A generalized anxiety disorder can determine the life and accompanies many people for a long time. But there are different ways to learn how to control fear and return to a normal life. Also, certain medications can help.
People with a generalized anxiety disorder (GAD) are not afraid of very specific things or situations but are afraid of everything possible. Therefore, one speaks also of “generalized” fear. It is psychologically very stressful and also causes various physical symptoms such as dizziness, muscle tension or tachycardia. To be constantly afraid is very exhausting. However, there are several treatments that can reduce anxiety to a tolerable level.
In contrast to other anxiety disorders, generalized anxiety disorder often occurs only in middle adult life. Basically, you can get an anxiety disorder at any age.
What can I do on my own?
Many people with a generalized anxiety disorder do not even get the idea to go to a doctor. They first try to get their fears under control themselves, for example by using books and information from the internet. Some learn relaxation techniques such as progressive muscle relaxation, autogenic training or yoga. The efficacy of such self-management options for anxiety disorders has not been well explored in studies. Relaxation techniques are often used in the context of psychotherapy. How useful they are, if they are used without other aids, we don’t know yet.
Some people resort to herbal sedatives such as valerian, lavender or passion petals. These funds have hardly been researched so far by studies. Many people assume that herbal medicines are better tolerated and safer than other medicines. But they can certainly have side effects and partly influence the effect of other drugs.
Self-treatment can make it take a long time to seek professional help. When an anxiety disorder severely limits everyday life, certain psychotherapies and medications can help.
What happens during a psychotherapy?
There are several psychotherapeutic procedures for treating a generalized anxiety disorder. The best studied and most effective is cognitive behavioral therapy (CBT).
Cognitive behavioral therapy
A CBT not only has a positive effect on anxiety. It can also relieve other symptoms, such as depression, that can be associated with anxiety disorder. However, since therapy requires a direct examination of one’s own fears, the treatment itself can sometimes be distressing. Generally, adverse effects of psychotherapy have not been well considered in studies so far.
Cognitive behavioral therapy is offered by behavioral therapists and usually adopted by the statutory health insurance. It usually consists of weekly sessions over several weeks or months. Cognitive behavioral therapy involves two parts: a “cognitive” part that deals with thoughts and feelings and one that deals with behavior.
The goal of the cognitive approach is to change anxiety-causing thought patterns by learning to
- recognize and question unrealistic fears and worries
- to estimate the actual probabilities and consequences of anxiety triggers and
- to deal with uncertainty
An example of fearsome thought patterns are “catastrophizing” thoughts, such as: drawing extreme, exaggerated conclusions about the extent of the supposedly impending disaster as soon as something disturbing happens. When such thoughts are recognized by therapists, they are working to break them down to better deal with them. Ultimately, CBT helps to think more clearly and to better control one’s own thoughts.
The second part of the therapy is about gradually reducing the anxiety in certain situations and changing the behavior. In doing so, one faces the fear, in order to overcome it gradually. For example, a working mother who is constantly calling nursery school to make sure her child is well could gradually reduce the number of her calls. In order to facilitate such behavioral changes, the therapy also conveys what can help to keep calm – for example breathing exercises or relaxation techniques.
Other psychotherapeutic approaches
The effectiveness of psychotherapy, which is more concerned with the possible causes of anxiety, such as traumatic events in childhood, is not well understood in people with generalized anxiety disorder. The few studies comparing cognitive behavioral therapy suggest that these “psychodynamic” therapies are less helpful than CBT.
What treatments are available?
For the treatment of a generalized anxiety disorder, various drugs are considered. Agents from the group of selective serotonin reuptake inhibitors (SSRIs) are often used.
Selective serotonin reuptake inhibitors (SSRIs)
These drugs belong to the group of antidepressants. They can alleviate anxiety symptoms and help against depressive symptoms that many sufferers have to deal with additionally.
It usually takes 2 to 6 weeks for SSRIs to have an anxiolytic effect. However, they help only a part of the people who take them. Therefore, it may be necessary to try several drugs. From the group of SSRI escitalopram and paroxetine for people with generalized anxiety disorder are well studied and approved.
If treatment with SSRIs has improved, it is recommended that you take the medication for another 6 to 12 months and then slowly reduce the dose. Studies indicate that the risk of a relapse is then smaller. However, some people find it difficult to take the medication permanently. One reason can be side effects, another: When you feel better, you can quickly stop taking it.
Possible side effects of SSRI include nausea, insomnia and sexual problems. For example, some people have less desire for sex or no orgasm. In men, ejaculation may be weaker or absent. For most people, however, there are no side effects.
In insomnia or nausea, it is sometimes difficult to say whether the drugs are actually the cause. Because these complaints are generally quite common. Often the body gets used to the active ingredients. Most side effects occur only in the first weeks of use. It may therefore be worthwhile to wait and not stop the treatment immediately if a side effect is noticeable.
There are a number of other medications that can be used in generalized anxiety disorder. Many, however, usually come into question only if a treatment with SSRI has not been successful or is not possible for certain reasons:
- Selective norepinephrine reuptake inhibitors (SNRI): These include the active substances duloxetine and venlafaxine. They work in a similar way to SSRIs.
- Pregabalin: This remedy is used primarily for nerve-related pain. However, it is also approved for the treatment of generalized anxiety disorder. The efficacy of the drug has been demonstrated in several studies. However, it often causes dizziness and fatigue.
- Opipramol: Opipramol is an antidepressant whose efficacy has been poorly studied and therefore only in exceptional cases is in question.
- Buspirone: This remedy can relieve anxiety symptoms but is not as well studied as other medications. Therefore, it is usually only used when, for example, SSRIs do not work or are not tolerated. Possible side effects of Buspirone are dizziness, nausea and insomnia.
- Hydroxyzine: This antihistamine drug is also likely to relieve symptoms of generalized anxiety disorder. However, it is also less well studied than other means and is therefore rarely used.
- Benzodiazepines: Benzodiazepines are sleep aids and tranquilizers that also help to solve anxiety. Their effect sets in quickly, but they can make after a few weeks dependent. Therefore, these agents are not recommended for the treatment of generalized anxiety disorder.
Although drugs such as imipramine from the group of tricyclic antidepressants or the neuroleptic quetiapine have been shown in studies to have an effect on generalized anxiety disorder. However, as there are more effective and better tolerated drugs with the SSRIs, these agents are not approved for the treatment of the disorder. Doctors prescribe these medications only if all other treatments have not helped (so-called off-label use).
There are relatively few studies comparing drugs directly. There are no clear benefits to a given drug from existing studies. Since not every medication works the same way in every human being, it can be useful to try different medications.
Which treatment is suitable?
Whether you opt for psychotherapy or drug treatment has a lot to do with personal attitudes and needs. Appropriate psychotherapy can be very effective and help to overcome the anxiety. But it requires a lot of initiative and strength, and often you have to wait longer for a therapy place. Depending on the personal situation and the severity of the illness, it may therefore be useful to take medication first. Sometimes it is only possible to start psychotherapy if the symptoms have been alleviated by medication.
Some people do not want to take antidepressants because they fear becoming addicted. Unlike certain painkillers, sleep aids and tranquilizers, however, antidepressants do not make them dependent. Others find it a sign of weakness to use pills to help them overcome their problems. But there is no reason to be ashamed when taking medication for mental illness. To overcome deep fears, medications can be helpful, sometimes even necessary.
However, you decide, there are both medications and psychotherapies that can help you cope with a generalized anxiety disorder and live a normal life again. So it is your choice.