What is Anxiety

Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe. Everyone experiences feelings of anxiety at some point in their life. For example, you may feel worried and anxious about sitting an exam or having a medical test or job interview.

Feeling anxious is sometimes perfectly normal. However, people with generalised anxiety disorder (GAD) find it hard to control their worries. Their feelings of anxiety are more constant and often affect their daily life.

There are several conditions for which anxiety is the main symptom. Panic disorder, phobias and post-traumatic stress disorder can all cause severe anxiety. These pages are about generalised anxiety disorder (GAD).

Generalised anxiety disorder (GAD)

GAD is a long-term condition which causes you to feel anxious about a wide range of situations and issues, rather than one specific event.

People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. GAD can cause both psychological (mental) and physical symptoms. These vary from person to person, but can include feeling irritable or worried and having trouble concentrating or sleeping.

How common is it?

GAD affects approximately 1 in 20 adults. Slightly more women are affected than men, and the disorder is most common in people in their 20s.

Outlook

GAD can significantly affect your daily life, making it difficult to perform everyday tasks. However, several different treatments are available to ease your psychological and physical symptoms.

 

Anxiety

Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen.

Panic

To panic is to be quickly overcome with a feeling of fear or worry.

You may have GAD if:

• your worrying significantly affects your daily life, including your job and social life
• your worries are extremely stressful and upsetting
• you worry about all sorts of things and have a tendency to think the worst
• your worrying is uncontrollable
• you have felt worried nearly every day for at least six months

 

 

Symptoms of Anxiety

Psychological symptoms

GAD can cause a change in your behaviour and the way you think and feel about things. Psychological symptoms of GAD include:

• restlessness
• a sense of dread
• feeling constantly 'on edge'
• difficulty concentrating
• irritability
• impatience
• being easily distracted

Your symptoms may cause you to withdraw from social contact (seeing your family and friends) to avoid feelings of worry and dread. You may also find it difficult and stressful going to work and may take time off sick. These actions can make you worry even more about yourself and increase your lack of self-esteem.

Physical symptoms

The physical symptoms of GAD can include:

• dizziness
• drowsiness and tiredness
• pins and needles
• irregular heartbeat (palpitations)
• muscle aches and tension
• dry mouth
• excessive sweating
• shortness of breath
• stomach ache
• nausea
• diarrhoea
• headache
• excessive thirst
• frequent urinating
• painful or missed periods
• difficulty falling or staying asleep (insomnia)

 

Cause of Anxiety

As with most conditions that affect mental health, the exact cause of generalised anxiety disorder (GAD) is not fully understood. Some people develop the condition for no apparent reason. Others may develop GAD after a major stressful incident.

Neurotransmitters

Research has suggested that GAD may be caused by an imbalance of certain chemicals that occur naturally in the brain. These chemicals are known as neurotransmitters.

Two neurotransmitters thought to affect anxiety are serotonin and noradrenaline. If the level of these chemicals in your brain becomes unbalanced, it can significantly affect your mood and increase your likelihood of developing anxiety-related conditions such as GAD.

However, GAD is most likely to have a complex combination of causes, rather than being triggered by just an imbalance of brain chemicals.

Combination of causes

Researchers believe that GAD is caused by a combination of factors, including:

• your body's biological processes
• genetics (the genes you inherit from your parents)
• your environment
• your life experience

 

Anxiety

Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen.

Genetic

Genetic is a term that refers to genes, the characteristics inherited from a family member.

Carers and anxiety

If you look after someone who is ill or disabled, you are more likely to have anxiety. A study conducted by the College of Psychiatrists in Ireland found that for more than half of carers, their responsibilities caused them increased worry. 

 

Diagnosing Anxiety

 

You should visit your GP if anxiety is affecting your daily life or is causing you distress.

Generalised anxiety disorder (GAD) can be difficult to diagnose. In some cases, it can also be difficult to distinguish from other mental health conditions, such as depression.

Talking to your GP

Your GP may ask you questions about your worries, fears and emotions. They may also ask about your personal life. Tell your GP about all of your symptoms - physical and psychological - and explain how long you have had them.

You may find it difficult to talk about your feelings, emotions and personal life. However, it is important that your GP understands your symptoms and circumstances so that the correct diagnosis can be made.

You are most likely to be diagnosed with GAD if you have had the symptoms for six months or more. Finding it difficult to manage your feelings of anxiety is also an indication that you may have developed the condition.

To help with the diagnosis, your GP may carry out a physical examination to rule out any other conditions that may be causing your symptoms.

You may have GAD if:

• your worrying significantly affects your daily life, including your job and social life
• your worries are extremely stressful and upsetting
• you worry about all sorts of things and have a tendency to think the worst
• your worrying is uncontrollable
• you have felt worried nearly every day for at least six months

Treating Anxiety

There are two main forms of treatment for generalised anxiety disorder (GAD):

• psychological therapy 
• medication

Depending on your circumstances, you may benefit from one of these types of treatment or a combination of the two.

Studies of different treatments for GAD have found that the benefits of psychological treatment last the longest, but no single treatment is the best for everyone.

Before you begin any form of treatment, your GP should discuss all of your treatment options with you, outlining the pros and cons of each, while also making you aware of any possible risks or side effects. With your GP, you can make a decision on the treatment most suited to you, taking into account your personal preferences and circumstances.

Psychological treatment

If you have been diagnosed with GAD, you will usually be advised to try psychological treatment before you are prescribed medication. The main type of psychological treatment for GAD is cognitive behavioural therapy (CBT).

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is one of the most effective types of treatment for GAD. Research suggests that around half of the people who have CBT recover from GAD and many others obtain some benefit.

CBT works by helping you to identify unhelpful and unrealistic beliefs and behavioural patterns. You and your therapist work together to help you change your behaviour and replace unhelpful beliefs with more realistic and balanced ones.

CBT mainly focuses on the problems that you are experiencing in the present, rather than events from the past. It teaches you new skills and helps you to understand how to react more positively to situations that would usually cause you anxiety.

The National Institute for Health and Clinical Excellence (NICE) in the UK recommends that you should have a total of 16 to 20 hours of CBT over a period of four months. Your treatment will usually involve a weekly one- to two-hour session.

See the A-Z topic about CBT for more information about this type of treatment.

Applied relaxation

Applied relaxation is an alternative type of psychological treatment. It was initially used to treat phobias, but it is now also being used to treat conditions such as GAD.

Applied relaxation focuses on relaxing your muscles in a particular way in situations that usually cause you anxiety. The technique will need to be taught to you by a trained therapist but involves: 

• learning how to relax your muscles
• learning how to relax your muscles quickly and in response to a trigger, such as the word 'relax'
• practicing relaxing your muscles in situations that make you anxious

You will need 12 to15 sessions to learn how to use applied relaxation correctly. It has been found to be as effective as CBT.

Medication

Your GP can prescribe a variety of different types of medication to treat GAD. Some medication is designed to be taken on a short-term basis, while other medicines are prescribed for longer periods. Depending on your symptoms, you may require medicine to treat your physical symptoms as well as your psychological ones.

If you are considering taking medication for GAD, your GP should discuss the different options with you in detail, including the different types of medication, length of treatment, side effects and possible interactions with other medicines before you start a course of treatment.

Long-term medication includes: 

• selective serotonin reuptake inhibitors (SSRIs), such as sertraline or paroxetine 
• venlafaxine 
• pregabalin

Short-term medication includes: 

• antihistamines 
• benzodiazepines 
• buspirone

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that increase the level of a chemical in your brain called serotonin. They can be taken on a long-term basis.

As with all antidepressants, SSRIs can take several weeks before they start working. You will usually be started on a low dose which will gradually be increased as your body adjusts to the medicine.

You may be offered an SSRI called sertraline. Sertraline is not specifically licensed to treat GAD, which means that the manufacturers of the medicine have not applied for a license for it to be used to treat the condition. However, it is used to treat similar conditions, such as panic disorder and obsessive compulsive disorder (OCD). 

Paroxetine is another SSRI that is often prescribed to treat GAD.

Common side effects of SSRIs include:

• nausea (feeling sick)
• low sex drive 
• blurred vision 
• diarrhoea or constipation 
• dizziness 
• dry mouth 
• loss of appetite 
• sweating 
• feeling agitated 
• insomnia 
• (problems sleeping)

When you start taking an SSRI, you should visit your GP after two, four, six and 12 weeks to check your progress and to see if you are responding to the medicine. Not everyone responds well to antidepressant medicines, so it is important that your progress is carefully monitored.

If your GP feels it is necessary, you may require regular blood tests or blood pressure checks when taking antidepressant medication. If, after 12 weeks of taking the medication, you do not show any signs of improvement, your GP may prescribe an alternative SSRI to see if that has any effect.

When you and your GP decide that it is appropriate for you to stop taking your SSRI medication, you will gradually be weaned off the medication by slowly reducing your dose. Never stop taking your medication unless your GP specifically advises you to.

Venlafaxine

If SSRIs do not help ease your anxiety, you may be prescribed a different type of antidepressant known as venlafaxine.

Venlafaxine belongs to a group of medicines known as selective serotonin and noradrenaline reuptake inhibitors (SNRIs). This type of medicine increases the amount of serotonin and noradrenaline in your brain, helping restore the chemical imbalance that sometimes causes GAD.

You cannot be prescribed venlafaxine if you: 

• have high blood pressure (hypertension) that is not being treated 
• have recently had a heart attack 
• are at risk of having irregular heartbeats (cardiac arrhythmias)

If you have any of the above conditions, you may be at risk of developing complications if you take venlafaxine.

Common side effects of venlafaxine may include: 

• nausea 
• headache 
• drowsiness 
• dizziness 
• dry mouth 
• constipation 
• indigestion 
• insomnia 
• sweating

If you are prescribed this medicine, your blood pressure will be monitored regularly.

Pregabalin

If SSRIs and SNRIs are not suitable for you, you may be offered pregabalin. This is an anticonvulsant that is used to treat conditions such as epilepsy (a condition that causes repeated seizures). However, it has also been found to be beneficial in treating anxiety.

The most commonly reported side effects of pregabalin include:

• drowsiness
• dizziness
• headaches

Pregabalin is less likely to cause nausea or a low sex drive than SSRIs or SNRIs.

Antihistamines

Antihistamines are usually prescribed to treat allergic reactions. However, some are also used to treat anxiety on a short-term basis.

Antihistamines have a calming effect on the brain, helping you to feel less anxious.

Antihistamines are only effective when used for a short period of time and will only be prescribed for a few weeks.

Hydroxyzine is the most commonly prescribed antihistamine for treating anxiety. This antihistamine can make you feel drowsy, so it is best not to drive or operate machinery when taking the medication. Other side effects of hydroxyzine include:

• dizziness 
• blurred vision 
• headache 
• dry mouth

Benzodiazepines

Benzodiazepines are a type of sedative that help ease the symptoms of anxiety within 30-90 minutes of taking the medication.

Although benzodiazepines are very effective in treating the symptoms of anxiety, they cannot be used for long periods of time. This is because they have the potential to become addictive if used for longer than four weeks. Benzodiazepines also start to lose their effectiveness after this time.

For these reasons, you will usually only be prescribed benzodiazepines to help you cope during a particularly severe period of anxiety. Benzodiazepines can cause side effects, including: 

• confusion 
• loss of balance 
• memory loss 
• drowsiness and light-headedness

Due to the above side effects, benzodiazepines can affect your ability to drive or operate machinery. Therefore, avoid these activities when taking the medication.

Speak to your GP if you experience any of the side effects listed above. They may be able to adjust your dose of medication or prescribe an alternative.

Buspirone

Buspirone is a medicine that can help ease the psychological symptoms of anxiety. It belongs to a group of medicines known as anxiolytics.

You will usually have to take buspirone for two weeks before you notice an improvement. It will be up to your GP how long you continue to take the medicine after this.

Buspirone works in a similar way to benzodiazepines, but does not become addictive. However, it is only recommended as a short-term form of medication.

Referral

If you have tried any two treatments (out of medication, CBT and self-help with guidance from your GP) and you still have significant symptoms of GAD, you may want to discuss with your GP whether you should be referred to a mental health specialist.

 

The mental health specialist will have an overall reassessment of your condition carried out They will ask you about your previous treatment and how effective you found it. They may also ask about things in your life that may be affecting your condition, or how much support you get from family and friends. Your specialist will then be able to devise a treatment plan for you, which will aim to effectively treat your symptoms. This may include any of the following:

• psychological therapies such as CBT 
• appropriate treatment of other diseases and conditions that may have an effect on your anxiety 
• other medication
• further referral to specialists

 

Self Help Treatments for Anxiety

There are many ways that you can ease the symptoms of generalised anxiety disorder (GAD) yourself.

Exercise

Regular exercise, particularly aerobic exercise, will help you to combat stress and release tension. It also encourages your brain to release the chemical serotonin, which can improve your mood.

Aim to do a minimum of 30 minutes of moderate exercise, at least five days a week. Moderate exercise should make you feel slightly out of breath and tired. Going for a brisk walk is a good example.

Relaxation

As well as getting regular exercise, learning how to relax is important. You may find relaxation and breathing exercises helpful, or you may prefer activities such as yoga or Pilates to help you unwind.

Diet

Changing your diet may help ease your symptoms. Too much caffeine can make you more anxious than normal. This is because caffeine can disrupt your sleep and also speed up your heartbeat. If you are tired, you are less likely to be able to control your anxious feelings.

Smoking and drinking

Smoking and alcohol have been shown to make feelings of anxiety worse. Drink alcohol in moderation and, if you smoke, try to give up.

It is recommended that that men should not drink more than twenty one standard drinks per week and women no more than fourteen per week. A standard drink is one glass of beer,a small glass of wine or a pub measure of spirits.

Support groups

Support groups can give you useful advice about how to effectively manage your anxiety. They are also a good way to meet other people with similar experiences.

Support groups often involve face-to-face meetings where you can talk about your difficulties and problems with other people. Many support groups also provide support and guidance over the phone or in writing. Ask your GP about local support groups for anxiety in your area.

Understanding your anxiety

Some people find that reading about anxiety can help them deal with their condition. There are many books and articles based on the principles of cognitive behavioural therapy (CBT).These may help you understand your psychological problems better and learn ways to overcome them by changing your behaviour.

 

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.