Anxiety disorders
Anxiety disorders include generalized anxiety, social anxiety, and panic attacks: persistent worry, fear in social situations, or sudden episodes of intense fear that seem to come from nowhere.
Generalized anxiety brings near constant worry that is hard to switch off. Social anxiety turns everyday interactions into something dreaded. Panic attacks arrive suddenly with a racing heart, shortness of breath, and a sense of doom. All three are common, all three are real, and all three respond to treatment.
Care starts with careful diagnosis, since anxiety overlaps with depression, thyroid problems, and other conditions. Anxiety disorders involve an overactive threat alarm in the brain, and SSRIs and SNRIs gradually turn down the volume on that alarm by adjusting serotonin and norepinephrine signaling. That is why worry loosens its grip over weeks rather than hours. They are designed for steady daily use, not quick sedation. Treatment is individualized and often combines medication with therapy based approaches.
Research and further reading
A few key papers behind how this condition is understood and treated today. Links open the abstract on PubMed, a free public database from the U.S. National Library of Medicine.
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Gosmann et al. · PLoS Medicine · 2021
Across 135 trials with more than 30000 patients, all tested SSRIs and SNRIs eased internalizing symptoms better than placebo, and differences between individual medications were small.
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Slee et al. · The Lancet · 2019
Across 89 trials with more than 25000 patients, duloxetine, venlafaxine, and escitalopram reduced generalized anxiety symptoms more than placebo with relatively good tolerability, while paroxetine and benzodiazepines were effective but less well tolerated.
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Pharmacological treatment of anxiety in older adults: a systematic review and meta-analysis
Neil-Sztramko et al. · Lancet Psychiatry · 2025
In adults over 60 with anxiety disorders, antidepressants reduced symptoms more than placebo, SSRIs eased symptoms more than SNRIs did, both classes reached similar remission rates, and evidence supporting benzodiazepines was very weak.
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Johnco et al. · Am J Geriatr Psychiatry · 2025
In adults over 60, about half of patients reached full remission after CBT compared with roughly a third after medication, and treatment response was clearly better than placebo for both approaches.
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Kong et al. · Front Pharmacol · 2020
In this network meta analysis of 32 trials with more than 13000 adults with generalized anxiety disorder, duloxetine, escitalopram, paroxetine and venlafaxine doubled the odds of remission versus placebo while sertraline and a few others were as well tolerated as placebo.
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Hu et al. · JAMA Network Open · 2024
In this 8 week trial across several anxiety disorders, escitalopram and mindfulness training lowered patient reported anxiety to a similar degree by week 8, though the medication group improved faster in the first month and reported more side effects.
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Cardoner et al. · Front Pharmacol · 2025
Across 14 trials with nearly 5,000 patients, pregabalin reduced anxiety more effectively than SSRIs, SNRIs, and benzodiazepines, with fewer people stopping treatment.
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Christensen et al. · J Psychopharmacol · 2022
In an 8 week study of people with both severe depression and severe anxiety, vortioxetine was linked to meaningful improvement in anxiety symptoms and daily functioning.
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Chawla et al. · BMJ · 2022
Across 87 trials, SSRIs offered strong remission rates with the lowest risk of side effects among drug classes, and sertraline and escitalopram showed the best balance of benefit and tolerability.
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Caiazza et al. · Hum Psychopharmacol · 2026
Mirtazapine matched SSRIs for reducing anxiety symptoms in generalized anxiety disorder and was tolerated similarly to placebo, suggesting it may be a useful alternative when first line options are not suitable.
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