Patient information from BMJ

Anxiety: what are the treatment options?

Last published:Feb 27, 2023

Everyone gets anxious from time to time. But if you worry so much that it stops you getting on with your life, there are treatments that can help you feel less anxious.

You can use our information to talk to your doctor and decide which treatments are best for you.

What treatments work?

Your doctor will probably recommend a 'talking treatment' (psychological treatment), medicines, or both, to help your anxiety.

The treatment your doctor recommends might depend on what treatment you would prefer to try, and on how severe your symptoms are. Different treatments suit different people.

Talking treatments

Talking treatments seem to work well for anxiety. One that is used a lot is called cognitive behaviour therapy (or CBT for short). Or you could have a more general type of psychotherapy.

If you have a talking treatment your symptoms should improve and you should feel more calm. But these treatments don’t work instantly. And you will need to practise the things you learn in the sessions, while you're at home.

During these treatments you work with a therapist who has been trained in helping people with mental health problems.

You normally see someone once a week over a period of several weeks or months. Depending on how severe your symptoms are you may need to see someone more often. Sessions normally last between one and two hours.

With cognitive behaviour therapy you and your therapist work together to try to change the way you think and how you behave.

Usually, the therapist tries to find out which thoughts make you worried and ill. For example, every time you want to drive you might think, 'I could crash the car.' Or every time the phone rings you might think, 'Someone must have died.'

You then learn ways to be more positive. For example, you might learn to change the thought 'My boss thinks I'm hopeless' to 'I must be good at my job. I've never been laid off, my colleagues like me, and I always meet my deadlines.'

There are many types of talking treatment, and your therapist might suggest a specific one that could help you, or even a combination of approaches.

Other types of therapy that people have found helpful for anxiety include mindfulness or meditation training, and applied relaxation training. If these therapies aren't available where you live, your doctor might be able to help you find reliable information about them online.

Medicines

There are several types of medicine used to treat anxiety. The treatment you are offered will depend on several things, including:

• how severe your symptoms are

• the type of symptoms you have

• whether you have another condition as well as anxiety, such as depression

• whether you are taking any other drugs that might interact badly with certain medicines

• whether you are pregnant or planning to become pregnant. Some of the medicines used to treat anxiety are not suitable for use during pregnancy

• whether there are particular side effects that might affect you with some medicines.

Short- and long-term treatment

Some medicines, such as antidepressants, are used to treat anxiety in the long term. But, as these drugs can take a few weeks to start working, you may also be offered faster-acting medicine to take in the short term while the longer-term medicine begins to work.

Antidepressants can help reduce feelings of anxiety, and help you sleep better and feel more comfortable around people.

Antidepressants can cause side effects in some people. For example, some of them can cause drowsiness, dizziness, nausea, or sexual problems. But if your side effects bother you, you might be able to switch to another drug and see if that bothers you less.

Antidepressants are a long-term treatment for anxiety. They start to work after a few weeks, but people usually take them for at least six months. 

Drugs called benzodiazepines work quickly and can help you relax and feel less worried. But doctors are prescribing them less than they used to. When doctors do prescribe these drugs, it's usually for just a few weeks, to help while other medicines start to work.

This is because benzodiazepines can have many side effects, including some serious ones, such as addiction, drowsiness that can lead to falls and injuries, and problems with memory and learning. They can also cause death if taken with opioid medications. 

You shouldn’t take a benzodiazepine if you’re pregnant.

You might be offered a type of medicine called an anticonvulsant. These drugs are usually used to prevent seizures (fits) in people with conditions like epilepsy, but they can also help with anxiety.

But these drugs are not used as often as antidepressants. They can cause serious side effects in some people, including kidney problems. 

Medicines called antipsychotics can help reduce anxiety and fear and help you sleep better. But, like anticonvulsants, they are not used as often as antidepressants.

Things you can do for yourself

Talking treatment doesn't have to end when you stop going to a therapist. You may use it as a way to learn how to help yourself. Then, if old ways of thinking and behaving come back, you can be your own therapist.

Some people find self-help books and online resources useful. Regular exercise also helps many people to feel less anxious.

You might also try cutting down on alcohol, or cutting out caffeine, especially later in the day.

Improving your sleep hygiene may help with anxiety. Good sleep hygiene means doing things that mean you get a healthy amount of good-quality sleep. It includes things like:

• not eating, or drinking alcohol or caffeine, near to bed time

• avoiding daytime naps

• taking regular exercise

• making sure your bedroom is a comfortable, relaxing place

• not watching TV or using other devices with screens (such as tablets or smartphones) in bed. 

Your doctor may suggest you join a local support group for people with anxiety, or perhaps an online group. Sharing your feelings, and hearing other people's stories, might help you feel less alone and more able to cope and get on with your life.

Anxiety in children

Some treatments have also been tested for children. We know that cognitive behaviour therapy and some antidepressants work for children with anxiety. But antidepressants may have serious side effects in children, so they're not often used.

More recent treatments for children and adolescents include smartphone apps. For example, in the UK, the Clear Fear app (clearfear.co.uk) is designed to help young people understand and cope with fear and anxieties.

Treating anxiety during pregnancy

Medicines are not generally recommended for treating anxiety during pregnancy, and especially not during the first three months (the first trimester) of pregnancy. Talking treatments are recommended instead.

But if talking treatments don't work there are some medicines that are more safe than others for pregnant women.

Useful resources for pregnant women include meditation, self-help materials (such as books and websites), and relaxation techniques. Online resources in particular are becoming an increasingly valuable source of help for pregnant women with anxiety.

If you become pregnant while taking medicine for anxiety, tell your doctor straight away so that together you can decide on the best and safest treatments for you during pregnancy.