Generalised Anxiety Disorder
Persistent, excessive worry that interferes with daily life.
Overview
Generalised anxiety disorder (GAD) involves excessive worry on most days for at least six months, with physical symptoms (tension, fatigue, poor sleep). Effective treatment combines psychological therapy (CBT) and, when needed, SSRI medication.
Symptoms
- • Persistent worry
- • Restlessness
- • Muscle tension
- • Difficulty concentrating
- • Sleep disturbance
- • Palpitations and breathlessness during panic
Risk factors
- • Family history
- • Childhood adversity
- • Chronic illness
- • Substance use
- • Female sex
Causes
- • Genetic vulnerability
- • Stressful life events
- • Chronic stress
- • Underlying medical conditions (e.g. hyperthyroidism)
🚨 Red flags — seek urgent care
- • Thoughts of self-harm or suicide — urgent
- • Severe panic with chest pain — exclude cardiac cause first
When to seek care
- • Symptoms interfering with work or relationships
- • Use of alcohol or substances to cope
Diagnosis
- • GAD-7 score to screen and grade severity (≥10 moderate, ≥15 severe)
- • Clinical interview using DSM-5/ICD-11 criteria — excessive worry on most days for ≥6 months with somatic features
- • Exclude medical mimics: hyperthyroidism, arrhythmia, phaeochromocytoma, substance use
- • Screen for comorbid depression (PHQ-9) and alcohol use (AUDIT)
Treatment
- • Stepped care: psychoeducation and self-help → low-intensity CBT → high-intensity CBT or medication
- • First-line drug: SSRI (sertraline preferred) or SNRI (venlafaxine, duloxetine); review after 2–4 weeks
- • Second-line: pregabalin; benzodiazepines only short-term in crisis
- • Lifestyle: sleep hygiene, regular exercise, reduce caffeine, mindfulness
Prevention
- • Early intervention for childhood anxiety and trauma
- • Resilience-building, social connection, sleep regularity
- • Limit alcohol, caffeine and stimulant use
- • Workplace mental-health support and stress management
Complications
- • Depression, suicidality
- • Substance misuse
- • Reduced occupational and social functioning
- • Cardiovascular risk and chronic pain
Education & self-care
This guidance is reviewed by Dr. Handel Emery, MD, FRCP (UK) and last updated 2026-06-08. It is educational and not a substitute for professional medical advice.
Frequently asked questions
Are SSRIs addictive?
SSRIs are not addictive but should be tapered slowly to avoid discontinuation symptoms.
Does therapy or medication work better?
Cognitive behavioural therapy (CBT) and SSRIs/SNRIs have similar effectiveness for most anxiety disorders. Combining them often gives the best results, especially in moderate-to-severe presentations.
Are benzodiazepines safe to use long-term?
No. They lose effect within a few weeks and carry significant dependence, falls and cognitive risks. Guidelines recommend they be used only for short crises (under 4 weeks).
Will exercise really help?
Yes — regular aerobic activity has a moderate antidepressant and anxiolytic effect comparable to a low-dose SSRI in mild-to-moderate anxiety, and improves sleep and resilience.