According to the Anxiety and Depression Association of America, generalized anxiety disorder (GAD) affects 6.8 million adults, or 3.1 percent of the U.S. population. So even though you might feel ashamed about your anxiety and like you’re the only one who’s struggling, you’re absolutely not alone.
It’s hard to live with excessive, uncontrollable, stubborn worry. Maybe it keeps you up at night. Maybe the worry arises first thing in the morning as you open your eyes. Maybe it feels like you’re rarely worry-free. In fact, people can worry anywhere from 3 to 10 hours a day.
However, this kind of crippling worry is highly treatable with psychotherapy and medication. For example, according to treatment guidelines from the Royal Australian and New Zealand College of Psychiatrists, for mild GAD, cognitive behavioral therapy (CBT) is best. For moderate GAD, CBT or a selective serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitors (SNRI) is recommended. For severe GAD, the most effective option is a combination of CBT and medication.
For most people who are newly diagnosed with GAD, UpToDate.com also recommends either an SSRI or SNRI, CBT, or both, because these are the best-studied treatments for effectively treating GAD.
Co-occurring conditions also are common with GAD—and will guide the specifics of your treatment. For instance, some individuals who have GAD and severe depression might not be able to fully participate in CBT. So they would start taking an SSRI and may or may not start CBT then, as well.
Both the National Institute for Health and Care Excellence (NICE) and Canadian treatment guidelines for anxiety disorders recommend psychological interventions (often CBT) as the first-line treatment, and an SSRI or SNRI for individuals who haven’t benefited from therapy (along with other medications as second-line options).
The first-line pharmacological treatment for generalized anxiety disorder (GAD) is a selective serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNRI). These medications are also highly effective for depression—which is important because depression commonly co-occurs with GAD. Which means that taking an SSRI or SNRI can decrease symptoms of both illnesses.
Your doctor will likely start with a low dose of an SSRI. While it varies by individual, you’ll begin to feel the benefits of the medication in 4 to 6 weeks. If you’re not showing much improvement, during that time, your doctor will likely increase the dose of the same medication. If that doesn’t seem to help, that medication will be tapered off, and your doctor will likely prescribe a different SSRI (or move on to an SNRI).
The SSRIs paroxetine (Paxil) and escitalopram (Lexapro) have been approved by the United States Food and Drug Administration (FDA) for treating GAD, along with the SNRIs venlafaxine XR (Effexor XR) and duloxetine (Cymbalta).
Your doctor might prescribe a medication “off label,” which is still effective for treating GAD (even though it hasn’t been FDA approved). One example is the SSRI sertraline (Zoloft).
While the side effects of each SSRI vary, they commonly include nausea, diarrhea, weight gain, and sexual problems (e.g., decreased sex drive, delayed orgasm, or inability to achieve orgasm). The side effects of SNRIs include nausea, dizziness, sedation, sweating, constipation, and insomnia.
If you abruptly stop taking an SSRI or SNRI, or often even if you taper off slowly, these medications can produce discontinuation syndrome, which can include flu-like symptoms, dizziness, and insomnia.
When you start taking an SSRI, it tends to cause agitation and insomnia. If you’re unable to tolerate these adverse effects (and don’t have any issues with substances), your doctor might prescribe a low-dose benzodiazepine short term.
Benzodiazepines begin working within minutes or hours. Though they’re highly effective, benzodiazepines can cause tolerance and dependence, and can be abused. They also cause sedation and cognitive impairment. (In general, it’s best to avoid long-term use of benzodiazepines.)
If you struggle with substance abuse or have in the past, your doctor might instead prescribe the antihistamine hydroxyzine (Vistaril) or the anticonvulsant pregabalin (Lyrica), along with the SSRI or SNRI.
Many people with GAD don’t respond to the initial medications they try. The next treatment your doctor prescribes will depend on your specific symptoms, treatment history, and preference.
For instance, one option is the FDA-approved anti-anxiety drug buspirone (Buspar), which has similar efficacy as benzodiazepines. However, unlike benzodiazepines, buspirone doesn’t cause physiological dependence, and does take time to take effect—about 4 weeks. Side effects include dizziness, drowsiness, nausea, nervousness, restlessness, and trouble sleeping.