What would you suggest as a next step in medication for my aniety? i have g.a.d. with occassional panic attacks. my family doctor referred me to a psychiatrist (psy.) about a 18 months ago. at that time my family doctor was prescribing me 1mg alprazolam

Anxiety : Anxiety is difficult to treat but we have several meds that are safer than benzodiazepines (xanax (alprazolam) and klonazepam) and have a good track record in treating panic attacks, and by the way not all ssri's are good for panic, nor are they the only option. Do you realize benzodiazepine withdrawal can result in seizures, dt's and even death?

As above : In my opinion the best and safest treatment for anxiety is cognitive behavioral therapy in addition medication can be used on short term basis . Talk with u pdychiatrist.

Not medication: The next step in medication that i would suggest is not medication. Drugs like Alprazolam mask symptoms and do not treat the cause of anxiety. Psychotherapy should address the cause. The fact that you are asking only about medication suggests that you (and possibly your doctor) have been sold a bill of goods by pharmaceutical advertising. Research shows that psychotherapy is effective.

CBT psychotherapy: Should be considered. However, psychotropic medications do not mask the problem. They treat the symptoms. There are many times when psychotherapy is completely ineffective hetrick the anxiety. Generalized anxiety is a particularly painful condition. I know because i've had it since early childhood. I was not treated until my early 30s. I suffered from many years with it. Like you, i had rare panic. Antidepressants as a class of medications can sometimes bring generalized anxiety disorder under control, but there are many occasions when antidepressant medication does not work even if they are approved for the condition. Buspirone is the safest and most effective of the medications for generalized anxiety disorder.If you are already on long-term benzodiazepines however you will have to be gradually tapered off the Alprazolam or you will run into significant withdrawal. The tapering schedule can take months. Do not rush it. Buspar (buspirone) can be started while you are onalprazolam.If it turns out that we need long-term benzodiazepine treatment, do not be ashamed of that. People with generalized anxiety disorder tend to underuse rather then overtake their medication. They are so fearful to begin with but they make pooraddicts.My preference in treating generalized anxiety disorder when long-term benzodiazepine treatment is necessary is to use clonazepam.Best wishes.