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Generalized Anxiety Disorder

Brief Overview: Generalized Anxiety Disorder (GAD) is a chronic mental health condition characterized by excessive, persistent worry about multiple aspects of daily life that is difficult to control and present more days than not for at least 6 months.
GAD commonly interferes with sleep, concentration, physical health, and quality of life and often coexists with other mental health or chronic medical conditions. With appropriate treatment, symptoms are highly manageable.

Prevalence: According to UpToDate, “Epidemiologic studies of nationally representative samples in the United States report a past-year prevalence of GAD to be 2.7 to 3.1 percent and a lifetime prevalence of GAD of 5.1 to 11.9 percent.”

Etiology:

  • Genetics
  • Neurotransmitter disturbances
  • Adverse childhood events (ACEs), childhood traumatic events
  • Psychological factors: maladaptive coping, excessive threat perception.
  • Environmental stressors: chronic stress, trauma, caregiving burden, financial or health-related stress
  • Medical contributors: thyroid disease, chronic pain, cardiovascular or respiratory illness

Risk Factors:

  • Family history of anxiety or mood disorders
  • Female sex
  • Chronic medical conditions
  • High stress levels or ongoing life stressors
  • History of trauma or adverse childhood experiences
  • Substance use (including caffeine and alcohol)
  • Poor sleep or shift work

Commonly Associated Conditions:

  • Major depressive disorder
  • Panic disorder or social anxiety disorder
  • Insomnia and sleep disorders
  • Irritable bowel syndrome and functional GI disorders
  • Chronic pain syndromes
  • Cardiovascular disease
  • Substance use disorders

Common Medications:

  • First-line treatment:
    • SSRIs – paroxetine, sertraline, citalopram, escitalopram, fluoxetine, fluvoxamine
    • SNRIs – duloxetine, venlafaxine
  • Alternatives: benzodiazepines, buspirone, pregabalin, mirtazapine, and tricyclic antidepressants (TCAs), hydroxyzine, beta-blockers (propranolol)

Common Labs, Imaging, and Tests:

  • Clinical diagnosis based on symptom history and duration.
  • Screening tools: GAD-7 questionnaire.
  • Basic labs (to rule out medical contributors):
    • Thyroid function (TSH)
    • CBC, CMP if clinically indicated
  • Substance use screening (caffeine, alcohol, stimulants).
  • Imaging is not routinely indicated unless neurologic symptoms are present.

Common Symptoms:

  • Psychological:
    • Excessive worry, fear, or anticipation of worst outcomes
    • Difficulty controlling worry
    • Irritability or restlessness
    • Poor concentration or “mind going blank”
  • Physical:
    • Muscle tension, headaches
    • Fatigue
    • Sleep disturbance (difficulty falling or staying asleep)
    • Palpitations, sweating, GI upset
    • Shortness of breath or chest tightness (non-cardiac)

Common Treatments:

  • Medication (see above)
  • Cognitive-Behavioral Treatment (CBT)
  • Aerobic exercise, if able
  • Mindfulness-based stress reduction
  • Yoga

Physical Findings:

  • Often normal physical exam.
  • May note muscle tension, restlessness, tachycardia, or elevated blood pressure during anxiety episodes.

Potential Complications and Contraindications:

  • Potential complications if untreated:
    • Depression and functional impairment
    • Sleep disorders
    • Increased healthcare utilization
    • Substance misuse
    • Poor control of chronic medical conditions
  • Contraindications / cautions:
    • Benzodiazepines: avoid long-term use, especially in older adults or those with substance use history
    • SSRIs/SNRIs: monitor for activation, GI effects, or mood changes early in treatment
    • Assess suicide risk if depressive symptoms are present

General Health and Lifestyle Guidance:

  • Encourage regular sleep schedule and sleep hygiene.
  • Promote routine physical activity (as tolerated, and approved by healthcare provider), which reduces anxiety symptoms.
  • Limit caffeine, nicotine, and alcohol.
  • Practice relaxation techniques (deep breathing, progressive muscle relaxation).
  • Encourage structured routines and realistic goal-setting.
  • Reinforce that improvement with medication often takes 4–6 weeks.

Suggested Questions to Ask Patients:

  • How often do you feel worried or anxious during the day?
  • What types of things do you worry about most?
  • How is anxiety affecting your sleep, work, or relationships?
  • Do you experience physical symptoms like muscle tension or palpitations?
  • Are you currently taking any medications or supplements for anxiety?
  • How much caffeine or alcohol do you consume daily?
  • Have you ever tried therapy or counseling?
  • Do you feel safe, and have you had thoughts of harming yourself?

Suggested Talking Points:

  • GAD is a common and treatable condition.
  • Anxiety often affects both the mind and body.
  • Medications help regulate brain chemistry, but they take time to work.
  • Therapy teaches practical tools to manage worry and stress.
  • Lifestyle changes can significantly improve anxiety symptoms.
  • You don’t have to manage this alone—support and treatment help.

Sources:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.