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The treatment of generalized anxiety disorder is decided on the basis of severity of symptoms and their effect on life.
There are multiple treatment options available for GAD amongst which psychotherapy and medicines are considered main treatment options which can be used individually or together:
Psychotherapy or psychological counseling is found useful in the treatment of GAD. A specific type of psychological counseling called cognitive-behavioral therapy (CBT) is used in these patients.
Here, a psychologist or doctor listens to person’s worries and tries to understand the psychology behind it. He would teach new ways of thinking, understanding, and reacting to situations.
It aims to generate less anxiety and develop a better sense of self well being while performing tasks.
There are multiple medicines available that could be effective for GAD. Some people respond to only particular medicine better and thus needs to work out with their doctor in assessing the best possible options:
• Selective serotonin reuptake inhibitors (SSRIs) and Serotonin-norepinephrine reuptake inhibitors (SNRIs): these are typically used for the treatment of depression. However, they are also useful in the treatment of GAD and are generally the first medicines to be given by doctors. These medicines could be duloxetine, escitalopram, or paroxetine, and others. They may take multiple days to several weeks to show effect. Side effects of these medicines could be nausea, loss of appetite, fatigue, or sleep problems.
• Other serotonergic medicines: like Buspirone could be used in GAD. It also takes multiple days to several weeks to be fully effective.
• Benzodiazepines: these are sedative medicines that are used only for a short time to manage severe symptoms. They are effective in significantly decreasing anxiety but can’t be used for a long period due to the development of dependence and tolerance. Both the treatment options take some time to reduce the symptoms and brought about significant change. A person shouldn’t give up on treatment, too early and should work out with the doctor with patients to develop what suits them the best.
Apart from psychotherapy and medicines there are other treatment options also available with some proven benefit.
Treatment options like lifestyle modifications and relaxation techniques like yoga, meditation, and others can be incorporated in life which can improve the ability to manage stress and bring down the symptoms. The lifestyle changes that could help are as follows:
• Exercise: being physically active in the day to day life and incorporating exercise in lifestyle can help reduce anxiety. Exercise is a powerful stress-buster that may elevate mood, enhance confidence, and reduce symptoms of worry and anxiety. Beginning with simpler exercises and for shorter duration and gradually building up a more intense routine can be done. A number of activities like running, swimming, cycling, dancing, weight training, and others can be used.
• Quitting substance abuse: alcohol and recreational drugs have been found to worsen anxiety and lead to other issues.
• Quit smoking and reducing or quitting coffee: Both nicotine and caffeine are stimulants that can increase anxiety and restlessness.
• Having good sleep: having good quality and adequate sleep helps to manage stress better. In cases of sleep issues, discuss with the doctor about what can be done.
• Eating healthy: having a healthy diet with good water intake is considered to help the body manage various types of stress better.
• Relaxation techniques: relaxation techniques have been found to relax body and mind. Various relaxation techniques such as yoga, meditation, or visualization techniques can be used depending upon one’s interest and body’s response.
Yoga consists of breath control (pranayama), physical exercises (asana), and meditation.
It is thought that yoga manages stress and anxiety by decreasing activation of the hypothalamic-pituitary-adrenal (HPA) axis, which gets stimulated under stress. It is thus believed to lower the heart rate, blood pressure, and respiration. Research has proved that yoga practice improves heart rate changes suggesting, better response to stress.
A study by found changes in brain chemicals showing reduced stress and improved health in people performing transcendental meditation regularly.
Vahia et al found that meditation was as effective as medicines like imipramine and chlordiazepoxide for the treatment of GAD, with no associated side effects.
They have also shown some benefit and may also become part of a treatment plan after discussing it with the doctor.
• Satvavajay chikitsa: Ayurveda has a concept of psychotherapy called Satvavajay chikitsa, which focuses on control of the mind or mental toughness against stressors.
It is considered that it can be attained via “spiritual knowledge, philosophy, understanding and concentration.”
In Ayurveda, anxiety is recognized and referred to as cittodveqa where Satvavajay helps by replacing the problematic emotions, providing assurance, and using psychoshock therapy.
• Ayurvedic herbs: in recent years some western studies have confirmed the role of ashwagandha (Withania somnifera) for treating anxiety and stress.
Herbs like sankhapuspi (Convolvulus pluricaulis) and brahmi (Bacopa monnieri), mandukaparni (Centella asiatica) and tulasi (Ocimum sanctum) have also been found effective in reducing stress.
Before taking any herbal medicine, it is important to the doctor to confirm its safety and use with other medications.
There are some studies that suggest the benefits of homeopathy in treating mild to severe anxiety disorders. However, there are other studies that suggest a limited role of homeopathy in anxiety disorders.
To cope with generalized anxiety disorder, here’s what you can do:
• Relax and let it go: Release the baggage of the past. Stop concerning about the future. Focus on the present moment and make it best.
• Follow an anxiety buster routine: Include a short session of meditation or deep breathing in the morning or evening. Take good sleep. Involve yourself in physical activity such as hitting the gym, playing sports, jogging, at least 4 to 5 times a week. It boosts your happy hormones which keep your mind more resilient towards stress.
• Deal better with acute stress: Realize early when you start feeling anxious and take a quick action. Indulge yourself into a more creative or engaging activity such as following a hobby or just taking a brisk walk or deep breathing. The activities help you to maintain focus and keep you away from worries.
• Come out of the virtual world and be an old school: Take a break from digital media and other stuff that bombards your mind with infinite things. Indulge yourself more in reading books, meeting, and interacting with friends and developing a hobby.
• Follow your treatment plan: Follow your doctor’s advice and planned visits. Utilize the tips you learn in psychotherapy. Take medicines as instructed. Don’t break the continuity.
• Prioritize issues and take action: Discuss with your doctor about the issues which matter to you and issues which make you anxious. Understand how to deal with the stressors and to maintain focus on what is important to you.
• Join an anxiety support group: The group helps you to find people who have faced similar situations or who are coping with it. They come and share their experiences, tips, and what worked best for them. The group provides an instant understanding of your problems and you tend to form a good bond and support system.
You can join the following support groups online:
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