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General Anxiety Disorder in the General Population

Jordan Harris
PBCC Psych
Prof. Heffner
11/27/07
Word Count: 2077
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ABSTRACT

Generalized Anxiety Disorder is a crippling anxiety disorder,

causing both physical and mental problems. When these problems and

symptoms such as intense anxiety, insomnia, and accelerated heartbeat

persist for six months or more and cause dysfunctions in patients’ social or

business lives it can be diagnosed as GAD. This disorder is most

commonly treated with a class of Antidepressants called Selective

Serotonin Reuptake Inhibitors. However the most effective treatment is

generally a combination SSRIs and cognitive-behavior therapy, which

attempts to give the patient strategies to deal with their anxiety and

change their thought patterns.

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GENERAL ANXIETY DISORDER

IN THE GENERAL POPULATION

Many normal Americans experience anxiety, sometimes even

intense anxiety, on a daily basis. However, what distinguishes anxiety

from General Anxiety Disorder or GAD is the anxiety lasts 6 months or

more is chronic and is usually accompanied by insomnia, restlessness and

irritability (Brinkerhoff 2004). Approximately 4 million Americans are

diagnosed with this disorder every year or about 3.6% of the population

(Helgoe 2005). Some experts believe this number is low due to under-

diagnosis of this disorder and believe it to be more like 8-9% of the

general population suffers from GAD (Helgoe 2005). Treatment options

are varied although the most commonly used is drug therapy. Many drugs

used effectively against depression, like SSRIs such as Paxil, Lexapro and

Zoloft, have been found to treat GAD as well as depression ( Helgoe

2005). Cognitive Behavior therapy has been found to be beneficial, both

on its own and in conjunction with medications (Hyman 2006). Prognosis

for people with Generalized Anxiety Order is good, if their problem is

chronic they may need to be medicated but with therapy in addition to

medicine they can often learn to handle their anxiety better and ultimately

to lead healthier lives (Hyman 2006).

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DIAGNOSIS

Anxiety disorders are the most common psychiatric illness in the

United States, at least one in every twenty Americans will suffer from an

anxiety disorder at some time in their life (Brinkerhoff 2004). An anxiety

disorder is when someone’s anxiety is excessive for the challenge or

situation that they are facing (Hyman 2006). When the anxiety is

excessive and indeed interferes with an individual’s daily life and routine

that is when an anxiety disorder may be diagnosed (Hyman 2006).

Anxiety is different from fear in that anxiety is usually vague, and ill

defined sometimes about things that are future oriented in nature (Hyman

2006). Anxiety can be considered the brain’s healthy fear response gone

haywire and that triggers our brain’s fight or flight response mistakenly in

situations that are not threatening (Hyman 2006).

Generalized Anxiety Disorder (GAD) is a type of anxiety disorder

that is defined by: excessive anxiety lasting more than six months with no

reasonable cause, and may include restlessness, irritability, insomnia,

difficulty concentrating and muscle tension (Binkerhoff 2004). Generally

to be diagnosed with GAD patients both have the excessive anxiety and

three of the other more minor symptoms as well and the focus of their

anxiety is not defined by another anxiety disorder (Helgoe 2005).

According to the Diagnostic and Statistical Manual of Mental Disorders,

Fourth Edition (DSM-IV) criteria GAD would not be diagnosed for

example if the patient’s anxiety was found to be caused by social phobia

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or obsessive compulsive disorder (Brinkerhoff 2004). Also the anxiety

must be of such severity that it limits the patient’s social and/or

occupational functioning or cause significant distress (Helgoe 2005).

Basically GAD is diagnosed when the person’s anxiety is a handicap and

pre-occupies their thoughts almost constantly (Hunt 2005). Also to be

considered GAD patients must be worried about numerous events and

activities (Hyman 2006). GAD is diagnosed in women more often than in

men (Birkenhoff 2004). It appears women are diagnosed more than

twice as often as men for most anxiety disorders, including GAD, the only

exceptions being obsessive compulsive disorder and social phobia

(Helgoe 2005). However, this number may be somewhat skewed by the

tendency of women to seek help more readily for mental health problems

(Helgoe 2005).

Doctors should do a thorough history as Generalized Anxiety

Disorder is known to have some genetic components (Birkenhoff 2004).

Identical twin studies have shown that anxiety disorders do tend to run in

families, as when one identical twin has an anxiety disorder it is more

likely to occur in their identical twin than it is in a fraternal twin (Hyman

2006). In a July 2003 issue of the Archives of General Psychiatry found

that about 1/3 of the subjects fear conditioning process could be attributed

to genetic rather than environmental factors (Hunt 2005). If a few of your

relatives have suffered from anxiety disorders some doctors’ feel you may

“inherit a more sensitive alarm system” (Helgoe 2005 p.5). In the case of
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GAD you have a 20% risk of developing the disorder if a blood relative

also suffers from it and a 10% chance is a blood relative suffers from

clinical depression (Hunt 2005).

Most people, about 90%, who are diagnosed with GAD also suffer

form another psychiatric disorder, oftentimes depression (Hyman 2006).

It is unknown which comes first the GAD or the depression. When these

two disorders occur together they are considered bi-directional; people

who are depressed tend to become more anxious the more depressed they

are and people who are anxious oftentimes become more depressed the

more anxious they get (Helgoe 2005).

SYMPTOMS

Anxiety disorders and Generalized Anxiety Disorder in particular

strike among a huge range of people, young and old and across all race

lines (Hunt 2005). Because of that fact the symptoms of GAD can very

greatly. Symptoms are generally broken into three categories: physical

symptoms, mental symptoms and behavioral symptoms. Physical

symptoms can encompass: fast heartbeat, stomach discomfort, shortness of

breath, nausea, sweating, and muscle tightness (Hyman 2006). Patients

suffering from GAD oftentimes complain of physical ailments such as

headaches, backaches, and in women, even menstrual cramping

(Birkenhoff 2004). Patients with GAD often also suffer from an

exaggerated startle response (Hyman 2006). Doctors do need to take care

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when diagnosing GAD as some of its physical symptoms can also be

caused by other physical illnesses or even medication the person is taking

(Helgoe 2005). Physical causes like hyperthyroidism and hypoglycemia

need to be ruled out before GAD is diagnosed as their symptoms,

including accelerated heart rate and anxiety can mimic that of GAD

(Helgoe 2005). Medications or stimulants such as amphetamines,

caffeine, and cocaine can also produce anxiety like symptoms (Helgoe

2005).

CAUSES & TREATMENTS

Patients who suffer from Generalized Anxiety Disease generally

have an imbalance of three neurotransmitters, serotonin, noradrenaline,

and gamma aminobutyric acid (GABA) (Hyman 2006). GAD can also

be exacerbated by certain lifestyle choices, genetics, and biology; because

of that many treatments for GAD include Cognitive Behavior Therapy

(Hyman 2006). Some risk factors that may increase a person’s chance of

developing GAD include: childhood adversity, serious illness such as

cancer (due to excessive worry about finances, treatment and the future),

stress, and genetics.

Drug treatments are probably the most common treatment used for

Generalized Anxiety Disorder. These drug treatments fall into six

categories: Antidepressants, Benzodiazepines, Buspar, Anticonvulsants,

Beta-Blockers, and Antihistamines. Of these six the most common are

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Antidepressants and Benzodiazepines (Helgoe 2005).

Antidepressants are generally considered the first line medication

to treat anxiety and are themselves broken down into four categories

(Helgoe 2005). Selective Serotonin Reuptake Inhibitors (SSRIs) work on

depression and anxiety by increasing the amount of serotonin available to

synapses of the nerve cells allowing chemical signals to travel across these

gaps more effectively (Hyman 2006). SSRIs must be taken on a daily

basis and can take four to eight weeks to work (Brinkerhoff 2004). These

medicines can initially increase a patient’s level of anxiety and to

counteract this effect doctors often start with low doses of the SSRIs and

then slowly increase the dosage (Brinkerhoff 2004). As this category of

drugs treats both depression and anxiety it is often the first choice of

medication for patients suffering from both conditions (Brinkerhoff 2004).

Drugs that fall into this category include: Prozac, Luvox, Paxil, Zoloft,

Celexa, and Lexapro (Helgoe 2005). Although all these drugs are

considered SSRIs, they all work slightly differently and sometimes a

patient may need to try several before finding one that works (Hyman

2006). A few drugs that are similar to SSRIs but not considered

technically in the same category of drugs are Cymbalta and Effexor

(Helgoe 2005). None of these drugs are considered addictive and are

non-sedating (Hunt 2005).

Tricyclic antidepressants (TCAs) are considered the third choice

for treatment of anxiety disorders (Brinkerhoff 2004). TCAs are first

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choice however in treating people with attention deficit/hyper-activity

disorders who also suffer with anxiety. TCAs, like SSRIs, also take some

weeks to take effect and must be taken everyday; they are also a

particularly inexpensive treatment choice (Helgoe 2005). TCAs can be

unsafe due to their numerous side effects but like SSRIs are also non-

sedating and not considered addictive (Helgoe 2005). Drugs in this class

include Elavil, clomipramine, imipramine, Norpramin and Surmontil

(Birkenhoff 2004).

Benzodiazepines are a different line of drugs that are used to treat

GAD. These drugs offer immediate relief to anxiety, usually within 30-60

minutes, and can also help with sleep disturbances (Helgoe 2005). Other

benefits of this drug class include acting as a muscle relaxant, an anti-

epileptic, and acting as an amnesic (Hunt 2005). Benzodiazepines

function in the brain by enhancing the effects of gamma amino butyric

acid (GABA), which is a neurotransmitter; GABA functions by inhibiting

the activity of the many nerves in the brain (Hunt 2005). Unfortunately

they are highly addictive and can become ineffective over time

(Brinkerhoff 2004). If they are discontinued abruptly or tapered off they

can cause rebound in anxiety symptoms (Brinkerhoff 2004). Because

Benzodiazepines are fat-soluble they tend to stay in the body longer than

some other medications (Hunt 2005). Because this class of drugs takes

effect so quickly they are often given in conjunction with SSRIs to provide

short-term relief from symptoms until the SSRIs begin to work (Hyman
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2006).

Beta-blockers, such as Tenormin and Inderal, are not used

commonly but are still sometimes used on people when SSRIs are not

effective. This class of drugs can help reduce the physical effects of

anxiety such as rapid heartbeat, sweating, shaking and tremors (Hyman

2006).

Buspar, and Anticonvulsants are gaining popularity with

psychiatrists although their effects on anxiety are not well studied at this

time (Helgoe 2005). Antihistamines, such as Benadryl, are occasionally

used in the treatment of anxiety (Helgoe 2005).

For Generalized Anxiety Disorder most doctors recommend

Cognitive-Behavioral Therapy (CBT) in addition to drug therapy (Hyman

2006). CBT differs from traditional talk therapies in that instead of

focusing on causes of the psychological issues from the past, therapists

focus treatment on the present and identifying and changing unhealthy

thought patterns (Hyman 2006). This type of therapy also focuses on

adjusting the patients’ thinking to respond better to symptoms of anxiety

(Helgoe 2005). CBT focuses on the present and future and so this type of

treatment tends to be both briefer and at the same time more effective than

other types of talk therapy (Hyman 2006).

Many patients also find that in addition to drug and CBT therapy

that joining a self-help group, practicing stress control techniques, aerobic

exercise, and avoiding caffeine can help in treating GAD (Hunt 2005).
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Generalized Anxiety Disorder can be a crippling anxiety disorder,

causing both physical and mental problems. When these problems and

symptoms such as intense anxiety, insomnia, and accelerated heartbeat

persist for six months or more and causes dysfunction in their social or

business lives it can be diagnosed as GAD. GAD is most often treated

with a combination of Antidepressants and Cognitive-behavior therapy.

As many people who suffer from GAD also suffer depression once the

correct drug and dosage is found many patients experience a relief from

their symptoms.

REFERENCES
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Brinkerhoff, Shirley (2004). Drug therapy and anxiety disorders.

Philadelphia: Mason Crest Publishers.

Helgoe, L.A., Wilhelm, L.R., and Kommor, M.J. (2005). Anxiety

answer book: professional, reassuring answers to your most pressing

questions. Naperville, IL: Sourcebooks, Inc..

Hunt, Douglas (2005). What your doctor may not tell you about

anxiety, phobias, & panic attacks: the all-natural program that can help

you conquer your fears. New York: Warner Books.

Hyman, B.M. & Pedrick, C.P. (2006). Anxiety disorders.

Minneapolis: Twenty-First Century Books.