Generalized Anxiety Disorder

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Generalized Anxiety Disorder

Topic Overview

What is generalized anxiety disorder?

Generalized anxiety disorder occurs when you feel worried and stressed about many everyday events and activities. Often the things you are worried about are small or not important. This type of worry disrupts your life most days. Everyone gets worried or anxious sometimes. But people with generalized anxiety disorder experience more than normal everyday worries.

Many people who have generalized anxiety disorder have physical symptoms, such as headaches or being tired all the time.

Anyone can get generalized anxiety disorder at any age. But it usually starts when you are a child or teenager. Most people with generalized anxiety disorder have felt nervous or anxious as long as they can remember. About 5% of people have generalized anxiety disorder at some time.1 Women are twice as likely as men to have the problem.

Many people with generalized anxiety disorder also have other problems such as depression, other anxiety illnesses (obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, or social anxiety disorder), alcohol abuse, or personality disorder.

What causes generalized anxiety disorder?

The cause of generalized anxiety disorder is not known. Some studies show that it might be passed through the family (genetic).

Some problems such as hyperthyroidism can cause generalized anxiety symptoms.

Some medicines can cause worry and stress or make your stress worse, such as medicines with amphetamines (Ritalin) or too much caffeine. Illegal drugs such as cocaine can also cause these symptoms. Be sure to talk with your doctor about any medicines you are taking.

What are the symptoms?

People who have generalized anxiety disorder get worried and stressed about many things almost every day. They have a hard time controlling their worry. Adults with this problem often worry about money, family, health, or work. Children with this problem often worry about how well they can do an activity, such as school or sports.

You might also have physical symptoms, such as:

  • Feeling tired or irritable, or having a hard time concentrating.
  • Having headaches or muscle aches.
  • Having a hard time swallowing.
  • Feeling shaky, sweating, or having hot flashes.
  • Feeling lightheaded, sick to your stomach, or out of breath.
  • Having to go to the bathroom often.
  • Feeling like you can't relax, or being startled easily.
  • Having problems falling or staying asleep.

How is generalized anxiety disorder diagnosed?

To find out if you have this problem, your doctor will ask questions about your symptoms and how long you have had them. Your doctor will also do a physical exam, ask questions about your medical history, and ask questions about medicines you are taking. This information helps your doctor find out whether you have any other condition.

To be diagnosed with generalized anxiety disorder, you must have more worry and stress than normal. You must feel worried and stressed about many things almost every day. And these feelings must last for at least 6 months. You will also have some physical symptoms. The worry, stress, and physical symptoms might make it hard for you to do normal activities such as going to work every day or doing grocery shopping.

If you think you may have an anxiety disorder, fill out a form(What is a PDF document?) to check your symptoms.

How is it treated?

Generalized anxiety disorder is treated with medicines and/or therapy.

The two kinds of therapy that are used to treat generalized anxiety disorder are called applied relaxation therapy and cognitive-behavioral therapy. In applied relaxation therapy, your therapist might ask you to imagine a calming situation to help you relax. In cognitive-behavioral therapy, your therapist will help you learn how to recognize and replace thoughts that make you feel stressed and worried.

Some of the medicines that are used to treat generalized anxiety disorder are:

  • Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft). Studies show sertraline to be a good medicine for children or adolescents with generalized anxiety disorder. These medicines usually take several weeks to a few months to work well.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor). Studies show venlafaxine to be a good medicine for people who have another problem along with generalized anxiety disorder, such as panic disorder or depression. These medicines take several weeks to work well.
  • Benzodiazepines, such as diazepam (Valium) or alprazolam (Xanax), which traditionally have been used to treat generalized anxiety disorder. In some people who take benzodiazepines, the body becomes too used to the medicine and the doctor might need to prescribe more of the medicine for it to work. If you stop taking benzodiazepines all of a sudden, you might feel more jittery or worried than usual (withdrawal symptoms). Some people might have seizures from stopping the medicine too quickly. Be sure to talk with your doctor before you stop taking your medicine. People can become addicted to it. Be sure not to let anyone else take this medicine.
  • Tricyclic antidepressants (TCAs), such as amitriptyline or nortriptyline (Pamelor), which have also traditionally been used to treat generalized anxiety disorder.
  • Buspirone, which is often used with other medicines to treat generalized anxiety disorder. It may be used alone if the anxiety is mild. It can take 2 to 3 weeks to start working. People who take buspirone will not become addicted to the medicine.
  • Trifluoperazine (Stelazine), an antipsychotic medicine that has been approved by the FDA to treat generalized anxiety disorder. Other antipsychotic medicines are also being studied. These medicines are not commonly used for generalized anxiety disorder because of their side effects, including mild to severe problems with body movements.

Tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs) can sometimes have side effects such as being restless and not being able to sleep. These symptoms can be similar to generalized anxiety disorder. But they usually go away after you take the medicine for a while.

Some medicines work better for some people than for others. Be sure to talk with your doctor about how the medicine is working for you. Sometimes you might need to try more than one type of medicine before you find one that works best for you.

Taking medicines for anxiety during pregnancy may increase the risk of birth defects. If you are pregnant, or thinking of becoming pregnant, talk to your doctor. You may need to keep taking the medicine if your anxiety is severe. But your doctor can help you weigh the risks of treatment against the risk of harm to your pregnancy.

Treatment for generalized anxiety disorder helps reduce the symptoms. Some people might feel less worried and stressed after a couple months of treatment. And some people might not feel better until after a year or more.

Unfortunately, many people don't seek treatment for anxiety disorders. You may not seek treatment because you think the symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.

If you need help deciding whether to see your doctor, see some reasons why people don't get help and how to overcome them.

Other Places To Get Help

Organizations

Anxiety Disorders Association of America (ADAA)
8730 Georgia Avenue
Suite 600
Silver Spring, MD  20910
Phone: (240) 485-1001
Fax: (240) 485-1035
Web Address: www.adaa.org
 

The Anxiety Disorders Association of America (ADAA) works to improve the lives of people who have anxiety disorders. Members of the association are not only people who have or are interested in anxiety disorders but also health professionals who do research and treat people who have anxiety disorders.


KidsHealth for Parents, Children, and Teens
Nemours Home Office
10140 Centurion Parkway
Jacksonville, FL 32256
Phone: (904) 697-4100
Web Address: www.kidshealth.org
 

This website is sponsored by the Nemours Foundation. It has a wide range of information about children's health—from allergies and diseases to normal growth and development (birth to adolescence). This website offers separate areas for kids, teens, and parents, each providing age-appropriate information that the child or parent can understand. You can sign up to get weekly emails about your area of interest.


Mental Health America
2000 North Beauregard Street, 6th Floor
Alexandria, VA 22311
Phone: 1-800-969-NMHA (1-800-969-6642) referral service for help with depression
(703) 684-7722
Fax: (703) 684-5968
Web Address: www.mentalhealthamerica.net
 

Mental Health America (formerly known as the National Mental Health Association) is a nonprofit agency devoted to helping people of all ages live mentally healthier lives. Its website has information about mental health conditions. It also addresses issues such as grief, stress, bullying, and more. It includes a confidential depression screening test for anyone who would like to take it. The short test may help you decide whether your symptoms are related to depression.


National Institute of Mental Health (NIMH)
6001 Executive Boulevard
Bethesda, MD 20892-9663
Phone: 1-866-615-6464 toll-free
Phone: (301) 443-4513
Fax: (301) 443-4279
Web Address: www.nimh.nih.gov
 

The National Institute of Mental Health (NIMH) provides information to help people better understand mental health, mental disorders, and behavioral problems. NIMH does not provide referrals to mental health professionals or treatment for mental health problems.


References

Citations

  1. Sadock BJ, Sadock VA, eds. (2007). Generalized anxiety disorder section of Anxiety disorders. In Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 622–627. Philadelphia: Lippincott Williams and Wilkins.

Other Works Consulted

  • Allgulander C, et al. (2003). WCA recommendations for the long-term treatment of generalized anxiety disorder. CNS Spectrums, 8(Suppl 1): 53–61.
  • American Psychiatric Association (2000). Anxiety disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 472–476. Washington, DC: American Psychiatric Association.
  • Deacon BJ, Abramowitz JS (2004). Cognitive and behavioral treatments for anxiety disorders: A review of meta-analytic findings. Journal of Clinical Psychology, 60(4): 429–441.
  • Fricchione GF (2004). Generalized anxiety disorder. New England Journal of Medicine, 351: 675–682.
  • Gale C, Millichamp J (2007). Generalised anxiety disorder, search date March 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  • Iacoviello BM, Mathew SJ (2010). Anxiety disorder. In EG Nabel, ed., ACP Medicine, section 13, chap. 1. Hamilton, ON: BC Decker.
  • Kapczinski F, et al. (2003). Antidepressants for generalized anxiety disorder. Cochrane Database of Systematic Reviews (2).
  • Keeton CP, Walkup JT (2009). Separation anxiety, generalized anxiety, and social phobia. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3684–3693. Philadelphia: Lippincott Williams and Wilkins.
  • Pine DS (2009). Anxiety disorders: Introduction and overview. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1839–1926. Philadelphia: Lippincott Williams and Wilkins.

Credits

ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerLisa S. Weinstock, MD - Psychiatry
Last RevisedJuly 11, 2011



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