What is Generalized Anxiety Disorder?

Generalized Anxiety Disorder (GAD) is overwhelming anxiety involving excessive worrying that is difficult to control.  The ruminations usually are over multiple every-day events and issues, and often interferes with solving the very problems being worried about.   Generalized anxiety is usually associated with irritability, muscle tension, a sense of restlessness or being on-edge, and difficulties sleeping.  Understandably, generalized anxiety disorder also often includes symptoms of excessive fatigue and difficulties focusing.  At least 6 months of symptoms that lead to decreased functioning need to be present to fulfill a formal diagnosis.  Generalized anxiety disorder is quite common, with an estimated lifetime prevalence of 5.7%- 14.8% in the United States (Arch Gen Psychiatry 2005 Jun; 62(6):593; Arch Fam Med 2000 Sep-Oct;9(9):876).

Around 60% of people suffering from generalized anxiety disorder also suffer from clinical depression (Am J Psychiatry 1999 Dec;156(12):1915).

GAD is associated with a much higher risk of suicide in young adults aged 16-25 years (Psychol Med 2007 Mar;37(3):431).  Substance abuse is also increased in people suffering from GAD.

Traditional Treatments for Generalized Anxiety Disorder

Cognitive behavioral therapy (CBT) can be very helpful in the treatment of generalized anxiety disorder.  CBT trains patients to use techniques to reduce their physical anxiety, such as progressive muscle relaxation, breathing retraining, and mindfulness meditation.  Patients are asked to log their worries throughout the day and are trained to reassess/question their thought patterns.  Sometimes, patients are asked to write down narratives of their worries and to review them repetitively until their anxiety dissipates; this is called exposure and habituation.

While hypnotic medications and antidepressants are often effective in treating generalized anxiety disorder,  medications such as Valium (diazepam) and Xanax (alprazolam) can sometimes result in abuse and dependence, and antidepressants can be insufficient.  For example, a 2003 Cochrane review suggested that 5 patients with anxiety need to be treated with an antidepressant in order for one to demonstrate significantly diminished symptoms (Cochrane Database Syst Rev. 2003;(2):CD003592).

Transcranial Magnetic Stimulation:  A Potential Future Treatment for Generalized Anxiety Disorder

Bystritsky and colleagues recently conducted a  study that showed promising preliminary results for the treatment of generalized anxiety with low frequency transcranial magnetic stimulation on the right side of the head overlying the frontal lobe (J Clin Psychiatry. 2008 Jul;69(7):1092-8).  After 3 weeks of treatment there were significant reductions in anxiety symptoms.  Six months later, follow-up interviews of the same patients demonstrated persistent benefits from the initial TMS treatment J Clin Psychiatry. 2009 Mar;70(3):431-2.  This is very exciting news, but because this study is preliminary with only 10 participants, more research is needed to completely clarify the effects of TMS on generalized anxiety.

Depression and generalized anxiety disorder commonly co-occur.  If you or a loved one are suffering from clinical depression as well as anxiety,  Transcranial magnetic stimulation (TMS) is an FDA-approved treatment for depression that can help not only the depression symptoms, but also the anxiety symptoms.

If you found this post on generalized anxiety disorder informative, take a look a our post on ECT and TMS.

The Most Common Symptoms of Anxiety

The Most Common Symptoms of Anxiety 

Some degree of anxiousness is a regular part of our day-to-day lives. Any time a new challenge is faced, such as a first date or a job interview, a bit of nervousness and apprehension is to be expected. When symptoms of anxiety are detached from specific events and become pervasive a challenge to be faced on daily basis anxiety can become a very disruptive presence in a person’s life, especially when it comes to social anxiety disorder symptoms.

Clinically diagnosed anxiety, referred to as General Anxiety Disorder (GAD), is characterized by long-lasting symptoms of anxiety that are not focused on any one object or situation. A diagnosis of GAD is made when a person has been excessively worried about an everyday problem for six months or more.

About four million adult Americans suffer from GAD during the course of a year. It most often begins in childhood or adolescence, but can also start in adulthood. Symptoms of anxiety are more common in women than in men.

Psychological or emotional symptoms of anxiety

Many of the psychological or emotional symptoms of anxiety are experienced regularly in an average person’s daily life. When these symptoms are experienced without provocation, or when the symptoms lead to a response that is out of proportion with what might be normally expected in a situation, GAD is often the cause.

Some of these symptoms of anxiety are:

• Irrational or excessive fear or worry
• Anticipating the worst outcome of any given situation
• Trouble concentrating and holding a thought
• Constantly looking for signs of danger or stress
• Feeling tense or irritable

Physical symptoms of anxiety

Anxiety is a product of the body’s “fight-or-flight” response, and induces many physical symptoms. Sometimes these physical symptoms of anxiety lead sufferers to mistake their disorder for a medical illness. They may visit many doctors and make numerous trips to the hospital before their anxiety disorder is discovered.

Some of these symptoms of anxiety are:

• Heart pounding and shortness of breath
• Sweating
• Muscle tension and tremors
• Headaches
• Nausea and/or dizziness
• Frequent urination or diarrhea
• Fatigue

The presence of some or all of these symptoms is what lead sufferers to seek medical assistance. Once at a doctor’s office, their doctor will work to establish a medical/family history while also performing a physical examination. There is no specific medical test to determine if a patient does have anxiety disorder, but this exam may discover other medical conditions that may be contributing to how the patient is feeling.

Treating symptoms of anxiety

Anxiety disorder is often accompanied by feelings of depression. Many of the symptoms of anxiety are nearly the same as the symptoms of depression. It is believed that both conditions are the result of similar physiological causes. Because of this, treatment for symptoms of anxiety is very similar to that of depression and comes in two primary forms medication and cognitive behavioral therapy (CBT).

Drugs are prescribed for anxiety typically when symptoms are inhibiting one’s ability to function on a daily basis. The family of drugs often prescribed is the benzodiazepine family. These medications do have the potential for dependence; therefore, it is important to work closely with your doctor when taking them. These are also called tranquilizers, as they smooth out the muscle tension and restlessness caused by anxiety. More straightforward antidepressants, such as Paxil and Prozac, have also been used in treating symptoms of anxiety.

As part of CBT, people displaying symptoms of anxiety are taught to recognize the types of thoughts and behaviors that lead to feelings of anxiety and tension. The goal is to teach the person to identify symptoms of anxiety while they are mild in order to avert a full-blown anxiety-induced event.

If you feel that you may be experiencing depression related to symptoms of anxiety, West Coast TMS Institute, located in Sherman Oaks, Los Angeles, is available to help you.  Our medical director has expertise in both the medication and a new non-medication treatments for depression and can provide you with a comprehensive psychiatric evaluation. Contact us if you feel you may be experiencing some symptoms of anxiety and would like to set up a consultation for possible anxiety treatment.