Generalized anxiety disorder: symptoms, treatment, prognosis and prevention.

Generalized anxiety disorder is a chronic mental disorder whose main manifestation is persistent anxiety over a long period of time. There is an important feature of the anxiety that arises - it is nonspecific, that is, it is not aimed at any one reason, any one unfavorable factor. Anxiety may gradually increase or is always at approximately the same level.

Sometimes anxiety disappears completely; such moments are called remission of an anxiety disorder. Unfortunately, remission is observed only in every fourth patient. In addition to anxiety, there are also external manifestations of generalized anxiety disorder: tension in the facial muscles, frowning eyebrows, trembling in the body, abdominal discomfort, pale skin, increased sweating of the palms, legs and armpits. Two thirds of all patients continually experience symptoms of this mental disorder every day for three years or longer. Such rather painful experiences weaken the body, and in some cases, against the background of debilitating symptoms, manifestations of depression and suicidal thoughts arise.

Usually, it is when a depressive picture of the disease occurs that patients seek medical help, since they lose the ability to independently control their emotional experiences.

Mixed anxiety and depressive disorder

• Mixed anxiety-depressive disorder is a rather controversial phenomenon, and not all existing diagnostic classifications include it. It is not that its existence is not recognized, and it is sometimes considered a depressive disorder with secondary anxiety characteristics rather than a single disorder.
• Mixed symptoms of anxiety-depressive disorder include anxiety and depression, but neither is clearly predominant. Neither is each of sufficient intensity to justify a separate diagnosis.
• The disorder presents with a mixture of relatively mild symptoms that are seen quite frequently in primary care, and its prevalence is high in the general population.
• The combination of depressive and anxiety symptoms causes significant impairment in the affected person's functioning.

IMPORTANT! However, those who oppose this diagnosis argue that the presence of this diagnosis prevents clinicians from distinguishing true depressive disorders from true anxiety disorders and takes away the time needed to obtain a complete psychiatric history of the patient.

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When is mixed anxiety-depressive disorder diagnosed?

To diagnose it, it is necessary to record the presence of low-intensity symptoms of anxiety and depression. In addition, there should be some autonomic symptoms such as tremors, palpitations, dry mouth and abdominal pain.

Please note: Some preliminary research has shown that mixed anxiety-depressive disorder is rarely diagnosed by general practitioners. However, it is possible that this lack of recognition only reflects the lack of an appropriate diagnostic label for these patients.

Anxiety-depressive disorder symptoms

• The clinical manifestations of this disorder combine symptoms of anxiety disorders and symptoms of depressive disorders.
• In addition, symptoms of autonomic nervous system overactivity, such as gastrointestinal discomfort, are common. This is why patients often seek medical help first.

DSM - criteria for mixed anxiety-depressive disorder

• The Diagnostic and Statistical Manual of Mental Disorders (DSM) puts forward a number of criteria for diagnosing this disorder. However, as we already mentioned, this is for research purposes only.
• An essential characteristic of this disorder is persistent or recurrent dysphoria (decreased mood) that lasts for at least 1 month. This condition is accompanied by additional symptoms of the same duration, including at least four of the following:

- Difficulty concentrating or memory, sleep disturbances, fatigue or lack of energy.

- Acute irritability.

- Permanent and intense anxiety.

- Increased tearfulness or feelings of hopelessness, pessimism about the future, worthlessness and low self-esteem.

- Increased vigilance, anticipation of danger.

These symptoms cause significant clinical discomfort or impairment in social, work, or other important activities.

• On the other hand, mixed anxiety-depressive disorder should not be diagnosed when symptoms are due to direct physiological effects of certain substances or other medical conditions. Or if the person has at any time been diagnosed with major depressive disorder, persistent depressive disorder, anxiety disorder, or generalized anxiety disorder.
• This diagnosis is also inappropriate if criteria for any other anxiety or mood disorder are simultaneously met, even if they are in partial remission.
• It is also necessary that the spectrum of symptoms cannot be consistent with another mental disorder. Much of the primary information about this disorder comes from primary care centers, where the disorder is more common and likely also has a higher prevalence among outpatients.

General information

Generalized anxiety disorder (ICD-10 code: F41.1) is a mental disorder . They are focused on a large number of situations and objects. The main manifestation is general free-floating, stable anxiety , which is caused not by certain phenomena or situations, but by various internal worries and premonitions. Usually accompanied by somatic manifestations, whereas, for example, panic attacks have a paroxysmal nature.
Anxiety is a normal reaction - a physiological emotional response of the central nervous system to situations of possible threat and danger, but when upset it manifests itself in the form of nervousness, trembling, muscle tension, sweating, palpitations, dizziness and discomfort in the celiac plexus. In addition, the symptoms can be supplemented by obsessive, depressive, phobic symptoms, causing paralysis of the will, and therefore they talk about other types of anxiety-psychological disorders. They are usually secondary and less dangerous.

Anxiety-depressive disorder with panic attacks

Very often, anxiety-depressive disorder is accompanied by panic attacks. First, let's figure out what panic attacks are?

These are sudden attacks of fear and anxiety, which are accompanied by symptoms characteristic of stress or fear. Symptoms of a panic attack:

• Dizziness and lightheadedness
• Tachycardia
• Feeling of depersonalization
• Excessive sweating
• Feeling of suffocation, “lump in throat”, difficulty inhaling or exhaling
• Pain behind the sternum, in the heart area
• Nausea, diarrhea, stomach pain
• Fear of dying or going crazy, doing something scary, for example, jumping off a roof, throwing yourself in front of a car

A panic attack is usually a natural result of increased anxiety. When a person is in a tense, depressed state for a long time, the psyche cannot stand it and goes into a tailspin, and the person experiences an acute sense of panic. A panic attack itself does not last long (usually no longer than 10 minutes) and is not dangerous to health, however, it is such a traumatic event that a person is afraid of its repetition, and subconsciously or consciously begins to avoid the events, places, circumstances where the panic attack occurred.

Having a panic attack further aggravates anxiety and depression, thus creating a vicious circle when anxiety reinforces panic and vice versa. And everything together gets worse and prevents the person from functioning normally, anxiety becomes a constant emotional background that accompanies the patient every day, and panic attacks occur with some increasing frequency.

Pathogenesis

Anxiety disorders are a fairly common phenomenon in modern society. Constant stress, psycho-emotional stress, exposure to the media, pressure on a person from society, the need to meet standards provoke mental disorders. It all starts with concern and the presence of a slight fear of getting sick, getting into an accident, anxiety for loved ones, which can ultimately develop into a more severe psycho-emotional state.

Subsequently, anxiety becomes a common and persistent symptom. It differs from reactions caused by limited or any other circumstances; it becomes free-floating, the so-called “free-floating”. As a result of the development of the pattern of anxious anticipation, variable symptoms begin to dominate: persistent nervousness, fear, muscle tension, increased sweating , abulia, signs of insanity, dizziness, trembling, tremor and, most often, discomfort in the epigastric region. The greatest symptoms are detected in conditions of a possible accident, the risk of developing the disease in the patient himself or in his relatives in the near future. The development of symptoms can worsen to the point of a panic attack or the development of suicidal ideas, as well as initiate paralysis of the will.

The flow trend is towards undulation and chronification. The mechanism is based on increasing vegetative arousal, as a result of which a person’s concentration on problems and fears narrows, which increases sensitivity to possible sources of danger. Patients may develop abulia as a manifestation of painful lack of will, which is expressed in the absence of desires and motivations for life.

What is the impact of mixed anxiety-depressive disorder?

1. The coexistence of major depressive disorder with an anxiety disorder is very common. Two thirds of patients with symptoms of depression also have overt symptoms of anxiety. One third of these may meet diagnostic criteria for panic disorder.
2. Some researchers report that 20% to 90% of all patients with anxiety disorders have episodes of major depressive disorder. These findings suggest that the coexistence of depressive and anxiety symptoms that do not meet diagnostic criteria for depressive or anxiety disorders is very common.
3. However, there is currently no official epidemiological data on mixed anxiety-depressive disorder. But some researchers have estimated that the prevalence of this disorder in the general population is 10%, although in primary care it becomes 50%. More conservative estimates suggest a prevalence of 1% in the general population.

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Causes of anxiety-depressive disorder

Four lines of research suggest that symptoms of anxiety and depression are associated with the following identified causes.

1. First, several researchers have found similar neuroendocrine causes of depressive and anxiety disorders. They include:

- cortisol response to adrenocorticotropic hormone

- growth hormone response to clonidine

- thyroid-stimulating hormone

- prolactin response to thyrotropin-releasing hormone

2. Second, a number of researchers have presented data that identify hyperactivity of the noradrenergic system as a significant factor in the occurrence of depressive and anxiety disorders in some patients

Specifically, these studies have shown that patients with depressive or anxiety disorders who are actively experiencing an anxiety crisis have high concentrations of the norepinephrine metabolite MHPG in their urine, plasma, or cerebrospinal fluid.

As with other anxiety-depressive disorders, serotonin and GABA may also be involved in the origin of mixed anxiety-depressive disorder.

3. Third, many studies have shown that serotonergic drugs such as fluoxetine and clomipramine are useful in the treatment of both depressive and anxiety disorders.

4. Finally, several family studies have provided evidence suggesting that anxiety and depressive symptoms are genetically transmitted, at least in some families.

Course of the disease and its prognosis

Based on current clinical information, it appears that patients may initially be equally likely to have predominant anxiety symptoms or predominant depressive symptoms, or a proportional mixture of the two.

During the course of the disease, anxiety and depressive symptoms may alternate in their predominance. The prognosis is still unknown.

However, individually, depressive and anxiety disorders tend to become chronic without adequate psychological treatment.

Tests and diagnostics

To make a diagnosis of an anxious mental disorder, it is necessary to identify primary symptoms of anxiety (apprehension, motor tension or autonomic activity) for several days in a row, and more reliably over several months. In addition to consulting a psychiatrist, the patient must undergo a comprehensive health examination to rule out organic anxiety disorder:

• determine the level of hormones and the condition of the thyroid gland;
• conduct tests for toxic substances in the bloodstream;
• determine the regimen and dosage of the medications used.

Treatment of anxiety-depressive disorder

• Because there are no good studies comparing treatments for mixed anxiety-depressive disorders, clinicians tend to prescribe treatment according to presenting symptoms, their severity, and previous experience with different treatments.
• Psychotherapeutic approaches may be used for a short period of time, such as behavioral or cognitive therapy. However, some clinicians use a less structured psychotherapeutic approach such as introspective psychotherapy.

Pharmacological treatment

• Pharmacological treatment of mixed anxiety-depressive disorders is usually carried out with anti-anxiety medications, antidepressants, or both.
• Among anxiolytic drugs, some evidence suggests that the use of triazolobenzodiazepines may be appropriate due to their effectiveness in treating anxiety-related depression.
• Substances that affect the 5-HT receptor, such as buspirone, may also be suitable. Among antidepressants, serotonergic drugs can be very effective in treating mixed anxiety-depressive disorder.

Psychological treatment

In any case, the treatment of choice for these types of pathologies is cognitive behavioral psychotherapy.

• On the one hand, first of all, we are talking about the patient reducing his level of physiological activation. This is achieved through breathing techniques (such as diaphragmatic breathing) and relaxation techniques (progressive muscle relaxation, autogenic training, mindfulness, etc.)
• Secondly, the patient needs to improve his mood. This can be achieved in various ways. Behavioral activation therapy can be very effective in this regard.

Please note: The idea is for the patient to resume his previous level of activity. To do this, the therapist encourages him to perform pleasant actions, either old ones that brought pleasure to the patient before, or by learning something new.

• Thirdly, a period of psychoeducation is useful. During this period, the patient receives an explanation of what is happening to him and why. They will learn some basic concepts about the characteristics of anxiety and depression in order to make sense of their experience.
• Subsequently, it may be necessary to change some beliefs or thoughts that may be fueling the problem. This may be due to cognitive restructuring techniques.

As you can see, mixed anxiety-depressive disorder does not have a specific identity in some diagnostic systems, but it is often encountered in primary care consultations. This is a fairly common occurrence.

This is a disorder that can be cured, but if not treated in time, it can become chronic.

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Is it possible to heal on your own?

Of course, a healthy person, especially one who knows self-regulation techniques, can cope with even severe anxiety, but the difference between an anxiety disorder and just anxiety is that the former is a disease, and a person cannot cope with it on his own. Even if she lets it go for a few hours or days, it will flare up again at any slightest trigger.

Unlike ordinary “healthy” anxiety, the disorder does not have a cause as such, by acting on which you can cope with even very strong emotions. The usual methods that work with healthy people - persuasion, habitual calming actions, communication with loved ones - do not and cannot work on anxiety-depressive disorder. Attempts at relaxation lead nowhere - the person is not able to relax.

Some desperate patients try to self-medicate with strong drugs, and also try to drown out anxiety with drugs or alcohol. But this is a road to nowhere. Drug therapy requires careful selection of drugs and their dosages, as well as constant monitoring of their use, since most of them have a wide range of side effects and cause withdrawal syndrome when trying to abruptly abandon them or change the dosage/switch to another drug.

Alcohol and drugs themselves are strong depressants, and while bringing temporary short-term relief, they only tighten the spiral of anxiety and depression. And to an anxiety-depressive disorder, a person risks adding alcohol or drug addiction, which requires separate specific treatment.

IMPORTANT! Self-medication of anxiety-depressive disorder, like most other mental or physical illnesses, is unacceptable.

Forecast

An anxiety disorder is diagnosed when persistent anxiety has been present for six months. In this state, the patient is already quite immersed in his fears and worries, most often leading an antisocial lifestyle, for example, refusing to go to work, so it is very important to receive psychological help in a timely manner.

Thanks to long-term drug therapy, it is possible to stop the main manifestations, but a person “on drugs” is deprived of many joys and opportunities. Most likely, it will be questioned whether, with a diagnosis of generalized anxiety disorder, it is possible to work intellectually, control complex mechanisms, as well as a car. Much better results can be achieved using modern methods and psychotherapy sessions, in most cases through fruitful work on internal problems and yoga classes. Other relaxation techniques have a good effect; this gives a person a chance to return to a full life.

Prevention of anxiety-depressive disorder

As with many illnesses, anxiety and depression should be prevented. To do this, you need to learn the basics of self-regulation, prevent or try to reduce the impact of stress on your body. Here are general common tips for preventing any psychological problems, including anxiety-depressive disorder:

1. Balanced diet.
2. Physical activity.
3. Compliance with work and rest schedules.
4. Quitting bad habits (smoking, alcohol abuse, drug addiction).
5. Good dream
6. Using relaxation techniques. Mental hygiene
7. Working with a psychologist: it is important to get rid of negative thinking patterns and stress in a timely manner

All of these tips will also be useful in the process of treating an already diagnosed anxiety disorder. It is very important to follow the recommendations of your doctor. It must be remembered that the effect of anti-stress and antidepressant therapy can be observed gradually, over 2-3 weeks. At the same time, a healthy lifestyle will help you prevent the disease or cope with it faster if it has already occurred, as well as prevent relapses in the future.

Very important

your active participation in treatment. Remember, the success of treatment depends only on you and your attitude towards your own health. Be healthy!

The information presented in this material is for informational purposes only and does not replace professional advice from a physician. If you notice signs of depression, consult a specialist!

Author: Editorial staff of the Help-Point.net portal