[GENERALIZED ANXIETY DISORDER]
About Your Diagnosis
Generalized anxiety disorder (GAD), one of many different anxiety disorders,
is characterized by excessive anxiety and worry about a number of events
and activities, such as work or school performance. In GAD, anxiety
and worry occur on most days and have been present for at least 6 months.
In addition to the anxiety, individuals find it very difficult to control
their worrying even when reassured by others. In GAD, anxiety and worry
are associated with specific symptoms, including restlessness or feeling
keyed up, uptight, or on edge; being easily fatigued or feeling "drained";
having difficulty concentrating or feeling that one's mind has gone
blank; irritability out of proportion to whatever may have caused it;
and feeling angry for no apparent reason. Muscle tension or tightness
occurs, as well as sleep disturbances, especially difficulty falling
or staying asleep or having a very restless, unsatisfying sleep. For
GAD to be diagnosed, the intensity of anxiety has to cause some impairment
in the individual's ability to function either on the job or in social
relationships. The anxiety may also cause physical symptoms including
shortness of breath, chest tightness, rapid and pounding heartbeat,
sweating, a sensation of choking, and abdominal distress.
Some forms of anxiety besides GAD include panic attacks, in which the
physical symptoms just mentioned occur "out of the blue" for
no apparent reason, last for a very brief period, and then resolve.
The individual with panic attacks may not, in fact, be anxious most
of the day and may be relatively calm between the episodes of panic.
Agoraphobia, another form of anxiety, is a fear of being out in open
spaces alone, where one might feel trapped and unable to get home. Agoraphobia
often occurs in conjunction with panic and sometimes leads individuals
to become virtual prisoners in their own homes.
Phobias are a type of anxiety involving fears of specific objects, places,
or behaviors. Examples of phobias include fear of urinating in public
restrooms, fear of using public transportation, fear of heights (acrophobia),
fear of foreigners (xenophobia), and fear of closed-in places (claustrophobia).
Other forms of anxiety include the obsessive-compulsive disorder, posttraumatic
stress disorder, and acute stress disorder, as well as the anxiety caused
by legal drugs such as caffeine, the anxiety caused by drugs of abuse
such as amphetamines or cocaine, and the anxiety caused by medical conditions
and medications, such as those used to treat asthma (steroids, aminophylline).
In general, anxiety is a state of fear or worry that (1) may or may
not have a cause, (2) the individual cannot control, and (3) that significantly
compromises the individual's ability to function normally.
It should be pointed out that worry and anxiety are normal feelings;
however, it is all a matter of degree. Sometimes anxiety can allow us
to make plans and provisions for the future and can, in fact, be beneficial.
Such beneficial anxiety is called anticipation.
Living With Your Diagnosis
Generalized anxiety disorder is fairly common, affecting up to 10% of
individuals at any particular point in time. Its childhood equivalent,
the so-called overanxious anxiety disorder of children is also fairly
common. Studies of families suggest that anxiety can be transmitted
to children genetically, especially in conditions such as panic disorder.
The matters about which anxious patients can worry are endless. They
are likely to report worry over minor matters, and they are often anxious
for at least half the day during an average day. In children and adolescents,
the worries will center around the quality of their school performance
or some aspect of their social functioning in school. They may also
be concerned with their own physical or mental imperfections as they
see them, and such anxious adolescents will require constant reassurance.
There are some medical conditions that have a high correlation with
anxiety. These include such conditions as ulcerative colitis, Crohn's
disease, asthma, hypertension, heart disease, ulcer disease, reflux
esophagitis, and headaches. During evaluation, anxious patients often
have rapid or pressured speech and often shift from one subject to another
without any apparent connection. These patients may be extremely restless,
shifting about in their chair or tapping their fingers or toes, ringing
their hands, putting their head in their hands, and often even getting
up and walking across the room. Patients will use such phrases as "I
feel like I'm going to jump out of my skin," "My whole body's
on fire," "I think I'm going to have a heart attack,"
or similar comments.
In the treatment of anxiety, it is important to determine whether some
medical condition or substance abuse is causing the anxiety. Common
drugs that can produce anxiety include theophylline, any medications
with caffeine, steroids, many antihypertensives including Aldomet, stimulating
antidepressants such as Prozac, inhalers used for breathing problems
such as Brethine and Vanceril, thyroid medication, and diet pills. Many
over-the-counter medications such as some antihistamines, some cough
and cold preparations, and diet pills that contain caffeine can also
cause anxiety, and dietary intake of excessive amounts of caffeine and
sugar can make any anxiety syndrome worse. Once a medication or a medical
condition has been eliminated as a cause of anxiety, then an adequate
history should be obtained for substance abuse to eliminate the possibility
that the individual may be using some kind of psychostimulant that might
be producing anxiety. Attention should also be directed toward uncovering
any precipitants in the individual's home environment or any major stressors
that might be contributing to the anxiety.
The treatment of anxiety involves both behavioral techniques and medication.
One behavioral technique used is biofeedback, wherein patients are hooked
to a machine and learn to decrease their muscle tone or control their
brain waves by regulating their breathing. Other behavioral techniques
include progressive muscle relaxation, which is often done to a prerecorded
tape; imagery, where individuals imagine that they are in some pleasant
setting; meditation; and hypnosis. Behavioral techniques have been very
effective in treating anxiety and are the commonly used methods in those
patients who prefer not to take medication.
If you have been prescribed a medication for anxiety, it is most likely
one of the minor tranquilizers of the benzodiazepine class. This would
include such drugs as alprazolam (Xanax), lorazepam (Ativan), or diazepam
(Valium). Although these drugs are effective for the rapid relief of
anxiety, they do have side effects. They typically slow down breathing
and therefore may not be the best drugs to use in someone who has asthma,
bronchitis, or emphysema. They also are broken down by the liver, so
they may be bad choices in someone who has severe liver disease, such
as cirrhosis or hepatitis. Finally, these drugs can be habit forming;
that is, they cannot be discontinued without being tapered for fear
of withdrawal signs and symptoms. Those individuals who have a history
of substance abuse, particularly abuse of depressant drugs, such as
alcohol, barbiturates, or benzodiazepines should not be prescribed these
drugs. Because the duration of action of some of the benzodiazepines,
such as Xanax and Ativan, is fairly short, they may have to be given
three or four times a day. Also, the benzodiazepines may produce a significant
degree of sedation, which can impair driving and the ability to operate
Another group of drugs that are used to treat anxiety are the antidepressants.
The tricyclic antidepressant drugs, such as imipramine, have been very
effective for years in treating anxiety disorders. The major drawback
of these medications is that they are not effective as quickly as the
benzodiazepines. It may take 10 days to 2 weeks before the beneficial
effects of imipramine and other tricyclic antidepressants are seen.
They also may initially increase anxiety before relieving it, and they
have side effects such as weight gain, sexual dysfunction, dry mouth,
constipation, and blurry vision. The advantages of the tricyclic antidepressants
are twofold: (1) they can be given once daily, and (2) they may be more
effective than the benzodiazepines when depression is associated with
the anxiety, as it often is.
Other antidepressants used to treat anxiety are the selective serotonin
reuptake inhibitors (SSRIs). In particular, paroxetine (Paxil) seems
to have significant antianxiety effects. It can be given once daily,
usually in the evening, and may improve sleep. It has few side effects,
except for diarrhea, constipation, and some sexual side effects. Paxil
is similar to imipramine in that its therapeutic onset is delayed; it
may take 2 to 3 weeks before he beneficial effects are seen. In addition,
you may have to avoid using Paxil if you are taking certain other medications
because of its interaction with them.
Buspirone (BuSpar) is also used for anxiety. It is the only drug approved
for anxiety that is not potentially physically addicting, so it is often
substituted for the benzodiazepines. The advantages of using BuSpar
are that it is less likely to cause sedation and that there is no withdrawal
on discontinuing it. Side effects of BuSpar may include gastrointestinal
distress and headaches.
Finally, the beta-blocker, propranolol (Inderal) is often used for treating
some of the effects of anxiety and is particularly effective for treating
the runaway heartbeat and sense of heart pounding that many anxious
patients feel. Because Inderal is also used to treat high blood pressure,
individuals with low blood pressure should not take it. It can also
sometimes make individuals feel very tired, and should not be used in
patients who have severe lung disease.
Anxiety disorders can cause significant suffering and worry for patients.
However, these are treatable conditions.
* If you have an anxiety disorder diagnosed, it is very important to
minimize your level of stress; to have some activity that you enjoy
doing such as reading, writing, or knitting; to participate in a regular
exercise program; and to watch your diet. If you are taking antianxiety
medications, you should be very careful when driving or operating dangerous
* Do not use products containing caffeine, and decrease your sugar intake
as much as possible. In addition, remember that most prescribed medications
for anxiety have some sedating effects; therefore you should avoid drinking
When to Call Your Doctor
* You should call your doctor if the nature of your anxiety changes,
if you notice any side effects from your medications, or if your anxieties
are accompanied by depression and suicidal ideation or thoughts.
For More Information
For more information on anxiety, please contact your local mental health
center or your local community hotline. There are various support groups
in most communities for specific anxiety disorders such as panic, obsessive-compulsive
disorder, and posttraumatic stress disorder.