Anxiety is a general feeling of being worried. Everyone experiences anxiety once in a while. People with generalized anxiety disorder (GAD), however, feel anxious frequently or excessively, not necessarily because of a particular situation. For them, anxiety interferes with their daily activities.

Symptoms of anxiety may include:

• Muscle tension, trembling
• Feeling restless or on edge
• Fast heartbeat (tachycardia)
• Fast or troubled breathing (dyspnea)
• Stomach upset
• Having a hard time concentrating
• Headache
• Sweating
• Fatigue
• Irritability
• Trouble falling asleep or staying asleep

Many things can cause anxiety -- for example, some medications may cause you to be anxious, or an underlying medical condition may prompt feelings of anxiety. Scientists aren't sure what causes GAD, although they think that certain chemicals in the brain (called neurotransmitters), including serotonin and norepinephrine, may be involved. Genes, your environment, and your life situation may also contribute to GAD.

Your doctor or mental health provider will talk to you about when you feel anxious and what it feels like. Your health care provider will take your medical history, give you a physical examination, and may take blood or urine samples for laboratory tests. Sometimes, you will have an electrocardiogram (EKG) to rule out heart problems. You may be asked to fill out a psychological questionnaire.

For someone to be diagnosed with GAD, the person must meet the following criteria:

• Excessive anxiety or worry most days for at least 6 months
• Difficulty controlling anxiety
• Anxiety associated with three or more of the following symptoms: feeling restless, being fatigues, having trouble concentrating, being irritable, having muscle tension, or having trouble sleeping
• Anxiety that interferes with your daily life
• Anxiety that is not related to another psychological condition, such as panic attacks
• Anxiety that is not related to another physical condition, such as substance abuse

Treatment Plan

Treatment for anxiety depends on the cause. If you have an underlying physical condition, your doctor will treat it. If your anxiety has no physical cause, your doctor may recommend counseling to help you learn coping strategies and problem-solving techniques. A 2007 review of studies that used cognitive behavioral therapy to treat anxiety found that it was effective for GAD. In cognitive behavioral therapy, you learn to modify or replace anxious thoughts with healthy ones. Your doctor may also suggest trying relaxation techniques, such as deep breathing. Sometimes, your doctor may prescribe medications to help until you have learned these techniques.

Drug Therapies

Prescription

• Benzodiazepines -- a group of drugs that help reduce anxiety and have sedating effects. They work quickly, but they can be habit forming and are usually prescribed for short-term use. They may cause drowsiness, constipation, or nausea. Do not take these drugs if you have narrow-angle glaucoma, a psychosis, or are pregnant. Benzodiazepines include:
  • Alprazolam (Xanax)
  • Chlordiazepoxide (Librium)
  • Clonazepam (Klonopin)
  • Diazepam (Valium)
  • Lorazepam (Ativan)
• Buspirone (BuSpar) -- an anti-anxiety drug that does not seem to cause drowsiness or dependence. However, you must take it for 2 weeks before feeling any effect. Side effects can include insomnia, nervousness, light-headedness, upset stomach, nausea, diarrhea, and headaches.
• Antidepressants -- a group of drugs that act on the same neurotransmitters (brain chemicals) believed to be involved in anxiety. Antidepressants sometimes used to treat anxiety include:
  • Duloxetine (Cymbalta)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Venlafaxine (Effexor)

Over-the-Counter

There are no over-the-counter therapies for treating anxiety.

Complementary and Alternative Therapies

Mind-body techniques, nutrition, exercise, and herbs may help reduce anxiety. Progressive muscle relaxation, diaphragmatic breathing, biofeedback, meditation, and self-hypnosis can help you relax and reduce your anxiety.

Exercise

Several studies suggest that exercise is effective in reducing depression, and at least one 2007 study found that regular, intense exercise (running or playing football, for example) can also have a positive effect on anxiety. The benefits lasted up to 5 years.

Nutrition

Although there is no diet to relieve anxiety, eating healthy meals keeps your body well nourished and strong. Avoid caffeine because it can make you feel restless. Avoid alcohol and nicotine as well. Eat more fresh vegetables, whole grains, and fruits. Keep your blood sugar at a steady level by eating frequent small meals that contain protein, complex carbohydrates, and healthy fats.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, take herbs only under the supervision of a health care provider.

• Valerian (Valeriana officinalis, 150 mg 2 - 3 times per day) is an herbal treatment for insomnia that is sometimes used to treat anxiety as well, although evidence is mixed. Some studies show that valerian does help reduce anxiety, but one study found that valerian was no better at reducing social anxiety than placebo. Valerian is often combined with lemon balm (Melissa officinalis) or with St. John's wort (Hypericum perforatum) for treating mild-to-moderate anxiety. Valerian may interact with other drugs that have a sedative effect, such as benzodiazepines, barbiturates, narcotics, antidepressants, and antihistamines. Do not take valerian if you are pregnant or nursing. Valerian can also affect the liver, so do not take it if you have liver problems. St. John's wort can affect other drugs you may be taking, including antidepressants, birth control, or other medications. You should avoid St. John's wort while pregnant or nursing. Talk to your doctor before using St. John's wort with any other medications.
• Passionflower (Passiflora incarnata) -- In a few studies, passionflower was as effective as some of the benzodiazepines in relieving anxiety. However, more studies are needed to know for sure whether passionflower is effective.
• Kava kava (Piper methysticum, 100 - 200 mg 2 - 4 times a day) is sometimes suggested for mild-to-moderate anxiety, but the Food and Drug Administration (FDA) has issued a warning concerning kava's effect on the liver. In rare cases, severe liver damage has been reported. Talk to your doctor before taking kava, and don’t take it for more than a few days.
• Other herbs sometimes suggested for anxiety include ginger (Zingiber officinalis), chamomile (Matricaria chamomilla), and licorice (Glycyrrhiza glabra). Avoid licorice if you have heart failure, heart disease, kidney or liver disease, or high blood pressure. Do not take licorice if you take a diuretic (water pills), anticoagulant (blood thinner), or antidepressant such as Prozac.

Essential oils of lemon balm, bergamot, and jasmine are calming, and you can use them as aromatherapy. Place several drops in a warm bath or atomizer, or on a cotton ball.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of anxiety based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Aconitum -- for anxiety accompanied by irregular or forceful heartbeat, shortness of breath, or fear of death.
• Arsenicum album-- for excessive anxiety that has no clear cause and is accompanied by restlessness, especially after midnight. It also may be used for perfectionists, including children, who worry about everything.
• Phosphorus-- for an impending sense of doom and anxiety when alone. It also may be used for impressionable adults and children who are easily influenced by the anxiety of others.
• Lycopodium-- for performance and other types of anxiety in those who are insecure, yet hide their low self-esteem with arrogance and bravado. It also may treat children with anxiety accompanied by bedwetting.
• Gelsemium-- for performance anxiety resulting in diarrhea, headache, dizziness, weakness, shakiness and trembling, or trouble speaking.
• Argentum nitricum-- for performance anxiety (such as before tests in school-age children) with rapid heart rate, feeling of faintness, diarrhea, or flatulence.

Acupuncture

Some evidence shows that acupuncture may help reduce symptoms of anxiety, especially when combined with behavioral therapies (including psychotherapy). One study showed that benefits lasted as long as one year after treatment. Acupuncturists treat people with anxiety based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. With anxiety, a qi deficiency is often detected in the kidney or spleen meridians. In addition to performing needling techniques, acupuncturists may also use lifestyle and breathing techniques as well as herbal and dietary therapy.

Massage

Therapeutic massage can help reduce anxiety and stress.

Follow your health care provider's instructions, and practice relaxation techniques as needed.

Be sure to tell your health care provider if you are pregnant. Call your provider if you experience any significant side effects from prescribed medications.

Avoid kava kava, valerian, and St. John's wort if you are pregnant or nursing.

Akhondzadeh S, Naghavi HR, Vazirian M, et al. Passionflower in the treatment of generalised anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther 2001;26:362-367.

Awad R, Levac D, Cybulska P, Merali Z, Trudeau VL, Arnason JT. Effects of traditionally used anxiolytic botanicals on enzymes of the gamma-aminobutyric acid (GABA) system.Can J Physiol Pharmacol. 2007 Sep;85(9):933-42.

Bellavite P, Magnani P, Zanolin E, Conforti A. Homeopathic Doses of Gelsemium sempervirens Improve the Behavior of Mice in Response to Novel Environments. Evid Based Complement Alternat Med. 2009 Sep 14. [Epub ahead of print]

Bilia AR, Gallon S, Vincieri FF. Kava-kava and anxiety: growing knowledge about the efficacy and safety. Life Sci. 2002;70:2581-2597.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:422,463-464.

Conrad A, Isaac L, Roth WT. The psychophysiology of generalized anxiety disorder: Effects of applied relaxation. Psychophysiology. 2008 Jan 23; [Epub ahead of print]

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3^rd ed. New York, NY: Penguin Putnam; 1997:334-338.

Davidson JR, Connor KM. St. John's wort in generalized anxiety disorder: three case reports. J Clin Psychopharmacol 2001;21:635-636.

Goldberg RJ. Anxiety reduction by self-regulation: theory, practice, and evaluation. Ann Intern Med. 1982;96:483.

Guizhen L, Yunjun Z, Linxiang G, Aizhen L. Comparative study on acupuncture combined with behavioral desensitization for treatment of anxiety neuroses. Am J Acupunct. 1998;26:117-120.

Hubner R, van Haselen R, Klein P. Effectiveness of the homeopathic preparation Neurexan compared with that of commonly used valerian-based preparations for the treatment of nervousness/restlessness - an observational study. ScientificWorldJournal. 2009 Aug 11;9:733-45.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996:250.

Kennedy DO, Little W, Haskell CF, Scholey AB. Anxiolytic effects of a combination of Melissa officinalis and Valeriana officinalis during laboratory-induced stress. Phytother Res. 2006;20(2):96-102.

Kohnen R, Oswalkd D. The effects of valerian, propranolol, and their combination on activation, performance and mood of healthy volunteers under social stress conditions. Pharmacopsychiatry. 1988;21:447-448.

Linde K. St. John's wort - an overview. Forsch Komplementmed. 2009 Jun;16(3):146-55.

Mantani R, Cimino A. A primer of comlentary and alternative medicine and its relevance in the treatment of mental health problems. Psychiatr Q 2002;73:367-381.

Meeks TW, Wetherell JL, Irwin MR, Redwine LS, Jeste DV. Complementary and alternative treatments for late-life depression, anxiety, and sleep disturbance: a review of randomized controlled trials. J Clin Psychiatry. 2007 Oct;68(10):1461-71. Review.

Olukoga A, Donaldson D. Liquorice and its health implications. J R Soc Health. 2000;120:83-89.

Panijel M. Treatment of moderately severe anxiety states. Therapiewoche. 1985;35:4659-4668.

Petruzzello SJ, Landers DM, Hatfield BD, et al. A meta-analysis on the anxiety-reducing effects of acute and chronic exercise: outcomes and mechanisms. Sports Med. 1991;11:143-182.

Saeed SA, Bloch RM, Antonacci DJ. Herbal and dietary supplements for treatment of anxiety disorders. Am Fam Physician. 2007 Aug 15;76(4):549-56. Review.

Setzer WN. Essential oils and anxiolytic aromatherapy. Nat Prod Commun. 2009 Sep;4(9):1305-16.

Singh JS, Hope DA. Cognitive-behavioral approaches to the treatment of social anxiety disorder. Isr J Psychiatry Relat Sci. 2009;46(1):62-9. Review.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992:44-45.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995:309.

van der Watt G, Laugharne J, Janca A. Complementary and alternative medicine in the treatment of anxiety and depression. Curr Opin Psychiatry. 2008 Jan;21(1):37-42.

Volz HP, Kieser M. Kava kava extract WS 1490 versus placebo in anxiety disorders -- a randomized placebo controlled 25 week outpatient trial. Pharmacopsychiatry. 1997;30:1-5.

Wang SM, Kain ZN. Auricular acupuncture: a potential treatment for anxiety. Anesth Analg. 2001;92:548-553.

Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 2009 Dec 2. [Epub ahead of print].