Generalised anxiety disorder (GAD) is a long-term condition, but a number of
different treatments can help.
If you have other problems alongside GAD, such as depression or alcohol misuse, these may need to
be treated before having treatment specifically for GAD.
Psychological therapies for GAD
If you have been diagnosed with GAD, you will usually be advised to try psychological treatment before you are
prescribed medication.
You can get psychological therapies like cognitive behavioural therapy (CBT) and applied relaxation on the NHS.
Your GP can refer you.
Guided self-help
Your GP or psychological therapies service may suggest trying a guided self-help course to see if it can help you
learn to cope with your anxiety.
This involves working through a CBT-based workbook or computer course in your own time with the support of a
therapist.
Or you may be offered a group course where you and other people with similar problems meet with a therapist every
week to learn ways to tackle your anxiety.
If these intitial treatments don't help, you'll usually be offered either a more intense psychological
therapy or medication.
Cognitive behavioural therapy
Cognitive behavioural
therapy (CBT) is one of the
most effective treatments for GAD.
Studies of different treatments for GAD have found that the benefits of CBT may last longer than those of
medication, but no single treatment works for everyone.
CBT helps you to question your negative or anxious thoughts and do things you would usually avoid because they
make you anxious.
It usually involves meeting with a specially trained and accredited therapist for a one-hour session every week
for three to four months.
Applied relaxation
Applied relaxation focuses on relaxing your muscles in a particular way during situations that usually cause
anxiety.
The technique needs to be taught by a trained therapist, but generally involves:
- learning how to relax your muscles
- learning how to relax your muscles quickly and in response to a trigger, such as the word "relax"
- practising relaxing your muscles in situations that make you anxious
As with CBT, applied relaxation therapy will usually mean meeting with a therapist for a one-hour
session every week for three to four months.
Medication
If the psychological treatments above have not helped or you would prefer not to try them, you will usually
be offered medication.
Your GP can prescribe a variety of different types of medication to treat GAD.
Some medication is designed to be taken on a short-term basis, while other medicines are prescribed for longer
periods.
Depending on your symptoms, you may require medicine to treat your physical symptoms as well as your
psychological ones.
If you are considering taking medication for GAD, your GP should discuss the different options with you in detail
before you start a course of treatment, including:
- the different types of medication
- length of treatment
- side effects and possible interactions with other medicines
You should also have regular appointments with your doctor to assess your progress when you are taking medication
for GAD.
These will usually take place every two to four weeks for the first three months, then every
three months after that.
Tell your GP if you think you may be experiencing side effects from your medication. They may be able to
adjust your dose or prescribe an alternative medication.
The main medications you may be offered to treat GAD are described below.
Selective serotonin reuptake inhibitors (SSRIs)
In most cases, the first medication you will be offered will be a type of antidepressant called a selective
serotonin reuptake inhibitor (SSRI).
This type of medication works by increasing the level of a chemical called serotonin in your brain.
Examples of SSRIs you may be prescribed include:
- sertraline
- escitalopram
- paroxetine.
SSRIs can be taken on a long-term basis but, as with all antidepressants, they can take several weeks
to start working.
You will usually be started on a low dose, which is gradually increased as your body adjusts to the medicine.
Common side effects of SSRIs include:
These side effects should improve over time, although some – such as sexual problems – can persist.
If your medication isn't helping after about two months of treatment or it's causing unpleasant side
effects, your GP may prescribe an alternative SSRI.
When you and your GP decide it's appropriate for you to stop taking your medication, you'll normally have
your dose slowly reduced over the course of a few weeks to reduce the risk of withdrawal effects.
Never stop taking your medication unless your GP specifically advises you to.
Serotonin and noradrenaline reuptake inhibitors (SNRIs)
If SSRIs don't help ease your anxiety, you may be prescribed a different type of antidepressant known
as a serotonin and noradrenaline reuptake inhibitor (SNRI).
This type of medicine increases the amount of serotonin and noradrenaline in your brain.
Examples of SNRIs you may be prescribed include:
Common side effects of SNRIs include:
- feeling sick
- headaches
- drowsiness
- dizziness
- dry mouth
- constipation
- insomnia
- sweating
SNRIs can also increase your blood pressure, so your blood pressure will be monitored regularly during treatment.
As with SSRIs, some of the side effects (such as feeling sick, an upset stomach, problems sleeping and feeling
agitated or more anxious) are more common in the first one or two weeks of treatment, but these usually settle
as your body adjusts to the medication.
Pregabalin
If SSRIs and SNRIs aren't suitable for you, you may be offered pregabalin.
This is a medication known as an anticonvulsant, which is used to treat conditions such as epilepsy, but, it's also been found
to be beneficial in treating anxiety.
Side effects of pregabalin can include:
- drowsiness
- dizziness
- increased appetite and weight gain
- blurred vision
- headaches
- dry mouth
- vertigo
Pregabalin is less likely to cause nausea or a low sex drive than SSRIs or SNRIs.
Benzodiazepines
Benzodiazepines are a type of sedative that may sometimes be used as a short-term treatment during a particularly
severe period of anxiety.
This is because they help ease the symptoms within 30 to 90 minutes of taking the medication.
If you're prescribed a benzodiazepine, it will usually be diazepam.
Although benzodiazepines are very effective in treating the symptoms of anxiety, they can't be used for long
periods.
This is because they can become addictive if used for longer than four weeks. Benzodiazepines also start to lose
their effectiveness after this time.
For these reasons, you won't usually be prescribed benzodiazepines for any longer than two to four weeks
at a time.
Side effects of benzodiazepines can include:
- drowsiness
- difficulty concentrating
- headaches
- vertigo
- tremor (an
uncontrollable shake or tremble in part of the body)
- low sex drive
As drowsiness is a particularly common side effect of benzodiazepines, your ability to drive or operate machinery
may be affected by taking this medication.
You should avoid these activities during treatment.
You should also never drink alcohol or use opiate drugs when taking benzodiazepine as doing so can be dangerous.
Referral to a specialist
If you've tried the treatments mentioned above and have significant symptoms of GAD, you may want to discuss
with your GP whether you should be referred to a mental health specialist.
A referral will work differently in different areas of the UK, but you'll usually be referred to your
community mental health team.
These teams include a range of specialists, including:
- psychiatrists
- psychiatric nurses
- clinical psychologists
- occupational therapists
- social workers
An appropriate mental health specialist from your local team will carry out an overall reassessment of your
condition.
They'll ask you about your previous treatment and how effective you found it.
They may also ask about things in your life that may be affecting your condition, or how much support you get
from family and friends.
Your specialist will then be able to devise a treatment plan for you, which will aim to treat your symptoms.
As part of this plan, you may be offered a treatment you haven't tried before, which might be one of the
psychological treatments or medications mentioned above.
Alternatively, you may be offered a combination of a psychological treatment with a medication, or a combination
of two different medications.