If you’ve been worrying nonstop for months-about work, health, money, or just everything-you might be dealing with generalized anxiety disorder (GAD). It’s not just being stressed. GAD means constant, uncontrollable worry that interferes with daily life. The DSM-5 says it’s diagnosed when this worry lasts more than six months and comes with at least three physical or mental symptoms: restlessness, fatigue, trouble concentrating, irritability, muscle tension, or sleep problems. About 6.8 million American adults live with it every year, and women are twice as likely to be affected as men.
Why SSRIs Are the First-Line Treatment
When doctors start treating GAD today, they almost always begin with SSRIs-medications like escitalopram (Lexapro), sertraline (Zoloft), and paroxetine (Paxil). These aren’t quick fixes. It takes 2 to 6 weeks before you feel any real change. But once they work, they work consistently. In clinical trials, about 50-60% of people with GAD see a meaningful drop in symptoms with SSRIs. That’s why the American Psychiatric Association, NICE in the UK, and the VA/DoD all list them as first-line treatment.
SSRIs don’t just calm anxiety-they also help with the depression that often comes with it. Around 60% of people with GAD also have major depression, and SSRIs treat both. They work by boosting serotonin, a brain chemical tied to mood and emotional regulation. Unlike older antidepressants, SSRIs have fewer dangerous side effects and aren’t addictive. The biggest downsides? Nausea in the first few weeks (affects about 62% of users), and sexual side effects like low libido or trouble reaching orgasm (happens in nearly half of users). Many people stop taking them because of this, but starting at a low dose and increasing slowly can help.
The Fast Relief-but High Risk-of Benzodiazepines
If you’re having a panic attack or can’t sleep for days because of anxiety, benzodiazepines like alprazolam (Xanax), lorazepam (Ativan), or diazepam (Valium) can feel like a lifesaver. They kick in within 30 to 60 minutes by boosting GABA, the brain’s natural calming chemical. For acute episodes, they’re hard to beat. A 2024 review found they’re significantly more effective than placebo in the short term.
But here’s the catch: they don’t fix the problem. They just mute the symptoms. After just a few weeks, your brain starts adapting. You need more to get the same effect. Studies show 40-50% of people on long-term benzodiazepines end up increasing their dose. Withdrawal can be brutal-worse than the original anxiety. Symptoms include rebound anxiety, insomnia, tremors, and even seizures in severe cases. That’s why the FDA added a boxed warning in 2020, and why most guidelines now say: don’t use these for more than a few weeks.
On Drugs.com, Xanax has a 7.4 out of 10 rating. But 72% of users report moderate to severe side effects: drowsiness, dizziness, memory lapses. One Reddit user wrote, “I took Xanax for three months. When I stopped, my anxiety came back harder than ever.” That’s not rare. The Ashton Manual, written by a leading expert on benzodiazepine withdrawal, details how tapering off safely can take 8 to 16 weeks-and even then, it’s tough.
CBT: The Skill-Based Solution That Lasts
Cognitive Behavioral Therapy (CBT) is the only treatment for GAD that doesn’t rely on chemicals. Instead, it teaches you how to think differently. In a typical 12-20 session program, you learn to spot catastrophic thoughts (“If I make a mistake at work, I’ll get fired and end up homeless”) and challenge them with evidence. You also do exposure exercises-like writing down your worst fears and sitting with them-until they lose their power.
It’s not easy. The first few sessions can make you feel worse because you’re facing what you’ve been avoiding. But the results stick. A 2021 meta-analysis found CBT works just as well as SSRIs at the end of treatment. But at 12 months? CBT wins. Only 25% of people who did CBT relapsed, compared to 45% who stopped taking medication. That’s because CBT gives you tools you can use for life.
Therapists certified in CBT are in short supply-only about 0.5 per 10,000 adults in the U.S. And each session costs $100-$150. But digital options are filling the gap. Apps like Woebot and SilverCloud are FDA-cleared and have shown real results. A 2021 JAMA study found digital CBT reduced anxiety by 37% in 12 weeks. On Psychology Today, 87% of users rate CBT therapists as “good” or “excellent.” The catch? You have to do the homework. People who complete their between-session exercises are over twice as likely to improve.
Comparing the Three: What Works Best, When?
| Feature | SSRIs | Benzodiazepines | CBT |
|---|---|---|---|
| Time to effect | 2-6 weeks | 30-60 minutes | 4-8 weeks (progressive) |
| Duration of benefit | Long-term (with continued use) | Short-term only | Years after treatment ends |
| Relapse rate at 12 months | 45% | 60%+ (after stopping) | 25% |
| Main side effects | Nausea, sexual dysfunction | Drowsiness, memory issues, dependence | Initial discomfort during exposure |
| Best for | Chronic anxiety + depression | Crisis moments, panic attacks | Long-term recovery, skill-building |
| Accessibility | High (generic versions, $10 copay) | Low (controlled substance, prior auth) | Medium (therapy shortage, $30-$50 copay) |
What Experts Agree On (and What They Don’t)
Most doctors agree on one thing: SSRIs and CBT should come first. The American Psychiatric Association gives both a Level A recommendation-the highest possible. Dr. Murray Stein from UC San Diego says benzodiazepines have “no place in chronic GAD treatment” because they change brain chemistry in harmful ways over time.
But not everyone agrees. Dr. Heather Ashton, who’s treated over 2,000 patients with benzodiazepines over 40 years, argues they’re safe and effective for some people when used carefully. She’s not alone. Some patients do well long-term on low doses, especially if they’re monitored closely. The VA/DoD guidelines take a middle ground: benzodiazepines are okay for short-term use during treatment initiation or in emergencies, but not as a standalone solution.
Dr. David Barlow, who pioneered CBT for anxiety, puts it simply: “Medications treat symptoms. CBT teaches skills you keep for life.” And the data backs him up. People who finish CBT don’t just feel better-they become better at handling stress, even years later.
What’s New in 2026?
The field is evolving. In 2023, the FDA approved zuranolone (Zurzuvae), a new drug that works like benzodiazepines but with far less risk of dependence. In trials, only 5% of users had withdrawal symptoms, compared to 25% with traditional benzos. It’s not a cure, but it’s a promising alternative for acute cases.
Digital CBT is growing fast. Apps like reSET and Woebot are now covered by some insurance plans. And pharmacogenetic testing-where a simple saliva test tells you which SSRI your body will respond to best-is becoming more common. One 2023 study showed patients who got medication based on their genes had 28% better results.
Integrated care is the future. The VA now pairs SSRIs with CBT for 72% of GAD patients. The result? 65% remission rate-much higher than either treatment alone. That’s the new gold standard: not choosing between medication and therapy, but using both.
What Should You Do?
If you’re struggling with constant worry, here’s what to try:
- See your doctor. Ask for a screening for GAD. Don’t self-diagnose.
- If you’re open to medication, start with an SSRI. Be patient. Give it 6 weeks. Talk to your doctor about side effects-you’re not alone in struggling with them.
- If you’re in crisis, ask about a short-term benzodiazepine prescription. But make a plan to stop it within 4 weeks. Don’t let it become a crutch.
- Find a CBT therapist. Use Psychology Today’s directory or ask your doctor for a referral. If cost is an issue, try a digital CBT app. Many are free or low-cost.
- Don’t quit treatment early. The hardest part comes right before the breakthrough.
There’s no magic pill. But there are proven paths. And with the right approach, GAD doesn’t have to control your life.
Can I take SSRIs and benzodiazepines together?
Yes, but only short-term and under strict supervision. Some doctors prescribe a benzodiazepine for the first 2-4 weeks while an SSRI builds up in your system. But this is not meant to be long-term. Combining them increases sedation and risk of dependence. Always follow your doctor’s plan and never adjust doses on your own.
Is CBT better than medication for anxiety?
It depends on your goal. If you need fast relief, medication wins. If you want lasting change, CBT wins. Studies show CBT and SSRIs work equally well at the end of treatment. But after a year, people who did CBT are far less likely to relapse. CBT gives you tools. Medication gives you relief. The best outcomes come from using both-especially if your anxiety is severe or long-standing.
How long should I stay on an SSRI for GAD?
Most doctors recommend staying on SSRIs for at least 12 months after symptoms improve. Stopping too soon increases relapse risk. After that, some people taper off successfully, especially if they’ve done CBT. Others stay on low doses long-term. There’s no one-size-fits-all. Work with your doctor to decide based on your history, side effects, and how well you’re managing without medication.
Why are benzodiazepines still prescribed if they’re risky?
Because they work-fast. For someone having a panic attack every day or unable to sleep for weeks, a short course can be life-changing. The problem isn’t the drug-it’s how it’s used. When prescribed for a few weeks with a clear exit plan, risks are low. But when used for months or years without monitoring, dependence and withdrawal become likely. That’s why guidelines now restrict them to emergencies or short-term use only.
Can I do CBT on my own without a therapist?
Yes, but with limits. Self-guided CBT using books, apps, or online programs can help mild to moderate anxiety. Apps like Woebot and MindShift have been clinically tested and show real results. But for severe GAD, working with a trained therapist is far more effective. Therapists help you spot blind spots in your thinking and adjust exercises based on your progress. If your anxiety is disrupting your job, relationships, or health, don’t rely on apps alone.
What if I can’t afford therapy or medication?
Start with free or low-cost options. Many community health centers offer sliding-scale therapy. Online CBT apps like Woebot and Sanvello have free tiers. Generic SSRIs like sertraline cost as little as $4 a month with insurance. Some universities have training clinics where therapy is provided by supervised students at reduced rates. And if you’re in crisis, call or text 988-the Suicide & Crisis Lifeline-for immediate support and referrals.
