Generalised anxiety disorder (GAD)

What is generalised anxiety disorder (GAD)?

Generalised anxiety disorder, or GAD, means worrying a lot of the time about many different things, in a way that is hard to control and that gets in the way of normal life. Everyone worries sometimes, but in GAD the worry is bigger, lasts longer (usually most days for six months or more), and is often out of proportion to what is actually happening.

GAD can affect your body as well as your mind. People often have tense muscles, a racing heart, tiredness, trouble sleeping, a churning stomach, or find it hard to concentrate. It is common, it is not a sign of weakness, and it is treatable.

The two main treatments are talking therapy (especially cognitive behavioural therapy, or CBT) and medication (usually a type of antidepressant called an SSRI). There is good evidence that both can help, and neither is automatically better — the right choice depends on how you feel, what you prefer, and what you have tried before.

Treatment helps most people feel calmer and more in control, but it is honest to say it usually reduces anxiety rather than removing it completely, and it can take time and some trial and error to find what suits you.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Talking therapy vs medication for GAD

There is no good evidence that one is better than the other. Many people use one, some use both, and your preference matters. Your clinician should help you weigh these up.

Preparing for your treatment

• Before an appointment, jot down what you worry about, how long it has been going on, and how it affects your sleep, work and relationships.
• Note anything that makes it better or worse, including alcohol, caffeine, cannabis and stimulant drugs, which can all worsen anxiety.
• Bring a list of any medicines and supplements you take, and any treatments you have tried before and how they went.
• Think about what you want from treatment and whether you lean towards therapy, medication, or both — your view should shape the plan.
• In England you can often refer yourself to NHS Talking Therapies if you are 18 or over, without waiting for a GP; in Scotland, Wales and Northern Ireland the service names and referral routes differ, so check what applies where you live.
• If your worry comes with chest pain, palpitations, weight loss or other physical symptoms, your clinician may check for physical causes such as thyroid problems first.
• If you have ever had thoughts of harming yourself, tell the clinician — it helps them keep you safe and does not mean treatment will be taken away.

What happens

Treatment usually starts with an assessment — a conversation with a GP, a talking-therapies practitioner or a psychiatrist about your worries, your physical symptoms, your history, and how anxiety affects your life. They will ask about mood, sleep, alcohol and drug use, and any thoughts of self-harm, partly to rule out other conditions and to keep you safe.

NHS care often follows a stepped approach: simpler, lower-intensity help first (such as guided self-help), stepping up to CBT or medication, and on to specialist services if needed. You should be offered a clear explanation of the options and a say in which to try.

If you start therapy, you will usually have regular sessions, often weekly, with tasks to practise between them. If you start medication, you will be told what to expect, including that side effects can appear before benefits and often settle, and you will be reviewed to check how it is working.

Is this treatment right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

The biggest practical issues are that medication side effects often come before benefits, and that stopping antidepressants suddenly can cause unpleasant withdrawal-type effects. Ask your clinician what side effects to expect, how long to give a treatment before judging it, and how to come off medication safely if you want to. If anxiety, agitation or thoughts of self-harm get worse after starting treatment, contact your clinician promptly.

Published figures to discuss

There are no surgical-style complication rates for anxiety treatment. How well treatment works, and how quickly, varies a lot from person to person, and depends on severity, other conditions, and which treatment is used. Because reliable, comparable figures for individual outcomes are limited and easily misread, this guide describes likely benefits and risks in words rather than quoting precise percentages. Two clinically important points are well established: relapse is common after stopping medication, which is why it is usually continued for at least a year if it helps; and a small number of people, especially younger adults, may notice increased agitation or thoughts of self-harm in the early weeks of an antidepressant, which is why early review matters.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

There is no physical recovery from treatment for GAD. What matters is what happens over the following weeks: getting started, giving a treatment a fair trial, and reviewing how it is working — because improvement usually builds gradually rather than all at once.

• Feeling a bit worse or more restless in the first week or two of medication before it settles
• Finding therapy tiring or emotional, especially early on
• Good days and bad days rather than a steady straight-line improvement
• Wanting to give up before a treatment has had a fair chance — sticking with it is usually worthwhile
• Needing the dose or the plan adjusted before things click

Aftercare

• Give each treatment a fair trial — therapy and medication both take weeks, not days, to show their full effect.
• Do the between-session tasks if you are having CBT; this is where much of the benefit comes from.
• Take medication regularly as prescribed and do not stop suddenly — talk to your clinician first.
• Cut down on alcohol, caffeine and recreational stimulants, which can all make anxiety worse.
• Keep up sleep, exercise and routine where you can — these genuinely help anxiety.
• Go to review appointments so the plan can be adjusted if it is not working well enough.
• Know who to contact if things get worse, and keep crisis numbers somewhere easy to find.

• A note of your main worries and how they affect daily life
• A list of current medicines and past treatments
• Questions written down for your clinician
• A plan for who to contact if you feel worse
• Crisis numbers saved: 999, Samaritans 116 123, text SHOUT to 85258, and your local urgent mental health line — 111 mental health option in England, Scotland or Wales, or Lifeline 0808 808 8000 in Northern Ireland
• Realistic time set aside for therapy sessions and homework

⚠ Get urgent help if…

• Thoughts of suicide or self-harm, or feeling you cannot keep yourself safe — call 999 or go to A&E now
• An immediate crisis at any time of day or night — call Samaritans free on 116 123 or text SHOUT to 85258. For urgent mental health support in England, Scotland or Wales, call 111 and choose the mental health option; in Northern Ireland, call Lifeline free on 0808 808 8000 or your GP out-of-hours service
• Anxiety, agitation or restlessness that clearly worsens in the first weeks of a new medication
• A sudden lift into an unusually 'high', overactive or irritable mood, which should be reviewed
• Severe panic attacks that stop you functioning, or new chest pain or breathlessness you are unsure about
• Drinking much more alcohol or using drugs to cope
• Feeling hopeless, or that life is not worth living — this needs prompt help, not waiting for the next appointment

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your psychiatrist gives you.

Results & realistic expectations

A good outcome for GAD usually means worry that is easier to control, fewer physical symptoms, better sleep and being able to do things you had started to avoid — rather than never feeling anxious again. Some people improve a lot, some partly, and some need to try more than one approach.

Treatment cannot guarantee that anxiety will never return, and it does not remove all of life's normal stresses. What it can do is give you tools, and where helpful medication, to keep anxiety at a level you can live with. If one treatment does not work, that is information, not failure — it helps guide the next step.

Many people stay well with the skills they learn, but GAD can come back, especially at times of stress. If medication is helping, it is usually continued for at least a year before being slowly reduced, because stopping early raises the chance of relapse. Therapy skills can be refreshed with a top-up course if symptoms return. Plans should be reviewed over time as your life and symptoms change.

Related tests, treatments or support

GAD often sits alongside depression, panic attacks, other anxiety problems or alcohol use, and treatment may need to address these together. Therapy and medication can be combined when one alone is not enough. Practical support — sleep, exercise, cutting caffeine and alcohol, and dealing with money or relationship stress — works alongside formal treatment rather than instead of it.

Follow-up & long-term care

After starting treatment you should be reviewed to check how it is working and to catch any problems, particularly in the first weeks of medication. Therapy includes regular sessions with a planned ending and sometimes a follow-up. If you are on medication long term, you should have periodic reviews. You should always know how to get back in touch sooner if things get worse.

• Regular review of medication while you take it, and a slow, planned reduction when stopping
• Refresher therapy or self-help if symptoms start to return
• Keeping up sleep, exercise, routine and limits on alcohol and caffeine
• A simple plan for early warning signs and what to do if anxiety flares

Repeat, follow-on and what comes next

• It is common to need to switch SSRI, change the dose, or move between therapy and medication before finding what works.
• The diagnosis may be revisited if treatment does not help, in case another condition fits better.
• Symptoms can return after stopping treatment, and a further course of therapy or medication may be needed.
• Plans are expected to be reviewed and adjusted over time rather than set once.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• A named contact and a clear plan for what to do if anxiety or mood worsens
• Early review after starting medication to check side effects and safety
• A planned course of therapy with a clear ending and option to return
• Sensible advice on how long to stay on medication and how to reduce it slowly
• Written crisis information, including 999/A&E, Samaritans 116 123, SHOUT to 85258, and the local urgent mental health route (111 mental health option in England, Scotland or Wales; Lifeline 0808 808 8000 in Northern Ireland)

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Whether you choose talking therapy, medication, or both
• The type and length of therapy (guided self-help, individual CBT, or longer specialist input)
• Who provides care — GP, accredited therapist, or consultant psychiatrist
• The number of sessions and how often you are seen
• Whether you need a fuller psychiatric assessment or reports
• Ongoing medication reviews and any blood tests where relevant
• Follow-up appointments and how long support continues

• The clinician's or therapist's fee and their accreditation or specialty
• How many sessions are included and the cost of further sessions
• What an initial assessment covers and costs
• Whether medication reviews and any tests are included
• What follow-up and between-session support are provided
• The cancellation policy
• What happens, and what it costs, if you need to be referred on or step up to specialist care

On the NHS? Treatment for GAD is widely available on the NHS and HSC. Access to psychological therapies is through your local service; in England this is often called NHS Talking Therapies and may allow self-referral, while service names, eligibility and referral routes differ in Scotland, Wales and Northern Ireland. Medication can be prescribed by your GP; private care may be used for faster access or particular therapists.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the psychiatrist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the psychiatrist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good psychiatrist will welcome every one of these.

• Based on what I have told you, would you suggest starting with therapy, medication, or both?
• What side effects should I expect, and how long before I should notice any benefit?
• How long would I stay on medication, and how would I come off it safely?
• What should I do, and who should I contact, if my anxiety or mood gets worse after starting treatment?
• If this treatment does not help enough, what is the next step?
• Could anything physical, or alcohol, caffeine or other drugs, be making my anxiety worse?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the psychiatrist who carries out my treatment, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this treatment not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified psychiatrist for generalised anxiety disorder (gad)

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Generalised anxiety disorder in adults NICE CG113 — Generalised anxiety disorder and panic disorder in adults: management NICE CG113 — Information for the public: treatments for GAD Royal College of Psychiatrists — Anxiety, panic and phobias Mind — Anxiety and panic attacks NHS — Where to get urgent help for mental health nidirect — Urgent and emergency care services (Northern Ireland) nidirect — GP out-of-hours service (Northern Ireland) NHS England — NHS 111 mental health crisis support NHS inform (Scotland) — Get urgent mental health help NHS 111 Wales — Mental health and wellbeing nidirect — Mental health emergency / Lifeline (Northern Ireland) NHS — Find NHS Talking Therapies (England) NHS inform (Scotland) — Psychological therapies and interventions NHS 111 Wales — Counselling nidirect — Mental health care professionals (Northern Ireland)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.