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Generalized Anxiety Disorder

By

John W. Barnhill

, MD, New York-Presbyterian Hospital

Last full review/revision Apr 2020| Content last modified Apr 2020
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Generalized anxiety disorder is common, affecting about 3% of the population within a 1-year period. Women are twice as likely to be affected as men. The disorder often begins in childhood or adolescence but may begin at any age.

Symptoms and Signs of Generalized Anxiety Disorder

The focus of the worry is not restricted as it is in other psychiatric disorders (eg, to having a panic attack Panic Attacks and Panic Disorder A panic attack is the sudden onset of a discrete, brief period of intense discomfort, anxiety, or fear accompanied by somatic and/or cognitive symptoms. Panic disorder is occurrence of repeated... read more , being embarrassed in public, or being contaminated); the patient has multiple worries, which often shift over time. Common worries include work and family responsibilities, money, health, safety, car repairs, and chores.

Diagnosis of Generalized Anxiety Disorder

  • Clinical criteria

Diagnosis is clinical based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Patients have

  • Excessive anxiety and worries about a number of activities or events

Patients have difficulty controlling the worries, which occur more days than not for ≥ 6 months. The worries must also be associated with ≥ 3 of the following:

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

  • Easily fatigability

  • Difficulty concentrating

  • Irritability

  • Muscle tension

  • Disturbed sleep

Treatment of Generalized Anxiety Disorder

  • Antidepressants and often benzodiazepines

Certain antidepressants, including 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 (SSRIs; eg, escitalopram, starting dose of 10 mg orally once a day) and serotonin-norepinephrine reuptake inhibitors Serotonin-Norepinephrine Reuptake Inhibitors 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 (SNRIs; eg, venlafaxine extended-release, starting dose 37.5 mg orally once a day) are effective but typically only after being taken for at least a few weeks. Benzodiazepines (anxiolytics) in small to moderate doses may also be effective, although sustained use may lead to physical dependence. One strategy involves starting with concomitant use of a benzodiazepine and an antidepressant. Once the antidepressant becomes effective, the benzodiazepine is tapered.

Buspirone is also effective; the starting dose is 5 mg orally two or three times a day. However, buspirone may require moderately high doses (ie, > 30 mg/day) and at least 2 weeks before it begins to help.

Psychotherapy, usually cognitive-behavioral therapy, can be both supportive and problem-focused. Relaxation and biofeedback may be of some help, although few studies have documented their efficacy.

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