Generalized Anxiety Disorder (GAD)

Introduction to Anxiety

Generalized anxiety disorder (or GAD) is characterized by excessive, exaggerated anxiety and worry about everyday life events with no obvious reasons for worry. People with symptoms of generalized anxiety disorder tend to always expect disaster and can't stop worrying about health, money, family, work, or school. In people with GAD, the worry often is unrealistic or out of proportion for the situation. Daily life becomes a constant state of worry, fear, and dread. Eventually, the anxiety so dominates the person's thinking that it interferes with daily functioning, including work, school, social activities, and relationships.

What Are the Symptoms of GAD?

GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as well. Symptoms of GAD can include:

•Excessive, ongoing worry and tension
•An unrealistic view of problems
•Restlessness or a feeling of being "edgy"
•Irritability
•Muscle tension

•Headaches

•Sweating

•Difficulty concentrating

•Nausea

•The need to go to the bathroom frequently

•Tiredness

•Trouble falling or staying asleep

•Trembling
•Being easily startled

In addition, people with GAD often have other anxiety disorders (such as panic disorder, obsessive-compulsive disorder, and phobias), suffer from depression, and/or abuse drugs or alcohol.

What Causes GAD?

The exact cause of GAD is not fully known, but a number of factors -- including genetics, brain chemistry and environmental stresses -- appear to contribute to its development.

•Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families.

•Brain chemistry: GAD has been associated with abnormal levels of certain neurotransmitters in the brain. Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts in certain situations, leading to anxiety.

•Environmental factors: Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools, may lead to GAD. GAD also may become worse during periods of stress. The use of and withdrawal from addictive substances, including alcohol, caffeine, and nicotine, can also worsen anxiety.

How Common Is GAD?

About 4 million adult Americans suffer from GAD during the course of a year. It most often begins in childhood or adolescence, but can begin in adulthood. It is more common in women than in men.

How Is GAD Diagnosed?

If symptoms of GAD are present, the doctor will begin an evaluation by asking questions about your medical history and performing a physical examination. Although there are no laboratory tests to specifically diagnose anxiety disorders, the doctor may use various tests to look for physical illness as the cause of the symptoms.

The doctor bases his or her diagnosis of GAD on reports of the intensity and duration of symptoms -- including any problems with functioning caused by the symptoms. The doctor then determines if the symptoms and degree of dysfunction indicate a specific anxiety disorder. GAD is diagnosed if symptoms are present for more days than not during a period of at least six months. The symptoms also must interfere with daily living, such as causing you to miss work or school.

How Is GAD Treated?

If no physical illness is found, you may be referred to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses like GAD. Treatment for GAD most often includes a combination of medication and cognitive-behavioral therapy.

•Medication: Drugs are available to treat GAD and may be especially helpful for people whose anxiety is interfering with daily functioning. The medications most often used to treat GAD in the short-term are from a class of drugs called benzodiazepines. These medications are sometimes referred to as "tranquilizers," because they leave you feeling calm and relaxed. They work by decreasing the physical symptoms of GAD, such as muscle tension and restlessness.

Common benzodiazepines include Xanax, Librium, Valium and Ativan. Antidepressants, such as Paxil, Effexor, Prozac, Lexapro, and Zoloft, are also being used to treat GAD. These antidepressants may take a few weeks to start working but they're more appropriate for long-term treatment of GAD.

•Cognitive-behavioral therapy: People suffering from anxiety disorders often participate in this type of therapy, in which you learn to recognize and change thought patterns and behaviors that lead to anxious feelings. This type of therapy helps limit distorted thinking by looking at worries more realistically.

In addition, relaxation techniques, such as deep breathing and biofeedback, may help to control the muscle tension that often accompanies GAD.

Are There Side Effects of GAD Treatment?

Dependency on anti-anxiety medications (benzodiazepines) is a potential complication of treatment. Side effects of antidepressants vary by specific drug and the person taking them. Common side effects can include sleepiness, weight gain, and sexual problems.

What Is the Outlook for People With GAD?

Although many people with GAD cannot be cured and symptoms can return from time to time, most people gain substantial relief from their symptoms with proper treatment.

Can GAD Be Prevented?

Anxiety disorders like GAD cannot be prevented. However, there are some things that you can do to control or lessen symptoms, including:

•Stop or reduce your consumption of products that contain caffeine, such as coffee, tea, cola and chocolate.
•Ask your doctor or pharmacist before taking any over-the-counter medicines or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
•Exercise daily and eat a healthy, balanced diet.
•Seek counseling and support after a traumatic or disturbing experience.
•Practice stress management techniques like yoga or meditation.

REFERENCES:
Campbell, S.G., and A.A. Abbass. "Chest Pain -- Consider Panic Disorder." Canadian Family Physician 53.5 May 2007: 807-808.
Furukawa, T.A., and N. Watanabe. "Psychotherapy Plus Antidepressant for Panic Disorder With or Without Agoraphobia." The British Journal of Psychiatry 188 (2006): 305-312.
Ham, P., D.B. Waters, and M.N. Oliver. "Treatment of Panic Disorder." American Family Physician 71.4 Feb. 15, 2005.
Katon, W.J. "Panic Disorder." The New England Journal of Medicine 354 June 2006: 2360-2367.
Kessler, R.C., W. Tat-Chiu, R. Jin, A. Meron-Ruscio, et al. "The Epidemiology of Panic Attacks, Panic Disorder and Agoraphobia in the National Comorbidity Survey Replication." Archives of General Psychiatry 63 (2006): 415-424..
National Institute of Mental Health of the U.S. Department of Health and Human Services
Saeed, S.A., R.M. Bloch, and D.J. Antonacci. "Herbal and Dietary Supplements for Treatment of Anxiety Disorders." American Family Physician 76 Aug. 2007:549-556.
Safren, S.A., B.S. Gershuny, P. Marzol, M. Otto, and M.H. Pollack. "History of Childhood Abuse in Panic Disorder, Social Phobia and Generalized Anxiety Disorder." The Journal of Nervous and Mental Disease 190.7 July 2002: 453-456.
Zvolensky, M.J., and N.B. Schmidt. "Introduction to Anxiety Sensitivity." Behavior Modification 31.2 (2007): 139-144.