Gabapentin used to be considered a nonaddictive medication for anxiety and for alcohol dependence, but we now know it may be misused and diverted for its euphoriant effect.

Diazepam has a long history of use with good efficacy for anxiety. Its long half-life makes it a particularly effective anxiolytic for some patients, and it is a good alternative to chlordiazepoxide for alcohol withdrawal.

Dexmedetomidine is an alpha-2 agonist (think clonidine) that is used at higher doses intravenously (IV) (as Precedex) for ICU sedation.

Due to its longer half-life, clonazepam causes fewer breakthrough symptoms compared to alprazolam when used for anxiety. May also work as a good short-term hypnotic, although development of dependence and long half-life limit this use.

Buspirone is a reasonable option in anxious patients for whom benzodiazepines are not appropriate. Don’t expect as robust a response, and make sure patients know it may take a week or two to kick in.

There are many medications available to treat insomnia.

Anxiety treatment algorithm