Anxiety medication in Australia

What medication is used for anxiety in Australia?

Australian psychiatry guidelines for panic disorder, social anxiety disorder and generalised anxiety disorder (GAD) recommend three equal starting options: cognitive behavioural therapy (CBT), medication, or both together ^[1]. The recommended medicines are SSRI or SNRI antidepressants, taken alongside advice on gradually facing the situations that trigger your anxiety ^[1].

That fits what Beyond Blue tells patients. Mild anxiety may be managed with lifestyle changes and online programs, while moderate to severe anxiety usually calls for psychological treatment, medication, or both ^[2].

Here's how the main options compare.

Can a GP prescribe anxiety medication?

Yes. GPs wrote about 85% of all mental health-related prescriptions dispensed in Australia in 2022–23 ^[3]. You don't need to see a psychiatrist to start most anxiety medicines.

A GP can also arrange a mental health care plan if you'd like to see a psychologist, and refer you to a psychiatrist when your situation needs specialist input.

SSRIs and SNRIs: the first-line anxiety medicines

SSRIs (selective serotonin reuptake inhibitors) include citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline. SNRIs (serotonin and noradrenaline reuptake inhibitors) include duloxetine, venlafaxine and desvenlafaxine ^[4]. Although they're called antidepressants, some can help manage anxiety even if you don't have depression ^[2].

What does the evidence say?

The largest comparison of anxiety medicines pooled 89 randomised trials with 25,441 adults with GAD ^[5]. Duloxetine, pregabalin, venlafaxine and escitalopram all worked better than placebo and were relatively well tolerated. Mirtazapine, sertraline, fluoxetine, buspirone and agomelatine also looked effective, though the evidence was thinner ^[5].

Drawing on UK guidance, the Australian guidelines name sertraline as a first-choice medicine for GAD, with venlafaxine or duloxetine as alternatives ^[1]. In practice, the "best" one is the one that works for you with side effects you can live with.

How they're started

Doctors usually start low, often around half the starting dose used for depression, then increase slowly as tolerated ^[1]. This lowers the chance and severity of early side effects ^[1].

You take them every day, not just when you feel anxious. It can take up to 6 weeks to notice a benefit and up to 12 weeks for the full effect ^[1]. Our guide on how long antidepressants take to work covers the timeline in more detail.

PBS subsidy

PBS subsidy depends on both the medicine and the condition. For example, escitalopram is PBS-listed for moderate to severe GAD and social anxiety disorder ^[6]. Ask your GP or pharmacist whether a particular medicine is subsidised for your situation.

Common side effects

Common antidepressant side effects include headaches, dizziness, nausea, weight gain, restlessness or anxiety, sleep changes and sexual problems such as low sex drive ^[4]. Some of these settle as your body gets used to the medicine ^[4].

A few things are worth knowing before you start:

• Feeling worse early on. Some people, especially young people, have suicidal thoughts when starting an antidepressant. Tell your GP straight away if this happens ^[4].
• Serotonin toxicity. This is rare but serious. Symptoms include tremor, confusion, sweating, fever and diarrhoea, and the risk is higher when antidepressants are combined with certain other medicines or drugs ^[4].
• Interactions. Fluoxetine and paroxetine can raise levels of some other medicines, and some combinations of antidepressants must be avoided ^[1]. Tell your GP about everything you take, including supplements.

What other anxiety medicines might a GP discuss?

Pregabalin

Pregabalin has beaten placebo in GAD trials, with a modest overall effect size of about 0.35 ^[1]. Dropout rates are high because of drowsiness, dizziness, headache and dry mouth ^[1]. It isn't registered in Australia for GAD, so using it for anxiety is off-label ^[1].

Pregabalin carries a boxed warning about misuse, abuse and dependence ^[7]. Combining it with opioids, benzodiazepines or alcohol is particularly risky ^[7].

Pregabalin can cause dizziness and drowsiness, so be careful driving or using machinery until you know how it affects you ^[16]. It shouldn't be stopped suddenly. If it's no longer needed, your doctor will reduce the dose gradually ^[16].

Agomelatine

Agomelatine is a melatonin-acting antidepressant. In Australia it's indicated for major depression and GAD in adults, but it isn't PBS-listed ^[8]. It needs liver blood tests before you start and at intervals during treatment, and people who drink heavily shouldn't take it ^[9].

Buspirone and quetiapine

Buspirone has beaten placebo in GAD trials but has shown limited effectiveness in real-world practice, so guidelines reserve it for people who haven't responded to first-line medicines ^[1]. Quetiapine, an antipsychotic, showed a large effect in GAD trials but is poorly tolerated, with risks including weight gain and sedation, and the Australian guidelines don't recommend it for GAD ^[1][5].

Beta blockers for performance anxiety

Beta blockers such as propranolol reduce shaking and a racing heart. They don't treat the anxiety itself, and in social anxiety disorder they haven't worked better than placebo ^[1]. The guidelines say not to use them for social anxiety disorder, GAD or panic disorder ^[1].

If your anxiety only shows up in specific situations, like giving a talk, discuss it with your GP. Propranolol isn't suitable for everyone, including people with asthma or certain heart conditions ^[10].

Benzodiazepines: why they're short-term only

Benzodiazepines include diazepam, oxazepam, alprazolam, clonazepam and lorazepam ^[1]. They reduce anxiety quickly, which is why people often ask about them.

The trade-off is significant. Guidelines list cognitive impairment, falls, sedation, tolerance, dependence and potential for misuse, and advise avoiding them in people with a history of substance use problems ^[1]. They aren't recommended as first-line treatment, and for GAD and social anxiety they should be limited to short-term regular use ^[1].

RACGP guidance notes that guidelines and formularies typically give durations of 1 to 4 weeks, that dependence is a recognised risk with treatment longer than a month, and that doctors should assume every patient is at risk ^[11]. Some people notice tolerance after only a few days ^[12].

Safety rules that matter

• Don't stop suddenly after regular use. Benzodiazepines should be reduced slowly under medical supervision, because abrupt withdrawal can cause serious symptoms including seizures ^[12].
• Don't mix with alcohol or other drugs. Combining them can lead to overdose ^[12].
• Take care with driving. Benzodiazepines can impair driving ^[1], so don't drive until you know how they affect you.
• Expect closer monitoring. Alprazolam has been a Schedule 8 controlled drug since February 2014, and since February 2017 PBS packs have been limited to 10 tablets with no repeats ^[13].

Real-time prescription monitoring

Every state and territory runs a real-time prescription monitoring system that shows prescribers and pharmacists your history of monitored medicines, including benzodiazepines and other sedatives ^[14]. Each jurisdiction sets its own list ^[14]. In Queensland, for example, QScript covers benzodiazepines, pregabalin, gabapentin, zolpidem and quetiapine, and prescribers are generally required to check it before prescribing these medicines ^[15].

It's a decision-support tool that gives your GP a fuller picture of what's been prescribed and dispensed ^[14]. If you're also struggling with sleep, our guide to sleeping tablets in Australia covers similar issues.

Is therapy better than medication for anxiety?

Neither is automatically better. Australian guidelines treat CBT (face-to-face or digital), an SSRI or SNRI, or a combination as valid starting points, chosen according to severity, your preference, access and cost ^[1].

The evidence for routinely combining CBT and medication is limited and mixed ^[1]. If one isn't helping enough, adding the other is a common next step ^[1]. For mild to moderate anxiety, online therapy programs can work as well as face-to-face services ^[2].

If cost is a barrier to therapy, see our guide to Medicare psychology rebates.

How does a GP decide which anxiety medication is right for you?

Treatment usually starts with information about anxiety and practical lifestyle advice, such as regular exercise, good sleep and cutting back on caffeine, tobacco and alcohol ^[1]. From there, your GP considers:

• the type and severity of your anxiety ^[1]
• your preferences, and how you've responded to treatment before ^[1]
• tolerability, safety, cost and access ^[1]
• other conditions that could be driving symptoms, including physical illness and substance use ^[1]

A consultation doesn't guarantee a prescription. Your GP decides what's clinically appropriate.

What if the first medicine doesn't work?

If you've had some response by 4 to 6 weeks, guidelines suggest staying the course ^[1]. If there's little change, your GP may add CBT or adjust the dose within the approved range ^[1].

If that still isn't enough, options include waiting up to 12 weeks for a delayed response, trying a different SSRI, switching to an SNRI, or, for GAD, changing to pregabalin or agomelatine ^[1].

How long do you need to take anxiety medication?

If medication works, Australian guidelines recommend continuing it for 12 months ^[1]. There's little research on the ideal length, and some people need longer ^[1].

When it's time to stop, your GP will usually reduce the dose gradually over weeks to months ^[1].

How do you stop anxiety medication safely?

Many people who stop some SSRIs and SNRIs, especially paroxetine and venlafaxine, get discontinuation symptoms ^[1]. These can include flu-like feelings, electric shock-like sensations, dizziness, poor sleep, vivid dreams, irritability, crying spells and sweating ^[1].

Your risk is higher with shorter-acting medicines, if you had strong side effects when you started, or if you've taken the medicine for more than 8 weeks ^[1]. Fluoxetine leaves the body slowly, so discontinuation symptoms are less likely ^[1].

Talk to your GP before reducing anything. If you get withdrawal symptoms while tapering, your GP may suggest a slower reduction ^[4].

When to talk to a GP about anxiety medication

See a GP if anxiety is affecting your work, sleep, relationships or ability to get through the day. If you're not sure how you're tracking, our free mental health check is a quick place to start, and you can read more about anxiety.

If you'd like to talk to a GP about how you've been feeling, you can request an appointment. Mental Health Clinic is for adults 18 and over and isn't an emergency service.

If you're in crisis or thinking about suicide, call Lifeline on 13 11 14 or 000 in an emergency.

This page is general information, not medical advice.