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 disorderCauses
Generalized anxiety disorder (GAD) is a common condition. The cause of GAD is not known, but biological and psychological factors play a role. Stressful life situations or behavior developed through learning may also contribute to 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
Generalized anxiety disorder has the following symptoms:
- Excess anxiety and worry that is out of proportion to the situation
- Difficulty controlling the worry
- Restlessness or feeling keyed up or "on the edge"
- Being easily tired
- Difficulty concentrating
- Irritability
- Muscle tension -- shakiness, headaches
- Sleep disturbance (difficulty falling or staying asleep; or restless, unsatisfying sleep)
- Excessive sweating, palpitations, shortness of breath, and stomach/intestinal symptoms
Exams and Tests
A physical examination and a psychological evaluation can rule out other causes of anxiety. Physical disorders that may mimic an anxiety state should be ruled out, as well as symptoms caused by drugs. This process may include different tests.
Treatment
The goal of treatment is to help the person function well. The success of treatment usually depends in part on how severe the generalized anxiety disorder is.
The standard approach combines cognitive-behavioral therapy (CBT) and an antidepressant medication.
Selective serotonin reuptake inhibitors (SSRIs), such as Paxil, are usually the first choice. Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor), are another choice. Other antidepressants and some anti-seizure drugs may be used for severe cases.
Other anti-anxiety medications may also be prescribed. Benzodiazepines may be recommended if antidepressants don't help.
Behavioral therapies that may be used together with drug therapy include relaxation techniques, pleasant mental imagery, and cognitive behavioral therapy to change distorted and possibly harmful perceptions of severe anxiety.
Other counseling and therapy techniques may help people gain an understanding of the illness and the factors that protect against or trigger it.
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.
Outlook (Prognosis)
The disorder may continue and be difficult to treat, but most patients see great improvement with medications or behavioral therapy.
Possible 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.
When to Contact a Medical Professional
Call your health care provider if you are experiencing the signs and symptoms of generalized anxiety disorder, especially if this has been going on for a period of 6 months or longer, or it interferes with your daily functioning.
References
Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby; 2004: 174-175.
Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001:416.
Gale C, Davidson O. Generalised anxiety disorder. BMJ, 2007;334:579-581.
Schneier FR. Social anxiety disorder. NEJM, 2006;355:1029-1036.
Katon WJ. Panic Disorder. NEJM. 2006;354:2360-2367.
Bernstein GA, Shaw K. Practice parameters for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry, 2007;46:267-283.
Reviewed By: Christos Ballas, MD, Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
