For people with a history of drug abuse or people who operate vehicles or heavy machinery or are physically active for work, benzodiazepines are not an effective treatment for anxiety. Luckily, two alternative medications effectively treat anxiety symptoms:
SSRIs and Beta-Blockers.
SSRIs or beta-blockers might be the best choice for alternative anxiety treatment. In this article, Klarity will outline the primary differences between SSRIs and beta-blockers and discuss where one medication might be better than the other, depending on certain medical conditions.
Determining which medication is best for you takes time, patience, and help from experienced anxiety-trained mental health specialists. Luckily for you, we can speed that process up—
Klarity has already helped 30,000+ Americans find online mental health treatments for anxiety and other mental illnesses. Our unique telehealth services are fast, affordable, and convenient, taking the wait, expense, and hassle out of finding the right anxiety treatment.
Schedule an appointment today and speak with an anxiety-trained mental health provider in as little as 48 hours.
|Drug Class||Selective serotonin reuptake inhibitors (SSRIs)||Beta Blockers|
|Brand/Generic Status||Brand-names and generics available|
Most common SSRIs:
• Prozac (fluoxetine)
• Paxil (paroxetine)
• Zoloft (sertraline)
• Celexa (citalopram)
• Luvox (fluvoxamine)
• Lexapro (escitalopram)
• Trintellix (vortioxetine)
• Viibryd (vilazodone)
|Brand names and generics available
Most common beta blockers:
• Sectral (acebutolol)
• Zebeta (bisoprolol)
• Coreg (carvedilol)
• Inderal (propranolol)
• Tenormin (atenolol)
• Lopressor (metoprolol)
|Form(s) of the Drug||Common forms of SSRIs include:|
• Color-coded* capsules
• Color-coded* tablets
• Flavored liquid suspensions
*Color-coding often indicates dosage amount
|Common forms of beta blockers include:
|Standard Dosage||Varies, depending on SSRI and condition being treated||Varies, depending on type of beta blocker and condition being treated|
|Conditions Treated||Conditions most often treated: |
• Major depressive disorder
• Generalized anxiety disorder
Other conditions treated:
• Obsessive-compulsive disorder (OCD)
• Eating disorders
• Premenstrual dysphoric disorder (PMDD)
Different SSRIs are • FDA-approved for different uses
Many SSRIs are prescribed off-label to treat certain conditions
|Conditions most often treated:
• Irregular heart rhythm (arrhythmia)
• Heart failure
• Chest pain (angina)
• High blood pressure
Other conditions treated:
• Generalized anxiety disorder (GAD)
• Panic disorder (PD)
• Post-traumatic stress disorder (PTSD)
|Cost||Average cost of a 30-day supply:|
• $4 to $40 for generic formulas*
• $130 or more for brand-name formulas**
*Some SSRIs don’t have a generic formula available for Rx.
**Cost of brand-name SSRIs may be offset by coupons and insurance
|Average cost of a 30-day supply:
• $6 to $32 for generic formulas*
• $111 to $$468 for brand-name formulas**
*Some beta blockers don’t have a generic formula available for Rx.
**Cost of brand-name beta blockers may be offset by coupons and insurance
|Side-Effects||Common side effects:|
• Nausea, vomiting, GI upset, or diarrhea
• Dry mouth
• Difficulty sleeping or insomnia
• Drowsiness or dizziness
• Increased nervousness, feelings of restlessness, or agitation
• Reduced libido, erectile dysfunction
• Increase or decrease appetite, leading to changes in weight
|Common side effects:
• Bradycardia (slow heart rate)
• Hypotension (low blood pressure)
• Arrhythmias (irregular heart rhythms)
• Dry mouth
• Dry eyes
|Warnings For Use||• Combination with other medications may cause serotonin syndrome|
• Symptoms of serotonin syndrome include:
• Anxiety or agitation
• Fever, sweating
• Lack of coordination
• Blood pressure and heart rate changes
• Rarely, SSRIs may cause
suicidal thoughts or behaviors
• Contact your doctor immediately if this occurs
• Discuss other medications with your doctor, as adverse reactions may occur
|Adverse drug interactions:
• OTC and Rx allergy medications
SSRIs For Anxiety
SSRIs, or selective serotonin reuptake inhibitors, are commonly prescribed antidepressants that help relieve anxiety symptoms. Regarding anxiety disorders, SSRIs are most effective at treating GAD or generalized anxiety disorder.
Symptoms of GAD include:
- Feeling on-edge
- Intrusive thoughts
- Unable to stop worrying or thinking
- Racing thoughts
- Poor concentration
- Muscle aches
- Upset stomach
- Unexplained pains
In addition to GAD, SSRIs can help treat the symptoms of other anxiety disorders, such as:
- panic disorder
- obsessive-compulsive disorder (OCD)
- post-traumatic stress disorder (PTSD)
- severe phobias; ex: agoraphobia or social phobia
How Do SSRIs Work?
SSRIs help your brain cells (called neurons) communicate more effectively by increasing the usable number of chemical messengers (called neurotransmitters) in the brain. Specifically, SSRIs help elevate levels of serotonin and dopamine.
This is where the reuptake inhibitor part of the name comes from. SSRIs block the channels that would normally reabsorb serotonin and dopamine after being used in a chemical exchange between neurons.
By preventing the reuptake of these chemical messengers, the total number available builds up over time, improving the ability of your brain cells to communicate effectively with one another.
Low levels of serotonin and dopamine are associated with many of the symptoms of anxiety and depression. SSRIs work by elevating the number of these crucial neurotransmitters, which help your brain function better.
What Do SSRIs Treat?
SSRIs are often the first choice when treating persistent or severe depression. This is because they have fewer side effects than older antidepressants like tricyclics.
SSRIs can also treat anxiety disorders. Additionally, some people have co-occurring anxiety and depression. In cases like this, an SSRI is an effective treatment option because it helps alleviate symptoms of anxiety and depression.
Off-Label Uses For SSRIs
Some healthcare providers may prescribe SSRIs as an off-label treatment for the following conditions.
- Vasomotor Symptoms (associated with menopause)
- Neurocardiogenic Syncope (fainting spells)
- Diabetic Neuropathy (nerve damage mostly in legs and feet)
- Migraine Headaches (prophylaxis)
- Premature Ejaculation
What Are the Most Commonly Prescribed SSRIs?
Several SSRIs are commonly prescribed in the US to treat depression, anxiety, and other off-label conditions. These medications affect serotonin transporters in the brain and prevent serotonin reuptake.
However, subtle differences between each SSRI produce slightly different side effect profiles. Discuss each SSRI with a trusted medical provider who can help you decide which SSRI is right for you.
Klarity will connect you with an anxiety specialist to help you determine if SSRIs are the right treatment plan for your anxiety disorder. Take our short online mental health assessment to talk to an anxiety specialist within 48 hours.
Here are the most common SSRIs:
- Prozac (Fluoxetine)
- Celexa (Citalopram)
- Zoloft ((Sertraline)
- Paxil (Paroxetine)
- Lexapro (Escitalopram)
Generic SSRIs are usually priced below $10 for a 30-day supply. Brand names may be more expensive, but not much more expensive. Certain extended-release forms might push prices into the $20 – $30 range.
Common Side Effects
Some people do not experience noticeable side effects while taking SSRIs, and those who initially experience side effects report that they lessen over time. However, for others, certain side effects do not go away.
If these side effects interfere with your life in a harmful way—causing stress, depression, or other negative feelings—then SSRIs might not be the best treatment option for that person.
Here are the most common SSRI side effects:
- Dry mouth
- Sexual problems: reduced sexual desire, difficulty reaching orgasm, or inability to maintain an erection (erectile dysfunction)
- Overeating or Undereating
Sure, I can provide some general information about drug interactions for SSRIs.
Selective serotonin reuptake inhibitors (SSRIs) are a class of medications commonly used to treat depression, anxiety, and other psychiatric disorders. They work by increasing the levels of the neurotransmitter serotonin in the brain. While SSRIs are generally considered safe and effective, they can interact with other medications, including prescription drugs, over-the-counter medicines, and herbal supplements.
Some general drug interactions for SSRIs include:
- Monoamine oxidase inhibitors (MAOIs): Taking SSRIs with MAOIs can cause a potentially life-threatening condition called serotonin syndrome, which can cause symptoms such as fever, agitation, confusion, and muscle rigidity.
- Blood thinners: SSRIs can increase the risk of bleeding when taken with blood thinners such as warfarin or aspirin.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Taking SSRIs with NSAIDs, such as ibuprofen or naproxen, can increase the risk of bleeding and can also reduce the effectiveness of SSRIs.
- Antiplatelet drugs: Taking SSRIs with antiplatelet drugs, such as clopidogrel or ticlopidine, can increase the risk of bleeding.
- Triptans: Taking SSRIs with triptans, medications used to treat migraines, can increase the risk of serotonin syndrome.
- St. John’s Wort: Taking SSRIs with St. John’s Wort, an herbal supplement used to treat depression, can increase the risk of serotonin syndrome and decrease the effectiveness of SSRIs.
- Other antidepressants: Taking SSRIs with other antidepressants, such as tricyclic antidepressants or bupropion, can increase the risk of serotonin syndrome.
Though serotonin is a necessary neurotransmitter, the hormone can reach toxic levels in the human body. When people increase their dosage of serotonin-elevating medication, start a new serotonin-elevating medication, or mix two different drugs that affect serotonin, this rare—but potentially fatal—condition can develop.
It’s crucial to monitor for symptoms of serotonin syndrome within the first few hours of taking a new medication or increasing the dose.
- Loss of muscle coordination or twitching muscles
- High blood pressure
- High fever
- Irregular heartbeat
- Muscle rigidity
- Heavy sweating
- Rapid heart rate and high blood pressure
- Dilated pupils
SSRIs are prescribed only after disclosing a black box suicidality warning. In 2004, placebo-controlled trials revealed a small increase in suicidal ideation and behaviors in children and adolescents who took antidepressants. These findings have not been replicated in adult populations.
People taking antidepressants need to be monitored and to self-monitor for increases in suicidal thoughts and behaviors when taking antidepressants. Caregivers, guardians, and parents of children prescribed antidepressants must monitor for sudden changes in behavior that indicate an increased risk of suicide:
- Changes in personality and appearance
- Social withdrawal
- Threatening or talking about suicide/harming oneself
- Severe sadness or moodiness
- Making preparations
- Severe trauma or life crisis
Beta Blockers For Anxiety
Beta-blockers, or beta-adrenergic blocking agents, are most often prescribed to treat cardiovascular symptoms, including
- Irregular heart rhythm (arrhythmia)
- Heart failure
- Chest pain (angina)
- High blood pressure
This medication reduces how hard your heart has to work to pump blood by reducing the strain on smooth muscle tissue, such as those found in blood vessels and the respiratory system.
Beta-blockers block your body from using the hormone epinephrine (adrenaline) and have a calming effect on your nervous system. Because of this particular effect, beta-blockers are prescribed off-label to treat anxiety disorders, including:
- Generalized anxiety disorder (GAD)
- Panic disorder (PD)
- Post-traumatic stress disorder (PTSD)
If you experience severe physical symptoms of anxiety, such as a racing heartbeat, intense sweating, feelings of impending doom or sudden danger, high blood pressure, or trembling, then beta-blockers may be an effective tool for managing the physical symptoms of anxiety or situational anxiety like performance anxiety or social anxiety.
However, it’s important to note that beta-blockers to not address the underlying reasons a person has anxiety symptoms and therefore do not directly treat psychological symptoms of anxiety disorders.
How Do Beta Blockers Work?
Beta-blockers work by blocking beta receptors, which are found on the surface of your body’s cells. These beta receptors respond to epinephrine—also known as adrenaline—and control certain types of cellular activity.
When these receptors are blocked, this cellular activity is lessened or prevented entirely. There are three types of beta receptors—B1, B2, and B3 receptors.
B1 receptors are found in the heart and kidneys. When activated, they:
- Increase heart rate
- Increase the force of heartbeats
B2 receptors are found in the nervous system, respiratory system, and in blood vessels. When activated, they:
- Relax smooth muscles in the respiratory system (helping people breathe better)
- Relax smooth muscles and lowers blood pressure in the circulatory system
- Can cause muscle tremors
- Cause the heart to work harder and beat faster
B3 receptors are found in fat cells and the bladder. When activated, they:
- Trigger fat cells to break down
- Relax the bladder
Some beta-blocker medications only work on certain types of beta receptors, while others work on all beta receptors. Most beta blockers prescribed for heart conditions and other off-label treatments are “cardioselective,” meaning they only work on B1 receptors found in the heart and kidneys.
What Do Beta Blockers Treat?
Though mostly prescribed for cardiovascular conditions, beta-blockers have other medical applications.
- Cardiovascular Symptoms
- Anxiety Disorder Symptoms
- Essential Tremors
What Are the Most Commonly Prescribed Beta-Blockers?
Here are the most commonly prescribed beta-blockers:
Beta-blockers have been on the market for several decades—being first prescribed in the 1960s. Because they’ve been around for a while, their costs are generally low. Most beta-blockers range between $6 and $32.
Beta Blocker Side Effects
Beta receptors are located all over your body. Even with cardioselective beta-blockers, the heart has a direct effect on the circulatory system, which, in turn, affects other systems. As a result, beta-blockers are associated with several side effects.
- Bradycardia (slow heart rate)
- Hypotension (low blood pressure)
- Arrhythmias (irregular heart rhythms)
- Dry mouth
- Dry eyes
Each beta-blocker has a slightly different chemical structure and produces a different side effect profile. It’s best to talk with a trained medical provider when discussing anxiety treatment options.
Beta-blockers can interact with many different types of medications. It’s important to fully disclose to your medical provider which medications, supplements, and vitamins you take with your healthcare provider.
Some drugs/drug classes that have known interactions with beta-blockers are
- Antiarrhythmics (prescribed for irregular heartbeats)
- Antihypertensives (prescribed to lower blood pressure)
- Antipsychotics (used to treat severe mental illness)
- OTC and Prescription Allergy Medications
- Clonidine (prescribed for high blood pressure and migraines)
- Mefloquine (prescribed to prevent or treat malaria)
- NSAIDs like aspirin, ibuprofen, naproxen
For a complete list of drug interactions, see this resource page.
Warnings for Use
Beta-blockers are not right for everyone. Depending on your medical history, your medical provider may prescribe one type of beta-blocker over another or choose a different treatment altogether.
For example, people with moderate to severe asthma should only be prescribed cardioselective beta-blockers that block B1 receptors. Non-selective beta-blockers can affect B2 receptors and trigger an asthma attack when blocked.
Beta-blockers lower blood pressure and heart rate by design. If a person has hypotension (low blood pressure) to begin with, then taking beta-blockers is not the best course of action.
People with Reynauld’s Syndrome should avoid taking beta-blockers, as this medication can make circulation problems worse by lowering blood pressure and heart rate.
People who have diabetes need to check their blood sugar more regularly because beta-blockers can mask certain symptoms of hypoglycemia, like sweating.
Which Anxiety Medication Is Best For You?
Your particular medical profile will determine what anxiety medication is best for you.
If you experience strong physical symptoms, including racing heartbeat, sweating, elevated blood pressure, and muscle tension, even when nothing identifiable prompts those symptoms, beta-blockers can help alleviate those physical symptoms.
However, beta-blockers will not treat the underlying causes of your anxiety symptoms. To treat the underlying causes of anxiety, you’ll likely need a different treatment plan that may include an SSRI and psychotherapy.
If You Suffer from Anxiety or Depression, Klarity Can Help
Need non-habit-forming anxiety medications but don’t want to wait weeks to be seen by an in-person medical provider? Klarity connects you with a board-certified mental health professional who can diagnose and prescribe beta-blockers, SSRIs, and other anxiety treatments online, if deemed necessary, in 48 hours or less.
To get started, schedule an appointment, and you’ll be speaking with an anxiety-trained medical provider online in two days.
Angela Gomez. “SSRIs and Benzodiazepines for General Anxiety Disorders (GAD).” Anxiety and Depression Association of America. https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/ssris-and-benzodiazepines-general-anxiety
“Do Beta Blockers Work For Anxiety?” Cleveland Clinic. https://health.clevelandclinic.org/beta-blockers-for-anxiety/
Lo Styx. “Beta Blockers Are the Buzziest New Anti-Anxiety Medicine—Here’s What to Know.” Very Well Mind. https://www.verywellmind.com/beta-blockers-are-the-buzzy-new-anti-anxiety-medicine-heres-what-you-need-to-know-5271756
Mayo Clinic Staff. “Selective Serotonin Reuptake Inhibitors (SSRIs).” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825
Megan Brown. “Can Beta Blockers Help Your Anxiety.” Healthline. https://www.healthline.com/health/beta-blockers-for-anxiety