Introduction:

Anxiety is a general feeling of being worried, and everyone occasionally experiences anxiety. People with generalized anxiety disorder (GAD), however, feel anxious frequently or excessively, not necessarily because of a particular situation.

Signs and Symptoms:

• Muscle tension, trembling
• Feeling restless or on edge
• Fast heartbeat (tachycardia)
• Fast or troubled breathing (dyspnea)
• Having a hard time concentrating
• Headache
• Sweating
• Fatigue
• Irritability
• Trouble falling asleep or staying asleep

What Causes It?:

Anxiety can have many causes -- for example, some medications may cause you to be anxious, or an underlying medical condition may prompt feelings of anxiety. Scientists aren't sure what causes GAD, although they think that certain chemicals in the brain (called neurotransmitters), including serotonin and norepinephrine, may be involved. Genes, your environment, and your life situation may also contribute to GAD.

What to Expect at Your Provider's Office:

Your doctor or mental health provider will talk to you about when you feel anxious and what it feels like. Your health care provider will take your medical history, give you a physical examination, and may take blood or urine samples for laboratory tests. Sometimes, you will have an electrocardiogram (EKG) to rule out heart problems. You may be asked to fill out a psychological questionnaire.

For someone to be diagnosed with GAD, the person must meet the following criteria:

• Excessive anxiety or worry most days for at least 6 months
• Difficulty controlling anxiety
• Anxiety associated with three or more of the following symptoms: feeling restless, being fatigues, having trouble concentrating, being irritable, having muscle tension, or having trouble sleeping
• Anxiety that interferes with your daily life
• Anxiety that is not related to another psychological condition, such as panic attacks
• Anxiety that is not related to another physical condition, such as substance abuse

Treatment Options:

Treatment Plan

Treatment for anxiety depends on the cause. If you have an underlying physical condition, your doctor will treat it. If your anxiety has no physical cause, your doctor may recommend counseling to help you learn coping strategies and problem-solving techniques. A 2007 review of studies that used cognitive behavioral therapy to treat anxiety found that it was effective for GAD. In cognitive behavioral therapy, you learn to modify or replace anxious thoughts with healthy ones. Your doctor may also suggest trying a method of relaxation, such as deep breathing. Occasionally, your doctor may prescribe medications to help until you have mastered these techniques.

Drug Therapies

Prescription

• Benzodiazepines -- a group of drugs that help reduce anxiety and have sedating effects. They take effect quickly, but they can be habit forming and are usually prescribed for short-term use. They may cause drowsiness, constipation, or nausea. Do not take these drugs if you have narrow-angle glaucoma, a psychosis, or are pregnant. Benzodiazepines include:
  • Alprazolam (Xanax)
  • Chlordiazepoxide (Librium)
  • Clonazepam (Klonopin)
  • Diazepam (Valium)
  • Lorazepam (Ativan)
• Buspirone (BuSpar) -- an anti-anxiety drug that does not appear to cause drowsiness or dependence. However, you must take it for 2 weeks before feeling any effect. Side effects can include insomnia, nervousness, light-headedness, upset stomach, nausea, diarrhea, and headaches.
• Antidepressants -- a group of drugs that act on the same neurotransmitters (brain chemicals) believed to be involved in anxiety. Antidepressants sometimes used to treat anxiety include:
  • Duloxetine (Cymbalta)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Venlafaxine (Effexor)

Over-the-Counter

There are no over-the-counter therapies for treating anxiety.

Complementary and Alternative Therapies

Mind-body techniques, nutrition, exercise, and herbs may help reduce anxiety. Progressive muscle relaxation, diaphragmatic breathing, biofeedback, meditation, and self-hypnosis can help you relax and reduce your anxiety.

Exercise

Several studies suggest that exercise is effective in reducing depression, and at least one 2007 study found that regular, intense exercise (running or playing football, for example) can also have a positive effect on anxiety. The benefits lasted up to 5 years.

Nutrition

Although there is no diet to relieve anxiety, eating healthy meals keeps your body well nourished and strong. Avoid caffeine because it can make you feel restless. Avoid alcohol and nicotine should as well. Eat more fresh vegetables, whole grains, and fruits. Keep your blood sugar level by eating frequent small meals that contain protein, complex carbohydrates, and healthy fats.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, take herbs only under the supervision of a health care provider.

• Valerian(Valeriana officinalis, 150 mg 2 - 3 times per day) is an herbal treatment for insomnia, and is sometimes used to treat anxiety as well, although evidence is mixed. Some studies show that valerian does help reduce anxiety, but one study found that valerian was no better at reducing social anxiety than placebo. Valerian is often combined with lemon balm (Melissa officinalis) or with St. John's wort (Hypericum perforatum) for treating mild-to-moderate anxiety. Valerian may interact with other drugs that have a sedative effect, such as benzodiazepines, barbiturates, narcotics, antidepressants, and antihistamines. Do not take valerian if you are pregnant or nursing. Valerian can also affect the liver, so do not take it if you have liver problems. St. John's wort can affect other drugs you may be taking, including antidepressants, birth control, or other medications. You should avoid St. John's wort while pregnant or nursing. Talk to your doctor before using St. John's wort with any other medications.
• Passionflower (Passiflora incarnata) -- In a few studies, passionflower was as effective as some of the benzodiazepines in relieving anxiety. However, more studies are needed to know for sure whether passionflower is effective.
• Kava kava (Piper methysticum, 100 - 200 mg 2 - 4 times a day) is sometimes suggested for mild-to-moderate anxiety, but the Food and Drug Administration (FDA) has issued a warning concerning kava's effect on the liver. In rare cases, severe liver damage has been reported. Talk to your doctor before taking kava, and don’t take it for more than a few days.
• Other herbs sometimes suggested for anxiety include ginger (Zingiber officinalis), chamomile (Matricaria chamomilla), and licorice (Glycyrrhiza glabra). Avoid licorice if you have heart failure, heart disease, kidney or liver disease, or high blood pressure. Do not take licorice if you take a diuretic (water pills), anticoagulant (blood thinner), or anti-depressant such as Prozac.

Essential oils of lemon balm, bergamot, and jasmine are calming, and you can use them as aromatherapy. Place several drops in a warm bath or atomizer, or on a cotton ball.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of anxiety based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Aconitum -- for anxiety accompanied by irregular or forceful heartbeat, shortness of breath, or fear of death.
• Arsenicum album-- for excessive anxiety that has no clear cause and is accompanied by restlessness, especially after midnight. It also may be used for perfectionists, including children, who worry about everything.
• Phosphorus-- for an impending sense of doom and anxiety when alone. It also may be used for impressionable adults and children who are easily influenced by the anxiety of others.
• Lycopodium-- for performance and other types of anxiety in those who are insecure, yet hide their low self-esteem with arrogance and bravado. It also may treat children with anxiety accompanied by bedwetting.
• Gelsemium-- for performance anxiety resulting in diarrhea, headache, dizziness, weakness, shakiness and trembling, or trouble speaking.
• Argentum nitricum-- for performance anxiety (such as before tests in school-age children) with rapid heart rate, feeling of faintness, diarrhea, or flatulence.

Acupuncture

Some evidence shows that acupuncture can help reduce the symptoms of anxiety, especially when combined with behavioral desensitization (including psychotherapy). One study showed that benefits continued as long as one year after treatment. Acupuncturists treat people with anxiety based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. With anxiety, a qi deficiency is often detected in the kidney or spleen meridians. In addition to performing needling techniques, acupuncturists may also employ lifestyle and breathing techniques as well as herbal and dietary therapy.

Massage

Therapeutic massage can help reduce anxiety and alleviate stress.

Following Up:

Follow your health care provider's instructions, and practice relaxation techniques as needed.

Special Considerations:

Be sure to tell your health care provider if you are pregnant. Call your provider if you experience any significant side effects from prescribed medications.

Avoid kava kava, valerian, and St. John's wort if you are pregnant or nursing.