Anxiety

Definition

Generalized anxiety disorder (GAD) is a pattern of frequent, constant worry and anxiety over many different activities and events. It is estimated by the American Institute of Stress, that 75% to 90% of all doctor’s visits are caused by reactions to stress.

Stress poses a profound difficulty for everyone, but is a particular problem for Blacks:

• 50% of African Americans who suffer from the “blues” or depression do not seek help.
• 88% of women and 69% of men will get headaches and stress is the number one cause.
• Stress is the number one health problem facing African Americans.  35% of African American men compared to 25% of other ethnic groups are affected by hypertension (high blood pressure).
• 1 out of every 9 women who seek care in the emergency rooms is there because of injuries resulting from domestic violence.  There is evidence to support that neighborhood crime is rooted in unhealthy stress.
• More black men die from heart attacks associated with stress than any other ethnic group in the United States.
• Adult Blacks are 20% more likely to report serious psychological distress than adult whites.
• As of 2019, 13.4% of the U.S. population identifies as Black, yet over 16%, or 7 million, identified with having a mental illness.
• According to the Journal of the American Heart Association Report, after 7 years, African Americans who reported high stress levels over time had a 22% increased risk of developing high blood pressure.
• Black African American teenagers are more likely to commit suicide than white teenagers.
• Adult African Americans are more likely to have feelings of worthlessness and hopelessness than adult whites.

Alternative Names

GAD; Anxiety Disorder

Causes

The exact cause of GAD is not fully known, but a number of factors — including genetics, brain chemistry and environmental stresses — appear to contribute to its development.

• Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families.
• Brain chemistry: GAD has been associated with abnormal levels of certain neurotransmitters in the brain. Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts in certain situations, leading to anxiety.
• Environmental factors: Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools, may lead to GAD. GAD also may become worse during periods of stress. The use of and withdrawal from addictive substances, including alcohol, caffeine, and nicotine, can also worsen anxiety.

Symptoms

A person with GAD may:

• Worry very much about everyday things
• Have trouble controlling their constant worries
• Know that they worry much more than they should
• Not be able to relax
• Have a hard time concentrating
• Be easily startled
• Have trouble falling asleep or staying asleep
• Feel tired all the time
• Have headaches, muscle aches, stomach aches, or unexplained pains
• Have a hard time swallowing
• Tremble or twitch
• Be irritable, sweat a lot, and feel light-headed or out of breath
• Have to go to the bathroom a lot.

Exams and Tests

If symptoms of GAD are present, the doctor will begin an evaluation by asking questions about your medical history and performing a physical examination. Although there are no laboratory tests to specifically diagnose anxiety disorders, the doctor may use various tests to look for physical illness as the cause of the symptoms.

The doctor bases his or her diagnosis of GAD on reports of the intensity and duration of symptoms — including any problems with functioning caused by the symptoms. The doctor then determines if the symptoms and degree of dysfunction indicate a specific anxiety disorder. GAD is diagnosed if symptoms are present for more days than not during a period of at least six months. The symptoms also must interfere with daily living, such as causing you to miss work or school.

Treatments

First, talk to your doctor about your symptoms. Your doctor should do an exam to make sure that another physical problem isn’t causing the symptoms. The doctor may refer you to a mental health specialist.

GAD is generally treated with psychotherapy, medication, or both.

Psychotherapy. A type of psychotherapy called cognitive behavior therapy is especially useful for treating GAD. It teaches a person different

ways of thinking, behaving, and reacting to situations that help him or her feel less anxious and worried.

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Medication. Doctors also may prescribe medication to help treat GAD. Two types of medications are commonly used to treat GAD—anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.

Antidepressants are used to treat depression, but they also are helpful for GAD. They may take several weeks to start working. These medications may cause side effects such as headache, nausea, or difficulty sleeping. These side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects you may have.

It’s important to know that although antidepressants can be safe and effective for many people, they may be risky for some, especially children, teens, and young adults. A “black box”—the most serious type of warning that a prescription drug can have—has been added to the labels of antidepressant medications. These labels warn people that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely, especially when they first start treatment with medications.

Some people do better with cognitive behavior therapy, while others do better with medication. Still, others do best with a combination of the two. Talk with your doctor about the best treatment for you.

Possible Complications

Generalized anxiety disorder does more than just make you worry. It can also lead to, or worsen, other mental and physical health conditions, including:

• Depression
• Substance abuse
• Trouble sleeping (insomnia)
• Digestive or bowel problems
• Headaches
• Teeth grinding (bruxism)
• Substance use disorders

When to Contact a Medical Professional

If you think you have an anxiety disorder, the first person you should see is your family doctor. A physician can determine whether the symptoms that alarm you are due to an anxiety disorder, another medical condition, or both.

Preventions

Anxiety disorders like GAD cannot be prevented. However, there are some things that you can do to control or lessen symptoms, including:

• Stop or reduce your consumption of products that contain caffeine, such as coffee, tea, cola and chocolate.
• Ask your doctor or pharmacist before taking any over-the-counter medicines or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
• Exercise daily and eat a healthy, balanced diet.
• Seek counseling and support after a traumatic or disturbing experience.
• Practice stress management techniques like yoga or meditation.

Natural Remedies

(BlackDoctor.org) — Take control of anxiety and get on with life. Some anxiety is normal—but it shouldn’t interfere with your ability to function. According to research or other evidence, the following self-care steps may be helpful:

What You Need To Know:

• Address your stress
  
  Reduce stress with meditation, counseling, and other methods
• Avoid caffeine
  
  If you are anxious, avoid stimulants such as caffeine
• Try valerian and passion flower
  
  Calm the nervous system by taking an herbal combination of valerian (100 to 200 mg) and passion flower (45 to 90 mg) three times a day
• Aim for better nutrition with a multivitamin
  
  Taking one a day may help reduce anxiety and feelings of stress