Your Health - Generalized Anxiety Disorder

Generalized Anxiety Disorder

(GAD)

Definition

Generalized anxiety disorder (GAD) causes chronic, exaggerated worrying and anxiety about everyday life. Everyone worries at times, but people with GAD can never relax and usually anticipate the worst. The intensity and pervasiveness of their worry interferes with normal functioning at school, at work, and in their relationships. The worrying is often not related to anything in particular. Instead, each day provokes tension and anxiety.

People with GAD often worry excessively about health, family, work, or money. The worry is so severe that it interferes with their ability to live their lives. The anxiety can also progress to the point where people "worry about worrying." GAD usually starts in childhood or adolescence, but it can also start in early adulthood. It is not unusual for GAD to start after age 20.

Causes

The exact cause of GAD is unknown. Researchers believe it is caused by a combination of genetic, environmental, developmental, and psychological factors.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for GAD include:

Sex: female
Family member with an anxiety disorder
Long-term exposure to abuse, poverty, or violence
Low-self esteem
Poor coping skills
Smoking or other substance abuse
Increase in stress

Symptoms

Symptoms of GAD usually build up slowly. People with GAD often have both psychological and physical symptoms of anxiety.

Psychological symptoms include:

Excessive ongoing worrying and tension
Feeling tense or edgy
Irritability, overly stressed
Difficulty concentrating, mind going "blank"
Stress

Physical symptoms include:

Fatigue
Muscle tension
Headaches
Trembling
Difficulty sleeping
Restlessness
Shortness of breath
Sweating
Heart palpitations
Choking sensation
Abdominal pain
Diarrhea
Nausea

Physical Reactions of Anxiety

People with GAD often have other anxiety disorders, depression , and/or problems with abusing alcohol or drugs.

Diagnosis

Your doctor will ask you about your symptoms and medical history. A physical exam will be performed. Your doctor will also look for other medical conditions that may be causing your symptoms (eg, an overactive thyroid ).

You will be asked about any medications you are taking, including over-the-counter and herbal medications. Some medications can cause side effects similar to the symptoms of GAD. Your doctor will also ask about addictive substances you may be using. These can include nicotine, caffeine, street drugs, prescription medications, and alcohol.

To make a diagnosis of GAD, symptoms must be:

Present more days than not
Present for at least six months
Interfering with your life (causing you to miss work or school, for example)

Treatment

If you have a mild form of GAD, your doctor will probably first have you try therapy to learn to manage anxious thoughts.

Therapies include:

Cognitive Behavioral Therapy

Your therapist will work with you to change your patterns of thinking. This will allow you to notice how you react to situations that cause anxiety. You will then learn to change your thinking so you can react differently. This can decrease the symptoms of anxiety.

Behavioral Therapy

Your therapist will teach you relaxation techniques, including deep breathing, muscle relaxation, and visualization. Learning ways to relax can help you gain control over anxiety. Instead of reacting with worry and tension, you can learn to remain calm. Your therapist may also slowly expose you to the situation that is causing the worry and tension. This can allow you to reduce your anxiety in a safe environment.

Support Groups

Joining a support or self-help group is often helpful. This form of support allows you to share your experience and learn how others have coped with GAD.

Biofeedback

Biofeedback works by attaching sensors to the body. A therapist helps you understand your body’s signals so you can use them to reduce your anxiety.

Medication

Medication can be prescribed for symptoms that are severe and make it difficult to function. Medications can help relieve symptoms so you can concentrate on getting better. It is important to note that many medications can not be stopped abruptly but need to be tapered off. Check with your doctor before discontinuing any medication.

Medications may include:

Benzodiazepines —to relax your body and keep it from tensing in response to anxious thoughts
- These medications need to be monitored closely because they may cause dependence.
Anti-anxiety drugs—to decrease anxiety
- Buspirone (BuSpar)—an anti-anxiety medicine that does not cause dependence
- Alprazolam (Xanax)—may be prescribed for short period of time
Antidepressant medications (most commonly selective serotonin re-uptake inhibitors , “SSRIs”)—to help control anxious thoughts
Beta-blockers—may be used to help with physical symptoms of anxiety

FDA Public Health Advisory for Antidepressants

The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose.

Although the warning is for all antidepressants, of most concern are the SSRI class such as:

Prozac ( fluoxetine ), Zoloft ( sertraline ), Paxil ( paroxetine ), Luvox ( fluvoxamine ), Celexa ( citalopram ), Lexapro ( escitalopram )

For more information, please visit: http://www.fda.gov/cder/drug/antidepressants/

Prevention

There are no guidelines for preventing GAD. Early diagnosis and treatment can help symptoms from becoming debilitating. Some evidence suggests that exercise can help reduce symptoms. To further reduce anxiety symptoms, avoid caffeine , nicotine, and over-the-counter cold medications.

RESOURCES:

Anxiety Disorders Association of America
http://www.adaa.org/

The National Mental Health Association
http://www.nmha.org/

CANADIAN RESOURCES:

Canadian Psychiatric Association
http://www.cpa-apc.org/

Mental Health Canada
http://www.mentalhealthcanada.com/

References:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders . 4th ed., Text Revision. Washington, DC: American Psychiatric Association; 2000.

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 . Published May 22, 2009. Accessed July 15, 2009.

Factsheet: Generalized anxiety disorder (GAD). Mental Health America website. Available at: http://www.nmha.org/index.cfm?objectid=C7DF9194-1372-4D20-C83F9C0D95A6265C . Accessed July 6, 2009.

Fricchione G. Generalized anxiety disorder. N Engl J Med . 2004;351(7):675-682.

Generalized anxiety disorder (GAD). National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/anxiety-disorders/generalized-anxiety-disorder-gad.shtml . Updated July 2009. Accessed July 6, 2009.

Generalized anxiety disorder: what you should know. American Academy of Family Physicians. FamilyDoctor.org website. Available at: http://familydoctor.org/online/famdocen/home/common/mentalhealth/anxiety/627.html . Published October 2000. Updated December 2006. Accessed July 6, 2009.

Gliatto MF. Generalized anxiety disorder. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20001001/1591.html . Published October 2000. Accessed July 6, 2009.

Professional Guide to Diseases. 9th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2009.

Last reviewed November 2009 by Theodor B. Rais, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.