Generalized Anxiety Disorder

People with GAD have multiple worries, which often shift over time. Common worries include work and family responsibilities, money, health, safety, car repairs, and chores. In GAD, the focus is not a single worry (eg, being embarrassed in public or becoming contaminated).

The course is usually fluctuating and chronic. Most patients with GAD have 1 or more comorbid psychiatric disorders, including major depression, specific phobia, social anxiety disorder, or panic disorder (1).

• Psychiatric assessment

To meet the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR) criteria for generalized anxiety disorder, 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).

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 and/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) and not be better accounted for by another psychiatric disorder or substance use.

Overview of Generalized Anxiet...

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

• Anxiolytic medications (eg, benzodiazepines, buspirone)Anxiolytic medications (eg, benzodiazepines, buspirone)

• Psychotherapy

Selective serotonin reuptake inhibitors (eg, escitalopram) and (eg, escitalopram) andserotonin-norepinephrine reuptake inhibitors (eg, venlafaxine) are the preferred medications for the treatment of GAD; their use typically results in symptom improvement after 3 to 6 weeks ((eg, venlafaxine) are the preferred medications for the treatment of GAD; their use typically results in symptom improvement after 3 to 6 weeks (1). 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, 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 Benzodiazepines). Then, when the GAD symptoms have become manageable, the benzodiazepine can be tapered and continued at a lower dose, or discontinued.

Buspirone may also be effective (Buspirone may also be effective (2), though typically symptoms do not diminish until the dose is gradually increased to the upper recommended range.

Herbal products such as kava may have antianxiety effects, although their effectiveness and safety for treating anxiety disorders such as generalized anxiety disorder require further study (3, 4).

Psychotherapy, usually cognitive-behavioral therapy, can be both supportive and problem-focused (5). Relaxation techniques, hypnosis, exercise, improved sleep, and mindfulness-based stress reduction are also often helpful. Cognitive-behavioral therapy has been shown to be the most effective psychotherapeutic modality for generalized anxiety disorder (6, 7).