Generalised anxiety disorder - Treatment 

Treating generalised anxiety disorder 

Mental and emotional health: talking therapies

Learn about different talking therapies that can help people overcome a range of problems, from depression to stress. Tip: check with your GP whether there are any IAPT services (Improving Access to Psychological Treatment) in your area.

Media last reviewed: 11/07/2013

Next review due: 11/07/2015

GAD medicines information

Read more about the medicines used to treat generalised anxiety disorder

Generalised anxiety disorder (GAD) is a long-term condition, but a number of different treatments can help.

Before you begin any form of treatment, your GP should discuss all your treatment options with you. They should outline the pros and cons of each and make sure you are aware of any possible risks or side effects.

With your GP, you can make a decision on the treatment most suited to you, taking into account your personal preferences and circumstances.

If you have other problems alongside GAD, such as depression and drug or alcohol misuse, these may need to be treated before having treatment specifically for GAD.

Initial treatment

At first, your GP may suggest trying an individual self-help course for a month or two to see if it can help you learn to cope with your anxiety.

This will usually involve working from a book or computer programme on your own (you will be given advice about how to use the book or programme before you start), with only occasional contact with your doctor.

Alternatively, you may prefer to go on a group course where you and a few other people with similar problems meet with a therapist every week to learn ways to tackle your anxiety.

See self-help tips for anxiety for more information about these treatments.

If these initial treatments do not help, you will usually be offered either a more intensive psychological treatment or medication. These are described below.

Psychological treatment

If you have been diagnosed with GAD, you will usually be advised to try psychological treatment before you are prescribed 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 is best for everyone.

CBT helps you to understand how your problems, thoughts, feelings and behaviour affect each other. It can also help you to question your negative and anxious thoughts, and do things you would usually avoid because they make you anxious.

CBT will usually involve meeting with a specially trained and accredited therapist for a one-hour session every week for three to four months.

Your therapist should carry out CBT in a standardised way according to a treatment manual, and they should receive regular supervision to support them in providing the most effective treatments.

Applied relaxation

Applied relaxation is an alternative type of psychological treatment that can be as effective as CBT in treating GAD.

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 you 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, including the different types of medication, length of treatment, side effects and possible interactions with other medicines, before you start a course of treatment.

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 sertralineescitalopram and 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 will gradually be increased as your body adjusts to the medicine.

Common side effects of SSRIs include:

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 will usually settle as your body adjusts to the medication.

If you or your GP feels that your medication is not helping after about two months of treatment, or if it is causing unpleasant side effects, your GP may prescribe an alternative SSRI to see if that has any effect.

When you and your GP decide that it is appropriate for you to stop taking your medication, you will 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 do not 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 the chemicals serotonin and noradrenaline in your brain.

Examples of SNRIs you may be prescribed include venlafaxine and duloxetine.

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 will usually settle as your body adjusts to the medication.

Pregabalin

If SSRIs and SNRIs are not 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 (a condition that causes repeated seizures). However, it has 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 (the sensation that you, or the environment around you, is moving or spinning)

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 because they help ease the symptoms within 30 to 90 minutes of taking the medication.

Examples of benzodiazepines you may be prescribed include chlordiazepoxidediazepam and lorazepam.

Although benzodiazepines are very effective in treating the symptoms of anxiety, they cannot be used for long periods of time 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 will not 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 therefore avoid these activities during treatment.

Referral to a specialist

If you have 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 will usually be referred to your community mental health team. These teams include a range of specialists, including psychiatrists, psychiatric nurses, clinical psychologists, occupational therapists and social workers.

An appropriate mental health specialist from your local team will carry out an overall reassessment of your condition. They will 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 effectively treat your symptoms.

As part of this plan, you may be offered a treatment you have not 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.

Page last reviewed: 25/02/2014

Next review due: 25/02/2016

Ratings

How helpful is this page?

Average rating

Based on 256 ratings

All ratings

Add your rating

Comments

The 12 comments posted are personal views. Any information they give has not been checked and may not be accurate.

AME80 said on 02 September 2014

I feel like I'm going crazy, for the past 10 years I have periods lasting for weeks - months of forgetting how to breathe. I then spend every minute of the day concentrating on it which hurts my chest as I feel like I need to take big breaths. This can give me a headache, but there is no let up I can't stop it, does anyone else have this?

Report this content as offensive or unsuitable

Toronto101 said on 20 November 2013

I am 40, I have suffered from anxiety since I was19. It affected me in numerous relation ships, confidence etc etc. I had panic attacks, hid from friends, made excuses that I had sickness or a bad back, anything which could put a tangible illness to my symptoms (all made up of course). I am posting this for one reason, I didn't go and see a doctor, thought I was just a pathetic loser and from being a confident sportsman, I ended up being a depressed wreck, self medicating on drink and sometimes drugs. It took me 10 years to go and talk about it to a doctor, who was very good. I tried cut, but it didn't work for me. I am treated with fluoxetine for GAD and I exercise 5 times a week x 5.5 miles . It has took me only to a few years ago now to talk about this freely. Everyone is different and needs to be treated differently. The one common message is this, go and see about it to your gp, if you don't feel you are being listened to properly then see another and another, the only way to start the journey is by finding the courage to talk about it, believe me it's worth it. Everyone has a secret to it and ive tried anything from Chinese to Tibetan herbs to painkillers and alcohol and the only thing that did work was believing in real medicine and exercise! It's a horrendous illness which no one seems to understand, and more common than you may think!

Report this content as offensive or unsuitable

tchopra said on 19 July 2013

iv had anxiety for almost 6 yrs now..n the worse part is it triggered when i was 19...i wont bother with the long story about my symptoms and fights, just to put it togeher im running a chain of restaurants successfully with a dsyfunctional personal life.. after many years of medications and trying almost all other possibe cures, anxiety remains constant, and so be it, my focus is now to let the anxiety remain but get rid of the panic attacks, iv been following reseearchs and constantly talking to my psychologist, one of the main triggers for me is change in weather, specially when its humid.... please do let me know if change in season, or weather, or even daylight has triggerd anxiety in anyone else? ur reply will be valuable... cheers

Report this content as offensive or unsuitable

User762484 said on 07 April 2013

Hi
Been having anxiety issues since dec.. And seriously its d symptoms are really frightening...
Lightheads
Tidness
Feeling like I'll faint or pass out
Pounding heartbeat
Agigtation
Fatigue
Pain all around
Mucsle strains
Cramps sometimes
Indigestion like my food digests so slow..etc
Did an abdominal scan which proved that my organs r okay,
Sme blood test and urinal to show my glucose level everything proves okay, I notice I'v been very sensitive I don't know if I'm reacting to some antibiotic I took or something.. I just need someone for councel...thanks

Report this content as offensive or unsuitable

Lexington9 said on 24 March 2013

Hello all anxiety sufferers,

Would just like to say how much more happier I feel by knowing I am not suffering alone.

I am currently on Propronalol and Amitriptaline to help me cope. However they make me extremely tired which make everyday a struggle particularly when at work which causing a risk of being laid off because i cannot give my 100% like i used before this happened and also completing general tasks around the house which is causing a lot of stress, upset and arguments in my relationship.

I seem to suffer terribly with headaches which have never been experienced before. They are so bad that they cause me to feel faint everyday and being sent home from work on a regular basis. I have been to A & E several times but I get no help and told that fainting is normal. I ask them how many times does one person like myself have to faint before you will do something about it. There was no answer just silence.

No proper diagnosis has been made up to now by either my GP or my Neurologist. I believe my anxiety started as many major stressful events occurred last year and body just couldn't stay strong any longer. Whether my headaches are caused by the anxiety is unknown.

Currently awaiting MRI scan results and I hope that nothing serious will show up and that a full and accurate diagnosis is made which will mean I can come off all medication all together and return to my life as normal like I was before.

Anyone who reads this and has experienced the exact same as me or may know the cause of this. I would appreciate your comments.

Report this content as offensive or unsuitable

JCJC777 said on 14 March 2013

Please include REBT on this page (as Mind do on theirs) - I have self-applied it (from Ellis' books), and found it very useful, accurate and powerful. It is entirely fair to say it has changed my life. Thank you.

Different things work for different people!

Report this content as offensive or unsuitable

queenmariebrizard said on 06 January 2012

Kendray4 posted about a good webiste on 31 December but the complete title isnt there - if you read this can you post it again please?

Report this content as offensive or unsuitable

kendray4 said on 31 December 2011

I have suffered from anxiety for as long as I can remember. I was prescribed diazepam and citalopram,but have now weaned myself off diazepam with my doctors help. My GP referred me to a clinical psychologist. There was a long wait, but it was worth it. The psychologist has been very helpful and the treatment effective. This site is good: http://treatanxiety.co I have been seeing a clinical psychologist and am having CBT and practising mindfulness. Finally my anxiety and panic is improving. Mindfulness has been very helpful.

Report this content as offensive or unsuitable

mkinsey said on 09 November 2011

I've just read these symptoms and realised I have over 50% of the symptoms of GAD! Since July this year, I've suffered with severe 'shortness of breath' and feeling as though something is blocked in my lung. I went to 2 docs, one of who said I wasn't short of breath as OX saturation was 99% and I had 'fluid on lungs' caused by a virus and it would clear up, if not go back for antibiotics. It still hadn't cleared within 4 weeks so went back to my GP who said my lungs were clear and there was no 'fluid' yet the 'shortness of breath' continued - as well as bloating, stomach pain, constipation, headaches, aching back and shoulders. I was prescribed Lansoprazole for 'excessive stomach acid' and tested for H.Pylori (negative). It eventually went away and thought that was the end of it but now its back. Breathlessness only happens when I'm sitting down though, got a constant aching and painful back and shoulder and an aching pain in my groin. Both legs and knees ache constantly. No one has any explanation as to what this is. Even my husband and parents are beginning to think I'm a hypochondriac. Its really there though, I'm not imagining it. I'm sick of traipsing back and forth to the doctors and feeling like they don't believe me. I'm constantly worrying I have something seriously wrong like Cancer or a random disease causing this pain and am getting no treatment. Hot baths, hot heat packs/hot water bottles, hot stone massage help ease the pain. It disappears completely when I'm in the bath then comes back when I get out. I'm losing the will to live and have resigned myself to a life of severe pain. I'm only 25 year old with a 2 year old son who I can't run after or play on the floor with due to aching muscles and I'm always knackered due to lack of sleep :( Glad there's someone else out there who has this disorder too x

Report this content as offensive or unsuitable

Anonrockdude said on 08 November 2011

If you have anxiety, panic, phobias etc I would urge you...URGE you to seek medical advice as soon as you can. I suffered from severe anxiety due to a traumatic experience which led to social phobia and agoraphobia. I left it months before I went to the doctors, spent 1000s on miracle Internet cures, self help books- the lot. I didn't want to go to the docs because I was embarrassed. Also I'd read countless stories on the Internet of people having bad experiences and no help from their doctors. And...I didn't want to end up just being offered medication. Anyway, this weekend I was left alone in the house and just broke down. I felt I couldn't go on anymore. I called NHs direct and they were so kind and understanding. They got an out of hours doctor to call me and hour later and he was so reassuring and really calmed me down. I then visited my doc today and broke down in front of her and told her everything. Her words made me understand what was happening to me and I felt so relieved.She referred me to counselling immediately and did not prescribe any medication. She did talk to me about it and said it might be something I'd like to consider (a very mild anti depressant). But we agreed it wasn't drugs that I needed. The only thing that was wrong with me was my thoughts taking over and therapy would sort that out. I'm now on a waiting list but my doc said I should expect therapy from the NHs in a short time- 4 weeks. I can cope with that because I do have a therapist I can access if I feel really bad in the meantime. Please- don't hang aroud, act as soon as possible. Don't read everything on the Internet and dont believe these horror stories about your condition. Also- please watch out for these Internet quick cures. Most are rubbish. The only one I came across that was worth the money was the linden method. I didn't follow the instructions so it hasnt worked for me yet, but I plan on using it from tomorrow whilst waiting for my therapy. But GO TO YOUR DOCS FIRST!!!

Report this content as offensive or unsuitable

lucylou1973 said on 27 February 2011

my daughter has gad she only 10years old and she had it for 2years and she on sleeping tablets as she cant sleep from worrying about everything...is there anything they can give to kids to help GAD she had 12weeks of CBT but it not worked...

Report this content as offensive or unsuitable

dhg said on 21 November 2009

It is good to be able to find information concerning the such personal issues, but why are children not mentioned. I have had several poor experiences with health professionals and other adults, concerning my child, who has heightened generalised anxeity. Please acknowledge that this does not just affect adults.

Report this content as offensive or unsuitable

Mental health helplines

If you're concerned about your mental health or that of a loved one, these helplines can offer advice and support

Ten ways to fight your fears

Whatever your fear is, these 10 tips can help you cope with your stress and anxiety