What is the Best SSRI for Anxiety? Types, Side Effects & Anxiety Treatment
At the We Level Up FL Treatment Center, we provide world-class care with round-the-clock medical professionals available to help you cope. All work as a team, giving anxiety treatment for successful recovery. Make this your opportunity to reclaim your life. Call today to speak with one of our treatment specialists. Our counselors know what you are going through and will answer any of your questions regarding the safe options for SSRI for anxiety.
By We Level Up FL Treatment Center | Editor Yamilla Francese | Clinically Reviewed By Lauren Barry, LMFT, MCAP, QS, Director of Quality Assurance | Editorial Policy | Research Policy | Last Updated: April 20, 2023
What is the Best SSRI for Anxiety?
Anxiety disorders are the most common and among the most disabling mental disorders in adults. Exposure of the general population to a 1:4 lifetime risk of disabling anxiety has inspired generations of fundamental and clinical psychopharmacologists, from the era of the earliest benzodiazepines (BZ) to that of the selective serotonin reuptake inhibitors (SSRIs) and related compounds, e.g., the serotonin and norepinephrine reuptake inhibitors (SNRIs).
It has been estimated by the Epidemiological Catchment Area (RCA) study  that approximately one-quarter of people will experience severe symptoms, disability, and handicap as a consequence of anxiety disorders at some time during their lifetime. These disorders are associated with significant morbidity and increased mortality, probably due to increased suicide rates among sufferers.
The spectrum of anxiety disorders includes generalized anxiety disorder (GAD), panic disorder (PD) and agoraphobia, obsessive-compulsive disorder (OCD), phobic disorder (including social phobia), and posttraumatic stress disorder (PTSD). With the discovery of new psychotropic medications, specific diagnosis within this spectrum is essential because each disorder responds to particular pharmacotherapy. The approach to anxiety should also recognize that anxiety and depression are often comorbid.
How Does SSRI for Anxiety Work?
Selective serotonin reuptake inhibitors (SSRIs), designed to treat depression, are also effective for many anxiety disorders. They have revolutionized the treatment of anxiety, replacing the chronic use of benzodiazepines (BZs). SSRIs are effective for OCD, PDs, phobias, PTSD, and GAD. Other antidepressants, including tianeptine, have proven effective in adjustment disorders in which both anxiety and depression are involved.
Doses of SSRIs for anxiety disorders could be higher than those used for depression. Still, they must be started at lower doses to minimize the short-term agitation sometimes experienced with these medications. The patient should be counseled that side effects often diminish with time and that empirical switching to another SSRI may be necessary.
BZs are the oldest class of medications used to treat anxiety. Although they have the advantage of rapid onset of action, they carry the risk of dependence, sedation, and tolerance. Withdrawal syndromes resulting in rebound anxiety, even reactions as severe as delirium tremens, are possible. BZs should be avoided in patients with a history of substance abuse, personality disorder, or dosage escalation. These medications are ideal for patients who experience infrequent anxiety or episodes of anxiety-related insomnia.
The SSRIs: Advantages, Disadvantages, and Differences
In the past few years, a new class of antidepressants has become available. Selective serotonin reuptake inhibitors (SSRIs) result from analytical research to find drugs as effective as tricyclic antidepressants (TCAs) but with fewer unwanted effects. The SSRIs are not ’perfect’ antidepressants-they do not work immediately, do not work in every patient, and still produce some side effects. However, they do represent a significant advance in the pharmacotherapy of depression.
The SSRIs may be given in a once-daily effective
therapeutic dose from the start of treatment, unlike the traditional TCAs, which are usually started at a sub-therapeutic dose to minimize unwanted side effects. The SSRIs do not appear to potentiate the effects of alcohol or other sedative drugs, and they have a low incidence of anticholinergic effects and weight gain.
Toxicity in Overdose
The available evidence suggests that SSRIs are less prone than TCAs to provoke mania in bipolar depressives. This supports the hypothesis that noradrenergic rather than serotonergic mechanisms are implicated in the switch to mania. The SSRIs appear to be essentially devoid of the cardiotoxicity of the TCAs. SSRIs have a significantly reduced risk of toxicity in overdose relative to TCAs. Because of this relative safety in overdose, SSRIs may be prescribed for longer treatment durations in patients on long-term therapy.
Safety in overdose is an important concern because the risk of suicide among patients with primary affective disorder is 30 times greater than in the
general population- – 15 percent of patients with primary affective disorder will ultimately commit suicide. Almost all single-drug antidepressant overdose deaths are due to the traditional TCAs. Data suggest that dothiepin may be more toxic in overdose, with significantly more seizures and arrhythmias reported than for other TCAs.
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Anxiety Fact Sheet
A mental health condition marked by intense feelings of worry, anxiety, or fear that interferes with daily activities. Panic attacks, obsessive-compulsive disorder, and post-traumatic stress disorder are examples of anxiety disorders.
The inability to put aside worry, restlessness, and stress that is out of proportion to the severity of the incident are among the symptoms.
Counseling or medicine, including antidepressants, are used as forms of treatment.
Behavioral: hypervigilance, irritability, or restlessness.
Cognitive: lack of concentration, racing thoughts, or unwanted thoughts.
Whole body: fatigue or sweating
Also common: anxiety, excessive worry, angor animi, fear, insomnia, nausea, palpitations, or trembling
- Support group: A place where those pursuing the same disease or objective, such as weight loss or depression, can receive counseling and exchange experiences.
- Cognitive behavioral therapy: A conversation treatment that aims to change the negative attitudes, actions, and feelings connected to psychiatric discomfort.
- Counseling psychology: A subfield of psychology that handles issues with the self that are connected to work, school, family, and social life.
- Anger management: To reduce destructive emotional outbursts, practice mindfulness, coping skills, and trigger avoidance.
- Psychoeducation: Mental health education that also helps individuals feel supported, validated, and empowered
- Family therapy: psychological counseling that improves family communication and conflict resolution.
It’s critical to understand the distinction between anxiety and depression. Anxiety, in its most basic form, is an excessive feeling of worry, whereas depression, in its most basic form, is an excessive feeling of worthlessness and hopelessness. It is conceivable for someone to experience depression and anxiety simultaneously.
GAD affects 6.8 million adults, or 3.1% of the U.S. population, yet only 43.2% receive treatment.
Source: National Institute on Mental Health
Nineteen million adults experience specific phobias, making it America’s most common anxiety disorder.
Source: ADAA, 2020
Major depressive disorder affects approximately 17.3 million American adults, or about 7.1% of the U.S. population aged 18 and older.
Source: National Institute of Mental Health
List of SSRI for Anxiety: Types of SSRI For Anxiety – Best Anxiety SSRI
What SSRI is best for anxiety? The FDA is in charge of deciding which medications are safe and effective for which reasons. Is there such a thing as the best SSRI anxiety? The following SSRIs (top SSRI for anxiety) are approved to treat depression, anxiety, and other mood disorders and the best SSRIs for anxiety:
- Citalopram (Celexa): Citalopram, sold under the brand name Celexa among others, is an antidepressant of the selective serotonin reuptake inhibitor class. It treats major depressive disorder, obsessive-compulsive disorder, panic disorder, and social phobia. The antidepressant effects may take one to four weeks to occur.
- Escitalopram (Lexapro): Escitalopram, sold under the brand names Cipralex and Lexapro, among others, is an antidepressant of the selective serotonin reuptake inhibitor class. Escitalopram is mainly used to treat major depressive disorder or generalized anxiety disorder. It is taken by mouth.
- Fluoxetine (Prozac): Fluoxetine, sold under Prozac and Sarafem, is an antidepressant of the selective serotonin reuptake inhibitor class. It treats major depressive disorder, obsessive-compulsive disorder, bulimia nervosa, panic disorder, and premenstrual dysphoric disorder.
- Fluvoxamine (Luvox, Luvox CR): Luvox CR is a prescription medicine used to treat the symptoms of Obsessive-Compulsive Disorder. Luvox CR may be used alone or with other medications.
- Paroxetine (Paxil, Paxil CR): Paroxetine treats depression, panic attacks, anxiety disorders, and a severe form of premenstrual syndrome (premenstrual dysphoric disorder). It works by helping to restore the balance of a particular natural substance (serotonin) in the brain.
- Sertraline (Zoloft): Sertraline, sold under the brand name Zoloft, is an antidepressant of the selective serotonin reuptake inhibitor class. The efficacy of sertraline for depression is similar to that of other antidepressants, and the differences are mostly confined to the side.
- Vilazodone (Viibryd): Vilazodone, sold under Viibryd, is a medication used to treat major depressive disorder. While it was being studied for generalized anxiety disorder, such research had stopped as of 2017. It is taken by mouth. Common side effects include nausea, diarrhea, and trouble sleeping.
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Best SSRI for Social Anxiety
Selective serotonin reuptake inhibitors (SSRIs) are usually the first choice of medication for treating social anxiety disorder (SAD). SSRIs affect your brain chemistry by slowing the reabsorption of the neurotransmitter serotonin, which we think helps regulate mood and anxiety. 
Three SSRIs, Paxil, Zoloft, and Luvox CR, have been approved by the FDA for treating social anxiety disorder. Clinical studies have shown all three medications to offer improvement of symptoms.
Paxil was the first SSRI to receive FDA approval and is still often prescribed. However, the medication that works for one person doesn’t always work for another. So, your doctor will work with you to find the right prescription.
Best SSRI for Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) often begins during adolescence or early adulthood and persists throughout the lifespan. Randomized controlled trials support the efficacy of selective serotonin and selective serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs, respectively), benzodiazepines, azapirones, anti-adrenergic medications, melatonin analogs, second-generation antipsychotics, kava, and lavender oil in GAD.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-choice medication options for GAD. Escitalopram (Lexapro) and paroxetine (Paxil) are FDA approved to treat GAD. But other SSRIs, like sertraline (Zoloft) and fluoxetine (Prozac), can be used off-label to treat GAD. All SSRIs work similarly but may differ in their side effects and how long they last in the body.
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Best SSRI for Anxiety and Depression & Best SSRI for Elderly Anxiety
There is no such thing as the best SSRI for depression and anxiety; each case is different. Selective serotonin reuptake inhibitors (SSRIs) are a class of medications most commonly prescribed to treat depression. They are often used as first-line pharmacotherapy for depression and numerous other psychiatric disorders due to their safety, efficacy, and tolerability.
SSRI for Anxiety currently has FDA-labeled indications  to treat the following conditions:
- Major depressive disorder.
- Generalized anxiety disorder SSRI.
- Bulimia nervosa.
- Bipolar depression.
- Obsessive-compulsive disorder.
- Panic disorder.
- Premenstrual dysphoric disorder.
- Treatment-resistant depression.
- Post-traumatic stress disorder.
- SSRI for Social anxiety disorder.
Other off-label uses include but are not limited to Binge eating disorder, Body dysmorphic disorder, fibromyalgia, premature ejaculation, paraphilias, autism, Raynaud phenomenon, and vasomotor symptoms associated with menopause.
Best SSRI for OCD and Anxiety
Knowledge of pharmacotherapeutic treatment options for obsessive-compulsive disorder (OCD) has grown considerably over the past 40 years. Serotonergic antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and clomipramine, are the established pharmacologic first-line treatment of OCD. Medium to large dosages and acute treatment for at least three months is recommended until efficacy is assessed. In case of significant improvement, maintenance treatment is necessary.
Unfortunately, about half of the patients do not respond sufficiently to oral serotonergic antidepressants; augmentation with atypical antipsychotics is an established second-line treatment strategy. Alternatives include intravenous serotonergic antidepressants and a combination with or switch to cognitive-behavioral psychotherapy.
Below we will review four SSRIs that have been FDA-approved to help treat OCD.
Fluoxetine (Prozac) is an SSRI used to treat OCD and other mental health conditions, including depression, anxiety, certain eating disorders, panic disorder, and bipolar disorder.
Fluvoxamine is used to treat OCD in adults. It’s usually taken nightly at bedtime, but larger doses can be divided and taken in the morning and nighttime.
Paroxetine (Paxil) is an SSRI used to treat OCD and various conditions, including depression, panic disorder, anxiety, and post-traumatic stress disorder (PTSD). It is approved for people 18 years and older and is taken once a day.
Sertraline (Zoloft) can be used to treat OCD as well as depression, panic disorder, PTSD, social anxiety disorder, and premenstrual dysphoric disorder (PMDD). Sertraline is taken once daily and can treat OCD in adults.
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How Long Do They Take to Work?
SSRIs are only available orally and come in multiple forms, including tablets, capsules, or liquid suspension/solution. There are currently no parenteral (IV, IM, SubQ), rectal, or other forms of SSRIs. SSRI administration is typically once-daily medication in the morning or nighttime. Except for vilazodone, SSRIs may be taken without regard to food. Vilazodone should be administered with food.
The effect of SSRIs may take up to 6 weeks before the patients feel the effects of treatment. If patients tolerate the current dose well, the clinician can consider an increase in dosage after several weeks.
All patients under 25 should be continually assessed for suicidal ideation and other unusual behaviors, as highlighted in the FDA black box warning for all SSRI medications.
Most people who use SSRI antidepressants don’t have major problems, but every medical treatment carries some risk.  The possible side effects of these antidepressants include:
- Blurred vision.
- Dry mouth.
- Agitation or nervousness.
- Feeling dizzy.
- Pain in the joints or muscles.
- Upset stomach, nausea, or diarrhea.
- Reduced sexual desire.
- Problems with erection or ejaculation.
Some people, especially children and young adults, may be more likely to have suicidal thoughts when they take SSRIs. Studies show that when compared to results from taking a placebo, chances of having suicidal thoughts doubled — from between 1% and 2% to between 2% and 4% — when taking any kind of antidepressant, including an SSRI. If you have thoughts of hurting yourself while taking an SSRI, call 911.
There are also important safety issues to consider about SSRIs. Although it’s rare, if too much serotonin accumulates in your system, you can develop a condition called serotonin syndrome. This happens most often if two different medications that increase serotonin are combined.
SSRIs can also have dangerous interactions with prescription and over-the-counter medicines, including herbs and supplements. Before starting on an SSRI, make sure to tell your doctor all the different kinds of medications and supplements you’re taking.
SSRI vs SNRI For Anxiety
The main difference between SSRIs and SNRIs is that SSRIs prevent the reuptake of serotonin, and SNRIs prevent the reuptake of serotonin and norepinephrine. Serotonin and norepinephrine are substances that the brain uses to send messages from one nerve cell to another.
SSRIs are currently some of the most commonly prescribed medications. They treat numerous conditions and may be used in many settings, not just in primary care or psychiatry. Patients may be on these medications for the long term. Therefore, the entire interprofessional team must have accurate medication reconciliation, including clinicians, pharmacists, nursing staff, and other health professionals.
Alternatives to SSRI for Anxiety & Alternatives to SSRI for Anxiety
There are some medications for anxiety, not SSRIs:
- The first-line alternatives to SSRIs in GAD are SNRIs, buspirone, hydroxyzine, pregabalin, and bupropion.
- Benzodiazepines are not recommended first-line agents for GAD due to their prominent side effect profile.
- If there is no response to an SSRI (or an alternative), switch to another SSRI, SNRI, benzo, or agomelatine.
- Antipsychotics are not recommended as augmenting agents in GAD due to their high risk of metabolic side effects and insulin resistance.
CBD vs SSRI For Anxiety
You’re not alone if you’ve been thinking about using CBD oil to treat anxiety and panic attacks (the best SSRI for anxiety and panic). Many people who suffer from anxiety are curious to learn about the potential advantages of CBD products. But how credible are these assertions, you might be wondering? Can CBD products, such as CBD oil, assist in reducing the symptoms of anxiety?
Currently, the scientific community is just beginning to study the real advantages of CBD. Before any definitive assertions can be made, more research must be conducted. However, given what we know, the outcomes are already starting to seem good. The evidence suggests that CBD may help with serotonin production, particularly for people with anxiety or depression.
A hormone and neurotransmitter made in the brain is serotonin. This hormone is essential for the control of emotions. People who suffer from anxiety or depressive illnesses frequently don’t make enough serotonin. Low moods or unbalanced emotions result from this.
Many widely used antidepressants aid serotonin synthesis. These antidepressants are classified as SSRIs. The 5-HT1A serotonin receptor is what SSRI drugs work to block, and it’s a tried-and-true way to improve mood in those with anxiety or depression.
Although our knowledge is still somewhat limited, CBD may have effects comparable to SSRIs. However, based on the information we have so far, the results seem to be promising and support the need for further study in the future.
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Is your anxiety is linked to an underlying health issue? Some anxiety signs and symptoms appear as the first indicators of your medical illness. Your doctor might suspect your anxiety that can cause a medical issue, and they may order tests to look for an official diagnosis. 
- Drug misuse or withdrawal.
- Thyroid problems, such as hyperthyroidism.
- Chronic pain or irritable bowel syndrome.
- Heart disease.
- Rare tumors that produce certain fight-or-flight hormones.
- Respiratory disorders, such as chronic obstructive pulmonary disease and asthma.
- Withdrawal from alcohol, anti-anxiety medications benzodiazepines, or other medications.
The standard way of treating anxiety is psychological counseling. This can include cognitive-behavioral therapy, psychotherapy, or a combination of therapies.
At the We Level Up FL Treatment Center, we provide world-class care with round-the-clock medical professionals available to help you cope. All work as a team, giving anxiety treatment for successful recovery. Make this your opportunity to reclaim your life. Call today to speak with one of our treatment specialists. Our counselors know what you are going through and will answer any of your questions regarding the safe options for SSRIs for anxiety. Your call is private and confidential, and there is never any obligation.
Top 5 Best SSRI for Anxiety FAQs
Which SSRI is best for anxiety?
These include fluoxetine (aka Prozac), paroxetine (aka Paxil), sertraline (aka Zoloft), fluvoxamine (aka Luvox), citalopram (aka Celexa), and escitalopram (aka Lexapro). They tend to be the first-line choice for multiple anxiety disorders and depression.
Is Lexapro the best SSRI for anxiety?
Yes, escitalopram (Lexapro) is one of the first-choice options for treating generalized anxiety disorder (GAD) and depression because of how well it works and how safe it is.
What is the best SSRI for anxiety panic disorder?
SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft).
What is the best SSRI for insomnia and anxiety?
SSRIs can cause insomnia and worsen sleep quality, but bupropion is surprisingly more favorable for sleep. These studies found that selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) improved subjective sleep measures in patients with depression.
What is the best SSRI for extreme anxiety?
SSRIs and SNRIs are often the first-line treatment for anxiety. Common SSRI brands are Celexa, Lexapro, Luvox, Paxil, and Zoloft. 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.
Powerful Coping Skills for Anxiety. Top Mental Health Tips & Anxiety Tips Advice from a Therapist Video.
4 Mental Health Tips & Advice From A Therapist To Remove Your Everyday Anxiety
“Anxiety, when gone untreated, can increase over time.
So here are four tips to calm your everyday anxiety.
Take a breath.
Do something that you enjoy.
Remove yourself from the situation and go for a walk.
Doing these four things gives you a better chance of calming your everyday anxiety.”
Search We Level Up FL “Best SSRI for Anxiety” Topics & Resources
 Psychopharmacology of anxiety disorders – National Center for Biotechnology Information, U.S. National Library of Medicine
 Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review Strawn JR, Geracioti L, Rajdev N, Clemenza K, Levine A. Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opin Pharmacother. 2018 Jul;19(10):1057-1070. doi: 10.1080/14656566.2018.1491966. PMID: 30056792; PMCID: PMC6340395.
 Selective Serotonin Reuptake Inhibitors – National Center for Biotechnology Information, U.S. National Library of Medicine
 Drug treatment of obsessive-compulsive disorder – SSRI Best for Anxiety – Kellner M. Drug treatment of an obsessive-compulsive disorder. Dialogues Clin Neurosci. 2010;12(2):187-97. doi: 10.31887/DCNS.2010.12.2/mkellner. PMID: 20623923; PMCID: PMC3181958.
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 Carpenter JK, Andrews LA, Witcraft SM, Powers MB, Smits JAJ, Hofmann SG. Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depress Anxiety. 2018 Jun;35(6):502-514. DOI: 10.1002/da.22728. Epub 2018 Feb 16. PMID: 29451967; PMCID: PMC5992015.
 Symptoms of Generalized Anxiety Disorder Among Adults: United States, 2019 – Centers for Disease Control and Prevention (CDC)
 Chand SP, Kuckel DP, Huecker MR. Cognitive Behavior Therapy. [Updated 2022 Sep 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470241/
 What is Cognitive Behavioral Therapy? – https://nij.ojp.gov/topics/articles/what-cognitive-behavioral-therapy National Institute of Justice (NIJ)
 Gautam M, Tripathi A, Deshmukh D, Gaur M. Cognitive Behavioral Therapy for Depression. Indian J Psychiatry. 2020 Jan;62(Suppl 2): S223-S229. DOI: 10.4103/psychiatry.IndianJPsychiatry_772_19. Epub 2020 Jan 17. PMID: 32055065; PMCID: PMC7001356.