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Medications for Generalized Anxiety Disorder (GAD)

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Generalized anxiety disorder (GAD) has a biological component. Abnormal amounts of certain brain chemicals may play a role in its development. The condition often responds to medication. Anxiolytics (anti-anxiety medications) and antidepressants help ease the symptoms of anxiety. They are often used in combination with counseling, such as cognitive-behavioral therapy.

Depending on your situation, medication may be advised for the short-term or for a lengthy period of time. In general, people who are treated for a longer period of time usually have a lower relapse rate. Medication will likely be recommended if anxiety impairs your ability to function.

Prescription Medications

Azapirones

  • Buspirone

Benzodiazepines

  • Lorazepam
  • Prazepam
  • Flurazepam
  • Clonazepam
  • Triazolam
  • Chlordiazepoxide
  • Halazepam
  • Temazepam
  • Oxazepam
  • Clorazepate
  • Diazepam
  • Alprazolam

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • Citalopram
  • Fluvoxamine
  • Paroxetine
  • Fluoxetine
  • Sertraline
  • Escitalopram

Tricyclic Antidepressants

  • Imipramine
  • Nortriptyline

Atypical Antidepressants

  • Trazodone
  • Venlafaxine
  • Nefazodone

Prescription Medications

Azapirones

Common name: Buspirone

Buspirone is a relatively new anxiolytic drug that is believed to enhance the activity of serotonin, a neurotransmitter involved in regulating anxiety and mood. It takes within two weeks to take effect. For that reason, it is not useful for treating acute anxiety and insomnia . The primary advantages of buspirone are that it is not sedating and it does not result in physical dependence or tolerance as compared with benzodiazepines.

Do not take buspirone with monoamine oxidase (MAO) inhibitors. Do not take with alcohol or other sedating drugs. Use with caution if you have liver or kidney disease .

Possible side effects include:

  • Excitability, nervousness
  • Headache
  • Nausea
  • Lightheadedness
Benzodiazepines

Common names include:

  • Lorazepam
  • Prazepam
  • Flurazepam
  • Clonazepam
  • Triazolam
  • Chlordiazepoxide
  • Halazepam
  • Temazepam
  • Oxazepam
  • Clorazepate
  • Diazepam
  • Alprazolam

Benzodiazepines reduce symptoms of anxiety by enhancing the function of gamma aminobutyric acid (GABA), a neurotransmitter thought to be abnormal in people with GAD. These drugs produce a sedative effect, reduce physical symptoms, such as muscle tension, and often cause drowsiness and lethargy.

Benzodiazepines are fast acting and useful for treating acute anxiety and insomnia. These drugs can be habit-forming when used long-term or in excess. They may cause withdrawal symptoms, such as anxiety, irritability, and insomnia when discontinued. In such cases, you should taper off the medication slowly, over a period of weeks or months under a doctor’s supervision.

Withdrawal from benzodiazepines can be severe at times. It can include restlessness, tremors, delirium tremens, and seizures that can be life threatening. Dangerously high fever, confusion, hallucinations, and dehydration may also occur. Benzodiazepines should not be used for more than 4 weeks. GAD may return after stopping the drug, but that is often true of any medication or treatment. Talk to your doctor before changing how you take this medication.

Do not take with alcohol or other sedating drugs. Do not take if you must drive a vehicle or operate machinery. Benzodiazepines should not be taken in combination with certain oral antifungal medications or by people with certain types of glaucoma.

Possible side effects include:

  • Drowsiness or lethargy
  • Confusion
  • Lightheadedness, particularly in elderly persons
  • Slow reaction time, impaired coordination
  • Memory changes
Selective Serotonin Reuptake Inhibitors (SSRIs)

Common names include:

  • Citalopram
  • Fluvoxamine
  • Paroxetine
  • Fluoxetine
  • Sertraline
  • Escitalopram

Selective serotonin reuptake inhibitors (SSRIs) affect the concentration of the neurotransmitter serotonin, which plays a role in anxiety. Although they are considered antidepressants, SSRIs have been used effectively for the treatment of anxiety disorders. Improvement is usually seen in 4-6 weeks after beginning treatment. You should not drink alcohol while taking an SSRI. Do not take SSRIs if you are taking MAO inhibitors, thioridazine, or pimozide. Use with caution if you have liver or kidney disease.

Possible side effects include:

  • Nausea or vomiting
  • Abdominal pain
  • Rash
  • Sweating, anxiety
  • Headaches
  • Dry mouth
  • Tremor
  • Diarrhea
  • Loss of appetite or weight loss
  • Weight gain
  • Nervousness
  • Insomnia
  • Lightheadedness
  • Sexual dysfunction—ranges from decreased arousal, to erectile dysfunction, and/or delayed time to orgasm
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients—young adults may be at a higher risk for this side effect
Tricyclic Antidepressants

Common names include:

  • Imipramine
  • Nortriptyline

Tricyclic antidepressants are thought to regulate serotonin and norepinephrine in the brain. They have been used effectively for the treatment of depression . Improvement is usually seen in 3-6 weeks after beginning treatment. These drugs are highly toxic if taken in large doses therefore, they are often not prescribed for suicidal patients. Tricyclic antidepressants are not addictive. These drugs are infrequently used for the treatment of GAD because of the many side effects, plus the overdose potential.

Possible side effects include:

  • Lightheadedness
  • Dry mouth
  • Constipation
  • Difficulty urinating
  • Weight gain
  • Low blood pressure
  • Sexual dysfunction
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients—young adults may be at a higher risk for this side effect
Atypical Antidepressants

Common names include:

  • Trazodone
  • Venlafaxine
  • Nefazodone

Atypical antidepressants affect the concentration of serotonin and can be effective in treating GAD. Improvement is usually seen in four to six weeks after beginning treatment.

Possible side effects include:

  • Nausea
  • Nervousness
  • Diminished sex drive
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients—young adults may be at a higher risk for this side effect

Special Considerations

Consultation with a specially trained mental health professional is recommended if you do not respond to treatment with medications. A mental health professional can help clarify the diagnosis and determine if another psychiatric disorder is present. They can also make recommendations about psychotherapy and changes in medications.

If you are taking medications, follow these general guidelines:

  • Take the medication as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medication.
  • Plan ahead for refills if you need them.
  • Do not share your prescription medication with anyone.
  • Medications can be dangerous when mixed. Talk to your doctor if you are taking more than one medication, including over-the-counter products and supplements.

When to Contact Your Doctor

Contact your doctor if you have any side effects that are troublesome and persistent or your symptoms are not improving.

Revision Information

  • Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273. Updated April 13, 2016. Accessed June 13, 2016.

  • Generalized anxiety disorder. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/generalized-anxiety-disorder.html. Updated March 2014. Accessed June 13, 2016.

  • Generalized anxiety disorder. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114697/Generalized-anxiety-disorder. Updated July 28, 2016. Accessed October 4, 2016.

  • Fricchione G. Clinical practice. Generalized anxiety disorder. N Engl J Med. 2004;351(7):675-682.

  • Medication. Anxiety and Depression Association of America website. Available at: http://www.adaa.org/finding-help/treatment/medication. Accessed June 13, 2016.

  • Stern T, Rosenbaum J, et al. Massachusetts General Hospital Comprehensive Clinical Psychiatry. Philadelphia, PA: Mosby Elsevier; 2008.

  • 2/18/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114697/Generalized-anxiety-disorder: Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.