Anxiety

Overview

Everyone worries sometimes. With generalized anxiety disorder (GAD), the worry is stronger and more frequent than the situation calls for. It is hard to control and can last for months or years.

People with GAD often worry about everyday things like work, health, money, or family. It usually starts slowly, often in early adulthood, but it can begin at any age. It is more common in women. With the right care, most people feel much better.

Symptoms

Symptoms often get worse during times of stress.

• Worry or anxiety that is hard to control
• Feeling restless or on edge
• Trouble sleeping, or feeling tired
• Trouble concentrating
• Tense muscles, headaches, or stomachaches
• Being easily annoyed

Less common

• Shaking or twitching
• Sweating, feeling lightheaded, or short of breath
• Trouble swallowing
• Going to the bathroom often

How it usually goes

• First: Worry slowly grows over months and starts to feel hard to stop.
• Ongoing: Symptoms come and go and are worse during stress.
• With treatment: Therapy and medicine often help within weeks to months.

When to get medical care

Causes

The exact cause isn't known. Family history, brain chemistry, stressful life events, and health problems may all play a part.

Caffeine, some medicines, and alcohol or drug use can make anxiety worse.

Does it spread or run in families?

• It isn't contagious. You can't catch it from someone else.
• It can run in families. Tell your doctor if a parent, brother, or sister has it.

Who is more likely to get it

• Family history of anxiety or depression
• Being female
• Stressful or hard life events, in childhood or as an adult
• Other mental health problems, like depression

Possible complications

• Depression: Often happens along with anxiety
• Insomnia: Long-term trouble sleeping
• Alcohol or drug use: Using substances to cope

Diagnosis

There is no lab test for anxiety. A healthcare professional asks about your feelings and checks for other causes.

Questions you may be asked

• What you worry about and how often
• How long it has been going on
• How it affects work, school, sleep, and family
• Caffeine, alcohol, drugs, and medicines you take
• Whether you feel down or have thoughts of hurting yourself

The exam

They may do a physical exam to look for a health problem that can cause anxiety signs, like a thyroid problem.

Tests

Tests aren't always needed. Sometimes:

• Questionnaire: A short list of questions to see how strong the symptoms are.
• Blood tests: To check for thyroid or other problems that can feel like anxiety.

Treatment

GAD is usually treated with talk therapy, medicine, or both. It may take some time to find what works best.

Self-care

• Cut back on caffeine, like coffee, energy drinks, and soda
• Get enough sleep and keep a regular bedtime
• Move your body, like a daily walk
• Try calming skills, like slow breathing, mindfulness, or meditation
• Talk to someone you trust about how you feel
• Limit alcohol, which can make anxiety worse

Medicines

All of these need a prescription. They can take weeks to work fully.

Never stop an anxiety medicine on your own. Your healthcare professional can help you lower the dose safely.

Healthy habits help, but they don't replace treatment. Cognitive behavioral therapy (CBT) is the best-studied talk therapy for GAD. It teaches you to notice and change worried thinking. Therapy can be done in person or by video.

How it compares

Prevention

You can't always prevent anxiety, but you can lower its effect:

• Get help early when worry starts to affect your life
• Keep up with sleep, exercise, and healthy meals
• Limit caffeine and alcohol
• Stay connected with friends and family

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a psychiatrist (for medicine) and a psychologist or licensed therapist (for talk therapy).

Living with it

• Keep a regular sleep, meal, and activity routine.
• Tell one trusted person how you're doing, and plan who to call on hard days.
• Limit alcohol and drugs. They often make symptoms worse.
• In a crisis, call or text 988 any time.
• Long-term illness can affect mood. Tell your doctor if you feel down or anxious.

Support groups and helplines

• NAMI (National Alliance on Mental Illness): Free support groups and a helpline (1-800-950-6264) for people and families.
• 988 Suicide & Crisis Lifeline: Call or text 988 any time for free, private support in a crisis.

Back to school, work, or sports

• Most people can keep working or going to school.
• Ask about changes that help, like extra breaks or a flexible schedule. Workers may be covered by the ADA. Students may get a 504 plan.
• The Family and Medical Leave Act (FMLA) may let you take unpaid time off for treatment without losing your job.

Children, pregnancy, and older adults

• Children and teens: They often worry about school, friends, or the future, and may try to be perfect. Therapy works well for kids.
• Pregnancy: Anxiety can start or get worse during pregnancy or after birth. Ask which treatments are safe.
• Older adults: Some anxiety medicines can cause falls or confusion. Ask about safer choices.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Many mental health medicines are used safely in pregnancy. Stopping suddenly can cause a relapse.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Mood problems can start during or after pregnancy. Postpartum Support International: 1-800-944-4773.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

For caregivers

• Listen without judging, and let them know you care.
• Encourage treatment, but don't force it unless they're in danger.
• If they talk about suicide, call or text 988 with them.
• Take breaks and ask for help. Caregivers need care too.

Outlook

GAD can last a long time, but it can be treated. Most people feel much better with therapy, medicine, or both.

Myths and facts

Getting ready for your visit

Writing things down helps you remember.

What to bring

• A list of your worries and symptoms
• How long they have been going on
• All medicines, supplements, and caffeine you use

Questions to ask

• Could a health problem be causing this?
• Is talk therapy, medicine, or both best for me?
• How long until I feel better?
• What can I do on bad days?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Anxiety