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 psychological therapies like cognitive behavioural therapy (CBT) and applied relaxation on the NHS.
You don't need a referral from your GP.
You can refer yourself directly to a psychological therapies service.
Or your GP can refer you if you prefer.
Your GP or psychological therapies service may suggest trying a guided self-help course to see if it can help you learn to cope with your anxiety.
This involves working through a CBT-based workbook or computer course in your own time with the support of a therapist.
Or you may be offered 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 either a more intensive psychological therapy or medication.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is one of the most effective treatments for GAD.
Studies of different treatments for GAD have found the benefits of CBT may last longer than those of medication, but no single treatment works for everyone.
CBT helps you to question your negative or anxious thoughts and do things you'd usually avoid because they make you anxious.
It usually involves meeting with a specially trained and accredited therapist for a 1-hour session every week for 3 to 4 months.
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 1-hour session every week for 3 to 4 months.
If the psychological 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 other medicines are prescribed for longer periods.
Depending on your symptoms, you may need medicine 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 detail before you start a course of treatment, including:
- the different types of medication
- length of treatment
- side effects and possible interactions with other medicines
You should also have regular appointments with your doctor to assess your progress when you're taking medication for GAD.
These will usually take place every 2 to 4 weeks for the first 3 months, then every 3 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)
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:
SSRIs can 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 is gradually increased as your body adjusts to the medicine.
Common side effects of SSRIs include:
- feeling agitated
- feeling or being sick
- diarrhoea or constipation
- loss of appetite and weight loss
- blurred vision
- dry mouth
- excessive sweating
- problems sleeping (insomnia) or drowsiness
- low sex drive
- difficulty achieving orgasm during sex or masturbation
- in men, difficulty obtaining or maintaining an erection (erectile dysfunction)
These side effects should improve over time, although some – such as sexual problems – can persist.
If your medication isn't helping after about 2 months of treatment or it's causing unpleasant side effects, your GP may prescribe an alternative SSRI.
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.
Serotonin and noradrenaline reuptake inhibitors (SNRIs)
If SSRIs don't 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 serotonin and noradrenaline in your brain.
Examples of SNRIs you may be prescribed include:
Common side effects of SNRIs include:
- feeling sick
- dry mouth
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.
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:
- increased appetite and weight gain
- blurred vision
- dry mouth
Pregabalin is less likely to cause nausea or a low sex drive than SSRIs or SNRIs.
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 they help ease the symptoms within 30 to 90 minutes of taking the medication.
If you're prescribed a benzodiazepine, it'll usually be diazepam.
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 usually be prescribed benzodiazepines for any longer than 2 to 4 weeks at a time.
Side effects of benzodiazepines can include:
- difficulty concentrating
- 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 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'll usually be referred to your community mental health team.
These teams include a range of specialists, including:
- 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 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 2 different medications.