US Pharm. 2014;39(11):17-18.

Persistent, Excessive Worrying

Generalized anxiety disorder, sometimes called GAD, affects millions of Americans. People who suffer from GAD worry far too much about everyday matters such as money, safety, family, or problems at work or home. GAD is twice as common in women, and typically develops over a period of time during early through middle-age adulthood. If left untreated, this extreme worry can eventually interfere with the ability to carry out everyday activities such as driving a car or falling asleep. It can take time to diagnose GAD because it causes symptoms seen with many other disorders. Successful treatment includes behavioral psychotherapy and/or medications to reduce anxiety.

Without Treatment, Anxiety Usually Does Not Improve On Its Own

Generalized anxiety disorder (GAD) affects more than 3% of the U.S. population, which translates to over 6 million people. Those at high risk for developing GAD include people with a family history of excessive anxiety, those living in a stressful environment, and those who have experienced a stressful event. Along with stress, the development of GAD is probably related to a person’s heredity, as well as differences in brain chemistry.

When Symptoms Interfere With Daily Activities

The symptoms of GAD make it difficult to diagnose because they develop slowly and resemble those of other conditions. Unrealistic and overwhelming worry, which ultimately can consume the life of a person with GAD, is the primary symptom. Most people with GAD realize their worry is extreme, but feel helpless to control it. Emotional symptoms of GAD include restlessness, irritability, inability to focus, poor memory, and racing thoughts. Physical symptoms can include muscle tension, headache, insomnia, fast heartbeat, shortness of breath, sweating, trembling, nausea, and diarrhea. People suffering from GAD may seek treatment for their physical symptoms, such as problems with sleep, and they may be treated for an extended time without recognizing that overwhelming anxiety is the root of the problem.

Diagnosis of GAD is made when uncontrollable and excessive anxiety occurs most days of the week for at least 6 months. This anxiety interferes with daily activities and is accompanied by some of the physical symptoms previously mentioned. Oftentimes, GAD is long-standing because it is mild and the person is able to avoid situations that worsen his or her anxiety and continues to function. People who suffer from persistent, excessive anxiety often do not seek help or are embarrassed by their feelings. Without treatment, GAD does not improve on its own. In more severe cases of GAD, a person may not be able to work or function in everyday activities. This is the point at which many people seek treatment.

Treatment Involves Psychotherapy and Medications

GAD can be treated with psychotherapy, medications, or a combination. Psychotherapy uses a technique called cognitive behavioral therapy, or CBT, to teach people how to think about and react to situations that cause anxiety. Relaxation techniques are also very helpful for many. Psychotherapy can be effective even over a short period of time. Psychologists and other mental-health practitioners are trained to teach the techniques used in CBT and may suggest the use of medication prescribed by a psychiatrist or primary care doctor to achieve the best results. Support groups for anxiety sufferers are often available locally and have proven to be a great resource for people with a variety of anxiety disorders.

Two classes of drugs are used to treat GAD: antianxiety medications and antidepressants. Benzodiazepines (such as alprazolam, diazepam, and lorazepam) are antianxiety medications that work rapidly but have side effects such as drowsiness and dizziness. They are primarily used for short-term treatment because they have the potential for addiction. Withdrawal symptoms occur when these drugs are discontinued without slowly tapering. Buspirone is another type of antianxiety agent, but unlike the benzodiazepines, it is slower-acting and does not cause sedation.

Antidepressants are also used in treating GAD and include paroxetine, escitalopram, and venlafaxine. These drugs take several weeks to see results, and their side effects include nervousness, difficulty sleeping, and changes in appetite. Antidepressants balance the chemicals in the brain that control both anxiety and depression. Although these agents are not addictive, they can also cause symptoms when abruptly stopped, so they must be slowly tapered when discontinuing.

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