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Generalized Anxiety Disorder

Anxiety Information

Anxiety is a problem that most individuals will encounter at one time or another in their lives. It is also normal for a person to feel anxiety about one or many problems in life. It is only when temporary or long-lasting fear becomes an interference with the things you want to get done in life that anxiety becomes a problem. It is also normal to feel anxiety about one or many problems in life. This is because anxiety will occur during any event that causes feelings of fear, dread, nervousness, or uneasiness about a problem or situation. For some people that may cause some extreme symptoms such as sweating, heart racing, and feeling restless. For others it can be a feeling of not being able to settle or feeling as though their mind might race.

Generalized anxiety disorder, often called anxiety, is a psychiatric disorder that is defined by the diagnostic and statistical manual of mental health (DSM-V). You must experience difficult to control symptoms of anxiety and worry more days than not for at least six months. These symptoms have at least three of the following symptoms (children only require one): 

  • Restlessness 

  • Loss of energy

  • Difficulty concentrating or focusing

  • Irritability

  • Muscle tightness

  • Problems falling or staying asleep or not feeling well rested

These problems must not have a better explanation (i.e. depression) and are not due to a problem such as substance abuse or a medical problem such as hyperthyroidism. 

Anxiety Treatment

Treatment for anxiety symptoms typically involves medications, education, and development of skills to help with symptoms of feeling worry and restlessness. Providers often involved in the treatment of anxiety are family medicine providers and mental health providers such as physician assistants, nurse practitioners, psychiatrists, and mental health therapists. 

Medications

  • Selective serotonin reuptake inhibitors (SSRIs). This class of drugs help anxiety by allowing more of the neurotransmitter serotonin to be available for neuron use. They are overall safe drugs and some in this class are used even during pregnancy. Typical SSRIs include:  citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), vortioxetine (Trintellix), and vilazodone (Viibryd).

  • Serotonin-norepinephrine reuptake inhibitors (SNRIs). This class of drugs help anxiety by allowing more of the neurotransmitters norepinephrine and serotonin  to be available for neuron use. Typical SNRIs include: duloxetine (Cymbalta), venlafaxine (Effexor XR), and desvenlafaxine (Pristiq).

  • Anxiolytics. This class of drugs help anxiety by increasing the action of serotonin receptors on neurons while also increasing levels of noradrenaline and dopamine. Typical anxiolytics include: buspirone (Buspar).

  • Atypical antidepressants. These types of  medications have more than one specific mechanism of action. These include: mirtazapine (Remeron) and trazodone (though it does share many SSRI properties).

  • Tricyclic antidepressants. This class of drugs work in several ways to achieve their effects. They work to increase the levels of serotonin and norepinephrine available for neuron use. Typical tricyclic medications  include: imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline (Elavil), and doxepin.

  • Other medications. Other medications are sometimes needed in addition to the above commonly prescribed drugs. Sometimes drugs are combined or other medications such as mood stabilizers or antipsychotics are used. 

Therapy

 

Counseling therapy can help improve anxiety symptoms by helping you develop skills to more effectively deal with the thoughts and feelings you are having. These therapies consist of:

  • Cognitive behavioral therapy. This type of therapy will help you cope better with anxiety by teaching skills specific to management of organization, patterns of thinking, and behavioral patterns. 

  • Family therapy. Because many people with anxiety encounter loved ones, family members, and spouses who are unfamiliar with anxiety, this therapy can help them overcome the stress associated with living with someone who struggles with anxiety symptoms. 

  • Music therapy. This therapy utilizes music to help relax an individual to enhance their mood. Music therapy activates  cognitive, motor, and speech centers in the brain to help improve overall functioning.

  • Talk therapy. This type of therapy employs a variety of techniques to help a person better deal with thoughts and behaviors.

  • Interpersonal therapy. IPT is a type of therapy that focus on personal relationships and how you feel. It is a short-term, intensive therapy.

  • Integrative therapy. This therapy approach takes aspects from different therapy types to create a personal therapy to best treat the presenting problem.

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