Medications for Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder (GAD) is characterized by unfounded chronic and exaggerated worry or apprehension that is more severe than the normal anxiety most people experience. If you've been diagnosed with GAD, certain medications may be used to help manage your condition.

Generalized anxiety disorder medication options include:

• Antidepressants: relieve symptoms of anxiety and depression
• Benzodiazepines: often considered tranquilizers, they reduce anxiety quickly
• Azapirones: medications with anti-anxiety and antidepressant properties that can help manage GAD long term
• Anti-convulsant/antipsychotic medications: other options that are sometimes used to manage anxiety

Antidepressants for GAD

Even though the symptoms of anxiety and depression are not the same, antidepressant medications are often effective in managing anxiety. They're considered first-line drugs for many anxiety disorders, or drugs that are a preferred treatment option.

Antidepressants can also be helpful for people with both GAD and depression. This is important since the two occur together frequently, with roughly one-half of people with GAD also having major depressive disorder (MDD).

There are several different classes of antidepressants that can be used to reduce GAD symptoms, each one working in a slightly different way. Here are several to consider, along with their potential side effects and addiction risk.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are among the most preferred generalized anxiety disorder medications. This class of antidepressants includes medications such as Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline).

SSRIs work by blocking the reabsorption of serotonin, a neurotransmitter that plays a role in mood, sleep, sexual desire, and more. Blocking serotonin's reabsorption increases the level of this neurotransmitter in the brain. This can be helpful for those with anxiety as low serotonin levels have been linked to anxiety issues.

Although SSRIs are generally well-tolerated, some people do experience side effects when taking them, with some of the most common adverse effects being:

• Agitation
• Decreased sex drive
• Drowsiness
• Headache
• Nausea or vomiting
• Trouble sleeping

SSRI side effects that are less common include extrapyramidal symptoms and serotonin syndrome. Extrapyramidal symptoms include muscle stiffness and involuntary muscle contractions. Increased anxiety, confusion, and irregular heartbeat are all signs of serotonin syndrome.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Whereas SSRIs block the reabsorption of serotonin, serotonin-norepinephrine reuptake inhibitors (SNRIs) block the reabsorption of both serotonin and norepinephrine. Norepinephrine is a neurotransmitter also involved with mood and sleep, along with memory, alertness, and arousal.

This class of antidepressants is another first-line anxiety medication and includes options such as Cymbalta (duloxetine) and Effexor (venlafaxine). Studies show that SSRIs are just as effective as SNRIs for treating anxiety disorders.

Although side effects from SNRI medications generally improve as your body gets used to the drugs, some of the most common effects include:

• Constipation
• Dizziness
• Drowsiness
• Dry mouth
• Excessive sweating
• Fatigue
• Nausea or vomiting
• Sexual dysfunction

It's also possible to experience serious side effects when taking SNRIs, two of which include serotonin syndrome and suicidal thoughts or behaviors. In fact, all antidepressants carry a black box warning issued by the U.S. Food and Drug Administration (FDA), which states that these medications may increase the risk of suicidality in pediatric patients.

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants (TCAs) work by inhibiting the reuptake of serotonin and noradrenaline, also affecting other neurotransmitters in the brain. Research studies have found that this antidepressant type can effectively manage GAD.

TCAs used to treat generalized anxiety disorder include Tofranil (imipramine), Pamelor (nortriptyline), and Anafranil (clomipramine). Generally speaking, these drugs are associated with more adverse effects than SSRIs or SNRIs; thus, other antidepressants should be tried first.

The most common side effects of TCAs, which often reduce over time, include:

• Blurred vision
• Constipation
• Dry mouth
• Increased heart rate
• Low blood pressure
• Sexual dysfunction
• Tremors
• Urinary retention
• Weight gain

One benefit of TCAs is that the risk of experiencing withdrawal symptoms when discontinuing these drugs is less than with many other antidepressants. If discontinuation effects do occur, then generally go away within one to two weeks.

Monoamine Oxidase Inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs) are some of the oldest psychiatric medications. They ease anxiety symptoms by hindering monoamine oxidase activity, which helps increase the level of certain neurotransmitters in the brain. This creates an anti-anxiety effect.

MAOIs have been found to be effective in the treatment of several anxiety and depression disorders. There is, however, the potential for side effects when taking this category of medications.

Some side effects are minor, such as nausea, dizziness, dry mouth, and trouble sleeping. Others are more serious, including:

• Hypomania
• Increased blood pressure
• Passing out or falling
• Weight gain

Following a low-salt diet and avoiding dehydration can help reduce serious effects, as can dividing the doses of the medicine throughout the day or taking the drug at bedtime.

Benzodiazepines for Generalized Anxiety Disorder

Benzodiazepines are another type of medication that can be taken to manage the symptoms of GAD. They work by strengthening the effects of the neurotransmitter GABA. This helps you feel more calm and relaxed while also improving your ability to sleep.

Benzodiazepines have a high effective rate for GAD compared to other medication options. They're also fast-acting, providing more immediate anxiety relief. Medications in this class include Klonopin (clonazepam), Ativan (lorazepam), and Xanax (alprazolam).

Benzodiazepines are generally well-tolerated but can have side effects such as:

• Confusion
• Dizziness
• Drowsiness
• Impaired coordination
• Vision issues
  

One drawback of benzodiazepines is that, when used long-term, you can develop a dependence on or addiction to the drug. This can lead to withdrawal symptoms if it is discontinued, some of which include increased feelings of anxiety and the potential for seizures. Therefore, you never want to stop benzodiazepine use without the guidance of your healthcare provider.

Treating GAD With Azapirones

Since long-term use of benzodiazepines can lead to dependence and addiction, another type of generalized anxiety disorder medication with a better benefits-risk ratio over time is azapirones. Azapirones are drugs that have both anti-anxiety and antidepressant effects.

Buspirone is the only FDA-approved azapirone for treating GAD, and it has been found effective for this purpose. This drug was once available under the brand name BuSpar, but that brand has since been discontinued. So, now it is available under the generic name of buspirone.

Potential side effects associated with buspirone use include:

• Dizziness
• Headache
• Nausea
• Movement issues

Unlike benzodiazepines, buspirone does not lead to drug dependence. When combined with an antidepressant, it can also help treat the adverse sexual side effects associated with the antidepressant drug.

Antipsychotic and Anticonvulsant GAD Medications

Other medications used for GAD include anticonvulsant (anti-seizure) medications and antipsychotics that fall into the category of atypical antipsychotics. These treatments may be considered if you do not improve with traditional therapies or if you experience intolerable side effects from other GAD drugs.

The anticonvulsant drug pregabalin has been found to reduce anxiety quickly in people with GAD, along with having minimal side effects and a low abuse potential. That makes them another option to consider.

Atypical antipsychotics can be helpful as well, particularly for GAD that is treatment-resistant. Vortioxetine is an atypical antipsychotic GAD treatment option. Research has found that it is effective short term, along with being highly effective for people with severe anxiety.

Finding the Right GAD Medication for You

Your mental health therapist can help you find the right general anxiety disorder medication for you. The important thing to remember is that you don't have to live with anxiety. Many treatment options exist, including a variety of medication options.

Talk to your health provider about your GAD symptoms and treatment-related concerns. Based on your condition and situation, they can help find a medication that you feel comfortable taking.