anxiety is a symptom and can be caused by variety of disorders. it can be due to cardiac problems, hormonal disorders, metabolic problem, some medications, substance abuse ( coffee, cannabis) etc. if anxiety is due to any of the above mentioned causes then treatment of that disorder will reduce the problem of anxiety. if all of the causes have been ruled out then you are having primary anxiety disorder. there are following treatments available for primary anxiety disorder. (1) treatment without medication: this treatment include different psychological treatment. in simple word, a psychologist/ psychiatrist will talk to you and will help you to overcome your anxiety. this treatment is very effective especially in cases of mild to moderate level of anxiety. (2) medication: there are some drugs like benzodiazepines ( like alprazolam or xanax, clonazepam, etizolam) which will provide you immediate relief from your anxiety. but these drugs can cause sedation that could be problematic. more importantly these drugs are habit forming so i would not recommend you to continue xanax. furthermore these drugs will only provide symptomatic relief and will not treat underlying cause. beta blocker (propranolol, bystolic) is another group of drugs that provide only symptomatic relief without having any effect on primary anxiety disorder. drugs like SSRI (fluoxetine, escitalopram, sertraline, paroxetine) ,SNRI (venlafaxine, duloxetine) are the mainstay treatment of anxiety disorder now a days. these drugs are slow to act and may take 2 to 4 weeks for any significant improvement. these drugs must be continue for sometime (at least six months or more depending upon clinical picture of individual patients) as advised by your psychiatrist. never abruptly stop these medication. most of the time psychiatrist usually start any one drug from SSRI or SNRI group according to patient profile. initial anxiety usually taken care by either any benzodiazepine or beta blocker as SSRI/SNRI don t act immediately. benzodiazepine or beta blocker usually discontinued gradually within a short period of time. (3) combination of both the above treatment: this is most effective. as you have not given the details of your problem, it is difficult to suggest any treatment but i will recommend you:- 1. stop xanax as it is not treating your primary disorder, making you prone to benzodiazepine addiction and will cause a lot of problems especially memory problems if taken for longer duration. 2. Bystolic again is providing only temporary relief, not addressing your basic problem. 3. visit to a psychiatrist ,so that an accurate diagnosis could be made. 4. once an accurate diagnosis is made, you ll get the right treatment. I m sure that you will be able to overcome your problem of anxiety very soon. Wish you all the best. Regards, Dr. Rakesh Yaduvanshi MBBS., M.D. Consultant Psychiatrist