Xanax is one of the most commonly prescribed psychotropic drugs in the United States. It’s one of the first options considered by doctors and medical professionals when it comes to anxiety and panic disorders. But it’s not the only way to approach treatment for an anxiety disorder.
Treating anxiety effectively may depend on the type of anxiety you have. Generalized anxiety might not be treated in the same ways that social anxiety is. Plus, each person is different and may respond to different treatment options.
Learn more about anxiety treatment and your possible alternatives to Xanax.
Treating something as complicated as anxiety can take some trial and error. Many people go into taking anxiety medication, assuming they will be cured. But there is no magic bullet for anxiety, and treating it may take some work. Your doctor may have to adjust your dose or try a new medication.
If you are looking for Xanax alternatives because you’d tried it and felt it hasn’t’ worked, don’t be discouraged. It’s common to go through a period of trying and adjusting medication when treating mental health. If you’re looking for Xanax alternatives because you’ve struggled with a substance use disorder related to benzodiazepines, feel free to skip to the next item on the list.
Xanax is the most common benzodiazepine in the United States, but it’s not the only one that can be used to treat anxiety. All benzodiazepines work by binding to gamma-aminobutyric acid (GABA) receptors and increase the effectiveness of GABA.
After Xanax, clonazepam and lorazepam are very popular in treating anxiety and insomnia. Lorazepam is sold under the popular brand name Ativan. These Xanax alternatives work in the same way that alprazolam does, but different drugs of the same class may offer slight variations in experience.
The treatment of anxiety disorders is often based on specific symptoms. The nature of your specific anxiety problems may be better treated by antidepressants than benzodiazepines. Though antidepressants are a first-line medication for treating depression, they can also be useful in treating certain kinds of anxiety as well. While benzodiazepines are more commonly used to treat panic disorders and more intense forms of anxiety, antidepressants may be used to treat generalized anxiety disorder.
Both common forms of antidepressants, which are selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can be used to treat anxiety. Generalized anxiety disorder is one of the most common forms of anxiety, and it may be the most common mental health issue in the United States.
It’s often characterized by feelings of fear or worry. It can also come with insomnia, headaches, hypervigilance, irritability, fatigue, obsessive thoughts, and body tremors. Antidepressants work with chemicals like serotonin and norepinephrine. These chemicals are tied to mood, energy levels, sleep, and a general feeling of well-being.
They can help people to stabilize their mood and offer a sense of contentment, which may be what someone with anxiety struggles with. Anxiety may be related to serotonin and norepinephrine levels in the brain. SSRIs and SNRIs both block serotonin from being removed from your system after being released. SNRIs do the same for norepinephrine. This allows more of these feel-good chemicals to bind to their receptors, having a greater effect on your brain and nervous system. If your anxiety stems from a lack of these chemicals in your brain, they may alleviate anxiety. Antidepressants are also less likely to cause substance use problems.
They have a lower misuse potential than Xanax, and they’re not likely to lead to addiction. If you stop taking them suddenly, you may experience some withdrawal, but symptoms aren’t like the potentially dangerous effects that can happen when quitting a depressant.
Anxiety and sleep problems often go hand in hand. Overexcitability in your nervous system can cause both sleep issues and anxiety problems. In some cases, sleeplessness and insomnia can contribute to mental health problems like anxiety and depression. Next to anxiety, sleep issues are one of the most common health issues that Americans face. According to the Centers for Disease Control and Prevention, a third of Americans don’t get the recommended amount of sleep they would need to maintain a healthy lifestyle.
While sleeping less than is optimal may be common, it comes with some significant consequences. Sleep issues can lead to cognitive and emotional issues, obesity, heart disease, and a number of serious problems. But sleep issues are often associated with anxiety. Anxiety may cause sleep problems. Insomnia that’s caused by worry and racing thoughts is common among people with anxiety disorders. However, the opposite can be true too; sleep issues may contribute to anxiety. If insomnia or other sleep issues are at the root of your anxiety, non-benzodiazepine sleep aids may be helpful.
A 2009 study found that extended-release zolpidem, a non-benzodiazepine sleep aid, was useful in improving sleep and next-day symptoms in people that had both insomnia and anxiety issues. Zolpidem is sold as the popular brand name Ambien, and it’s just one sleep aid in the class that’s sometimes called Z-drugs. Z-drugs work similarly to benzodiazepines, but they generally aren’t as potent and come with fewer side effects. They may also be less likely to lead to chemical dependence or substance use issues.
Many mental health issues and even daily mental health care can benefit from certain forms of psychotherapy. Speaking with a psychologist or therapist can go a long way in learning about yourself, your mental health problems, and new ways to overcome them. In some cases, therapy can be needed, even if you’re already taking medication. Plus, mental health care is health care, and it’s treated like other health needs by insurance companies. If you’re covered for anxiety medications, you may also be at least partially covered for other mental health services.
However, just like there are no magic pills that can cure anxiety, a therapist can’t make your anxiety just disappear. Addressing a mental health issue may take work, whether it involves medications or therapy. There are many types of psychotherapy, and there are more than one that can be helpful in addressing an anxiety disorder.
Cognitive Behavioral Therapy (CBT) is a form of therapy commonly used in treating various psychological and behavioral problems, from anxiety to substance use problems. A 2015 article found that CBT proved to be an effective treatment for anxiety disorders. CBT is used to identify the triggers and causes of symptoms and to develop better coping responses to help avoid the escalation of symptoms. The cognitive part of CBT examines how thoughts may relate to anxiety problems and anxious feelings. The behavior part of CBT deals with your behavioral responses to anxiety triggers.
Through CBT, you’ll learn to identify triggers and situations that may cause anxiety. By learning about triggers, you can develop methods to avoid or cope with these situations. Coping methods for anxiety may include thought restructuring, which is when you challenge negative thoughts and replace them with positive alternatives.
For instance, if you’re worried that a close friend doesn’t actually like you, you can challenge the thought by examining the evidence for your assumption. Perhaps your only evidence is a delayed text response. While frustrating, someone not texting back doesn’t mean they no longer like you. Replacing the thought involves coming up with a more likely or positively reframed alternative. Maybe their phone is on the charger or in another room.
Exposure therapy is another type of therapy that’s used to treat many different kinds of mental health problems. Exposure therapy is often associated with mental health problems that involve fear like post-traumatic stress, panic disorders, and phobias.
The idea behind exposure therapy is that in confronting stressful or fear-inducing triggers in a controlled setting, you can take some of the potency out of them when you encounter them in daily life. While exposure therapy for a phobia of snakes might involve being near or handling snakes, exposure therapy for generalized anxiety will involve talk therapy and perhaps role-play.
You and your therapist may go over some ways to help cope with anxious feelings when they occur. Then you’ll list some things that often trigger anxiety, and you may rank them in order of how intensely they affect you. Exposure may involve going through each one, talking about experiences, and inducing some of the anxious feelings associated with them. Your therapist may walk you through ways to relax and cope with anxious feelings in those specific situations.
Dialectical behavioral therapy (DBT) is a specific type of behavior therapy that’s centered on accepting your mental health challenges while seeking to improve them. It was originally developed to treat borderline personality disorder, but it’s been adapted to treat a variety of issues, just like CBT. DBT might involve mindfulness, which is being present in the moment and consciously examining passing thoughts without letting them overwhelm you. It may also help you to learn to better manage emotions by preventing anxious feelings from becoming distressing.
American Psychological Association. (2017, July). What is cognitive behavioral therapy? from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
CDC. (2018, February 22). Sleep and Sleep Disorders. from https://www.cdc.gov/sleep/index.html
Kaczkurkin, A., & Foa, E. (2015, September). Cognitive-behavioral therapy for anxiety disorders: An update on the empirical evidence. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610618/
Mayo Clinic. (2019, September 17). Selective serotonin reuptake inhibitors (SSRIs). from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825
RxList. (2018, February 6). Benzodiazepines Drug Class: Side Effects, Types & Uses. from https://www.rxlist.com/benzodiazepines/drug-class.htm