Understanding Generalized Anxiety Disorder

Medically Reviewed by Zilpah Sheikh, MD on June 29, 2024
Written by Stephanie Booth
8 min read

If you feel like you're worrying all the time and it's starting to affect your life, you might have generalized anxiety disorder (GAD). One in 3 people are diagnosed with it, and it's becoming more common in younger people.

The first step in getting diagnosed is to talk to your doctor. They'll need to rule out the possibility that your symptoms are being caused by a medical condition. Among the health issues that can cause symptoms similar to those of anxiety are hyperthyroidism (an overactive thyroid), too much or too little calcium, low blood sugar, and some heart conditions. Certain medicines can also cause you to feel worried and on edge.

To rule out any of these conditions, your doctor may order tests like:

  • Thyroid blood test, to see how well your thyroid is working
  • Blood tests, to measure levels of certain vitamins and minerals like iron, folate, and vitamin B12
  • Chest X-ray, to get a good look at your heart and lungs
  • Echocardiogram, a test that checks your heart function
  • EKG, to monitor your heart rate
  • Exercise stress test, which watches your heart rate while you walk on a treadmill or pedal an exercise bike
  • Holter monitoring test, in which a wearable device records your heart activity for a day or 2

If a medical issue isn't found and the symptoms you're having seem out of proportion to any situation you're facing, your doctor may suspect GAD.

GAD test

Some researchers have come up with a blood test for anxiety. It looks for biomarkers (traits in your blood) that can show how severe your anxiety is and which treatments could be a good fit for you. But this test isn't available to the public yet. Right now, doctors continue to use the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision,to see whether you have GAD.

To be diagnosed, the following must be true:

  • You have excessive anxiety and worry on more days than not for at least 6 months.
  • You have a hard time controlling the worries.
  • The worries must be about multiple things.
  • The anxiety causes you extreme distress or prevents you from going about your daily life.
  • The anxiety isn't due to a substance abuse or medical condition.

You must also have at least three of the following symptoms:

  • Feeling restless or on edge
  • Easily irritated
  • Finding it hard to concentrate
  • Trouble sleeping
  • Fatigue (feeling tired even after you've rested)
  • Muscle tension

 

For many people, GAD is an ongoing condition. But it is one that you can learn to better manage.

Therapy for GAD

A lot of the time, your doctor will suggest you try generalized anxiety therapy before any medications. Several kinds have been found to be helpful, including:

Cognitive behavioral therapy (CBT)

This form of talk therapy helps you understand how some of your thoughts can be feeding your anxiety symptoms. Your counselor or therapist can then teach you how to reshape those negative thought patterns. CBT can't cure your anxiety — no treatment can. But it can help you live better with it and feel better about yourself. People who tried CBT for one study said that they still had less anxiety a year later.

Mindfulness-based therapies

A type of therapy called mindfulness-based cognitive therapy (MBCT) combines mindfulness-based stress reduction (like yoga or meditation) with traditional CBT. More than 200 studies have shown that MBCT can be very useful in easing anxiety. There's also some data that shows it can be an effective treatment for depression.

Acceptance and commitment therapy (ACT)

A newer therapy that builds on CBT principles, ACT operates off the theory that trying to avoid your anxiety can actually keep you feeling anxious. An ACT-trained therapist can help you learn new ways to acknowledge and address difficult thoughts and feelings when they arise. Studies dating back to the 1980s show that ACT can be an effective anxiety treatment.

Psychodynamic psychotherapy

Based on the theories of the famous psychiatrist Sigmund Freud, this mode of therapy helps you understand how your current feelings and actions are shaped by your past. With the help of a trained therapist, you'll look for unconscious patterns in your life that are keeping you anxious and "stuck."

Supportive-expressive therapy

If you try this type of treatment, a therapist will guide you through understanding issues in your life that you want to change. You'll spend time talking about your relationships, habits, and ways to solve certain challenges.

Biofeedback

When you're anxious, many of your body functions change. For instance, your heart beats faster, your muscles tense, and you might take shallow breaths. Biofeedback is a mind-body technique that helps you become aware of these changes and how you can try to return them to a normal state. You'll work with a therapist, as well as a biofeedback machine that gives you information about your body in real time.

There's no cure for anxiety, but different drugs can ease symptoms of GAD. Known as anxiolytics, they're some of the most common medications in the world.

The type your doctor prescribes will depend on the type of anxiety, symptoms, and any other health issues you have. Some anxiety drugs can be habit-forming and are usually prescribed only on a short-term or as-needed basis. Others are proven safe to be taken every day, and your doctor may suggest that you take them for a long period.

GAD medications can include:

Antidepressants

These drugs, which include selective serotonin reuptake inhibitors (SSRIs), are widely used to treat and prevent various anxiety disorders. SSRIs commonly used to treat chronic anxiety include:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

Other types of antidepressants that are used as GAD treatment include:

  • Serotonin and norepinephrine reuptake inhibitors like duloxetine (Cymbalta) and venlafaxine (Effexor)
  • Tricyclic antidepressants like imipramine (Tofranil)
  • Atypical antidepressants such as mirtazapine (Remeron)

If your doctor prescribes antidepressants, it's important to take them exactly as prescribed, whether you have anxiety on that particular day.

Antihistamines

These types of drugs help with allergy symptoms. They block histamine, the chemical that your immune system releases in response to an allergen like dust or pollen. But some types of antihistamines, such as hydroxyzine, can also help with anxiety.

Beta-blockers

Often used to treat heart conditions like high blood pressure, beta-blockers can relieve the physical symptoms of anxiety like a racing heart, sweaty palms, and trembling. They work by blocking the adrenaline that your body releases when you feel anxious. Drugs such as propranolol usually work best right before an anxiety-provoking event, for example, before you give a speech.

Antiseizure medicines

Some drugs that can prevent seizures, like gabapentin (Neurontin) and pregabalin (Lyrica), can ease anxiety symptoms. This is probably because they change the way your brain cells "talk" to each other.

Antianxiety drugs

If you have acute anxiety (panic attacks), your doctor may prescribe a medicine that can quickly relieve your symptoms. The most well-known type is benzodiazepines. Among them are:

  • Alprazolam (Xanax)
  • Clonazepam (Klonopin)
  • Chlordiazepoxide (Librium)
  • Diazepam (Valium)
  • Lorazepam (Ativan)

These drugs can have some severe drawbacks. A lot of people build up a tolerance to benzodiazepines and need to start taking higher and higher doses to get relief. You could also become dependent on them.

Another antianxiety drug is buspirone (Buspar). While it's less addictive than benzodiazepines , it may need to be taken for 3-4 weeks before you feel its full effects.

Self-care is an important part of GAD treatment. That doesn't mean you need to go to a spa everyday. It means making daily choices, even small ones, to care for your mental and physical well-being. For instance, you can try to:

Get regular exercise. Daily exercise can be a helpful treatment for anxiety symptoms. You could join a gym, play a sport you enjoy, or go for walks by yourself or with a friend.

Try to get enough sleep. Poor rest can trigger anxious feelings. One study showed that anxiety levels were 30% higher in sleep-deprived people than in participants who had slept well the night before.

Plan healthy meals. Some data shows that healthy foods like fruits, vegetables, and whole grains may help lower anxiety levels.

Cut back on alcohol, recreational drugs, tobacco, and caffeine. These can all make your anxiety worse, not better.

Keep a journal. Writing down your thoughts and feelings can help you better understand what's going on in your life and different ways you could respond. Some people share their journal entries with a therapist, or you could keep your entries private.

Join a support group. You may feel like you're the only one who feels anxious, but anxiety disorders are the most common mental health condition in the U.S., affecting just over 19% of the population. Connecting with others who are also trying to manage their anxiety can be a good form of support. Many nonprofits like the Anxiety & Depression Association of America have online communities you can join for free.

Practice deep breathing. Anxiety can cause you to take fast, short, shallow breaths. Slowing your breathing can signal your brain and body that it's time to get out of "fight or flight" mode and relax. Try the following form of yoga breathing:

  • Lie on your back in a comfortable, safe place.
  • Breathe in slowly through your nose. Use your diaphragm to suck air into your lungs. (If you put your hand on your belly, it should rise like a beach ball as you inhale.) Once your belly's rounded, continue to inhale as deeply as possible.
  • When you breathe out, reverse the process. Your belly should flatten while you exhale slowly and completely.
  • Repeat this process several times.

Progressive relaxation. To do this technique, you'll tense, then relax one part of your body, usually beginning with your toes. Once this part of your body is relaxed, you'll tense and relax the next muscle group (for instance, your lower legs) until your entire body is free of tension.

Visualization. A therapist or meditation can guide you through choosing a relaxing image to hold in your mind. You'll then build on that by imagining soothing sensations, like a calming scent or relaxing sounds. With practice, you can learn to do this yourself when you need to lower your anxiety levels.

Like all medicines, anxiety treatments can cause some side effects. For instance:

  • Antidepressants can cause an upset stomach, weight gain, trouble sleeping, fatigue (feeling tired), constipation, and sexual side effects like a reduced sex drive or finding it hard to orgasm.
  • Buspirone may make you feel dizzy, confused, weak, or more sweaty than usual. Some people who take it feel angry or even hostile toward others.
  • Benzodiazepines sometimes cause drowsiness, irritability, dizziness, and memory and attention problems.
  • Antiseizure medicines could lead to side effects like headaches, blurred vision, weight gain or loss, and mood changes. If you use them for a long time, your osteoporosis (bone thinning) risk may rise.

Talk to your doctor about how you can try to avoid side effects or ways that they can be treated if you do have them. Make sure you also understand which side effects are a medical emergency.

GAD treatment often focuses on learning new ways to live with the ongoing fears and worries in your head. Different talk therapies can help you do this, but in severe cases, your doctor may prescribe medication as well. Eating healthy foods, getting exercise, and trying to get enough quality sleep can also help you better manage your anxiety.