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SSRIs vs SNRIs For Anxiety – How do SSRIs & SNRIs work and which is better for anxiety?

Last Updated: September 8, 2022

SSRI (selective serotonin reuptake inhibitors) and SNRI (serotonin-norepinephrine reuptake inhibitors) drugs are both used to treat depression and anxiety symptoms, but they function slightly differently and come with different methods of action, side-effects and levels of effectiveness. Here we look at what SSRIs and SNRIs are, how they work for anxiety, what the drawbacks & side-effects are for each of them, analyze which is more effective and even look at some natural alternatives.

It is not rare at all, in this day and age, to experience anxiety from time to time. According to the National Institute of Mental Health, anxiety disorders affect more than 19% of adults within the US, in any given year [1]. This means that one in five people in America are having to push through their daily activities such as performing at their job, completing school work, and maintaining relationships; all while trying to deal with anxiety-related issues [3].

Fortunately, as the amount of anxiety symptoms and cases raises, so do the many strategies that can be used to find relief. For some, anxiety can start to affect your day-to-day functioning and become a hindrance to your life. In these situations, more long-term anxiety solutions are needed.

Benzodiazepines, which became available in the 1960s, have long been seen as the first-line anxiety medication recommended and prescribed by doctors. But, although “Benzos” work quickly and effectively, they carry a (very) high risk of dependence, sedation, and tolerance buildup [4].

This has left anxiety-sufferers seeking alternatives to Benzodiazepines like Xanax to help with their anxiety symptoms and disorders, but without the same risks of addiction & other side-effects.

This has led to the rise in prominence of antidepressant medications that are used to treat symptoms of anxiety, depression, and other mood or mental health disorders [2]. Specifically, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

SSRIs and SNRIs have no addictive potential, and have shown in studies and through wide-spread usage that they are effective anxiety drugs. In this article, we are going to look at what SNRIs & SSRIs are exactly, how they work, known side-effects & downsides and finally some natural non-addictive alternatives that also work for anxiety.

Controlled Substances vs Non-controlled Substances for Anxiety

“Non-controlled” anxiety medications refer to medications that do not carry the risk of dependence or addiction, according to the U.S. Drug Enforcement Administration (DEA) [5].

Benzodiazepines, typically prescribed under the brand names Valium, Xanax, Restoril, Ativan and Klonopin, are the oldest and most well-known controlled substances for anxiety. While benzodiazepines have the advantage of working quickly, they carry a high risk of addiction [3].

Today, the most commonly recommended alternatives to benzodiazepines are SSRIs and SNRIs.

The main difference between SSRIs and SNRIs, compared to Benzodiazepines, is that SSRIs & SNRIs are shown to treat the source of the anxiety, whereas benzodiazepines typically only treat the symptoms.

What Are Selective Serotonin Reuptake Inhibitors (SSRIs) & How Do They Work?

Selective serotonin reuptake inhibitors (SSRIs) are a class of prescription drugs originally developed to treat depression, and more recently have been shown to help reduce anxiety.

SSRIs work by increasing the amount of serotonin in your brain, which has a mood-boosting effect [3]. They are particularly effective in treating post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) [6]. SSRI brand names include:

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

Importantly, SSRIs for anxiety have no addictive potential. They also have the added advantage of effectively treating depression, which commonly co-occurs with anxiety disorders [7].

Possible side effects of SSRIs

The downside to SSRIs is that they take four to six weeks to build up in your system before you can feel the full effects.

SSRIs can also cause uncomfortable withdrawal effects if you suddenly stop taking them; including vertigo, nausea or vomiting, chills, shock sensations or “brain zaps,”” and visual disturbances [6]. Around 30% to 50% of people experience mild side effects with SSRIs, but only about 19% discontinue the medication due to these effects [7]. That says something about the perceived effectiveness of this drug.

What Are Serotonin-norepinephrine Reuptake Inhibitors (SNRIs) & How Do They Work?

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are preferred over SSRIs for disorders like generalized anxiety disorder and panic disorder. SNRIs are similar to SSRIs in that they boost serotonin, but they are unique because they also regulate norepinephrine.

Norepinephrine is a neurotransmitter related to alertness and concentration. Regulating norepinephrine and boosting serotonin has an overall strong, positive effect on mood [6]. SNRIs are available under the brand names:

  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)

SNRIs for anxiety are usually used after SSRIs are non-effective, and like SSRIs they also have no addictive potential. SNRIs have a delayed onset of action, usually taking at least two weeks to show their anti-anxiety effects [7].

Possible side effects of SNRIs

The side effects are reported to be similar to those of SSRIs, plus potentially fatigue, loss of appetite, and constipation [6]. SNRIs can also cause withdrawal effects when you abruptly stop taking them, similar to those of SSRIs [3].

In some rare cases, as SNRIs focus on the neurotransmitter norepinephrine, which can have energizing effects, some have reported worse physical symptoms of anxiety after usage. This is not generally typical, however.

SNRI vs SSRI: Which one should I use?

There is currently no consensus on which of the two antidepressants is more effective in treating anxiety. SSRIs do tend to be more widely used than SNRIs and are often considered the ‘first line’ of defense [2]. According to one 2021 review [8], side effects tend not to be as severe for SSRIs when compared with SNRIs.

SSRIs and SNRIs can be equally effective options for treating anxiety disorders. Another 2018 review [9] that compared the two medications found that there are no major differences. But reviewers did find that both drugs are most effective in treating social anxiety disorder, specifically.

Also, a 2008 review [10] of SSRIs and SNRIs research showed that SNRIs might be more effective in treating severe depression symptoms, but these differences tend to be modest and aren’t true for all SNRI drugs [2]. Overall, it is advised that you talk with a medical health professional who should be able to help you determine which antidepressant is best for you.

Are there other Non-addictive Natural Remedies For Anxiety?

Although the potential risks of SNRIs & SSRIs are nowhere near as bad as those of Benzodiazepines, such as (severe) risks of dependence, it still is a good idea to consider natural alternatives to any prescription drug. The inconvenience of renewing prescriptions and potential cost, for some, is enough to seek out alternatives. Fortunately, there are some natural anxiety remedies that can provide the same benefits for anxiety as SSRIs & SNRIs.

Many foods, minerals and dietary supplements have similar properties to prescription anxiety medications & antidepressants, in terms of lowering the negative effects of stress and anxiety.

The major difference is that natural anxiety remedies are less likely to have side-effects, carry a lower risk of dependence or addiction, and are generally more widely available, as you do not need a prescription. Almost all alternatives I come across (at least those that I take seriously) are beneficial to your health in more areas than one [11].

Here are some notable natural remedies for anxiety that you can consider trying:

Lavender (Silexan)

Silexan is an extract of lavender oil created by Wilmar Schwabe GmbH, a German pharmaceutical company. The creators claim that silexan is “introducing a new therapeutic alternative in the field of anxiety disorder treatment” [12].

Silexan is essentially a standardized essential oil of L. angustifolia (lavender) flowers, prepared using steam distillation [13].

Studies involving Silexan have shown that “uniquely prepared, pharmaceutical quality lavender oil” (potent silexan) can improve symptoms of mild anxiety. Two recent studies found lavender oil capsules to be just as effective as commonly prescribed benzodiazepine Lorazepam and the antidepressant Paroxetine [14].

The anxiolytic (anti-anxiety) properties of lavender/silexan seem to come from the antagonization of NMDA and GABA-related receptors in the central nervous system that influence muscle contraction, as well as inhibition of the serotonin transporter [3]. In this way, the mechanism of action for Silexan seems to be similar to anxiolytic and antidepressant drugs like SSRIs, SNRIs and Benzodiazepines [15].

The major upside to lavender/silexan over other anti-anxiety medications (or antidepressants used for anxiety purposes) is the almost complete lack of abuse potential in healthy recreational users of the lavender extract [16]. Downsides can include the affectionately-titled “lavender burps” which are potential mild gastrointestinal issues. There are also some recent studies showing that chemicals in lavender oil are potential endocrine disruptors with varying effects on receptors for two hormones — estrogen and androgen [17].

GABA

Gamma-Aminobutyric Acid, shortened to GABA, is a naturally-occurring amino acid that acts as a neurotransmitter within the body. GABA has been shown in numerous studies to have a calming effect, and GABA deficiency is believed to play a part in several anxiety disorders [18].

Studies that used GABA supplementation have found it may have a positive effect on stress and anxiety [19], which would help block the symptoms associated with anxiety in a similar way to other anti-anxiety medications.

L-theanine

L-theanine is an amino acid that is well regarded for its relaxing properties [20]. Studies have repeatedly shown that L-theanine may decrease the severity of stress-related symptoms in test subjects, while also increasing cognitive performance [21].

This means that taking L-theanine may help people counteract the nerves that come with anxiety, while also providing better focus and clearer thought. A pretty impressive feat!

L-theanine can be taken in supplement form, and is also present in green, black and oolong teas, as well as some mushrooms.

L-arginine

L-arginine is another kind of natural amino acid that effectively lowers blood pressure, and may provide relief from the symptoms of hypertension and even some forms of heart disease [22][23].

L-arginine works by increasing the release of nitric oxide in the blood, which in turn causes blood vessels to open, allowing blood to flow more freely.

There is still more research necessary to definitively prove whether or not L-arginine is effective for anxiety in the same way as other anxiety medications and antidepressants are. But, a major upside is that there is no addictive potential with L-arginine.

L-arginine can be found in supplement form, as well as found in red meat, dairy, poultry and fish.

Cognitive performance Supplements

Some dietary supplements contain a mix of ingredients that support focus, calm and cognition, which may counteract the negative side-effects of anxiety (particularly stage fright and performance anxiety).

One example that I personally like and recommend to clients is PerformZen, which contains GABA, L-theanine and Magnesium, as well as cognitive-enhancing ingredients Ginkgo Biloba, Vitamin B6 and Theacrine. These ingredients have been shown to help induce a calming effect on the body, as well as keeping the brain as sharp as it needs to be during your performance.

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Final thoughts on SSRIs vs SNRIs

If you’re currently living with anxiety, you are not alone! Anxiety disorders are the most prevalent psychiatric disorder in the world, currently affecting over 40 million adults in the United States alone [24].

It is common for anxiety symptoms to interfere with your daily life and cause significant distress. If this is your current situation, consider reaching out to a mental health professional who can properly advise you about the right treatment that can reduce your symptoms and significantly improve your quality of life.

Your doctor may even recommend SSRIs, SNRIs or one of the anxiety solutions talked about above, but if you are not comfortable using prescription medications, talk with them about the alternatives that are less risky, and have less-to-no risk of dependence & addiction, and may end up healthier for you in the long term.

  1. ^ https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder
  2. ^ https://psychcentral.com/anxiety/ssris-vs-snris-for-treating-anxiety
  3. ^ https://performzen.com/non-addictive-anxiety-medication/
  4. ^ https://psychcentral.com/anxiety/non-addictive-anxiety-medication
  5. ^ https://www.dea.gov/factsheets/benzodiazepines
  6. ^ https://www.washburnhouse.com/addiction-recovery-blog/non-addictive-anxiety-medication/
  7. ^ https://www.therecoveryvillage.com/mental-health/anxiety/non-addictive-anxiety-medication/
  8. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984896/
  9. ^ https://onlinelibrary.wiley.com/doi/abs/10.1002/da.22854
  10. ^ https://pubmed.ncbi.nlm.nih.gov/18668017/
  11. ^ https://performanceanxiety.com/natural-beta-blocker-alternatives/
  12. ^ https://www.businesswire.com/news/home/20131017005763/en/Schwabe-Pharmaceuticals-underlines-its-commitment-to-research-and-development-with-a-Symposium-on-the-latest-study-results-in-the-CNS-field-at-the-ECNP-European-College-of-Neuropsychopharmacology-in-Barcelona
  13. ^ https://psychiatryeducationforum.com/silexan/
  14. ^ https://www.dailymail.co.uk/health/article-6761759/Leading-expert-claims-doctors-dish-LAVENDER-OIL-line-treatment-anxiety.html
  15. ^ https://examine.com/members/deep-dives/article/can-lavender-take-the-edge-off-of-anxiety/
  16. ^ https://academic.oup.com/ijnp/article/24/3/171/6029371
  17. ^ https://factor.niehs.nih.gov/2019/9/feature/3-feature-lavender/index.htm
  18. ^ https://pubmed.ncbi.nlm.nih.gov/12662130/
  19. ^ https://pubmed.ncbi.nlm.nih.gov/16971751/
  20. ^ https://www.sciencedirect.com/science/article/pii/S2352385915003138?via%3Dihub
  21. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836118/
  22. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5021928/
  23. ^ https://pubmed.ncbi.nlm.nih.gov/28538181/
  24. ^ https://adaa.org/understanding-anxiety/facts-statistics

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OTC Xanax Alternatives for Anxiety
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PerformanceAnxiety.com Owner & Lead Writer

Anita is the owner and lead writer for PerformanceAnxiety.com. A seasoned musician and public speaker herself, she is no stranger to the very real fear and anxiety that can strike right before a high-pressure situation. That's why Anita is passionate about writing content that helps people learn about and overcome their anxieties & social fears so that they can perform at their best when it counts and live anxiety-free lives.