Best anti anxiety medication with the least side effects

Key takeaways:

  • Social anxiety disorder is a chronic mental health condition characterized by an intense fear of being judged or evaluated by others.

  • Sertraline (Zoloft), paroxetine (Paxil), and venlafaxine ER (Effexor XR) are FDA-approved medications for social anxiety disorder.

  • Non-medication treatments, such as cognitive behavioral therapy (CBT) and support groups, may be helpful in relieving anxiety symptoms.

Best anti anxiety medication with the least side effects
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One step forward and a hundred steps back — this can be an overwhelming feeling, especially when its weight falls on your shoulders every single day. Imagine feeling like every move you make is continuously watched and judged by people around you.

People with social anxiety disorder experience this fear on a daily basis. If untreated, this condition can cause people to avoid certain activities or interactions and negatively affect their work, relationships, and daily lives. Thankfully, there are several treatment options and medications available for this mental health condition.

What is social anxiety disorder?

Social anxiety disorder — previously called social phobia — is a mental health condition that affects about 12% of U.S. adults during their lifetime.

This condition is characterized by an overwhelming fear of being negatively judged or evaluated. Unlike the nervousness that many people experience in challenging situations, social anxiety disorder involves a long-lasting fear that disrupts people’s everyday routines.

If left untreated, the condition can continue negatively impacting people’s lives, causing some people to avoid certain places or interactions. Social anxiety disorder can lead to depression, self-harm, or thoughts of suicide.

People with social anxiety disorder also have difficulty performing daily activities, which can have negative consequences such as:

  • Lower educational levels

  • Lower income levels

  • Difficulties with romantic relationships 

What’s more, it may be challenging for people with social anxiety disorder to seek medical help, as they fear what other people might think or say.

Can social anxiety disorder be cured?

Depending on the conditions’ severity and the treatment that people receive, social anxiety disorder may affect people differently. For some, social anxiety may be short and brief, while others may experience a more chronic condition with symptom relapses.

Studies suggest that over 50% of people with social anxiety disorder get better with treatment, and no longer experience symptoms. Regardless of how long people experience symptoms, social anxiety disorder can be treated with cognitive behavioral therapy (CBT), certain medications, or a combination of both.

Which social anxiety disorder medications are FDA-approved?

Common medications for social anxiety disorder are selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). 

FDA-approved SSRIs and SNRIs include:

  • Sertraline (Zoloft)

  • Paroxetine (Paxil)

  • Venlafaxine (Effexor)

SSRIs work by raising the levels of serotonin in your brain — a chemical signal important for regulating mood and anxiety. Similarly, extended-release (ER) venlafaxine (an SNRI) works by boosting brain levels of serotonin and norepinephrine — a chemical signal important for regulating stress.

After starting these medications, it may take at least 4 to 6 weeks before experiencing any improvement in symptoms. For some people, it may take even up to 12 weeks before the condition improves.

What are the most common side effects of SSRIs and SNRIs?

  • Nausea

  • Upset stomach

  • Diarrhea or constipation

  • Weight gain

  • Headache

  • Dizziness

  • Sexual difficulties, including lower sex drive and erectile dysfunction

  • Feeling too sleepy or having trouble falling asleep

  • Restlessness or anxiety

When taking an SSRI or venlafaxine, it’s important to know that these medications have a boxed warning — a strict warning issued by the FDA — due to the potential risk for self-harm and suicidal thinking or behaviors. This risk is higher for people under 25 years old.

If you notice any sudden mood or behavior changes after starting your medication, contact your provider right away.

If you or your loved one are experiencing thoughts of suicide, the National Suicide Prevention Lifeline 1-800-273-8255 offers 24/7 support and helpful resources.

Which medications work best for social anxiety disorder?

Although many medications may be prescribed for social anxiety disorder, SSRIs and venlafaxine ER are considered first-choice medications. Research shows that more than half of those taking these medications experienced an improvement in their symptoms.

SSRIs and venlafaxine also have a lower risk of side effects compared to other antidepressants, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). These medications can help treat other symptoms that people with social anxiety disorder may experience, such as depression. Among sertraline, paroxetine, and venlafaxine, there is no particular medication that has been found to be more effective than the others for social anxiety disorder. 

Can you use other medications to treat social anxiety disorder?

Other medications may be used off-label to treat social anxiety disorder. According to the Anxiety and Depression Association of America (ADAA), other SSRIs that can be helpful include: 

  • Citalopram (Celexa)

  • Escitalopram (Lexapro)

  • Fluvoxamine (Luvox)

A healthcare provider may prescribe these if sertraline, paroxetine, or venlafaxine ER haven’t seemed to help enough.

Benzodiazepines, including clonazepam (Klonopin) and alprazolam (Xanax), may sometimes be second-choice treatments for people with social anxiety disorder. Because many of these medications help calm anxiety symptoms within a few hours of a dose, they can be helpful when first starting SSRIs or venlafaxine until they kick in.

However, people taking benzodiazepines long-term may develop dependence on the medication and experience withdrawal symptoms when attempting to stop them. It’s best to discuss the safest way to take benzodiazepines with your healthcare provider if they prescribe them for you.

Medications used to treat seizures or nerve pain, such as gabapentin and pregabalin (Lyrica), are also sometimes used off-label to treat social anxiety disorder. However, research suggests that these medications are less effective in relieving symptoms than SSRIs or venlafaxine.

Can medication help with performance anxiety?

Some medications may be particularly effective in treating specific symptoms of social anxiety disorder, such as performance anxiety. People with performance anxiety may have an intense fear or worry while speaking or performing in public.

The beta blocker propranolol can be used to alleviate certain physical performance anxiety symptoms such as tremors (shakiness), sweating, or a racing heart. Keep in mind that these medications do not treat the condition but may help manage certain symptoms people with social anxiety disorder may experience.

People who don’t respond to one medication may respond better to a different treatment. Some people may have to try a few medications before finding the right one for them. Therefore, it’s important to communicate with your provider and discuss how your treatment is going.

What other treatment options and resources are available for social anxiety disorder?

In addition to medication, there are a lot of other ways to treat social anxiety disorder. These can include therapy, peer support, and lifestyle strategies. Let’s take a look at these in more detail below. 

Therapy

CBT can also be a first-choice treatment for people with social anxiety disorder. During CBT, people are encouraged to focus their attention outward instead of on themselves to help reframe their thoughts about social situations. Multiple studies suggest that CBT significantly improves social anxiety symptoms.

According to the ADAA, the most effective part of CBT involves exposing people to feared social situations (exposure therapy). CBT that includes exposure therapy is an effective option for managing multiple types of anxiety conditions, including social anxiety disorder.

For some people, combining CBT with medications may help manage social anxiety disorder. A randomized controlled trial showed that adding CBT to antidepressants was successful in relieving anxiety symptoms in almost 50% of people with social anxiety disorder who continued to have symptoms despite taking medications. 

Support groups

Support or self-help groups can also be helpful for some people in managing this condition. In these settings, people are encouraged to share their challenges and accomplishments with others dealing with similar problems.

Support groups are available both in-person and online. Although internet forums and chat rooms can be accessed easily, you should talk with your healthcare provider before following any medical or mental health advice that you receive online. 

Lifestyle changes

Aerobic exercise — such as running, biking, or swimming — may be a helpful addition for some people with social anxiety disorder. Research suggests that adding exercise to other therapies, such as CBT or medications, can help relieve anxiety symptoms for some people. Be sure to speak with your provider about how to safely add exercise into your routine before doing so.

Other resources

There are also different resources available to help you get connected with therapies for managing social anxiety disorder:

  • The National Institute of Mental Health offers a helpful brochure describing social anxiety disorder.

  • The U.S. Department of Veteran Affairs has a screening checklist for people who may be dealing with social anxiety as well as multiple mental health resources for veterans. 

  • The Substance Abuse and Mental Health Services Administration offers a locator tool to help people get connected with behavioral health treatment resources near them. 

  • The National Alliance on Mental Illness has helpful resources for people to navigate insurance coverage for mental health treatment.

  • The Anxiety and Depression Association of America has a listing of support groups for people dealing with anxiety.

  • Social Anxiety Support is an online forum for people to connect with others with social anxiety disorder and share their experiences.

The bottom line

Social anxiety disorder is a mental health condition that negatively impacts different parts of people’s lives, including their work, relationships, and daily activities. Currently, the only FDA-approved medications for social anxiety disorder are sertraline, paroxetine, and venlafaxine. Other medications like benzodiazepines and propranolol are sometimes used off-label to treat certain symptoms of this condition.

Non-medication treatments, such as CBT, can also be helpful in treating anxiety symptoms. Different resources and support groups are available to connect people with others with similar challenges. Since people respond differently to various therapies, make sure to have an open and honest discussion with your provider so they can determine the most effective treatment for you.

Anxiety and Depression Association of America. (2022). Support groups.

Beesdo, K., et al. (2007). Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. JAMA Psychiatry.

Canton, J., et al. (2012). Optimal treatment of social phobia: Systematic review and meta-analysis. Neuropsychiatric Disease and Treatment.

Chu, A., et al. (2022). Selective serotonin reuptake inhibitors. StatPearls.

Endocrine Society. (2022). Brain hormones.

Jazaieri, H., et al. (2012). A randomized trial of MBSR versus aerobic exercise for social anxiety disorder. Journal of Clinical Psychology.

Kaczkurkin, A. N., et al. (2015). Cognitive-behavioral therapy for anxiety disorders: An update on the empirical evidence. Dialogues in Clinical Neuroscience.

National Alliance on Mental Illness. (n.d.). Understanding health insurance.

National Institute of Mental Health. (n.d.). Social anxiety disorder.

National Institute of Mental Health. (2022). Social anxiety disorder: More than just shyness.

Olfson, M., et al. (2000). Barriers to the treatment of social anxiety. American Journal of Psychiatry.

Singh, D., et al. (2022). Venlafaxine. StatPearls.

SocialAnxietySupport.com. (n.d.). About us.

Substance Abuse and Mental Health Services Administration. (n.d.). Behavioral Health Treatment Services Locator.

U.S. Department of Veterans Affairs. (2022). Anxiety.

U.S. Food and Drug Administration. (2018). Suicidality in children and adolescents being treated with antidepressant medications.

Vriends, N., et al. (2014). Social anxiety disorder, a lifelong disorder? A review of the spontaneous remission and its predictors. Acta Psychiatrica Scandinavica.

Wyeth Pharmaceuticals LLC. (2021). Effexor XR [package insert].

Yoshinaga, N., et al. (2016). Cognitive behavioral therapy for patients with social anxiety disorder who remain symptomatic following antidepressant treatment: A randomized, assessor-blinded, controlled trial. Psychotherapy and Psychosomatics.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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What is the safest prescription for anxiety?

Non-Addictive Anxiety Medications.
Fluoxetine (Prozac®).
Escitalopram (Lexapro®).
Citalopram (Celexa®).
Paroxetine (Paxil®).
Sertraline (Zoloft®).

What is the drug of choice for anxiety?

Types of Anti-anxiety Medications (Benzodiazepines) Benzodiazepines most commonly used to treat anxiety disorders are clonazepam (Rivotril)*, alprazolam (Xanax) and lorazepam (Ativan).

What is the best mild anti

SSRIs and SNRIs are often the first-line treatment for anxiety. Common SSRI brands are Celexa, Lexapro, Luvox, Paxil, and Zoloft, and common SNRI brands are Pristiq, Cymbalta, and Effexor XR. Pros: They are effective for a lot of people and they have a solid safety profile.

Which antidepressant has the least side effects for treating anxiety disorders?

Selective serotonin reuptake inhibitors (SSRIs). Health care providers often start by prescribing an SSRI . These antidepressants generally cause fewer bothersome side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants.