Is there any anxiety medication that won't make me sleepy?

February 9, 2022 3:54 PM

You are not my doctor. I am not seeking medical advice. I am seeing a real doctor on Monday. I just want some information to temper my expectations. Is there an anxiety medication out there that won't make me sleepy?

About 10 years ago my anxiety became impossible to control and I started to take Zoloft. I tapered on very slowly but the side effects were still awful. The worst side effect was the drowsiness. I was completely incapacitated. I couldn't stay awake for more than 4 hours at a time. I work for school district and fortunately it was summer so I was able to take a ton of naps. I would not have been able to work, drive, or take care of my day-to-day business while I was acclimating to the medicine. Even after I had tapered up to a full dose the drowsiness remained to the point where I had to take the medication at night so I could sleep through the initial effects. I wound up tapering back off the medication when I got pregnant and never went back on.

Now it's 10 years later and my therapist and physician agree that it's probably time to start anxiety medication again. Please trust that I've tried every non-medication alternative. Is there any medication out there that doesn't make you incredibly drowsy? I had initially hoped that in the past decade some new medication had come out, but my initial Google search doesn't seem promising. Is there anything out there that does not have drowsiness as a side effect?

posted by christinetheslp to Health & Fitness (21 answers total)

I believe most of the likely drugs (I am not a doctor) can cause drowsiness in a certain percentage of cases. Buproprion is less likely to cause drowsiness, but it still does in some patients (circa 5%, iirc). Could be worth a try, if it's one of the options you're given? I found it much more tolerable than Paxil, Zoloft, or Effexor.
posted by aramaic at 4:17 PM on February 9, 2022 [1 favorite]

For me, quantity is key. 0.5 mg of Lorazepam helps tremendously without making me sleepy at all.

I have an ongoing joke with my psychiatrist that 0.5 mg is actually too small to do anything for me but the placebo effect is working out so well that I don’t want him to tell me about it.
posted by Tell Me No Lies at 4:19 PM on February 9, 2022 [4 favorites]

It's technically an antidepressant that happens to work really well for many people with anxiety, but after the first few weeks Lexapro (escitalopram) stopped making me briefly drowsy ~90 minutes after taking it and I went back to taking it in the morning because it was making my sleep thin and easily disturbed.

I'm actually now not certain if that drowsiness was just because I was in crisis at first, because I absolutely do not sense any dip any more.
posted by Lyn Never at 4:24 PM on February 9, 2022

Buspirone is from a different class of drug and is specifically anti-anxiety rather than anti-depressant. Another option.
posted by praemunire at 4:54 PM on February 9, 2022 [8 favorites]

Yes! Highly recommend buspirone. I’m on a low dose and it has been wonderful for me, no side effects once the dosage was correct.
posted by sevensnowflakes at 4:58 PM on February 9, 2022 [2 favorites]

Another vote for Buspirone. The first time I took it, I was kind of sleepy, but once I acclimated to it, the effect was entirely in the background.
posted by ivanthenotsoterrible at 5:17 PM on February 9, 2022 [1 favorite]

There has been a lot of progress on antianxiety meds, both dosages and combinations and types, in the past decade. Be extremely clear at your appointment what types of side effects are intolerable for you, and which ones you are willing to work with. There is something worth trying for nearly every type of anxious person.
posted by Mizu at 5:22 PM on February 9, 2022 [1 favorite]

Is your real doctor in general practice or a psychiatrist. There are so many options and each has their own profile and each will interact with your specific body in a different way. General practitioner usually know the most common options, a specialist will be more knowledgeable about the whole topic. You might need to try a few to find the right one. If your current doctor isn't that helpful, look for a specialist (in this case a psychiatrist)
posted by metahawk at 5:35 PM on February 9, 2022

In a study of one: I was very sleepy with Zoloft and Lexapro. In my case, one of the oldest antidepressant/anti-anxiety meds, Imipramine HCL works best: no sleepiness, no weight gain, and no libido suppression, like the newer meds did. It has one side effect, dry mouth, which in my case is a good effect because it dries up nearly all my seasonal allergies.

There is a daytime (cheap generic) and a nighttime (expensive) version. Imipramine HCL is the day version. When I first started taking it I also had a prescription for Xanax, but I found I didn't need it with Imipramine HCL.

Don't give up; it sometimes takes several tries to find just the right med for your particular needs.
posted by a humble nudibranch at 6:19 PM on February 9, 2022 [2 favorites]

I take propranolol, which is a beta-blocker, often used for high blood pressure. My psychiatrist has had me on it for years for anxiety and it works well for me. There is no sedative effect that I've noticed (although I'm always up for a nap!).
posted by furtheryet at 8:03 PM on February 9, 2022 [1 favorite]

I took Buspirone for almost a year, and it made me borderline narcoleptic. I guess you can’t be anxious when you fall asleep abruptly within 10 seconds or so and stay asleep for hours!

Cleared up immediately when I stopped taking it.
posted by verbminx at 8:28 PM on February 9, 2022

Effoxor and bupropion are ones that advertise not to cause drowsiness. Effexor in my opinion causes less jitters. Do not take bupropion after 5 pm it will keep you up at night
posted by The_imp_inimpossible at 9:39 PM on February 9, 2022

I take generic Abilify for anxiety. It's kind of an off-label RX but all the normal ones made me absolutely insane so a low dose of this med is helpful for me. I did experience drowsiness when I took it at first, so I had to take it at night -- it did not cause me to be drowsy beyond what I would consider normal sleep hours after taking it. Now I'm acclimated to the medicine and if I take it in the daytime, I have no side effects at all.
posted by Medieval Maven at 5:18 AM on February 10, 2022

I am someone who is very prone to experiencing the drowsiness side effects from medications. Except, apparently, with duloxetine (Cymbalta). I got my anxiety under control with it... and my only complaint is that because I take it at night, it actually keeps me up. YMMV obviously.
posted by daikaisho at 9:07 AM on February 10, 2022

Another vote for beta blockers! I take propranolol as needed for panic attacks and it works well with no noticeable side effects.
posted by kiripin at 2:17 PM on February 10, 2022

I want to second daikaisho -- Cymbalta / duloxetine doesn't make me drowsy, and I'm very prone to feeling drowsy if a med has that side effect. I'm prescribed duloxetine for a common off-label use for neuropathy pain but it also handles my anxiety great!
posted by Katravax at 4:19 PM on February 10, 2022

I take Wellbutrin and it manages my anxiety. It's kind of a weird thing because it's an antidepressant and is also known to amplify anxiety as a side effect but at the same time sometimes it is prescribed for anxiety. In my case it helps a lot. It does not tend to cause sleepiness (of course IANAD, IANYD, YMMV).
posted by virve at 9:56 PM on February 10, 2022

I'm on a low does of escitalopram and it doesn't make me sleepy. YMMV, of course.
posted by elizabot at 10:53 AM on February 11, 2022

Just to say I am also on a blood-pressure medication (metoprolol) for anxiety. I get drowsy with just about anything that can make you drowsy, but this has worked really well, and it also helps reduce my migraines.
posted by wellifyouinsist at 8:21 PM on February 11, 2022

I'm currently taking Wellbutrin and escitalopram together (but will likely drop the escitalopram eventually). I had been taking escitalopram by itself for a little bit too. None of that has ever made me drowsy at all.
posted by VTX at 8:35 PM on February 12, 2022 [1 favorite]

Came here to also suggest Buspirone. I took it for about a year and I felt that it more or less "excised" the anxiety for me. I didn't experience any sleepiness.
posted by absquatulate at 5:56 PM on June 15, 2022