Generalized anxiety disorder

Definition

Generalized anxiety disorder (GAD) is a pattern of constant worry and anxiety over many different activities and events.

Alternative Names

GAD; Anxiety disorder

Causes, incidence, and risk factors

Generalized anxiety disorder (GAD) is a common condition. Genes may play a role. Stress may also contribute to the development of GAD.

Anyone can develop this disorder, even kids. Most people with the disorder report that they have been anxious for as long as they can remember. GAD occurs somewhat more often in women than in men.

Symptoms

The main symptom is the almost constant presence of worry or tension, even when there is little or no cause. Worries seem to float from one problem to another, such as family or relationship problems, work issues, money, health, and other problems.

Even when aware that their worries or fears are stronger than needed, a person with GAD still has difficulty controlling them.

Other symptoms include:

• Difficulty concentrating
• Fatigue
• Irritability
• Problems falling or staying asleep, and sleep that is often restless and unsatisfying
• Restlessness, and often becoming startled very easily

Along with the worries and anxieties, a number of physical symptoms may also be present, including muscle tension (shakiness, headaches) and stomach problems, such as nausea or diarrhea.

Signs and tests

The health care provider will perform a physical and mental health exam. Tests will be done to rule out other conditions and behaviors that cause similar symptoms.

Treatment

The goal of treatment is to help you function well during day-to-day life. A combination of medicine and cognitive-behavioral therapy (CBT) works best.

Medications are an important part of treatment. Once you start them, do not suddenly stop taking them without talking with your health care provider. Medications that may be used include:

• Selective serotonin reuptake inhibitors (SSRIs) are usually the first choice in medications. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another choice.
• Other antidepressants and some antiseizure drugs may be used for severe cases.
• Benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), and lorazepam (Ativan) may be used short-term if antidepressants don't help enough with symptoms. Long-term use can lead to dependence on these drugs.
• A medication called buspirone may also be used.

Cognitive-behavioral therapy helps you understand your behaviors and how to gain control of them. You will have 10 to 20 visits over a number of weeks. During therapy you will learn how to:

• Understand and gain control of your distorted views of life stressors, such as other people's behavior or life events.
• Recognize and replace panic-causing thoughts, decreasing the sense of helplessness.
• Manage stress and relax when symptoms occur.
• Avoid thinking that minor worries will develop into very bad problems.

Avoiding caffeine, illicit drugs, and even some cold medicines may also help reduce symptoms.

A healthy lifestyle that includes exercise, enough rest, and good nutrition can help reduce the impact of anxiety.

Support Groups

A support group allows you to talk to people who share common experiences and problems. This may help ease the stress related to a medical condition.

Support groups are not a substitute for effective treatment, but can be a helpful addition to it.

Expectations (prognosis)

How well a person does depends on the severity of the condition. GAD may continue and be difficult to treat. However, most patients get better with a combination of medication and behavioral therapy.

Complications

Depression and substance abuse may occur with an anxiety disorder.

Calling your health care provider

Call your health care provider if you constantly worry and feel anxious and it interferes with your daily activities.

Prevention

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References

Anxiety Disorders. National Institute of Mental Health. U.S. Department of Health and Human Services. Accessed February 5, 2010.

Hoffmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008;69:621-632.

Pollack MH, Kinrys G, Delong H, Vasconcelos e Sá D, Simon NM. The pharmacotherapy of anxiety disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 41.

Connolly SD, Bernstein GA. Work Group on Quality Issues. Practice parameter for the assessment and treatmetn of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2007;46:267-283.