Department of Psychiatry
Penn Behavioral Health

Center for the Treatment and Study of Anxiety

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Generalized Anxiety Disorder




Treatment of GAD with Medication

Antidepressant Medications: SSRIs

The main pharmaceutical treatment for GAD is with selective serotonin reuptake inhibitors (SSRIs), which are antidepressants that block the re-absorption of serotonin in the brain. Although SSRIs are commonly given for depression, research has shown they can also be effective for the treatment of anxiety. Common side effects may include: headaches, nausea, sexual dysfunction, and diarrhea among others. The most commonly prescribed SSRIs for GAD are:

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

Other drugs prescribed for GAD include:

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

Effexor is a category of drug known as a serotonin-norepinephrine reuptake inhibitor (SNRI), which affects the re-absorption of both serotonin and norepinephrine in the brain. Tofranil is a category of drug known as a tricyclic antidepressant (TCA). Tricyclics affect levels of serotonin, norepinephrine, and dopamine. BuSpar also acts as a blocker of serotonin reuptake.


Benzodiazepines

Benzodiazepines, also referred to as “Benzos”, are sedative medications which are sometimes prescribed to treat GAD as well as other anxiety disorders. This class of medications is usually prescribed for short-term use, as they have been found to be habit-forming for some patients. Common benzodiazepines prescribed for GAD include:

  • Xanax (Alprazolam)
  • Klonipin (Clonazepam)
  • Valium (Diazepam)
  • Ativan (Lorazepam)


Because SSRI medications may take several weeks to start showing an effect, psychiatrists may prescribe both a SSRI and a Benzodiazepine medication at the same time. When the SSRI begins to show an effect, the Benzo will begin to be tapered off.

Although medications have proven to be effective in the treatment of GAD symptoms, there are several drawbacks to their use for the long-term symptom reduction of both GAD and other anxiety disorders. Aside from the side effect risks and in the case of Benzodiazepines the threat of addiction, the treatment of GAD through medication does not seem to change the way people think about their worries. Because of this, patients who discontinue their medication are likely to see a relapse of their anxiety symptoms.




Treatment of GAD through Psychotherapy

Cognitive Behavioral Therapy

Of the many forms of psychotherapy for GAD, the most heavily researched and effective form of therapy is cognitive behavioral therapy, sometimes referred to as CBT. CBT has been shown to produce significant long-term reductions in symptoms for GAD as well as other anxiety disorders. The focus of CBT is usually two-fold: the first involves the therapist helping the patient to identify and examine the specific thoughts that are contributing to their feelings of anxiety. Once these thoughts are identified, the patient and the therapist work together to examine information that may disconfirm the thoughts or beliefs the patient holds, and in doing so develop alternative thoughts that are more realistic and less anxiety-provoking. In the case of GAD, the patient and therapist might examine what the actual probability is of something catastrophic happening to either the patient or a family member. If a patient continuously worries about the health of family and friends, the therapist might ask the patient to list what if any evidence exists that would point to those people becoming seriously ill. The goal of these exercises is to allow the patient to carefully examine their anxiety-producing thoughts and hopefully come to the realization that they are baseless and the source of their distress.

The second focus of a CBT intervention involves a therapeutic process known as exposure therapy. During exposure, patients are repeatedly presented with either real-world or imagined situations that are anxiety provoking and that have been avoided in the past. The goal of exposing patients to feared situations and scenarios is to help them understand that while they will initially experience anxiety at the beginning of the exposure, as time passes during the exposure their anxiety will start to steadily decrease. The therapist will ask the patient to perform exposure exercises both during sessions and at home as homework assignments. For a patient with GAD, the therapist would be more likely to utilize exposure to imagined situations, since the worries of GAD patients are often future oriented and therefore can’t always be confronted in the present. An example of an imaginal exposure a therapist could do with a GAD patient who worries about getting fired at work would be to create a scenario where the patient is reprimanded for their conduct or performance at work and is let go. The therapist will usually record the exposure and ask the patient to listen to the tape as a homework assignment in between sessions.

Therapists may sometimes also include two other components, relaxation training and coping strategies, in the cognitive behavioral treatment of GAD. In relaxation training, patients are taught breathing exercises and other techniques that can be implemented during times of intense stress or anxiety to help them calm down. Although CBT therapists will teach these procedures as tools patients can use, they will not want patients to use them during exposure exercises, since the goal is to have patients become anxious and learn there anxiety will eventually decrease on its own.


Psychodynamic Treatments

Psychodynamic therapies can also be used to anxiety disorders, including GAD. This form of therapy is usually heavily focused on the patient-therapist relationship, and uses discussion and other analytic methods to discover the root, unconscious causes of the patients’ anxiety. Psychodynamic treatments for anxiety are usually carried out over a long period of time. While individual patients may have found this form of therapy to be helpful in reducing anxiety symptoms, there is very little research that shows significant results for this form of therapy in reducing anxiety.



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