Anxiety

Definition

Generalized anxiety disorder (GAD) is a pattern of frequent, constant worry and anxiety over many different activities and events. It is estimated by the American Institute of Stress, that 75% to 90% of all doctor’s visits are caused by reactions to stress.

Rates of depression and anxiety vary widely among different segments of the U.S. Hispanic and Latino population, with the highest prevalence of depressive symptoms in Puerto Ricans, according to a new report from Albert Einstein College of Medicine of Yeshiva University and the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

The researchers’ findings also suggest that depression and anxiety may be undertreated among Hispanics and Latinos, particularly if they are uninsured.  Many Hispanics/ Latinos rely on their extended family, community, traditional healers, and/ or churches for help during a health crisis. As a result, thousands of Hispanics/Latinos with mental illness often go without professional mental health treatment.

Lack of access to mental health services continues to be the most serious problem in the Hispanic/ Latino community. Hispanic Americans use mental-health services far less than other ethnic and racial groups.

Alternative Names

GAD; Anxiety Disorder

Causes

The exact cause of GAD is not fully known, but a number of factors — including genetics, brain chemistry and environmental stresses — appear to contribute to its development.

• Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families.
• Brain chemistry: GAD has been associated with abnormal levels of certain neurotransmitters in the brain. Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts in certain situations, leading to anxiety.
• Environmental factors: Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools, may lead to GAD. GAD also may become worse during periods of stress. The use of and withdrawal from addictive substances, including alcohol, caffeine, and nicotine, can also worsen anxiety.

Symptoms

A person with GAD may:

• Worry very much about everyday things
• Have trouble controlling their constant worries
• Know that they worry much more than they should
• Not be able to relax
• Have a hard time concentrating
• Be easily startled
• Have trouble falling asleep or staying asleep
• Feel tired all the time
• Have headaches, muscle aches, stomach aches, or unexplained pains
• Have a hard time swallowing
• Tremble or twitch
• Be irritable, sweat a lot, and feel light-headed or out of breath
• Have to go to the bathroom a lot.

Exams and Tests

If symptoms of GAD are present, the doctor will begin an evaluation by asking questions about your medical history and performing a physical examination. Although there are no laboratory tests to specifically diagnose anxiety disorders, the doctor may use various tests to look for physical illness as the cause of the symptoms.

The doctor bases his or her diagnosis of GAD on reports of the intensity and duration of symptoms — including any problems with functioning caused by the symptoms. The doctor then determines if the symptoms and degree of dysfunction indicate a specific anxiety disorder. GAD is diagnosed if symptoms are present for more days than not during a period of at least six months. The symptoms also must interfere with daily living, such as causing you to miss work or school.

Treatments

First, talk to your doctor about your symptoms. Your doctor should do an exam to make sure that another physical problem isn’t causing the symptoms. The doctor may refer you to a mental health specialist.

GAD is generally treated with psychotherapy, medication, or both.

Psychotherapy. A type of psychotherapy called cognitive behavior therapy is especially useful for treating GAD. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious and worried.

Medication. Doctors also may prescribe medication to help treat GAD. Two types of medications are commonly used to treat GAD—anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.

Antidepressants are used to treat depression, but they also are helpful for GAD. They may take several weeks to start working. These medications may cause side effects such as headache, nausea, or difficulty sleeping. These side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects you may have.

It’s important to know that although antidepressants can be safe and effective for many people, they may be risky for some, especially children, teens, and young adults. A “black box”—the most serious type of warning that a prescription drug can have—has been added to the labels of antidepressant medications. These labels warn people that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely, especially when they first start treatment with medications.

Some people do better with cognitive behavior therapy, while others do better with medication. Still others do best with a combination of the two. Talk with your doctor about the best treatment for you.

Possible Complications

Generalized anxiety disorder does more than just make you worry. It can also lead to, or worsen, other mental and physical health conditions, including:

• Depression
• Substance abuse
• Trouble sleeping (insomnia)
• Digestive or bowel problems
• Headaches
• Teeth grinding (bruxism)
• Substance use disorders

When to Contact a Medical Professional

If you think you have an anxiety disorder, the first person you should see is your family doctor. A physician can determine whether the symptoms that alarm you are due to an anxiety disorder, another medical condition, or both.

Preventions

Anxiety disorders like GAD cannot be prevented. However, there are some things that you can do to control or lessen symptoms, including:

• Stop or reduce your consumption of products that contain caffeine, such as coffee, tea, cola and chocolate.
• Ask your doctor or pharmacist before taking any over-the-counter medicines or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
• Exercise daily and eat a healthy, balanced diet.
• Seek counseling and support after a traumatic or disturbing experience.
• Practice stress management techniques like yoga or meditation.

Natural Remedies

Take control of anxiety and get on with life. Some anxiety is normal—but it shouldn’t interfere with your ability to function. According to research or other evidence, the following self-care steps may be helpful:

What You Need To Know:

• Address your stress
  Reduce stress with meditation, counseling, and other methods
• Avoid caffeine
  If you are anxious, avoid stimulants such as caffeine
• Try valerian and passion flower
  Calm the nervous system by taking an herbal combination of valerian (100 to 200 mg) and passion flower (45 to 90 mg) three times a day
• Aim for better nutrition with a multivitamin
  Taking one a day may help reduce anxiety and feelings of stress