter your mood or cognition should be thoroughly researched and used with caution. In the case of non-addictive anxiety medications, several types of drugs are used to increase serotonin levels, reduce the effects of adrenaline on the body, and promote other anxiety-reducing mechanisms.

SSRIs (Selective Serotonin Reuptake Inhibitors)

Examples:

• Escitalopram (Lexapro)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

The consistency of SSRIs as an anxiety treatment continues to be demonstrated in clinical research findings.[1] When nerve cells communicate, they send the neurotransmitter serotonin. After the message is sent, leftover serotonin is absorbed back into the nerve cell. SSRIs inhibit the reuptake of serotonin into presynaptic neurons, increasing serotonin levels in the synaptic cleft, which enhances its action on postsynaptic receptors.

The free serotonin is now able to engage with the second nerve cell again. More serotonin uptake by the nerve cell comes with a broad range of mental health benefits, such as reducing anxiety. Serotonin’s complex effects on mood states are still being explored.

Beta Blockers

Examples:

• Propranolol
• Atenolol

Anyone who has endured an anxiety attack is acutely aware of the effects of norepinephrine. Also referred to as noradrenaline, this chemical messenger jolts the body into a heightened state of awareness. The “fight-or-flight” response is engaged as a result.

Symptoms of an anxiety attack include shortness of breath, increased heart rate, and trembling, to name a few. As for the associated mental state, most people experiencing an attack feel panicked, as if they are doomed.

Beta blockers interfere with this loop by blocking beta-adrenergic receptors. There are several types of beta receptors, one of which decreases the speed and force of your heartbeat.

While the effectiveness of beta blockers for other forms of anxiety is still debated, several findings point to their potential for acute attacks related to stage fright and other social situations.[2]

Hydroxyzine

Hydroxyzine is an antihistamine medication reduces anxiety symptoms through two mechanisms.[3] Histamine receptors are not only involved in allergic reactions, but they also promote alertness. Hydroxyzine’s ability to block histamine receptors helps to create a mild sedative effect that can relieve anxiety symptoms.

Hydroxyzine may exert anxiolytic effects partially through antagonism at 5-HT2A receptors, but it does not increase serotonin levels in the way SSRIs do. Similar to how an SSRI works, serotonin is then free to populate the space between nerves (synapse) because it is not allowed access to the receptor.

Other Non-Addictive Anxiety Medications

There are several other non-addictive anxiety medications available on the market today, including buspirone, pregabalin, and gabapentin, among others. Various claims argue that there is still a potential for psychological dependence or substance use disorder. Gabapentin has a lower risk of physical dependence than benzodiazepines, but it still has potential for misuse and dependence, especially in those with substance use disorders.

Non-Addictive Anxiety Medication Versus Benzodiazepines

Benzodiazepines have held the mantle as the go-to treatment option to relieve symptoms of anxiety, as they are fast-acting and effective. However, as benzodiazepine mortality numbers continue to climb, it’s becoming increasingly difficult to ignore the serious consequences of long-term use and substance abuse.[4] Outside of deliberate abuse, accidental overdose (sometimes exacerbated by combining benzodiazepines with other drugs) is also an issue that claims lives every year.

Before comparing benzodiazepines to non-addictive alternatives, it’s important to understand how they work and why abuse is such a problem.

What Are Benzodiazepines?

Also referred to as “benzos,” benzodiazepines are a class of drugs that increase the effectiveness of GABA, or gamma-aminobutyric acid. This chemical messenger’s main function in the brain is to exert a calming effect. GABA slows brain activity, helping you feel less frantic and more relaxed.

Benzodiazepines bind to specific GABA receptors, making it easier for GABA to attach to its receptors. This augments the calming effect, significantly slowing down or even stopping certain nerves from firing.

Commonly used benzodiazepines include:

• Alprazolam (Xanax)
• Diazepam (Valium)
• Lorazepam (Ativan)
• Clonazepam (Klonopin)

Some benzodiazepines can indirectly enhance dopamine release in reward-related brain areas, particularly when combined with other substances, but this is not their primary mechanism of action. Benzodiazepines can even alter how nerves communicate over time to increase your risk of dependence.

How Prevalent Is Benzodiazepine Addiction?

A CDC report on fatal and non-fatal benzodiazepine overdoses from 2019-2020 provides a harrowing set of statistics relating to benzodiazepine abuse, addiction, and death.[5]

Per the report:

• Benzodiazepines were involved in 6,982 deaths (16.8%) of 41,496 overdose deaths between January 2019 and June 2020.
• A very high percentage (92.7%) of benzodiazepine deaths also involved opioids.
• The number of benzodiazepine deaths increased 42.9% from Q2 2019 through Q2 2020, encompassing increases in both prescription and illicit benzodiazepine deaths.

In 2016, the CDC discouraged doctors from prescribing opioids and benzodiazepines, but of course, this has not significantly alleviated the issue of illegally obtained drugs. Continued awareness efforts and legislative changes seek to curb these numbers, but they continue to increase.

How Do Benzodiazepines and Non-Addictive Anxiety Drugs Compare?

Aside from the established point of addictive potential, benzodiazepines and non-addictive anxiety drugs demonstrate several key differences.

For one, benzodiazepines tend to be faster; their effects take hold in minutes, not days. Depending on the non-addictive medication, it may take multiple weeks before you notice a significant improvement in anxiety symptoms.

However, a significant downside to benzodiazepines that may contribute to abuse is the diminishing returns on their effectiveness. Over time, most benzodiazepines cause the body to develop a tolerance, requiring higher doses and promoting misuse. Benzodiazepines are typically prescribed for short-term or acute management of anxiety symptoms, including panic attacks. Some non-addictive medications like SSRIs and buspirone are also used to treat generalized anxiety disorder and, in some cases, panic disorder.

Beyond Medication: At-Home Symptom Management for Improved Outcomes

Applied Relaxation

“Just relax” may sound like a half-hearted throwaway of a suggestion to someone with anxiety. Still, research has found relaxation techniques to be just as effective as therapy in patients with panic disorder.[6]

Specifically, applied relaxation is a legitimate therapeutic technique that encourages a mindful and proactive approach to managing anxiety-increasing situations.[7] It emphasizes identifying potential stressors and engaging in progressive muscle relaxation.

The Importance of Sleep

Consistently getting seven to nine hours of sleep per night is essential when looking to manage anxiety symptoms. Beyond getting the hours in, sleeping at the same time every night, and making your bedtime routine as calming as possible can also help with anxiety.

Finally, make sure to limit your use of stimulants like caffeine before bed. Especially when paired with a nutritionally dense diet, a healthy sleep schedule will help you cope with and prevent anxiety symptoms.

Meditation and Healthy Activity Levels

Mindfulness and meditation, regular physical activity, journaling, and keeping your home environment calm and clean can all help prevent or decrease anxiety symptoms.

Medication is not a replacement for self-care. Practicing these simple strategies consistently, when combined with an effective medication, can give you the best possible chance of taking control of your anxiety symptoms.

Struggling With Your Anxiety Medication? Help Is Available

If you’ve developed an unhealthy dependence on your anxiety medication, you’re not alone. Though you may feel the urge to isolate, you must seek out the support you need immediately to prevent further harm.

Services are available to address your addiction at the source while providing sustainable solutions for your anxiety symptoms. Regain control of your peace of mind and get connected with support services today.

Amanda is a prolific medical content writer specializing in eating disorders and addiction treatment. She graduated Magna Cum Laude from Purdue University with a B.S. in Social Work. Read more