When anxiety does not improve with the first treatment, it is easy to feel stuck. Most people still get better with the next step, and the next step is usually not a benzodiazepine.
First, check the basics
- Was the dose high enough, for at least six to eight weeks?
- Has the medicine been taken daily, as planned?
- Are sleep problems, caffeine, alcohol, thyroid problems or another condition driving symptoms?
- Has cognitive behavioral therapy (CBT) been part of the plan? CBT is as effective as medication for many anxiety disorders.
Medication options
- Another SSRI or an SNRI: escitalopram (Lexapro), sertraline (Zoloft), venlafaxine XR (Effexor XR) or duloxetine (Cymbalta). Not responding to one does not predict the next.
- Buspirone: a non-habit-forming daily medicine for generalized anxiety, alone or added to an SSRI.
- Hydroxyzine: a non-habit-forming option for occasional use.
- Pregabalin: used off-label in the United States for generalized anxiety when other options have not worked. It is a controlled medicine (Schedule V) that can be misused and cause withdrawal if stopped suddenly, and combined with opioids, alcohol or other sedatives it can cause dangerous breathing problems, so it needs extra caution.
Ready to Get Started?
Primary care, mental health, and addiction medicine in one practice. New patients are often able to be scheduled within a week of requesting an appointment.
Why benzodiazepines are not the long-term answer
Benzodiazepines work quickly, but daily long-term use brings dependence, memory and balance problems and difficult discontinuation. Read why long-term benzodiazepine use is discouraged.
Get help from Hope Integrative Medicine
If your anxiety treatment is not working, we can review the basics and the next options with you. Our mental health team sees patients in person in West Ashley and by telehealth across South Carolina, and new patients are often able to be scheduled within a week of requesting an appointment. Request an appointment.
This article is general health information and does not replace advice from your own provider. Never start, stop or change a medication without talking with your prescriber. If you are having thoughts of harming yourself, call or text 988 or call 911.
Frequently Asked Questions
Check that the dose was adequate for six to eight weeks and taken daily. Next steps include another SSRI or an SNRI, adding buspirone, and cognitive behavioral therapy.
No. Buspirone is not habit-forming. It is taken daily and usually takes a few weeks to help.
Hydroxyzine is a non-habit-forming antihistamine sometimes used for occasional anxiety. It can cause drowsiness.