Merck Manual

Please confirm that you are a health care professional

honeypot link

Generalized Anxiety Disorder

By

John W. Barnhill

, MD, New York-Presbyterian Hospital

Reviewed/Revised Aug 2023
View PATIENT EDUCATION
Topic Resources

Generalized anxiety disorder (GAD) is common, affecting about 3% of the population within a 1-year period (1 General references Generalized anxiety disorder is characterized by excessive anxiety and worry about a number of activities or events that are present more days than not for ≥ 6 months. The cause is unknown,... read more ). Prevalence is twice as high in women as in men (2 General references Generalized anxiety disorder is characterized by excessive anxiety and worry about a number of activities or events that are present more days than not for ≥ 6 months. The cause is unknown,... read more ). The disorder more commonly begins in adulthood but may begin at any age. GAD typically has a chronic course and is often associated with significant functional disability and a diminished quality of life.

General references

  • 1. Kessler RC, Chiu WT, Demler O, et al: Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):617-627, 2005. doi: 10.1001/archpsyc.62.6.617

  • 2. Wittchen HU, Zhao S, Kessler RC, et al: DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1994 May;51(5):355-64. doi: 10.1001/archpsyc.1994.03950050015002

Symptoms and Signs of Generalized Anxiety Disorder

Diagnosis of Generalized Anxiety Disorder

  • Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR) criteria

To meet DSM-5-TR criteria for GAD, patients must have excessive anxiety and worry about a number of activities or events (eg, work and school performance), occurring more days than not for 6 months (1 Diagnosis reference Generalized anxiety disorder is characterized by excessive anxiety and worry about a number of activities or events that are present more days than not for ≥ 6 months. The cause is unknown,... read more ).

The worries are difficult to control and must be associated with 3 of the following:

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

  • Easy fatigability

  • Difficulty concentrating

  • Irritability

  • Muscle tension

  • Disturbed sleep

The psychiatric symptoms must cause significant distress or significantly impair social or occupational functioning. Also, the anxiety and worry cannot be accounted for by substance use or a general medical disorder (eg, hyperthyroidism Hyperthyroidism Hyperthyroidism is characterized by hypermetabolism and elevated serum levels of free thyroid hormones. Symptoms include palpitations, fatigue, weight loss, heat intolerance, anxiety, and tremor... read more Hyperthyroidism ).

Overview of Generalized Anxiety Disorder
VIDEO

Diagnosis reference

  • 1. Diagnostic and Statistical Manual of Mental Disorders, 5th edition,Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC, pp 250-254.

Treatment of Generalized Anxiety Disorder

  • Antidepressant medications (eg, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors)

  • Anxiolytic medications (eg, benzodiazepines, buspirone)

  • Psychotherapy

Selective serotonin reuptake inhibitors Selective Serotonin Reuptake Inhibitors (SSRIs) Several drug classes and drugs can be used to treat depression: Selective serotonin reuptake inhibitors (SSRIs) Serotonin modulators (5-HT2 blockers) Serotonin-norepinephrine reuptake inhibitors... read more (eg, escitalopram) and serotonin-norepinephrine reuptake inhibitors Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) Several drug classes and drugs can be used to treat depression: Selective serotonin reuptake inhibitors (SSRIs) Serotonin modulators (5-HT2 blockers) Serotonin-norepinephrine reuptake inhibitors... read more (eg, venlafaxine) are the preferred medications for the treatment of GAD; their use typically results in symptom improvement after 3 to 6 weeks (1 Treatment references Generalized anxiety disorder is characterized by excessive anxiety and worry about a number of activities or events that are present more days than not for ≥ 6 months. The cause is unknown,... read more ). Small to moderate doses of benzodiazepines may immediately reduce anxiety, although sustained use may lead to physical dependence as well as a variety of adverse effects Chronic effects Sedatives include benzodiazepines, barbiturates, and related drugs. High doses can cause decreased level of consciousness and respiratory depression, which may require intubation and mechanical... read more , including sedation, forgetfulness, and clumsiness. One strategy for treating GAD involves starting with both a benzodiazepine and an antidepressant medication, as well as an anxiety-focused psychotherapy (see table ). Then, when the GAD symptoms have become manageable, the benzodiazepine can be tapered and continued at a lower dose, or discontinued.

Psychotherapy, usually cognitive-behavioral therapy, can be both supportive and problem-focused (3 Treatment references Generalized anxiety disorder is characterized by excessive anxiety and worry about a number of activities or events that are present more days than not for ≥ 6 months. The cause is unknown,... read more ). Relaxation techniques, hypnosis, exercise, improved sleep, and mindfulness-based stress reduction are also often helpful.

Table

Treatment references

Drugs Mentioned In This Article

Drug Name Select Trade
BuSpar, Buspar Dividose
Lexapro
Levophed
Effexor, Effexor XR, Venlafaxine
View PATIENT EDUCATION
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
quiz link

Test your knowledge

Take a Quiz! 
iOS ANDROID
iOS ANDROID
iOS ANDROID
TOP