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.

Flurazepam is an older benzodiazepine that has fallen out of favor due to its very long half-life and its active metabolites.

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.

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.

Alprazolam is fast-acting and effective for generalized anxiety disorder (GAD) and panic disorder, but its short duration of action may contribute to breakthrough symptoms between doses and make withdrawal more difficult.

Although antidepressants are arguably the most effective medications for anxiety disorders, in this chapter, we focus on benzodiazepines and other drugs used specifically for symptoms of anxiety or anxiety disorders.

Anxiety treatment algorithm