Medications for Treatment of GAD

Medications for Treatment of GAD GAD Treatment Print Medications for Generalized Anxiety Disorder (GAD) By Nancy Schimelpfening Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be. Learn about our editorial policy Nancy Schimelpfening Reviewed by Reviewed by Amy Morin, LCSW on July 01, 2019 facebook twitter instagram Amy Morin, LCSW, is a psychotherapist, author of the bestselling book 13 Things Mentally Strong People Dont Do, and a highly sought-after speaker. Learn about our Wellness Board Amy Morin, LCSW Updated on February 04, 2020 Generalized Anxiety Disorder Overview Symptoms & Diagnosis Causes Treatment Living With In Children Jonathan Nourok / Getty Images If you have generalized anxiety disorder (GAD), you may receive a combination of counseling and medication for management of your condition. GAD is characterized by symptoms of unfounded  chronic  and exaggerated worry or apprehension that is more severe than the  normal anxiety  most people experience.   Treatments for GAD fall into several categories: Antidepressants relieve symptoms of anxiety and depression.Benzodiazepines, often considered tranquilizers, reduce anxiety quickly.Azapirones, considered mild anti-anxiety medications, take longer than benzodiazepines to have their effect and are recommended for long-term use.Anti-convulsants and antipsychotic medications are also options that are sometimes used to manage anxiety. Antidepressants Interestingly, while the symptoms of anxiety and depression are not the same, antidepressants are usually effective in managing anxiety. There are different classes of  antidepressants  used to reduce anxiety in GAD. Over half of people who are diagnosed with GAD also have depression, and antidepressants work to relieve those symptoms as well. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): This class includes Cymbalta (duloxetine) and Effexor (venlafaxine). They are considered as effective as the SSRIs and are the first-line treatment for GAD.Selective Serotonin Reuptake Inhibitors (SSRIs):  This class includes Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline). The side effects of  SSRIs  are less severe than those of tricyclic antidepressants (TCAs). SSRIs produce fewer cardiac effects and less  weight gain  and sedation  than the TCAs.Tricyclic Antidepressants: TCAs used to treat panic disorder include Tofranil (imipramine), Pamelor (nortriptyline), Norpramin (desipramine), and Anafranil (clomipramine). Tricyclics, unlike benzodiazepines, require only a single daily dose of medication. However, TCAs may produce feelings similar to those of a panic attack. People with panic disorder are especially sensitive to this effect of TCAs and some may experience an activation of their symptoms, including agitation, irritability, and restlessness, at the start of treatment. Generally, treatment with a TCA starts with a low dose which is increased over time. Dividing the dose, with the majority of the medication taken before bedtime, can alleviate some side effects. One major disadvantage of tricyclics is that they can produce cardiac side effects, such as dizziness and heart palpitations, along with weight gain and sedation.Monoamine Oxidase Inhibitors (MAOIs): These medications have been found to be highly effective in the treatment of anxiety disorders, including panic disorder and  social phobia. There are, however, serious side effects. People taking MAOIs must follow a restrictive diet to avoid 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. Because antidepressants take weeks to have their effect, a benzodiazepine, which is a fast-acting anti-anxiety agent, may be prescribed during the initial phase of treatment. Benzodiazepines Benzodiazepines can be taken regularly to manage the symptoms of GAD for a short while when antidepressants are beginning to take effect. Medications in this class include Klonopin (clonazepam), Ativan (lorazepam), and Xanax (alprazolam). There is a high incidence of panic disorder among people who are diagnosed with GAD.  Benzodiazepines are effective in reducing panic attacks  and behavior that stems from phobias (irrational fears). They are also used in the  anticipatory  phase of panic attacks. Benzodiazepines act quickly, and approximately one-half of people who use them  experience withdrawal symptoms when the medication is discontinued. Some people may develop a tolerance to them.  A history of alcohol or drug abuse may be a contraindication to  benzodiazepine  use. Benzodiazepines cause side effects such as sedation, and may also increase falls and cause confusion and memory problems in the elderly. A person who works with heavy machinery might not be able to take benzodiazepines if drowsiness occurs. Once a prescribed antidepressant takes effect, the dose of a benzodiazepine can be gradually decreased until it can be safely stopped. How Benzodiazepines Can Help People With Anxiety Problems Azapirones Buspirone  may also be used to treat GAD. The brand name of BuSpar is no longer on the market, but generics may be available.  Buspirone is slow acting and it takes a few weeks to take effect. Buspirone does not cause sedation like the benzodiazepines and it does not lead to drug dependence. An Overview of BuSpar as an Anxiety Treatment Antipsychotic and Anticonvulsant Medications Other medications used for GAD include anticonvulsant (anti-seizure) medications, such as pregabalin, and antipsychotics that fall into the category of atypical antipsychotics, such as vortioxetine. These treatments may be considered if you do not improve with traditional therapies or if you experience intolerable side effects.