Question 1

What medications treat anxiety disorders and how do I choose between them?

Accepted Answer

SSRIs are first-line for every major anxiety disorder, with larger effect sizes for anxiety (aggregate SMD -0.56 vs placebo) than for depression. Sertraline and escitalopram rank highest for combined efficacy and tolerability in network meta-analyses. SSRIs show a clear dose-response in anxiety (NNT 14-16 for high-dose benefit), absent for SNRIs. The 2025 Cochrane review (12,226 adults) shows NNT of 7 for GAD response. In pediatrics, CAMS (N=488) established combination CBT+sertraline (81% response, pediatric trial, ages 7-17) as the gold standard for pediatric anxiety. 40-50% of patients fail first-line treatment; the 2024 Domschke Delphi consensus provides the first formal staging model for treatment-resistant anxiety. Benzodiazepines provide unmatched acute relief (NNT 4 for panic) but are not first-line monotherapy; bridge therapy during SSRI onset is the most defensible use pattern. Phenelzine produces the largest effect size of any anxiolytic (1.02 for SAD) but requires dietary and drug interaction management.

Question 2

Which SSRI is best for anxiety?

Accepted Answer

SSRIs are first-line for every major anxiety disorder, with larger effect sizes for anxiety (aggregate SMD -0.56 vs placebo) than for depression. Sertraline and escitalopram rank highest for combined efficacy and tolerability in network meta-analyses. SSRIs show a clear dose-response in anxiety (NNT 14-16 for high-dose benefit), absent for SNRIs. The 2025 Cochrane review (12,226 adults) shows NNT of 7 for GAD response. In pediatrics, CAMS (N=488) established combination CBT+sertraline (81% response, pediatric trial, ages 7-17) as the gold standard for pediatric anxiety. 40-50% of patients fail first-line treatment; the 2024 Domschke Delphi consensus provides the first formal staging model for treatment-resistant anxiety. Benzodiazepines provide unmatched acute relief (NNT 4 for panic) but are not first-line monotherapy; bridge therapy during SSRI onset is the most defensible use pattern. Phenelzine produces the largest effect size of any anxiolytic (1.02 for SAD) but requires dietary and drug interaction management.

Question 3

How long does it take for anxiety medication to work?

Accepted Answer

SSRIs are first-line for every major anxiety disorder, with larger effect sizes for anxiety (aggregate SMD -0.56 vs placebo) than for depression. Sertraline and escitalopram rank highest for combined efficacy and tolerability in network meta-analyses. SSRIs show a clear dose-response in anxiety (NNT 14-16 for high-dose benefit), absent for SNRIs. The 2025 Cochrane review (12,226 adults) shows NNT of 7 for GAD response. In pediatrics, CAMS (N=488) established combination CBT+sertraline (81% response, pediatric trial, ages 7-17) as the gold standard for pediatric anxiety. 40-50% of patients fail first-line treatment; the 2024 Domschke Delphi consensus provides the first formal staging model for treatment-resistant anxiety. Benzodiazepines provide unmatched acute relief (NNT 4 for panic) but are not first-line monotherapy; bridge therapy during SSRI onset is the most defensible use pattern. Phenelzine produces the largest effect size of any anxiolytic (1.02 for SAD) but requires dietary and drug interaction management.

Question 4

What do I do when the first medication doesn't work?

Accepted Answer

SSRIs are first-line for every major anxiety disorder, with larger effect sizes for anxiety (aggregate SMD -0.56 vs placebo) than for depression. Sertraline and escitalopram rank highest for combined efficacy and tolerability in network meta-analyses. SSRIs show a clear dose-response in anxiety (NNT 14-16 for high-dose benefit), absent for SNRIs. The 2025 Cochrane review (12,226 adults) shows NNT of 7 for GAD response. In pediatrics, CAMS (N=488) established combination CBT+sertraline (81% response, pediatric trial, ages 7-17) as the gold standard for pediatric anxiety. 40-50% of patients fail first-line treatment; the 2024 Domschke Delphi consensus provides the first formal staging model for treatment-resistant anxiety. Benzodiazepines provide unmatched acute relief (NNT 4 for panic) but are not first-line monotherapy; bridge therapy during SSRI onset is the most defensible use pattern. Phenelzine produces the largest effect size of any anxiolytic (1.02 for SAD) but requires dietary and drug interaction management.

Question 5

Are benzodiazepines safe for anxiety?

Accepted Answer

SSRIs are first-line for every major anxiety disorder, with larger effect sizes for anxiety (aggregate SMD -0.56 vs placebo) than for depression. Sertraline and escitalopram rank highest for combined efficacy and tolerability in network meta-analyses. SSRIs show a clear dose-response in anxiety (NNT 14-16 for high-dose benefit), absent for SNRIs. The 2025 Cochrane review (12,226 adults) shows NNT of 7 for GAD response. In pediatrics, CAMS (N=488) established combination CBT+sertraline (81% response, pediatric trial, ages 7-17) as the gold standard for pediatric anxiety. 40-50% of patients fail first-line treatment; the 2024 Domschke Delphi consensus provides the first formal staging model for treatment-resistant anxiety. Benzodiazepines provide unmatched acute relief (NNT 4 for panic) but are not first-line monotherapy; bridge therapy during SSRI onset is the most defensible use pattern. Phenelzine produces the largest effect size of any anxiolytic (1.02 for SAD) but requires dietary and drug interaction management.

Question 6

What medications work for children with anxiety?

Accepted Answer

SSRIs are first-line for every major anxiety disorder, with larger effect sizes for anxiety (aggregate SMD -0.56 vs placebo) than for depression. Sertraline and escitalopram rank highest for combined efficacy and tolerability in network meta-analyses. SSRIs show a clear dose-response in anxiety (NNT 14-16 for high-dose benefit), absent for SNRIs. The 2025 Cochrane review (12,226 adults) shows NNT of 7 for GAD response. In pediatrics, CAMS (N=488) established combination CBT+sertraline (81% response, pediatric trial, ages 7-17) as the gold standard for pediatric anxiety. 40-50% of patients fail first-line treatment; the 2024 Domschke Delphi consensus provides the first formal staging model for treatment-resistant anxiety. Benzodiazepines provide unmatched acute relief (NNT 4 for panic) but are not first-line monotherapy; bridge therapy during SSRI onset is the most defensible use pattern. Phenelzine produces the largest effect size of any anxiolytic (1.02 for SAD) but requires dietary and drug interaction management.

Question 7

How long should I stay on anxiety medication?

Accepted Answer

SSRIs are first-line for every major anxiety disorder, with larger effect sizes for anxiety (aggregate SMD -0.56 vs placebo) than for depression. Sertraline and escitalopram rank highest for combined efficacy and tolerability in network meta-analyses. SSRIs show a clear dose-response in anxiety (NNT 14-16 for high-dose benefit), absent for SNRIs. The 2025 Cochrane review (12,226 adults) shows NNT of 7 for GAD response. In pediatrics, CAMS (N=488) established combination CBT+sertraline (81% response, pediatric trial, ages 7-17) as the gold standard for pediatric anxiety. 40-50% of patients fail first-line treatment; the 2024 Domschke Delphi consensus provides the first formal staging model for treatment-resistant anxiety. Benzodiazepines provide unmatched acute relief (NNT 4 for panic) but are not first-line monotherapy; bridge therapy during SSRI onset is the most defensible use pattern. Phenelzine produces the largest effect size of any anxiolytic (1.02 for SAD) but requires dietary and drug interaction management.

Question 8

What is treatment-resistant anxiety?

Accepted Answer

SSRIs are first-line for every major anxiety disorder, with larger effect sizes for anxiety (aggregate SMD -0.56 vs placebo) than for depression. Sertraline and escitalopram rank highest for combined efficacy and tolerability in network meta-analyses. SSRIs show a clear dose-response in anxiety (NNT 14-16 for high-dose benefit), absent for SNRIs. The 2025 Cochrane review (12,226 adults) shows NNT of 7 for GAD response. In pediatrics, CAMS (N=488) established combination CBT+sertraline (81% response, pediatric trial, ages 7-17) as the gold standard for pediatric anxiety. 40-50% of patients fail first-line treatment; the 2024 Domschke Delphi consensus provides the first formal staging model for treatment-resistant anxiety. Benzodiazepines provide unmatched acute relief (NNT 4 for panic) but are not first-line monotherapy; bridge therapy during SSRI onset is the most defensible use pattern. Phenelzine produces the largest effect size of any anxiolytic (1.02 for SAD) but requires dietary and drug interaction management.

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What Medications Treat Anxiety and How Do I Choose?