Carra Powell, Pharm.D. Candidate 2019 Pharm Phacts: Generalized Anxiety Disorder December 2018 What is Generalized Anxiety Disorder (GAD)? While occasional anxiety is common before stressful events, it can become a problem when it does not go away. There are a variety of anxiety disorders including GAD, panic disorder, social anxiety disorder, and phobia- related disorders. These disorders frequently involve sudden and intense feelings of fear, discomfort, and/or worry. For GAD, excessive worry occurs most days of the week for at least 6 months. This anxiety often interferes with activities of daily living including school, work, and social outings and can decrease productivity greatly. Worrying may occur with ordinary or routine activities and is often out of proportion to the event or activity. GAD is considered a chronic condition, often lasting up to a decade or longer, with high likelihood of relapse and low recovery rates. While GAD may not be curable, it is treatable. In this issue: ü Signs and Symptoms ü Causes ü Statistics and Diagnosis ü Non- Drug Therapy and Other Tips ü Medication Therapy
PHARM PHACTS: GENERALIZED ANXIETY DISORDER DECEMBER 2018 2 Signs and Symptoms Signs can vary, but GAD can include the following: Overthinking plans and solutions Perceiving threats when there are none Difficulty with uncertainty Indecisiveness and/or fear of making wrong decisions Inability to stop worrying Difficulty concentrating GAD can also manifest as physical symptoms: Fatigue Problems sleeping Muscle aches, tension, or headaches Restlessness, twitching, and/or trembling Sweating Diarrhea and/or nausea Irritability Rapid breathing Rapid heart rate Taken from https://www.pinterest.com/pin/353673376959552567/?lp=true WHAT CAUSES GAD? While the true cause is unknown, there are many factors that can work together and lead to the development of GAD: ü Problems with biological processes or functions of the brain ü Genetics ü Traumatic or negative life events ü Development and personality ü Medications, illegal substances, and/or medical illnesses
PHARM PHACTS: GENERALIZED ANXIETY DISORDER DECEMBER 2018 3 Who has GAD? ü Most common anxiety disorder lifetime prevalence of 4-7% ü Women twice as likely as men ü Begins often between childhood and middle age (average age of 21 years old) but can occur at any age DIAGNOSIS GAD can be difficult to diagnose as there are many different symptoms that can be mistaken for other conditions. All of these symptoms must be unrelated to other conditions and cannot be caused by medications, alcohol, or recreational drugs in order for a patient to be diagnosed. The Diagnostic and Statistical Manual of Mental Disorders (DSM- 5) lists a few criteria for GAD diagnosis, as seen on the left side of this page. Additional criteria generally included is that the anxiety interferes with daily functioning and/or routine activities. If you feel you have anxiety or have many of the symptoms common with anxiety, it is important to seek help from a medical professional whether you have GAD or not as they can determine your true diagnosis and are aware of the many resources available to patients. Also, the medications used in anxiety disorders are prescription only and therefore must be written by a physician.
PHARM PHACTS: GENERALIZED ANXIETY DISORDER DECEMBER 2018 4 Non-Drug Treatment Patients often benefit from both medical and psychological therapy. The most successful psychological therapy is cognitive behavioral therapy (CBT) as the relapse rate has been shown to be less with CBT over other strategies. CBT includes the following: Ø Weekly sessions for several weeks Ø Self- monitoring of worry determining patterns and stressors Ø Relaxation training Ø Rehearsal of coping skills Anxiety Do s: Ø See a counselor Ø Join a support group Ø Stress management Ø Meditation Ø Eat healthy Ø Physical activity Ø Practice mindfulness Ø Make sleep a priority MEDICATION THERAPY Antidepressants are often the first choice and include: Duloxetine (Cymbalta) Escitalopram (Lexapro) Paroxetine (Paxil) Sertraline (Zoloft) Venlafaxine (Effexor) If one does not work, your doctor may increase the amount or try another. Benzodiazepines can also be used for quick relief or temporarily until the antidepressant takes effect Not the best option due to abuse and dependence Alternative agents, often used when antidepressants fail, include: Buspirone Hydroxyzine Imipramine Quetiapine Pregabalin Anxiety Don ts: Ø Nicotine Ø Caffeine and/or energy drinks Ø Non- prescription stimulants (Adderall, Vyvanse, etc.) Ø Diet pills Ø Excessive alcohol intake
PHARM PHACTS: GENERALIZED ANXIETY DISORDER DECEMBER 2018 5 References 1. Melton ST, Kirkwood CK. Anxiety Disorders: Generalized Anxiety, Panic, and Social Anxiety Disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 10e New York, NY: McGraw- Hill; http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146065193. Accessed November 29, 2018. 2. Anxiety. Lexi- Comp Online [AUHSOP Intranet]. Hudson (OH): Lexi- Comp/Wolters Kluwer Health. [updated August 1, 2018, cited November 28, 2018]. Available from: http://online.lexi.com/lco/action/home/switch 3. Generalized Anxiety Disorder (GAD) Anxiety and Depression Association of America, ADAA. Adaa.org. https://adaa.org/understanding- anxiety/generalized- anxiety- disorder- gad. Published 2018. Accessed November 28, 2018. 4. NIMH» Generalized Anxiety Disorder: When Worry Gets Out of Control. Nimh.nih.gov. https://www.nimh.nih.gov/health/publications/generalized- anxiety- disorder- gad/index.shtml. Accessed November 30, 2018. 5. Generalized anxiety disorder - Diagnosis and treatment - Mayo Clinic. Mayoclinic.org. https://www.mayoclinic.org/diseases- conditions/generalized- anxiety- disorder/diagnosis- treatment/drc- 20361045. Published 2018. Accessed November 27, 2018. Images 1. Scott Donovan L. CBT and GAD (Generalized Anxiety Disorder). Scott Donovan, LMFT #101211. https://scottdonovanlmft.com/blog/f/cbt- and- gad- generalized- anxiety- disorder. Published 2018. Accessed November 27, 2018. 2. Folk J, Folk M. Anxiety Symptoms and Signs - Over 100 listed. anxietycentre.com. https://www.anxietycentre.com/anxiety- symptoms.shtml. Published 2018. Accessed November 29, 2018. 3. 7 Powerful Prayers for Anxiety and 6 Verses from the Bible. Holylandprayer.com. https://www.holylandprayer.com/prayer_for/prayers- for- anxiety/. Accessed November 28, 2018. 4. Thomas N. Is Generalized Anxiety Disorder considered a disability?. Quora. https://www.quora.com/is- Generalized- Anxiety- Disorder- considered- a- disability. Published 2018. Accessed November 29, 2018. 5. Generalized Anxiety Disorder Brittany F. Writes. Brittanyfichterwrites.com. http://brittanyfichterwrites.com/generalized- anxiety- disorder/. Published 2013. Accessed November 28, 2018. 6. List of Anxiety Drugs. Healthline. https://www.healthline.com/health/anxiety- drugs. Published 2018. Accessed December 2, 2018.