(See also Overview of Anxiety Disorders.)
Generalized anxiety disorder is common, affecting about 3% of the population within a 1-year period. Women are twice as likely to be affected as men. The disorder often begins in childhood or adolescence but may begin at any age.
The focus of the worry is not restricted as it is in other psychiatric disorders (eg, to having a panic attack, being embarrassed in public, or being contaminated); the patient has multiple worries, which often shift over time. Common worries include work and family responsibilities, money, health, safety, car repairs, and chores.
Diagnosis is clinical based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Patients have difficulty controlling the worries, which occur more days than not for ≥ 6 months. The worries must also be associated with ≥ 3 of the following:
Also, the anxiety and worry cannot be accounted for by substance use or another medical disorder (eg, hyperthyroidism).
Certain antidepressants, including selective serotonin reuptake inhibitors (SSRIs; eg, escitalopram, starting dose of 10 mg orally once a day) and serotonin- norepinephrine reuptake inhibitors serotonin-norepinephrine reuptake inhibitor (SNRIs; eg, venlafaxine extended-release, starting dose 37.5 mg orally once a day) are effective but typically only after being taken for at least a few weeks. Benzodiazepines (anxiolytics) in small to moderate doses may also be effective, although sustained use may lead to physical dependence. One strategy involves starting with concomitant use of a benzodiazepine and an antidepressant. Once the antidepressant becomes effective, the benzodiazepine is tapered.
Buspirone is also effective; the starting dose is 5 mg orally two or three times a day. However, buspirone may require moderately high doses (ie, > 30 mg/day) and at least 2 weeks before it begins to help.
Psychotherapy, usually cognitive-behavioral therapy, can be both supportive and problem-focused. Relaxation and biofeedback may be of some help, although few studies have documented their efficacy.