What is Generalized Anxiety Disorder?

Meaning of generalized anxiety disorder

Generalized anxiety disorder is characterized by continuous excessive worry about life events. It is extremely difficult to control this anxiety, which affects concentration and sleep. Such worry is not proportional to the actual risk or problems. Normally, people worry about paying bills when their homes are near foreclosure, but individuals with generalized anxiety disorder might worry about paying bills even when no financial problems exist. Other common concerns for those with generalized anxiety disorder include health issues, household chores, punctuality, work-related tasks, and competence in various activities. People with generalized anxiety disorder do not always experience panic attacks. Instead, they often struggle with muscle tension, difficulty sleeping, or problems with concentration.

Symptoms of Generalized Anxiety Disorder

To be diagnosed, individuals must experience at least three of the following symptoms most days for the past 6 months:

1. Restlessness

   
   

2. Easily fatigued

   
   

3. Difficulty concentrating

   
   

4. Irritability

   
   

5. Muscle tension

   
   

6. Sleep disturbance (difficulty falling asleep, problems with staying asleep, and unsatisfying sleep)

The anxiety, worry, or physical symptoms cause distress or impairment in social, occupational, or other important areas of functioning. The symptoms should not be attributable to the physiological effects of a substance (drug of abuse, medication) or a medical condition.

Causes of Generalized Anxiety Disorder

1. Stress [1]

   
   

2. Side effects of a medication or substance abuse [1]

   
   

3. Health conditions (such as hyperthyroidism [1], diabetes [3], depression [3])

   
   

4. Genetics [3]

   
   

5. Environmental factors, e.g. child abuse [3]

Treatment of Generalized Anxiety Disorder

Research shows that a combination of medication and psychotherapy is the best method for the treatment of generalized anxiety disorder [2].

1. Medications[1]: This includes antidepressants, benzodiazepines, and buspirone [2].

   a. Antidepressants [2]: Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro) are commonly preferred as first-line treatments [2]. Other antidepressants with different mechanisms, such as mirtazapine (Remeron), venlafaxine (Effexor), and duloxetine (Cymbalta), are also effective options [2]. While older antidepressants, including tricyclic antidepressants like nortriptyline and imipramine, can be effective, they often come with more challenging side effects [2]. Since antidepressants generally require several weeks to take effect, your doctor may also prescribe a fast-acting benzodiazepine for immediate relief [2].

   b. Benzodiazepines [2]: These medications influence a chemical messenger involved in the brain's fear response system [2]. Common benzodiazepines include clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), and alprazolam (Xanax), which can offer rapid relief from anxiety symptoms [2]. Due to their fast-acting nature, they may be prescribed in the initial weeks of treatment until an antidepressant becomes effective [2]. Benzodiazepines are typically prescribed for a short duration due to concerns about dependency, as the body can build tolerance to their effects over time, reducing their effectiveness [2]. If discontinuation is needed, it should be done gradually under medical supervision to avoid withdrawal symptoms [2].

   c. Buspirone [2]: Buspirone is an antianxiety medication that may be effective in treating generalized anxiety disorder, though it is prescribed less often than the medications mentioned above [2]. Similar to antidepressants, it generally takes two to three weeks to start showing effects [2].

   
   

2. Psychotherapy [2]: Several psychotherapy techniques can effectively address anxiety. Cognitive behavioral therapy focuses on identifying and altering irrational thoughts and behaviors [2]. Psychodynamic therapy aims to explore the historical roots of symptoms, helping individuals recognize how past fears may still influence them, which can build present-day confidence [2]. Interpersonal therapy assists in managing anxiety-inducing conflicts within relationships, promoting healthier resolutions [2]. Exposure therapy supports confronting and overcoming specific fears, especially useful for those avoiding crucial tasks due to anxiety [2]. Additionally, applied relaxation, through practices like deep breathing, meditation, and visualization, enables individuals to manage physical symptoms by harnessing muscle control and mental focus [2].

   
   

3. Healthy lifestyle such as exercise, staying away from stimulating substances, not smoking, and avoiding drug and alcohol use. [1]

Statistics

Approximately 4% percent of people will experience generalized anxiety disorder in their lifetime. The ratio of females to males with generalized anxiety disorder is 2:1. The development of generalized anxiety disorder usually begins in early adulthood.

References

1. Generalized Anxiety Disorder (GAD). (2024, April 16). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/generalized-anxiety-disorder#:~:text=What%20is%20generalized%20anxiety%20disorder,for%20at%20least%206%20months.

2. LeWine, H. E., MD. (2022, March 10). Generalized Anxiety Disorder. Harvard Health. https://www.health.harvard.edu/a_to_z/generalized-anxiety-disorder-a-to-z

3. Munir, S., & Takov, V. (2022, October 17). Generalized Anxiety Disorder. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK441870/