Generalized Anxiety Disorder- What It Is And How To Treat It



hello I'm dr. Carlo Karin Deng and I'm a psychiatrist with anxiety Boscombe today I will talk about generalized anxiety disorder generalized anxiety disorder also known as GA D is an anxiety disorder where you have excessive worry about events and situations and it disrupts your life so you as the audience will benefit from this presentation by learning more about gid and how it can be treated so I'm an expert and anxiety and depression and I'm a psychiatrist with over 15 years of experience treating patients with anxiety and depression in addition I'm the author of the self-help book anxiety protocol and founder of anxiety Boscombe so I have many years of research and teaching experience on the topics of anxiety and depression so let's look at some facts about gid the lifetime prevalence of GID and the population is approximately 4.1 percent so in other words if you look at the lifespan of people in the population you will see that at some point in people's life in the population 4.1 percent of them will have developed GA D so this is not a rare condition this is actually fairly common so also when you look at GA D it is the most common anxiety disorder that presents to family doctors in primary care settings also those that increase risk for developing GID include women low income earners and those who are separated divorced or widowed so these are some of the groups that are at increased risk for developing GID and GID also tends to co-occur with other disorders such as substance abuse other anxiety disorders mood sorters and personality disorders so generalized anxiety disorder is characterized by symptoms of excessive worry and rumination about everyday events and situations so for instance you might have extreme worries about your finances you might have extreme worries about your children you might have worries about your spouse your relationships your jobs so what happens in generalized anxiety disorder is that the worry about everyday events about everyday events and situations are taken to another level where not only do you worry about things that you would normally worry about but you take it to another to another level in which you worry about it almost all the time and you worry about different things not just one thing but different things and it's the intensity of the worry and ruminations that defines generalized anxiety disorder and what differentiates it from normal worry so with normal worry you might have a problem with your finances or you might have a problem with your boss at your job and of course you would normally worry about those things and when you have normal worry the function of normal worry is to actually solve problems however when you have generalized anxiety disorder your worry becomes a problem onto itself so instead of having worry solved problems what happens is is that the worrying become the worrying becomes the problem so that it paralyzes you where you can't do anything about the problem besides to worry about it because if you have normal worry what the worry does it actually you know actually helps you to think and rethink and ruminate about well not roommate normal worry is not rumination but in normal worry it helps you to think over and over again about what to do about about a problem and then eventually to actually solve it and take action and to solve it whereas with pathological worry as with so with pathological worry that you see and generalized anxiety disorder what happens is that the worrying then becomes the problem and you don't actually solve the problem that you're worrying about in the first place because now you have worry as the biggest problem and it paralyzes you to take actions to solve your problems so that's what differentiates generalized anxiety disorder worry from normal worry so in addition to the worry in the negative ruminations and by the way negative ruminations are are repeatedly thinking about negative thoughts over and over again it's just the non stopped recounting of negative thoughts so that n worry so that's the that's what you call rumination so this excessive worry and ruminations lasts most of the time and it lasts for at least six months and then when you have the excessive worry and the ruminations you can also get the physical symptoms of anxiety which include restlessness you can have fatigue because all of this worrying actually expends a lot of energy and you become tired easily you also become quite irritable so when you have generalized anxiety disorder you're at the end of your rope because you spend all of your time and energy worrying constantly worrying and ruminating that you become irritable so any little thing will just set you up boom so even some little irritation some little thing will just set you off where you become highly irritable another physical symptom of gid includes muscle tension so when you're always worrying it just revs you up so that your muscles are always tense so you're just tense you feel like you're in need of massages all the time because your muscles are too tense because you can't relax because you're on edge because of the worry and then you can have poor concentration as the worrying distracts you from anything else so again the worrying becomes the problem you become revved up and you're not able to focus on the at hand and also when you're worrying and have extreme anxiety from generalized anxiety disorder it then affects your sleep so you're not able to go to sleep or you might wake up a lot and you don't feel rested so it can contribute to sleep problems so how do you diagnose generalized anxiety disorder well as described in the previous slide you have to have those symptoms of extreme worry and ruminations in combination with the physical symptoms of anxiety which I described in the previous slide so you have to have these constellation of symptoms and it can't be normal worry it has to be pathological worry as I explained in the previous slide so in addition to the pathological Rory and ruminations and the physical problems of anxiety in order to make the diagnosis of gid it needs to interfere with your life and it needs to disrupt your functioning so it needs to have it needs to actually paralyze you to the point where you're not able to do anything else and you're not able to accomplish tasks ineffectual relationships it affects your job performance it affects your ability to care for yourself so when the worry and anxiety disrupts your life to the point where you're not able to take care of yourself or impacts your relationships your job performance then this is definitely impacting your life and it could be generalized anxiety disorder also before making the diagnosis of generalized anxiety disorder these symptoms are not the result of a substance such as caffeine or FM amphetamines so caffeine and amphetamines if you take too much of it can actually review up to the point where you become highly anxious and irritable and it can look like you might have generalized anxiety disorder and also you got to make sure you all your doctor has to make sure that the anxiety symptoms are not the result of a medical illness such as hyperthyroidism so when when you have hyperthyroidism hyperthyroidism as an example the thyroid gland that sits above your that sits on top of your vocal cords when your throat that's where your thyroid gland sits so when you have hyperthyroidism your thyroid gland produces too much thyroid hormone from various causes it can happen from various causes so when you have too much when you have hyperthyroidism you produce too much thyroid hormone and it circulates in your bloodstream and this can Rev you up and it can make you highly anxious and so these excessive thyroid hormone can actually look like look like anxiety so your doctor needs to rule out medical illness before generalized anxiety disorder is diagnosed so what's the clinical course of generalized anxiety disorder well gid can start when you are a child it can start in your teenage years or it can start when you're an adult generalized anxiety disorder also has a chronic and fluctuating course in other words it can last for a long time and it can come and go so you might have times where you have an exacerbation of generalized anxiety disorder and then you'll have periods where it goes away and you can function normally again and have normal worry however periods of stress so stressors such as pressures on the job relationship problems so those kind of stressors will usually trigger an episode of generalized anxiety disorder so an important part of treatment for generalized anxiety disorder involves identifying your stressors that trigger your generalized anxiety and so what happens is that treatment then becomes about anticipating your stressors so that you can minimize the impact of those stressors on your gid so how does generalized anxiety disorder develop well if you've listened and watched my previous talks I talked about how events and triggers lead the thoughts about these triggers and how these thoughts can then lead to anxious feelings and how anxious feelings can lead to avoidant behaviors and how these avoidant behaviors then can maintain the belief in your thoughts which then serve to maintain the negative cycle of anxiety so here I give an example of the negative cycle of gid worry and uncertainty so let's say you have a stressor and then you have thoughts that something bad is going to happen you might think that you will not be able to cope you might think you can't stand uncertainty you might think the future and risks are unknown and that you must be prepared to reduce the risk so these thoughts then induce anxiety so you're worried you're fearful so in addition to the anxious feelings you get the physical symptoms of anxiety which include nervousness tenseness you're not able to relax and you have disrupted sleep so these anxiety symptoms are very uncomfortable so the anxiety makes you want to overcompensate to decrease the anxiety over the short term so what you do is then as you you can't stand uncertainty you try to increase the certainty by planning ahead making lists / preparing and / educating yourself so for instance if you have some concern that you might have some physical illness you might go on the internet and research all there is to know about the particular illness that you worried about and you spend all your time educating yourself eventually then you just avoid and then you put things off however these behaviors maintain the intolerance of uncertainty because if you're not able to stand uncertainty and you try to increase the certainty what happens is is that the behaviors just maintain this intolerance of uncertainty and then it just perpetuates this negative cycle of gid worry and uncertainty so that's how generalized anxiety disorder develops in which your thoughts leads to feelings leads to overcompensating behaviors which then serve to maintain the intolerance of uncertainty and then eventually it maintains this negative vicious cycle of gid so let's talk now about the neurobiology and family history of generalized anxiety disorder so in generalized anxiety disorders increased activity in the amygdala so the amygdala is a part of the brain which controls your anxiety feelings and symptoms so in GID there might be a disruption of brain circuits which connect the anterior cingulate cortex also known as the ACC and the amygdala and it also may disrupt the dorsal medial prefrontal cortex and the amygdala and these have been postulated to be involved in negative emotional emotion regulation so what happens is that in GID the thinking part of your brain the frontal cortex which is right here that's the thinking part of your brain connects directly to the amygdala which is here so the amygdala is actually located on both sides of the hemispheres of your brain and it's located in this area and what's in a region called a temporal lobe so what happens is the frontal lobe then connects the neurons and circuits to the amygdala and so this thinking part of the brain there court.the the cortex here the frontal cortex the thinking part of the brain connects with the amygdala which is the feeling the emotion part of the brain and this connection then there's a disruption in this canoe action which is thought to be involved with the pathogenesis and neurobiology of generalized anxiety disorder so the this is just initial research but the this is the this is the hypothesis at this point given our current findings is that there's a disruption between the cortex and the amygdala which leads to generalized anxiety disorder so generalized anxiety disorder runs in families and it does have a significant genetic component so how do you treat generalized anxiety disorder well the first-line treatment for generalizing sighted disorder is psychotherapy so if you have generalized anxiety disorder the first thing you should do is to receive psychotherapy so which psycho therapies are effective for gid specifically cognitive behavioral therapy also known as CBT and short-term psychodynamic psychotherapy are both effective for GID so if you have GID you want to go to a therapist that has that has specialized skills and experience with anxiety disorders and also with CBT or short term short term psychodynamic psychotherapy so these are the things to look for in a therapist when you're wanting help with GID so what about prescription medication treatment for generalizing Zhai disorder well a prescription drug treatment for generalized anxiety disorder is a last resort treatment so drugs are not first-line for generalized anxiety disorder prescription drug treatment is only for cases where psychotherapy is not effective or for severe cases so when you have generalized anxiety disorder the first thing you want to do is to actually seek psychotherapy so participate in CBT so until so there's you know there's a problem right now where people are actually going to their doctors and their doctors are automatically prescribing prescription medications for anxiety disorders such as GID without even starting psychotherapy but this is a mistake because medications were not meant to be given as first-line for anxiety disorders such as generalized anxiety disorders medication treatment prescription medication treatment was meant to be a last resort if first-line treatments didn't work so so for instance if you had CBT cognitive behavioral therapy for generalized anxiety disorder and ended up not working then that would be a case where you would consider prescription medication treatment to treat your anxiety symptoms or the other time where you might consider prescription medication treatment for anxiety for your GID is if you have such severe symptoms that it severely impacts your functioning where you're not able to perform your job you're not able to care for yourself your relationships are in shambles so those are in that case where multiple domains of your life are in shambles because of your anxiety illness then that would be a case where for severe cases where you would consider prescription medication drug treatment so to repeat prescription medication treatment for generalizing for generalized anxiety disorder is a last resort treatment you need to try other other primary modalities such as cognitive behavioral therapy before even considering prescription medication treatment I think in this society that we have currently we are quick to to request a prescription to take care of all our problems that we want the silver magic bullet to take care of our problems including our anxiety problems however that's not the way to go about treating your generalized anxiety disorder the first line is cognitive behavioral therapy not medication treatment however if you do need medications for generalized anxiety disorders there are effective options which include selective serotonin reuptake inhibitors also known as SSRIs there there is also another antidepressant called serotonin norepinephrine reuptake inhibitors called SSRIs so those can be effective for GID you also have benzodiazepines boosts firown' and pregabalin so these are the lists of prescription medications that are effective for GID so you might ask what about treatments with benzodiazepines and this is a common question because benzodiazepines are over prescribed for all anxiety disorders it's given out like aspirin doctors prescribe this like water basically it's ridiculous the amount of benzodiazepines that are prescribed let me repeat benzodiazepines are over prescribed so for generalized anxiety disorders benzodiazepines are generally not prescribed for GID given that GID is a chronic illness and for a chronic illness you can't prescribe benzodiazepine benzodiazepines on a long-term basis because the longer you're on benzodiazepines the more risks are involved with taking it because of their addictive potential benzodiazepines are highly addictive and it's best not to actually start on a benzodiazepine if you have generalized anxiety disorder just because generalized anxiety disorder can last a long time and benzos benzodiazepines although they are effective over the short-term they have long-term risks because you can get addicted to it and then you have another problem if you start to become addicted to benzodiazepines then you would need to be referred to a rehab program to address your drug addictions to been to the as pain so let me repeat benzodiazepines are over diagnosed are over prescribed for anxiety disorders and should really not be prescribed for anxiety there's other there's better treatment options with regards to anxiety treatment besides benzodiazepines however if you have severe anxiety then that might be a case where benzodiazepines can be prescribed on a short-term basis let me repeat only if you have severe anxiety symptoms that maybe your doctor can at that time in that specific instance can prescribe you on a short-term basis it means a day as opinions and in the meantime if they're prescribing the benzodiazepine there has to be other primary treatments that are prescribed at the same time so that when it comes time for the primary treatments to become effective weeks later such as SSRIs and SNRIs these are antidepressants that actually take weeks they could take up to eight weeks for it to have full effect for your anxiety disorder so while you're waiting for the SSRI or the SNRI to take effect weeks later several weeks later then and you have severe anxiety symptoms then benzodiazepines can be concurrently prescribed at that time but only prescribed for a few weeks then once the SSRI or the SNRI becomes effective then the benzodiazepine can be slowly tapered and eventually discontinued in addition the SSRI and SNRI may initially cause increased anxiety and agitation so as I mention oh and as your doctor should talk to you about before they prescribe prescription medication for anxiety is that these prescription medications have significant side effects so this piece of this is the reason why your doctor prescribes it and monitors these medications because these prescription medications have significant side effects and that's to be on these medications and you'll be monitored by doctor so the problem with SSRIs and SNRIs is that they may initially caused increased anxiety and agitation during the first couple of weeks of taking it so if this happens then your doctor might consider a benzodiazepine to address this side effect on a short-term basis until the SSRI or SNRI becomes effective for anxiety so for your anxiety symptoms weeks later so this is one of the problems of actually prescribing antidepressants as SSRIs and SNRIs for anxiety is that it may might actually increase your anxiety in the first couple weeks so this you know if you're already having severe anxiety symptoms and then the SNRI or SSRI actually increases the anxiety then you got to ask yourself is it really worth taking these medications in the first place so if you're having problems your prescription medications you should always go to your doctor to discuss these side-effects but the purpose of talks like this is to give you education regarding when is the appropriate time to take these medications and it's it is my opinion that these prescription medications are over prescribed and that other treatment modalities should be considered first before taking these prescription medications we have significant side effects such as these benzodiazepines which are highly addictive and also the SSRIs and SNRIs which have significant side effects which include increased anxiety and increase education when you first take it so go figure why would somebody would anxiety want to subject themselves to these side-effects I don't know for me if I have if I have anxiety and I go to my doctor I want to be treated with something that's actually going to be helpful over the short-term and the long-term so I do not necessarily want to get the quick fix although I want my anxiety to be treated effectively the problem is is that if you go for the quick fix then there are other problems that may or may arise so if you decide to go for prescription drug treatment for your anxiety then you subject yourself to the significant side effects that can occur with these prescription medication so let's talk now about other treatments for gid so let's talk now about natural supplements there are multiple studies that show several different natural supplements are effective and safe for generalized anxiety disorder which include lavender passionflower gal fille Mia glocca ginkgo biloba and chamomile so natural supplements which include herbal and nutritional supplements they generally have fewer side effects and are generally less expensive than prescription medications for anxiety fortunately there are natural supplements that are out there that can help for anxiety so there is this supplement that I created it's called compro so compro is a natural supplement that has the reach research studies showing its ingredients are both effective and safe for generalized anxiety disorder so the good news is about generalized anxiety disorder you don't necessarily have to resort to prescription medication drug treatment despite what the drug companies advertise and market to you directly it's not the first it's not the primary solution for GID there are other treatments out there first of which is CBT cognitive behavioral therapy and then there's alternative treatments like natural supplements such as compro for GID so other alternative treatments for generalized anxiety disorder includes self-help so research has shown that self-help interventions are effective for generalizing xited disorder so self-help interventions our convenience can be done on your own time do not require a doctor visit do not require a therapist visit and are relatively inexpensive so fortunately there are self-help books out there that can help for your generalized anxiety disorder so I wrote this book called anxiety protocol which is a self-help book which uses evidence-based techniques to help you treat your generalized anxiety disorder so to summarize this talk on generalized anxiety disorder let's go through the main points here so gid is characterized by excessive worry about events and situations gid has effective treatments which includes psychotherapy as first-line treatment and pharmaco therapy also known as prescription medication treatment which is last resort treatment there are also alternative treatments which include natural supplement treatments such as with compro and also self-help intervention such as with the book anxiety protocol and other alternative treatments such as meditation and exercise which have preliminary evidence that they are both effective and safe for anxiety disorders such as generalized anxiety disorder this concludes my talk I'm dr. Carlo Karen Deng thank you for listening

33 comments

  1. I totally identify with the worry becoming the problem and how it can paralyze you. I wouldn't wish it on anyone. It's crazy how mental illness can make a person suffer in unimaginable ways.

  2. Im 99% convinced I suffer from GAD. Since I was a child iv felt the same way you have described in this video. I'v never been to the doctors about this because I always believed I could over come it on my own and without medication. And I always thought no one would understand. Because I'v told many people about it and all I get is man up or just calm down. It's getting to breaking point now, iv lost so many good jobs to this. I'm 28 and I genuinely carnt see any point in carrying on like this. I'v made a choice to make an appointment at my doctor's next week. But I'm not very optimistic.

  3. Thanks for this video. The most troubling symptom I have is inability to fall asleep. When night comes flight or fight automatically kicks in and I’ll even twitch as I fall asleep. Have Xanax and Trazodone, but they don’t always work and sleep quality is very low. Any suggestions for more specific medications I can discuss with my doc? Would CBT be useful for this type of physical symptom? Need my sleep.

  4. I can feel my heartbeat. I hate that. I gave up coffee two months ago and changed my diet. went to the doctor. nothing found. it sucks. I hate feeling tired all the time, I just wanna feel like me again.

  5. I have anxiety I'm felling dying because of my anxiety my head is felling full of air dizziness what would I do I'm from Philippines thank you very much

  6. I probably have GAD, though I'm not sure. I worry and use the bathroom constantly. Sometimes I have nausea and diarrhea. I tend to put things off because I get really anxious. I'm afraid to go out, because I fear something bad might happen.

  7. I went on antidepressants for like a month and I decided they aren’t for me and trying to get over it the natural way

  8. i have also faced gad my b.p shoots and i felt that i m dying ,dr prescribed me the b.p medication.after research i found that was panic attack and GAD,then i consult psychiatrist he prescribed me cipralex 10mg ,i m taking i since two years.and GAD fully overcame.is it good to continue it for mental health,plz rep

  9. Gabba, 5htp, Passion Flower, Lemon Balm, and L- Theanine are key to finally overcoming your anxiety. Stay away from these dangerous drugs which the psychiatrist admits to here.

  10. I've had GAD since age 13. . I was on a whole bunch of different medications until age 21. Ativan, zoloft, xanax, lithium, risperidal etc. I did CBT for three years. Nothing worked and I was always a zombie with so many meds. I figured out the real reason behind my GAD is because of my childhood trauma and unstable upbringing. None of these will be a permanent or a complete fix. I am sure many agree with me that these methods barely even work. I am going to look into EMDR, DBT and others that are less well known and that seem much more efficient.

  11. I'm experiencing all the symptoms but I'm not sure if i have mental illness..and also I'm being paranoid most of the time..

  12. I think i have gad. I have all the symptomes. I started zoloft 2 weeks ago, and take 50 mg seroquel. However this is not helping. I have rapit hearbits almost all the time, its driving me crazy. The only solution i can think of is to up the doze of seroquel. My anxiety is so bad that i feel paralyzed. Since ive only taken zoloft, 50mg for two weeks its probably to early to see if it will help. Thanks for a great video.

  13. I was on benzodiazepines for over 17 years because the SSRI's didn't work. I think it's important to note that a couple of the Atypical Antipsychotics such as Seroquel and Risperidone are used off label and are effective for GAD when other options have been utilized but have failed to relieve symptoms. The Risperidone along with the Buspar works for me just fine. I found it interesting that benzodiazepines are generally not prescribed for GAD considering I know a lot of doctors where these are their first line of treatment. It was a very interesting and informative video Dr. Carandang.

  14. I have general anxiety that leads to depression. I was on escitalopram(50mg) and it worked wonderfully. However, I gained 40 lbs so I tapered off. I tried fluoxetine and that sent me into depression after one pill. Now, I am taking 150mg of Sertraline. I have only been on 150mg for 3 weeks. I started out at 25mg 2.5 months ago. I also take Buspirone 7.5mg twice a day. The depression is gone but I still have a little anxiety such as the globus sensation. Should give the Sertraline more time or switch to a different SSRI?

  15. I've been taking 1.5 mg of bromazepam for my insomia and it helps with my anxiety to.. But im worried that i would be addicted to it. Sometimes i just take half a pill

  16. I know this is off topic but what if one of my parents of GAD but don’t notice it how to make them notice it?

  17. Benzos are the best for someone as myself with SEVERE social anxiety and just overall anxiety as well…. without Xanax I wouldn’t have been able to graduate high school yet alone leave my house. It can be addictive but I’ve tried CBT, yoga, prayer, meditation, changes in diet, etc…. nothing works: pop a Xanax, get through the day, pop one to go to sleep and it’s fine

  18. I wanted to ask my psychiatrist suggested mood stabilisers for treatment resistant anxiety disorders. Have you ever used them and if so, how effective are they on people with clinical anxiety such as GAD and panic disorder?

  19. Yet I never worry but have an anxiety disorder?? What the hell, and I have been in benzo's for nearly 30 years to just have had them pulled. Now I am suffering the withdrawal symptoms…

  20. My husband is suffering for severe anxiety. He has not worked since September. He has been in and out of outpatient support groups. He was recently discharged because the hospital does not know how to treat him. He tried to admit himself into our local ER last week, and they were confused how to help him. We have had every test under the sun. He has become hopeless, and has mentioned suicide. I don't understand why he can get the right help. He has been on Klonopin for more then 7 years. he can not get a correct dosage that makes him comfortable, or it has stopped working. He is not able to function without it. He will not take any other meds due to side effects and how he will react causing more anxiety. Plus he has had a DNA test to see what meds may take, and the list was very short. My thoughts are he needs to be somewhere where he can get of Klonopin and get on a more effective less addictive med, but where can we go to get help?

  21. I've had this for years. I think I would have benefited more in the long run if I had been treated for my anxiety rather than for my depression, as even when the depression lifted, the anxiety was still there.

  22. Dr. Carandang, Viewing your video on GAD was very informative and certainly connects with someone like myself who has suffered form GAD since childhood. At 50 yrs. old now; I have indeed ridden the roller coaster ride of GAD with respect to the extreme lows, as you describe accurately as being paralyzed against normal daily tasks, and the extreme highs of happiness as a result of effectively taking on all daily tasks with positive and constructive results. My GAD was untreated for 47 years of my life, and only the last 3 years have I been properly diagnosed. As you mention – true to General Practice – my GAD diagnosis was immediately treated with a long term prescription of Cipralex, and short term prescriptions of Clonazepam as required. I can appreciate my diagnosis; as it is accurate – however I am also going to pursue psychotherapy during my next visit with my GP. Thank you so very much for posting your info-video. It was like looking in a mirror throughout it's entirety. I have fortunately been able to help my 11 yr. old daughter with her GAD – she showed symptoms at 3 yrs. old. This disorder, as I am sure you know Dr. Carandang, can be debilitating without the proper effective psychotherapy and/or pharmacotherapy, keeping in mind however that "pharmakia" represents poison in the Greek language. I reside in Hamilton, ON. Canada. Approximately 60 km's west of Toronto. Can you please provide to me; any information regarding psychotherapy that is covered by the province of Ontario (OHIP), and that is within a reasonable commute from Hamilton. Thank you again for your post. Extremely helpful and and easily understood. Respectfully, David.

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