A guide to generalized anxiety disorder (GAD) medication

GAD medications can reduce your anxiety, helping you manage your daily tasks and improve your quality of life.

They work in the central nervous system by altering the levels of brain chemicals (neurotransmitters) to relieve anxiety. Doctors may prescribe medications alone or in combination with psychotherapy to treat GAD.

There are different classes of GAD medications, and each type alters the level of a specific brain chemical. Antidepressants called selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, and selective norepinephrine reuptake inhibitors (SNRIs) like venlafaxine are the first-line medications for treating GAD.

Antidepressants

SSRIs

SSRIs change the levels of neurotransmitters that influence your mood. They mostly affect serotonin, and sometimes they affect dopamine and norepinephrine.

These medications bind and block the receptors of these neurotransmitters. This gradually increases their concentration in the spaces between nerves, which reduces anxiety symptoms.

Here are typical examples of SSRIs that a doctor may prescribe for GAD:

• fluoxetine (Prozac)
• paroxetine (Paxil)
• sertraline (Zoloft)
• citalopram (Celexa)

Each medication has its unique side effects, but most people tolerate SSRIs well.

Here are some of the possible adverse effects of SSRIs:

• nausea and vomiting
• weight gain
• diarrhea
• sleepiness
• sexual side effects, such as a lack of desire or ability to engage in sexual activity

SNRIs

SNRIs are antidepressants that can help with GAD symptoms. They increase the concentration of serotonin and norepinephrine in the brain.

SNRIs and SSRIs have similar mechanisms of action, but SNRIs have a more substantial effect on norepinephrine receptors.

SNRIs examples include:

• venlafaxine (Effexor)
• desvenlafaxine (Pristiq) 
• duloxetine (Cymbalta)

Side effects of SNRIs can include:

• dose-related rises in blood pressure and heart rate
• nausea
• sleepiness
• dry mouth
• constipation

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Benzodiazepines

Benzodiazepines are medications that affect a neurotransmitter called gamma-aminobutyric acid (GABA). By stimulating GABA, benzodiazepines produce a relaxing effect in people with anxiety disorders.

Benzodiazepines are short-acting, so doctors typically prescribe them when a person requires rapid symptom relief.

Examples of benzodiazepines are:

• diazepam (Valium) 
• clonazepam (Klonopin)
• lorazepam (Ativan)

Potential side effects of benzodiazepines are:

• drowsiness
• fatigue (low energy)
• confusion
• nervousness

There is also a risk of benzodiazepine misuse and dependence, so doctors prescribe them with caution.

Benzodiazepine withdrawal has profound side effects, such as extreme anxiety and tremors. If you’re taking a benzodiazepine, follow your prescription and talk with a doctor before stopping the medication.

Azapirones

Azapirones are medications that partially stimulate serotonin receptors called 5-HT1A. This helps with mood and has a relaxing effect.

Buspirone is a common example of medication in this class. Doctors typically use buspirone as a supportive medication along with SSRIs. Buspirone does not cause sedation in most people. It has a late onset of action.

The possible side effects of buspirone include:

• nausea
• dizziness
• headaches
• buspirone-induced movement disorders 

GABAergics 

GABAergics are a group of medications that influence GABA neurotransmissions in the brain.

They work by closing the calcium channels in nerve endings, which reduces the release of excitatory neurotransmitters in the brain. This helps calm the nerves and reduce anxious feelings.

Doctors do not often prescribe GABAergics for GAD, and there is less research into their effects on anxiety.

Examples of GABAergics include:

• pregabalin (Lyrica)
• gabapentin (Neurontin)

Possible side effects of GABAergics include:

• dizziness
• sleepiness
• headaches
• dry mouth
• diarrhea
• weight gain

Second-generation antipsychotics 

Second-generation or atypical antipsychotics have mood-stabilizing and relaxing effects because they increase the concentration of dopamine and serotonin in the nerve endings in the brain.

These antipsychotics act by blocking dopamine and serotonin receptors in the brain.

Antipsychotics for anxiety are off-label treatments. It’s important that you and your healthcare professional consider their side effects profile to make sure the benefits outweigh the risks.

Examples of second-generation antipsychotics medications are:

• olanzapine (Zyprexa)
• quetiapine (Seroquel)
• risperidone (Risperdal)

Side effects of second-generation antipsychotics include:

• weight gain
• restlessness
• insomnia
• nervousness
• dizziness
• sedation

Other treatments for GAD

Apart from medication, psychotherapy is one of the treatment methods for GAD.

Psychotherapy involves a series of supportive talk therapy sessions to help people cope and manage their anxiety.

Cognitive behavioral therapy (CBT) is a standard method of psychotherapy for managing anxiety disorders.

CBT helps people with anxiety disorders identify and change harmful thought patterns that affect their mood and lead to anxiety. The therapy typically involves multiple psychoeducation and counseling sessions.

Other supportive therapies include:

• engaging in regular aerobic exercises
• complementary medicine methods, such as acupuncture
• getting enough sleep
• eating a nutritious diet

Summary

GAD medications affect the concentration of brain neurotransmitters, which affects your mood. There are different classes of GAD medications. Common examples are SSRIs, SNRIs, and benzodiazepines.

Sudden withdrawal or changing your intake of these medications can lead to significant adverse effects. That’s why it’s important to follow a doctor’s prescription when taking any of these medications.

If you need help covering the cost of medications, Optum Perks’ free Discount Card could help you get up to 80% off prescription medication. See how much you can save on your medication here.