Questions about Generalized Anxiety Disorder, Answered by a Healthcare Provider

Everyone experiences anxiety from time to time. If a stranger approaches you at an ATM, you should feel some anxiety. If you are hiking and spot a bear, you will probably feel some anxiety. It’s a feeling or nervousness or unease about an event where the outcome may be uncertain.

Emotions, like anxiety, are typically short-lived. However, in some, anxiety can become persistent, causing fret and worry even with no real reason at all.

According to the Anxiety & Depression Association of America, anxiety disorders are the most common mental illness in the United States, affecting 40 million adults every year. There are several types of anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, specific phobias, social anxiety disorder, and separation anxiety disorder.

This month is Mental Health Awareness Month, a national movement to raise awareness about mental health. In observance of this month, Andora Nicholson, a family nurse practitioner with the Iredell Physician Network, answers a few questions about generalized anxiety disorder, including the stigma around anxiety and treatment options.

Q: At what point does anxiety start to become a problem?
A: If you find yourself worrying on most days and for longer than six months, you might be experiencing Generalized Anxiety Disorder (GAD). However, some folks can worry on most days for longer than six months and not have GAD. Some examples of this might be if you have a loved one going through cancer treatment or if your workplace has been sold to a new owner, and there are many elements of that transition that are unknown. However, situations like this can actually trigger GAD.

Other things that can trigger GAD include chronic disease or illness, such as having kidney disease and being on dialysis. Prolonged financial worries or relationship difficulties like going through a divorce can also trigger GAD. If you’re going through a similar situation, are anxious on most days, and begin to fret about things you would not have typically worried about in the past, or things that really don’t warrant being anxious, you may have GAD.

Anyone of any age can suffer from GAD, including young children. A child that has been raised in heavy neglect or abuse is certainly eligible for GAD. However, the average age of onset for GAD is around 30 years. Women, for reasons we still don’t fully understand, will suffer from GAD almost twice as often as men.

Q: What are the symptoms of GAD?
A: Symptoms of GAD include fretting, worrying, and being anxious on most days for a prolonged period of time. Feeling anxious about things that do not warrant anxiety or fretting over things that you would not have been anxious about in the past can be a significant sign of GAD. Often, this dynamic is pointed out to you by a family member or friend. GAD symptoms vary from person to person, and you may not experience every symptom.

Other symptoms of GAD may include sleeping difficulties, being tremulous or shaky, being tense, and holding your breath often or feeling as if you can’t catch your breath. Headaches, unusual irritability, hot flashes, lightheadedness, nausea, fatigue, trouble concentrating or getting tasks completed, and generally not being able to relax are also possible symptoms of GAD.

Q: Can you explain the stigma around anxiety disorders?
A: I often compare mental health to heart health for my patients. Most of us have a basic understanding of illness or disorders like heart disease. The heart may be affected by cholesterol issues or high blood pressure, and if these things are not controlled, you may end up having a heart attack or heart failure. The organ in your body that is responsible for your feelings, including emotions like anxiety, is the brain, and just like your heart and every other organ in your body, it can malfunction. The brain performs thousands, if not millions, of jobs for you every day, and regulation of emotions is only one of them.

It’s important to understand this because most issues related to mental health, like GAD, unfortunately, carry a stigma from our culture, which pushes folks to avoid treatment. In our society, if someone is experiencing crushing chest pain, most people would say, “Go to the ER!” or “Let’s call for help now!” However, people can be experiencing crushing pain or disability from their brain, in the form of a disorder like GAD, and there are too many of us that will still inappropriately respond with “Get a grip” or “Just deal with it.”

This is particularly true for men, who have been given the very unfair stereotype that it is somehow weak or less than masculine to acknowledge brain-related conditions like GAD or depression. Nothing could be further from the truth. If you have ruptured your bicep tendon, you are most likely going to seek care or even have surgery. If emotional regulation in your brain is causing you to suffer from unreasonable anxiety, keeping you from being the best partner or parent you could be, affecting your ability to get out and socialize with family and friends the way you used to, affecting your work, or even just keeping you uncomfortable in your own skin, your brain deserves comprehensive, effective treatment just like your bicep tendon, heart, or any other part of your body.

Q: Do you have a metaphor or comparison that would help better explain GAD to people who may not understand it?
A: A model I use to help explain GAD to my patients is to imagine that your brain is living every day, walking along a path. Life is happening. Signs or things come up along the path. Some signs or events may make your brain stop walking, taking a few minutes to read or look at what has shown up, digesting it. Eventually, your brain will make a decision, “This is OK, keep going,” “I’m going to go slower or take some care around this thing,” or “I’m going to take a different path.”

In circumstances of extreme anxiety, the brain has safety mechanisms. I liken them to rabbit holes beside the path, which you may dive down in response to something truly anxiety provoking. At times, going down the rabbit hole is appropriate and protective. In GAD, the brain is too quick to go down the rabbit hole. Minor events or situations that don’t deserve that degree of reaction will elicit a quick protective response, and with GAD, this is often an overdone or not appropriate response. Unfortunately, in GAD, the longer this goes on, the more firmly entrenched our “rabbit hole response” will become.

Q: Many medical problems worsen if left untreated. Is the same true for GAD?
A: Yes, it is crucial to recognize GAD early and to treat it robustly and comprehensively. Most folks are not going to feel well living a “rabbit hole response” life. People who live with untreated GAD may eventually have other brain dysfunctions, such as mood disorders, like depression. Other parts of health interact in poor ways with GAD as well, including cardiovascular health, gastrointestinal health, and others. If you think you have GAD, it is very important for many reasons to seek treatment.

Q: Should you seek help if you suspect you have GAD?
A: If you think you may have GAD, you should seek the help and evaluation of a healthcare provider — a nurse practitioner like myself, a doctor, or a physician assistant. Other medical conditions can mimic GAD, like hyperthyroidism or PTSD, and need to be ruled out. Some medications have a side effect of anxiety and need to be looked at, including over-the-counter supplements and products.

If you are drinking alcohol heavily or using illegal substances, it is very important to share this with your provider as they can either induce symptoms similar to GAD, or you may be, even unknowingly, attempting to treat symptoms of GAD yourself. Your healthcare provider will also review your family history, as GAD can run in families. GAD, like many health-related conditions or illnesses, is part environment and part genetics.

Q: Will someone with GAD always have anxiety?
A: People’s experiences with GAD vary. Some struggle on and off throughout their lives, and some people fight a near-constant battle with anxiety. Rarely will someone experience one episode of GAD in their life and never experience it again. Most of us with GAD need to own that diagnosis permanently. You may have repeat episodes of worsened or more intense symptoms throughout your lifetime. When you talk about your health history with a new healthcare provider, GAD should be in the list along with things like high blood pressure and acid reflux.

Again, this isn’t a moral failing or weakness. It’s the recognition of owning a particular brain that, when stressed, even for no reason, may not work for us in the best ways possible. Recognizing this allows us to intervene quickly when flares or exacerbations of GAD come along. It’s even possible to look forward and begin to recognize certain circumstances that will be tough for your brain, and make plans to help your brain move through those situations in ways that are healthier and more productive.

Q: How is GAD treated?
A: The good news is that GAD is treatable. In medicine, we speak of treatment modalities, which is simply different methods of treating a health problem. Most people respond best if they are treated with multiple methods. The same treatment methods that work for many health issues also work for GAD.

If someone has high blood pressure, that is not severe, it is reasonable to take 3-6 months and use non-pharmaceutical methods to try and improve their blood pressure. The same is true for GAD. Exercise does a world of good for the brain. In fact, when you go to the gym, the very most important thing you are doing is treating your brain. Aerobic activities, in particular, help the brain in regards to managing emotions and related moods.

Getting adequate sleep is also critical for good brain function. While you sleep, the brain does massive amounts of work to restore and heal your brain for the next day. Adults need 7-8 hours a night of good sleep. Children, including teenagers, need even more sleep for good brain function.

What you eat is important for brain function too. Have a lunch full of simple carbs (white bread, white rice, sugars, and white potatoes) and your brain is going to be feeling this a couple of hours later.

If you hurt a muscle, you may go to rehab or therapy. The brain responds to rehab as well, typically as counseling. In counseling, we can take out that hurting brain and begin to re-work and process issues that are contributing to GAD in ways that are healing. In therapy for your brain, you can learn methods that help your brain reshape the way it responds to situations more appropriately, learning how to avoid the automatic “rabbit hole” response. The brain responds beautifully to methods that help it quiet down, such as mindfulness and meditation. These are techniques anyone can learn with a little practice. We’ve also learned that the anxious brain responds well to time in green spaces, so getting outside, particularly if you can be quiet and disconnect, even for a few minutes, is helpful.

Many people that seek care with me want to avoid medications in treating their brain. To a degree, this can be OK – we never want to use a medication we don’t need, so in milder degrees of GAD, we may be able to use the non-medication treatment methods to resolve symptoms. However, in more severe GAD, medication can be a total game-changer. In the end, I tell my patients that it’s not correct to weigh taking a med for GAD versus not taking a med for GAD. What’s better is to weigh how life feels with GAD and no medication versus living life with well-controlled GAD using a well-curated medication safely. The difference between those two situations can be night and day. It may take some work to find a medication that works for you, at a good dose for you, but it is worth discussing and considering with your healthcare provider.

Q: Is there anything else you would like to add about GAD?
A: Like most disorders or illnesses humans suffer from, GAD occurs across a spectrum of intensity. People can have GAD with milder symptoms, which is relatively easy to treat. Others, unfortunately, may have severe symptoms with GAD, which can bring about intense, difficult and even fatal outcomes. If you think you have GAD and have had any thoughts of harming yourself, please reach out immediately to your healthcare provider, the national suicide hotline by calling 988, or even a family member or friend. Regardless of how mild or severe your GAD symptoms are, please know that there is help and things can be better.

Nicholson is the corporate wellness provider for Iredell County employees. If you are an Iredell County Government employee, dependent, or retiree, you can schedule an appointment with Andora Nicholson, FNP, by calling 704-878-3065.