Generalised Anxiety disorder (GAD)
This is often called the common cold of anxiety because of its frequency. You do not have GAD if your anxieties and worries are realistic. If unemployment strikes and you have no income and bills to meet it is normal to feel anxious. If your symptoms are persistent , long lasting and unrealistic then you probably have GAD. If you you are concerned that you have GAD then you should seek advice from a health professional. The first person to consult is your family doctor or GP. He or she can exclude physical causes and make the correct diagnosis.
There are four core features of Generalised Anxiety Disorder :
- It should have lasted for at least 6 months
- It is uncontrollable
- It is unrealistic
- Worry is central
The usual symptoms of GAD are as follows:
- Restlessness, irritability, feeling on edge, fidgety
- Presence of muscle tension especially in neck, shoulders, face, and back
- Poor concentration
- Difficulty with sleep. This includes going to asleep and staying asleep
- General tiredness
The symptoms of anxiety vary from person to person, and not everyone has the typical symptoms described above. Other symptoms experienced include:
- Shortness of breath
- The sensation of butterflies
- Tremor, shaking
- Dry mouth,difficulty swallowing
- Excessive sweating
- Nausea, stomach upset
- Being easily startled
Case example of generalised anxiety disorder
“Jane had been a quiet child and had been painfully shy. During her teens she frequently felt anxious. Her first job on leaving school was working as a secretary. She wanted to have friends, but was too embarrassed to call anyone. She was married to Kevin who one day left unexpectedly. Jane developed symptoms of anxiety with nausea, palpitations and butterflies in her stomach. She was easily startled by loud noises. She was unable to control her feelings. Her worries were unrealistic and out of proportion. She lay awake at night worrying. During the day she was tired and unable to work properly. Her concentration was poor. After 7 months of struggling she was still feeling unwell and she went to see her family doctor who diagnosed her with generalised anxiety disorder. She was referred to a clinical psychologist for treatment.”
Treatment of generalised anxiety disorder (GAD)
Treatment is either with medication or with psychological therapies:
Three types of medication have been shown to be effective in the treatment of GAD: Benzodiazepines, Antidepressants and Azapirones. Other drugs such as anti-histamines and anti-psychotics have also been tried but there is insufficient data to recommend their use.
Examples include diazepam, lorazepam and alprazolam. They first became available in the early 1960’s and they became the most prescribed medication for anxiety. Hundreds of studies have shown them to be effective compared with placebo in 65-70% of patients. Recurrence of anxiety is common after stopping this type of medication.
These drugs work quickly with most studies showing an effect within a week. The experience of patients and doctors is that they can work very quickly – within 15-30 minutes with some benzodiazepines.
They are Gaba agonists. In other words they increase gamma-aminobutyric acid inhibitory impulses in the central nervous system, which are mediated via benzodiazepine receptors.
They are more effective in treating the somatic rather than the psychic symptoms (worry etc) of anxiety.
Safety is a concern with benzodiazepines. Typical side effects include sedation, impairment of psycho-motor coordination and anterograde amnesia. There is also concern about the addictive potential of benzodiazepines.
Many antidepressants have been tried as a treatment for anxiety. Of the older tricyclic antidepressants imipramine and clomipramine have been shown to be effective in the treatment of anxiety. Selective serotonin reuptake inhibitors have been extensively studied as treatments for generalised anxiety disorder. Paroxetine and escitalopram are approved by the US FDA as treatments for GAD in patients who have no associated symptoms of depression. Other SSRIs such as citalopram, fluoxetine, sertraline and fluvoxamine are also prescribed as treatments for GAD but do not have FDA approval. The SNRI Venlafaxine has FDA approval as a treatment for GAD.
In 1996 Buspirone was approved by the US FDA for the treatment of of GAD. Other azapirones have been studied in the treatment ofGAD, but none have shown be as effective as buspirone. This drug is thought to work by binding to serotonin 5-HT1A receptors in the brain. Buspirone generally takes longer to work than benzodiazepines. It is also thought to have more of an effect on psychic symptoms than somatic symptoms, in contrast to benzodiazepines. Studies have shown that buspirone has little dependence or abuse potential.
Various psychological treatments have been tried for GAD. One of the most widely used is cognitive behavioural therapy (CBT). This has shown to help in about 40-60% of patients. Other treatments that have been tried are “worry exposure”, and mindfulness.
Treatments such as CBT and mindfulness are now widely available and help large numbers of people. But a lot are not helped by these therapies.
One treatment method that has a high percentage success rate is the Panic Away Treatment Program.