What is generalized anxiety disorder?

Generalized anxiety disorder (GAD) is a common mental health condition, affecting about 3% of the population within a one year period. According to the National Institute of Mental Health, GAD is "excessive anxiety and worry about a variety of events or activities (e.g., work or school performance) that occurs more days than not, for at least 6 months." [1]

The disorder often begins in childhood or adolescence but may start at any age, with women being twice as likely to be affected as men.

GAD treatment options

With treatment, those suffering from GAD can have a better quality of life. Patients can benefit from a combination of behavioral therapy and medications. There may be a period of trial and error before the most beneficial methods are found. With successful response to treatment, people with GAD can learn to manage their anxiety and live happy and fulfilling lives.

While some medication is used short-term, others may be required for extended periods. In either case, your mental health professional and primary care provider will discuss different options with you. You must always take the medications as prescribed, no more and no less. These medications should not be stopped abruptly as this might worsen your condition. [2]

Antidepressants 

Antidepressants are a common type of medication used to treat GAD. They work by correcting imbalances in brain chemistry that are thought to contribute to anxiety and depressive disorders. There are a variety of antidepressants available, and the best one for each individual may vary depending on factors like side effects and medical history.

Selective serotonin reuptake inhibitors (SSRIs), such as escitalopram, are a type of antidepressant medication commonly used to treat GAD. They work by inhibiting serotonin reuptake, which helps improve mood and ease anxiety. SSRIs are generally considered safe and effective treatments for GAD, with few adverse effects. However, they can take several weeks to reach their full effect and may not be suitable for everyone.

Since it may take some weeks for the anxiety to be relieved, sometimes SSRIs are given together with a benzodiazepine (an anxiolytic), which is slowly decreased, then stopped.

Selective serotonin-norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include such as venlafaxine. SNRIs work by inhibiting serotonin and norepinephrine reuptake, which helps to increase levels of these neurotransmitters in the brain. This, in turn, can help to improve mood and reduce anxiety. SNRIs are generally well-tolerated, but some common side effects include headache, dry mouth, and nausea. [3]

Benzodiazepines

Benzodiazepines are drugs typically used to treat anxiety, insomnia, and seizures. They bind to GABA receptors in the brain, which helps reduce activity in the nervous system. The FDA formally approved alprazolam for the treatment of GAD.

Other benzodiazepines such as clonazepam, lorazepam, and diazepam are also used in adults (and sometimes children) with GAD. They are typically considered safe and effective for short-term use, but they can be habit-forming and may cause side effects such as drowsiness, confusion, and slurred speech. For people with GAD, benzodiazepines may be prescribed for long-term use, especially when other treatment plans have proven ineffective.

In some cases, benzodiazepines are combined with other medications, such as antidepressants, to help manage symptoms. While benzodiazepines can effectively reduce anxiety, they should be used cautiously due to the risk of addiction and other potential side effects. [3]

Anxiolytics 

Anxiolytics are a class of medication used to treat anxiety disorders. Beta-blockers block adrenaline, which can cause physical anxiety symptoms. Potential physical symptoms of anxiety include excessive sweating and a fast heartbeat.

Buspirone is well-tolerated and has been used successfully in pediatric and adult patients. Pregabalin is another option if SSRIs and SNRIs aren't suitable for the patient. It is an anticonvulsant used in epilepsy but is beneficial in treating anxiety. [4]

What alternative treatments are there?

In addition to medication, several other treatment options can be helpful for people with generalized anxiety disorder. One approach is cognitive-behavioral therapy, which helps people with anxiety disorders to identify and change the negative thinking patterns that contribute to anxiety. Another option is relaxation techniques such as yoga or meditation, which can promote feelings of calm and reduce anxiety.

Exercise has also been shown to be an effective treatment for GAD, as it can help reduce stress levels and improve mood. [5] Finally, ensuring that you get enough sleep and eating a balanced diet can also help manage symptoms of GAD.

Resources:

  1. Generalized Anxiety Disorder. (n.d.). National Institute of Mental Health (NIMH). Retrieved November 29, 2022, from https://www.nimh.nih.gov/health/statistics/generalized-anxiety-disorder
  2. Generalized Anxiety Disorder—Mental Health Disorders. (n.d.). MSD Manual Consumer Version. Retrieved November 30, 2022, from https://www.msdmanuals.com/home/mental-health-disorders/anxiety-and-stress-related-disorders/generalized-anxiety-disorder?query=Generalized%20Anxiety%20Disorder
  3. Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for Generalized Anxiety Disorder in Adults and Pediatric Patients: An Evidence-Based Treatment Review. Expert Opinion on Pharmacotherapy, 19(10), 1057–1070. https://doi.org/10.1080/14656566.2018.1491966
  4. Treatment—Generalised anxiety disorder in adults. (2021, February 10). NHS.UK. https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/treatment/
  5. Exercise for Stress and Anxiety. (n.d.). Anxiety and Depression Association of America, ADAA. Retrieved November 30, 2022, from https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety