Treatment for Generalized Anxiety Disorder (GAD)

Content warning: Discussion of anxiety, depression, and suicide.

An estimated 1 in 3 adults in the United States experiences an anxiety disorder.

Andrew J. Melaragno, MD, MS, is a Mass General Brigham psychiatrist who practices at Brigham and Women's Hospital and Brigham and Women's Faulkner Hospital. Below, he discusses the history of anxiety, shares symptoms to look out for, and highlights anxiety treatment options. 

What is anxiety?

Anxiety is a normal feeling that we all experience. It can range from nervousness about everyday situations (like a first date) to full-blown fear.

When we experience anxiety, we react in one of four main ways: fighting, flying/fleeing, freezing, or fawning. This is called our “fear response.”

"The fear response can help us escape life-threatening situations," says Dr. Melaragno. "It can motivate us to plan and perform at high levels."

Anxiety itself isn’t dangerous. But anxiety disorders can be. People with anxiety disorders experience excessive fear and worry about both real and imagined threats. This may affect their sleep. It can cause depression. And in some cases, it can lead to suicide. 

A brief history of anxiety

Anxiety disorders are not new. In fact, they have been recognized throughout history. Unfortunately, they have not been well understood—especially as they relate to women.

For example: Plato believed that anxiety, what he called “hysterical behaviors,” were caused by the uterus. Later, Freud considered anxiety an exclusively female disease.

By the middle of the 20th century, doctors were trying remedies such as hypnosis or strong sedatives in hopes of treating anxiety disorders.

Thankfully, as science evolved, these outdated theories were disproven. Today, we have a much better understanding the complex symptoms and underlying biology of anxiety disorders.

What are the symptoms of generalized anxiety disorder?

Generalized anxiety disorder is an ongoing feeling of anxiety, fear, or dread. It can feel like you are always overwhelmed and can’t relax.

Core symptoms of generalized anxiety disorder include:

• Uncontrolled worries
• Feeling restless, wound-up, or on-edge
• Fatigue
• Sleep problems
• Difficulty concentrating or focusing
• Being irritable or excitable 

How is anxiety disorder diagnosed?

If you have symptoms of anxiety, talk to your primary care provider (PCP). They can connect you to a mental health provider who can help you determine if you have anxiety disorder. Often, they will begin to learn more about you and your condition through a conversation. Your provider may want to discuss your symptoms and how they affect your daily life. They may give you a test or screening to learn more about the severity of your symptoms.

Once they’ve collected enough information, your provider will compare your results to specific criteria and confirm your diagnosis.

How is anxiety treated?

The two main treatments for anxiety are psychotherapy and medications. It takes some time to figure out what treatment is right for you. Often, a combination of medication and therapy is most effective.

"Imagine an anxiety disorder is an injury sustained in battle,” says Dr. Melaragno. “Medication serves as the dressing for the wound. It protects you, keeps the wound from getting worse, but ultimately something else will be needed to address the open wound underneath, and that's the therapy."

Mental health providers are still researching and refining the diagnosis and treatment of anxiety disorders.

One of the most effective types of therapy for anxiety is cognitive behavioral therapy (CBT). And new research suggests that intensive CBT programs with short bursts of daily treatment can be just as effective as the traditional 12 to 20 weeks of weekly therapy.

Transcranial magnetic stimulation (TMS) is another therapeutic approach to treating anxiety. TMS is used to target specific areas in the brain with powerful magnets. This changes the brain’s electrical activity and can effectively restore the integrity of its wiring.

Researchers are also looking into how these therapies work together, comparing standard medication with other interventions such as physical exercise, mindfulness, yoga, and resilience training.

"While we don't have extensive data yet on how this improves mental health, I still enthusiastically recommend these other interventions to patients because they are safe, affordable, and have a broad range of mental and physical benefits," says Dr. Melaragno.

At the end of the day, any step in the direction of treatment can go a long way. What’s most important is consulting with an expert about the best treatment for you.