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General Anxiety Disorder – An Overview

Overview of Anxiety and General Anxiety Disorder

Welcome my friend, this is Sergio. Today we’re going to talk about General Anxiety Disorder (GAD), what is it, how common it is, its causes, and how it is treated in our current health care system. This will be an interesting subject because anxiety affects millions of people. Let’s dive right in and learn about it!

What is Anxiety?

Anxiety is an emotional state of mind where a person has a perceived sense of danger or threat, whether the threat is real or thought to be real.

What is Normal Anxiety?

Anxiety in light of a dangerous situation is a normal bodily response where the body uses the heightened sense of the danger-emotion to avoid an actual danger or react to a dangerous situation. This can be normally thought of as the fight or flight response. During a perceived danger or an actual state of danger, every person will show symptoms of nervousness and apprehension when stress is present. In this normal case of anxiety, this anxious emotional state of mind is temporary and is an adaptive response to a dangerous situation at hand.

Anxiety That’s Not Normal

If a person has a problem with the body’s normal anxiety response to a dangerous situation or perceived to be dangerous situation and it becomes excessive beyond reasonable, this person will become uncomfortable and have potentially psychologically debilitating thoughts such as worrying and feelings of threat that are NOT appropriate for the actual threat at hand. In an anxiety disorder, the anxiety symptoms cause a person to become debilitated and have anxiety that is normally unjustified based on the severity of whatever caused the anxiety symptoms. In addition to the overwhelming psychological symptoms, a person can also show physiological (bodily) symptoms such as an increased heart rate, shortness of breath, sweating, uneasy feeling.

Normal Anxiety

During an actual threat or a perceived threat, a person will NORMALLY show the psychological symptoms of anxiety AND the physiological symptoms as well.

The psychological symptoms of normal anxiety are:

  • Worry about a threat
  • Feeling of a threat
  • Apprehension

The normal physiological anxiety symptoms are:

  • Increased heart rate
  • Increased breathing
  • Increased sweating
  • Increased blood pressure

In a person with an Anxiety Disorder, the psychological and physiological symptoms will be PERSISTENT, more frequent, and EXCESSIVE beyond reasonable. With an anxiety disorder, the persistent, severe symptoms and irrational fears can significantly impair someone’s normal daily functioning, which results in an anxiety disorder. The impairment of functioning and inability to control the thoughts and emotions during the anxiety event are what primarily make up an Anxiety Disorder. There are various types of anxiety disorders that are known. Some of the common ones are:

  • General Anxiety Disorder
  • Social Anxiety Disorder
  • Social Phobia
  • Panic Disorder

These various anxiety disorders are the most frequent psychological ailments that are seen in medical practice today. Anxiety disorders are often undiagnosed or misdiagnosed in a person because of a possible confusion with a person’s other medical conditions. Other medical conditions can have similar symptoms to anxiety disorders and oftentimes a medical provider will not pick up on an underlying anxiety disorder because they look so similar to other chronic medical condition symptoms (increased worrying, increased heart rate, difficulty breathing, etc.). As a result, millions of people go undiagnosed, underdiagnosed or undertreated for an actual anxiety disorder that they may have. It’s been estimated that only about ¼ of people with other medical conditions receive appropriate treatment for their anxiety disorder.

            Underdiagnosis and undertreatment of anxiety disorders can lead to many other problems for a person. This lack of treatment for an anxiety disorder can cause someone to overuse medical facilities (hospitals, ER visits, urgent care), increased risk of substance abuse, and increased suicide risk that can go along with an anxiety disorder. Even worse, untreated anxiety disorders can contribute to gastrointestinal disorders, cardiovascular (heart, blood vessels) conditions, cerebrovascular (brain) conditions, and respiratory disorders (breathing) for such a person. All of these are found to be more common in persons with an untreated anxiety condition compared to someone in the general public.

How common are Anxiety Disorders?

Combining all of the common anxiety disorders (general anxiety, social anxiety, panic disorder, etc.), it’s been estimated that about 33.7% of the population have an anxiety disorder within their lifetime. In the United States, for persons greater than 18 years old, the one-year prevalence for an anxiety disorder is about 21.3%. For panic disorder it’s 3.1%, for social anxiety disorder it’s 8%, and 2.9% for general anxiety disorder. The numbers of people with anxiety disorders is staggering, which means that millions of people are walking around with an anxiety disorder, and only about ¼ of these millions of people are actually appropriately treated for it!

The common anxiety disorders are unfortunately are found more frequently in women than in men, and they usually develop before the age of 30. Anxiety disorders are also more commonly found in person with:

  • Social issues
  • Family history of anxiety and depression

One anxiety disorder contributes to developing other disorders. Oftentimes, persons are found to have multiple anxiety disorders (not always though), substance abuse, and major depression disorder at the same time. When evaluating a person for an anxiety disorder, a medical provider will oftentimes find that a person actually has a mix of both depression and anxiety together and not just anxiety alone. In this case, the medical provider must treat all of the disorders and not just one.

Medical Conditions Associated and Anxiety

A person with an anxiety disorder can also be found to have other associated medical conditions that are correlated to an anxiety disorder. Many times, such as person can have a lower quality of life due to lower physical levels, a physical disability, or another chronic medical condition at the same time as having an anxiety disorder. The symptom from these can be similar to an anxiety disorder. Usually, anxiety that is related to an illness will decrease or become less intense once a person notices relief from the illness. However, if a person has a chronic medical condition and persistent anxiety, they should be evaluated for an anxiety disorder as well.

There are common medical conditions that are associated with anxiety disorders. Some of the more common ones are:

  • Crohn’s disease, ulcerative colitis, irritable bowel disease, peptic ulcer disease
  • Seizures, migraines, neoplasm (type of cancerous cells), stroke, and poor control of pain
  • Cancer, anemias, systemic lupus erythematosus, dysfunction of the vestibular apparatus
  • Pneumonia, asthma, chronic obstructive pulmonary disease, pulmonary embolism
  • Diabetes, hyperthyroidism, hyperparathyroidism, hypoglycemia (low blood sugar), pheochromocytoma, vitamin b12 deficiency, folate deficiency, hyperkalemia (high blood potassium), hyponatremia (low blood sodium), Cushing’s disease.
  • Heart Arrythmias, angina, congestive heart failure, high blood pressure, ischemic heart disease, heart attack (myocardial infarction), mitral valve prolapse, cardiomyopathy (disease of the heart).
  • Anxiety disorders are found in other severe psychiatric illnesses such as mood disorders, schizophrenia, dementia, and substance abuse disorders.

Drug Induced Anxiety

There are many over the counter, herbal, and prescriptions medications that can induce anxiety symptoms.  Central nervous system (CNS) stimulant drugs can activate the CNS and produce symptoms of anxiety, ranging from mild to severe, all depending on the drug and the specific dose. Generally, the higher the dose of a CNS stimulant medication, the more intense the anxiety symptoms will be and the more types of symptoms will be present as well. Some CNS stimulant medications can even cause a panic attack at the start of taking a new medication.

On the other hand, some CNS Depressants can also cause symptoms of anxiety, even causing an anxiety attack to occur. This can occur in children and the elderly with some CNS depressant drugs. However, this is not as common and is more frequently found when someone abruptly discontinues or withdraws a CNS depressant medication.

The list of drugs that can cause symptoms of anxiety is fairly extensive, and I’ll name a few of the most common one’s here. The following is a list of the most common anxiety-inducing drugs:

  • Amantadine, dopamine (Dopamine Agonists)
  • Bupropion, selective-serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors-(SNRIs) (usually due to abruptly stopping the medication or tapering off the medication too quickly). (Antidepressant Medications)
  • Carbamazepine, phenytoin (Seizure medications)
  • Anticholinergics, digoxin, antihistamines
  • Levothyroxine (thyroid medication)
  • Phenylephrine, pseudoephedrine (decongestant medications)
  • Amphetamines, cocaine, caffeine, nicotine
  • Non-steroidal anti-inflammatory medications (indomethacin, ibuprofen, etc)
  • Marijuana, ecstacy
  • Ephedra, Ginseng, Ma Huang
  • Prednisone
  • Theophylline, albuterol
  • Isoniazid, quinolone antibiotics
  • Felodipine, clonidine

The above list of anxiety-causing medications is fairly extensive. In light of medications, a warning that is important for everyone: It is very important to not begin, change the dosing, or stop use of a medication without first notifying your medical provider. The reason for this is because many medications can cause anxiety symptoms when started, the dose increased or decreased, or withdrawal symptoms if the medication is abruptly stopped. Withdrawal is when the body becomes agitated or “shocked” when the medication is no longer taken or the dose becomes too low from what the body is used to. The withdrawal symptoms of medications occur when the body’s nervous system goes into a hyperactive mode. Sudden withdrawal of certain medications or the dose suddenly being too low can cause the body to go into this hyperactive mode and produce the psychological and physiological symptoms of anxiety.

What Causes Anxiety Disorders?

An anxiety disorder is caused by an imbalance of the chemical transmitters in the neurons of the brain. The neurotransmitters involved are norepinephrine, serotonin, gama-aminobutyric acid (GABA), corticotropin-releasing hormone (CRF), and cholecystokinin. The nervous system in the brain is made up of nerve connections of smaller nerves called neurons. These neurons talk to each other through these neurotransmitters. If there is a problem with too much or too little of one or more neurotransmitters (a disbalance), then the neurons will be hyperactive and cause more disbalance in various areas of the brain. In the case of an anxiety disorder, the disbalance is usually a lack of serotonin and norepinephrine activity is some areas of the brain. In addition, the GABA receptor is not working adequately enough to help tone the anxiety symptoms down.

General Anxiety Disorder (GAD)?

General Anxiety Disorder is a human medical condition in which a person has excessive worrying and mental distress that is persistent and difficult to control most days of the week. This person has overwhelming anxious thoughts that they cannot control, and these thoughts occur on most days of the week, persisting for at least 6 months out of a year. GAD is anxiety or apprehension about an expectation (event) with at least 3 psychological or physical symptoms (see below). General anxiety is PERSISTENT anxiety on most days of the week and not just simple occasional anxiety about an event that is happening now or upcoming in the future. In addition, a General Anxiety Disorder symptom is also when someone has difficulty controlling the anxious thoughts combined with the psychological and/or physical symptoms of anxiety as well (see below).

Other features of GAD:

  • Has a gradual onset
  • Usually starts at the average age of 21
  • Most people that have GAD are between 35-45 years of age.
  • Women are two times more likely to have GAD than men.
  • Severe Psychological stressors (things that cause mental anguish) can make GAD worse or start later on in a person’s life.
  • GAD can last years or decades (chronic illness)
  • There is a high rate of relapsing
  • Low rates of recovery
  • 90% of people with GAD have another psychiatric illness.
  • 60% of people with GAD have depression
  • GAD has a severe impact in a person’s daily functioning. Many people will seek medical help for uncontrolled anxiety.

The Psychological Symptoms of GAD are:

  • Persistent anxiety (excessive)
  • A keyed-up feeling or a feeling of being on edge
  • Worries that are very difficult to control
  • Trouble concentrating or mind that goes blank
  • Apprehension
  • Unrealistic or excessive anxiety about activities or events

The Common Physical Symptoms of GAD:

  • Fatigue
  • Restlessness
  • Muscle tension
  • Irritability
  • Disturbances in sleep

General anxiety disorder is one of the most common mental disorders in the United States. In fact, in the US as a lifetime prevalence, about 5.1 to 11.9% of the population will suffer from general anxiety. General anxiety disorder is the most common anxiety disorder within the elderly population. When it comes to women, women are twice as likely to have it compared with men.

Anxiety can be a very debilitating medical condition when its not managed appropriately. Management of General Anxiety Disorder is done through cognitive behavioral therapy, medication management with certain selective-serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), and relaxation techniques. (more on this later in another article).

Treatment of General Anxiety Disorder

In treating acute GAD, the goal of therapy is to improve the overall functioning of a person’s daily life and reduce how severe the anxiety symptoms are and how long the symptoms last. In regards to the long term (chronic) management of GAD, the goals are for someone to:

  • Go through an anxiety disorder remission (mostly anxiety free) or not have the anxiety symptoms.
    • Definition of Medical Remission“a diminution of the seriousness or intensity of disease or pain; a temporary recovery.”
  • Not have a functional impairment to daily living.
  • An improvement in quality of life by decreasing the impact of anxiety on daily living.
  • Prevent future episodes of anxiety disorders from coming up and taking hold again.

The general strategy of treating GAD is the use of both psychotherapy and medication therapy. Psychotherapy is cognitive behavioral therapy (CBT), which is the least invasive and safest form of treating GAD. Cognitive Behavioral therapy is usually a 12-20 weeks program that is administered by someone with specialized training in Cognitive Behavioral Therapy. In addition to psychotherapy, medication therapy can be added by a medical provider when necessary. Anti-anxiety medications are usually reserved for someone who experiences enough anxiety symptoms that it impairs their daily functional living.

Some of the major determining factors that a medical provider would consider for prescribing medication therapy would be:

  • The current anxiety symptoms and how severe they are
  • Someone’s current medication history
  • Age
  • Other medical conditions
  • Other psychiatric conditions
  • How someone responded to previous medications for anxiety disorders
  • Which side effects are to be expected and able to be tolerated by the patient.
  • Someone’s preference for anxiety medications
  • Cost of antianxiety medication

Non-Pharmacological Treatment for Anxiety

Therapy without the use of medications is the preferred starting point for someone who doesn’t have anxiety that is severe enough to impair their daily functioning. A medical provider will first start with things such as psychoeducation, short-term counseling, psychotherapy, stress management techniques, or exercise. Psychotherapy is usually done by a medical provider with specialized training. Psychoeducation is the education about anxiety and the overall strategy of how to treat general anxiety disorder.

            There are certain stimulating medications and herbal products that should be avoided when someone has GAD. Someone with GAD should avoid caffeine, large amounts of alcohol, nicotine, non-prescription stimulants (ex. Pseudoephedrine, ephedra, etc.), and diet pills. All of these can make an anxiety disorder worse and the symptoms worsen.

            The majority of people with an anxiety disorder require a combination of psychotherapy AND medication therapy in order to improve their daily functioning and control of anxiety symptoms. However, it is possible to control the anxiety disorder with medications alone or cognitive behavioral therapy alone.

            Cognitive behavioral therapy (CBT) is psychotherapy that is done by a specially training medical provider. It is performed on a weekly basis and usually last 12-20 weeks in duration. This therapy consists of overcoming fears and anxiety, cognitive restructuring, training on how to relax, and coping with anxious or fearful situations (rehearsal). CBT is one of the most preferred psychotherapy trainings because it’s the most useful of all the psychotherapy trainings and doesn’t really have any negative side effects arising from it.

Medication Management of General Anxiety Disorder

            There are several medication classes that are used to help control the anxiety symptoms in GAD. For someone suffering from an acute anxiety attack, the preferred prescription medications are the benzodiazepines (ex. Alprazolam, lorazepam, diazepam, etc.). The benzodiazepines are usually not preferred for long term use because they are controlled substances and they place a person at a higher risk of psychological and physical dependence on these medications. The benzodiazepines are the most effective for the autonomic symptoms (higher blood pressure, sweating, etc.) and the somatic symptoms (fatigue, muscle tension, insomnia, etc.) of GAD.

            Prescription antidepressants are the medication class that are the preferred therapy for the treatment of GAD. The reason is because they are generally well-tolerated and they don’t have dependency issues like the benzodiazepines do. Antidepressants are mostly effective in treating the psychological symptoms of anxiety (such as apprehension and worry) in anxiety disorders. The antidepressants are used for the treatment of chronic anxiety and especially preferred if someone also has depression that comes along with their anxiety disorder (GAD). Another drug called Buspirone (Buspar) is a miscellaneous anti-anxiety medication that is used for the treatment of GAD and other anxiety disorders. However, buspirone is not indicated for use in depression.

            There are certain medications that are not as widely used for treating anxiety disorders because of they have unfavorable side effects and toxicity. Some of these medications are the:

  • barbiturates (ex. Phenobarbital, secobarbital, etc.)
  • the anti-psychotic medication class
  • combination of antipsychotics and antidepressant medications
  • antihistamines (ex. Diphenhydramine, etc.)

The Preferred Prescription Medications for General Anxiety Disorder

The following is a list of the commonly preferred medications for GAD based on our current medical guidelines:

First Line Medications for GAD (medications that are the most preferred for GAD treatment)

  • Duloxetine (Cymbalta) – SNRI class
  • Venlafaxine XR (Effexor XR) – SSRI class
  • Escitalopram (Lexapro)  – SSRI class
  • Sertraline (Zoloft) – SSRI class
  • Paroxetine (Paxil) – SSRI class

Second Line Medications for GAD (second in preference for GAD treatment)

  • Benzodiazepines (ex. Lorazepam, alprazolam, clonazepam, diazepam, clorazepate, etc.)
  • Imipramine (Tofranil) – Tri-Cyclic Antidepressant
  • Pregabalin (Lyrica) – Seizure Medication/Nerve Pain Medication
  • Buspirone (Buspar) – miscellaneous anti-anxiety medication

Alternative Medications for GAD

  • Quetiapine (Seroquel) – Atypical Antipsychotic
    • Not FDA approved for GAD but still used when someone really needs it.
    • Atypical antipsychotics have a lot of side effects and are generally reserved for use by a specialist when other anti-anxiety medications are not helping.
  • Hydroxyzine (Vistaril, Atarax) – First generation antihistamine and anti-anxiety medication
    • Used as a second line medication because it can’t be used in someone who has other psychiatric conditions (such as depression) in addition to GAD
    • Usually not used for >4 months of therapy.

Other Herbal Medications that are generally NOT used for GAD treatment anymore:

  • Kava Kava, an herbal product, has been used before for GAD but can have problems with liver toxicity, therefore it’s not recommended for GAD treatment.
  • St. John’s Wort, Valerian Root, and Passionflower have also been used for GAD, but all of these have limited evidence of their usefulness and effectiveness. Because of this, it’s not advisable to use these medications. St. John’s Wort can also have significant drug interactions with other prescription and non-prescription medications that can be life threatening in some circumstances.

Using Antidepressant Prescription Medications for GAD

            The antidepressant medications are the first-choice prescription medications that are used for the acute (right now) and long-term treatment of GAD. The reason for this is that the antidepressants are effective and generally safe for long-term use. The SSRIs and SNRIs are the most commonly used antidepressants for short term and long-term GAD treatment. They have less side effects than other medications (such as with the benzodiazepines) and are more well tolerated. The FDA approved antidepressants for GAD are extended-release Venlafaxine (Effexor XR), duloxetine (Cymbalta), and escitalopram (Lexapro). Other antidepressants that can be used to treat GAD are:

  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Vilazodone (Viibryd)
  • Vortioxetine (Brintellix, Trintellix)

Other non-antidepressants that are also used to treat anxiety are:

  • Buspirone (Buspar)
  • Pregabalin (Lyrica)
  • Quetiapine XR (Seroquel XR)

            The Selective-Serotonin Reuptake Inhibitors (SSRIs), the Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), and the Tricyclic Antidepressants (TCAs) are the preferred antidepressants for GAD treatment. For acute anti-anxiety therapy, they are usually used for a short-term 8-12 weeks trial period to see how someone tolerates the medication and to find a more effective dose (called Dose-Response Titration). About 60-68% of people who start an 8-12 weeks trial of an anti-depressant medication for anxiety will respond to them and only about 30% will have remission of their GAD.

How Anti-Depressants Work to Treat Anxiety Symptoms

            It’s not clearly understood how the antidepressants work to improve the psychological symptoms of anxiety. However, it’s been generally accepted in the medical community that the anti-depressant medications are used to harmonize or more stabilize the serotonin, dopamine, and norepinephrine disbalance that occurs in people with anxiety disorders. These neurotransmitters are used to connect one neuron to another as they are the little chemical messengers the neurons use to communicate with each other. Any disbalance in the connection of one neuron to another will cause disharmony and disbalance of that specific neuron network within the human brain and human mind. By increasing the norepinephrine and serotonin levels within the neurons of specific parts of the brain, the human mind and brain are more able to control the thoughts and emotions associated with apprehension, fear, and anxiety that are commonly found in anxiety disorders.

Benzodiazepine Use in General Anxiety Disorder

The Benzodiazepines are a prescription medication class that are mainly used for the short-term treatment of anxiety disorders and help alleviate the psychological and physiological symptoms of anxiety disorders. The benzodiazepines are controlled substance medications because of their: 1) euphoric effects after taking them and 2) their psychological and physical dependency for a person. The Benzodiazepines are Schedule 4 controlled substances in the United States. They are available by prescription only.

GAD = general anxiety disorder

List of Common Benzodiazepines:

  • Lorazepam (Ativan)
    • FDA approved for GAD treatment
  • Clonazepam (Klonopin)
    • FDA approved for GAD treatment
  • Midazolam (Versed) – IV medication, used in hospitals for procedures for preoperative sedation
  • Alprazolam (Xanax)
    • FDA approved for GAD treatment
  • Clorazepate (Tranxene)
    • Usually used for alcohol withdrawal management
    • FDA approved for GAD treatment
  • Estazolam (Prosom)
  • Flurazepam (Dalmane)
  • Temazepam (Restoril)
  • Oxazepam (Serax)
    • FDA approved for GAD treatment
  • Quazepam (Doral)
  • Triazolam (Halcion)
  • Diazepam (Valium)
    • FDA approved for GAD treatment
  • Chlordiazepoxide (Librium)
    • FDA approved for GAD treatment

All of the benzodiazepine medications have anti-anxiety effects. They are usually reserved for more severe and difficult to control anxiety symptoms and for a short-term course of therapy. Short-term course of therapy means either on an as-needed basis, for a few days, or weeks. The definition of “short-term” will be dependent on your severity and frequency of anxiety disorder symptoms and how comfortable your treating physician is prescribing benzodiazepines for you. Due to the possible psychological and physical (physiological) dependence of these medications, most medical providers will not put someone on a long-term course of benzodiazepine medication unless they really have to.

How Effective Are Benzodiazepines for Treating GAD?

Benzodiazepines are very effective at treating GAD. In clinical trials, it’s been found that 65-75% of people have a range of improvement of an improved anxiety response to a moderate anxiety response to taking a benzodiazepine medication. This improvement in GAD symptoms usually occurs within the first 2 weeks of taking a benzodiazepine. While the benzodiazepines work on the psychological anxiety symptoms as well, they are generally most effective for the somatic (physical) symptoms of anxiety such as helping with lowering the breathing rate, sweating, heart rate, insomnia, etc. that usually occurs with an anxiety attack.

Benzodiazepine medications are potent CNS depressants and have the potential for serious side effects. Some of the most common side effects of benzodiazepines are:

Side EffectsComments
Anterograde amnesia, Impairment of MemoryWorsened by use with alcohol.
Fatigue, DrowsinessPerson should avoid operating large, heavy machinery. Person will become more tolerant of fatigue and drowsiness with repeated dosing of the benzodiazepine.
Withdrawal SymptomsShould never abruptly discontinue, lower, or increase the dose of a benzodiazepine medication without your personal medical provider recommendations (physician). Do NOT self-taper your medication because you can go into withdrawal symptoms (worsening of anxiety disorder/symptoms).
DependenceBenzodiazepine have a higher risk for physical and psychological dependence.
Respiratory DepressionIs the slowing down and potentially stopping of breathing. Usually caused by use of a benzodiazepine with another CNS depressants (ex. Alcohol, opioids, etc.)
Impairment of Balance and Coordination (Psychomotor impairment)Higher fall risk. Need to have strategies and vigilance to prevent slips and falls.
Paradoxical DisinhibitionParadoxical reaction where someone takes a benzodiazepine and has an increase in irritability, anxiety, or agitation. More likely to be seen in children and the elderly.

Benzodiazepine Abuse

Benzodiazepine medications are associated with an increased risk of dependence and abuse with prolonged use. Within the general population, benzodiazepine abuse and dependence is less common. However, if someone has a history of multiple drug abuse, they will be at a much higher risk for benzodiazepine abuse. Usually self-adjusting of dosing and early refills of medications may be an early warning sign of potential substance abuse of benzodiazepines.

Benzodiazepine Withdrawal

If someone more frequently or more consistently uses a benzodiazepine medication and if they abruptly discontinues the use of their benzodiazepine medication, they will be at a high risk for withdrawal symptoms. These withdrawal symptoms are essentially a higher form of an anxiety attack (beyond what someone’s baseline is) since the body is used to functioning with a benzodiazepine medication helping to control the anxiety symptoms. Sudden withdrawal of the benzodiazepine medication results in a flood of:

  • Anxiety, restlessness, insomnia, muscle tension, and irritability.
  • In addition, someone may notice a general malaise, nausea, coryza, blurred vision, diaphoresis (sweating), depression, nightmares, hyperreflexia, and ataxia.
  • Benzodiazepine withdrawal may sometimes (rarely) cause confusion, tinnitus (ringing in ears), hallucinations, delusions (paranoid) and seizures.

Withdrawal symptoms can last days to weeks. The severity of withdrawal symptoms will be based upon the dose of the medication, the specific benzodiazepine medication, and how sensitive someone is to not having the medication.

How long is someone usually placed on a Benzodiazepine Medication for GAD?

For acute management of GAD, a 2 to 4 weeks course of benzodiazepine therapy is tried with daily dosing during this 2 to 4 weeks course to prevent withdrawal symptoms from occurring. An as-needed dosing schedule is sometimes used for shorter courses of therapy such as for air travel, dental treatment phobia, etc.

Conclusion of General Anxiety Disorder

General Anxiety Disorder is a serious anxiety condition that affects millions of people. A great majority of persons will have periods of time in their life where their normal anxiety symptoms will progress into a functional anxiety disorder. The psychological and physiological symptoms of anxiety will become severe enough to cause a functional impairment and prevent someone from living their life to their fullest potential.

            Anxiety disorders are oftentimes seen with other psychiatric conditions such as depression and substance abuse disorders. All disorders should be treated and managed at the same time. Since many people have both depression and GAD, the anti-depressant prescription medications are employed to combat the short-term and long-term courses of anxiety treatment. Since the SSRIs and SNRIs anti-depressants are non-habit forming, they are the first line of therapy for both acute and chronic GAD. Other medications such as the Tri-Cyclic Antidepressants, Buspirone, and Quetiapine can also be used to treat GAD but are the second line medications and not used as frequently. Usually, a specialist will prescribe and monitor second-line medications since they are less commonly used due to more side effects and toxicity.

            The benzodiazepine class of medications are also used to help with a short-term (acute) course of GAD. Benzodiazepine medications are less commonly prescribed than the antidepressants but are used when someone has a more severe functional impairment due to their anxiety disorder. The benzodiazepines have more side effects than other anti-anxiety medications and must be used more cautiously to prevent complications.

            Cognitive Behavioral Therapy is oftentimes used in addition to medication therapy for GAD. Behavioral therapy focuses on anxiety education and use of certain techniques to control the flow of thoughts and emotions to prevent or correct the anxiety disorder. Usually a specially trained person will administer this 12 to 20 week training program.

Message from the author, Sergio

            I hope you enjoyed reading this article about General Anxiety Disorder and found it informative. If you enjoyed reading this article and have learned something today, I encourage you to leave comments or questions below in the comments section. In a future article, I’ll address the ins and outs of the medications that are used to treat GAD as well information about the other anxiety disorders such as Panic Disorder, Social Anxiety Disorder, etc.

I’ll see you in the next article.

Sergio, Pharmacist


  1. DiPiro, J.T., Talbert, R.L, Yee, G.C., Matzke, G.R., Wells, B.G., Posey, L.M. (2017). Anxiety Disorders: Generalized Anxiety, Panic, and Social Anxiety Disorders. Pharmacotherapy. A Pathophysiologic Approach. 10Th Edition, 70, 1079-1089.
  2. Baldwin, D., Stein, M.B., Hermann, R. (2019). Generalized Anxiety Disorder in Adults: Epidemiology, Pathogenesis, Clinical Manifestations, Course, Assessment, and Diagnosis. Up To Date 2019. Retrieved 7/29/19 from

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