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Generalized anxiety disorder: Are sedatives and antidepressants the only medicines for this condition?

Last Update: September 27, 2011.

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The anti-anxiety drugs called azapirones are an additional option to try to reduce generalized anxiety disorder. They have not been as well-studied as antidepressants and sedatives for this condition. They appear to be a bit less effective than sedatives, but they cause less adverse effects.

People with generalized anxiety disorder (GAD) experience constant, unbearable and uncontrollable worry about everyday things. The anxiety is chronic, which means it has been going on for more than six months and its effects are felt every single day. And it is not just about a few things – the person is constantly in a state of anxiety.

This extensive and constant worrying can cause symptoms like tiredness, irritability, poor concentration and headaches. The worrying is so intense that the person can be constantly vigilant and tense. They could have symptoms of nervous system hyperactivity, like shortness of breath, a rapid heartbeat and dizziness. The worrying and the symptoms make it hard to manage everyday tasks properly.

About 1 out of every 20 people will have an episode of GAD at some point in their lives, and they will often also have another problem at the same time – particularly depression or other types of anxiety disorder. The problem can continue for years, but it affects people less when they are older: people generally become better at dealing with stress as they get older.

Treatment options include psychotherapeutic techniques like cognitive behavioral therapy (CBT), where the therapist helps the person think about and manage their anxiety differently. The most commonly prescribed drugs are antidepressants and benzodiazepines (sedatives). These drugs can help, but they also cause adverse effects. Benzodiazepines can become addictive and can cause drowsiness, poor coordination and forgetfulness. If an addiction has developed, withdrawal symptoms will occur when use of the medication is stopped. Antidepressants can cause, among other things, nausea, dry mouth and drowsiness. You can read more about GAD and treatment options in our fact sheet.

If other drug treatments have not helped, another option is to try an anti-anxiety drug from the group called azapirones. Although there are several drugs in this group, there is one in particular that is used for GAD, called buspirone. That is the only one of these drugs that is approved for use for GAD in Europe. Azapirones are anti-anxiety drugs, but they are not believed to lead to dependence or withdrawal symptoms.

To see what the possible benefits and adverse effects of azapirones might be for adults with GAD, researchers from Cochrane Collaboration did an extensive search for trials that tested these drugs. They found 36 trials of azapirones for people with GAD. Some of the trials compared it with a placebo or dummy tablet, while others compared it with benzodiazepines, antidepressants or psychotherapy.

The trials showed that azapirones worked better than placebo for treating generalized anxiety disorder, but not as well as benzodiazepines. Two small trials asked people whether they thought their symptoms had improved. Compared with the placebo group, an extra 23% of participants who had taken azapirones answered that they were much or very much improved after having taken this medication for a few weeks.

Overall, there was marked improvement in 54% of the participants treated compared with 31% of people in the placebo group. Yet there is not enough data to be able to say with certainty how many people benefit from azapirones. We also do not know how azapirones compare with antidepressants or psychotherapy.

In these trials, many of the most common adverse effects are also quite common symptoms of GAD itself, so some of the people taking placebos had them as well. The most common problem was dizziness: 34% of the people taking azapirones reported dizziness, compared to 11% of the people taking placebos. That means that azapirones caused dizziness in an extra 23% of people (23 out of 100).

Around 23% of people taking azapirones reported nausea, compared to 10% who were on placebos. And 17% reported drowsiness, compared with 10% of the people who were taking placebos. The researchers only found trials that lasted an average of four to nine weeks (with one trial lasting for 14 weeks). So that means we do not know what the outcomes of long-term use are.

None of the medications for GAD are intended for long-term or permanent use. The most effective treatment for GAD that also has the fewest adverse effects is cognitive behavioral therapy. You can read more about that here.


  • Chessick CA, Allen MH, Thase ME, Batista Miralha da Cunha ABC et al. Azapirones for generalized anxiety disorder. Cochrane Database of Systematic Reviews 2006, Issue 3. [Cochrane summary] [PubMed: 16856115]
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