People often arrive at this question with a firm instinct one way or the other. Some want to avoid medication. Others want relief soon and are unsure what talking would add. The research does not settle it for you, but it does narrow the choices.
This article reports what official sources say. It is not advice to start, stop, skip or change any medication. Those decisions are made with the clinician who prescribes it.
Is therapy or medication better for anxiety?
The guidance reviewed for this guide does not name a winner. For generalized anxiety disorder, NICE, the United Kingdom's guideline body, tells clinicians to offer either a psychological treatment or a medication and to base the choice on the person's preference, because there is no evidence that either is better. That is UK guidance, not a U.S. rule, but it is a careful summary of the evidence.
For moderate to severe panic disorder, NICE suggests considering referral for CBT, or an antidepressant if the disorder is long-standing or the person has not benefited from or has declined psychological treatment. What the therapies are, and how their evidence compares, is covered in types of anxiety therapy and what the research says.
Which medications are prescribed for anxiety?
The National Institute of Mental Health (NIMH) describes four groups. No doses are given here, and which one suits a person is a prescriber's judgment.
- SSRIs and SNRIs. These are antidepressants that are also used for anxiety. NIMH says that for panic disorder or social anxiety disorder, providers typically start with SSRIs or other antidepressants because they have fewer side effects than other medications. Among medications for generalized anxiety disorder, NICE also puts an SSRI first.
- Benzodiazepines. NIMH says these are used for some short-term anxiety symptoms and are sometimes used for generalized anxiety disorder. It says providers usually prescribe them for short periods and taper them slowly, because taking them over long periods may lead to tolerance or even dependence.
- Beta-blockers. NIMH says providers may prescribe these off-label for short-term anxiety symptoms, even though they are not approved for that purpose.
- Buspirone. NIMH says it must be taken every day for 3 to 4 weeks to reach its full effect and is not effective on an as-needed basis.
The sources do not fully agree on benzodiazepines. NIMH, a U.S. agency, describes them as usually prescribed for short periods. NICE, in its UK guidance, is stricter. It says not to offer them for generalized anxiety disorder except as a short-term measure during crises and, in a recommendation dated 2004, that they should not be prescribed for panic disorder. A prescriber weighs this for the individual.
How long does medication take to work?
Antidepressants are not quick. NIMH says they usually take 4 to 8 weeks to work, and that sleep, appetite, energy and concentration often improve before mood lifts.
Stopping is also a decision for the prescriber. In NIMH's words: "People should not stop taking a prescribed medication, even if they are feeling better, without the help of a health care provider. A provider can adjust the treatment plan to slowly and safely decrease the medication dose."
What are the FDA boxed warnings?
A boxed warning is what the U.S. Food and Drug Administration (FDA) calls its most prominent warning. Two apply to medications used for anxiety.
Benzodiazepines. In 2020 the FDA required the boxed warning to be updated for all benzodiazepine medicines to address "the serious risks of abuse, addiction, physical dependence, and withdrawal reactions." The FDA states that "even when taken at recommended dosages, their use can lead to misuse, abuse, and addiction. Abuse and misuse can result in overdose or death, especially when benzodiazepines are combined with other medicines, such as opioid pain relievers, alcohol, or illicit drugs. Physical dependence can occur when benzodiazepines are taken steadily for several days to weeks, even as prescribed. Stopping them abruptly or reducing the dosage too quickly can result in withdrawal reactions, including seizures, which can be life-threatening." The FDA tells patients not to stop suddenly without first discussing with their health care professional a plan for slowly decreasing the dose and frequency.
Antidepressants. The boxed warning on a current SSRI label begins: "Antidepressants increased the risk of suicidal thoughts and behavior in pediatric and young adult patients in short-term studies." It tells prescribers to monitor all antidepressant-treated patients closely for clinical worsening and for the emergence of suicidal thoughts and behaviors. The label's Medication Guide says antidepressants may increase suicidal thoughts or actions in some people 24 years of age and younger, especially within the first few months of treatment or when the dose is changed. The label reports that no suicides occurred in any of the pediatric studies.
If you are taking an antidepressant and notice thoughts of suicide, tell your prescriber. You can also call or text 988 at any hour, or call 911 in an emergency.
Does combining therapy and medication work better?
For panic disorder, the evidence favors it. A 2007 Cochrane review of 21 trials with 1,709 patients, most of them testing behavioral or cognitive behavioral therapy, found that during treatment the combination did better than an antidepressant alone and better than psychotherapy alone. It also produced more dropouts due to side effects than psychotherapy alone. After treatment ended, the combination still did better than medication alone and was as effective as psychotherapy alone. The reviewers concluded that either combined treatment or psychotherapy alone may be chosen first, depending on the person's preference. The review's searches ran only to 2005.
A 2014 meta-analysis of 52 trials with 3,623 patients compared an antidepressant alone with an antidepressant plus psychotherapy. Thirty-two trials concerned depressive disorders and 21 concerned anxiety and related disorders, with one counted in both. Of the 21, 10 were on panic disorder, 4 on obsessive-compulsive disorder, 4 on social anxiety disorder, 2 on PTSD and 1 on generalized anxiety disorder. Combined treatment did better overall. The authors found sufficient evidence of this for major depression, panic disorder and obsessive-compulsive disorder. The study tested adding therapy to medication, not the reverse.
So combination is not always the answer. For generalized anxiety disorder that has not responded to earlier steps of treatment, NICE tells clinicians to be aware that evidence for the effectiveness of combination treatments is lacking.
Who can prescribe in Massachusetts?
In Massachusetts, physicians and psychiatric nurse practitioners prescribe. Physicians include psychiatrists, who are medical doctors, and primary care doctors. Psychologists provide assessment and psychotherapy and do not prescribe. State law defines the practitioners who may dispense controlled substances, a term the law uses to include prescribing. Psychologists are not on that list.
The differences between these professionals, and where to start, are set out in psychologist, psychiatrist or counselor: who to see for anxiety.
How does this work with Dr. Rabin?
Dr. Rabin is a licensed clinical psychologist. She does not prescribe, and she can coordinate with a prescriber if medication is part of your care. Her anxiety therapy is psychodynamic, attachment-based, trauma-informed and mindfulness-based, and she also offers CBT.
You do not need to have decided about medication before you talk with a therapist. If you are weighing the question, you can raise it on a free consultation of about 15 minutes, requested through the contact page. Practical questions about fees are answered on the fees and insurance page.
Keep reading
Sources
- NICE, Generalised anxiety disorder and panic disorder in adults: management, CG113, Recommendations (2011, updated 2020)
- National Institute of Mental Health, Mental Health Medications (2023)
- U.S. Food and Drug Administration, FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class (2020)
- DailyMed, ZOLOFT (sertraline hydrochloride) prescribing information and Medication Guide (2025)
- Furukawa, Watanabe and Churchill, Combined psychotherapy plus antidepressants for panic disorder with or without agoraphobia (2007)
- Cuijpers et al., Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis (2014)
- Massachusetts General Laws, chapter 94C, section 1
- American Psychiatric Association, What is Psychiatry? (2026)
Last reviewed October 2026. This guide is general information, not medical advice or a diagnosis. If you are in crisis, call or text 988, or call 911 in an emergency.
