anxiety disorder? The cause is not clear. The condition often develops for no apparent reason. Various factors may play a part. For example: Your genetic 'makeup' may be important (the material inherited from your parents which controls various aspects of your body). Some people have a tendency to have an anxious personality, which can run in families. Childhood traumas such as abuse or death of a parent, may make you more prone to anxiety when you become older. A major stress in life may trigger the condition. For example, a family crisis or a major civilian trauma such as a toxic chemical spill. But the symptoms then persist when any trigger has gone. Common minor stresses in life, which you may otherwise have easily coped with, may then keep the symptoms going once the condition has been triggered. Some people who have other mental health problems such as depression or schizophrenia may also develop GAD. How is generalised anxiety disorder diagnosed? If the typical symptoms develop and persist then a doctor can usually be confident that you have GAD. At the moment, guidelines suggest the diagnosis should be made if you have had your symptoms for six months but new guidelines are about to be published (DSM-5) which suggest that the diagnosis should be made if you have had your symptoms for a month. It is sometimes difficult to tell if you have GAD, panic disorder, depression, or a mixture of these conditions. Some of the physical symptoms of anxiety can be caused by physical problems which can be confused with anxiety. So, sometimes other conditions may need to be ruled out. For example: Drinking a lot of caffeine (in tea, coffee and cola). The side-effect of some prescribed medicines. For example, selective serotonin reuptake inhibitor (SSRI) antidepressants. An overactive thyroid gland. Taking some street drugs. Certain heart conditions which cause palpitations (uncommon). Low blood sugar level (rare). Tumours which make too much adrenaline and other similar hormones (very rare). What is the outlook (prognosis)? Although GAD gets better in some people, in others it tends to come and go. Some people need to take medicines for a long time but are otherwise able to lead perfectly normal lives. Symptoms may flare up and become worse for a while during periods of major life stresses. For example, if you lose your job or split up with your partner. People with GAD are more likely than average to smoke heavily, drink too much alcohol, and take street drugs. Each of these things may ease anxiety symptoms in the short term. However, addiction to nicotine, alcohol or drugs makes things worse in the long term,and can greatly affect your general health and well-being. What are the treatment options? TALKING TREATMENTS AND OTHER NONDRUG TREATMENTS Cognitive behavioural therapy Cognitive behavioural therapy (CBT) is probably the most effective treatment. It probably works for over half of people with GAD to reduce symptoms and improve quality of life. Cognitive therapy is based on the idea that certain ways of thinking can trigger or fuel certain mental health problems such as anxiety. The therapist helps you to understand your current thought patterns – in particular, to identify any harmful, unhelpful and false ideas or thoughts which you have that can make you anxious. The aim is then to change your ways of thinking to avoid these ideas. Also, to help your thought patterns to be more realistic and helpful. Therapy is usually done in weekly sessions of about 50 minutes each, for several weeks. You have to take an active part and are given homework between sessions. For example, you may be asked to keep a diary of your thoughts which occur when you become anxious or develop physical symptoms of anxiety. Behavioural therapy aims to change any behaviours which are harmful or not helpful. For example, with phobias your behaviour or response to the feared object is harmful and the therapist aims to help you to change this. Various techniques are used, depending on the condition and circumstances. As with cognitive therapy, several sessions are needed for a course of therapy. CBT is a mixture of the two where you may benefit from changing both thoughts and behaviours. (Note: cognitive and behavioural therapies do not look into the events of the past. They deal with and aim to change, your current thought processes and/or behaviours.) Counselling In particular, counselling that focuses on problem-solving skills may help some people. Anxiety management courses These may be an option if they are available in your area. Some people prefer to be in a group course rather than have individual therapy or counselling. The courses may include learning how to relax, problem-solving skills, coping strategies and group support. Self-help You can get leaflets, books, tapes, videos, etc on relaxation and combating stress. They teach simple deep-breathing techniques and other measures to relieve stress and help you to relax. They may ease anxiety symptoms. There are also websites offering self-help advice, treatment and support on the internet. – eg Fearfighter© (see Further Reading, below). See separate leaflet called Stress and Tips on How to Avoid it. MEDICATION Antidepressant medicines These are commonly used to treat depression but also help reduce the symptoms of anxiety even if you are not depressed. Research trials suggest that antidepressants can ease symptoms in over half of people with GAD. They work by interfering with brain chemicals (neurotransmitters) such as serotonin which may be involved in causing anxiety symptoms. Antidepressants do not work straight away. It takes 2-4 weeks before their effect builds up. A common problem is that some people stop the medicine after a week or so, as they feel that it is doing no good. You need to give them time to work. Antidepressants are not tranquillisers and are not usually addictive. There are several types of antidepressants, each with various pros and cons. For example, they differ in their possible side-effects. However, SSRI antidepressants are the ones most commonly used for anxiety disorders. The two SSRIs licensed to treat GAD are escitalopram and paroxetine. Other antidepressants that have been found to help include venlafaxine and duloxetine. Note: after first starting an antidepressant, in some people the anxiety symptoms become worse for a few days before they start to improve.