Generalized anxiety disorder

Generalized anxiety disorder (GAD) is an anxiety disorder characterized by excessive, uncontrollable, and often irrational worry about events or activities.^[5] Worry often interferes with daily functioning. Individuals with GAD are often overly concerned about everyday matters such as health, finances, death, family, relationship concerns, or work difficulties.^[6][7] Symptoms may include excessive worry, restlessness, trouble sleeping, exhaustion, irritability, sweating, and trembling.^[2]

Symptoms must be consistent and ongoing, persisting at least six months for a formal diagnosis.^[5][6] Individuals with GAD often have other disorders including other psychiatric disorders, substance use disorder, or obesity, and may have a history of trauma or family with GAD.^[8] Clinicians use screening tools such as the GAD-7 and GAD-2 questionnaires to determine if individuals may have GAD and warrant formal evaluation for the disorder. In addition, screening tools may enable clinicians to evaluate the severity of GAD symptoms.^[9][10]

Treatment includes types of psychotherapy and pharmacological intervention.^[11][8] CBT and selective serotonin reuptake inhibitors (SSRIs) are first-line psychological and pharmacological treatments; other options include serotonin–norepinephrine reuptake inhibitors (SNRIs). In more severe, last resort cases, benzodiazepines, though not as first-line drugs as benzodiazepines are frequently abused and habit forming. In Europe and the United States, pregabalin is also used.^[12][13] The potential effects of complementary and alternative medications (CAMs), exercise, therapeutic massage, and other interventions have been studied.^[14][15] Brain stimulation, exercise, LSD, and other novel therapeutic interventions are also under study.

Genetic and environmental factors both contribute to GAD. A hereditary component influenced by brain structure and neurotransmitter function interacts with life stressors such as parenting style and abusive relationships. Emerging evidence also links problematic digital media use to increased anxiety. GAD involves heightened amygdala and prefrontal cortex activity, reflecting an overactive threat-response system. It affects about 2–6% of adults worldwide, usually begins in adolescence or early adulthood, is more common in women, and often recurs throughout life. GAD was defined as a separate diagnosis in 1980, with changing criteria over time that have complicated research and treatment development.