Generalized anxiety disorder medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

There are a variety of medications which can be used to treat generalized anxiety disorder, and they generally work well particularly in conjunction with psychotherapy. The first line treatments are the SSRI class of antidepressants such as fluoxetine, paroxetine, and escitalopram. Other antidepressants such as imipramine, venlafaxine, and buspirone may also be effective. Benzodiazepines provide quick, effective relief from anxiety, however must be prescribed with caution due to a high risk of abuse and dependence.

Medical Therapy

Selective Serotonin Reuptake Inhibitor

Main article: Selective serotonin reuptake inhibitor

Pharmaceutical treatments for GAD, include selective serotonin reuptake inhibitors (SSRIs), which are antidepressants that influence brain chemistry to block the reabsorption of serotonin in the brain. SSRIs are mainly indicated for clinical depression, but are also effective in treating anxiety disorders. Common side effects include nausea, sexual dysfunction, headache, diarrhea, among others. Common SSRIs prescribed for GAD include:

• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Escitalopram (Lexapro;Cipralex)

Other Medications

Venlafaxine (Effexor) is a serotonin-norepinephrine reuptake inhibitor (SNRI). SNRIs, a class of drugs related to the SSRIs, alter the chemistries of both norepinephrine and serotonin in the brain. Imipramine (Tofranil) is a tricyclic antidepressant (TCA). TCAs are thought to act on serotonin, norepinephrine, and dopamine in the brain. Buspirone is a serotonin receptor agonist belonging to the azaspirodecanedione class of compounds.

• Imipramine (Tofranil)
• Venlafaxine (Effexor)
• Buspirone (BuSpar)

Benzodiazepines

Main article: Benzodiazepine

Benzodiazepines (or "benzos") are fast-acting sedatives that are also used to treat GAD and other anxiety disorders. These are often given in the short-term due to their nature to become habit-forming. Side effects include drowsiness, reduced motor coordination and problems with equilibrioception. Common benzodiazepines used to treat GAD include:

• Alprazolam (Xanax)
• Chlordiazepoxide (Librium)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Lorazepam (Ativan)

Herbal

Main article: Kava

• Kava, a relaxant made from a root only of a relative of the black pepper plant, is effective at controlling anxiety - particularly when used as a short term fast acting drug in combination with CBT (see below).
• The recommended use is for a support person such as the GAD sufferer's partner or housemate to encourage a dose when anxiety strikes as the patient is often unwilling/unable to dose themselves.
• Kava is absorbed through most mucous membranes and takes effect in roughly the same time as alcohol.
• It is a symptomatic relief for anxiety and does not address the fundamental problem, but it does give the patient a reliable mental crutch to work through the core problems.
• It appears that the required dosage actually decreases with regular use, perhaps as a form of conditioning.
• Two major advantages of Kava supported therapy are:
• The rapid response of the active ingredients (removing the need for titration)]
• The lack of withdrawal symptoms.
• There are no specific contraindications with other chemical treatments, but caution must be observed when the patient is already taking psychoactive drugs.