Treatment - Generalised anxiety disorder

Generalised Anxiety Disorder (GAD) can be a long-term condition.

There are different treatments available. Your GP will discuss all the treatment options with you. They will tell you about any possible risks or side effects.

You can decide on the most suitable treatment with your GP.

Initial treatment

Your GP may suggest some educational resources about anxiety.

This usually involves working from a book or computer programme. A health professional such as a psychologist or a mental health nurse will support you.

Another option is going to a group course. At these courses you and a few other people with similar conditions meet with a therapist every week. You learn ways to manage your anxiety.

You may need more intensive therapy or medicine if initial supports do not help.

Primary care psychology

You do not need a referral from your GP. You can refer yourself to primary care psychology.

Your GP will be happy to talk it through with you first, if you prefer.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is one of the most effective treatments for GAD. The benefits may last longer than the benefits from medicine.

CBT helps you manage problems by thinking in a more balanced way. It can free you from unhelpful patterns of behaviour.

It can also help you do things you would usually avoid.

Mindfulness and applied relaxation

Mindfulness and applied relaxation are alternative types of psychological treatment.

Mindfulness helps you focus on the present moment. It allows you to acknowledge and accept certain feelings. It can reduce anxiety associated with the fear of actual situations or sensations.

Applied relaxation focuses on relaxing your muscles in a particular way. A trained therapist teaches you how to do this.

This alleviates anxiety and involves:

• learning how to relax your muscles
• relaxing your muscles quickly in response to a trigger
• practising relaxing your muscles in situations that make you anxious

Find out more about mindfulness

Medicine

If psychological treatments do not help, medicine might be the next option.

There is a range of medicines your GP can prescribe to treat GAD.

Your GP can discuss options with you in detail, such as:

• the different types of medicines
• the length of treatment
• the side effects and possible interactions with other medicines

You should see your GP regularly while taking medicine for GAD.

Tell your GP if you think you may be experiencing side effects from your medicine. They may be able to adjust your dose or prescribe an alternative medicine.

The main medicines for treating GAD are:

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant. They increase the level of a chemical called serotonin in your brain.

Common SSRIs prescribed for anxiety include:

• sertraline
• escitalopram
• paroxetine

SSRIs are taken on a long-term basis. You'll start with a low dose and increase as your body adjusts to the medicine.

They can take several weeks to start working.

Common side effects of SSRIs include:

• feeling agitated
• feeling or being sick
• indigestion
• diarrhoea or constipation
• loss of appetite and weight loss
• dizziness
• blurred vision
• dry mouth
• excessive sweating
• headaches
• problems sleeping or drowsiness
• low sex drive
• difficulty achieving orgasm during sex or masturbation
• in men, difficulty obtaining or maintaining an erection

These side effects should improve after 2 weeks, but some side effects can persist.

If your medicine is not helping after about 2 months of treatment, talk to your GP.

When it's OK for you to stop taking your medicine, your GP will reduce your dose slowly. This reduces the risk of withdrawal effects.

Do not stop taking your medicine unless your GP advises you to.

Find out more about antidepressants

Serotonin and noradrenaline reuptake inhibitors (SNRIs)

Serotonin and noradrenaline reuptake inhibitors (SNRIs) are another type of antidepressant. They increase the amount of serotonin and noradrenaline in your brain. SNRIs can also increase your blood pressure.

Examples of SNRIs include:

• venlafaxine
• duloxetine

Common side effects of SNRIs include:

• feeling sick
• headaches
• drowsiness
• dizziness
• dry mouth
• constipation
• insomnia
• sweating

As with SSRIs, some of the side effects are more common in the first 1 or 2 weeks of treatment. These usually settle as your body adjusts to the medicine.

Pregabalin

If SSRIs and SNRIs are not suitable for you, pregabalin is an option. This is a medicine known as an anticonvulsant. It is used to treat conditions such as epilepsy. It can also help treat 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, sometimes used as a short-term treatment. They are particularly effective during a severe period of anxiety. They will help to ease the symptoms within 30 to 90 minutes of being taken.

If you're prescribed a benzodiazepine, it will usually be diazepam.

Benzodiazepines are very effective in treating the symptoms of anxiety. But they can become addictive if you use them for longer than 4 weeks. Benzodiazepines also start to lose their effectiveness after this time.

They are usually not prescribed for any longer than 2 to 4 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

Referral to a specialist

If the symptoms of GAD persist, talk to your GP about a referral to a community mental health team (CMHT).

A CMHT usually has the following:

• psychiatrists
• psychiatric nurses
• clinical psychologists
• occupational therapists
• social workers

Members of the mental health team will speak to you again about your difficulties. They'll ask you about your previous treatment and how effective you found it.

They'll ask about things in your life that may be affecting your condition, as well as how much support you get from family and friends.

Your mental health team will then develop an individual care plan with you. This will focus on your goals and how to support you.

This plan may include a treatment you have not tried before.

You may need psychological treatment and medicine. A combination of 2 different medicines is also an option.

Organisations that provide mental health services