Short answer: There is no single anxiety pill with the least side effects for everyone, because people react differently. In general, doctors start with SSRIs or SNRIs, a type of antidepressant, because they tend to cause fewer side effects than older options. Buspirone is another daily, non-habit-forming choice. Benzodiazepines such as alprazolam (Xanax) work fastest but carry an FDA boxed warning about dependence and withdrawal. The right choice depends on your symptoms, health and other medicines, so it is one to make with your doctor.
Why “least side effects” depends on you
A medicine that one person barely notices can make another person nauseous or sleepy. Your doctor weighs your type of anxiety, how often it happens, your age, pregnancy plans, other health conditions and every medicine and supplement you take. Many side effects are strongest in the first weeks and then fade. Medicine is also only one part of care: talk therapy, especially cognitive behavioral therapy (CBT), helps many people, and some like to add a non-pill option, such as our Emotional Balance herbal pouch, alongside the care their doctor recommends.
5 types of anxiety medicine compared
| Type | Examples | Habit-forming? | Common side effects |
|---|---|---|---|
| SSRIs and SNRIs (antidepressants, usually tried first) | escitalopram (Lexapro), sertraline (Zoloft), venlafaxine (Effexor XR), duloxetine (Cymbalta) | No | Nausea, headache, sleep changes, sexual side effects; usually take several weeks to work |
| Buspirone | buspirone (formerly BuSpar) | No | Dizziness, headache, nausea, nervousness; taken daily for a few weeks before it helps |
| Hydroxyzine (an antihistamine) | hydroxyzine (Vistaril, Atarax) | No | Drowsiness, dry mouth; often used as needed |
| Beta-blockers (blood-pressure medicines) | propranolol (Inderal) | No | Tiredness, dizziness, cold hands; used for physical symptoms such as a racing heart before a speech |
| Benzodiazepines | alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) | Yes | Drowsiness, dizziness, memory and coordination problems; fast-acting, generally for short-term use |
Examples are common U.S. medicines, not recommendations. Your prescriber chooses the medicine and the dose.
The warnings worth knowing
- Benzodiazepines: in 2020 the FDA strengthened their boxed warning, its strongest kind, to highlight the risks of misuse, addiction, physical dependence and withdrawal. Taking them with opioids or alcohol can be dangerous, and older adults have a higher risk of falls.
- Antidepressants (SSRIs and SNRIs): they carry a boxed warning about suicidal thoughts in children, teens and young adults under 25, especially in the first weeks. Anyone starting one should be watched for mood changes.
- Buspirone: it should not be combined with certain antidepressants called MAOIs, and it does not work as an as-needed pill.
- Beta-blockers: doctors usually avoid them in people with asthma, and they can mask signs of low blood sugar in people with diabetes.
Non-addictive anxiety medication: what that means
SSRIs, SNRIs, buspirone, hydroxyzine and beta-blockers are not habit-forming. Benzodiazepines are the main habit-forming group. “Non-addictive” does not mean you can stop suddenly: stopping an SSRI or SNRI abruptly can cause discontinuation symptoms such as dizziness and irritability, so any change should be planned with your prescriber.
Questions to ask your doctor
- Which side effects are most likely for me, and how long do they usually last?
- How long before I should expect it to help?
- Is it habit-forming, and how would we stop it safely later?
- Does it interact with my other medicines, supplements or alcohol?
- Is it safe if I am pregnant, planning pregnancy or breastfeeding?
- Could therapy be added, or tried first?
If a medicine is not helping or the side effects are hard to live with, our guide to reviewing an anxiety medicine with your prescriber helps you prepare.
A non-pill option to use alongside your care
Emotional Balance is a sealed fabric pouch of dry herbs, worn externally at the navel with a soft reusable belt: nothing to swallow. You wrap the belt around your waist, slide a pouch under it over your navel, and switch to a fresh pouch every five days; six pouches make one 30-day course. It draws on the Chinese medicine tradition of easing emotional tension. In a review of seven selected records from Dr. Wang’s practice, five people directly reported less emotional tension or distress; these are selected, uncontrolled observations, and the evidence overview explains them.
It is not an anxiety medicine and not a replacement for one. If you take anxiety medicine, keep taking it as prescribed and tell your prescriber or pharmacist you are using the pouch; formal interaction studies have not been done. Check with your clinician first if you are pregnant, breastfeeding or have herbal allergies. Your first course comes with the belt free and our 90-day first-course guarantee.
Common questions
Which anxiety medicine has the fewest side effects?
It varies by person. SSRIs and SNRIs are usually tried first because they tend to be well tolerated over the long term; buspirone is another non-habit-forming option. Your doctor matches the choice to you.
Do anxiety medicine side effects go away?
Many early side effects, such as nausea or headache, ease within a few weeks. If they do not, or if they are severe, call your prescriber rather than stopping on your own.
Is there a natural alternative to anxiety pills?
Therapy, regular exercise, good sleep and less alcohol all help with anxiety. Natural products are not substitutes for prescribed medicine; discuss any change with your doctor. Curious about calming patches? Our guide to anxiety patches explains the three types.
Independent sources
- NIMH: Mental health medications
- NIMH: Generalized anxiety disorder
- Open RN, Nursing Mental Health: Antianxiety medications
- 988 Suicide & Crisis Lifeline
Qingcai Wang, MD, PhD, trained in clinical medicine and hematology and spent more than 20 years in biomedical and cancer research at USC Norris Comprehensive Cancer Center, the Weizmann Institute of Science and the University of Michigan/HHMI before inventing external herbal pouch therapy in 2015. He developed the Five Essences formulations, compiled the practice observations, and has a commercial interest in their sale. The independent sources cited do not evaluate or endorse Emotional Balance.
General education; ask your own doctor before starting, stopping or changing any medicine. Emotional Balance is a wellness product, not intended to diagnose, treat, cure or prevent any disease.