When Worrying Gets Out of Control

By George Pratt, Ph.D.,
Scripps Memorial Hospital La Jolla

July 19, 2007

“Butterflies” in your stomach just before an interview for your dream job. A racing heartbeat when you realize the highway patrol officer’s sirens are meant for you. Lying wide-awake in bed all night before an important presentation.

Nearly all of us feel mildly anxious once in a while. But for nearly seven million American adults, anxiety is a chronic, debilitating problem. Far from a mild case of “nerves”, people with a condition known as Generalized Anxiety Disorder (GAD) experience irrational worry, uncertainty and dread for months on end. They may spend hours a day worrying that something terrible is about to happen. Their anxiety can make it nearly impossible to concentrate at work or school, make simple decisions, and enjoy everyday activities. In extreme cases, they may worry about simply getting through the day.

Moreover, while most people with GAD realize their anxiety is unwarranted, they feel helpless to control it.

GAD comes on gradually and can begin at any age, although it is most common between adolescence and middle age. It affects about twice as many women as men. GAD is diagnosed when daily feelings of unfounded anxiety last at least six months; in addition, people with GAD may struggle with physical symptoms such as headaches, muscle aches, sweating, shortness of breath, fatigue and difficulty sleeping. Often GAD is accompanied by other problems, such as depression or substance abuse.

Easing the Anxiety

If anxiety is a problem for you or someone you know, the first step is to see a psychologist or a physician for a diagnosis, as well as to rule out a physical problem. If other disorders such as depression or alcohol abuse are present, they may need to be treated at the same time (or even before) the anxiety is addressed. Fortunately, there are a number of effective treatments for GAD, including psychotherapy, medications, or both, and insurance will usually cover care.

The most common medications for GAD are anti-anxiety drugs known as benzodiazepines, such as Xanax® and Ativan®, which help to control anxiety and have few side effects. However, because people may develop a tolerance for benzodiazepines, the dosage often has to be increased over time, making these drugs best for short-term use.

A newer anti-anxiety medication, azapirone, has proven effective for long-term treatment of GAD. Sold under the brand name Buspar®, azapirone generally must be taken for at least two weeks before symptoms begin to subside, and may cause side effects, including headache and nausea.

Although antidepressants were originally intended to treat depression, they also can be useful for anxiety. Selective serotonin reuptake inhibitors (SSRIs) increase the amount of a chemical called serotonin in the brain, which can help ease anxiety. SSRIs must be taken for four to six weeks to achieve the full benefit; side effects may include nausea, sleepiness, and dry mouth.

For many with GAD, a combination of psychotherapy and medication is the most effective treatment. A mental health professional trained in working with anxiety disorders, such as a psychologist, psychiatrist, or social worker, may help people with GAD determine the causes behind their anxiety, recognize irrational thought patterns (cognitive therapy), and learn to overcome constant worrying. If you would like a referral to a therapist, ask your doctor.

Some people with mild anxiety may find relief through non-medical therapies as well. Calming activities that focus the mind and relax the body, such as yoga, meditation and deep breathing exercises, and provide some relief and can be used alone or in conjunction with other treatment.

The key to overcoming GAD is finding what works for you. By working with your psychologist or physician, you can find the best treatment (or combination of treatments) for your individual care.