Generalized anxiety disorder (GAD) is a mental health condition characterized by excessive worry that is present for most of the time for at least six months. [1] This worry centers around multiple daily activities and situations, instead of focusing on one type of event. Symptoms can include restlessness, irritability, trouble sleeping, and difficulty concentrating. [3]

GAD is relatively common, affecting roughly 3.1% of the general population. [2] The level of worry can significantly impair one’s functioning both socially and at work.

Effective treatment options for this psychiatric disorder include psychotherapy, medication, or a combination of the two. Lifestyle changes can also be beneficial in managing symptoms.

GAD therapy

There are several approaches to psychotherapy that have been found effective in generalized anxiety disorder treatment. The most widely used are cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

Cognitive behavioral therapy 

Cognitive behavioral therapy is the most widely recommended type of therapy for GAD. [1] CBT focuses on challenging maladaptive thinking patterns that contribute to anxiety and educating patients on more effective coping mechanisms.

It may also include exposure therapy, where a patient gradually faces their anxiety triggers to diminish the effect, they have on them.

This evidence-based model has been proven to be just as effective as medication in treating anxiety. [1] Symptoms are also less likely to resurface after stopping CBT than they are after stopping medication, as long-term coping skills have usually been developed. [3]

Acceptance and commitment therapy 

Acceptance and commitment therapy is a therapy which shows promising initial results. [5] The focus is on goal setting and mindfulness techniques. In ACT, the therapist helps the patient reduce avoidance behaviors, which can make anxiety worse. Patients are taught to accept their anxiety, rather than fighting it.

In ACT, therapists teach patients mindfulness techniques in order to reduce stress. [5] They are taught to focus on the present moment and accept their feelings without judgment.

GAD medications

In addition to psychotherapy, certain medications can be beneficial for GAD treatment. Medications may take several weeks to start working. Do not stop taking them without consulting with your doctor or healthcare provider. It is also important to continue medication for at least 12 months after you start feeling better. [3] 

Antidepressants

Antidepressant medications, specifically selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are the most widely prescribed medications for GAD. [5] While primarily used to treat depressive disorders, these medications have also been found effective for anxiety symptoms. Between 30-50% of cases respond well to this treatment plan. [4]

SSRIs, like fluoxetine and sertraline, are considered first line treatment options. They increase the levels of serotonin, a chemical in the brain that helps to regulate mood and sleep. [6]

SNRIs, like venlafaxine and duloxetine, may be prescribed if SSRIs are ineffective for a given patient. [6] Like SSRIs, they increase serotonin levels in the brain. They also increase norepinephrine, which can help with the body’s fear response. [6]

Benzodiazepines

Benzodiazepines, like Valium and Xanax, may be prescribed in conjunction with antidepressants to speed up recovery. [3] Benzodiazepines work by increasing GABA levels in the brain, which can produce a calming, sedative effect. [6] 

They are generally only recommended for short-term use, as long-term use can increase the risk of tolerance and misuse. [3] They are also not recommended for patients with a history of drug or alcohol addiction.

Other medications for GAD 

While antidepressants and benzodiazepines are the most commonly used medications for generalized anxiety disorder treatment, others may sometimes be prescribed based on patient history or symptoms.

Buspirone is an anti-anxiety medication that acts on the brain’s dopamine and serotonin receptors to help regulate emotions. While it is not as effective as benzodiazepines, buspirone is less likely to lead to addiction. [6] The side effects are also milder. [4]

Second-generation antipsychotics, like quetiapine, may sometimes be used to treat GAD. [6] Like buspirone, they act on the brain’s dopamine and serotonin receptors.

What is the outlook for people with GAD?

While GAD is a life-long disorder, symptoms can usually be well-managed with therapy and medication. Early diagnosis and intervention can increase an individual’s quality of life. 

In addition to therapy and medication, self-care and lifestyle changes can be beneficial. Avoiding caffeine, getting enough sleep, and exercising can all help to keep symptoms under control. 

If left untreated, generalized anxiety disorder can lead to some complications. It can lead to major depression, insomnia, and suicidal ideation. [4] Individuals with untreated GAD are also at an increased risk for substance misuse and addiction. The physical symptoms of GAD can lead to gastrointestinal problems. [4]

Resources:

  1. Borza L. (2017). Cognitive-behavioral therapy for generalized anxiety. Dialogues in clinical neuroscience, 19(2), 203–208. https://doi.org/10.31887/DCNS.2017.19.2/lborza 
  2. Boston Children’s Hospital. (n.d.). Generalized Anxiety Disorder (GAD). Retrieved November 29, 2022 from https://www.childrenshospital.org/conditions/generalized-anxiety-disorder-gad
  3. Gale, C. K. (2003). Generalized Anxiety Disorder. Am Fam Physician, 67(1):135-138.
  4. Munir S, Takov V. (2022). Generalized Anxiety Disorder. StatPearls. Retrieved November 30, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK441870/
  5. National Institute of Mental Health. (n.d.). Generalized Anxiety Disorder: When Worry Gets Out of Control. Retrieved November 30, 2022 from https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad 
  6. Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert opinion on pharmacotherapy, 19(10), 1057–1070. https://doi.org/10.1080/14656566.2018.1491966