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There are two main forms of treatment for generalised anxiety disorder (GAD) - psychological therapy and medication. Depending on your individual circumstances, you may require either one of these types of treatment, or a combination of the two. Before you begin any form of treatment, your GP will discuss all of your options with you, outlining the pros and cons of each form of treatment, while also making you aware of any possible risks, or side effects. It is important that you understand what your treatment will involve. If you do not understand something your GP has told you, make sure that you ask them to explain it in more detail. Psychological treatmentIf you have been diagnosed with GAD, you will usually be advised to undergo psychological treatment before you are prescribed medication. The main form of psychological treatment for GAD is cognitive behavioural therapy. 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 those with the condition. CBT works by helping you to identify any unhelpful and unrealistic beliefs and behavioural patterns you might have. Your therapist then shows you ways in which 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 to understand how to react more positively to situations which would usually cause you anxiety. The National Institute for Health and Clinical Excellence (NICE) recommend that you should have at total 16-20 hours of CBT. Your treatment will usually involve having a 1-2 hour long session, once a week. Self-helpThere are some ways that you can help to ease the symptoms of GAD yourself. Regular exercise, particularly aerobic exercise, will help you to combat stress and release tension. You should be aiming 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, but not to the point where it is unbearable. Going for a brisk walk is a good example of moderate exercise. Regular exercise also encourages your brain to release the chemical serotonin, which can help to improve your mood. As well as getting regular exercise, learning how to relax is also important. You may find relaxation and breathing exercises helpful, or you may prefer activities such as yoga or pilates to help you unwind. Changing your diet may also help to ease your symptoms. Too much caffeine in your diet 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 alcohol have also been shown to worsen feelings of anxiety, so you should make sure that you drink in moderation, and try your best to give up smoking. Drink in moderationThe Department of Health recommends that men should not drink more than 3-4 units of alcohol a day, and women no more than 2-3 units a day. A unit of alcohol is equivalent to half a pint of ordinary strength larger, a pub measure (25ml) of spirits, or a small (125ml) glass of wine. If you drink alcohol, you should try to stay within these recommended limits. Stopping smokingGiving up smoking will not only help you to feel less anxious, it will also improve your general health. Stopping smoking also reduces the risk of you developing smoking-related conditions, such as lung cancer and heart disease. If you plan to give up smoking, contact your GP, who will be able to give you advice and guidance about the best ways for you to quit. Alternatively, you can call the NHS smoking helpline, on 0800 022 4 332, where a specially trained advisor can offer free and confidential advice. The phone line is open seven days a week, from 7am-11pm. The NHS 'go smokefree' website also offers lots of helpful information about ways you can give up smoking. Support groupsSupport groups will be able to provide you with useful advice about how you can effectively manage your anxiety, and they are also a good way of meeting other people with similar experiences of the condition. Support groups often involve face to face meetings where you can talk about your difficulties and problems with others. Many support groups can also provide support and guidance over the telephone, or in writing. Ask your GP about local support groups for anxiety in your area. MedicationThere are a variety of different types of medication that your GP can prescribe for you to help treat your GAD. Some medication is designed to be taken on a short-term basis, while you may have to take other medicines for longer periods of time. Depending on your symptoms, you may require medicine to help treat your physical symptoms, as well as your psychological ones. Short-term medicationIf your anxiety is severely affecting you, you may be given medication on a short-term basis to help provide immediate relief from your symptoms. The types of short-term medication you may be prescribed are outlined below. Benzodiazepines:Benzodiazepines are a type of sedative which help to 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 they are 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:
Due to the above side effects of benzodiazepines, this type of medication can affect your ability to drive or operate machinery. You should therefore avoid these activities when taking this form of medication. Speak to your GP if, while you are taking benzodiazepines, you experience any of the side effects that are 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 work by having a calming effect on the brain, helping you to feel less anxious. As with benzodiazepines, this type of medicine is only effective when used for a short period of time. They are therefore only prescribed for several weeks at a time. Hydroxyzine is the most commonly prescribed antihistamine for treating anxiety. This antihistamine can make you feel drowsy so it is best not drive or operate machinery when taking the medication. Other side effects of hydroxyzine include:
Long-term medicationSome people who have GAD require long-term treatment in order to help manage their anxiety, rather than treatment for the immediate relief of their symptoms. The types of long-term medication that you may be prescribed are outlined below. Selective serotonin reuptake inhibitors (SSRIs):Selective serotonin reuptake inhibitors (SSRIs) are a form of antidepressant which work by increasing the level of a chemical in your brain called serotonin. As with any antidepressant, it will usually take several weeks before your SSRI medication starts to work. SSRIs are usually started at a low dose, and then the dose is gradually increased as your body adjusts to the medicine. Common side effects of SSRIs include:
When you start taking an SSRI, you should see your GP after two, four, six, and 12 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 try prescribing an alternative SSRI for you, 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 dosage. However, you should never stop taking your medication unless your GP specifically advises you to. Venlafaxine:If SSRIs do not help to ease your anxiety, you may have to be prescribed a different type of antidepressant known as venlafaxine. Venlafaxine belongs to a group of medicines known as selective serotonin and norepinephrine reuptake inhibitors (SNRIs). This type of medicine works by increasing the amount of serotonin and norepinephrine in your brain, helping to restore the chemical imbalance that sometimes causes GAD. You cannot be prescribed venlafaxine if you:
If you have any of the above conditions, you may be at risk of developing complications if you take venlafaxine. Therefore, your blood pressure will be monitored on a regular basis if you are prescribed this medicine. Common side effects of venlafaxine may include:
Other types of medicationBuspironeBuspirone is a medicine which can help to 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 unlike benzodiazepines, buspirone does not become addictive, which means that you will be able to take it for longer periods of time. However, it is still generally used as a relative short-term form of medication Beta blockersBeta blockers are usually used to treat conditions such as angina (chest pain) and high blood pressure (hypertension). However, they can also help ease some of the symptoms of anxiety. Beta blockers will not affect your psychological symptoms, such as irritability and restlessness. Instead they can help you with some of your physical symptoms, such as sweating and palpitations (when you can feel your heart beating faster than normal). Beta blockers work by blocking the chemicals that can cause these physical symptoms. ReferralIf medication, CBT, or support groups fail to help improve your GAD, you may have to be referred to a mental health specialist. A mental health specialist will carry out an overall re-assessment of your condition. They will ask you about your previous treatment, and how effective you found it. They may also ask you 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. The type of mental health specialist that you are referred to will depend on your individual situation. You may be referred to one, or more, of the specialists described below.
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