Understanding Generalized Anxiety Disorder -- Diagnosis and Treatment

How Do I Know If I Have Generalized Anxiety Disorder?

The first step is to rule out the possibility that your symptoms are being caused by a medical condition that is not psychiatric. Among the conditions that produce symptoms similar to those of anxiety are hyperthyroidism or other endocrine problems, too much or too little calcium, low blood sugar, and certain heart problems. Certain medicines also can sometimes cause anxiety. A thorough evaluation by your health care provider will determine if any of these conditions are the cause of your symptoms.

If no other medical culprit can be found and the symptoms seem out of proportion to any situation you are facing, you may be diagnosed with an anxiety disorder.

What Are the Treatments for Generalized Anxiety Disorder?

Medication for Anxiety

Medication is useful for alleviating the symptoms of generalized anxiety disorder and is often prescribed in conjunction with other therapies. Some types of anxiety drugs can be habit-forming and are usually prescribed on a short-term or as-needed basis.

Different anxiety disorders have different medication regimens. Some are preventive and some are designed to cure the problem.

Antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs), are widely used to treat and prevent a variety of anxiety disorders. Examples of SSRIs that are commonly used to treat chronic anxiety include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). The antidepressants duloxetine (Cymbalta) and venlafaxine (Effexor), SNRIs (serotonin and norepinephrine reuptake inhibitors) which act on the brain chemicals serotonin and norephinephrine, and some of the tricyclic antidepressants like imipramine (Tofranil), may also help. Novel antidepressants such as mirtazepine (Remeron) are also prescribed at times.

Antihistamines (such as hydroxyzine) and beta-blockers (such as propranolol) can help mild cases of anxiety as well as performance anxiety, a type of social anxiety disorder. Antidepressants such as SSRIs or SNRIs or tricyclics need to be taken daily whether or not you have anxiety on that particular day, as prescribed by your health care provider. Antihistamines or beta- blockers are usually taken only when needed for anxiety, or immediately before an anxiety-provoking event (for example, taking propranolol shortly before giving a speech). Finally, certain anticonvulsant medicines, such as gabapentin (Neurontin) and pregabalin (Lyrica), are also beginning to show value in treating some forms of anxiety in initial research studies

If you have acute anxiety (panic attack), you will likely need to take an anti- anxiety medicine as well. The most prominent of anti-anxiety drugs for the purpose of immediate relief are those known as benzodiazepines; among them are alprazolam (Xanax), clonazepam (Klonopin), chlordiazepoxide (Librium), diazepam (Valium), and lorazepam (Ativan). They have drawbacks: Benzodiazepines sometimes cause drowsiness, irritability, dizziness, memory and attention problems, and physical dependence. Nonetheless, in recent decades they have largely replaced barbiturates because they tend to be safer if taken in large doses.

Another anti-anxiety drug is busprirone (Buspar). It has fewer side effects than the benzodiazepines and is not associated with dependence. Buspar, however, can have its own side effects and may not always be as effective when a person has taken benzodiazepines in the past.

Therapy for Anxiety

Psychotherapy, with or without medication, is often considered a fundamental aspect of treatment for generalized anxiety disorder.

Several specific forms of psychotherapy have been described in research studies as helpful for alleviating the symptoms of GAD. Two -- psychodynamic psychotherapy and supportive-expressive therapy -- focus on anxiety as an outgrowth of feelings about important relationships. Another form of psychotherapy, called cognitive-behavioral therapy, involves learning behavioral relaxation techniques as well as restructuring patterns of thinking that foster anxiety.

Biofeedback is another helpful tool. In a series of sessions with a therapist, you watch your own brain-wave patterns on an electroencephalograph and gradually learns to control the waves. This teaches you to achieve a more relaxed state at will. Practitioners estimate that after about a dozen sessions, you will be able to exert control over mental activity without the help of the therapist or monitoring instrument.

Lifestyle Modifications to Alleviate Anxiety

Daily exercise can be another helpful treatment for anxiety symptoms. If you find that exercise works for you, push yourself to go for brisk walks or undertake an active sport that you enjoy. Get your heart rate into the target range for your age for at least 30 minutes each time you exercise.

Since anxiety is often accompanied by shallow breathing, deep breathing exercises can also be helpful. Try the following form of yoga breathing:

• Lie on your back in a comfortable place.
• Breathe in slowly through your nose, using your diaphragm to suck air into your lungs while allowing your abdomen to expand. (Put your hand on your abdomen just below the navel to make sure the abdomen is being pushed up and out by the diaphragm.) After the abdomen is expanded, continue to inhale as deeply as possible.
• When you breathe out, reverse the process: Contract the abdomen while exhaling slowly and completely.
• Repeat several times.

Progressive relaxation is another helpful technique. It begins by tensing and then relaxing one part of the body, usually beginning with the toes. When this part of the body is relaxed, another part of the body is tensed and relaxed until the entire body is free of tension.

Relaxing visualization can also help. A therapist or meditation trainer suggests relaxing images for a person to hold in mind. Once the image is in place, the person imagines soothing sensations such as pleasant scents and sounds. Eventually people can learn to do this themselves when they anticipate -- or find themselves in -- stressful situations.

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