Merck Manual

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Generalized Anxiety Disorder

By

John W. Barnhill

, MD, Weill Cornell Medical College and New York Presbyterian Hospital

Last full review/revision Apr 2020| Content last modified Apr 2020
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Generalized anxiety disorder consists of excessive nervousness and worry about a number of activities or events. People have anxiety more days than not over a period of 6 months or longer.

  • 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 drugs (usually antianxiety drugs and sometimes antidepressants) and psychotherapy.

Generalized anxiety disorder is a common type of anxiety disorder. 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 Generalized Anxiety Disorder in Children) 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

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

  • A doctor's evaluation, based on specific 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

  • A combination of psychotherapy and drug therapy

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, 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 drugs that relieve anxiety quickly, typically almost immediately. However, because long-term use of benzodiazepines can lead to a drug use disorder (see Antianxiety and Sedative Drugs), these drugs 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 drug, is effective for some people with generalized anxiety disorder. Its use does not lead to a drug use disorder. However, buspirone may take 2 weeks or longer to start working.

Herbal products such as kava and 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 do the following:

  • Recognize where their thinking is distorted

  • Control their distorted thinking

  • Modify their behavior accordingly

Relaxation, yoga, meditation, exercise, and biofeedback techniques may also be of some help (see Types of Complementary and Alternative Medicine : Mind-Body Medicine).

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