Merck Manual

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Generalized Anxiety Disorder


John W. Barnhill

, MD, New York-Presbyterian Hospital

Reviewed/Revised Aug 2023
Topic Resources
  • People are anxious and worried about a variety of issues, activities, and situations, not just one type.

  • For this disorder to be diagnosed, several other symptoms (such as a tendency to tire easily, difficulty concentrating, and muscle tension) must accompany the anxiety.

  • Treatment involves a combination of medications (usually antianxiety medications and sometimes antidepressants) and psychotherapy.

For most people, the disorder fluctuates, worsening at times (especially during times of stress), and persists over many years.

Overview of Generalized Anxiety Disorder

Symptoms of Generalized Anxiety Disorder

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 greater than the situation warrants.

Worries are general in nature, include many topics, and often shift from one topic to another over time. Common worries include work and family responsibilities, money, health, safety, car repairs, and chores.

Diagnosis of Generalized Anxiety Disorder

  • A doctor's evaluation, based on standard psychiatric diagnostic criteria

For a doctor to diagnose generalized anxiety disorder, a person must experience worry or anxiety that

  • Is excessive

  • Concerns a number of activities and events

  • Is present more days than not over a period of 6 months or longer

In addition, the person must have 3 or more of the following symptoms:

  • Restlessness or a keyed-up or on-edge feeling

  • A tendency to tire easily

  • Difficulty concentrating

  • Irritability

  • Muscle tension

  • Disturbed sleep

Before diagnosing generalized anxiety disorder, doctors do a physical examination. They may do blood or other tests to make sure the symptoms are not caused by a physical disorder or use of a drug.

Treatment of Generalized Anxiety Disorder

  • A combination of psychotherapy and medications

The disorder is often managed with a combination of some form of psychotherapy and drug therapy. Psychotherapy can address the causes of anxiety and provide ways to cope.

Some antidepressants Medications for depression Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to interfere with functioning. It may follow a recent... read more , particularly selective serotonin reuptake inhibitors (such as escitalopram) and serotonin-norepinephrine reuptake inhibitors (such as venlafaxine), are effective for generalized anxiety disorder. These antidepressants usually take a few weeks to relieve anxiety, so some people are first given a benzodiazepine along with the antidepressant. Benzodiazepines are antianxiety medications that relieve anxiety quickly, typically almost immediately. However, because long-term use of benzodiazepines can lead to a medication dependence and addiction (see Antianxiety and Sedative Drugs Misuse of Antianxiety Medications and Sedatives Antianxiety and sedative medications are prescription drugs used to relieve anxiety and/or help with sleep, but their use can result in dependency and a substance use disorder. Using prescription... read more ), these medications are usually given for only a relatively short time. Once the antidepressant and psychotherapy becomes effective, the dose of the benzodiazepine may be decreased slowly, then stopped. Benzodiazepines should not be stopped abruptly.

Buspirone, another antianxiety medication, is effective for some people with generalized anxiety disorder. However, buspirone may take 2 weeks or longer to start working.

  • Recognize where their thinking is distorted

  • Control their distorted thinking

  • Modify their behavior accordingly

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Effexor, Effexor XR, Venlafaxine
BuSpar, Buspar Dividose
No brand name available
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