Generalised anxiety disorder (GAD) is a long-term condition,but a number of different treatments can help.
If you have other problems alongside GAD, such as depressionor alcohol misuse, these may need to be treated before you have treatment specifically for GAD.
Psychological therapies for GAD
If you have been diagnosed with GAD, you'll usually be advised to try psychological treatment before you're prescribed medication.
You can get talking therapies like cognitive behavioural therapy (CBT) and applied relaxation on the NHS.
You can refer yourself directly to an NHS talking therapies service without a referral from a GP.
Or your GP can refer you if you prefer.
Guided self-help and cognitive behavioural therapy (CBT)
Your GP or talking therapies service may suggest trying a self-help course to see if it can help you learn to cope with your anxiety.
Self-help courses for GAD are usually based on the principles of cognitive behavioural therapy (CBT).
CBT is a type of talking therapy that can help you manage your problems by changing the way you think and behave.
CBT is one of the most effective treatments for GAD.
There are several ways you may be offered self-help and CBT:
- you work through a CBT workbook or computer course in your own time
- you work through a CBT workbook or computer course with the support of a therapist who you see every 1 or 2 weeks
- you take part in a group course where you and other people with similar problems meet with a therapist every week to learn ways to tackle your anxiety
If these initial treatments don't help, you'll usually be offered more intensive CBT where you usually have weekly sessions with a therapist for 3 to 4 months, or another type of therapy called applied relaxation or medication.
You can try some self-help cognitive behavioural therapy (CBT) techniques on the Every Mind Matters website. This is not a full CBT course or guided self-help, but it has practical self-help tips and strategies based on CBT techniques.
Applied relaxation
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 andgenerally 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 1-hour sessionevery week for 3 to 4 months.
Relaxation therapy may not be available in all areas, so you might be offered CBT instead.
Video: Talking therapies for stress, anxiety and depression
Animated video explaining self-referral to talking therapies services for stress, anxiety or depression.
Media last reviewed: 14 March 2022
Media review due: 14 March 2025
Medication
If thepsychological treatments above haven't helped or you'd prefer not to try them, you'll 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 others are prescribed for longer periods.
Depending on your symptoms, you may need medication to treat your physical symptoms, as well as your psychological ones.
If you're considering taking medication for GAD, your GP should discuss the different options with you in detailbefore you start a course of treatment, including:
- the different types of medication
- length of treatment
- side effects and possible interactions with other medicines
- which medication is best for you if you’re pregnant, planning a pregnancy or breastfeeding
You should also have regular appointments with your doctor to assess your progress when you're taking medication for GAD.
Thesewill usuallytake place every2 to 4 weeks for the first 3 months, then every 3months after that.
Tellyour 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.
Selective serotonin reuptake inhibitors (SSRIs)
In most cases, the first medication you'll be offered will be a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI).
This type of medication works byincreasing the level of a chemical called serotonin in your brain.
Examples of SSRIs you may be prescribed include:
- sertraline
- escitalopram
- paroxetine
SSRIscan be taken on a long-term basis but, as with all antidepressants, they can take several weeks to start working.
You'll usually be started on a low dose, which may be gradually increased as your body adjusts to the medication.
Common side effects of SSRIs include:
- feeling agitated
- feeling or beingsick
- indigestion
- diarrhoeaorconstipation
- loss of appetiteand weight loss
- dizziness
- blurred vision
- dry mouth
- excessive sweating
- headaches
- problems sleeping (insomnia) or drowsiness
- low sex drive
- difficulty achieving org*sm during sex or masturbation
- in men, difficulty obtaining or maintaining an erection (erectile dysfunction)
These side effects should improve over time, although some may be related to your underlying condition.
Serotonin and noradrenaline reuptake inhibitors (SNRIs)
If SSRIs don't help ease your anxiety, you may be prescribed a different type of antidepressant known asaserotonin and noradrenaline reuptake inhibitor (SNRI).
This type of medication increases the amount of serotonin and noradrenaline in your brain.
Examples of SNRIs you may be prescribed include:
- venlafaxine
- duloxetine
Common side effects ofSNRIsinclude:
- feeling sick
- headaches
- drowsiness
- dizziness
- dry mouth
- constipation
- insomnia
- sweating
- sexual problems, such as low sex drive or difficulty getting an erection
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 1 or 2 weeks of treatment, but these usually settle as your body adjusts to the medication.
Stopping antidepressants
If your medication is not helping after about 2 months of treatment or it's causing unpleasant side effects, your GP may prescribe an alternative medication.
When you and your GP decide it's appropriate for you to stop taking your medication, you'll 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.
Pregabalin
If SSRIs and SNRIs aren't 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, but it's 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
Benzodiazepines
Benzodiazepines are a type of sedative that may sometimes be used as a short-term treatment during a particularly severe period of anxiety.
This is because theyhelp ease the symptoms within 30 to 90 minutes of taking the medication.
If you're prescribed a benzodiazepine,it'll usually bediazepam.
Although benzodiazepines are very effective in treating the symptoms of anxiety, they can't be used for long periods.
This is because they can become addictive if used for longer than 4 weeks. Benzodiazepines also start to lose their effectiveness after this time.
For these reasons, you won't usuallybe prescribed benzodiazepines for any longer than 2 to 4 weeks at a time.
Side effects of benzodiazepines can include:
- drowsiness
- difficulty concentrating
- headaches
- vertigo
- an uncontrollable shake or tremble in part of the body (tremor)
- 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 avoid these activities during treatment.
You should also never drink alcohol or use opiate drugs when taking benzodiazepine as doing so can be dangerous.
Referral toa 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'll usually be referred to your community mental health team.
These teams include a range of specialists, including:
- psychiatrists
- psychiatric nurses
- clinical psychologists
- occupational therapists
- social workers
An appropriate mental health specialist from your local team will carry out an overall reassessment of your condition.
They'll 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 treat your symptoms.
As part of this plan, you may be offered a treatment you haven't tried before, which might bepsychological treatments or medication.
Alternatively, you may be offered a combination of a psychological treatment with a medication, or a combination of 2 different medications.
