When worries pile up, seem inescapable and interfere with day-to-day activities, it's time to see a doctor. Overwhelming worry is a symptom of generalized anxiety disorder (GAD). The March issue of Mayo Clinic Health Letter covers the symptoms of GAD and treatment options.
With generalized anxiety disorder, shedding worries is difficult, even when the worry is seemingly out of proportion to the concern. ("I can't face my book club tonight." "I wish I didn't have to leave the house and deal with anyone." "I hope I don't feel sick again today. What if I am?" )
Other symptoms include startling easily, trouble falling or staying asleep, difficulty concentrating, fatigue, muscle tension, restlessness, feeling out of breath, nausea, diarrhea, headaches and excessive irritability.
Signs and symptoms appear gradually over time. Some who have GAD cannot recall the last time they felt at ease. Often the disorder begins between childhood and middle age, but it can occur anytime.
GAD is one of several types of anxiety disorders. Others include phobia, obsessive-compulsive disorder, post-traumatic stress disorder and social anxiety disorder. Anxiety disorders can occur on their own, independent of other health concerns. Or anxiety can be a symptom of several health conditions, such as heart or lung disease, thyroid problems -- even dietary problems. Treating the underlying condition can help reduce or manage the anxiety.
When anxiety is the primary concern, psychotherapy and medications can help worries become manageable.
Psychotherapy involves working with a therapist to identify unhealthy, negative beliefs and behaviors that contribute to anxiety and, then, learning how to replace them with healthy, positive beliefs.
Medications, both antidepressants and anti-anxiety drugs, also can help.
Among antidepressants, the first choice often is a selective serotonin reuptake inhibitor (SSRI). This category includes fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and citalopram (Celexa). Other antidepressants that may be considered include duloxetine (Cymbalta) and venlafaxine (Effexor). These drugs can be highly effective, but may take several weeks to months before the full effects are evident. And, treatment may require trying more than one drug to determine what works best for an individual.
For acute anxiety and short-term help, your physician may recommend a benzodiazepine, which generally eases anxiety within 30 to 90 minutes. Drugs in this category include alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan). Long-term use of these medications is a concern because they can be habit-forming and cause unsteadiness or balance problems, drowsiness and reduce muscle coordination. Buspirone (BuSpar) is another medication prescribed for anxiety. It doesn't pose a risk of dependence but takes several weeks of regular doses to be effective.
Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today's health and medical news. To subscribe, please call 800-333-9037 (toll-free), extension 9771, or visit www.HealthLetter.MayoClinic.com.
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