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Generalized anxiety disorder consists of excessive, usually daily, nervousness and worry (lasting 6 months or longer) about many activities or events.

• Anxieties are general in nature and may shift from topic to topic.
• For this disorder to be diagnosed, several other symptoms (such as difficulty concentrating) must accompany the anxiety.
• Treatment involves a combination of drugs (usually antianxiety drugs and sometimes antidepressants) and counseling.

Generalized anxiety disorder is common. About 3% of adults have it during any 12-month period. Women are twice as likely as men to have the disorder. It often begins in childhood or adolescence (see Mental Health Disorders in Children: Generalized Anxiety Disorder) but may start at any age. For most people, the disorder fluctuates, worsening at times (especially during times of stress), and persists over many years.

Symptoms and Diagnosis

People with generalized anxiety disorder constantly feel worried or distressed and have difficulty controlling these feelings. The severity, frequency, or duration of the worries is disproportionately greater than the situation warrants. Worries are general in nature and often shift from one topic to another over time. Common worries include work responsibilities, money, health, safety, car repairs, and chores.

For a doctor to diagnose generalized anxiety disorder, a person must experience worry or anxiety and three or more of the following symptoms:

• Restlessness
• Easy fatigue
• Difficulty concentrating
• Irritability
• Muscle tension
• Disturbed sleep

Treatment

The disorder is best managed with a combination of some form of counseling and drug therapy. Counseling can address the root causes of anxiety and provide ways to cope.

Antianxiety drugs such as benzodiazepines are usually prescribed. However, because long-term use of benzodiazepines can lead to drug dependence (see Drug Use and Abuse: Antianxiety and Sedative Drugs), the drug, if stopped, must be tapered off slowly rather than stopped abruptly. The relief that benzodiazepines bring usually outweighs any mild side effects and the possibility of drug dependence.

BuspironeSome Trade Names
BUSPAR
is another antianxiety drug effective for some people with generalized anxiety disorder. Its use does not lead to drug dependence. However, buspironeSome Trade Names
BUSPAR
may take 2 weeks or longer to start working, in contrast to benzodiazepines, which begin to work within an hour.

Some antidepressants, such as venlafaxineSome Trade Names
EFFEXOR
, paroxetineSome Trade Names
PAXIL
, and other selective serotonin reuptake inhibitors, are also effective for treatment of generalized anxiety disorder. These antidepressants start to relieve anxiety quickly, sometimes after a few days. Initially, people may be given a benzodiazepine and an antidepressant. When the antidepressant starts working, the dose of benzodiazepine is decreased, then stopped.

Herbal products such as kava (see Medicinal Herbs and Nutraceuticals: Kava) and valerian (see Medicinal Herbs and Nutraceuticals: Valerian) may have antianxiety effects, although their effectiveness and safety for treating anxiety disorders such as generalized anxiety disorder require further study.

Cognitive-behavioral therapy has been shown to be beneficial for generalized anxiety disorder. With this therapy, people learn to recognize where their thinking is distorted, to control their distorted thinking, and to modify their behavior accordingly. Relaxation, yoga, meditation, exercise, and biofeedback techniques may also be of some help (see Complementary and Alternative Medicine (CAM): Mind-Body Techniques).

Last full review/revision August 2007 by John H. Greist, MD