SSRIs and SNRIs have fewer cardiovascular adverse effects than TCAs and are better tolerated by older patients and patients with cardiovascular illnesses. Caution is necessary with venlafaxine because it can raise blood pressure.
SSRIs and SNRIs tend to stimulate the GI tract and can aggravate GI symptoms, particularly in patients with comorbid IBS. In such patients the anticholinergic effects of a tertiary TCA, such as doxepin(Drug information on doxepin), can reduce abdominal pain and improve bowel movements.
The ultimate goal of treatment for somatic symptoms in patients with GAD is to help the patients become self-sufficient without the need for medication. However, a minority of patients who have GAD need continuous pharmacotherapy, including benzodiazepines. It would be shortsighted and insensitive to deny such patients medications that could improve their quality of life.