Generalized Anxiety Disorders: Rationale Of Treatment

Causes and risk factors

As is the case with most mental health issues, the causes for generalized anxiety disorder (GAD) may include genetic and other factors. Women tend to be diagnosed with GAD more often than men are. People with mild temperaments and who avoid potentially dangerous activities also tend to become more prone to developing GAD.

Psychological symptoms

Generalized anxiety disorder can elicit symptoms which vary in nature. Psychological manifestations of these symptoms can include the following:

• There's persistent worrying or obsessing over various concerns that's disproportionate to the event that caused the anxiety. Excessive worrying about yourself or loved ones, or that something bad will happen would fit this category.
• The patient doesn't have the ability to let go of or set aside the worry.
• The patient struggles to relax and seems to be continuously restless and edgy.
• There's difficulty in concentrating.
• The anxious feelings increase when making life decisions and worrying that it may be a wrong decision that's being made.
• There's a vicious cycle of worrying about worrying too much.
• Patients find it difficult to be able to handle uncertain situations or they're indecisive.
• They seem to only find negative conclusions to possible options or solutions to a situation or problem.

Physical symptoms

The brain is a very powerful organ and if there's an illness which affects it, then physical symptoms can also be experienced by the affected patient. These are called psychosomatic experiences and they can include the following signs and symptoms.

• Increased perspiration.
• Fatigue.
• Muscle tension and spasms which can result in aches and pains.
• Trembling and feeling twitchy.
• Irritability.
• Being easily startled or scared.
• Issues with sleep.
• Headaches.
• Nausea.
• Diarrhoea or irritable bowel syndrome.

Symptoms in children and adolescents

The following are also important symptoms which these children may experience and should be taken note of.

• They become very anxious trying to fit in with others.
• They strive for approval.
• They spend an excessively long time doing homework.
• They try to be perfectionists.
• There's a lack of confidence in them.
• Redoing tasks because they're not perfect.
• They require a lot of reassurance about their performances.

Complications

Besides increased worrying and anxiety, GAD can also lead to an impairment of one's ability to perform tasks efficiently due to poor concentration. It can also result in being fatigued during the day, sleep disturbances and worsening of other mental and physical health conditions.

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When to see a doctor

You should see a doctor as soon as possible if your anxiety is associated with the following:

• The anxiety is interfering with your relationships, work or other important parts of your life.
• If you are depressed or struggle with other mental health issues.
• If you have become addicted to alcohol, medications or illicit drugs, gambling or sex.

Treatment Of Generalized Anxiety Disorder

There are two main treatments involved in managing patients with GAD. Many studies have shown that combining pharmacotherapy and psychotherapy has yielded the best results and outcomes for patients diagnosed with this mental health condition.

Pharmacotherapy

Oral medications can be initially prescribed by the patient's primary care doctor, if they feel that they are needed by the patient. If the medication isn't successful or the patient's case is more complex, they are then referred to see a psychiatrist. They would also be able to prescribe medication to the patient and follow them up accordingly.

The following are examples of medications which can be prescribed by the patient's doctor in order to help reduce the abnormal anxious feelings which are being experienced.

• Antidepressants - the most helpful antidepressants for GAD are those that belong to the groups called the selective serotonin reuptake inhibitors (SSRIs); such as citalopram, escitalopram, fluoxetine and paroxetine and serotonin/norepinephrine reuptake inhibitors (SNRIs); such as duloxetine and venlafaxine. The way these medications work are by adjusting the mentioned hormones in the brain which then help to reduce anxiety and elevate one's mood.
• Anti-anxiety medications - buspirone is specifically used as an anti-anxiety medication as it doesn't affect the patient's mood like antidepressants do.
• Benzodiazepines - these sedatives may be prescribed to help reduce acute anxiety attacks and symptoms in patients with GAD. Examples of these drugs include diazepam, lorazepam and alprazolam, being the most commonly prescribed. These medications can be habit-forming and they can cause patients to become dependent on them, therefore caution should be exercised when prescribing them especially to patients who have problems with alcohol and/or drug abuse.

Psychotherapy

Patients diagnosed with GAD would also need to see a psychologist. This health care professional can help the patient incorporate cognitive and behaviour therapies (CBT) which can help reduce anxious feelings and promote more positive thinking.

CBT is a short-term treatment which helps a patient to incorporate coping mechanisms in order to deal with anxious feelings over the long-term. It's also used to help a patient to gradually return to activities which they regarded as gratifying before and avoided due to the increased anxiety they were experiencing. 

Lifestyle changes

Changes in certain habits and lifestyle activities can also help reduce high anxiety levels. By following these steps, a patient will give themselves the biggest chance at managing GAD properly.

• Regular exercise helps to reduce stress and anxiety due to the release of certain chemicals and hormones which occurs during the process of exertion. One would start slowly and then increase the intensity of the training as the body gets used to the activity.
• Avoid substances which can depress the central nervous system such as alcohol and sedative medications. These can worsen symptoms of increased anxiety.
• Avoid stimulants such as caffeine and nicotine as well as they can also worsen anxiety symptoms.

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• A healthy diet with all the necessary minerals, nutrients and fatty acids needed by the body by focusing on fruits, vegetables and fish should be consumed. An adequate amount of water, of around 8 glasses, should also be consumed every day.
• Adequate, quality sleep is also needed in order to be well rested for the following day. A person should get at least 6-8 hours of sleep every night.