This article can give you a general idea about each of the medicines listed below. Only the most general side effects are listed. Ask your doctor if you need to take any special precautions. Use medicine as recommended by your doctor. If you have questions about use or side effects, contact your doctor.

Certain brain chemicals may play a role in GAD. Medicine may help to balance these chemicals. Anxiolytics (anti-anxiety medications) and antidepressants help ease the symptoms of anxiety. Medicine can help ease symptoms to help you make changes. They are often used along with counseling. Medicine may be used short or long-term.

Prescription Medications

Selective Serotonin Reuptake Inhibitors (SSRIs):

  • Escitalopram
  • Paroxetine
  • Sertraline
  • Citalopram
  • Fluvoxamine
  • Fluoxetine

Atypical Antidepressants:

  • Venlafaxine
  • Trazodone
  • Nefazodone

Azapirones:

  • Buspirone

Benzodiazepines:

  • Alprazolam
  • Diazepam
  • Lorazepam

Tricyclic Antidepressants:

  • Imipramine
  • Nortriptyline

Prescription Medications

 

Selective Serotonin Reuptake Inhibitors (SSRIs)

Common names include:

  • Citalopram
  • Fluvoxamine
  • Paroxetine
  • Fluoxetine
  • Sertraline
  • Escitalopram

Selective serotonin reuptake inhibitors (SSRIs) can affect the level of a chemical in the brain, called serotonin. This chemical plays a role in anxiety. SSRIs are mainly used to treat depression but have been helpful with anxiety disorders too. Benefit often begin to appear within 4 to 6 weeks after starting treatment. Alcohol should not be consumed while taking an SSRI. Do not take SSRIs if you are taking MAO inhibitors, thioridazine, or pimozide. Use with caution if you have liver or kidney disease.

Possible side effects include:

  • Nausea or vomiting
  • Abdominal pain
  • Rash
  • Sweating, anxiety
  • Headaches
  • Dry mouth
  • Tremor
  • Diarrhea
  • Loss of appetite or weight loss
  • Weight gain
  • Nervousness
  • Insomnia
  • Lightheadedness
  • Sexual dysfunction—ranges from decreased arousal, to erectile dysfunction, and/or delayed time to orgasm
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients—young adults may be at a higher risk for this side effect
 

Atypical Antidepressants

Common names include:

  • Trazodone
  • Venlafaxine
  • Nefazodone

Atypical antidepressants also change level of serotonin in the brain. Benefits may appear about 4 to 6 weeks after treatment is started.

Possible side effects include:

  • Nausea
  • Nervousness
  • Diminished sex drive
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients—young adults may be at a higher risk for this side effect
 

Azapirones

Common name: Buspirone

Buspirone may improve the action of serotonin. It takes effect within 2 weeks. Buspirone does not cause sleepiness that others ma. It also does not cause a dependance like benzodiazepines may.

Do not take buspirone with monoamine oxidase (MAO) inhibitors. Do not take with alcohol or other sedating drugs. Use with caution if you have liver or kidney disease.

Possible side effects include:

  • Excitability, nervousness
  • Headache
  • Nausea
  • Lightheadedness
 

Benzodiazepines

Common names include:

  • Lorazepam
  • Clonazepam
  • Chlordiazepoxide
  • Oxazepam
  • Clorazepate
  • Diazepam
  • Alprazolam

Benzodiazepines work by effecting a brain chemical known as gamma aminobutyric acid (GABA). GABA can be abnormal in people with GAD. This group of drugs help the body relax. They may ease physical problems like muscle tension. They also cause drowsiness.

Benzodiazepines are fast acting. They are useful for treating an anxiety attack and insomnia. These drugs can be habit-forming when used long-term or in excess. They may cause anxiety, irritability, and sleep problems when you stop taking them. Some symptoms can be severe and life-threatening. This medicine should be slowly reduced over a period of weeks or months until you can stop.

Benzodiazepines should not be used for more than 4 weeks. GAD may return after stopping the drug. Talk to your doctor about how to use this medicine in your care plan.

Do not take with alcohol or other sedating drugs. Do not take if you must drive a vehicle or operate machinery. Benzodiazepines should not be taken in combination with certain oral antifungal medications or by people with certain types of glaucoma.

Possible side effects include:

  • Drowsiness or lethargy
  • Confusion
  • Lightheadedness, particularly in elderly persons
  • Slow reaction time, impaired coordination
  • Memory changes
 

Tricyclic Antidepressants

Common names include:

  • Imipramine
  • Nortriptyline

Tricyclic antidepressants may help to manage serotonin and norepinephrine in the brain. They have been used for treatment of depression. Improvement is often seen in 3 to 6 weeks after the start of treatment. These drugs are highly toxic if taken in large doses. Tricyclic antidepressants are not addictive. They are often a second line drug for GAD because of the many side effects.

Possible side effects include:

  • Lightheadedness
  • Dry mouth
  • Constipation
  • Difficulty urinating
  • Weight gain
  • Low blood pressure
  • Sexual dysfunction
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients—young adults may be at a higher risk for this side effect

Special Considerations

Talk to a specially trained mental health professional about your care plan. Let them know if medicine is not working for you. It may take some time to find the right combination of treatment. The doctor or counselor may also want to look for other possible mental health issues.

If you are taking medications, follow these general guidelines:

  • Take the medication as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medication.
  • Plan ahead for refills if you need them.
  • Do not share your prescription medication with anyone.
  • Medications can be dangerous when mixed. Talk to your doctor if you are taking more than one medication, including over-the-counter products and supplements.

When to Contact Your Doctor

Contact your doctor if you have any side effects that are troublesome and persistent or your symptoms are not improving.

REFERENCES:

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273. Accessed January 13, 2020.

Generalized anxiety disorder. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/generalized-anxiety-disorder. Accessed January 13, 2020.

Generalized anxiety disorder. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/generalized-anxiety-disorder. Accessed January 13, 2020.

Medication. Anxiety and Depression Association of America website. Available at: https://www.adaa.org/finding-help/treatment/medication. Accessed January 13, 2020.

Stern T, Rosenbaum J, et al. Massachusetts General Hospital Comprehensive Clinical Psychiatry. Philadelphia, PA: Mosby Elsevier; 2008.

2/18/2011 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T113820/Antidepressant-medication-overview: Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.

Last reviewed May 2020 by Adrian Preda, MD  Last Updated: 7/29/2020