GAD

Everyone experiences anxiety as a normal reaction to threatening, dangerous, uncertain, or important situations. Psychiatric medicine classifies anxiety as normal or pathological. Normal anxiety can enhance some people’s function, motivation, and productivity, such as the person who works well under pressure. People with generalized anxiety disorder (GAD) experience pathological anxiety, which is excessive, chronic, and typically interferes with their ability to function in normal daily activities. Generalized or "free-floating" anxiety is distinguished from phobia because it is not triggered by a specific object or situation.
Incidence and Prevalence
GAD affects 4,000,000 to 5,000,000 people in the United States. The chance that any given person in the United States will develop it over a lifetime is estimated at 8% to 9%. More than 10% of people seen in anxiety treatment clinics are diagnosed with GAD, which affects more women (60%) than men (40%).
Because perceptions and descriptions of anxiety differ among cultures, it is hard to assess the global prevalence of anxiety disorders. Many people in the United States who are diagnosed with GAD claim to have been nervous or anxious their whole lives. Eastern societies, on the other hand, perceive and treat anxiety differently, as something associated with pain.

Risk Factors
There are biological and environmental risk factors for GAD, which include the following:
Environmental stressors (e.g., work, school, relationships)
Genetics
Sleep deprivation, sleep inconsistency
Stressful situations in the following areas can intensify symptoms:
Financial concerns
Health
Relationships
School problems
Work problems
Research has shown a 20% risk for GAD in blood relatives of people with the disorder and a 10% risk among relatives of people with depression. There also seems to be a correlation between GAD and other psychiatric disorders, including depression, phobia disorder, and panic disorder. Anxiety is a risk factor for sleep disorders such as insomnia.

Causes

GAD is associated with irregular levels of neurotransmitters in the brain. Neurotransmitters are chemicals that carry signals across nerve endings. Neurotransmitters that seem to involve anxiety include norepinephrine, GABA (gamma-aminobutyric acid), and serotonin.
Norepinephrine is concentrated in the locus ceruleus (nerve cluster that lies near the brain’s fourth ventricle). Increased activity in the locus ceruleus is associated with anxiety, and decreased activity in the locus ceruleus diminishes anxiety. Increased levels of GABA and serotonin seem to reduce anxiety. All of these neurotransmitters interact during heightened anxiety.

There are several widely used approaches to the treatment of GAD. A great number of patients suffering from GAD are treated by pharmacological means, mostly with benzodiazepines, azapirones (buspiron), less with tricyclic antidepressants (Lader, 1994; Andrews, 1990; Swinson, Cox, & Fergus, 1993). Few outcome studies investigating chronic treatment with anxiolytics exist. They generally show that anxiolytics are relatively efficacious in acute management of GAD (Rickels, Wiseman, Norstadt et al., 1983; Schweizer & Rickels, 1991). However, the relapse rate is very high, especially with benzodiazepines, often exceeding 50% (Brown et al., 1994; Rickels & Schweizer, 1990).

Some studies have also demonstrated that in treatment of GAD, anxiolytics failed to show superior efficacy when compared to placebo (Brown et al., 1994). Moreover, benzodiazepines have a number of side effects. The most prominent short-term side effects are sedation, impairment of cognitive and psychomotor functioning and in some cases aggressive behavior. In the long-run, memory may be affected (Lader, 1994). In addition to the limited efficacy of the benzodiazepine treatment, there is a potential danger of developing dependency, resulting in rebound anxiety due to a discontinuation of medication (Rickels et al., 1986; Petursson & Lader, 1981; Solomon & Hart, 1978). It is thus not surprising that demand exists for alternative treatment options, expressed by not only the patients themselves but also by the media and epidemiologists who stress the potentially excessive prescribing of anxiolytics and sleep medication to patients suffering from excessive anxiety.