Feeling anxious sometimes is perfectly normal. However, for people with generalised anxiety disorder (GAD), feelings of anxiety are much more constant
Brought to you by NHS Choices
Everyone experiences feelings of anxiety during their lifetime. For example, you may feel worried and anxious about sitting an examination or having a medical test or job interview. Feeling anxious sometimes is perfectly normal. However, for people with generalised anxiety disorder (GAD), feelings of anxiety are much more constant and tend to affect their day-to-day life.
There are several conditions for which anxiety is the main symptom. Panic disorder, phobias, and post-traumatic syndrome can all cause severe anxiety.
Generalised anxiety disorder (GAD)
This article deals with generalised anxiety disorder (GAD). GAD is a long-term condition that makes people feel anxious about a wide range of situations and issues, rather than one specific event. People with GAD find that they feel anxious most days, and will often struggle to remember the last time that they felt relaxed. GAD can cause both psychological and physical symptoms.
GAD affects approximately one in 50 people at some stage during their lifetime. Slightly more women are affected than men, and the disorder is most common during your 20s.
GAD can significantly affect your daily life, making it difficult for you to perform everyday tasks. However, there are several different treatment options available, which can help ease both your psychological and physical symptoms.
Symptoms of anxiety
The symptoms of general anxiety disorder (GAD) often develop slowly. The severity of the symptoms can vary from person to person. Some people experience only one, or two symptoms, while others experience many more. Anxiety can affect you both physically and mentally (psychologically).
GAD can cause a change in your behaviour, and the way that you think and feel about things. Psychological symptoms of the condition include:
- sense of dread,
- feeling ‘on edge’,
- difficulty concentrating,
- impatience, and
- being easily distracted.
As well as affecting you psychologically, anxiety can also affect you physically. The physical symptoms of GAD can include:
- pins and needles,
- irregular heart beat (palpitations),
- muscle aches,
- dry mouth,
- excessive sweating,
- shortness of breath,
- stomach ache,
- excessive thirst,
- frequent urinating,
- painful or missed periods, and
- difficulty in falling, or staying, asleep.
Most people with mild anxiety feel anxious about a specific event, or situation. For example, you may feel anxious about sitting an examination. Those who are anxious as a result of a phobia, or because of panic disorder, will usually know what the cause of their anxiety is. For example, people with claustrophobia (a fear of enclosed spaces) know that being enclosed will trigger their anxiety.
However, if you have GAD, what you are feeling anxious about may not always be clear. Not knowing what triggers your anxiety can intensify your feelings of anxiousness. If you do not understand the cause of your anxiety, you may start to worry that there will be no solution. Many people with GAD struggle to remember the last time they felt calm and relaxed.
Causes of anxiety
As with most conditions which affect your mental health, the exact cause of generalised anxiety disorder (GAD) is not fully understood. Some people develop the condition for no apparent reason. Other people may develop GAD following a major stressful incident, or event.
Some research has suggested that GAD may be caused by an imbalance of certain chemicals which occur naturally in your brain. These chemicals are known as neurotransmitters.
Two of the neurotransmitters that are thought to affect anxiety are serotonin and norepinephrine. If the level of these chemicals in your brain becomes unbalanced, it can significantly affect your mood, and increase the likelihood that you will develop anxiety-related conditions, such as GAD.
Combination of causes
GAD is most likely to have a complex combination of causes, and the condition is not just triggered by an imbalance of brain chemicals. Researchers believe that the condition is caused by a combination of factors including your:
- body’s biological processes,
- environment, and
- life experience.
You should visit your GP if you feel that anxiety is affecting your day-to-day life, or it is causing you distress. Generalised anxiety disorder (GAD) can be a difficult condition to diagnose. In some cases, it can also be difficult to distinguish from other mental health conditions, such as depression.
Talking to your GP about how you feel is very important
Your GP may ask you questions about your worries, fears, and emotions. They may also ask about your personal life. Make sure that you tell your GP about all of your symptoms, and also explain how long you have been experiencing them.
You may find it difficult to talk about your feelings, emotions, and personal life, but it is important that your GP has a good understanding of your symptoms and circumstances, so that the correct diagnosis can be made.
You are most likely to be diagnosed with GAD if you have displayed the symptoms of the condition for six months, or more. Finding it difficult to manage your feelings of anxiety is also an indication that you may have developed the condition.
To help with the diagnosis, your GP may also carry out a physical examination in order to rule out any other conditions which may be causing your symptoms.
There are two main forms of treatment for generalised anxiety disorder (GAD) - psychological therapy and medication. Depending on your individual circumstances, you may require either one of these types of treatment, or a combination of the two.
Before you begin any form of treatment, your GP will discuss all of your options with you, outlining the pros and cons of each form of treatment, while also making you aware of any possible risks, or side effects. It is important that you understand what your treatment will involve. If you do not understand something your GP has told you, make sure that you ask them to explain it in more detail.
If you have been diagnosed with GAD, you will usually be advised to undergo psychological treatment before you are prescribed medication. The main form of psychological treatment for GAD is cognitive behavioural therapy.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is one of the most effective types of treatment for GAD. Research suggests that CBT improves the symptoms of over half of all those with the condition.
CBT works by helping you to identify any unhelpful and unrealistic beliefs and behavioural patterns you might have. Your therapist then shows you ways in which you can replace these beliefs with more realistic and balanced ones. This type of therapy does not concentrate on dealing with events from your past, but instead focuses on the difficulties that you are experiencing in the present. CBT teaches you new skills, and helps you to understand how to react more positively to situations which would usually cause you anxiety.
The National Institute for Health and Clinical Excellence (NICE) recommend that you should have at total 16-20 hours of CBT. Your treatment will usually involve having a 1-2 hour long session, once a week.
There are some ways that you can help to ease the symptoms of GAD yourself. Regular exercise, particularly aerobic exercise, will help you to combat stress and release tension.
You should be aiming to do a minimum of 30 minutes of moderate exercise, at least five days a week. Moderate exercise should make you feel slightly out of breath and tired, but not to the point where it is unbearable. Going for a brisk walk is a good example of moderate exercise. Regular exercise also encourages your brain to release the chemical serotonin, which can help to improve your mood.
As well as getting regular exercise, learning how to relax is also important. You may find relaxation and breathing exercises helpful, or you may prefer activities such as yoga or pilates to help you unwind.
Changing your diet may also help to ease your symptoms. Too much caffeine in your diet can make you more anxious than normal. This is because caffeine can disrupt your sleep, and also speed up your heartbeat. If you are tired, you are less likely to be able to control your anxious feelings.
Smoking and alcohol have also been shown to worsen feelings of anxiety, so you should make sure that you drink in moderation, and try your best to give up smoking.
Drink in moderation
The Department of Health recommends that men should not drink more than 3-4 units of alcohol a day, and women no more than 2-3 units a day. A unit of alcohol is equivalent to half a pint of ordinary strength larger, a pub measure (25ml) of spirits, or a small (125ml) glass of wine. If you drink alcohol, you should try to stay within these recommended limits.
Giving up smoking will not only help you to feel less anxious, it will also improve your general health. Stopping smoking also reduces the risk of you developing smoking-related conditions, such as lung cancer and heart disease.
If you plan to give up smoking, contact your GP, who will be able to give you advice and guidance about the best ways for you to quit.
Alternatively, you can call the NHS smoking helpline, on 0800 022 4 332, where a specially trained advisor can offer free and confidential advice. The phone line is open seven days a week, from 7am-11pm. The NHS ‘go smokefree’ website also offers lots of helpful information about ways you can give up smoking.
Support groups will be able to provide you with useful advice about how you can effectively manage your anxiety, and they are also a good way of meeting other people with similar experiences of the condition.
Support groups often involve face to face meetings where you can talk about your difficulties and problems with others. Many support groups can also provide support and guidance over the telephone, or in writing. Ask your GP about local support groups for anxiety in your area.
There are a variety of different types of medication that your GP can prescribe for you to help treat your GAD. Some medication is designed to be taken on a short-term basis, while you may have to take other medicines for longer periods of time. Depending on your symptoms, you may require medicine to help treat your physical symptoms, as well as your psychological ones.
If your anxiety is severely affecting you, you may be given medication on a short-term basis to help provide immediate relief from your symptoms. The types of short-term medication you may be prescribed are outlined below.
Benzodiazepines are a type of sedative which help to ease the symptoms of anxiety within 30-90 minutes of taking the medication.
Although benzodiazepines are very effective in treating the symptoms of anxiety, they cannot be used for long periods of time. This is because they have the potential to become addictive if they are used for longer than four weeks. Benzodiazepines also start to lose their effectiveness after this time.
For these reasons, you will usually only be prescribed benzodiazepines to help you cope during a particularly severe, or intense, attack of anxiety. Benzodiazepines can cause side effects including:
- loss of balance,
- memory loss,
- drowsiness, and light-headedness.
Due to the above side effects of benzodiazepines, this type of medication can affect your ability to drive or operate machinery. You should therefore avoid these activities when taking this form of medication.
Speak to your GP if, while you are taking benzodiazepines, you experience any of the side effects that are listed above. They may be able to adjust your dose of medication, or prescribe an alternative.
Antihistamines are usually prescribed to treat allergic reactions. However, some are also used to treat anxiety on a short-term basis. Antihistamines work by having a calming effect on the brain, helping you to feel less anxious.
As with benzodiazepines, this type of medicine is only effective when used for a short period of time. They are therefore only prescribed for several weeks at a time. Hydroxyzine is the most commonly prescribed antihistamine for treating anxiety. This antihistamine can make you feel drowsy so it is best not drive or operate machinery when taking the medication. Other side effects of hydroxyzine include:
- blurred vision,
- headache, and
- dry mouth.
Some people who have GAD require long-term treatment in order to help manage their anxiety, rather than treatment for the immediate relief of their symptoms. The types of long-term medication that you may be prescribed are outlined below.
Selective serotonin reuptake inhibitors (SSRIs):
Selective serotonin reuptake inhibitors (SSRIs) are a form of antidepressant which work by increasing the level of a chemical in your brain called serotonin.
As with any antidepressant, it will usually take several weeks before your SSRI medication starts to work. SSRIs are usually started at a low dose, and then the dose is gradually increased as your body adjusts to the medicine. Common side effects of SSRIs include:
- low sex drive,
- blurred vision,
- diarrhoea, or constipation,
- dry mouth,
- loss of appetite,
- feeling agitated, and
- insomnia (not being able to sleep).
When you start taking an SSRI, you should see your GP after two, four, six, and 12 weeks to check your progress, and to see if you are responding to the medicine. Not everyone responds well to antidepressant medicines, so it is important that your progress is carefully monitored.
If your GP feels it is necessary, you may require regular blood tests, or blood pressure checks, when taking antidepressant medication. If, after 12 weeks of taking the medication, you do not show any signs of improvement, your GP may try prescribing an alternative SSRI for you, to see if that has any effect.
When you and your GP decide that it is appropriate for you to stop taking your SSRI medication, you will gradually be weaned off the medication, by slowly reducing your dosage. However, you should never stop taking your medication unless your GP specifically advises you to.
If SSRIs do not help to ease your anxiety, you may have to be prescribed a different type of antidepressant known as venlafaxine.
Venlafaxine belongs to a group of medicines known as selective serotonin and norepinephrine reuptake inhibitors (SNRIs). This type of medicine works by increasing the amount of serotonin and norepinephrine in your brain, helping to restore the chemical imbalance that sometimes causes GAD.
You cannot be prescribed venlafaxine if you:
- have high blood pressure (hypertension) which is not being treated,
- have recently had a heart attack, or
- you are at risk of having cardiac arrhythmias (irregular heart beats).
If you have any of the above conditions, you may be at risk of developing complications if you take venlafaxine. Therefore, your blood pressure will be monitored on a regular basis if you are prescribed this medicine.
Common side effects of venlafaxine may include:
- dry mouth,
- insomnia, and
Other types of medication
Buspirone is a medicine which can help to ease the psychological symptoms of anxiety. It belongs to a group of medicines known as anxiolytics. You will normally have to take buspirone for four to nine weeks before you notice an improvement. It will be up to your GP how long you continue to take the medicine after this.
Buspirone works in a similar way to benzodiazepines, but unlike benzodiazepines, buspirone does not become addictive, which means that you will be able to take it for longer periods of time. However, it is still generally used as a relative short-term form of medication
Beta blockers are usually used to treat conditions such as angina (chest pain) and high blood pressure (hypertension).
However, they can also help ease some of the symptoms of anxiety. Beta blockers will not affect your psychological symptoms, such as irritability and restlessness. Instead they can help you with some of your physical symptoms, such as sweating and palpitations (when you can feel your heart beating faster than normal). Beta blockers work by blocking the chemicals that can cause these physical symptoms.
If medication, CBT, or support groups fail to help improve your GAD, you may have to be referred to a mental health specialist.
A mental health specialist will carry out an overall re-assessment of your condition. They will ask you about your previous treatment, and how effective you found it. They may also ask you about things in your life that may be affecting your condition, or how much support you get from family and friends. Your specialist will then be able to devise a treatment plan for you, which will aim to effectively treat your symptoms.
The type of mental health specialist that you are referred to will depend on your individual situation. You may be referred to one, or more, of the specialists described below.
- Psychiatrists train as medical doctors, and then choose to specialise in mental health. A psychiatrist is one of the only mental health specialists who is able to prescribe medication.
- Clinical psychologists are trained in the scientific study of human behaviour and mental processes. They focus solely on the assessment and treatment of mental health conditions. A clinical psychologist will help you to manage your feelings of anxiety.
The information below has been added to the NHS Direct Health Encyclopaedia as part of a pilot project to make data used by NHS Direct call centres available to the public on our website. If you have any feedback relating to this pilot please contact us.
First Steps to Freedom
Helpline: 365 days a year 10.00am-10.00pm
Offers confidential help, practical advice and support to those people affected by phobias, general anxiety, panic attacks, obsessional and compulsive disorders, anorexia and bulimia or tranquilliser withdrawal. Provides help and support for carers of those with borderline personality disorder. Also offers one to one telephone counselling and self-help groups. Membership available, which offers newsletter, penpal lists, audio and visual tapes, fact sheets self-help booklets and book list.
Who for: Anyone.
Cost:£10 annual fee for members.
There is a complaints procedure.
Helpline : 08451202916
National Phobics Society
Helpline: Mon-Fri 9.30am-5.00pm, answerphone available.
NPS provides a listening service and information on phobias and all anxiety disorders including Obsessive Compulsive Disorder. Members can be put in touch locally with other members via a contact list if they wish and have access to a helpline manned by staff who have extensive knowledge of anxiety disorders. Therapy available with home visits includes, cognitive behavioural therapy, counselling, clinical hypnotherapy and complimentary therapies. Cognitive behavioural therapy and counselling is also available via telephone and on-line. Members also receive newsletters, factsheets, self-help information packs and therapy tapes.
Who for: Anyone affected by anxiety disorders, including family members, carers and friends.
Cost:£15 for annual membership.
Premises have accessible entrance and toilet. Weekly drop in support group. Provides a range of information tapes.
There is a complaints procedure.
- Helpline : 0870 7700 456
- Helpline : 01612279862
Helpline: 7 days, 10.00am-10.00pm (recorded message out of hours)
Aims to aid the relief and rehabilitation of people affected by panic attacks, phobias, obsessive compulsive disorder, related anxiety disorders and tranquilliser withdrawal. Offers support to patients their families and carers. Provides telephone support, literature, books, audio and video cassettes and a contact service for members wishing to make phone-friends and pen pals.
Who for: Anyone affected by or with an interest in anxiety disorders.
Referral: Any method.
Cost: Optional membership fee.
Information is also available in large print and on audio cassette.
Helpline : 08088080545
NHS Choices links
- News: anxiety diabetes risk
- Live Well: anxiety
- Health A-Z: depression
- Health A-Z: panic disorder
- Health A-Z: phobias
- Health A-Z: agoraphobia
- Health A-Z: stress