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January 2011



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Treatment Options For Generalized Anxiety Disorder

A little worry is normal, but people who constantly worry about daily concerns, even when times are good, may have generalized anxiety disorder (GAD).

GAD is excessive worry that lasts at least six months and disrupts daily activities, according to the March issue of Mayo Clinic Women’s HealthSource. Typically starting during middle age and more common in older adults, GAD affects an estimated 4 to 7 percent of adults 65 and older and often goes hand in hand with depression or other anxiety disorders, such as phobias.

It’s believed that people with GAD have abnormal levels of brain chemicals that affect the response to stressful or uncertain situations. This overactive fear circuitry in the brain can cause a person to view many situations, even harmless ones, as threats.

Other signs and symptoms of GAD include irritability; inability to relax; difficulty concentrating; muscle aches and headaches; trouble falling or staying asleep; gastrointestinal discomfort or diarrhea; trembling or twitching; sweating, light-headedness or shortness of breath.

Several treatment options are available, but finding relief may take some time. Treatment options include:

Cognitive behavioral therapy: This type of psychotherapy focuses on identifying and changing the thinking patterns that reinforce anxiety or reactions to stressful situations. Short-term treatment usually lasts about 12 weeks.

Medications: Several categories of medications can effectively treat anxiety. Some medications may not be fully effective for up to two months. Often, medications are used in combination with cognitive behavioral therapy. Antidepressants considered for GAD treatment include venlafaxine (Effexor), duloxetine (Cymbalta), paroxetine (Paxil), citalopram (Celexa) and escitalopram (Lexapro). The anti-anxiety medication buspirone (BuSpar) can be effective for GAD and can be taken with antidepressants.

Other medications, called benzodiazepines, may be prescribed for short periods. Options include clonazepam (Klonopin), lorazepam (Ativan) and alprazolam (Xanax).

Self-care: Exercise produces chemical changes that can calm the body and combat anxiety. Meditation, yoga, music and massages promote relaxation and can ease anxiety. Healthy eating, with regular meals and energy-boosting snacks, is helpful, as is avoiding caffeine and nicotine.

Source: Mayo Clinic

View drug information on Celexa; Clonazepam; Cymbalta.

Massage Eases Anxiety, But No Better Than Simple Relaxation Does

A new randomized trial shows that on average, three months after receiving a series of 10 massage sessions, patients had half the symptoms of anxiety. This improvement resembles that previously reported with psychotherapy, medications, or both. But the trial, published in the journal Depression and Anxiety, also found massage to be no more effective than simple relaxation in a room alone with soft, soothing music.

“We were surprised to find that the benefits of massage were no greater than those of the same number of sessions of ‘thermotherapy’ or listening to relaxing music,” said Karen J. Sherman, PhD, MPH, a senior investigator at Group Health Research Institute. “This suggests that the benefits of massage may be due to a generalized relaxation response.”

Massage therapy is among the most popular complementary and alternative medical (CAM) treatments for anxiety, she added. But this is the first rigorous trial to assess how effective massage is for patients with generalized anxiety disorder.

The trial randomly assigned 68 Group Health patients with generalized anxiety disorder to 10 one-hour sessions in pleasant, relaxing environments, each presided over by a licensed massage therapists who delivered either massage or one of two control treatments:

  • *Relaxation therapy: breathing deeply while lying down

  • *Thermotherapy: having arms and legs wrapped intermittently with heating pads and warm towels
All three treatments were provided while lying down on a massage table in a softly lighted room with quiet music. All participants received a handout on practicing deep breathing daily at home. Unlike the two control treatments, massage was specifically designed to enhance the function of the parasympathetic nervous system and relieve symptoms of anxiety including muscle tension.

Using a standard rating scale in interviews, the researchers asked the patients about the psychological and physical effects of their anxiety right after the 12-week treatment period ended and three months later, Dr. Sherman said.

All three of the groups reported that their symptoms of anxiety had decreased by about 40 percent by the end of treatment – and by about 50 percent three months later. In addition to the decline in anxiety, the patients also reported fewer symptoms of depression and less worry and disability. The research team detected no differences among the three groups; but the trial did not include a control group that got no treatment at all.

“Treatment in a relaxing room is much less expensive than the other treatments (massage or thermotherapy), so it might be the most cost-effective option for people with generalized anxiety disorder who want to try a relaxation-oriented complementary medicine therapy,” Dr. Sherman said.

The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, funded this study.

Dr. Sherman’s co-authors were Senior Investigator Daniel C. Cherkin, PhD, Assistant Investigator Andrea J. Cook, PhD, Senior Research Associate Evette J. Ludman, PhD, and Project Manager Rene Hawkes of Group Health Research Institute; Peter P. Roy-Byrne, MD, and Susan Bentley, DO, of the University of Washington; and Marissa Z. Brooks, MPH, LMP, of Portland State University and private practice.

Rebecca Hughes
Group Health Cooperative Center for Health Studies

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