Anxiety Medication UK: Names, Sertraline, Citalopram and Fluoxetine Explained

What medication is used for anxiety in the UK?

For generalised anxiety disorder (GAD), the first medicine offered in the UK is usually an SSRI antidepressant, and NICE suggests sertraline first. If it doesn’t help or suit you, the next options are another SSRI or an SNRI such as venlafaxine or duloxetine, then pregabalin. Benzodiazepines are for short-term crises only, and propranolol only eases physical symptoms.

NICE’s guideline for GAD and panic disorder in adults (CG113) uses a stepped approach. Step 1 is information and keeping an eye on symptoms. Step 2 is low-intensity help such as guided self-help or a group course. At step 3, for anxiety that is having a big effect on daily life or hasn’t improved, you’re offered either a high-intensity talking therapy (CBT or applied relaxation) or medicine. NICE says to base that choice on your preference, because there’s no evidence that one is better than the other.

The NHS says a GP will usually advise you to try talking therapies before they prescribe medicine. For panic disorder, NICE says antidepressants should be the only medicines used long term, and that benzodiazepines should not be prescribed. For what anxiety feels like and how it’s diagnosed, see anxiety symptoms and stress vs anxiety.

Anxiety medication names: the UK list

These are the medicines most often prescribed for anxiety in the UK. “Licensed for” shows the anxiety-related uses listed in the BNF; licensing can vary between brands, so your pharmacist can check the leaflet that comes with yours. Side effects are the common ones listed by the NHS.

Some extra points from the NHS and NICE:

• Pregabalin became a Class C controlled drug in April 2019, and NICE asks prescribers to check for any history of drug misuse first. It’s usually tried only if SSRIs and SNRIs don’t suit you.
• Propranolol treats the physical side of anxiety, like sweating and shaking. The NHS says an overdose can be very serious: if you’ve taken more than prescribed, call 111, or 999 if you have a slow heartbeat, breathing problems or chest pain. The BNF says it isn’t suitable for people with asthma. For tiredness on it, see do beta blockers make you tired?
• Benzodiazepines such as diazepam: NICE says don’t offer them for GAD except as a short-term measure during a crisis. The NHS says diazepam should only be used for up to 4 weeks, because longer use can cause addiction and withdrawal symptoms.
• Antipsychotics: NICE says they shouldn’t be offered for GAD in primary care, and that neither antipsychotics nor sedating antihistamines should be prescribed for panic disorder.

Is sertraline good for anxiety?

Sertraline is often the first medicine tried for anxiety in the UK. NICE suggests doctors consider sertraline first for generalised anxiety disorder, mainly because it is the most cost-effective SSRI. It’s licensed in the UK for panic disorder, social anxiety disorder, PTSD and OCD. Whether it’s right for you is a decision for you and your GP.

For GAD, sertraline is prescribed outside its UK licence (off-label). NICE notes this and says your informed consent should be recorded. In the BNF, the usual starting dose for panic disorder, PTSD and social anxiety is 25mg once a day for a week, then 50mg; your doctor sets your dose.

The NHS says most side effects ease after a couple of weeks, and that it’s best not to drink alcohol while taking sertraline. If you notice yawning or night sweats, see why am I yawning so much? and night sweats. If it keeps you awake or makes you drowsy, see does sertraline cause insomnia?

Is citalopram good for anxiety?

Citalopram is licensed in the UK for panic disorder as well as depression, so it is used for some types of anxiety. It isn’t one of the medicines licensed for generalised anxiety disorder in the BNF. It can rarely cause a serious heart rhythm problem, so it may not suit people with some heart conditions. Your GP weighs this up with you.

The NHS says you may need to take citalopram for a few weeks before you notice an improvement, and that your doctor may start you on a low dose and raise it over several weeks. For panic disorder, the BNF starting dose is 10mg a day for 7 days, then 20mg. If you get a fast, irregular heartbeat, light-headedness or fainting, get medical help straight away. For panic symptoms in the moment, see how to stop a panic attack.

Does fluoxetine help with anxiety?

Fluoxetine (Prozac) isn’t licensed in the UK for anxiety disorders. The NHS and the BNF list it for depression, OCD and bulimia. NICE notes that some SSRIs are prescribed off-label for GAD, and a doctor can do this with your informed consent. If you take fluoxetine and still feel anxious, talk to your GP rather than changing your dose.

NICE also says SSRIs can cause “activation” at the start, with more anxiety, agitation or sleep problems for a while. The fluoxetine leaflet lists insomnia and fatigue among its very common side effects. For more, see does fluoxetine make you tired?

How long do anxiety medicines take to work?

Antidepressants usually take 1 to 2 weeks to start having an effect and can take up to 8 weeks to work fully, the NHS says. NICE says the full effect on anxiety builds gradually over a week or more, and that SSRIs can make anxiety, agitation and sleep worse at first. Keep in touch with your GP during the early weeks.

• Reviews: NICE says your doctor should review how the medicine is working, and its side effects, every 2 to 4 weeks for the first 3 months, then every 3 months.
• If you’re under 30: NICE says you should be warned that SSRIs and SNRIs are linked to a higher risk of suicidal thoughts and self-harm in a minority of younger people, seen within a week of starting and checked weekly for the first month. The NHS says people aged 24 or under may be most at risk.
• How long you take it: if a medicine works for GAD, NICE advises carrying on for at least a year, because the chance of anxiety coming back is high. The NHS says antidepressants are usually taken for at least 6 months after you feel better.
• Pregabalin takes at least a few weeks to work, the NHS says.

Early side effects such as poor sleep are common. For help with nights, see insomnia, and keep alcohol low: see alcohol and sleep.

Stopping anxiety medication

Don’t stop an anxiety medicine suddenly. The NHS says stopping antidepressants such as sertraline, citalopram or paroxetine suddenly can cause withdrawal symptoms, and your doctor will lower the dose gradually over several weeks or months. Pregabalin, diazepam and propranolol also need to be reduced gradually. Speak to your GP first, even if you feel better.

NICE says withdrawal symptoms can happen if a medicine is stopped abruptly, sometimes if a dose is missed and occasionally when the dose is lowered. For propranolol, the NHS says stopping suddenly may make your health problem worse, and the dose is usually reduced over 1 to 2 weeks. If side effects are the problem, your doctor can look at the dose, the timing or a different medicine.

Talking therapies first

Talking therapies are usually the first treatment for anxiety on the NHS. In England, adults can refer themselves to NHS Talking Therapies without seeing a GP (from 16 in some areas). Services help with constant worry, panic attacks, social anxiety, health anxiety and phobias, usually with CBT. Elsewhere in the UK, start with your GP.

You can find your local service on the NHS website by searching “NHS talking therapies”. Many people combine therapy and medicine: NICE says that if a medicine only partly helps, a high-intensity talking therapy can be added. To check how you’re doing before an appointment, you can use a questionnaire such as the Hospital Anxiety and Depression Scale. Practical help for day-to-day anxiety is in how to deal with anxiety, social anxiety and health anxiety.

Supplements and CBD with anxiety medication

No supplement replaces an anxiety medicine. Tell your GP or pharmacist about any herbal remedies, vitamins or supplements you take. Some can raise the risk of serotonin syndrome with SSRIs: the NHS says not to take St John’s wort with fluoxetine, and the fluoxetine leaflet adds tryptophan. Check before taking tryptophan or 5-HTP. For a wider look, see natural supplements and anxiety medicines and magnesium with antidepressants.

CBD: CBD can interact with some medicines, and drowsiness can add up. The FSA advises people taking any medication not to take CBD unless under medical direction, so we don’t suggest CBD alongside anxiety medicines. Speak to your prescriber or pharmacist first, and see can CBD interact with medication?

iIf you’re pregnant, planning a pregnancy or breastfeeding, speak to your GP or midwife before starting or stopping any of these medicines.

When to get urgent help

If you’re told to go to A&E, don’t drive yourself: ask someone to take you or call 999. Take the medicine packet with you. You can report side effects through the MHRA Yellow Card scheme. If low mood is part of the picture, see low mood vs depression.

See also St John’s wort: why it doesn’t mix with antidepressants.