What are the best drugs to treat generalized anxiety disorder?

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Generalized anxiety disorder (GAD) is not a disease that can be treated with a single medication. Treatment plans are based on factors like the severity of symptoms and how the patient responds to prescribed drugs. Antidepressants, however, are the most common medications used to treat GAD.

One person’s treatment for GAD might not work for another. Most people find out what works for them by trial and error.

This article gives an overview of GAD. The report then describes the side effects and functions of some of the most commonly prescribed medications.

What is GAD?

GAD is a mental health condition. People with GAD experience excessive, persistent, unrealistic worry about everyday things. People may worry about finances, family, health, or the future.

The following symptoms can occur:

  • Restlessness
  • fatigue
  • Problems concentrating
  • Irritability
  • Muscle tension
  • Sleep issues

The two mainTrustedSource treatments for GAD are medication and Cognitive Behavioral Therapy (CBT). The doctors may prescribe a combination of both.

GAD is one of many best treatments. What works for someone else might not work for another. People often find out the best medication by trial and error.

Which is the first medication that a doctor would prescribe for GAD?

Antidepressants are usually the first medication that doctors recommend to treat GAD.

Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI) are both antidepressants. They will be effective in between 30% and 50% of cases.

They increase the amount of serotonin within the brain. Serotonin, a neurotransmitter (a chemical) that transmits messages between brain cells is a neurotransmitter. It is involved in happiness and feelings of well-being.

Doctors prescribe antidepressants in the following types:

  • sertraline (Zoloft)
  • vanlafaxine (Effexor XR)
  • citalopram (Celexa)
  • escitalopram (Lexapro)

Antidepressants

Antidepressants can start working after a few weeks (Trusted Source) and begin to increase serotonin in the brain.

Dose

Antidepressants are taken every day. The dose depends on the antidepressant the doctor prescribes and the severity of symptoms.

Finding the correct dose can sometimes be a matter of trial and mistake.

Typical doses can include:

AntidepressantDose

escitalopram A doctor can prescribe 10-20 mg, once or twice a day with or without food.

Duloxetine, A doctor can prescribe 20 to 120 mg with or without food once or twice daily.

Venlafaxine, A doctor can prescribe between 37.5 and 300 mg 2-3 times daily, with or without eating.

Paroxetine, A doctor can prescribe 10-40 mg once or twice a day with or without food.

Side effects

According to the United Kingdom’s National Health Service, antidepressants may cause the following side effects:

  • An agitation
  • anxiety
  • nausea
  • indigestion
  • constipation or diarrhoea
  • appetite loss
  • dizziness
  • insomnia
  • headaches
  • Loss of libido
  • Having difficulty achieving orgasm
  • Having and maintaining erections is difficult

People should never stop taking their medications without consulting a doctor to avoid withdrawal symptoms.

What should one avoid while taking this medication?

A person shouldn’t take SSRIs or SNRIs together:

  • Other SSRIs
  • MAOIs
  • tricyclic Antidepressants
  • Psychotropic drugs
  • Triptans
  • Some antibiotics, including linezolid
  • amphetamines

Some antidepressants may also increase the effect of other medications. These include:

  • ibuprofen
  • warfarin
  • aspirin

Benzodiazepines

When a patient needs immediate relief from anxiety symptoms, a doctor will prescribe a prescription for benzodiazepines. Mental Health America states they start working in 30 minutes or an hour and then wear off after a few hours.

These medications are usually taken for a short period, as they carry a high risk of dependence.

Benzodiazepines increase the amount of a neurotransmitter that calms nerves called Gamma-aminobutyric Acid (GABA).

diazepam, and Clonazepam are two types of benzodiazepines.

Dose

The National Alliance on Mental Illness states that diazepam or clonazepam can be taken at any time, whether at a regular dose or as needed.

Speak to your doctor about the number of daily doses you can take.

Side effects

Some of the most common side effects associated with benzodiazepines are:

  • dizziness
  • Drowsiness
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  • lightheadedness
  • A decreased ability to focus
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In rare cases, a person may experience:

  • Shortness of Breath
  • Increased heart rate
  • Headaches
  • irritability
  • Memory impairment
  • Restlessness

What should one avoid while taking this medication?

If you are taking benzodiazepines, you should not drink alcohol.

Some medications should be avoided by people who take benzodiazepines. The benzodiazepine a person is taking will determine which drugs they should avoid.

Speak to your doctor about which medications you should avoid.

Anxiolytic Drugs

Another treatment option for GAD is anxiolytic drugs such as Buspirone. Anxiolytics, like antidepressants, also increase the effect of serotonin on the brain.

It can take up to two weeks for Trusted Source medication to begin working.

Dose

Buspirone is usually taken twice daily with or without food.

The dose depends on the response of the patient to the drug. Finding the correct amount can take a lot of trial and error.

Side effects

Buspirone can be used for a long time, provided the medication is taken as prescribed by a doctor. Side effects are possible.

Included in this category are:

  • nausea
  • Headaches
  • changes in dreams
  • dizziness
  • Drowsiness
  • Lightheadedness

What should one avoid while taking this medication?

Buspirone is not to be taken with alcohol or illegal drugs. They can reduce the effectiveness of the medication and increase the risk of adverse effects.

If you take Buspirone with the following medications in the next two weeks, your blood pressure may increase significantly.

  • monoamine oxidase inhibitors (MAOIs)
  • Selegiline
  • tranylcypromine

Buspirone should not be taken with the following medications.

  • diltiazem
  • verapamil
  • rifampin

Buspirone levels can be increased by drinking large quantities of grapefruit juice.

Boxed Warnings

According to a 2022 articleTrusted source, warnings in boxes inform people of the risks associated with certain drugs.

The United States Food and Drug Administration has put boxed warnings for benzodiazepines and other antidepressants.

The FDA warns benzodiazepines may cause breathing problems or even death when combined with other opioid drugs. A person can also become dependent on these drugs. You may also experience withdrawal.

The warnings also state that antidepressants may cause suicidal thoughts and actions in children or adults younger than 25.

Suicide prevention

If you are aware of someone who is at immediate risk for self-harm, suicidal thoughts, or harming others:

  • You can ask yourself, “Are your thoughts of suicide increasing?”
  • Listen without judging.
  • Text TALK or call 911 to reach a crisis counsellor.
  • Keep the person company until help arrives.
  • Remove potentially dangerous objects, such as weapons, medicines, and other items.

A suicide prevention hotline is available to help you or someone who has self-harm thoughts. The Crisis and Suicide Lifeline can be reached 24 hours a day at 988. People who are deaf can dial their preferred relay service during a crisis or call 711 and then 988.

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Payment for medications

Mental health medications can be costly. Some people’s health insurance covers medications for GAD. Check your insurance policy to see what you are entitled to.

Medicaid can help some people.

The following organizations can also be of benefit to people:

  • NeedyMeds
  • RxHope
  • PAN Foundation

Alternative treatments to medication

Doctors will recommend to people with GAD that they use CBT in conjunction with Trusted Source. CBT is an anxiety treatment that helps you change your thought patterns.

The Anxiety and Depression Association of America recommends that people exercise regularly. Exercise can reduce anxiety and stress.

 

Doctors usually prescribe antidepressants to treat GAD. They can include escitalopram, duloxetine, venlafaxine and paroxetine. The FDA has put a boxed caution on these drugs as they may cause suicidal tendencies and thoughts in people under 25.

A doctor can prescribe benzodiazepines to relieve anxiety symptoms in the short term. These medications are fast acting and should not be taken for long periods.

A boxed warning is also included on benzodiazepines. People should not take benzodiazepines for long periods as they can cause dependency and serious adverse effects.

Buspirone, a nonbenzodiazepine drug, does not cause dependence. This medication does not have a boxed warning.

Speak to a doctor for the proper doses and what other medications you should avoid when taking this medication.