Generalized Anxiety Disorder (GAD)
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, 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 can also start in early adulthood. It is not unusual for GAD to start after age 20.
The exact cause of GAD is unknown. Researchers think it may be related to chemical imbalances in the brain.
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 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"
Physical symptoms include:
• Muscle tension
• Difficulty sleeping
• Shortness of breath
• Stomach ache (abdominal pain)
People with GAD often have other anxiety disorders, depression, and/or problems with abusing alcohol or drugs.
Your doctor will ask you about your symptoms and medical history, and perform a physical exam. 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)
If you have a mild form of GAD, your doctor will probably first have you try therapy to learn to manage anxious thoughts.
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.
Your therapist will teach you relaxation techniques. 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.
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.
Medications may include:
• Benzodiazepines – to relax your body and keep it from tensing in response to anxious thoughts
o These medications need to be monitored closely because they may cause dependence.
• Buspirone (BuSpar) – an antianxiety medicine that does not cause dependence
• Antidepressant medications (most commonly selective serotonin re-uptake inhibitors, “SSRIs”) – to help control anxious thoughts
o Note: On March 22, 2004, the US Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there is an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants.
There are no guidelines for preventing GAD. Early diagnosis and treatment can help symptoms from becoming debilitating.