Safer Alternatives to Xanax: What You Need to Know

By Dr. Aneel Ursani, Medical Director — Next Step Psychiatry, Lilburn, GA

Xanax (alprazolam) is one of the most widely recognized anti-anxiety medications in the United States. It works fast, and for people in the grip of a panic attack, that speed can feel like a lifeline. But Xanax comes with significant risks—including physical dependence, sedation, and cognitive impairment—that make it a poor long-term solution for most anxiety patients.

At Next Step Psychiatry in Lilburn, Georgia, we prioritize effective treatments that are sustainable and safe for the long haul. Here's what you should know about alternatives to Xanax.

Why Xanax Is Risky for Long-Term Use

Xanax belongs to the benzodiazepine family, which works by enhancing the brain chemical GABA to slow down nervous system activity. While effective in the short term, benzodiazepines carry serious concerns:

• Dependence: Your brain adapts to the medication, requiring higher doses for the same effect.
• Withdrawal: Stopping abruptly can cause seizures, rebound anxiety, and other dangerous symptoms.
• Cognitive effects: Memory problems, drowsiness, and impaired coordination are common.
• Dangerous interactions: Combining benzodiazepines with opioids or alcohol can be fatal.

The FDA now requires a boxed warning on all benzodiazepines due to these risks.

Effective Alternatives to Xanax

SSRIs (Selective Serotonin Reuptake Inhibitors)

Medications like sertraline (Zoloft), escitalopram (Lexapro), and fluoxetine (Prozac) are first-line treatments for generalized anxiety disorder, panic disorder, and social anxiety. They take 4–6 weeks to reach full effectiveness, but they are not habit-forming and provide sustained relief.

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

Venlafaxine (Effexor) and duloxetine (Cymbalta) target both serotonin and norepinephrine, making them particularly useful for patients with both anxiety and depression or those who experience physical pain alongside anxiety.

Buspirone

Buspirone is an anti-anxiety medication that works differently from benzodiazepines. It's non-habit-forming and can be effective for generalized anxiety, though it also requires consistent daily use to work.

Hydroxyzine

This antihistamine has anxiety-reducing properties and can be used on an as-needed basis without the dependence risk of benzodiazepines. It's often used for situational anxiety or as a sleep aid.

Therapy (CBT)

Cognitive behavioral therapy is one of the most evidence-backed treatments for anxiety disorders. CBT teaches you to identify and challenge anxious thought patterns and develop practical coping strategies. For many patients, therapy combined with medication produces the best outcomes.

Spravato (Esketamine)

For patients with treatment-resistant depression that co-occurs with anxiety, Next Step Psychiatry offers Spravato—an FDA-approved nasal spray administered in our Lilburn office. While not a direct Xanax replacement, it represents an innovative option when standard treatments haven't been enough.

Finding the Right Treatment for You

The best anxiety medication is the one that works for your specific symptoms, medical history, and lifestyle. There is no universal answer—which is exactly why working with a psychiatric provider matters. At Next Step Psychiatry, Dr. Aneel Ursani and Fathima Chowdhury, PA-C, take the time to understand your complete picture before recommending a treatment plan.

Disclaimer: This article is for informational purposes only and does not replace professional medical advice. Never stop or change medications without consulting your provider.