Generalized anxiety disorder

Generalized anxiety disorder (GAD) is more than worrying now and then. People with GAD feel very worried or nervous more often, or more intensely, about everyday things like health, money, work, family and chores, even when the worry is out of proportion to the situation. It isn't tied to one stressful event, and it can last for months or even years.

GAD usually develops gradually, often starting in early adulthood, though it can begin at any age. Symptoms can come and go, and they often get worse during stressful times, such as an illness or a conflict at home.

Common signs, in plain language

• Worry or nervousness that's hard to control
• Feeling restless, irritable or on edge
• Trouble concentrating
• Trouble falling or staying asleep, or feeling worn out
• Headaches, muscle aches, stomachaches or tension
• Sweating, feeling lightheaded or feeling out of breath

These signs are a general guide, not a checklist for diagnosis.

Some people with GAD keep up with work and family while the worry runs underneath. If that sounds familiar, you may also want to read about high-functioning anxiety.

GAD is diagnosed when worry is hard to control on most days for at least 6 months, along with other signs such as restlessness, fatigue, trouble concentrating, irritability, muscle tension or sleep problems. A careful evaluation looks at:

• When the worry began, how long it has lasted, how often it shows up, and what it's costing you
• Your physical health, to make sure an unrelated physical problem isn't causing the symptoms
• Conditions that often come with GAD, such as depression, other anxiety disorders, PTSD, or alcohol and substance use
• What you've tried before, and what has or hasn't helped

This is part of a comprehensive psychiatric evaluation, so we understand the full picture before any treatment decision. Your first evaluation is up to 90 minutes in length. Some people need more time, some less, and we take the time you need. Follow-up visits are typically 20 to 30 minutes, and extended follow-ups are available.

GAD is treatable. Treatment usually involves therapy, medication, or both, chosen around your needs, preferences and health.

Medication, when appropriate. Four antidepressants are FDA-approved for GAD, and buspirone is approved for anxiety and was studied in GAD. Antidepressants may take several weeks to start working, and buspirone takes about 3 to 4 weeks to work fully. Starting low and going up slowly helps keep side effects mild. We explain what to expect from each option, and why we'd suggest it. See the medication quick facts below, or the fuller list on our anxiety disorders page.

Practical work in your visits. We help you notice automatic worry thoughts and question them, the core of CBT-informed strategies. We also talk about sleep, caffeine and stress management, which can ease anxiety alongside treatment.

Therapy. CBT is a well-studied therapy for GAD, and acceptance and commitment therapy (ACT) has growing research support. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them.

Regular follow-ups. We check how you're doing and adjust carefully. The goal is less constant worry, better sleep and more room to think, not a life with no worry at all.