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Generalized anxiety disorder

Definition

Generalized anxiety disorder (GAD) is a pattern of frequent, 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. Stressful life situations or learned behavior may also contribute to the development of GAD.

The disorder may start at any time in life, including childhood. 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 or feeling keyed up or "on the edge," 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).

Depression and substance abuse may occur with an anxiety disorder.

Signs and tests

A physical examination and psychological evaluation can rule out other causes of anxiety. The health care provider should rule out physical disorders that may mimic anxiety, as well as symptoms caused by drugs. This process may include different tests.

Treatment

The goal of treatment is to help you function well during day-to-day life. Cognitive-behavioral therapy (CBT) and medications are the mainstays of treatment.

Medications are an important part of treatment. Once you start them, do not suddenly stop 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 if antidepressants don't help enough with symptoms. Long-term dependence on these drugs is a concern. Short-term memory problems may also develop with long-term use.
  • A medication called buspirone may also be used.

Cognitive-behavioral therapies should be used together with drug therapy. Ten to 20 visits with a mental health professional should take place over a number of weeks. Common parts of this therapy include:

  • Gaining an understanding of, and control over distorted views of life stressors, such as other people's behavior or life events.
  • Learning to recognize and replace panic-causing thoughts, decreasing the sense of helplessness.
  • Learning stress management and relaxation techniques to help when symptoms occur.
  • Learning not to quickly think 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

Support groups may be helpful for some patients with GAD. Patients have the opportunity to learn that they are not unique in experiencing excessive worry and anxiety.

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

Expectations (prognosis)

The success of treatment usually depends on the severity of the generalized anxiety disorder. The disorder may continue and be difficult to treat, but most patients see great improvement with medications or behavioral therapy.

Complications

People with GAD may develop other psychiatric disorders, such as panic disorder or depression. Substance abuse or dependence may become a problem if you try to self-medicate with drugs or alcohol to relieve anxiety.

Calling your health care provider

Call your health care provider if you are experiencing the signs and symptoms of generalized anxiety disorder, and they are interfering with your daily life and well-being.

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.


Review Date: 2/14/2010
Reviewed By: Fred K. Berger, MD, Addiction and Forensic Psychiatrist, Scripps Memorial Hospital, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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