What treatments should I be offered for GAD?

Some treatments may not be suitable for you, depending on your exact circumstances. If you have questions about specific treatments and options covered, please talk to a member of your healthcare team.

Treatments for GAD include psychological treatments and medication. These are explained below. Most treatments can be provided by your GP or other healthcare professionals in primary care.

If you have a learning disability or other problem that may affect your understanding, you should be offered the same treatments as other people with GAD. The treatment may be adapted to suit your needs.

If you also have depression or another kind of anxiety disorder (such as obsessive–compulsive disorder or post-traumatic stress disorder), your healthcare professional should discuss with you which condition would be best treated first.

If you have problems with alcohol or drugs you may be offered treatment for your alcohol or drug problem first. This is because GAD sometimes gets better after an alcohol or drug problem is treated.

GAD may get better by itself with no treatment at all, or after discussions with and advice from a healthcare professional.

Initial treatments

If you decide to have treatment, you should first be offered one that you can either do on your own (self-help) or a course with other people. Both treatments should help you to understand your symptoms and develop ways of coping with them.

Self-help involves working from a book or a computer program for about 5 to 14 weeks. You should be given advice about how to use the book or program before you start. Some types of self-help involve very little contact with a healthcare professional; others involve meeting with or talking on the phone to a healthcare professional for a short time every week or fortnight.

If you choose to go on a course with other people you will have meetings every week for about 6 weeks. You may also be given a self-help book to work through.

If you do not think that initial treatment has helped you, you should be offered one of the further treatments described below.

Further treatments

If your symptoms are seriously affecting you, or the initial treatments have not helped you, or your symptoms are getting worse, you should be offered a psychological treatment (either one called cognitive behavioural therapy or one called applied relaxation), or medication.

Psychological treatments

Both cognitive behavioural therapy (sometimes shortened to CBT) and applied relaxation involve weekly meetings with a healthcare professional for about 3 to 4 months. CBT helps you to understand how your problems, thoughts, feelings and behaviour affect each other. It can also help you to question your negative and anxious thoughts, and do things you would usually avoid because they make you anxious.

Applied relaxation involves learning how to use muscle relaxation techniques when you are feeling anxious or in situations that could make you feel anxious. Your healthcare professional will help you to gradually encounter and cope with these situations.

You may be offered treatment in your preferred language if possible.

If you do not think that the course of CBT or applied relaxation has helped you, you should be offered medication.

Medication

If you would prefer to have medication rather than psychological treatment, or psychological treatment did not help you, you should be offered a type of antidepressant called a selective serotonin reuptake inhibitor (sometimes shortened to SSRI). Antidepressants can be an effective treatment for GAD – being offered an SSRI does not mean that you have depression.

If the first SSRI does not help you, or you have side effects that cause you problems, you should be offered a different SSRIor another type of antidepressant called a serotonin–noradrenaline reuptake inhibitor (sometimes shortened to SNRI). If antidepressants are not suitable for you, you may be offered pregabalin.

You should not usually be offered a benzodiazepine to treat GAD, except temporarily to help you through crisis periods (for example, when your anxiety is very difficult to manage and you feel out of control). If you do take a benzodiazepine in a crisis it should only be for a short time.

You should not usually be offered an antipsychotic to treat GAD by your GP or other healthcare professional in primary care.

Your healthcare professional should discuss with you all the options for medication and any concerns you have about the medication. You should also be given full written information about taking medication. The information should explain:

  • that when you first start taking an antidepressant you may feel more anxious and agitated, and may have problems sleeping and eating, but that this usually passes after a short time

  • the side effects and the withdrawal symptoms that might occur when you stop taking the medication

  • the likelihood of the medication for GAD affecting any other medication you are taking

  • the importance of carefully following the instructions about taking your medication so that it works properly.

You should also be advised that medications you can buy without a prescription at a chemist may affect the way your medication for GAD works.

Your healthcare professional should check whether you have any side effects when you first start taking your medication. If you do, they should check to see whether these improve over time. The dose of your medication could be reduced, or you could try a different medication or a psychological treatment (see above) instead.

While you are taking medication your healthcare professional should see you every 2 to 4 weeks for the first 3 months, and every 3 months after that.

If you are under 30 and you are taking an antidepressant your healthcare professional should tell you that there is a small chance that you will have thoughts of harming yourself. Your healthcare professional should see you every week for the first month.

If the medication is working, you should keep taking it for at least a year because this can help you to stay well.

What happens if I don't feel better after psychological treatment or medication?

If the first course of treatment (CBT, applied relaxation or medication) does not help you, you should be offered one that you have not tried before.

If you are taking medication and it is helping, but you still have some symptoms, you may be offered a psychological treatment in addition to your medication.

If none of the treatments you have tried has helped you, you may be offered an appointment with a specialist (see below).

Questions you could ask your healthcare team

  • Do I have a choice about which treatment I have?

  • What will the treatment involve?

  • What are the advantages, disadvantages and risks of this treatment?

  • How long will it take for my medication to work?

  • When should I start to feel better? What should happen if I don't start to feel better by then?

  • Would it help to make changes to my current treatment?

  • What other treatment options are there?

Specialist care

You may be offered a referral for specialist care if your symptoms are so severe and persistent that they make daily activities very difficult to carry out and:

  • the treatments you have tried have not helped or

  • you have a serious physical illness or another mental illness or

  • you are harming yourself or having suicidal thoughts or

  • you have a drug or alcohol problem.

In specialist care you will meet with a psychiatrist, a psychologist, a psychiatric nurse, an occupational therapist, or a healthcare professional with special experience in the care of people with GAD.

Your specialist should ask you the questions listed in 'What should happen when I see a healthcare professional about GAD?'. They should also ask you about your life at home and whether you have any support, whether you are looking after yourself properly and whether there is a chance that you might harm yourself.

The specialist should agree a plan for your care and treatment with you. As part of this plan you may be offered a treatment you have not tried before. This might be one of the psychological treatments or medications described in 'Further treatments'. You may be offered a combination of a psychological treatment with a medication, or a combination of two different medications. The advantages and disadvantages of the combination should be discussed with you before you agree to it.

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