Anxiousness impacts a whole bunch of hundreds of thousands of individuals yearly. What therapies can be found, and the way have they modified over time?
Anxiousness is the commonest psychological well being situation globally. It’s estimated that 4% to five% of individuals on the earth have an anxiousness dysfunction at any given time.
Lengthy-term surveys in america recommend that round one-third of individuals expertise an anxiousness dysfunction in some unspecified time in the future of their lives.1
Which means most of us will both wrestle with anxiousness ourselves or know somebody shut who has or will. That is additionally true for the 2 of us, and seeing how large an influence it may have on folks’s on a regular basis lives, we all know that having efficient therapies that alleviate or at the very least scale back signs may be life-changing.
On this article, we study the historical past of pharmacological therapies — particularly, medication — used to deal with anxiousness because the Nineteen Fifties. These have modified so much within the 5 a long time till the early 2000s, however there have been no new anxiousness drugs permitted since 2004.2
Whereas there was a slowdown within the variety of new medication permitted for anxiousness (which is the main target of this text), the utilization and variety of prescriptions for anti-anxiety drugs have seemingly continued to extend in latest a long time.
It may be laborious to get concrete and constant knowledge on this as a result of, as we’ll see, most of the most up-to-date medication are primarily antidepressants; so even when prescription figures can be found, it’s normally not clear whether or not they’re getting used to deal with melancholy or anxiousness. In some instances, it may be each. Even in simply the previous couple of years, there have been noticeable will increase within the proportion of American adults receiving psychological well being therapy, which incorporates taking drugs.
The world over, a variety of therapies are used to alleviate anxiousness. Constructing a constant timeline for all international locations can be tough, so right here we concentrate on the timeline of treatment approvals in america. No less than 22 medication have been formally permitted for anxiousness therapy there since 1955.
Within the chart under, we’ve created a timeline. Every dot represents a single drug, with its official identify and commerce identify (which you’ll have heard extra about) labeled. Tuna Acisu and Saloni Dattani produced this dataset primarily based on knowledge from the US Meals and Drug Administration (FDA).3
Most of us will both wrestle with anxiousness ourselves or have somebody near us who has or will.
The date allotted to every drug is when the FDA first permitted it. This implies the FDA discovered the molecule to be a secure and efficient therapy for a specific situation. A few of these medication had been first permitted explicitly for anxiousness, however others had been used for different circumstances and had been solely permitted for anxiousness later. For instance, “duloxetine” was permitted for the therapy of melancholy in 2004, which is the date proven on the timeline. It acquired licensed for anxiousness three years later.
Every drug is coloured based on its therapeutic class, decided by its energetic ingredient and mechanism of motion in treating anxiousness.
Notice that right here we solely concentrate on medication formally permitted for anxiousness therapy by the FDA. Which means “off-label” drugs — which suggests a physician decides {that a} specific drug might be helpful for a affected person, regardless of it not being formally permitted for anxiousness — usually are not included.
The timeline may be cut up into three large elements: tranquilizers within the Nineteen Fifties, the benzodiazepine period as much as the mid-Nineteen Eighties, and the period of antidepressants within the following twenty years.
Tranquilizers
The primary treatment on our timeline is meprobamate, generally referred to as Miltown. It’s a tranquilizer, which was the principle therapy for anxiousness within the Nineteen Fifties. Miltown has typically been framed as the primary “blockbuster” psychiatric drug in america, attributable to its recognition and the way it was promoted to “shoppers”.4
Miltown was marketed as a “minor tranquilizer”: it was stated to take the sting off anxiousness signs with out the complete results of sedation that earlier tranquilizers brought on. It labored by slowing exercise within the central nervous system, typically lowering the acute signs of tension.
Whereas it was safer than earlier medication, it nonetheless carried important dangers of overdose and habit and was later changed by safer therapies.
On this period, anxiousness was typically handled as a short-term nervous response. That’s why therapies like tranquillizers had been used: they focused the bodily signs of the nervous system reasonably than the underlying causes.
However as you’ll be able to see within the timeline, antidepressants, resembling monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) began getting used within the early Sixties. These can alter the affected person’s temper and have an effect on their anxiousness by altering mind chemistry. Their effectiveness recommended that anxiousness had a neurological foundation that might be modified in the long run by means of drugs, reasonably than relying solely on short-term therapies that focused nervous signs. This represented a transparent change within the total scientific understanding of tension issues.
The benzodiazepine revolution of the Sixties and ‘70s
The most important therapy revolution of the Sixties and ‘70s was within the growth of benzodiazepine anxiolytics.5 Within the timeline above, you’ll be able to see them within the purple field. These turned the go-to anxiousness therapy for many years. Valium and Xanax are two of essentially the most well-known medication on this class.
Benzodiazepines work by enhancing the impact of GABA, the mind’s most important calming neurotransmitter. By amplifying this neurotransmitter, these medication scale back mind exercise, producing leisure and reduction from anxiousness.
A vital function of benzodiazepines is that they’ll work in a short time, lowering signs inside hours and even minutes. That’s very completely different from many antidepressants, which might take weeks to have an impact.
Many research on benzodiazepines have discovered constructive ends in lowering signs in comparison with a placebo.6
Benzodiazepines are sometimes efficient in treating acute bodily signs resembling panic assaults, however don’t essentially present a long-term answer.
The primary considerations with these medication are tolerability, abuse, dependence, and withdrawal signs.7 Rising considerations about these issues led to them falling out of favour amongst many clinicians, particularly with the arrival of SSRI antidepressants.5 Their use for anxiousness has declined within the late twentieth century, although some argue that benzodiazepines may be simply as efficient and tolerable for many individuals because the medication that adopted.8
The usage of antidepressants because the Nineties
Within the late Nineteen Eighties, a brand new technology of tension therapies was born: selective serotonin reuptake inhibitors (SSRIs). You’ll be able to see them within the inexperienced field in our timeline.
SSRIs had been initially launched to deal with melancholy, however had been additionally efficient throughout a number of anxiousness issues. They work by blocking the reabsorption of serotonin — a “messenger” within the mind that performs a key function in temper regulation, anxiousness, and sleep — in order that extra of it stays accessible.
When somebody struggles with an anxiousness dysfunction, the amygdala within the mind (their “concern alarm system”) tends to be overactive, whereas their prefrontal cortex (which helps to control that concern) is underactive. When SSRIs enhance serotonin availability, they scale back the noise from the amygdala and strengthen the prefrontal cortex to control feelings of concern. That may scale back anxiousness signs and panic responses.
Many research present that SSRI antidepressants are efficient in treating anxiousness issues. A Cochrane Assessment, which included 37 research targeted on “generalized anxiousness dysfunction”, concluded that they “have excessive confidence that antidepressants are more practical than placebo at bettering therapy response”.9
Different massive meta-analyses have discovered related outcomes for the therapy of common anxiousness dysfunction.10
SSRIs have additionally been proven to assist with extra particular anxiousness issues, resembling social anxiousness, however with smaller advantages.11 A unique Cochrane Assessment discovered that they had been efficient in treating social anxiousness relative to a placebo, however this was primarily based on “very low‐ to average‐high quality proof.”12 This offers us decrease confidence than the Cochrane Assessment on treating generalized anxiousness dysfunction, which was primarily based on higher-quality proof. Nonetheless, it does recommend SSRIs seemingly have some constructive influence on social anxiousness, too.
One key cause why medical doctors are more likely to prescribe SSRIs over benzodiazepines is that they don’t have the identical potential for abuse and dependency. In contrast to earlier therapies, which frequently had a extra acute and instant impact, SSRIs are inclined to act extra slowly. It will probably often take a month or extra for folks to really feel the constructive impacts on their signs and temper. Nevertheless, they are usually extra sustainable, long-term options, that means folks can safely take them for longer, in comparison with earlier medication.
A few of the mostly prescribed drugs for anxiousness in the present day are SSRIs permitted within the Nineties. We each know a number of individuals who have taken sertraline (Zoloft) to handle their signs, for instance.
An identical drug sort, serotonin-norepinephrine reuptake inhibitors (SNRIs), additionally turned accessible within the Nineties and early 2000s. They block the reabsorption of serotonin, but in addition block one other neurotransmitter referred to as norepinephrine. This could enhance the affected person’s power ranges, motivation, and focus — key signs for somebody scuffling with anxiousness.
The final new anxiousness treatment that was permitted within the US was duloxetine, an SNRI. This was in 2004, greater than twenty years in the past.
The timeline we’ve simply walked by means of is particular to the US. However we’d discover related patterns for different international locations, such because the UK or others in Europe. There would, nonetheless, be some variations, particularly within the particular dates of approval. There are additionally some medication permitted in Europe — etifoxine is one instance — which aren’t permitted within the US, and vice versa. Citalopram is one other instance; it’s permitted for panic dysfunction therapy within the UK, however is solely used “off-label” for anxiousness issues within the US.
No new medication have been permitted for treating anxiousness in nearly twenty years. However these two silent a long time don’t imply there have been no developments within the therapy of tension.13
First, there have been incremental adjustments in formulations and dosage regimes for current drugs. For instance, the US FDA permitted a delayed-release type of duloxetine — the final drug on the timeline — and an extended-release model of lorazepam, which was first permitted in 1977. Europe supplies one other instance, the place the formulation Duloxetine Lilly was permitted in 2014. Nevertheless, these are variations of current medication reasonably than discoveries.
Whereas current therapies may be life-changing for some, we nonetheless have some solution to go to develop efficient therapies for everybody.
Second, some newer antidepressant medication are additionally prescribed “off-label” for anxiousness. This implies medical doctors resolve, primarily based on their judgment, {that a} specific drug might be helpful for a affected person with anxiousness, regardless of it not being formally permitted for that goal. There are a stunning variety of these; we discovered at the very least twelve when engaged on this timeline. It’s price noting that the dearth of approval for anxiousness particularly can have implications for his or her availability and affordability, as it may have an effect on insurance coverage protection.
Third, a number of promising new drug improvements are at numerous levels of growth and medical trials.14 A few of these goal the identical pathways as SSRIs and SNRIs, however in improved methods. Others take totally novel approaches. Not all of those will succeed and grow to be key therapies exterior of the lab, but it surely appears seemingly that at the very least some will.
Lastly, there have been developments in non-pharmaceutical therapies in latest a long time. This text focuses on medication, however there may be an rising variety of different approaches, together with cognitive behavioral remedy, non-invasive neurostimulation, and digital actuality publicity applied sciences.
Regardless of these, it’s laborious to dispute that progress in the previous couple of a long time has slowed relative to the earlier 50 years. Whereas current therapies may be very efficient for some folks — the truth is, life-changing for some — we nonetheless have some solution to go to develop efficient therapies for everybody who struggles with an anxiousness dysfunction, and guarantee these therapies can be found to them.
Acknowledgments
Many due to Saloni Dattani for serving to to organize the dataset on which this timeline depends. Thanks additionally to Max Roser and Edouard Mathieu for his or her suggestions and feedback on this text and its visualization.
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Hannah Ritchie and Tuna Acisu (2025) - “Anxiousness is likely one of the world’s commonest well being points. How have therapies advanced during the last 70 years?” Printed on-line at OurWorldinData.org. Retrieved from: 'https://ourworldindata.org/timeline-anxiety-medications' [Online Resource]BibTeX quotation
@article{owid-timeline-anxiety-medications,
writer = {Hannah Ritchie and Tuna Acisu},
title = {Anxiousness is likely one of the world’s commonest well being points. How have therapies advanced during the last 70 years?},
journal = {Our World in Information},
12 months = {2025},
be aware = {https://ourworldindata.org/timeline-anxiety-medications}
}
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