Generalized anxiety

Just what is "generalized" anxiety? Like the name implies, it is a "general" state of excessive worry or tension. There are other symptoms - feelings of fatigue, shortness of breath, rapid heart rate, dizziness, feeling keyed up, and problems with concentration. Past research has shown that about 1 in 20 people develop generalized anxiety disorder at some time during their lives.¹ The problem with anxiety often begins in young adulthood, sometimes in response to an increase in the number of minor life stresses. It can also accompany depression.² If left untreated, generalized anxiety can be life-long - and can worsen in older adults. The good news: There are several safe and effective treatments. This study provides a review of treatments - which are the fastest, safest, or can be used the longest?

A review of treatment studies

In their analysis, the two researchers in New Zealand took an in-depth look at past studies in which people with generalized anxiety were treated. They examined these previous studies to see what kinds of trends and patterns could be identified with regard to the best forms of treatment for generalized anxiety. The treatments fell into two main categories: (1) cognitive-behavioral therapy (described below) and (2) four different types of medications.

Cognitive-behavioral therapy

"Cognitive-behavioral" therapy is a type of psychological treatment that involves helping patients change their behaviors and beliefs in order to better cope with or get rid of the problem. Techniques include having the individual:

• Learn ways to relax the body
• Experience anxiety-producing situations in safe, controlled "exposure" sessions to help develop tolerance for uncomfortable emotions and physical symptoms
• Adopt new beliefs about the physical symptoms of anxiety - that the bodily sensations alone will not cause harm
• Develop "replacement" thoughts for the constant worry

The researchers looked at 35 studies of cognitive-behavioral therapy that involved over 4,000 people (60% women). A year after treatment, people who received this type of treatment experienced less anxiety than patients who either received no treatment at all or were in a type of psychotherapy where symptoms were only talked about.

An advantage of cognitive-behavioral therapy is that there are no known unhealthy side effects. The treatment is quite safe.

Drug treatments

Researchers looked at four different types of drug treatments, and considered how the benefits stack up against any potential harm to people who take the medications.

Benzodiazepines are a type of medication that can quickly reduce the symptoms of generalized anxiety. Diazepam (Valium) is a drug in this group. The researchers found (in reviewing 24 different treatment studies) that when a person needs rapid relief of anxiety, benzodiazepines can be very helpful over an 8- to 12-week period. But benzodiazepines have potential risks. They can cause extreme drowsiness, as well as problems with thinking, memory, and the ability to pay attention - for these reasons, benzodiazepines should not be used when driving or operating machinery. A patient can also become dependent on the medication for relief of anxiety. The next two drug treatments (below) are safer.

Buspirone is a specific drug that has been proven to be helpful in treating generalized anxiety. Buspirone has different trade-offs from the benzodiazepines - it works more slowly in relieving symptoms of anxiety, but it has fewer side effects. Some patients may have mild upset stomach or dizziness, but most people can continue to drive while taking the medication. The researchers found (in reviewing 9 different treatment studies) that buspirone is just as effective as the benzodiazepines (drugs like Valium) in relieving generalized anxiety, and carries fewer risks.

Antidepressants have also been found effective for treating symptoms of generalized anxiety. It has been shown that, over 2 to 3 months, they may even be more effective than benzodiazepines. Antidepressants start to work gradually, so are not as helpful if rapid relief is needed. However, most antidepressants can be taken safely and have few unpleasant side effects. Also, most antidepressants can safely be taken for much longer than the benzodiazepines, so they may be a better treatment for anxiety if therapy goes beyond 8 to 12 weeks.

In order to be thorough, the researchers also looked at antipsychotics, which are medications used to help relieve symptoms of severe mental illness, such as hearing voices that are not really there. Although one antipsychotic medication was found to be helpful with generalized anxiety, this group of drugs is not recommended for most people because the medications often have serious negative effects that far outweigh the benefits. Antipsychotics are rarely used to treat generalized anxiety.

Comment

This study points out that there is effective help available for anxiety. This can take the form of cognitive-behavior therapy, medication or a combination of both. Although researchers in this review of treatment did not look specifically at "combined" treatments, other research has shown that this type of combined treatment offers the best of both - a medication to help reduce anxiety quickly, and longer-term psychological treatment to help over the lifespan and to help prevent relapse (i.e. recurrence of the anxiety).

As with all health matters, it is important to discuss treatment options with your physician, who can be helpful both in prescribing medication as well as making appropriate referrals for psychological care. If you think you might be helped by medication, then talk with your doctor and chose one that will give you the most relief, but with the least number of unpleasant side effects - so you don't have to worry!