Generalised anxiety disorder (GAD): symptoms, causes and treatment

The NHS describes generalised anxiety disorder as a common mental health condition where you often feel very anxious about lots of different things. Most people feel anxious sometimes, and the NHS says it does not always mean you have GAD: it is more likely to be GAD if you feel anxious most of the time and it affects your everyday life.

The NHS notes there are other types of anxiety disorder and it is common to have more than one at the same time, for example panic disorder, with sudden attacks of anxiety and panic, or phobias, with an overwhelming fear of something specific.

The NHS says the main symptom of GAD is feelings of stress or worry that affect your daily life and are difficult to control. Other symptoms may include the following.

• Difficulty sleeping.

• Feeling restless, irritable or finding it difficult to concentrate.

• Getting tired easily.

• Feeling tense.

• Stomach problems.

• A more noticeable or unusual heartbeat (palpitations).

• Feeling lightheaded or dizzy.

• Low mood or depression.

The NHS says to see a GP if you think you might have GAD, or if you have been diagnosed with GAD and treatments are not helping.

The NHS says to get advice from 111 or ask for an urgent GP appointment if you need urgent help for your mental health, and you can call 111 and select the mental health option. Call 999 or go to A&E now if someone's life is at risk, for example if they have seriously injured themselves or taken an overdose, or if you do not feel you can keep yourself or someone else safe. The NHS also points to Samaritans, a free listening service.

The NHS says treatment can help you manage your symptoms, but it may take time. A GP will usually advise you to try talking therapies before they prescribe medicine or refer you to a specialist. NICE guideline CG113 sets out a stepped-care approach in which the least intrusive, most effective intervention is offered first.

NICE says that if a person with GAD chooses drug treatment, an SSRI should be offered, and sertraline should be considered first because it is the most cost-effective. If it is ineffective an alternative SSRI or an SNRI is offered, and if SSRIs or SNRIs cannot be tolerated, pregabalin may be considered. NICE says a benzodiazepine should not be offered except as a short-term measure in a crisis, and an antipsychotic should not be offered in primary care.

The NHS says antidepressants usually take 1 to 2 weeks to start having an effect and can take up to 8 weeks to work fully, and that if prescribed you will usually take them for at least 6 months after you feel better. SSRIs are usually the first type prescribed because their side effects are generally easier to manage. If you are finding side effects hard to manage, the NHS says to talk to your doctor.

The NHS suggests things you can try yourself if you have GAD. It says not to focus on things you cannot change, not to avoid situations that make you anxious (building up slowly instead), to limit caffeine, which can disrupt sleep and make anxiety harder to control, and not to use alcohol, cigarettes, gambling or drugs to relieve anxiety.

• Talk about your feelings to a friend, family member, health professional or counsellor.

• Use recommended self-help therapies, such as books, online tools or courses.

• Learn calming breathing exercises or try activities such as yoga or pilates.

• Try to get enough sleep, exercise regularly and eat a healthy diet with regular meals.

• Try CBT-based self-help techniques from NHS Every Mind Matters.

The NHS says GAD does not usually have an obvious cause, but some things can increase your chances of having it. It also says GAD is more common in women than men.

• Having another anxiety disorder, such as panic disorder or social phobia.

• Having close relatives with anxiety disorders, depression or other mental health conditions.

• A history of stressful or traumatic experiences, such as domestic violence, child abuse or bullying.

• A painful long-term health condition, such as arthritis.

• A history of drug or alcohol misuse.

The NHS says a GP will ask you some questions about your worries and physical symptoms, and that it is important to be honest even if it is difficult to talk about your emotions. NICE says clinicians should consider the diagnosis in people presenting with anxiety or significant worry, and that assessment should consider distress and functional impairment as well as the number, severity and duration of symptoms.

The NHS lists the features a GP looks for, including worrying about a wide range of things, anxiety affecting daily life, difficulty controlling feelings and feeling anxious a lot of the time for at least 6 months.

The NHS says if you are pregnant or have given birth within the last 12 months, your midwife, doctor or health visitor can also help you get support. NICE says to follow the Medicines and Healthcare products Regulatory Agency (MHRA) safety advice on pregabalin in pregnancy, so any medicine in pregnancy should be discussed with your doctor.

The NHS page on GAD is about adults aged 18 and over, and it directs parents to separate information about anxiety disorders in children. This site also has a guide to anxiety in children.

On the NHS, you can refer yourself to a talking therapies service (if aged 18 or over) or see a GP, who can arrange therapy, medicines or referral to a community mental health team. Waiting times vary by area.

Some people choose private therapy to start sooner. The NHS says you can find an accredited CBT therapist on the UK CBT register. It is sensible to tell your GP so that medicines and monitoring stay joined up.