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What Are the Best Anxiety Medications for Generalized Anxiety Disorder (GAD)?

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Updated July 03, 2014

Prozac, Paxil and Zoloft anti-depressant tablets
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Question: What Are the Best Anxiety Medications for Generalized Anxiety Disorder (GAD)?
Answer:

GAD, or Generalized Anxiety Disorder, is characterized by symptoms of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience. Studies have found that as many as 60-65% of those with GAD also have other psychiatric disorders in conjunction with it--most often 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. Drugs in this class include clonazepam (Klonopin) , lorazepam (Ativan) , and alprazolam (Xanax) . While benzodiazepines act quickly, are effective, and are medically safe, 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. Benzodiazepines may also increase falls, and cause confusion and memory problems in the elderly.

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ANTIDEPRESSANTS

Of the antidepressants, the tricyclic antidepressant, imipramine (Tofranil), has been the most extensively investigated and is considered by some a standard treatment for anxiety. Other cyclic drugs that have been found to be effective in treating panic disorder include Pamelor (nortryptyline), 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.

Patients with panic disorder are often very sensitive to the cyclics; 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. Because tricyclics are slower acting than benzodiazepines, they are often prescribed in combination with a benzodiazepine during the initial stages of panic disorder.

A second type of antidepressant, MAOIs 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.

A third type of antidepressant is the SSRI. Examples of SSRIs are Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline). Research from ongoing clinical trials is mounting that SSRIs are an effective course of treatment for anxiety disorders.

The side effect of SSRIs are less severe than the TCAs. SSRIs produce fewer cardiac effects than the cyclics. The TCAs may produce feelings similar to a panic attack. They also cause less weight gain and sedation than the cyclics.

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AZAPIRONES

Of the latter category, azapirones, there is currently only one medication available. This drug is buspirone, brand name BuSpar. Many clinicians report great success using buspirone to treat GAD as compared to other forms of anxiety disorders. When choosing between benzodiazepines and buspirone some important factors will need to be considered. First of all, is there a need for immediate effect? Compared to benzodiazepines, buspirone is slow acting (needs a couple of weeks to take effect) while benzodiazepines exert an almost immediate effect. If you're in immediate danger of losing your job due to anxiety, two weeks might seem like an eternity. A second factor to consider is whether the sedative effects of the benzodiazepines will put you at any type of risk. Buspirone does not cause sedation like the benzodiazepines. The elderly, who are at risk for falls, might not be a good candidate for benzodiazepines. A person who works with heavy machinery might also be a poor candidate. Thirdly, a history of alcohol or drug abuse may be a contraindication to benzodiazepine use.

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