O Generalized Anxiety Disorder (GAD) is a topic that is gaining increasing attention from both patients and mental health professionals. This is mainly due to the growing awareness of the importance of treating anxiety properly.
This is a mental condition that can have a major impact on the patient's day-to-day life. Throughout the article, we'll understand more about the condition and when treatment becomes crucial to improving quality of life.
What is generalized anxiety disorder?
Generalized Anxiety Disorder is a condition characterized by constant and disproportionate worry about various aspects of life. This excessive anxiety is not restricted to a specific situation, but spreads to various areas, such as work, health, relationships and money, for example.
People with GAD often experience a sense of apprehension and constant tension, even in the absence of real or imminent danger. This incessant worry can lead to physical symptoms, such as fatigue, muscle tension and sleep disturbances, and negatively impact the ability to function on a daily basis.
It is important to note that for a diagnosis of GAD, the symptoms of the disease need to have been present for the last 6 months on most days.
Difference between anxiety and Generalized Anxiety Disorder (GAD)
It's important to understand that there is a difference and that anxiety is not always synonymous with a pathology. After all, it's inherent in human beings and extremely important. In fact, without it, perhaps the human race wouldn't have survived to tell the tale.
Anxiety is a chain reaction that the body has when faced with danger or great stress.
Think, for example, of a caveman hiding out, trying not to be devoured by the great animals of the time. When he went out to find food, anxiety was generated and the body went into a state of alert, knowing that, at any moment, danger could appear and our bodies would have to be ready to react in order to survive.
The big problem is when this anxiety becomes disproportionate and this feeling of fear and anguish goes beyond what is necessary to control the situation. In this case, we have GAD (Generalized Anxiety Disorder).
In GAD there is excessive and irrational worry about something that might happen, even if it is an extremely remote possibility. There is great suffering and anguish, even over simple everyday things.
In these cases, the amygdala, located in the brain, plays a fundamental role in this functionality and is responsible for assessing situations, releasing the amount of neurotransmitters necessary for the body to react to a real danger.
However, in GAD, the amygdala can work harder than it should and thus become overactive, generating an exaggerated response to a problem. This, in turn, triggers a series of problems that can lead to other emotional and physical illnesses.
Risk factors
There is no exact cause for GAD, but there are risk factors, i.e. variables that can make a person more predisposed to developing the condition.
Stress is undoubtedly one of the main triggers of anxiety. The loss of a family member, the discovery of an illness in oneself or a loved one, significant changes such as moving to a new city, divorce... all of these are important stress factors that can be a trigger for GAD to manifest itself.
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In addition to stress, age is also an important factor. According to the American Association of Geriatric Psychiatry, GAD affects 10 to 20% of the elderly, but many of them are not diagnosed.
If we consider that it is precisely in older age that we begin to lose friends and family, that income tends to fall and that health problems increase, all these points generate great concern for the future, leading to the development of GAD.
Associated factors
In addition to the risk factors, there are also associated factors which, in some cases, cannot be changed. Let's take a look at them:
- Genetic factors: several studies have shown that children with parents who suffer from anxiety and depression are more likely to develop GAD, and that this occurs earlier when compared to children of parents without the disorders;
- Neurobiology: people with GAD usually have a lower production of neurotransmitters that help control anxiety, such as noradrenaline and serotonin. For example, the brain is always ready to produce more noradrenaline than necessary and so more of this neurotransmitter remains in the synaptic cleft, generating the signs and symptoms of GAD;
- Environment: the environment is undoubtedly an important associated factor. For example, people with less education tend to have a lower income and a lack of resources can generate a stressful environment, which in turn can be a trigger for GAD;
- Comorbidities: drug addicts, obese people and other illnesses can trigger GAD. Cancer, for example, is an important comorbidity. A study published in 2024 showed that, within the sample of cancer patients, almost 70% had anxiety.
Diagnosis and clinical picture of Generalized Anxiety Disorder (GAD)
The diagnosis of Generalized Anxiety Disorder (GAD) begins with a clinical assessment by a mental health professional. During this interview, the patient discusses their symptoms, medical history and how anxiety affects their daily life. Self-assessment questionnaires can also be used to measure the frequency and intensity of the symptoms reported.
Confirmation of the diagnosis follows the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). GAD is diagnosed when there is excessive worry that is difficult to control, present most days for at least six months, and which causes significant distress or impairment in daily functioning.
For a diagnosis in adolescents and adults, in addition to the criteria, 3 or more of the 6 symptoms in the DSM-5 must be present. In the case of children, only one of the symptoms must be frequent.
Symptoms of Generalized Anxiety Disorder (GAD)
Emotional symptoms
The patient is usually always worried, with an excessive fear that is disproportionate to the situation. This fear usually comes from past experiences, traumas or limiting beliefs that have been established in the person's mind.
This fear, when persistent for a long time, can trigger other psychiatric problems such as depression, panic disorder and others.
Cognitive symptoms
According to the DSM-5 criteria, some of the cognitive symptoms that patients with GAD may present are: difficulty concentrating or the famous "blank" when trying to remember something, feeling on edge, difficulty sleeping or even relaxing in moments that should be leisurely and peaceful.
Physical symptoms
There are various physical symptoms that can be part of GAD and many of them are a kind of chain reaction.
For example, when we are very anxious, the brain understands that there is an imminent danger situation and begins to produce more noradrenaline than is ideal. This neurotransmitter, in turn, generates a series of reactions that lead to physical symptoms that are usually related to GAD:
- increased blood pressure;
- tachycardia;
- tachypnea;
- nausea;
- intense sweating;
- muscle tension;
- feeling of fatigue.
Can Generalized Anxiety Disorder (GAD) be diagnosed more than once at different times of life?
Yes, TAG is often triggered by a specific event in the person's life. It could be the death of a loved one or a pet, moving to another city, a diagnosis such as cancer, a poor prognosis for a disease, among many other events that can bring out all the symptoms associated with this disorder.
With the right treatment, which can involve the use of medication combined with CBT (Cognitive Behavioral Therapy), the symptoms can be controlled and the patient can improve, no longer showing the signs and symptoms of the disease.
A clearer way of looking at it is when GAD is related to the environment. When that scenario or situation changes to a better circumstance, anxiety returns to normal. This can happen, for example, when the person is working in a place with high tension, a lot of demands, overwork and changes jobs, going to a company where there are none of these stress factors.
And since bad things can happen at different times in life, the same person who no longer has GAD, when faced with a situation that generates a high level of stress, can be diagnosed again.
Read also: Post-traumatic stress disorder in severe post-Covid-19 patients
Treatment of generalized anxiety disorder
The treatment of GAD can involve various approaches, and a doctor can guide the best strategy for each patient. Currently, the following treatment options are most common:
Cognitive-Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) helps patients identify and modify negative thought patterns and behaviors that exacerbate anxiety.
CBT teaches practical techniques for dealing with excessive worry and promotes positive behavioral changes. The benefits include a significant reduction in anxiety symptoms and a general improvement in quality of life.
This is the first-line treatment and is therefore recommended as health practice in several countries such as the United Kingdom, Canada, the United States and others. It can be used for children, adolescents, adults and the elderly.
The patient will self-monitor their thoughts, behaviors and physical reactions, identify the errors in their thoughts and, with the help of the professional, establish coping strategies. In addition, the psychologist can teach relaxation and breathing techniques that can be very useful in times of crisis.
Medicines
Medications can be used to treat GAD, including antidepressants and anxiolytics. Antidepressants help decrease anxiety levels over a period of weeks, while anxiolytics offer faster relief from anxiety.
These two are the first-line drugs for the pharmacological treatment of the problem.
The most commonly used antidepressants are selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs). The function of these drugs is to keep serotonin and noradrenaline (in the case of SNRIs) in the synaptic cleft for longer.
One of the big problems in this case is that patients often complain of adverse effects in the first 14 days such as diarrhea and discomfort in the digestive system, worsening anxiety, insomnia, headaches and others.
The main advantage of anxiolytics (benzodiazepines), on the other hand, is that they act quickly, i.e. the symptoms are eliminated almost immediately. The big problem is that, precisely because of this, they can lead to addiction and abuse.
It is important to follow medical advice and be aware of possible side effects, such as drowsiness or changes in appetite. Regular medical monitoring is essential to adjust treatment as necessary and ensure effectiveness and safety.
Read also: Epigenetic drugs for anxiety disorders?
Lifestyle changes
In addition to professional treatment, some lifestyle changes can be beneficial:
- Relaxation techniques: practices such as deep breathing and meditation can help reduce anxiety;
- Physical exercise: regular physical activity improves mood and reduces tension. Exercise stimulates the production of serotonin, one of the main neurotransmitters that help control GAD. Here, we can include various types of exercise that go beyond weight training, such as yoga, dance, functional exercise, swimming, running, walking and so on;
- Healthy sleeping habits: maintaining a consistent sleep routine and creating a suitable environment for resting can improve sleep quality;
- Social media: In a highly connected world, we can't help but mention the use of social media as part of the treatment of GAD. Several studies show a direct correlation between the use of social media and increased anxiety. Therefore, having greater control over your time on social media is one of the ways to help your treatment.
These strategies complement treatment and help promote more effective management of anxiety on a daily basis.
Specialist in psychiatry and clinical psychopharmacology in Campinas
The sooner you seek help, the better you will be able to manage the symptoms and the impact on your daily life. Having the support of a psychiatrist can make all the difference in creating a treatment plan that suits your needs.
If you are experiencing symptoms of GAD, schedule an appointment with Dr. Petrus Raulino now for a specialized evaluation towards the best path for you. Remember, taking the first step towards treatment can be the start of a journey towards a more peaceful and balanced life.
