Affecting more than 6 million Americans and twice more women than men, generalized anxiety disorder (GAD) is a condition characterized by feelings of exaggerated tension and worry over various concerns, including, but not limited to, family problems, financial conditions, health, career, and even environmental disasters, in some cases.
GAD: Diagnosis
People with this disorder are observed to worry excessively about different problems over a period of half a year or more. Their concerns are way above what the situation warrants, and because of this, they find it difficult to function normally and accomplish their day-to-day activities.
Symptoms of Generalized Anxiety Disorder
A GAD diagnosis is generally made when excessive worrying, or 'apprehensive expectation' over one or several events occurs more often than not for a minimum of 6 months. The patient finds it difficult to control his or her behavior, and the worries are associated with three or more of the following symptoms and behaviors: fatigue, sleep disturbance, edginess, muscle tension, irritability, and restlessness.
Their extreme worrying makes it impossible for patients of generalized anxiety disorder to normally function in their daily activities, and it can be said that their occupational and social lives are adversely affected.
It is important to note that the worry associated with GAD should not be due to drug abuse or some other mental disorder.
More specific symptoms of this condition include: inability to relax, muscle aches, trembling, twitching, hot flashes, irritability, nausea, and feeling out of breath, lightheadedness, fatigue, and frequent urination. They may also be easily startled and have considerable difficulty concentrating.
According to the World Federation for Mental Health, GAD can be manifested in different ways by people of different ethnicities. For instance, in Asians, this condition may be manifested through somatic symptoms such as stomachaches, while in Western cultures; anxiety is more frequently expressed through cognitive ways. In Africa, it may not be unusual for sufferers of GAD to experience imaginary sensations of parasite infestation or overwhelming feelings of heat in the head.
It is therefore important for healthcare providers to be aware of the regional differences in symptoms, as GAD may be misdiagnosed or totally missed.
GAD Treatment
Standard treatment
In developed countries, this condition is treated with a combination of therapy and medication. The options include exposure therapy, cognitive-behavioral therapy, and anxiety medication and management. While in the past, medications were as harmful as the symptoms themselves, today, the drugs come with minimal side effects and are recommended to complement therapy. It's always best to consult your doctor for the best medication to avoid debilitating side effects.
Cognitive-behavioral therapy helps patients identify and understand the reasons behind their anxiety. It helps them discover ways to control it or keep it to a minimum so as not to affect their quality of life.
The objective of cognitive therapy is to modify thought patterns that are disturbing to the patient. As he or she undergoes self-examination, the feelings are evaluated and reality is separated from what is merely imaginary. Behavior therapy, on the other hand, aims to change the patient's undesirable behavior by presenting various alternatives to cope with situations that are feared. Often, exposure to these situations is essential in treating the GAD patient.
There are four types of drugs used for the treatment of anxiety disorders. They are as follows:
Tricyclic Antidepressants. Examples of these are imipramine, amitriptyline, and nortriptyline. Although these are considered a better alternative than long-term use of benzodiazepines, there are still significant side effects such as hypotension, blurry vision, urinary retention, constipation, or dryness of the mouth.
Benzodiazepines. Recommended for short-term anxiety management, benzodiazepines such as diazepam, alprazolam, lorazepam and clonazepam have been used in the 1960s and are known to be useful in relieving muscle tension and promoting relaxation. However, when used long-term, higher doses may be required to make them effective, increasing the risk of dependence, and there have been reports of withdrawal symptoms such as insomnia and rebound anxiety.
SNRIs. These are serotonin-nor epinephrine reuptake inhibitors. These drugs work by increasing neurotransmitter levels by inhibiting their reassertion into brain cells. Examples of these drugs are duloxetine and venlafaxine. Their side effects may include a minor increase in blood pressure, insomnia, headache, stomach upset, and sexual dysfunction.
SSRIs. These are selective serotonin reuptake inhibitors. They work by blocking the reuptake of serotonin by nerve cells in the patient's brain, which makes serotonin more available and thus improves the mood. They became popular in the 1980s when they were first used because of the minimal side effects. SSRIs have side effects similar to SNRIs and, like them, are considered first-line treatments due to their effectiveness. Classified under SSRIs are sertraline, fluoxetine, citalopram, paroxetine, and escitalopram.
Other medications
Busiprone is a drug that takes longer in providing an anti-anxiety effect on a patient than benzodiazepines but offers a lower risk of dependence. Medications such as olanzapine, quetiapine, and ziprasidone are also known as "second-generation" drugs or atypical antipsychotics, and are dispensed at low doses. They are especially significant in improving sleep.
Alternative treatments
More and more doctors now recommend alternative treatments to avoid the side effects of regular medications altogether. For generalized anxiety disorder, taking medication is not the only solution. A patient can also engage in self-help by following these 5 steps, as suggested by the Anxiety Disorders Association of America (ADAA):
1. Exercise. Making jogging or running part of your regular routine helps you relax and relieve tension in the muscles. Meditation and yoga are also practical and inexpensive solutions to generalized anxiety disorder.
2. Involve a significant other. Talking to your spouse, a friend, or your doctor can help you thresh out hidden reasons behind your anxiety.
3. Maintain a journal. Writing down your thoughts may help reveal certain anxiety factors that you have kept hidden through the years.
4. Diet can play a part in anxiety levels. Make sure to eat a balanced diet regularly and avoid caffeine.
5. Look for support groups and online help. ADAA is but one of the many organizations that offer assistance for patients of generalized anxiety disorder. The important thing to keep in mind is that GAD, although it should be taken seriously, is a treatable condition.