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.
Tricyclic Antidepressants (TCAs)
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. Some may even 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.
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.
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.
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. 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.
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.
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. For more mental health resources, see our National Helpline Database.
