DO YOU WORRY TOO MUCH?

We all worry when faced with a crisis or problems at work or at home. However, for some people, excessive worry or anxiety is more than just an uncomfortable nuisance and can become uncontrollable, affecting daily functioning and even causing physical symptoms.

About 5 percent of American adults will suffer from generalized anxiety disorder (GAD) and more women than men are affected. Most people with GAD suffer from other psychiatric illnesses including social phobia (also known as social anxiety disorder), other phobias, panic disorder, major depression, or alcohol or drug abuse. Up to half of people diagnosed with major depression are also diagnosed with GAD.

In order to be diagnosed with GAD, an individual needs to have had anxiety symptoms more days than not for at least six months. If a person has had symptoms for less than six months, particularly if the anxiety developed in response to a particular stressor, he or she may be more appropriately diagnosed with an adjustment disorder. These people may also suffer in their relationships with family members or at work and may be helped by some of the same treatments that are used for GAD.

People with anxiety may worry about major issues such as finances and personal health but their worry might also focus on more trivial issues like chores or being late for appointments. The worry is often more intense and disabling than is warranted by the issue involved and typically interferes with a person’s ability to concentrate or perform tasks competently.

Many people with anxiety develop physical symptoms. In some cases, the physical symptoms are the primary reason for seeking medical care. Some people with anxiety may be entirely focused on their physical complaints and may not even connect these complaints with anxiety or current life stress. These physical symptoms may include muscle tension, fatigue, memory loss, difficulty swallowing, insomnia, and stomach or intestinal complaints.

In order to diagnose anxiety, your doctor needs to collect a thorough history, making sure that an underlying medical condition is not responsible for the symptoms. He or she will also ask about any history of other psychiatric difficulties including depression or other anxiety disorders, history of psychiatric disorders in family members, and history of drug or alcohol abuse. The doctor will gather information about your current life situation and any stress that may be going on. Depending on your general medical condition and symptoms, your doctor may obtain lab studies or an EKG.

Generalized anxiety disorder may be treated with psychotherapy or with medication. For some patients, very short courses of psychotherapy – perhaps six to ten sessions – may be adequate. Depending on an individual’s life circumstances, family or marital therapy might be appropriate.

Many people are treated with medications – typically antidepressants, buspirone, or benzodiazepines. Antidepressants like Prozac, Paxil, or Effexor are often a good choice in anxious people because they treat both anxiety and depression – two diagnoses that, as discussed above, often coexist. Buspirone (Buspar) also is effective against anxiety but does not have an effect against depression. Unfortunately, the antidepressants and buspirone may take weeks to start working and so are not effective in the short-term. Benzodiazepines – including Xanax, Ativan, and Klonopin – are very effective for short-term treatment of anxiety. Many doctors are reluctant to prescribe these drugs because of a perceived potential for abuse. However, very few patients – except those with a history of drug or alcohol abuse – actually abuse these drugs or become dependent on them. The benzodiazepines are often used in conjunction with an antidepressant. After a few weeks, once the antidepressant has become effective, the benzodiazepine can be gradually tapered off.

Dr. McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny County and Pennsylvania Medical Societies. She is in solo practice in the North Hills of Pittsburgh.