MENTAL HEALTH Stress & Anxiety • Obsessive-compulsive disorder • Post-traumatic stress disorder (PTSD) • Phobias • Panic attacks • Generalized anxiety disorder • Adjustment disorders • Social anxiety disorder (social phobia) • Oppositional defiant disorder (ODD)

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It's normal to feel anxious or worried at times. Everyone does. In fact, a moderate amount of anxiety can be good. It helps you respond appropriately to real danger, and it can help motivate you to excel at work and at home.

But if you often feel anxious without reason and your worries disrupt your daily life, you may have generalized anxiety disorder (GAD). Generalized anxiety disorder causes excessive or unrealistic anxiety and worry about life circumstances, usually without a readily identifiable cause.

The term for persistent anxiety that affects your day-to-day life is "anxiety disorder." Along with phobias, panic attacks and obsessive-compulsive disorder, generalized anxiety disorder is among the most common anxiety disorders. Women are more likely than men are to experience generalized anxiety disorder.

Living with generalized anxiety disorder can be difficult, but treatment is available. Medications and professional counseling or therapy can help you cope with the effects of generalized anxiety disorder.

The signs and symptoms of generalized anxiety disorder can vary in combination or severity. They may include:

• Restlessness
• Feeling of being keyed up or on edge
• Feeling a lump in your throat
• Difficulty concentrating
• Fatigue
• Irritability
• Impatience
• Being easily distracted
• Muscle tension
• Trouble falling or staying asleep (insomnia)
• Excessive sweating
• Shortness of breath
• Stomachache
• Diarrhea
• Headache

If you have generalized anxiety disorder, you may experience times when your worries don't consume you, but you still feel anxious. You may feel on edge about many or all aspects of your life. For example, you may feel intense worry about your safety or that of your loved ones, or you may feel that something bad is about to happen, even when there's no apparent danger.

Generalized anxiety disorder often begins at an early age, and the signs and symptoms may develop more slowly than in other anxiety disorders. Many people with GAD can't recall when they last felt relaxed or at ease.

When you feel anxious, your body releases hormones that prepare you to react to a threat. This is called the fight-or-flight response. When anxiety gets out of control, this response can occur almost continuously, even during times when you seem calm. Doctors and researchers don't fully understand why this happens.

Although the cause of generalized anxiety disorder is unknown, certain factors may contribute to the disorder:

• Specific medical conditions. Certain disorders, such as an overactive thyroid gland (hyperthyroidism), can produce anxiety, among other signs and symptoms.
• Coping with illness. Having a serious physical illness, such as cancer, can make you anxious. Worrying about the implications of your diagnosis and possible treatment can become excessive and overwhelming.
• Stress. A buildup of stressful life situations may trigger excessive anxiety. For example, having a physical illness, along with the stress of missing work or losing pay, may combine to cause generalized anxiety disorder.
• Personality. People with some personality types are more prone to anxiety disorders. People with unmet psychological needs, such as having a close relationship that isn't fulfilling, may feel less secure and be more at risk of generalized anxiety disorder. In addition, personality disorders, such as borderline personality disorder, also can bring about GAD.
• Heredity. Generalized anxiety disorder appears to run in some families.

Certain factors may increase your risk of generalized anxiety disorder. These include:

• A buildup of stress
• A serious or prolonged physical illness
• A personality type or disorder that is more prone to anxiety
• An anxiety disorder in your family

Generalized anxiety disorder and other anxiety disorders occur more frequently in people with chronic medical illnesses such as diabetes and high blood pressure.

If you have difficulty controlling your worries, or if anxiety interferes with your daily life, see your doctor.

Generalized anxiety disorder is distinguished from normal worrying and other anxiety disorders by how long it lasts and how it affects your daily life. If you've experienced intense anxiety and worry almost constantly for six months or more, you may have GAD. Persistent anxiety that affects you on a day-to-day basis is considered a medical problem.

Your doctor will likely perform a physical examination and a psychological evaluation to rule out other anxiety disorders or medical problems that may resemble GAD. A psychological evaluation consists of a questionnaire about yourself and an interview by your doctor. Other tests, such as a laboratory test to measure thyroid function, may be performed. Depending on the cause and severity of your condition, you may be referred to a mental health professional or other medical specialist.

People with anxiety disorders such as generalized anxiety disorder are more likely to develop other medical illnesses, and having an anxiety disorder can prolong the course of such illnesses. Generalized anxiety disorder often coexists with depression and other mental health disorders, such as panic attacks or phobias. Substance abuse or dependency, often from incorrectly self-medicating your symptoms, may accompany generalized anxiety disorder. The constant worry and tension that GAD causes may bring about insomnia, irritable bowel syndrome, headache and teeth grinding (bruxism).

The two main treatments for generalized anxiety disorder are medication and psychotherapy, either alone or in combination.

Medications
Doctors use antidepressants and anti-anxiety medications to treat generalized anxiety disorder and other various types of anxiety disorders. Commonly prescribed drugs include:

• Anti-anxiety drugs. Benzodiazepines are sedatives that often ease anxiety within 30 to 90 minutes, but they can be habit-forming if you take them for more than a few weeks. For this reason, your doctor may prescribe them for only a short time to help you get through a particularly anxious period. The most commonly prescribed sedatives include: alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan).

  These medications may cause unsteadiness, drowsiness, reduced muscle coordination and problems with balance. Higher doses and long-term use can cause memory problems. Don't drive or use heavy machinery while taking these drugs.

  Another medication prescribed for anxiety disorders such as GAD is buspirone (BuSpar). This drug often doesn't work as well if you've taken benzodiazepines in the past. A common side effect of buspirone is a brief feeling of lightheadedness shortly after taking the medicine. Less common side effects include headaches, nausea, nervousness and insomnia.

• Antidepressants. These drugs influence the activity of certain brain chemicals (neurotransmitters) to help nerve cells (neurons) in your brain send and receive messages. Examples of antidepressants used to treat anxiety include: fluoxetine (Prozac), paroxetine (Paxil), imipramine (Tofranil), venlafaxine (Effexor) and escitalopram (Lexapro).

  In general, antidepressants are effective most of the time. But because your doctor can't predict which medication will work best for you, you may need to try more than one to find which drug works best for you. Furthermore, antidepressants usually don't work immediately. The medication may begin to work within two weeks, but it may take up to eight weeks before you notice its full effects.

Psychotherapy
Also known as talk therapy, this treatment involves receiving help from a mental health professional through a combination of talking and listening.

One type of psychotherapy, cognitive behavior therapy, examines distortions in thinking that lead to psychological problems. Cognitive behavior therapy is highly effective in treating mental illness, particularly anxiety disorders such as GAD. It's based on the foundation that you are what you think.

During cognitive behavior therapy, a therapist helps you identify distorted thoughts and beliefs that trigger psychological stress, fear or depression. You learn to replace negative thoughts with more positive, realistic perceptions, and you learn ways to view and cope with life events differently. Generally a short-term treatment, cognitive behavior therapy emphasizes learning to develop a sense of mastery and control over your thoughts and feelings.

Treatment for generalized anxiety disorder or any mental illness is tailored to each person. No single treatment regimen works for everyone. Most treatment occurs on an outpatient basis, but some people may need care in a hospital setting.

These tips may help reduce your anxiety:

• Take action. Determine what's making you anxious and address it. For example, if finances are your concern, draw up a budget.
• Let it go. Don't dwell on past concerns. Change what you can and let the rest take its course.
• Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus.
• Take care of yourself. Get enough rest, eat a balanced diet, exercise and take time to relax. Avoid caffeine and nicotine, which can worsen anxiety. Don't turn to alcohol or unprescribed drugs for relief.
• Talk to someone. Share your problems with a friend or professional counselor who can help you gain perspective.

Living with generalized anxiety disorder can be difficult. In addition to dealing with excessive worry, you may find that other conditions, such as depression, often accompany GAD and can make you feel even more anxious. Ultimately, anxiety may affect your interaction with friends and family, your productivity at work, and the overall quality of your life.

You may find that talking to a counselor or therapist can help you cope with the effects of generalized anxiety disorder. Or you may find encouragement and understanding in an anxiety support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area.