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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 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 persons 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 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 treatment of depression. However, they are also useful in treatment of GAD and are generally 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 short time to manage severe symptoms. They are effective in significantly decreasing anxiety but can’t be used for long period due 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 doctor with patience to develop what suits them the best.
Apart from the psychotherapy and medicines there are other treatment options also available with some proven benefit.
The 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 life style changes that could help are as follows:
• Exercise: being physically active in day to day life and incorporating exercise in lifestyle can help reduce anxiety. Exercise is a powerful stress buster which 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. 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 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 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 conformed the role of ashwagandha (Withania somnifera) for treatment anxiety and stress.72. Herbs like sankhapuspi (Convolvulus pluricaulis) and brahmi (Bacopa monnieri), mandukaparni (Centella asiatica) and tulasi (Ocimum sanctum) have also been found effective in reducing stress.71 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 suggested benefits of homeopathy in treating mild to severe anxiety disorders.86 However, there are other studies that suggested limited role and contradictory findings, in conforming the substantial role of homeopathy in anxiety disorders.87
• Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
• Keep a journal. Keeping track of your personal life can help you and your mental health professional identify what’s causing you stress and what seems to help you feel better.
• Prioritize issues in your life. You can reduce anxiety by carefully managing your time and energy.
To cope with generalized anxiety disorder, here’s what you can do:
• Stick to your treatment plan. Take medications as directed. Keep therapy appointments. Practice the skills you learn in psychotherapy. Consistency can make a big difference, especially when it comes to taking your medication.
• Take action. Work with your mental health professional to figure out what’s making you anxious and address it.
• Let it go. Don’t dwell on past concerns. Change what you can in the present moment and let the rest take its course.
• Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus your mind away from your worries.
• Socialize. Don’t let worries isolate you from loved ones or enjoyable activities. Social interaction and caring relationships can lessen your worries.
• Join a support group for people with anxiety. Here, you can find compassion, understanding and shared experiences. You may find support groups in your community or on the internet, for example, the National Alliance on Mental Illness (NAMI).
Build a support group for anxiety and other mental disorders
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