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10 March 2004

What to do if you are suffering from GAD

There are several different medications that can be used for the treatment of generalised anxiety disorder. These include benzodiazepines, buspirone, hydroxyzine, and antidepressants.

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There are several different medications that can be used for the treatment of generalised anxiety disorder. These include benzodiazepines, buspirone, hydroxyzine, and antidepressants.

Benzodiazepines are also known as "tranquilizers". Their major advantage is that they work very quickly to reduce anxious feelings as well as physical symptoms of anxiety. Their major disadvantage is that when people discontinue them, there is often a "rebound" anxiety, with return of GAD symptoms. Also, they are not effective for the depressive symptoms that commonly co-occur in GAD. Furthermore, there is an association between the use of benzodiazepines and motor vehicle collisions due to subtle cognitive impairment.

Buspirone (or Buspar) is the only medication in its particular class. A major advantage of this agent is that it has relatively few side effects; most people with GAD tolerate it very well. Disadvantages of buspirone are that it takes 3-4 weeks before the agent begins to work, and that it is not effective for the depressive symptoms and other anxiety disorders that are often seen in people with GAD.

Hydroxyzine is a medication that has long been available. Like buspirone, it too can be readily stopped at any point. Hydroxyzine is, however, initially associated with some feelings of sedation. This can be an advantage for some people (e.g. those with insomnia), but it may be a disadvantage for others (e.g. those who need to operate machinery). As in the case of benzodiazepines and buspirone, it is not effective for the depressive symptoms that often co-occur with GAD.

The term "antidepressants" is a very poor one, as these medications are in fact the first choice of medication for many different anxiety disorders. Many of the antidepressants are effective in GAD, and they are also often effective for the depressive symptoms and other anxiety disorders seen together with GAD. Their major disadvantage is that like buspirone, it may take several weeks of daily medication before their positive effect becomes apparent.

Venlafaxine is one of the few antidepressants that is in fact licensed for the treatment of GAD, although other agents are likely to be registered in the future.

Psychotherapy
People with GAD can be seen as viewing the world through a lens which colours everything with negative predictions. Psychotherapy focuses on attempting to change this lens (technically, this is the "cognitive" part of "cognitive-behavioural therapy".

Steps in the cognitive-behavioural therapy of GAD can include self-monitoring and cognitive restructuring. Self-monitoring involves paying closer attention to one's thoughts and feelings. In some ways this is an exposure ("face the fear") technique, but the technique is also useful in demonstrating to oneself the connection between fearful thoughts about the future and feelings of anxiety.

Cognitive restructuring involves providing good counter-arguments which dispell the logic of worry and fear found in GAD. Common cognitive distortions in GAD include probability overestimation, catastrophizing, and all or nothing thinking. Overcoming such distortions may well require the help of a professional.

Information supplied by the Mental Health Information Centre (Toll free number: 0800 600 411)

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