If you have generalised anxiety disorder (GAD) you have a lot of anxiety (feeling fearful, worried and tense) on most days.
What is generalised anxiety disorder?
If you have generalised anxiety disorder (GAD) you have a lot of anxiety (feeling fearful, worried and tense) on most days. The condition persists long-term. Some of the physical symptoms of anxiety may come and go. Your anxiety tends to be about various stresses at home or work, often about quite minor things. Sometimes you do not know why you are anxious.
It can be difficult to tell the difference between normal mild anxiety in someone with an anxious personality and someone with GAD. As a rule, symptoms of GAD cause you distress and affect your day-to-day activities. In addition, you will usually have some of the following symptoms:
- Feeling restless, on edge, irritable, muscle tension, or keyed up a lot of the time.
- Tiring easily.
- Difficulty concentrating and your mind going blank quite often.
- Poor sleep (insomnia). Usually it is difficulty in getting off to sleep.
You do not have GAD if your anxiety is about one specific thing. For example, if your anxiety is usually caused by fear of one thing then you are more likely to have a phobia.
Who develops generalised anxiety disorder?
GAD develops in about 1 in 50 people at some stage in life. Twice as many women as men are affected. It usually first develops in your 20s but is frequently being recognised in older people.
What causes generalised anxiety disorder?
The cause is not clear. The condition often develops for no apparent reason. Various factors may play a part. For example:
- Your genetic 'makeup' may be important (the material inherited from your parents which controls various aspects of your body). Some people have a tendency to have an anxious personality, which can run in families.
- Childhood traumas such as abuse or death of a parent, may make you more prone to anxiety when you become older.
- A major stress in life may trigger the condition. For example, a family crisis or a major civilian trauma such as a toxic chemical spill. But the symptoms then persist when any trigger has gone. Common minor stresses in life, which you may otherwise have easily coped with, may then keep the symptoms going once the condition has been triggered.
Some people who have other mental health problems such as depression or schizophrenia may also develop GAD.
How is generalised anxiety disorder diagnosed?
If the typical symptoms develop and persist then a doctor can usually be confident that you have GAD. Current guidelines from the International Classification of Diseases tenth edition (ICD-10) suggest the diagnosis should be made if you have had your symptoms for six months but it is sometimes difficult to tell if you have GAD, panic disorder, depression, or a mixture of these conditions.
Some of the physical symptoms of anxiety can be caused by physical problems which can be confused with anxiety. So, sometimes other conditions may need to be ruled out. For example:
- Drinking a lot of caffeine (in tea, coffee and cola).
- The side-effect of some prescribed medicines. For example, selective serotonin reuptake inhibitor (SSRI) antidepressants.
- An overactive thyroid gland.
- Taking some street drugs.
- Certain heart conditions which cause the sensation of having a 'thumping heart' (palpitations) - uncommon.
- Low blood sugar level (rare).
- Tumours which make too much adrenaline (epinephrine) and other similar hormones (very rare).
What are the treatment options?
TALKING TREATMENTS AND OTHER TREATMENTS NOT USING MEDICATION
Cognitive behavioural therapy (CBT) and GAD
Cognitive behavioural therapy is a type of therapy that deals with your current thought processes and/or behaviours and aims to change them through creating strategies to deal with negative patterns, which may help you to manage generalised anxiety disorder more effectively.
In particular, counselling that focuses on problem-solving skills may help some people.
Anxiety management courses
These may be an option if they are available in your area. Some people prefer to be in a group course rather than have individual therapy or counselling. The courses may include learning how to relax, problem-solving skills, coping strategies and group support.
You can get leaflets, books, CDs, DVDs and downloads on relaxation and combating stress. They teach simple deep-breathing techniques and other measures to relieve stress and help you to relax. They may ease anxiety symptoms. There are also websites offering online self-help advice, treatment and support on the internet. See the separate leaflet called Stress and Tips on How to Avoid It.
MEDICATION FOR GENERALISED ANXIETY DISORDER
Antidepressants are not only useful for depression but also for GAD. Studies suggest that over half the people with GAD are helped by antidepressants. It's thought that they work by interfering with the way chemicals such as serotonin work within the brain. Antidepressants are particularly beneficial if you have the type of GAD in which anxiety is mixed with depression. SSRI antidepressants are commonly used and escitalopram and paroxetine are both licensed for this condition.
Benzodiazepines, such as diazepam, used to be the most commonly prescribed medicines for anxiety. They usually work well to ease symptoms. The problem is, they are addictive and can lose their effect if you take them for more than a few weeks. They may also make you drowsy. Therefore, they are not used much now for persistent anxiety conditions such as GAD. A short course of up to 2-4 weeks may be an option now and then to help you over a particularly bad spell.
Buspirone is another option to treat GAD. It is an anti-anxiety medicine but different to the benzodiazepines. It is not clear how it works but it is known to affect serotonin, a brain chemical which may be involved in causing anxiety symptoms. It causes less drowsiness than benzodiazepines.
Pregabalin is a medicine used for several conditions (principally epilepsy). It has been found useful in GAD. It tends to be considered for GAD if the other treatments mentioned above have been unhelpful.
Beta-blockers, such as propranolol, tend to work better in short-lived (acute) anxiety rather than in GAD and so are not usually considered appropriate treatment here.
A combination of treatments
CBT plus an antidepressant medicine may work better in some cases than either treatment alone.
What is the outlook for generalised anxiety disorder?
Although GAD gets better in some people, in others it tends to come and go. Some people need to take medicines for a long time but are otherwise able to lead perfectly normal lives.
Symptoms may flare up and become worse for a while during periods of major life stresses. For example, if you lose your job or split up with your partner.
People with GAD are more likely than average to smoke heavily, drink too much alcohol and take street drugs. Each of these things may ease anxiety symptoms in the short term. However, addiction to nicotine, alcohol or drugs makes things worse in the long term and can greatly affect your general health and well-being.
Further reading and references
Social anxiety disorder: recognition assessment and treatment; NICE Clinical Guideline (May 2013)
Anxiety disorders; NICE Quality Standards, Feb 2014