The medical literature suggests that antidepressants can be effective here, and there are always people with impressive stories about how much the medicine helped them. In my practice as a psychiatrist I see a different picture. More and more I ask myself whether antidepressants are a good choice for anxiety at all, given the many problems I observe in the people I see.

Effectiveness in the literature versus experience in practice

Officially it is recognised that antidepressants can play a part in the treatment of anxiety. They are supposed to reduce symptoms and so improve quality of life. But the medical research is limited. It looks at selected groups and follows people for a very short time. The way the research is set up works in favour of the medication under study.

Everyday practice shows a different picture. Many people run into serious problems when they start antidepressants. In the build-up phase in particular, strong symptoms often occur, such as nausea, restlessness and worse anxiety. This is because people with anxiety are often extremely sensitive to the physical side effects of antidepressants.

The vicious circle of starting and stopping symptoms

When antidepressants are built up, people are often prescribed a tranquilliser, such as lorazepam, to suppress the initial side effects. This leads to a complicated situation in which people struggle for a long time to get used to the medication, while the starting symptoms can make the anxiety worse.

Tapering off antidepressants is a source of great problems as well. People with anxiety seem to be sensitive to starting symptoms and to withdrawal symptoms alike. As a result they often get stuck in a pattern in which they keep switching medication, each time with new starting and stopping problems. This creates a circle of increasing anxiety and medication changes that is hard to break.

Alternatives to medication for anxiety

So the question is whether antidepressants are the right choice for anxiety. In many cases treatments without medication are more effective and more lasting. The guidelines support this. An important approach is exposure therapy, in which people are gradually exposed to the situations that call up the anxiety. This helps them to learn to face the anxiety and to reduce its power.

Lifestyle changes play a crucial part too. Meditation, enough sleep, healthy food and regular exercise can contribute a good deal to reducing anxiety. This approach takes a lot of motivation and effort, but can have lasting, positive effects without the side effects of medication.

Conclusion: be careful with antidepressants for anxiety

My experience in practice has made me doubt the routine use of antidepressants for anxiety. Yes, some people say the antidepressant was effective, but often the non-specific placebo effect of the medication lies underneath. Too often I see people get into trouble through the strong starting and stopping symptoms. Antidepressants can be useful in some cases, but it is essential to be very careful when starting this medication for anxiety. Other approaches, such as exposure therapy and lifestyle changes, are often more effective and safer.

I therefore always advise people to think carefully and to weigh different options before starting antidepressants for anxiety. It is important to choose a treatment plan that is effective, and also lasting and bearable for the person.

Jim van Os

Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare. 

Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.

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