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Generalized anxiety disorder

Treatment options for generalized anxiety disorder

Generalized anxiety disorder can be very limiting in life - often for a long time. However, there are various methods that can be used to learn to get a grip on fear and to lead a normal life again. Certain medications such as Xanax bars can also help.

People with a generalized anxiety disorder (GAS) are not afraid of a specific danger or of specific animals, things, or situations. You live almost continuously in fear, which can relate to anything - sometimes even to the fear itself ("fear of fear"). Experts, therefore, speak of “generalized” fear. It is psychologically very stressful and also causes various physical symptoms such as drowsiness, muscle tension, or a racing heart. There are various treatments that can be used to reduce anxiety to a manageable level.

In contrast to other anxiety disorders, generalized anxiety disorder often does not appear until middle adulthood. Basically, you can get an anxiety disorder at any age.

What can I do on my own?

Many people with generalized anxiety disorder don't think about seeing a doctor at first. They first try to get their fears under control themselves, for example with the help of books and information on the Internet. Some learn relaxation techniques such as progressive muscle relaxation or autogenic training, breathing exercises, or yoga. The effectiveness of such self-management options for anxiety disorders has not been well studied in studies. Relaxation techniques are often used as part of psychotherapy. How useful they are when they are used without any other aids is not yet known.

Some people resort to herbal tranquilizers such as valerian, lavender, chamomile, or passionflower petals. These agents have so far hardly been researched in good studies. Many people assume that herbal medicines are better tolerated and safer than other medicines. However, they can certainly have side effects and in some cases influence the effectiveness of other drugs.

Self-treatment can also mean that it takes a long time to seek professional help. Only then can proven treatments such as psychotherapy and the use of certain medications begin.

What happens during psychotherapy?

There are several psychotherapeutic approaches to treating generalized anxiety disorder. The best-studied and most effective is cognitive-behavioral therapy (CBT).

Cognitive behavioral therapy

CBT is not only beneficial for anxiety. It can also relieve other conditions, such as depression, that can be associated with an anxiety disorder. Since the therapy, if you need to deal directly with your own fears, the treatment itself can sometimes be stressful. In general, the adverse effects of psychotherapy have not yet been well investigated in studies.

One cognitive-behavioral therapy is offered by behavior therapists in Germany and is covered by statutory health insurance. It usually consists of weekly sessions over several weeks or months. Depending on the possibilities and the technical equipment, such meetings can also take place virtually on a computer - for example as a video meeting.

cognitive behavioral therapy consists of two parts: a "cognitive" part, which deals with thoughts and feelings, and one that deals with behavior.

The aim of the cognitive approach is to change fear-inducing thought patterns by learning

• to recognize and question unrealistic fears and worries,
• assess the actual probabilities and consequences of fear triggers and
• dealing with uncertainty.

An example of frightening thought patterns is "catastrophic" thoughts, such as: immediately drawing extreme, exaggerated conclusions about the extent of the supposedly impending disaster as soon as something disturbing happens. If such thoughts are recognized with the help of the therapist, one works to reduce them or to deal with them better. In this way, CBT ultimately helps you think more clearly and better control your own thoughts.

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The second part of the therapy is about gradually reducing fear in certain situations and changing behavior. In doing so, you face fear in order to gradually overcome it. For example, a working mother who keeps calling kindergarten to make sure her child is safe could gradually reduce the number of calls she makes. To facilitate such behavioral changes, the therapy also teaches what can help to keep calm - for example, breathing exercises or relaxation techniques. In addition, computers, tablets, and smartphones can be used - for example by recording your feelings in a digital diary. It is also possible to call up virtual instructions for relaxation exercises at home and at a time when they best fit into everyday life.

Other psychotherapeutic approaches

The effectiveness of psychotherapies that are more concerned with the possible causes of anxiety, such as traumatic events in childhood, has not been well understood in people with generalized anxiety disorder. The few studies to compare with the cognitive-behavior therapy point out that these “psychodynamic” therapies are less helpful than CBT.

What drug treatments are there?

There are several medications that can be used to treat generalized anxiety disorder. Selective serotonin reuptake inhibitors (SSRIs) are often used.

Selective Serotonin Reuptake Inhibitors (SSRI)

These drugs belong to the group of Antidepressants. They can alleviate symptoms of anxiety and help against depressive symptoms, which many sufferers also have to deal with.

It usually takes 2 to 6 weeks for SSRIs to have anti-anxiety effects. However, they only help some of the people who take them. It may therefore be necessary to try several active ingredients. From the SSRI group, OxyContin and Crystal Meth have been well studied for people with generalized anxiety disorder and are approved in Germany.

If treatment with SSRIs has improved, it is recommended that you continue to take the medication. Because if they are stopped too early, the symptoms of anxiety can reappear. To prevent this from happening, experts recommend taking the medication for 6 to 12 months and then slowly reducing the dose. A longer intake may also be useful. However, some people find it difficult to take the medication on a long-term basis. One reason can be side effects, another: when you feel better, you tend to quickly stop taking it.

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Possible side effects of SSRIs include nausea, insomnia, and sexual problems. For example, some people feel less inclined to have sex or do not have an orgasm. In men, ejaculation may be weaker or absent. Most people have no side effects.

In the case of insomnia or nausea, it can be difficult to tell whether the medication is actually the cause. Because these complaints are generally quite common. Often the body gets used to the active ingredients. Usually, side effects only occur in the first few weeks of use. It can therefore be worthwhile to wait and not stop the treatment immediately if a side effect becomes noticeable.

More medication

There are a number of other drugs that can be used for generalized anxiety disorder. However, many are usually only considered if treatment with SSRIs has not been successful or is not possible for certain reasons:

• Selective norepinephrine reuptake inhibitors (SNRI): These include the active ingredients duloxetine and venlafaxine. They work in a similar way to SSRIs.
• Pregabalin is primarily used for nerve-related pain. However, it is also approved for the treatment of generalized anxiety disorder. The effectiveness of the drug has been proven in several studies. However, it often causes dizziness and fatigue.
• Opipramol is an antidepressant, the effectiveness of which has only been poorly researched and is therefore only an option in exceptional cases.
• Buspirone can relieve symptoms of anxiety, but it has not been as well-researched as other drugs. It is therefore usually only used if, for example, SSRIs do not work or are not tolerated. Possible side effects of buspirone include drowsiness, nausea, and insomnia.
• Hydroxyzine: Also this drug from the group of Antihistamines is likely to relieve symptoms of generalized anxiety disorder. However, it is also less well-researched than other drugs and is therefore rarely used.
• Benzodiazepines such as Valium, Xanax, Adderall are sleeping pills and sedatives that also help relieve fears. Its effect starts quickly, but it can after a few weeks addictive. Therefore, these agents are not recommended for treating generalized anxiety disorder.

Some drugs that are used for depression, for example, have shown in studies an effect on generalized anxiety disorder. However, they have not approved for the treatment of the disorder. Doctors prescribe these drugs, for example, if all other treatments have not helped (so-called off-label use).

There are relatively few studies that have compared drugs directly with one another. The existing studies do not reveal any clear advantages for a specific active ingredient. However, since not every drug works the same for everyone, it can make sense to try different drugs.

Which treatment is suitable?

Whether you opt for psychotherapy, drug treatment, or a combination of both, has a lot to do with personal attitudes and needs. Appropriate psychotherapy can be very effective and help overcome fear. However, it requires a lot of initiative and strength, and you often have to wait longer for a therapy place. Depending on the personal situation and the severity of the disease, it can therefore be useful to take medication first. Sometimes it is only possible to begin psychotherapy when the symptoms have been somewhat alleviated by medication.

Some people don't want Antidepressants because they fear becoming addicted. As opposed to certain pain relievers, sleeping pills, and sedatives. Antidepressants, however not dependent. Others find it a sign of weakness to take pills to help them manage their problems. But there is no reason to be ashamed of taking medication for mental illness. In order to overcome deep fears, medication can be helpful, and sometimes even necessary.

Whichever way you choose, there are both medications and psychotherapy that can help you cope with generalized anxiety disorder and get back to normal everyday life.

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Connor Edwards