Psychiatric Care · 03
MEDICAL TREATMENT.
Pharmacological management of Generalized Anxiety Disorder using selective serotonin reuptake inhibitors — overseen by a board-certified psychiatrist.
Pharmacological Options
FIRST-LINE MEDICATIONS FOR GAD.
SERTRALINE
Brand: Zoloft
Typical Dose
25–100 mg
First-line for Mr. M
ESCITALOPRAM
Brand: Lexapro
Typical Dose
10–20 mg
Alternative SSRI option
VENLAFAXINE
Brand: Effexor XR
Typical Dose
75–225 mg
Second-line consideration
BUSPIRONE
Brand: Buspar
Typical Dose
15–60 mg
Non-sedating adjunct
Mechanism of Action
HOW SSRIs RESHAPE THE ANXIOUS BRAIN.
SSRIs block the reabsorption (reuptake) of serotonin into the presynaptic neuron, increasing the amount available in the synaptic cleft. Over several weeks, downstream neuroadaptive changes — including receptor regulation and improved limbic-cortical communication — reduce the intensity and frequency of anxiety symptoms.
Serotonin released from presynaptic neuron.
SSRI blocks the reuptake transporter.
More serotonin remains in the synapse.
Receptors adapt over 4–6 weeks → symptom relief.
ONSET TIMELINE
Week 1–2
Initial titration. Possible temporary anxiety increase.
Week 4
Early therapeutic effects emerge.
Week 6–8
Full effect typically established.
COMMON SIDE EFFECTS
- Nausea, gastrointestinal upset
- Headache
- Insomnia or drowsiness
- Sexual dysfunction
- Temporary increase in anxiety during weeks 1–2
MONITORING PROTOCOL
- Follow-up at weeks 2, 4, and 8
- Suicidal ideation screening in first month
- Blood pressure and weight checks
- Gradual tapering at discontinuation
Combining Psychotherapy and Medication
Research consistently demonstrates that combining psychotherapy — particularly Cognitive Behavioral Therapy — with SSRI pharmacotherapy produces superior outcomes for Generalized Anxiety Disorder compared with either approach alone. Medication addresses the biological dysregulation of serotonin and provides faster relief from physiological symptoms, while CBT equips clients with durable cognitive and behavioral skills that prevent relapse after medication is tapered.
For an elite athlete like Mr. M, this integrated approach allows pharmacology to reduce baseline arousal so therapy techniques can be practised and consolidated under realistic competitive pressure. The combined model addresses both biological and psychological contributing factors, consistent with the biopsychosocial framework endorsed by the American Psychiatric Association and the National Institute of Mental Health.
STRENGTHS
- Strong evidence base for GAD
- Non-addictive, suitable for long-term use
- Improves both psychological and physical symptoms
LIMITATIONS
- Delayed onset of 4–6 weeks
- Side effects may affect adherence
- Does not teach coping skills — symptom relief only