Generalized Anxiety Disorder

Topic Overview

What is generalized anxiety disorder?

Generalized anxiety disorder occurs when you feel worried and stressed about many everyday events and activities. Often the things you are worried about are small or not important. This type of worry disrupts your life most days. Everyone gets worried or anxious sometimes, but people with generalized anxiety disorder experience more than normal everyday worries.

Many people who have generalized anxiety disorder have physical symptoms, such as headaches or being tired all the time.

Anyone can get generalized anxiety disorder at any age, but it usually starts when you are a child or teenager. Most people with generalized anxiety disorder have felt nervous or anxious as long as they can remember. About 5% of people have generalized anxiety disorder at some time.¹ Women are twice as likely as men to have the problem.

Many people with generalized anxiety disorder also have other problems such as depression, other anxiety illnesses (obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, or social anxiety disorder), alcohol abuse, or personality disorder.

What causes generalized anxiety disorder?

The cause of generalized anxiety disorder is not known. Some studies show that it might be passed through the family (genetic).

Some problems such as hyperthyroidism can cause generalized anxiety symptoms.

Some medicines can cause worry and stress or make your stress worse, such as medicines with amphetamines (Ritalin) or too much caffeine. Illegal drugs such as cocaine can also cause these symptoms. Be sure to talk with your doctor about any medicines you are taking.

What are the symptoms?

People who have generalized anxiety disorder get worried and stressed about many things almost every day. They have a hard time controlling their worry. Adults with this problem often worry about money, family, health, or work. Children with this problem often worry about how well they can do an activity, such as school or sports.

You might also have physical symptoms, such as:

• Feeling tired or irritable; having a hard time concentrating.
• Having headaches or muscle aches.
• Having a hard time swallowing.
• Feeling shaky; sweating or having hot flashes.
• Feeling light headed, sick to your stomach, or out of breath.
• Having to go to the bathroom often.
• Feeling like you can't relax; being startled easily.
• Having problems falling or staying asleep.

How is generalized anxiety disorder diagnosed?

To find out if you have this problem, your doctor will ask questions about your symptoms and how long you have had them. Your doctor will also do a physical exam, ask questions about your medical history, and ask questions about medicines you are taking. This information helps your doctor find out whether or not you have any other condition.

To be diagnosed with generalized anxiety disorder, you must have more worry and stress than normal. You must feel worried and stressed about many things almost every day, and these feelings must last for at least 6 months. You will also have some physical symptoms. The worry, stress, and physical symptoms might make it hard for you to do normal activities such as going to work every day or doing grocery shopping.

How is it treated?

Generalized anxiety disorder is treated with medicines and/or therapy.

The two kinds of therapy that are used to treat generalized anxiety disorder are called applied relaxation therapy and cognitive-behavioral therapy. In applied relaxation therapy, your therapist might ask you to imagine a calming situation to help you relax. In cognitive-behavioral therapy, your therapist will help you learn how to think positive thoughts instead of thoughts that make you feel stressed and worried.

Some of the medicines that are used to treat generalized anxiety disorder are:

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft). Studies have shown sertraline to be a good medicine for children or adolescents with generalized anxiety disorder. These medicines usually take several weeks to a few months to work well.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor). Studies have shown venlafaxine to be a good medicine for people who have another problem along with generalized anxiety disorder, such as panic disorder or depression. These medicines take several weeks to work well.
• Benzodiazepines, such as diazepam (Valium) or alprazolam (Xanax), which traditionally have been used to treat generalized anxiety disorder. In some people who take benzodiazepines, their body becomes too used to the medicine and their doctor might need to prescribe more of the medicine for it to work. If you stop taking benzodiazepines all of a sudden, you might feel more jittery or worried than usual (withdrawal symptoms). Some people might have seizures from stopping the medicine too quickly. Be sure to talk with your doctor before you stop taking your medicine. People can become addicted to it. Be sure not to let anyone else take this medicine.
• Tricyclic antidepressants (TCAs), such as amitriptyline (Elavil) or nortriptyline (Pamelor) have also traditionally been used to treat generalized anxiety disorder.
• Buspirone is often used with other medications to treat generalized anxiety disorder. It may be used alone if the anxiety is mild. It can take 2 to 3 weeks to start working. People who take buspirone will not become addicted to the medicine.

Tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs) can sometimes have side effects such as being restless and not being able to sleep. These symptoms can be similar to generalized anxiety disorder, but they usually go away after you take the medicine for a while.

Some medicines work better for different people than others. Be sure to talk with your doctor about how the medicine is working for you. Sometimes you might need to try more than one type of medicine before you find one that works best for you.

Treatment for generalized anxiety disorder helps reduce the symptoms. Some people might feel less worried and stressed after a couple months of treatment, and some people might not feel better until after a year or more.

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Author:	Jeannette Curtis	Last Updated August 27, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Lisa S. Weinstock, MD - Psychiatry
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