Medications for Generalized Anxiety Disorder

What you need to know about medications for GAD

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After receiving a diagnosis of Generalized Anxiety Disorder (GAD), the next step will be to devise a treatment plan with your clinician. Treatments for GAD include psychotherapies, such as cognitive behavioral therapy, medications, and self-help resources.

Many different types of medications are used in the treatment of anxiety disorders. They may be a short- or long-term treatment option, depending on the severity of your symptoms, other co-occurring medical or psychiatric conditions, and individual circumstances.

Overall, these medications can be very effective. They include the following:

Types of Drugs

Antidepressants don’t just treat depression; they have a well-documented ability to help in the treatment of GAD and other anxiety disorders. The first line antidepressant treatment option is typically a class of medications called selective serotonin reuptake inhibitors (SSRIs). SSRIs work by blocking the reabsorption of a neurotransmitter (i.e., brain chemical) called serotonin. Changing the balance of this chemical seems to impact communication between brain cells and this, in turn, helps improve mood and anxiety. SSRIs [such as sertraline (Zoloft) or fluoxetine (Prozac)] are considered a good choice for the treatment of GAD because they are relatively safe and tend to be well tolerated by individuals.

Another class of antidepressants is serotonin and norepinephrine reuptake inhibitors (SNRIs). Similar to SSRIs, SNRIs [such as venlafaxine (Effexor) and duloxetine (Cymbalta)] alter the chemical balance in the brain by blocking the absorption of two brain chemicals – in this case, both serotonin and norepinephrine.

Antidepressants can take several weeks to take effect. Sometimes individuals taking antidepressants find that their close supports (family and friends) notice a change in their anxiety level before they notice it in themselves. Therefore, it is important to be patient and to participate in regular monitoring of symptoms and side effects with your prescribing physician.

Anxiolytics, or anti-anxiety medications, are the other class of medications used to treat GAD. Within this category, Azipirones are a type of anxiolytic that work by enhancing serotonin activity in the brain. Buspirone (Buspar) is a medication in this class that is approved for the treatment of GAD. There is some evidence that buspirone may also help augment antidepressants. Unlike traditional anti-anxiety medications described below, this drug is not known to be habit-forming.

Benzodiazepines, traditionally used as anxiolytics, are effective in the treatment of anxiety but have drawbacks including notable potential side effects like sedation as well as a tendency to be habit-forming. These medications are also thought to be unable to treat the underlying cause of the anxiety. In contrast to antidepressants which block the uptake of neurotransmitters, these medications enhance the action and efficiency of the brain chemical GABA (Gamma Amino Butyric Acid), which functions to slow or calm things down.

Drugs in this class [including alprazolam (Xanax), clonazepam (Klonopin), and lorazepam (Valium)] are fast-acting in easing anxiety and are sometimes used to help with sleep. Because medications in this class can be habit-forming, they are most commonly recommended for short-term treatment of acute anxiety and are sometimes offered for symptom relief at the start of an antidepressant trial because those medications can take longer to take effect.

If SSRI/SNRI antidepressants or buspirone are not effective, or if there are concerns about the long-term use of benzodiazepines, doctors sometimes recommend older categories of antidepressants such as Tricyclic Antidepressants [for example, amitriptyline (Elavil) or imipramine (Tofranil)] or Monoamine Oxidase Inhibitors (MAOIs) [such as tranylcypromine (Parnate) or phenelzine (Nardil)]. However, drugs in these classes may carry some potentially significant side effects.

Medication Combined with Therapy

In cases of GAD, medication is sometimes regarded as a temporary measure to relieve symptoms at the beginning of the course of psychological treatment or thought of as a helpful addition when combined with psychotherapy. Medications can be paired with a variety of psychological treatments for GAD. On their own, medications and psychotherapy can be quite helpful; however, in some cases, pairing them together may boost effectiveness.

More Information

For additional information on medications for anxiety disorders, check out this summary by the Anxiety and Depression Association of America or this GAD Help Guide.

As with deciding to try any type of new drug, it is important to discuss with your clinician whether or not a medication might be right for you and to weigh the risks and benefits of a medication trial with a prescribing specialist (in this case, a psychiatrist). And remember, it often takes time and patience to find the medication that works best for you. 

References

Allgulander, C. Generalized anxiety disorder: A review of recent findings. J Exp Clin Med. 2012; 4(2):88-91.

Chessick CA, Allen MH, et al. Azapirones for generalized anxiety disorder. Cochrane Database of Systematic Reviews. 2006; Issue 3. 

Hoge EA, Ivkovic A, Fricchione GL. Generalized anxiety disorder: Diagnosis and treatment. BMJ. 2012; 345:e7500.

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