Generalized Anxiety Disorder
Generalized anxiety disorder consists of excessive, usually daily, nervousness and worry (lasting 6 months or longer) about a variety of activities or events.
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 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.
People with generalized anxiety disorder constantly feel worried or distressed and find it difficult to control these feelings. The severity, frequency, or duration of the worries is disproportionately greater than the situation warrants. Worries are general in nature; common worries include work responsibilities, money, health, safety, car repairs, and chores. The focus of worry may shift from one topic to another over time.
For a doctor to make a diagnosis of generalized anxiety disorder, a person must experience worry or anxiety and three or more of the following symptoms: restlessness, easy fatigue, difficulty concentrating, irritability, muscle tension, and disturbed sleep.
Treatment
Optimal management is best achieved with a combination of some form of counseling and drug therapy. Counseling can address the root causes of anxiety and ways to cope.
Antianxiety drugs such as benzodiazepines are usually prescribed. However, because long-term use of benzodiazepines can lead to drug dependence (see Section 7, Chapter 108), the drug, if discontinued, must be tapered off slowly rather than stopped abruptly. The relief that benzodiazepines bring usually outweighs any mild side effects and the possibility of drug dependence.
Buspirone is another antianxiety drug 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, in contrast to benzodiazepines, which begin to work within an hour.
Some antidepressants, such as venlafaxine, paroxetine, and other selective serotonin reuptake inhibitors, are also effective for treatment of generalized anxiety disorder. These antidepressants start to relieve anxiety quickly, sometimes after a few days.
Herbal products such as kava and valerian (see Section 2, Chapter 19) appear to have antianxiety effects, although their effectiveness for treating anxiety disorders such as generalized anxiety disorder requires further study.
Cognitive-behavior therapy has been shown to be beneficial for generalized anxiety disorder. Relaxation, yoga, meditation, exercise, and biofeedback techniques may also be of some help (see Section 25, Chapter 302).
 See the drug table Antianxiety Drugs.
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