Generalized Anxiety Disorder: When Worry Gets Out of Control

Occasional anxiety is a normal part of life. You might worry about things like health, money or family problems. However, people with generalized anxiety disorder (GAD) feel extremely worried or feel nervous about these and other things — even when there is little or no reason to worry about them. People with GAD find it difficult to control their anxiety and stay focused on daily tasks.

The good news is that GAD is treatable. Call your doctor to talk about your symptoms so that you can feel better.

What are the signs and symptoms of GAD?

GAD develops slowly. It often starts during the teen years or young adulthood. People with GAD may:

• Worry very much about everyday things.
• Have trouble controlling their worries or feelings of nervousness.
• Know that they worry much more than they should.
• Feel restless and have trouble relaxing.
• Have a hard time concentrating.
• Be easily startled.
• Have trouble falling asleep or staying asleep.
• Feel easily tired or tired all the time.
• Have headaches, muscle aches, stomachaches or unexplained pains.
• Have a hard time swallowing.
• Tremble or twitch.
• Be irritable or feel "on edge."
• Sweat a lot, feel light-headed or out of breath.
• Have to go to the bathroom a lot.

Children and teens with GAD often worry excessively about:

• Their performance, such as in school or in sports.
• Catastrophes, such as earthquakes or war.

Adults with GAD are often highly nervous about everyday circumstances, such as:

• Job security or performance.
• Health.
• Finances.
• The health and well-being of their children.
• Being late.
• Completing household chores and other responsibilities.

Both children and adults with GAD may experience physical symptoms that make it hard to function and that interfere with daily life. Symptoms may get better or worse at different times, and they are often worse during times of stress, such as with a physical illness, during exams at school, or during a family or relationship conflict.

What causes GAD?

GAD sometimes runs in families, but no one knows for sure why some family members have it while others don't. Researchers have found that several parts of the brain, as well as biological processes, play a key role in fear and anxiety. By learning more about how the brain and body function in people with anxiety disorders, researchers may be able to create better treatments. Researchers are also looking for ways in which stress and environmental factors play a role.

How is GAD treated?

First, talk to your doctor about your symptoms. Your doctor should do an exam and ask you about your health history to make sure that an unrelated physical problem is not causing your symptoms. Your doctor may refer you to a mental health specialist, such as a psychiatrist or psychologist. GAD is generally treated with psychotherapy, medication or both. Talk with your doctor about the best treatment for you.

Psychotherapy

A type of psychotherapy called cognitive behavioral therapy (CBT) is especially useful for treating GAD. CBT teaches a person different ways of thinking, behaving and reacting to situations that help him or her feel less anxious and worried.

Medication

Doctors may also prescribe medication to help treat GAD. Your doctor will work with you to find the best medication and dose for you. Different types of medication can be effective in GAD:

• Selective serotonin reuptake inhibitors (SSRIs).
• Serotonin-norepinephrine reuptake inhibitors (SNRIs).
• Other serotonergic medications.
• Benzodiazepines.

Doctors commonly use SSRIs and SNRIs to treat depression, but they are also helpful for the symptoms of GAD. They may take several weeks to start working. These medications may also cause side effects, such as headaches, nausea or difficulty sleeping. These side effects are usually not severe for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects that you have.

Buspirone is another serotonergic medication that can be helpful in GAD. Buspirone needs to be taken continuously for several weeks for it to be fully effective.

Benzodiazepines, which are sedative medications, can also be used to manage severe forms of GAD. These medications are powerfully effective in rapidly decreasing anxiety, but they can cause tolerance and dependence if you use them continuously. Therefore, your doctor will prescribe them only for brief periods of time if you need them.

Don't give up on treatment too quickly. Both psychotherapy and medication can take some time to work. A healthy lifestyle can also help combat anxiety. Make sure to get enough sleep and exercise, eat a healthy diet, and turn to family and friends whom you trust for support.

What is it like to have GAD?

"I was worried all the time and felt nervous. My family told me that there were no signs of problems, but I still felt upset. I dreaded going to work because I couldn't keep my mind focused. I was having trouble falling asleep at night and was irritated at my family all the time."

"I saw my doctor and explained my constant worries. My doctor sent me to someone who knows about GAD. Now I am working with a counselor to cope better with my anxiety. I had to work hard, but I feel better. I'm glad I made that first call to my doctor."