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Treatments for Generalized Anxiety Disorder (GAD)

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

 

The two main forms of treatment available for Generalized Anxiety Disorder are psychotherapy and medications. See the GAD guidelines for recommendations on when to consider using each of these different modalities.

Psychotherapy for Generalized Anxiety Disorder

Cognitive Behavioral Therapy (CBT) and Applied Relaxation Training have been the most extensively studied psychotherapies for Generalized Anxiety Disorder, and for this reason would be the first choices for treatment [ref, ref]. These two therapeutic approaches are often combined in the same therapy. There is also some evidence that Short-term Psychodynamic Psychotherapy is as effective as CBT for treating GAD [ref].

Medications for Generalized Anxiety Disorder

Antidepressants for GAD

Antidepressants have been shown to be effective for treating Generalized Anxiety Disorder and would be considered the first-line options for this condition [ref, ref]. These include the SSRIs (with the most evidence for Escitalopram, Paroxetine and Sertraline), Venlafaxine, and Duloxetine.

Buspirone, a medication with properties that are similar to some antidepressants, is also a first-line treatment for GAD [ref, ref].

Imipramine, a Tricyclic Antidepressant, has been shown to work for GAD [ref] but, because of its side-effect profile, the other medications listed above would be preferred [ref].

Two other antidepressants, Mirtazapine and Bupropion, are options to consider, but so far very few studies have been done to test their effects on GAD [ref].

Benzodiazepines for GAD

Benzodiazepines when used alone can help treat GAD. Although they work more quickly than the antidepressants, some studies have found that they may not be as effective in the long run [ref]. Also, benzodiazepines seem to be of little benefit for treating GAD when the person is suffering from a concurrent episode of Major Depression (in which case antidepressants are preferred) [ref].

Although in studies benzodiazepines are usually prescribed on a regular basis with a consistent daily dose, in practice they are often used on an as-needed basis and seem to work equally well in this way [ref].

The main problem with using the benzodiazepines is that discontinuing them at the end of treatment tends to be difficult and to produce a significant rebound in symptoms, especially when shorter-acting forms like Alprazolam are used [ref]. Longer-acting benzodiazepines such as Clonazepam or Diazepam are thus preferred.

Contrary to popular belief, the development of abuse or tolerance (needing higher doses for the same effect) to these medications is not a significant risk when used for treating conditions like GAD [ref, ref].

Atypical Antipsychotics for GAD

There is some evidence that Atypical Antipsychotics can be added to antidepressants in order to boost their effects for difficult cases of GAD [ref, ref]. Quetiapine XR has also been shown to be effective on its own as monotherapy for treating GAD [ref].

Other medications for GAD

Pregabalin and Hydroxyzine have both been shown in various studies to be effective in treating symptoms of GAD when used alone [ref, ref].

Combining Psychotherapy and Medications for GAD

There is some evidence that psychotherapy and medications are roughly equally effective when used on their own for treating Generalized Anxiety Disorder, though individuals who receive psychotherapy may retain the gains of the treatment for longer after the therapy has ended compared with those who took medications [ref].

There has not been much research examining the question of whether there is any benefit to combining psychotherapy and medications at the outset for treating GAD, versus just starting either one of these treatments alone. In most cases, it makes sense to choose one of these treatments first, and then add the second if needed, though in severe cases it may be warranted to begin both kind of treatment right away.

 

Course & Prevalence

Treatment Guidelines