Generalized Anxiety Disorder: Symptoms, Medication, Causes and Treatment

For more than half the days in at least 6 months, the patient experiences excessive anxiety and worry about several events or activities.

The patient has trouble controlling these feelings.
Associated with this anxiety and worry, the patient has 3 or more of the following symptoms, some of which are present for over half the days in the past 6 months:
- Feels restless, edgy, keyed up
- Tires easily
- Trouble concentrating
- Irritability
- Increased muscle tension
- Trouble sleeping (initial insomnia or restless, unreflecting sleep
Aspects of another Axis I disorder do not provide the focus of the anxiety and worry.
The symptoms cause clinically important distress or impair work, social or personal functioning.
The disorder is not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.
It does not occur only during a Mood Disorder, Psychotic Disorder, Posttraumatic Stress Disorder or Pervasive Developmental Disorder

Signs and symptoms

The signs and symptoms of generalized anxiety disorder can vary in combination or severity. They may include:

Restlessness
Feeling of being keyed up or on edge
Feeling a lump in your throat
Difficulty concentrating
Fatigue
Irritability
Impatience
Being easily distracted
Muscle tension
Trouble falling or staying asleep (insomnia)
Excessive sweating
Shortness of breath
Stomachache
Diarrhea
Headache

If you have generalized anxiety disorder, you may experience times when your worries don't consume you, but you still feel anxious. You may feel on edge about many or all aspects of your life. For example, you may feel intense worry about your safety or that of your loved ones, or you may feel that something bad is about to happen, even when there's no apparent danger.

Generalized anxiety disorder often begins at an early age, and the signs and symptoms may develop more slowly than in other anxiety disorders. Many people with GAD can't recall when they last felt relaxed or at ease.

Causes

When you feel anxious, your body releases hormones that prepare you to react to a threat. This is called the fight-or-flight response. When anxiety gets out of control, this response can occur almost continuously, even during times when you seem calm. Doctors and researchers don't fully understand why this happens.

Although the cause of generalized anxiety disorder is unknown, certain factors may contribute to the disorder:

Specific medical conditions. Certain disorders, such as an overactive thyroid gland (hyperthyroidism), can produce anxiety, among other signs and symptoms.
Coping with illness. Having a serious physical illness, such as cancer, can make you anxious. Worrying about the implications of your diagnosis and possible treatment can become excessive and overwhelming.
Stress. A buildup of stressful life situations may trigger excessive anxiety. For example, having a physical illness, along with the stress of missing work or losing pay, may combine to cause generalized anxiety disorder.
Personality. People with some personality types are more prone to anxiety disorders. People with unmet psychological needs, such as having a close relationship that isn't fulfilling, may feel less secure and be more at risk of generalized anxiety disorder. In addition, personality disorders, such as borderline personality disorder, also can bring about GAD.
Heredity. Generalized anxiety disorder appears to run in some families.

Treatment

The two main treatments for generalized anxiety disorder are medication and psychotherapy, either alone or in combination.

Medications

Doctors use antidepressants and anti-anxiety medications to treat generalized anxiety disorder and other various types of anxiety disorders. Commonly prescribed drugs include:

Anti-anxiety drugs.

Benzodiazepines are sedatives that often ease anxiety within 30 to 90 minutes, but they can be habit-forming if you take them for more than a few weeks. For this reason, your doctor may prescribe them for only a short time to help you get through a particularly anxious period. The most commonly prescribed sedatives include: alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan).

These medications may cause unsteadiness, drowsiness, reduced muscle coordination and problems with balance. Higher doses and long-term use can cause memory problems. Don't drive or use heavy machinery while taking these drugs.

Another medication prescribed for anxiety disorders such as GAD is buspirone (BuSpar). This drug often doesn't work as well if you've taken benzodiazepines in the past. A common side effect of buspirone is a brief feeling of lightheadedness shortly after taking the medicine. Less common side effects include headaches, nausea, nervousness and insomnia.

Antidepressants

These drugs influence the activity of certain brain chemicals (neurotransmitters) to help nerve cells (neurons) in your brain send and receive messages. Examples of antidepressants used to treat anxiety include: fluoxetine (Prozac), paroxetine (Paxil), imipramine (Tofranil), venlafaxine (Effexor) and escitalopram (Lexapro).

In general, antidepressants are effective most of the time. But because your doctor can't predict which medication will work best for you, you may need to try more than one to find which drug works best for you. Furthermore, antidepressants usually don't work immediately. The medication may begin to work within two weeks, but it may take up to eight weeks before you notice its full effects.

Psychotherapy

Also known as talk therapy, this treatment involves receiving help from a mental health professional through a combination of talking and listening.

One type of psychotherapy, cognitive behavior therapy, examines distortions in thinking that lead to psychological problems. Cognitive behavior therapy is highly effective in treating mental illness, particularly anxiety disorders such as GAD. It's based on the foundation that you are what you think.

During cognitive behavior therapy, a therapist helps you identify distorted thoughts and beliefs that trigger psychological stress, fear or depression. You learn to replace negative thoughts with more positive, realistic perceptions, and you learn ways to view and cope with life events differently. Generally a short-term treatment, cognitive behavior therapy emphasizes learning to develop a sense of mastery and control over your thoughts and feelings.

Treatment for generalized anxiety disorder or any mental illness is tailored to each person. No single treatment regimen works for everyone. Most treatment occurs on an outpatient basis, but some people may need care in a hospital setting.

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