Overview
Definition
Excessive, uncontrollable, and often irrational worry about everyday things that is disproportionate to the actual source of worry.
Epidemiology
Lifetime prevalence ~5%. Twice as common in women.
Etiology & Risk Factors
- Biological (dysregulation of GABA and serotonin systems), genetic predisposition, and environmental/psychological factors (chronic stress, trauma).
Clinical Symptoms
- Excessive worry occurring more days than not
- Restlessness or feeling on edge
- Easily fatigued
- Difficulty concentrating (mind going blank)
- Irritability
- Muscle tension
- Sleep disturbance
Clinical Approach
Diagnosis
- DSM-5 Criteria: Excessive worry for ≥ 6 months about various domains (work, school, health, family)
- Must have ≥ 3 of the somatic symptoms listed above
- Must cause significant distress or impairment
Management
- First-line Pharmacotherapy: SSRIs (e.g., Escitalopram, Paroxetine) or SNRIs (Venlafaxine, Duloxetine)
- First-line Psychotherapy: Cognitive Behavioral Therapy (CBT)
- Short-term bridge therapy: Benzodiazepines (e.g., Clonazepam) can be used short-term while waiting for SSRIs to take effect (due to high addiction potential)
- Buspirone (a non-habit-forming anxiolytic) as an adjunct
Complications
- Severe impairment in occupational/social functioning
- High comorbidity with Major Depressive Disorder (MDD) and substance abuse