(See also Overview of Anxiety Disorders Overview of Anxiety Disorders Everyone periodically experiences fear and anxiety. Fear is an emotional, physical, and behavioral response to an immediately recognizable external threat (eg, an intruder, a car spinning on... read more .)
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.
The course is usually fluctuating and chronic, with worsening during stress. Most patients with generalized anxiety disorder have one or more other comorbid psychiatric disorders, including major depression Major depression (unipolar disorder) Depressive disorders are characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities. Exact cause is unknown... read more , specific phobia Specific Phobic Disorders Specific phobic disorders consist of persistent, unreasonable, intense fears (phobias) of specific situations, circumstances, or objects. The fears provoke anxiety and avoidance. The causes... read more , social phobia Social Phobia Social phobia is fear of and anxiety about being exposed to certain social or performance situations. These situations are avoided or endured with substantial anxiety. Phobias are a type of... read more , and panic disorder 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 .
Diagnosis of Generalized Anxiety Disorder
Diagnosis is clinical based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
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
Also, the anxiety and worry cannot be accounted for by substance use or another medical disorder (eg, hyperthyroidism Hyperthyroidism Hyperthyroidism is characterized by hypermetabolism and elevated serum levels of free thyroid hormones. Symptoms are many and include tachycardia, fatigue, weight loss, nervousness, and tremor... read more ).
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.