Signs and Symptoms
Symptoms of anxiety may include:
- Muscle tension, trembling
- Feeling restless or on edge
- Fast heartbeat, tachycardia
- Fast or troubled breathing, dyspnea
- Stomach upset
- Having a hard time concentrating
- Trouble falling asleep or staying asleep
What Causes It?
Many things can cause anxiety. For example, some medications may cause you to be anxious, or a medical condition may trigger feelings of anxiety. Scientists are not sure what causes GAD, although they think certain chemicals in the brain, called neurotransmitters, including serotonin and norepinephrine, may be involved. Genes, your environment, and your life situation may also contribute to GAD. In fact, several studies suggest that parental anxiety is a stron predictor of childhood anxiety.
What to Expect at Your Provider's Office
Your doctor or mental health provider will talk to you about times when you feel anxious and what it feels like. Your health care provider will take your medical history, give you a physical examination, and may take blood or urine samples for laboratory tests. Sometimes, you will have an electrocardiogram (EKG) to rule out heart problems. You may be asked to fill out a psychological questionnaire.
To be diagnosed with GAD, a person must meet the following criteria:
- Excessive anxiety or worry most days for at least 6 months
- Trouble controlling anxiety
- Anxiety associated with 3 or more of the following symptoms: restlessness, fatigue, irritability, trouble concentrating, having muscle tension, or having trouble sleeping
- Anxiety that interferes with your daily life
- Anxiety that is not related to another psychological condition, such as panic attack
- Anxiety that is not related to another physical condition, such as substance abuse
Treatment for anxiety depends on the cause. If you have an underlying physical condition, your doctor will treat it. If your anxiety has no physical cause, your doctor may recommend counseling to help you learn coping strategies and problem-solving techniques.
A 2007 review of studies found that when used, cognitive behavioral therapy helped treat GAD. In cognitive behavioral therapy, you learn to modify or replace anxious thoughts with healthy ones.
Your doctor may also suggest trying relaxation techniques, such as deep breathing. Sometimes, your doctor may prescribe medicines to help you until you have learned these techniques.
- Benzodiazepines. A group of drugs that help reduce anxiety and have sedating effects. They work quickly, but they can be habit forming and are usually prescribed for short-term use. They may cause drowsiness, constipation, or nausea. DO NOT take these drugs if you have narrow-angle glaucoma, a psychosis, or you are pregnant. Benzodiazepines include Alprazolam (Xanax), Chlordiazepoxide (Librium), Clonazepam (Klonopin), Diazepam (Valium), and Lorazepam (Ativan).
- Buspirone (BuSpar). An anti-anxiety drug that does not seem to cause drowsiness or dependence. However, you must take it for 2 weeks before feeling any effect. Side effects can include insomnia, nervousness, light headedness, upset stomach, nausea, diarrhea, and headaches.
- Antidepressants. A group of drugs that act on the same brain chemicals believed to be involved in anxiety. Antidepressants sometimes used to treat anxiety include Duloxetine (Cymbalta), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil), and Venlafaxine (Effexor).
- Selective Serotonin Reuptake Inhibitors (SSRIs). A review of studies examining the tolerability and effectiveness of medication for anxiety found that SSRIs showed clear benefit, with a response rate almost double that of placebo treatment. SSRIs sometimes used to treat anxiety include Sertraline, Fluoxetine, Fluvoxamine, Citalopram, and Paroxetine.
Complementary and Alternative Therapies
Mind-body techniques, nutrition, exercise, and herbs may help reduce anxiety. Progressive muscle relaxation, diaphragmatic breathing, biofeedback, meditation, and self hypnosis can help you relax and reduce your anxiety. Music therapy, visual imagery, and aromatherapy may also help reduce feelings of anxiety.
Several studies suggest that exercise helps reduce depression, and at least one 2007 study found that regular, intense exercise, such as running or playing football, can also have a positive effect on anxiety. The benefits lasted up to 5 years.
Although there is no diet to relieve anxiety, eating healthy meals keeps your body well nourished and strong. Avoid caffeine because it can make you feel restless. Avoid alcohol and nicotine as well. Eat more fresh vegetables, whole grains, and fruits. Keep your blood sugar steady by eating frequent small meals that contain protein, complex carbohydrates, and healthy fats.
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, take herbs only under the supervision of a health care provider.
If you already take medication for anxiety, ask your doctor before taking any herbs. Some of the herbs used to treat anxiety can interact with anxiety medications.
- Valerian ((Valeriana officinalis) is an herbal treatment for insomnia that is sometimes used to treat anxiety as well, although evidence is mixed. Some studies show that valerian helps reduce anxiety, but one study found that valerian was no better at reducing social anxiety than a placebo. Valerian is often combined with lemon balm (Melissa officinalis) or St. John's wort (Hypericum perforatum) for treating mild-to-moderate anxiety. Valerian may interact with other drugs that have a sedative effect, such as benzodiazepines, barbiturates, narcotics, antidepressants, and antihistamines. DO NOT take valerian if you are pregnant or nursing. People with liver problems should not take valerian. St. John's wort can affect other drugs you may be taking, including antidepressants, birth control, or other medications. You should avoid St. John's wort while pregnant or nursing. Talk to your doctor before using St. John's wort with any other medications.
- Passionflower (Passiflora incarnate). In a few studies, passionflower relieved anxiety as well as some of the benzodiazepines. However, more studies are needed to know for sure whether passionflower is effective. Passionflower may interact with other drugs that have a sedative effect, such as benzodiazepines, barbiturates, narcotics, antidepressants, and antihistamines.
- Kava kava (Piper methysticum) is sometimes suggested for mild-to-moderate anxiety, but the Food and Drug Administration (FDA) has issued a warning concerning kava's effect on the liver. In rare cases, severe liver damage has been reported. Talk to your doctor before taking kava, and do not take it for more than a few days.
- Other herbs sometimes suggested for anxiety include ginger (Zingiber officinalis), chamomile (Matricaria chamomilla), and licorice (Glycyrrhiza glabra). Ginger can increase the risk of bleeding, especially if you also take blood-thinners, such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin. Ginger may also interact with some drugs used to treat high blood pressure. Avoid licorice if you have heart failure, heart disease, kidney or liver disease, or high blood pressure. DO NOT take licorice if you take a diuretic (water pills), anticoagulant (blood thinner), or antidepressant such as Prozac. Chamomile may interact with a number of medications, including blood thinners. People who have or are at risk for hormone-sensitive cancers such as breast, uterine, ovarian, or prostate cancer should avoid taking chamomile. Some people may be allergic to chamomile.
Essential oils of lemon balm, bergamot, and jasmine are calming, and you can use them as aromatherapy. Place several drops in a warm bath or atomizer, or on a cotton ball.
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths, based on their knowledge and experience, may consider the following remedies for the treatment of anxiety. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
- Aconitum. For anxiety accompanied by irregular or forceful heartbeat, shortness of breath, or fear of death.
- Arsenicum album. For excessive anxiety that has no clear cause and is accompanied by restlessness, especially after midnight. It also may be used for perfectionists, including children, who worry about everything.
- Phosphorus. For an impending sense of doom and anxiety when alone. It also may be used for impressionable adults and children who are easily influenced by the anxiety of others.
- Lycopodium. For performance and other types of anxiety in those who are insecure, yet hide their low self esteem with arrogance and bravado. It also may treat children with anxiety accompanied by bedwetting.
- Gelsemium. For performance anxiety resulting in diarrhea, headache, dizziness, weakness, shakiness and trembling, or trouble speaking.
- Argentum nitricum. For performance anxiety (such as before tests in school-age children) with rapid heart rate, feeling of faintness, diarrhea, or flatulence.
Some evidence shows that acupuncture may help reduce symptoms of anxiety, especially when combined with behavioral therapies, including psychotherapy. One study showed that benefits lasted as long as one year after treatment.
Acupuncturists treat people with anxiety based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. With anxiety, a qi deficiency is often detected in the kidney or spleen meridians. In addition to performing needling treatments, acupuncturists may also use lifestyle and breathing techniques, as well as herbal and dietary therapy.
Therapeutic massage can help reduce anxiety and stress. Preliminary studies also suggest that meditation, yoga, and other mind/body therapies may help alleviate anxiety.
Follow your health care provider's instructions. Practice relaxation techniques as needed.
Be sure to tell your health care provider if you are pregnant. Call your provider if you experience any significant side effects from prescribed medications.
DO NOT take kava kava, valerian, and St. John's wort if you are pregnant or nursing.
Akhondzadeh S, Naghavi HR, Vazirian M, et al. Passionflower in the treatment of generalised anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther. 2001;26:362-7.
Aktar E, Majdandzic M, de Vente W, Bogels SM. Parental social anxiety disorder prospectively predicts toddlers' fear/avoidance in a social referencing paradigm. J Child Psychol Psychiatry. 2014;55(1):77-87.
Awad R, Levac D, Cybulska P, Merali Z, Trudeau VL, Arnason JT. Effects of traditionally used anxiolytic botanicals on enzymes of the gamma-aminobutyric acid (GABA) system.Can J Physiol Pharmacol. 2007 Sep;85(9):933-42.
Bazzan AJ, Zabrecky G, Monti DA, Newberg AB. Current evidence regarding the management of mood and anxiety disorders using complementary and alternative medicine. Expert Rev Neurother. 2014;14(4):411-23.
Bellavite P, Magnani P, Zanolin E, Conforti A. Homeopathic doses of gelsemium sempervirens improve the behavior of mice in response to novel environments. Evid Based Complement Alternat Med. 2009 Sep 14. [Epub ahead of print]
Bilia AR, Gallon S, Vincieri FF. Kava-kava and anxiety: growing knowledge about the efficacy and safety. Life Sci. 2002;70:2581-97.
Bystritsky A, Hovav S, Sherbourne C. Use of complementary and alternative medicine in a large sample of anxiety patients. Psychosomatics. 2012;53(3):266-72.
Chen KW, Berger CC, Manheimer E, et al. Meditative therapies for reducing anxiety: a systemic review and meta-analysis of randomized controlled trials. Depress Anxiety. 2012;29(7):545-62.
Conrad A, Isaac L, Roth WT. The psychophysiology of generalized anxiety disorder: Effects of applied relaxation. Psychophysiology. 2008 Jan 23; [Epub ahead of print]
Conrad P, Adams C. The effects of clinical aromatherapy for anxiety and depression in the high risk postpartum woman - a pilot study. Complement Ther Clin Pract. 2012;18(3):164-8.
Davidson JR, Connor KM. St. John's wort in generalized anxiety disorder: three case reports. J Clin Psychopharmacol. 2001;21:635-6.
Ferri: Ferri's Clinical Advisior 2016. Philadelphia, PA: Elsevier; 2016.
Hendriks SM, Spijker J, Licht CM, et al. Disability in anxiety disorders. J Affect Disord. 2014;166:227-33.
Hubner R, van Haselen R, Klein P. Effectiveness of the homeopathic preparation Neurexan compared with that of commonly used valerian-based preparations for the treatment of nervousness/restlessness - an observational study. Scientific World Journal. 2009 Aug 11;9:733-45.
Huh J, Goebert D, Takeshita J, Lu BY, Kang M. Treatment of generalized anxiety disorder: a comprehensive review of the literature for psychopharmacologic alternatives to newer antidepressants and benzodiazepines. Prim Care Companion CNS Disord. 2011;13(2). pii: PCC.08r00709.
Ivan MC, Amspoker AB, Nadorff MR, et al. Alcohol use, anxiety, and insomnia in older adults with generalized anxiety disorder. Am J Geriatr Psychiatry. 2014;22(9):875-83.
Karagozoglu S, Tekyasar F, Yilmaz FA. Effects of music therapy and guided visual imagery on chemotherapy-induced anxiety and nausea-vomiting. J Clin Nurs. 2013;22(1-2)39-50.
Kennedy DO, Little W, Haskell CF, Scholey AB. Anxiolytic effects of a combination of Melissa officinalis and Valeriana officinalis during laboratory-induced stress. Phytother Res. 2006;20(2):96-102.
Kodish I, Rockhill C, Ryan S, Varley C. Pharmacotherapy for anxiety disorders in children and adolescents. Pediatric Clinics of North America. Philadelphia, PA: Elsevier Saunders. 2011;58(1).Lakhan SE, Vieira KF. Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutr J. 2010 Oct 7;9:42. Review.
Linde K. St. John's wort - an overview. Forsch Komplementmed. 2009 Jun;16(3):146-55.
Mantani R, Cimino A. A primer of complementary and alternative medicine and its relevance in the treatment of mental health problems. Psychiatr Q. 2002;73:367-81.
Meeks TW, Wetherell JL, Irwin MR, Redwine LS, Jeste DV. Complementary and alternative treatments for late-life depression, anxiety, and sleep disturbance: a review of randomized controlled trials. J Clin Psychiatry. 2007 Oct;68(10):1461-71. Review.
Mullur LM, Khodnapur JP, Bagali S, Aithala M, Dhanakshirur GB. Role of yoga in modifying anxiety level in women. Indian J Physiol Pharmacol. 2014;58(1):92-5.Ngan A, Conduit R. A double-blind, placebo-controlled investigation of the effects of Passiflora incarnata (passionflower) herbal tea on subjective sleep quality. Phytother Res. 2011 Aug;25(8):1153-9. doi: 10.1002/ptr.3400.
Olukoga A, Donaldson D. Liquorice and its health implications. J R Soc Health. 2000;120:83-89.
Ravindran AV, da Silva TL. Complementary and alternative therapies as add-on to pharmacotherapy for mood and anxiety disorders: a systemic review. J Affect Disord. 2013;150(3):707-19.
Rector NA, Man V, Lerman B. The expanding cognitive-behavioural therapy treatment umbrella for the anxiety disorders: disorder-specific and transdiagnostic approaches. Can J Psychiatry. 2014;59(6):301-9.
Saeed SA, Bloch RM, Antonacci DJ. Herbal and dietary supplements for treatment of anxiety disorders. Am Fam Physician. 2007 Aug 15;76(4):549-56. Review.Sarris J, Panossian A, Schweitzer I, Stough C, Scholey A. Herbal medicine for depression, anxiety and insomnia: A review of psychopharmacology and clinical evidence. Eur Neuropsychopharmacol. 2011 Dec;21(12):841-60. Epub 2011 May 23.
Setzer WN. Essential oils and anxiolytic aromatherapy. Nat Prod Commun. 2009 Sep;4(9):1305-16.
Singh JS, Hope DA. Cognitive-behavioral approaches to the treatment of social anxiety disorder. Isr J Psychiatry Relat Sci. 2009;46(1):62-9. Review.
Sylvia LG, Shesler LW, Peckham AD, Grandin T, Kahn DA. Adjunctive deep toucch pressure for comorbid anxiety in bipolar disorder: mediated by control of sensory input? J Psychiatr Pract. 2014;20(1):71-7.
van der Watt G, Laugharne J, Janca A. Complementary and alternative medicine in the treatment of anxiety and depression. Curr Opin Psychiatry. 2008 Jan;21(1):37-42.
Wang SM, Kain ZN. Auricular acupuncture: a potential treatment for anxiety. Anesth Analg. 2001;92:548-53.
Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 2009 Dec 2. [Epub ahead of print].