Anxiety (Generalized Anxiety Disorder)

What Is Anxiety (Generalized Anxiety Disorder)?

Generalised Anxiety Disorder is a psychiatric condition, and is classified in the DSM-V (Diagnostic and Statistic Manual of Mental disorders, Fifth Edition) by standardised defining criteria.

Generalised anxiety disorder is one of the commonest mental health concerns worldwide, and it is estimated that a significant number of cases are left undiagnosed.

Patients with GAD present with excessive worry and anxiety in usual day-to-day life activities. This worry interferes with their normal functioning and is often regarded as irrational or out of proportion. The worry affects areas such as health, personal relationships, finances, and career.

Diagnosis of GAD may be difficult to make as it is commonly occurs in conjunction with other mental disorders such as depression. Online and easily accessible tools such as the Generalised Anxiety Disorder-7 questionnaire may assist in the diagnosis.

The average age of diagnosis is around thirty years of age.

What Are The Symptoms Of Anxiety (Generalized Anxiety Disorder)?

According to the DSM-V criteria, a patient with GAD must present with at least three of the symptoms listed below. The symptoms must be present for a minimum of six months, on most days, rather than at irregular intervals.

Symptoms include:

• Feeling impatient or on edge
• Getting worn-out quickly
• Struggling to focus or concentrate. The mind seems like it goes "blank."
• Getting annoyed quite quickly
• Muscle tension
• Some disruption of normal sleeping patterns- either having problems falling asleep, waking up at night, or having restless sleep.

The anxiety or worry must interfere with important areas of functioning such as social or employment spheres. It is important to exclude that the symptoms are not caused by other medical conditions e.g. thyroid function disturbances or by a particular substance or medication.

Patient with GAD may also have other physical manifestations of anxiety, along with those already mentioned. These include:

• Trembling, feeling jittery or being startled easily
• Gastrointestinal upsets such as nausea, diarrhoea or irritable bowel syndrome symptoms.
• Recurrent tension headaches

What Are The Causes Of Anxiety (Generalized Anxiety Disorder)?

Generalised Anxiety Disorder is not linked to a specific aetiology, but different risk and associated factors have been identified, with a primary focus on genetics and environmental causes.

Life stressor may trigger anxiety in genetically predisposed individuals. Life stressors include social issues such as isolation, lack of family support and poor self-esteem. Financial stressors such as inadequate income or debt may also contribute.

Women are more often affected than men.  GAD is seen less often in married couples or those in long-term relationships, than those without a life-partner.

Personality types may also play a role in developing GAD. Avoidant, dependent and obsessive-compulsive personalities are most commonly associated with anxiety.

What Are The Things One Should Do To Manage Anxiety (Generalized Anxiety Disorder)?

Exercise. Cardiovascular exercise is a good way to assist with stress relief, as well as managing symptoms of anxiety

Start practicing specific and directed relaxation techniques to help anxiety

Psychotherapy has been proven to be as beneficial as medication and is of additive benefit to patients who are on treatment.

Lower your caffeine intake. Caffeine is a stimulant that releases sympathomimetics (the same chemical neurotransmitters that are released during anxiety or fear

What Are The Things One Should Avoid To Manage Anxiety (Generalized Anxiety Disorder)?

• Do not smoke. Nicotine is a stimulant that stimulates your cardiovascular system and mimics a stress response. However, anticipated difficulty with quitting smoking may worsen anxiety. It is important to consult a doctor or counsellor to assist you, as well as to ensure that you have a good support structure around you, before attempting to stop.
• Avoid alcohol. It is a sedative but may cause a reflex/ compensatory stimulatory response by your body. Dehydration, impaired cognitive functioning, and memory impairment seen in alcohol use may also contribute to anxiety. Alcohol also lowers serotonin levels, which are important in maintaining mood and anxiety.
• Do not isolate yourself. Pursue meaningful inter-personal relationships and spend time with loved ones, as this has shown to lower anxiety

What Are The Best Foods For Anxiety (Generalized Anxiety Disorder)?

• Fresh fruits and vegetables give your body the nutrients it needs to keep your cognitive functioning optimal.
• Dehydration may worsen anxiety. Make sure to drink the recommended amount of water per day.
• Tryptophan rich foods. Tryptophan is a precursor of serotonin Foods that contain tryptophan includes: Sesame seeds, peanut butter, chicken, bananas, and turkey.
• Foods that are high in vitamin B such as red meat, tuna, eggs and salmon.
• Low GI carbohydrates. Carbohydrates increase serotonin production in the body, but refined carbohydrates cause insulin spikes. Low GI grains and bread are healthier, keep the blood glucose levels constant, and will increase serotonin levels.
• Food that is high in omega-3 such as mackerel, salmon, tuna, sesame seeds and avocados.

What Are The Worst Foods For Anxiety (Generalized Anxiety Disorder)?

• Caffeine- coffee, black tea, chocolate.
• Sugar and artificial sweeteners. Sugar has shown to increase depression and anxiety. Sugar-spikes wreak havoc on your insulin-glucose pathway and induce a "stress-response" in the body that worsens anxiety.
• Foods high in unsaturated fatty acids, that increase neural inflammation.

What Are The Medicines For Anxiety (Generalized Anxiety Disorder)?

Along with psychotherapy, treatment of GAD is mainly with anti-depressants. Selective Serotonin Reuptake Inhibitors (SSRIs) are used most often. These include escitalopram, fluoxetine and venlafaxine.

SSRIs are started at the lowest possible dose and then increased to the highest dose that alleviates symptoms. Initially, the SSRIs may worsen anxiety, and it is important that patients should be informed about it. Up-tapering of the medication dosage should be slow and controlled, to prevent overwhelming anxiety, and a higher risk of patients defaulting medication.

Often, patients are given benzodiazepines (sedatives) in conjunction with anti-depressants, to assist with the initial worsening of anxiety. Benzodiazepines include lorazepam or alprazolam. It is important that benzodiazepines are only used short term, as they have a high rate of addiction.

Other anti-depressants that can also be used include Buspirone (an azapirone), which works as an agonist of the serotonin receptors in the brain (thus potentiates the action of serotonin). 

What Are The Tips To Manage Anxiety (Generalized Anxiety Disorder)?

• Supplements such as omega-3, as well as magnesium and calcium may be beneficial.
• Aromatherapy, massage therapy, and reflexology may also assist with anxiety and stress reduction in general.