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Generalized Anxiety Disorder

by John H. Greist, MD

Generalized anxiety disorder consists of excessive, usually daily nervousness and worry (lasting 6 months or longer) about many activities or events.

  • People are anxious and worried about a variety of issues and/or activities.

  • For this disorder to be diagnosed, several other symptoms (such as a tendency to tire easily, difficulty concentrating, and muscle tension) must accompany the anxiety.

  • Treatment involves a combination of drugs (usually antianxiety drugs and sometimes antidepressants) and psychotherapy.

Generalized anxiety disorder is common. About 3% of adults have it during any 12-month period. Women are twice as likely as men to have the disorder. It often begins in childhood or adolescence (see Generalized Anxiety Disorder in Children) but may start at any age. For most people, the disorder fluctuates, worsening at times (especially during times of stress), and persists over many years.

Symptoms and Diagnosis

People with generalized anxiety disorder constantly feel worried or distressed and have difficulty controlling these feelings. The severity, frequency, or duration of the worries is disproportionately greater than the situation warrants. Worries are general in nature, include many topics, and often shift from one topic to another over time. Common worries include work responsibilities, money, health, safety, car repairs, and chores.

For a doctor to diagnose generalized anxiety disorder, a person must experience worry or anxiety for 6 months or longer and have three or more of the following symptoms:

  • Restlessness

  • A tendency to tire easily

  • Difficulty concentrating

  • Irritability

  • Muscle tension

  • Disturbed sleep


The disorder is best managed with a combination of some form of psychotherapy and drug therapy. Psychotherapy can address the root causes of anxiety and provide ways to cope.

Some antidepressants, particularly selective serotonin reuptake inhibitors (such as escitalopram) and serotonin-norepinephrine reuptake inhibitors (such as venlafaxine) are effective for generalized anxiety disorder. These antidepressants usually take a few weeks to relieve anxiety, so some people are given a benzodiazepine along with the antidepressant. Benzodiazepines are antianxiety drugs that relieve anxiety quickly, typically almost immediately. However, because long-term use of benzodiazepines can lead to drug dependence (see Antianxiety and Sedative Drugs), these drugs are usually given for only a relatively short time. Once the antidepressant becomes effective, the dose of the benzodiazepine is decreased slowly, then stopped. The drug is not stopped abruptly. The relief that benzodiazepines bring usually outweighs any mild side effects and the possibility of drug dependence. Some people must take benzodiazepines for a long time.

Buspirone, another antianxiety drug, is effective for some people with generalized anxiety disorder. Its use does not lead to drug dependence. However, buspirone may take 2 weeks or longer to start working.

Herbal products such as kava (see Kava) and valerian (see Valerian) may have antianxiety effects, although their effectiveness and safety for treating anxiety disorders such as generalized anxiety disorder require further study.

Cognitive behavioral therapy has been shown to be beneficial for generalized anxiety disorder. With this therapy, people learn to recognize where their thinking is distorted, to control their distorted thinking, and to modify their behavior accordingly. Relaxation, yoga, meditation, exercise, and biofeedback techniques may also be of some help (see Mind-Body Techniques).

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