Feeling anxious, nervous, or agitated? You’re not alone! General Anxiety Disorder (GAD) affects 6.8 million adults every year. Although GAD is among the most common mental illnesses in the United States, it can significantly affect your quality of life.

What is General Anxiety Disorder (GAD)?

Normally, individuals occasionally experience fear and worry when faced with situations at work, school, or home, such as taking an exam, speaking in public, or going for a job interview. You may even experience physical symptoms, such as increased heart rate, shortness of breath, upset stomach, insomnia, or fatigue. These symptoms of occasional anxiety come and go, tend to resolve once the temporary issue is over, and do not interfere with your daily life.

An anxiety disorder is different. When individuals have an anxiety disorder, they experience persistent or excessive symptoms that interfere with their ability to do well at school or work and can harm relationships. People with a generalized anxiety disorder (GAD) feel anxious and worried most of the time, and these worries may be chronic (long-term), severe, and can cause great distress.

See also our blog on What is Depression.

Signs and Symptoms of GAD:

GAD is a type of anxiety disorder characterized by long-term anxiety, excessive worry, tension, and dread, even when nothing has occurred to trigger or provoke it.

GAD is marked by physiological and physical symptoms that persist for over 6 months and include:

• Rapid heartbeat (palpitations)
• Feeling restless, or “on-edge”
• Feeling shaky or weak
• Easily tired and fatigued
• Feeling irritable
• Having difficulty concentrating
• Difficulty controlling feelings of worry
• Problems relaxing
• Being easily startled
• Having difficulty falling or staying asleep
• Increased muscle aches, tension, and/or soreness (i.e. sore jaw or back)
• Experiencing difficulty participating in everyday activities (i.e. work, study, seeing friends and family)
• Headaches and/or light-headedness
• Sweaty palms
• Dry mouth
• Trouble breathing

How is GAD Diagnosed?

Symptoms must be present most days of the week for at least 6 months in order to receive a diagnosis of GAD. GAD is diagnosed with a mental health screening completed by your doctor or mental health professional. You may answer self-report questionnaires regarding your symptoms and how long you’ve had them, such as the Generalized Anxiety Disorder Scale-7, which will help your doctor identify the precise diagnosis and severity of GAD. Diagnosis may also include:

• Bloodwork and/or urine test, to examine hormone levels that may signify a thyroid disorder.
• A gastric reflux test, for instance, an X-ray of your digestive system or an endoscopy procedure to examine your esophagus for GERD.
• Stress test, to check for heart conditions.
• Physical exam, to check for signs indicating that your anxiety may be related to medications or an underlying medical condition.
• Patient interview and/or psychological questionnaire to form medical history, symptom details, and determine a diagnosis.
• An assessment of symptom criteria, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

What Causes GAD?

In many cases, a combination of factors can contribute to the development of GAD.

1. Biological factors: Differences in brain chemistry and function.
2. Psychological factors: Particular personality traits can increase your risk of GAD. For example, being emotional or a distressed person, sensitive/fragile, having difficulty enduring irritation/annoyance, and having a personality that strives for flawlessness. Additionally, those that are more negative, have a timid character or tend to evade danger.
3. Family history: Genetics play a role in GAD when individuals have a history of mental health problems in their family.
4. Health conditions: Thyroid issues or heart arrhythmias.
5. Traumatic events: You may have an increased risk of developing GAD if you have experienced a severe life change that has caused nervousness, including grief, childbirth, or workplace-induced trauma. If you have experienced any form of abuse, such as emotional, physical, or sexual abuse, you may be more at risk of developing GAD.

Treatment Options for GAD

Treatment options are dependent on how much GAD is affecting your ability to function in your daily life. Various types of medications are used to treat GAD.

1. Antidepressants

Antidepressants are used as first-line medication options to treat GAD and relieve symptoms. These medications need to be titrated (built-up) in your system slowly to minimize anxiousness. SSRIs and SNRIs are used daily and do not provide immediate relief; takes at least 4 weeks or more for a noticeable effect.

When first starting SSRIs/SNRIs, you may experience some unpleasant side effects, however, they generally decrease or go away after 4-8 weeks.

Common side effects include:

• Decreased libido (sexual arousal)
• Drowsiness
• Insomnia
• Nausea—Taking your medication with food may reduce nausea
• Diarrhea
• Dry mouth
• Headache
• Dizziness

Suicide Risk and Antidepressants:

Although most antidepressants are generally safe, the FDA requires that all antidepressants carry a black box warning (the strictest warnings for prescriptions) of a possible increase in suicidal thoughts or actions in some children, teenagers, or young adults under 25 within the first few months of treatment or when the dose is changed.

If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Selective Serotonin Reuptake Inhibitor (SSRI) works on serotonin, an essential neurotransmitter (chemical messenger used to communicate between brain cells), that plays a role in feelings of pleasure and comfort, as well as thinking, memory, sleep, digestion, and circulation. SSRIs can decrease the physiological symptoms of GAD, such as muscle tension, difficulties with sleep, and headaches.

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Serotonin and Norepinephrine Reuptake Inhibitor (SNRI) block the reabsorption (reuptake) of the neurotransmitters serotonin and norepinephrine in the brain.

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2. Buspirone

Buspirone is an anti-anxiety medication that belongs to the drug class known as azapirones and is used as a second-line treatment option for GAD. This medication is slow-acting and does not provide immediate relief; takes 2-4 weeks to work when taken on a scheduled basis. Buspirone is most commonly used in combination with an SSRI or an SNRI to enhance the effect of the antidepressant. Buy Buspirone now

Common side effects of buspirone include:

• Nausea
• Dizziness and/or drowsiness
• Headache
• Lightheadedness

3. Benzodiazepines

Benzodiazepines are sedatives that enhance the effect of the neurotransmitter GABA, which is the primary inhibitory (“turn off”) signaler in the brain. GABA plays a role in feeling calm, muscle relaxation, decreasing insomnia, and a decrease in brain activity. These medications are used to relieve acute symptoms of GAD, such as the feeling of worry, muscle aches, headaches, insomnia, and restlessness.

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—Fast relief: Benzodiazepines do not treat the underlying cause of GAD. Unlike antidepressants, benzodiazepines work fast, causing you to experience immediate anxiety relief. This temporary anxiety relief helps you complete important obligations that you may have been putting off, such as traveling, giving a presentation, or interviewing for a job.

—Short-term use: Benzodiazepines can be appropriate for short-term use when there is a sudden onset of anxiety, causing increased stress, insomnia, and disruption of life. This can be due to a recent death of a loved one, a natural disaster, or another stressful situation.

Common side effects of benzodiazepines include:

• Impaired coordination
• Drowsiness
• Confusion
• Dizziness
• Depression
• Vision problems

Safe Use of Benzodiazepines

Benzodiazepines should not be used for more than 1–2 weeks, as this can increase the risk for physical dependence (addiction). Mixing these medications with alcohol can be very dangerous.