Anxiety disorders are among the most common health conditions in Canada, and they are among the most treatable. The two treatments with the strongest evidence are cognitive behavioural therapy (CBT) and SSRI or SNRI medications; both are first-line in Canadian guidelines, and either works for many people. A large 2022 trial found an 8-week mindfulness program worked as well as escitalopram for anxiety disorders.
Benzodiazepines work fast but carry dependence risk, so they are second-line. Exercise has real anti-anxiety effects. Most supplements have weak evidence. Selank, a peptide approved as an anti-anxiety drug in Russia, has limited and mostly Russian human data and is not approved in Canada. Below is everything, with costs and free options in Canada.
If you are thinking about suicide or harming yourself, call or text 9-8-8, the Suicide Crisis Helpline, available 24/7 across Canada, or go to the nearest emergency department. If you are in immediate danger, call 911.
Normal anxiety vs an anxiety disorder
Anxiety is a normal, useful alarm system. It becomes a disorder when it is out of proportion to the situation, persistent, hard to control, and interferes with life: work, relationships, sleep or doing things you value. Avoidance is a key sign: turning down opportunities, skipping places or conversations to keep anxiety down.
In Statistics Canada’s 2022 Mental Health and Access to Care Survey, about 5% of Canadians aged 15 and older met criteria for generalized anxiety disorder in the past year, roughly double the rate a decade earlier (Statistics Canada, 2023).
Types of anxiety disorders
| Type | Core feature |
|---|---|
| Generalized anxiety disorder (GAD) | Persistent, hard-to-control worry about many things, with tension, fatigue and poor sleep |
| Panic disorder | Recurrent sudden panic attacks and fear of the next one |
| Social anxiety disorder | Intense fear of judgment in social or performance situations |
| Specific phobias | Fear of specific things (flying, needles, heights) |
| Agoraphobia | Fear of places where escape feels hard, often linked to panic |
Obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are related but treated with specific approaches. Anxiety and depression very often occur together.
Physical causes to rule out
- Overactive thyroid
- Caffeine and energy drinks, including high-dose pre-workouts
- Alcohol withdrawal and “hangxiety”
- Cannabis, especially high-THC products
- Medications: decongestants, steroids, some asthma and ADHD medications
- Heart rhythm problems, low blood sugar, and in rare cases adrenal tumours
- Perimenopause (see menopause treatment)
- Sleep deprivation and sleep apnea
The treatment scorecard
| Treatment | Evidence | Speed | Lasting after stopping? |
|---|---|---|---|
| CBT | Very strong | Weeks | Yes |
| Mindfulness (MBSR) | Strong | Weeks | Often |
| SSRIs / SNRIs | Very strong | 4–6 weeks | Relapse risk if stopped early |
| Pregabalin (GAD) | Strong | Days to weeks | No |
| Benzodiazepines | Strong (short-term) | Minutes | No; dependence risk |
| Exercise | Moderate-strong | Immediate and cumulative | While maintained |
| Supplements | Mostly weak | Varies | — |
| Selank | Limited, mostly Russian | Unknown | Unknown; not approved in Canada |
CBT: the first-line therapy
Cognitive behavioural therapy is a structured, skills-based therapy, typically 8 to 20 sessions. Canadian clinical practice guidelines recommend it as a first-line treatment for all major anxiety disorders (Katzman et al., 2014). Its core tools:
- Exposure: gradually and deliberately facing feared situations, which teaches the brain the danger is lower than predicted. This is the most powerful ingredient for panic, phobias and social anxiety.
- Cognitive restructuring: catching catastrophic predictions and testing them against evidence.
- Worry management for GAD: scheduled worry time, tolerating uncertainty.
- Dropping safety behaviours that maintain anxiety.
CBT also works well in group, online and self-guided formats, which matters for access in Canada.
Mindfulness: as good as a pill in one big trial
In a randomized trial of adults with anxiety disorders, an 8-week Mindfulness-Based Stress Reduction (MBSR) course was non-inferior to escitalopram, a first-line SSRI, in reducing anxiety severity (Hoge et al., 2023). Side effects were far fewer in the mindfulness group. That makes structured mindfulness a credible option, not just a wellness extra, though it requires practice and attendance.
SSRIs and SNRIs
Selective serotonin reuptake inhibitors (SSRIs, such as escitalopram and sertraline) and serotonin-norepinephrine reuptake inhibitors (SNRIs, such as venlafaxine and duloxetine) are first-line medications for anxiety disorders in Canadian guidelines.
- Timing: benefits build over 4 to 6 weeks, sometimes longer. Many people quit too early.
- Early side effects: nausea, sleep changes and a temporary increase in jitteriness are common in the first weeks; prescribers often start low and go slow.
- Ongoing side effects: sexual side effects, emotional blunting and weight changes for some.
- Duration: guidelines typically suggest continuing for 12 months or more after improvement, then tapering slowly with a prescriber to avoid discontinuation symptoms and relapse.
- Cost: most are inexpensive generics and widely covered.
Both are first-line. Therapy has more lasting effects after stopping; medication requires less time commitment and may be easier to access quickly. Combining them is common for moderate to severe anxiety.
Pregabalin, buspirone, hydroxyzine and others
- Pregabalin is a first-line option for GAD in Canadian guidelines and works faster than SSRIs. Drowsiness, dizziness and misuse potential are concerns.
- Buspirone is a non-sedating option for GAD with modest effect.
- Hydroxyzine, an antihistamine, is used for short-term relief without dependence, but causes drowsiness.
- Other antidepressants such as mirtazapine are used in specific situations.
- Atypical antipsychotics like quetiapine have some evidence in GAD but significant side effects; they are not first-line.
Benzodiazepines: fast, but with a catch
Lorazepam, clonazepam, alprazolam and similar drugs relieve anxiety within minutes by boosting GABA, the brain’s main calming signal. That speed is their appeal and their problem:
- Tolerance and dependence develop with regular use; stopping suddenly after long use can cause dangerous withdrawal.
- They can maintain anxiety by acting as a safety behaviour that prevents learning.
- Sedation, memory problems and falls, particularly in older adults.
- Dangerous with alcohol and opioids.
Canadian guidelines place them second-line, typically for short-term or occasional use while first-line treatment takes effect.
Propranolol for performance anxiety
Propranolol, a beta-blocker, blocks the physical symptoms of adrenaline: racing heart, trembling hands, shaky voice. Taken before a specific event like a presentation, it helps many people with performance anxiety. It does not treat the worry itself, and it is not suitable for people with asthma or certain heart conditions. Prescription required.
Exercise, sleep, caffeine and alcohol
- Exercise: meta-analyses show regular exercise reduces anxiety symptoms, and a single session lowers anxiety for hours. Both aerobic and resistance training help.
- Sleep: poor sleep amplifies anxiety, and anxiety disrupts sleep. Treating insomnia directly helps (see insomnia treatment in Canada).
- Caffeine: in sensitive people, high caffeine intake can trigger panic-like symptoms. Try cutting back gradually.
- Alcohol: calms anxiety short-term but worsens it the next day and over time.
- Breathing: slow breathing with a longer exhale activates the calming parasympathetic system.
Natural remedies and supplements
| Product | Evidence | Notes |
|---|---|---|
| Lavender oil capsules (silexan) | Moderate in some trials | Burping, GI upset |
| Chamomile | Small studies | Low risk |
| L-theanine | Small studies | Mild calming |
| Ashwagandha | Small, mixed studies | Rare liver injury reports; thyroid effects |
| Magnesium | Weak | May help if deficient |
| Kava | Some efficacy | Liver toxicity concerns |
| St John’s wort | Mainly for depression | Many drug interactions |
Natural health products in Canada are licensed but not held to the same evidence standard as drugs. Tell your pharmacist what you take, especially if you’re on prescription medication.
Cannabis and CBD
Many Canadians use cannabis for anxiety. The evidence is weak, and THC can trigger or worsen anxiety and panic, particularly at higher doses or with frequent use. CBD has some early research for anxiety, but good-quality trials are limited and product quality varies. Regular cannabis use also complicates sleep and motivation.
Selank: what the peptide research shows
Selank is a seven-amino-acid synthetic peptide modelled on tuftsin, a naturally occurring immune peptide. It was developed at the Institute of Molecular Genetics of the Russian Academy of Sciences and is approved in Russia as an anti-anxiety medication.
- Mechanism: research suggests it modulates GABA signalling, slows the breakdown of enkephalins (natural calming opioid peptides), and influences genes involved in inflammation and neurotransmission.
- Claimed advantages: described in Russian literature as calming without the sedation, memory impairment or dependence associated with benzodiazepines.
- Evidence limits: human studies are small, mostly published in Russian journals, and have not been replicated in Western randomized controlled trials. Selank is not approved by Health Canada, the FDA or the European Medicines Agency.
Its cousin Semax, an ACTH-derived peptide, is studied more for cognition. We compare them in Selank vs Semax and cover common pitfalls in Selank research mistakes.
If you have an anxiety disorder, CBT, mindfulness and first-line medications have far stronger evidence than any research peptide, and they are accessible in Canada. Selank is a research compound here, not a treatment.
| Research compound | Origin | From |
|---|---|---|
| Selank | Tuftsin analog | $40 |
| Semax | ACTH(4–10) analog | $41 |
| DSIP | Sleep-related peptide | $35 |
Sold for laboratory research use only, with lab reports in our COA library.
Getting help in Canada, including free options
| Option | Cost | Notes |
|---|---|---|
| Family doctor / nurse practitioner | Covered | Diagnosis, medication, referrals |
| Psychiatrist | Covered with referral | Waits can be long; often consult-only |
| Psychologist / registered psychotherapist | Private; commonly $150–$250+ per session | Often partly covered by extended health benefits |
| Publicly funded CBT programs | Free | For example, Ontario Structured Psychotherapy; other provinces have similar programs |
| Community mental health / CMHA | Free or low cost | Groups, counselling, navigation |
| Employee assistance programs | Free through many employers | Short-term counselling |
| Digital CBT programs and apps | Free to low cost | Good for mild to moderate anxiety |
| University and college counselling | Free for students |
Ask your doctor or local Canadian Mental Health Association branch what publicly funded programs exist in your province. Many people don’t realize free structured CBT is available.
What to do during a panic attack
- Name it: “This is a panic attack. It’s uncomfortable but not dangerous, and it will pass.” Most peak within about 10 minutes.
- Slow your breathing: in for 4, out for 6 to 8.
- Ground yourself: name things you can see, hear and touch.
- Don’t flee if you can help it: staying teaches your brain the situation is safe.
- Get checked if it’s your first episode or chest pain is unusual: panic can mimic heart problems, and the reverse is also true.
Why anxiety feels so physical
Many people are surprised that anxiety shows up in the body before the mind. That is because anxiety runs on the fight-or-flight system. When the brain’s threat detector (the amygdala) fires, the sympathetic nervous system and stress hormones like adrenaline and cortisol prepare the body for action:
| Symptom | What the body is doing |
|---|---|
| Racing or pounding heart | Pumping more blood to muscles |
| Shortness of breath, tight chest | Faster breathing to take in oxygen; often over-breathing |
| Tingling hands, dizziness | Over-breathing lowers carbon dioxide, changing blood chemistry |
| Nausea, butterflies, diarrhea | Digestion is diverted; the gut is highly sensitive to stress signals |
| Shaking, muscle tension | Muscles primed to move |
| Sweating, hot flushes | Cooling a body that expects exertion |
| Feeling unreal or detached | A protective dampening response during intense arousal |
None of these is dangerous in itself, but they feel alarming, and the alarm creates more fear: the classic panic loop. Understanding the mechanism is part of CBT for panic, and it is often a turning point. The body is doing exactly what it is designed to do, just at the wrong time.
The gut deserves special mention. The gut and brain are linked through the vagus nerve and shared signalling molecules, which is why anxiety and digestive problems like IBS travel together so often. Treating one frequently helps the other; see our guide to IBS treatment.
Health anxiety
Health anxiety (formerly hypochondria) is persistent worry about having or developing a serious illness, despite reassurance. It often involves body checking, repeated searching of symptoms online, and seeking repeated tests or, at the other extreme, avoiding doctors entirely.
Two points make it worth understanding:
- Reassurance doesn’t last. Each normal test brings brief relief, then doubt returns, often with a new symptom. Reassurance-seeking is a safety behaviour that keeps the cycle going.
- It responds well to CBT, which focuses on gradually reducing checking and searching, tolerating uncertainty, and testing feared predictions.
A practical step: set a rule of discussing new symptoms with your clinician at scheduled visits rather than searching online in the moment, unless a symptom is clearly urgent.
Anxiety in teens, pregnancy and older adults
Teens and young adults
Anxiety disorders often begin in childhood or adolescence, and rates among young Canadians have risen over the past decade. CBT is first-line, and family involvement helps. For moderate to severe anxiety in youth, SSRIs are also used, with closer monitoring because of a small increased risk of suicidal thoughts early in treatment, which is why prescribers check in frequently at the start. Post-secondary students can access free campus counselling, and many provinces fund youth mental health hubs.
Pregnancy and postpartum
Perinatal anxiety is at least as common as perinatal depression and is often missed. Untreated anxiety during pregnancy is not harmless, so treatment decisions weigh the risks of medication against the risks of untreated illness. CBT is first-line, and some SSRIs are commonly used in pregnancy and breastfeeding after discussion with a clinician. Intrusive, frightening thoughts about the baby are a recognized feature of postpartum anxiety and OCD and are very treatable.
Older adults
Anxiety in later life is frequently mistaken for normal worry or for physical illness. Benzodiazepines are particularly risky in older adults because of falls, fractures and confusion, and Canadian deprescribing initiatives encourage alternatives. CBT works well at any age, and SSRIs are generally preferred over sedatives.
How to choose a therapist in Canada
Several professions provide psychotherapy in Canada, regulated differently by province:
| Professional | Training | Notes |
|---|---|---|
| Psychologist | Doctoral or master’s level, regulated | Can diagnose; usually highest fees |
| Registered psychotherapist (RP) | Master’s level, regulated in some provinces such as Ontario | Often lower fees |
| Registered social worker (RSW/MSW) | Master’s level, regulated | Widely covered by extended benefits |
| Canadian certified counsellor (CCC) | Certified by a national association | Coverage varies by insurer |
| Psychiatrist | Medical doctor | Covered by provincial plans; often focuses on diagnosis and medication |
What to look for:
- Specific training in CBT or exposure therapy for anxiety; ask directly.
- A clear plan: goals, a rough number of sessions, homework between sessions.
- Check your benefits: many plans cover only certain designations, so confirm before booking.
- Fit matters: it’s fine to switch after a few sessions if it isn’t working.
- Sliding-scale fees are offered by many private therapists and training clinics at universities.
Anxiety at work
Work is both a common trigger and, often, part of recovery. Things worth knowing in Canada:
- Employee assistance programs provide confidential short-term counselling at no cost through many employers.
- Accommodation: under human rights law, employers have a duty to accommodate disability, including mental health conditions, to the point of undue hardship. Examples include adjusted schedules, a quieter workspace or a gradual return.
- Sick leave: if you need time off, Employment Insurance sickness benefits can provide up to 26 weeks of income support for eligible workers, and many employers offer short-term disability.
- Gradual return usually works better than a sudden full return after leave.
Coming off medication safely
When anxiety has been well controlled for a sustained period, often a year or more, many people want to stop medication. Doing it well matters:
- Never stop abruptly, especially benzodiazepines, which can cause dangerous withdrawal, and SSRIs or SNRIs, which can cause discontinuation symptoms such as dizziness, irritability, flu-like feelings and “brain zaps.”
- Taper gradually with your prescriber, sometimes over months, with slower steps at lower doses.
- Time it well: avoid tapering during a major life stressor.
- Have CBT skills in place: people who have done CBT have lower relapse rates after stopping medication.
- Know the difference between withdrawal symptoms (often within days, physical) and relapse (gradual return of the original anxiety).
A 4-week self-help starter plan
For mild anxiety, or while waiting for treatment, this structure draws on CBT principles:
| Week | Focus | Daily practice |
|---|---|---|
| 1 | Notice and track | Log anxiety triggers, thoughts and what you did; 10 minutes of slow breathing |
| 2 | Body and routine | 30 minutes of movement; fixed wake time; reduce caffeine after noon |
| 3 | Thoughts | Write down one worry a day and the evidence for and against it; schedule a 15-minute “worry window” |
| 4 | Face it | Build a ladder of avoided situations from easiest to hardest and take the first steps |
If anxiety is severe, getting worse, or affecting your ability to function, don’t wait: talk to a clinician.
First-line medications compared
Canadian guidelines list several first-line medications for anxiety disorders. They are broadly similar in effectiveness; the choice depends on side effects, other conditions, interactions, past response and cost.
| Medication | Class | Notes |
|---|---|---|
| Escitalopram | SSRI | Often well tolerated; few interactions |
| Sertraline | SSRI | Widely used; common in pregnancy and with heart conditions |
| Paroxetine | SSRI | Effective but more weight gain, sedation and discontinuation symptoms; interacts with tamoxifen |
| Fluoxetine | SSRI | Long half-life, so missed doses and stopping are gentler; can be activating early |
| Venlafaxine XR | SNRI | Effective for GAD, panic and social anxiety; can raise blood pressure; marked discontinuation symptoms |
| Duloxetine | SNRI | Useful when chronic pain coexists |
| Pregabalin | Gabapentinoid | First-line for GAD; faster onset; dizziness, drowsiness, misuse potential |
A few practical points: if the first medication doesn’t work after an adequate dose and duration, switching within or between classes helps many people. Genetic testing to choose antidepressants is marketed in Canada, but evidence that it improves outcomes for anxiety is limited. And combining medication with CBT generally works better than either alone for moderate to severe anxiety.
Panic disorder and social anxiety: specific approaches
Panic disorder
Panic disorder is driven by fear of the physical sensations of anxiety. CBT for panic has a few distinctive elements:
- Interoceptive exposure: deliberately bringing on harmless sensations (spinning to cause dizziness, running on the spot to raise heart rate, breathing through a straw) so the brain learns they aren’t dangerous.
- Dropping safety behaviours such as carrying water, sitting near exits or always having a companion.
- Gradual return to avoided places, especially in agoraphobia.
SSRIs and SNRIs are effective medications for panic. Benzodiazepines can stop an attack but tend to maintain the disorder if used as a crutch.
Social anxiety disorder
Social anxiety involves an intense fear of being judged or embarrassed. Effective approaches include:
- CBT with exposure to feared social situations, often in groups, which provide built-in practice.
- Shifting attention outward: people with social anxiety focus inward on how they appear, which worsens performance and anxiety. Practising attention to the other person helps.
- Video feedback: watching a recording often shows that you looked far less anxious than you felt.
- SSRIs or SNRIs for more severe or generalized social anxiety; propranolol for purely performance-based anxiety.
Common treatment mistakes
- Stopping an SSRI after two weeks because it isn’t working yet or side effects appeared. Most benefits come after 4 to 6 weeks, and early side effects often fade.
- Relying on benzodiazepines long-term without a first-line treatment in place.
- Avoiding everything that causes anxiety, which shrinks life and strengthens the fear.
- Reassurance-seeking, from people or the internet, which brings short relief and long-term persistence.
- Using alcohol or cannabis to cope, which worsens anxiety over time.
- Choosing therapy that isn’t evidence-based for anxiety; supportive talk alone helps less than CBT with exposure.
- Stopping treatment as soon as you feel better, which raises relapse risk.
- Ignoring sleep, caffeine and physical activity, which can undo progress.
FAQ
Tap a question to reveal the answer.
What is the best treatment for anxiety?
Cognitive behavioural therapy and SSRI or SNRI medications are both first-line in Canadian guidelines. Mindfulness-based stress reduction performed as well as escitalopram in a large trial.
How long do anxiety medications take to work?
SSRIs and SNRIs usually take 4 to 6 weeks to show clear benefit. Benzodiazepines work within minutes but are recommended only short-term.
Can anxiety be treated without medication?
Yes. CBT, mindfulness programs and regular exercise are effective, and many people recover with therapy alone.
Are benzodiazepines safe for anxiety?
They are effective short-term but carry risks of tolerance, dependence, sedation and falls, and are dangerous with alcohol or opioids. Canadian guidelines list them as second-line.
Where can I get free therapy in Canada?
Options include provincial structured psychotherapy programs such as Ontario Structured Psychotherapy, community mental health services, employee assistance programs and student counselling.
Does Selank work for anxiety?
It is approved as an anti-anxiety drug in Russia, but human studies are small and mostly Russian, with no Western randomized trials. It is not approved in Canada.
Is CBD good for anxiety?
Evidence is early and limited. THC, the other main cannabis compound, can worsen anxiety.
Why does anxiety cause physical symptoms?
Anxiety activates the fight-or-flight system, releasing adrenaline and stress hormones that raise heart rate, speed breathing, tense muscles and divert digestion. The symptoms feel alarming but are not dangerous.
How do I find a therapist covered by my benefits in Canada?
Check which designations your plan covers (for example psychologist, registered psychotherapist or social worker), then look for a clinician trained in CBT for anxiety. Your employee assistance program may offer free sessions first.
Can I get time off work for anxiety in Canada?
Yes. Eligible workers can receive up to 26 weeks of Employment Insurance sickness benefits, and employers have a legal duty to accommodate mental health conditions.
Which SSRI is best for anxiety?
Several SSRIs and SNRIs are first-line and broadly similar in effectiveness. Escitalopram and sertraline are commonly started because they are well tolerated; the best choice depends on your health, other medications and past response.
Related reading
References
- Katzman MA, Bleau P, Blier P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(Suppl 1):S1. PubMed
- Hoge EA, Bui E, Mete M, et al. Mindfulness-based stress reduction vs escitalopram for the treatment of adults with anxiety disorders: a randomized clinical trial. JAMA Psychiatry. 2023;80(1):13–21. PubMed
- Statistics Canada. Mental Health and Access to Care Survey, 2022. The Daily, 2023. Statistics Canada
- 9-8-8 Suicide Crisis Helpline. 988.ca
This article is general information, not medical advice. Talk to a doctor, nurse practitioner or mental health professional about anxiety treatment. In a crisis, call or text 9-8-8. TrueLabs research compounds are sold for in vitro and laboratory research use only and are not intended for human or veterinary use.