Treatment
There are two main forms of treatment for generalised anxiety disorder (GAD):
- psychological therapy
- medication
Depending on your circumstances, you may benefit from one of these types of treatment or a combination of the two.
Studies of different treatments for GAD have found that the benefits of psychological treatment last the longest, but no single treatment is the best for everyone.
Before you begin any form of treatment, your GP should discuss all of your treatment options with you, outlining the pros and cons of each, while also making you 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.
Psychological treatment
If you have been diagnosed with GAD, you will usually be advised to try psychological treatment before you are prescribed medication. The main form of psychological treatment for GAD is cognitive behavioural therapy (CBT).
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is one of the most effective types of treatment for GAD. Research suggests that CBT improves the symptoms of over half of all people with the condition.
CBT works by helping you identify unhelpful and unrealistic beliefs and behavioural patterns. Your therapist then shows you ways that you can replace these beliefs with more realistic and balanced ones.
This type of therapy does not concentrate on dealing with events from your past, but instead focuses on the difficulties that you are experiencing in the present. CBT teaches you new skills and helps you understand how to react more positively to situations that would usually cause you anxiety.
The National Institute for Health and Clinical Excellence (NICE) recommends that you should have a total of 16-20 hours of CBT over four months. Your treatment will usually involve a one- to two-hour session, once a week.
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.
Benzodiazepines
Benzodiazepines are a type of sedative that help ease the symptoms of anxiety within 30-90 minutes of taking the medication.
Although benzodiazepines are very effective in treating the symptoms of anxiety, they cannot be used for long periods of time. This is because they have the potential to become addictive if used for longer than four weeks. Benzodiazepines also start to lose their effectiveness after this time.
For these reasons, you will usually only be prescribed benzodiazepines to help you cope during a particularly severe or intense attack of anxiety. Benzodiazepines can cause side effects, including:
- confusion
- loss of balance
- memory loss
- drowsiness and light-headedness
Due to the above side effects, benzodiazepines can affect your ability to drive or operate machinery. Therefore, avoid these activities when taking the medication.
Speak to your GP if you experience any of the side effects listed above. They may be able to adjust your dose of medication or prescribe an alternative.
Antihistamines
Antihistamines are usually prescribed to treat allergic reactions. However, some are also used to treat anxiety on a short-term basis.
Antihistamines have a calming effect on the brain, helping you to feel less anxious.
As with benzodiazepines, antihistamines are only effective when used for a short period of time and will only be prescribed for a few weeks.
Hydroxyzine is the most commonly prescribed antihistamine for treating anxiety. This antihistamine can make you feel drowsy, so it is best not to drive or operate machinery when taking the medication. Other side effects of hydroxyzine include:
- dizziness
- blurred vision
- headache
- dry mouth
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are a form of antidepressant that increase the level of a chemical in your brain called serotonin. They can be taken on a long-term basis.
As with any antidepressant, an SSRI will usually take several weeks before it starts to work. You will usually be started on a low dose, which is then gradually increased as your body adjusts to the medicine.
Paroxetine is the most commonly prescribed SSRI for the treatment of GAD.
Common side effects of SSRIs include:
- nausea
- low sex drive
- blurred vision
- diarrhoea or constipation
- dizziness
- dry mouth
- loss of appetite
- sweating
- feeling agitated
- insomnia (not being able to sleep)
When you start taking an SSRI, see your GP after two, four, six and twelve weeks to check your progress and to see if you are responding to the medicine. Not everyone responds well to antidepressant medicines, so it is important that your progress is carefully monitored.
If your GP feels it is necessary, you may require regular blood tests or blood pressure checks when taking antidepressant medication. If, after 12 weeks of taking the medication, you do not show any signs of improvement, 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 SSRI medication, you will gradually be weaned off the medication by slowly reducing your dose. Never stop taking your medication unless your GP specifically advises you to.
Venlafaxine
If SSRIs do not help ease your anxiety, you may be prescribed a different type of antidepressant known as venlafaxine.
Venlafaxine belongs to a group of medicines known as selective serotonin and noradrenaline reuptake inhibitors (SNRIs). This type of medicine increases the amount of serotonin and noradrenaline in your brain, helping restore the chemical imbalance that sometimes causes GAD.
You cannot be prescribed venlafaxine if you:
- have high blood pressure (hypertension) that is not being treated
- have recently had a heart attack
- are at risk of having cardiac arrhythmias (irregular heartbeats)
If you have any of the above conditions, you may be at risk of developing complications if you take venlafaxine.
Common side effects of venlafaxine may include:
- nausea
- headache
- drowsiness
- dizziness
- dry mouth
- constipation
- indigestion
- insomnia
- sweating
If you are prescribed this medicine, your blood pressure will be monitored regularly.
Buspirone
Buspirone is a medicine that can help ease the psychological symptoms of anxiety. It belongs to a group of medicines known as anxiolytics.
You will normally have to take buspirone for four to nine weeks before you notice an improvement. It will be up to your GP how long you continue to take the medicine after this.
Buspirone works in a similar way to benzodiazepines, but does not become addictive, which means you can take it for longer periods. However, it is still generally used as a relatively short-term form of medication.
Self-help
There are many ways you can ease the symptoms of GAD yourself.
Exercise
Regular exercise, particularly aerobic exercise, will help you to combat stress and release tension. It also encourages your brain to release the chemical serotonin, which can improve your mood.
Aim to do a minimum of 30 minutes of moderate exercise, at least five days a week. Moderate exercise should make you feel slightly out of breath and tired. Going for a brisk walk is a good example.
Relaxation
As well as getting regular exercise, learning how to relax is important. You may find relaxation and breathing exercises helpful, or you may prefer activities such as yoga or Pilates to help you unwind.
Diet
Changing your diet may help ease your symptoms. Too much caffeine can make you more anxious than normal. This is because caffeine can disrupt your sleep and also speed up your heartbeat. If you are tired, you are less likely to be able to control your anxious feelings.
Smoking and drinking
Smoking and alcohol have been shown to make feelings of anxiety worse. Drink alcohol in moderation and, if you smoke, try to give up.
The Department of Health recommends that men should not drink more than three to four units of alcohol a day, and women no more than two to three units.
Support groups
Support groups can give you useful advice about how to effectively manage your anxiety. They are also a good way to meet other people with similar experiences.
Support groups often involve face-to-face meetings where you can talk about your difficulties and problems with other people. Many support groups also provide support and guidance over the phone or in writing. Ask your GP about local support groups for anxiety in your area.
Understanding your anxiety
Some people find that reading about anxiety can help them deal with their condition. There are many books and articles based on the principles of CBT. These may help you understand your psychological problems better and learn ways to overcome them by changing your behaviour.
Referral
If you have tried any two treatments (out of medication, CBT and self-help with guidance from your GP) and you still 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. This includes 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. This may include any of the following:
- psychological therapies such as CBT
- appropriate treatment of other diseases and conditions that may have an effect on your anxiety
- other medication
- further referral to specialists
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