Best Anxiety Medications for Generalized Anxiety Disorder (GAD)

Short-term and long-term medications are used for anxiety

Prozac, Paxil and Zoloft anti-depressant tablets
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If you have generalized anxiety disorder (GAD) you will often receive a combination of talk therapy and drug therapy. GAD is characterized by symptoms of chronic , exaggerated worry and tension that are unfounded or much more severe than the normal anxiety most people experience. Studies have found that as many as 60 to 65 percent of those with GAD also have other psychiatric disorders in conjunction with it—most often the combination of panic disorder and major depression.

Treatments for GAD currently include benzodiazepines, antidepressants, and azapirones.

Benzodiazepines

Benzodiazepines are effective in reducing panic attacks and phobic behavior, as well as the anticipatory phase of panic attacks. They are used to treat symptoms of GAD for a short term while antidepressants are taking effect. Drugs in this class include Klonopin (clonazepam), Ativan (lorazepam), and Xanax (alprazolam).

While benzodiazepines act quickly, approximately one-half of patients experience withdrawal symptoms when removed from the medication and many clinicians believe that patients receiving them may develop a tolerance to the drug. Once the prescribed antidepressant takes effect, the dose of benzodiazepine is slowly decreased until it can be stopped safely.

Benzodiazepines cause sedation and may also increase falls, and cause confusion and memory problems in the elderly. A person who works with heavy machinery might also be a poor candidate.

A history of alcohol or drug abuse may be a contraindication to benzodiazepine use.

Antidepressants

There are different classes of antidepressants that can be used to treat GAD. These medications can take weeks to take effect. Because antidepressants are slower acting than benzodiazepines, they are often prescribed in combination with a benzodiazepine during the initial treatment.

  • Selective Serotonin Reuptake Inhibitors (SSRIs): This class includes Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline). The side effects of  SSRIs are less severe than the those of tricyclic antidepressants (TCAs). SSRIs produce fewer cardiac effects and less weight gain and sedation than the TCAs.
  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): This class includes Cymbalta (duloxetine) and Effexor (venlafaxine), which may be used for GAD. They are considered as effective as the SSRIs and are the first-line treatment for GAD.
  • Tricyclic Antidepressants (TCAs): Tofranil (imipramine) is often used to treat anxiety. Other tricyclic drugs that have been found to be effective in treating panic disorder include Pamelor (nortriptyline), Norpramin (desipramine), and Anafranil (clomipramine). Tricyclics, unlike benzodiazepines, require only a single daily dose of medication. They are well studied and also help to guard against depression, which is often comorbid with panic disorder. However, TCAs may produce feelings similar to a panic attack. Patients with panic disorder are often very sensitive to the tricyclics; some may experience activation (subjective agitation, irritability, and restlessness) at the start of treatment. Generally, treatment with a TCA starts with a lower dose which is increased over time. Some clinicians suggest having the patient split the dose, with the majority of the medication taken before bedtime, thus causing many of the side effects to occur when the patient is sleeping. One major disadvantage of tricyclics is that they sometimes produce cardiac side effects (such as dizziness and heart palpitations) along with weight gain and sedation.
  • Monoamine Oxidase Inhibitors (MAOIs): These drugs have been found to be highly effective in the treatment of anxiety disorders, including panic disorder and social phobia. There are, however, certain serious side effects with these drugs. People taking MAOIs have to have a restrictive diet because of a substance called tyramine that is found in certain foods. The interaction between tyramine and MAOIs can precipitate a hypertensive crisis characterized by a dramatic increase in blood pressure.

Azapirones

Buspirone may also be used to treat GAD. The brand name of BuSpar is no longer on the market, but generics may be available.

 Buspirone is slow acting and needs a couple of weeks to take effect. Buspirone does not cause sedation like the benzodiazepines and it does not lead to drug dependence.

Sources:

Anxiety Disorders: Types, Diagnosis and Treatment. NIH MedlinePlus. https://medlineplus.gov/magazine/issues/summer15/articles/summer15pg6-8.html.

Generalized Anxiety Disorder: When Worry Gets Out of Control. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml.

Greist JH. Generalized Anxiety Disorder (GAD). http://www.merckmanuals.com/professional/psychiatric-disorders/anxiety-and-stressor-related-disorders/generalized-anxiety-disorder-gad#v1025319.

Medication. Anxiety and Depression Association of America. https://www.adaa.org/finding-help/treatment/medication.

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