Alternatives to Xanax: Is Anything as Effective?

Anxiety is one of the most common mental health concerns in the United States, impacting more than 40 million people [9]. Its effects can be far-reaching, often affecting daily activities and diminishing an individual’s overall quality of life. Among the array of treatments, Xanax has emerged as a frequently prescribed medication to address anxiety. Still, it’s vital to recognize that this is just one among many anxiolytic medications and one of many options to treat generalized anxiety disorder. Shedding light on alternatives to Xanax can lead individuals struggling with anxiety to try other treatments that are less habit-forming yet just as effective for long-term anxiety management.

In recent years, the medical field has significantly advanced in understanding anxiety and developing alternative treatments. This article aims to shed light on some of these options, spanning from benzodiazepines and non-benzodiazepines to the innovative approach of transcranial magnetic stimulation (TMS). We’ll also explore the power and benefits of psychotherapy and the holistic options that provide avenues for anxiety relief. By unveiling these alternatives, we hope to empower those seeking relief to examine a variety of paths toward managing anxiety and regaining control over their lives.

Anxiolytic Medications

Anxiolytic medications, also known as anti-anxiety drugs, are psychiatric medications used to prevent and treat anxiety disorders. Anxiolytic medications target key neurotransmitters in the brain, which serve as chemical messengers that send signals between different nerve cells in the brain. The primary neurotransmitter involved in anxiety is gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter that decreases nerve cell activity in the brain. Prescription psychiatric medications that are used to treat anxiety often quell excessive neuronal firing and reduce levels of GABA in the brain, thereby promoting calm and relaxation.

In individuals with anxiety disorders, GABA imbalance leads to heightened anxiety and excessive worry. Anxiolytic medications help restore this balance by enhancing GABA effects. There are many different types of benzodiazepine and non-benzodiazepine medications used to treat anxiety.

Benzodiazepine Medications

Benzodiazepines are a class of sedative-hypnotic prescription drugs used to treat conditions such as anxiety, epilepsy, and insomnia.  

Some common benzodiazepines include:

• Alprazolam (Xanax)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Lorazepam (Ativan)

These medications attach themselves to specific receptors in the brain, enhancing the effects of gamma-aminobutyric acid (GABA) and depressing the central nervous system. As a result, nerve cell activity is more strongly suppressed, leading to feelings of sedation, relaxation, and a reduction in anxiety.

Each one of these medications acts upon the brain in a very similar way, so each one of these benzodiazepines could be an effective Xanax alternative.

The side effects of benzodiazepines can vary depending on the specific medication and individual factors. Physical and mental side effects are both possible and may include: 

• Drowsiness  
• Dizziness 
• Headache  
• Nausea or vomiting  
• Diarrhea 
• Constipation 
• Dry mouth
• Tremors  
• Blurred or double vision
• Fainting  
• Decreased libido or sexual problems 
• Coordination issues, which could make falling or accidents more likely. 
• Irritability 
• Excitability
• Insomnia or other sleep problems 
• Confusion or forgetfulness 
• Changes in behavior, such as increased risk-taking
• Delirium, which is especially common in older people. [3-4, 7]

Benzos can be effective for managing severe anxiety and panic disorders, but they may not be suitable for individuals with a history of addiction or a family history of addiction. It’s important to note that Xanax and other benzodiazepines have the potential to create dependence and should only be used under the guidance of a medical practitioner [4]. Even for those without a history of addiction, people taking benzos for an extended period of time are at a high risk of developing physical dependence on these medications, which can lead to withdrawal symptoms and addiction.

If you require long-term anti-anxiety medication for an anxiety disorder, panic disorder, or post-traumatic stress disorder, exploring alternatives to Xanax is a good idea. Xanax alternatives, such as cognitive-behavioral therapy, mindfulness techniques, or non-addictive medications, can provide effective solutions while minimizing the potential for dependence, addiction, and severe Xanax withdrawal symptoms.

Non-Benzodiazepine Medications

Several non-benzodiazepine medications are used to treat anxiety disorders. These medications are often preferred over benzodiazepines because they lower the risk of dependence and addiction. Here are some examples of other anti-anxiety medications that are not benzodiazepines but are still used to treat anxiety: 

SSRIs and SNRIs:

Two types of antidepressants, Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), are often considered the first-line drugs for treating anxiety. SSRIs elevate serotonin levels in the brain, a neurotransmitter that controls mood, sleep, and appetite. SNRIs work by raising the brain’s level of serotonin and norepinephrine. These neurotransmitters control energy levels, mood, and responses to stress. Common SSRIs used to treat anxiety include:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Escitalopram (Lexapro)

Common SNRIs include:

• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)
• Desvenlafaxine (Pristiq)

The possible side effects of SSRIs and SNRIs are generally similar and may include:

• Nervousness
• Nausea
• Headache
• Fatigue
• Diarrhea or constipation
• Tremor (shaking)
• Sweating
• Appetite changes
• Sexual problems
• Increase or decrease in body weight. [1]

SSRIs, SNRIs, and other antidepressant medications are good long-term alternatives to Xanax because they are not habit-forming and, therefore, do not carry the same risk of substance abuse as benzodiazepines. It may take several weeks for SSRIs and SNRIs to alleviate anxiety symptoms, and they should be taken consistently to maintain effectiveness. 

Beta Blockers:

Beta-blockers are sometimes used off-label to treat anxiety. Beta-blockers prevent the stress hormone adrenaline (epinephrine) from contacting the beta receptors in the heart, which prevent the heart from pumping harder or faster. This helps to decrease the physical symptoms of anxiety, such as a fast heart rate, a shaky voice, or hands, sweating, and dizziness. Like any medication, beta-blockers may cause side effects like fatigue, dizziness, and low blood pressure.

It is important to note that the prescribed medication will depend on the individual’s needs and preferences and their healthcare provider’s recommendations. Medication is often used with other therapies, such as psychotherapy, to treat anxiety disorders effectively.

Spravato

Spravato, also known as esketamine, is a nasal spray prescribed by doctors. The FDA has recently approved Spravato for the treatment of anxiety. It effectively treats treatment-resistant depression (TRD) and major depressive disorder (MDD) in individuals with acute suicidal thoughts or behavior, but many medications, including Spravato, may be used “off-label” to treat other conditions, such as anxiety. 

Spravato works differently than other medications. It is a prescription drug that works to block the N-methyl-D-aspartate (NMDA) receptor in the brain, which is involved in regulating mood and anxiety. By blocking the NMDA receptor, Spravato increases levels of glutamate. This neurotransmitter is involved in learning and memory and increases levels of glutamate, which may help restore neural pathways disrupted in depression and anxiety. 

The most commonly reported side effects include:

• Sleepiness
• Dizziness
• Nausea or vomiting
• Vertigo
• Dissociation

It’s important to note that not all people will encounter these side effects, and there may be additional side effects not listed here. 

If you or someone you know is experiencing anxiety and seeking potential treatment options or alternatives, consider contacting Neuro Wellness Spa for more information on whether Spravato may be a good fit. Taking the first step towards managing your anxiety can be daunting, but Neuro Wellness Spa’s team of professionals is dedicated to providing guidance and support throughout the process. 

Contact Neuro Wellness Spa today to gain further insight into how Spravato may positively impact your well-being. Taking charge of your mental health is a step towards a happier and healthier life.

Psychotherapy

Anxiolytic medications are typically prescribed for short-term use, as they can be habit-forming and may lead to dependence if taken for extended periods. They are often used alongside therapy, such as cognitive-behavioral therapy (CBT).

Cognitive-behavioral therapy (CBT) helps individuals manage anxiety symptoms by addressing avoidant behaviors and safety-seeking habits that hinder correcting faulty beliefs. This process supports stress management, reducing stress-related disorders and enhancing overall mental health. CBT targets negative thought patterns that impact behavior and emotions. Under stress, people might develop pessimistic thoughts and be unable to solve problems. CBT promotes balanced thinking, which improves coping abilities during stressful situations.

Numerous studies have evaluated CBT’s impact on conditions ranging from mental and physical disorders to behavioral problems. Research suggests that CBT can be effective for conditions like anxiety, depression, and many other mental health concerns [8].

Related: Anxiety Therapy and Integrated Strategies

Transcranial Magnetic Stimulation (TMS)

Transcranial Magnetic Stimulation (TMS) is a non-invasive procedure that sends magnetic pulses to the brain, which can alter nerve cell activity in specific areas of the brain that help regulate mood. TMS is not FDA-approved for treating anxiety, although some research suggests it might help manage anxiety symptoms when other medications haven’t worked. 

TMS is a safe and well-tolerated procedure with minimal side effects compared to medication. Common side effects are generally considered mild and may include:

• Temporary Tinnitus (wearing earplugs reduces the risk)
• Scalp irritation or discomfort
• Headache
• Jaw, face, or neck pain
• Dizziness
• Fatigue
• Facial muscle twitches

This is not an exhaustive list, and discussing whether TMS is a potential treatment option for you is important. Your healthcare provider can answer questions and review your unique health needs, physical and mental health history to determine if you are a potential candidate for TMS treatment. 

Related: TMS for Anxiety

Holistic Treatments

Several self-management techniques can help individuals manage their anxiety symptoms on their own. These include: 

Mindfulness

Mindfulness is a practice that revolves around cultivating a calm and open awareness of the present moment. It involves directing full attention toward one’s internal experiences, such as thoughts, feelings, and sensations while attuning to the external environment. [5] Mindfulness promotes openness, curiosity, and acceptance. [5] Mindfulness-based interventions (MBIs) include meditation, yoga, or guided mindfulness exercises, which help participants stay present and reduce anxiety.

Natural Alternatives to Xanax

Natural Xanax alternatives will likely not be as effective as prescription medications, and people interested in natural alternatives to Xanax should know that natural supplements and herbs are not regulated by the FDA. Because of this, it is sometimes hard to be confident in the amount of a substance that you are taking, or whether the substance has been well studied. However, these are some of the ways that people have reported to help alleviate symptoms of anxiety:

1. Valerian Root: Valerian is a popular herb that has been used for centuries to promote relaxation and ease anxiety. It may help improve sleep quality as well.
2. Chamomile: Chamomile is a well-known herb with soothing properties that can help reduce anxiety and promote better sleep.
3. Lavender: Lavender essential oil or supplements have been shown to have calming effects and can be used to alleviate mild anxiety and stress.
4. L-Theanine: L-Theanine is an amino acid found in tea leaves, particularly in green tea. It can promote relaxation without causing drowsiness.
5. Magnesium: Magnesium is a mineral that plays a role in relaxation and stress reduction. Low magnesium levels have been linked to increased anxiety.
6. 5-HTP: 5-Hydroxytryptophan (5-HTP) is a compound that the body produces from the amino acid tryptophan. It is involved in the production of serotonin, a neurotransmitter that contributes to feelings of well-being and happiness.
7. Ashwagandha: Ashwagandha is another adaptogenic herb that may help lower cortisol levels and reduce anxiety and stress.
8. Lemon Balm: Lemon balm is an herb that belongs to the mint family and has calming effects, making it useful for reducing anxiety and promoting relaxation.

Remember to consult a healthcare professional before incorporating any new herbs or supplements into your routine, especially if you have existing medical conditions or are taking other medications, as some of these compounds will interact with other medications in the body.

Healthy Diet

Managing anxiety often involves making lifestyle adjustments. Although no diet can completely cure anxiety, being mindful of what you eat might help. Here are some suggestions: [11]

• Strive for balanced, nutritious meals. Eating well is essential for overall mental and physical health. Include plenty of fresh fruits and vegetables. Adding omega-3 fatty acid-rich fish like salmon to your diet might also be beneficial in improving anxiety. [10-11]
• Opt for complex carbohydrates. These can boost serotonin in your brain, which can have a calming effect. Choose whole grains like oatmeal, quinoa, whole-grain bread, and cereals. Avoid sugary foods and drinks. [11]
• Stay hydrated by drinking enough water; any amount of dehydration can affect your mood. [2,11]
• Be cautious with alcohol. While alcohol might have an immediate calming effect, it can eventually make you feel edgy and interfere with sleep. [11]
• Limit or avoid caffeine. Caffeine-filled drinks can make you feel jittery and nervous and disrupt your sleep. [12]

Exercise

Physical exercise may have protective effects against anxiety disorders and has been shown to reduce anxiety symptoms. [6]

Accessing Effective Anxiety Treatment in California

It is important to note that the most effective treatment approach for anxiety disorders often involves a combination of psychotherapy and medication management.

If you or a loved one is struggling with anxiety, depression, or other forms of mental illness, contact Neuro Wellness Spa. Our compassionate and skilled psychiatry and therapy team offers a variety of treatments that can support those diagnosed with an anxiety disorder, including in-person and online psychiatry for medication management, psychotherapy, and TMS therapy. Don’t let anxiety hold you back any longer. Contact us today and start your journey towards a calmer, happier life.

References:

1. Bandelow, B., Michaelis, S., Wedekind, D., Treatment of anxiety disorders. Dialogues Clin Neurosci. 2017 Jun; 19(2): 93–107. doi: 10.31887/DCNS.2017.19.2/bbandelow
2. Benton, D., Jenkins, K. T., Watkins, H. T., & Young, H. A. (2016). Minor degree of hypohydration adversely influences cognition: a mediator analysis. The American journal of clinical nutrition, 104(3), 603–612. https://doi.org/10.3945/ajcn.116.132605
3. Bounds CG, Nelson VL. Benzodiazepines. [Updated 2023 Jan 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470159/
4. Edinoff, A. N., Nix, C. A., Hollier, J., Sagrera, C. E., Delacroix, B. M., Abubakar, T., Cornett, E. M., Kaye, A. M., & Kaye, A. D. (2021). Benzodiazepines: Uses, Dangers, and Clinical Considerations. Neurology International, 13(4), 594–607. https://doi.org/10.3390/neurolint13040059
5. Hofmann, S. G., & Gómez, A. F. (2017). Mindfulness-Based Interventions for Anxiety and Depression. The Psychiatric Clinics of North America, 40(4), 739–749. https://doi.org/10.1016/j.psc.2017.08.008
6. Kandola, A., & Stubbs, B. (2020). Exercise and Anxiety. Advances in experimental medicine and biology, 1228, 345–352. https://doi.org/10.1007/978-981-15-1792-1_23
7. (2023, July 1). Side Effects. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/diazepam-oral-route/side-effects/DRG-20072333
8. Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive-behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial medicine, 15(1), 16. https://doi.org/10.1186/s13030-021-00219-w
9. National Institute of Mental Health (n.d.). Any Anxiety Disorder. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder
10. Null, G., Pennesi, L., & Feldman, M. (2017). Nutrition and Lifestyle Intervention on Mood and Neurological Disorders. Journal of evidence-based complementary & alternative medicine, 22(1), 68–74. https://doi.org/10.1177/2156587216637539
11. Sawchuck, C.N. (2017). Coping with anxiety: Can diet make a difference? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/expert-answers/coping-with-anxiety/faq-20057987
12. Winston, A., Hardwick, E., & Jaberi, N. (2005). Neuropsychiatric effects of caffeine. Advances in Psychiatric Treatment, 11(6), 432-439. doi:10.1192/apt.11.6.432