Generalized Anxiety Disorder

All of us worry about things like health, money, or family problems. But people with GAD are extremely worried about these and many other things, even when there is little or no reason to worry about them. They are very anxious about just getting through the day. They think things will always go badly. At times, worrying keeps people with GAD from doing everyday tasks.

GAD develops slowly. It often starts during the teen years or young adulthood. Symptoms may get better or worse at different times, and often are worse during times of stress.

People with GAD may visit a doctor many times before they find out they have this disorder. They ask their doctors to help them with headaches or trouble falling asleep, which can be symptoms of GAD but they don’t always get the help they need right away. It may take doctors some time to be sure that a person has GAD instead of something else.

You should limit or avoid completely:

• alcohol

• nicotine

• amphetamines

• antihistamines

• slimming tablets

• thyroid preparations

• xanthine compounds (theophylline and caffeine)

Psychological and Physical Symptoms of GAD

Psychological

●Feeling keyed up or on edge

●Restlessness

●Difficulty concentrating

●Difficulty relaxing

●Exaggerated startle response

Physical

●Palpitations

●Symptoms of hyperventilation

●tightness in chest

●light-headedness

●numbness or tingling

●Sweating

●Dry Mouth

●Nausea

●Diarrhea

●Frequent urination

●Muscular tension, particularly across the shoulders and back

●Trembling

●Headaches

Excessive caffeine is the most commonly unrecognized ‘impersonator’ of substance-induced generalized anxiety. Caffeine intoxication can mimic both GAD and panic disorder. When the symptoms mimic GAD, the person has typically consumed larger and larger amounts of caffeine, sometimes unsuspectingly, over several weeks or months. While an individual may initially have consumed caffeine to combat fatigue, unintentional consumption of toxic levels may occur through frequent use of over-the-counter medications or beverages not known by the consumer to contain caffeine.

Initial episodes of stimulant-induced anxiety usually disappear when the substance is discontinued. The exception is individuals at increased genetic risk (i.e. those with first- degree relatives who suffer from GAD), who may still suffer from anxiety after the discontinuation of caffeine or other stimulants. Individuals who are physiologically dependent on caffeine require gradual tapering of their caffeine intake.

Conversely, anxiety symptoms can result from withdrawal of alcohol or other substances, including caffeine. Anxiety is a poorly appreciated but common consequence of caffeine withdrawal in individuals with a history of high caffeine consumption. GAD may therefore be caused both by chronic use caffeine and by caffeine withdrawal. GAD can occur in association with other psychiatric disorders, notably depression and other mood disorders, other anxiety disorders and early on in schizophrenia. 

How is GAD treated?

First, talk to your doctor about your symptoms. Your doctor should do an exam to make sure that another physical problem isn’t causing the symptoms. The doctor may refer you to a mental health specialist.

GAD is generally treated with psychotherapy, medication, or both.

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

Medication. Doctors also may prescribe medication to help treat GAD. Two types of medications are commonly used to treat GAD—anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.

Antidepressants are used to treat depression, but they also are helpful for GAD. They may take several weeks to start working. These medications may cause side effects such as headache, nausea, or difficulty sleeping. These side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects you may have.

It’s important to know that although antidepressants can be safe and effective for many people, they may be risky for some, especially children, teens, and young adults. A “black box”—the most serious type of warning that a prescription drug can have—has been added to the labels of antidepressant medications. These labels warn people that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely, especially when they first start treatment with medications.

Some people do better with cognitive behavior therapy, while others do better with medication. Still others do best with a combination of the two. Talk with your doctor about the best treatment for you.