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Anxiety: Generalized Anxiety Disorder
 

Signs & Symptoms

We all know someone who worries constantly - the so-called "worry-wart", whose free-floating, non-specific anxieties torture the worrier and often those around them. Unlike agoraphobia, the anxiety that characterizes GAD is not related to anything in particular - people just worry excessively, about everything, all the time.

Between 3 to 5% of adults, with again twice as many women as men, suffer from GAD, but the kind of worries they have may be somewhat different, depending on the person's life situation. On-the-job, people in competitive work may feel "uptight" all the time, and they fear that they will somehow fail - despite often being very competent at what they do.


Do not be anxious about tomorrow; tomorrow will look after itself.

Matthew 6:34

Leisure activities will still bring pleasure, but GAD can make people feel inexplicably irritable, and they are often tired from poor quality sleep. As is true for many other anxiety disorders, between 35 to 50% of people with clinical depression also have GAD.

GAD can occur at any age, including childhood, and most people with GAD report that they have felt anxious and nervous all their lives. That said, symptoms, though chronic, fluctuate and are often worse at times of stress. Caffeine can aggravate symptoms too and should be avoided.

GAD Checklist

If someone worries more than half of the time over a period of six months, worries excessively about several things at once, and can't control their feelings, they meet the criteria for GAD. Associated with this, three or more of the following symptoms must be present, some of which must have been present for over half of the time over the past six months. If someone meets these criteria plus has three or more of the following symptoms, the diagnosis of GAD would be made:

Generalized Anxiety Disorder Checklist
Feelings of being restless, edgy, keyed up
Easily fatigued
Trouble concentrating
Irritable
Increased muscle tension
Trouble sleeping
 
Treatment

Some people with GAD do respond to meditation, relaxation techniques and more structured cognitive behavioural therapy. However, if non-medical therapies are unsuccessful and the anxiety is truly interfering with a person's ability to enjoy life, treatment with one of the SSRIs or the newer cyclic antidepressants can help stop the incessant worrying and rid the person of his or her ever-present anxiety. The benzodiazepines have been long used to treat GAD as well, and symptoms can often improve quite quickly. However, as with their use elsewhere, benzodiazepines can cause tolerance if take over the longer term, and withdrawal symptoms are an important concern, especially if people abruptly discontinue medication. Possibly the best choice of medication for GAD is buspirone (Buspar).

Unlike the benzodiazepines, buspirone has no anticonvulsant or muscle relaxant properties and it is not addictive. Rather, buspirone works more like a selective serotonin reuptake inhibitor (SSRI) to increase serotonin transmission along with activity of several other brain chemicals. Symptom improvement is gradual, with effects becoming noticeable after 7 to 10 days of treatment. Side effects associated with buspirone are infrequent, the most commonly reported ones being dizziness, stomach upset and headache. Calming effects from the medication are not immediate. In its favor, buspirone causes little sedation and it does not impair thinking processes.

People who report chronic irritability may also respond well to buspirone.

In Canada, currently recommended treatments for GAD include: Cognitive behavioural therapy, buspirone (Buspar), SSRIs, newer cyclic antidepressants.