Peace of mind: if you always feel anxious and stressed, you may have Generalized Anxiety Disorder. Here's how to reclaim a sense of calm

Natural Health, Dec, 2007 by Ben Kallen

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TWO WEEKS after the World Trade Center was destroyed, Lisa Miller (a pseudonym) began experiencing intense anxiety symptoms. "I went to work, and though I was functional, I was constantly exhausted," the 39-year-old finance manager recalls. "I'd get an anxious thought in my head, and it would get out of control and trigger a panic attack." She eventually left New York for a new job near Durham, N.C., hoping to find calm in a new setting--but the anxiety followed her.

While almost everyone feels anxious from time to time, when you worry excessively for six months or more, you may be suffering from Generalized Anxiety Disorder (GAD). Other symptoms can include difficulty relaxing or sleeping, fatigue, headaches, muscle tension, irritability, sweating, nausea, light-headedness, frequent bathroom trips, feeling out of breath, and even hot flashes. R also can be associated with social phobia, depression, or substance abuse. While experts believe GAD may have a genetic component or stem from childhood fears or restrictive parents, the symptoms can be triggered by trauma--like many New Yorkers at the time, Miller felt profoundly affected by the attacks of 9/11--or a difficult life event such as a divorce or a death in the family.

Anxiety is usually accompanied by a heightened state of arousal--the nervous system is constantly over-activated, even when there's no external reason for it. "In the presence of a threat, your body will naturally click into the fight-or-flight response," notes Jeffrey Brantley, M.D., founder and director of the Mindfulness-Based Stress Reduction Program at Duke University's Center for Integrative Medicine in Durham, which offers an eight-week stress-reduction course. "Your body can't tell if the threat is outside or inside your head. So if you have a threatening story going on in your own mind, your body will go into the same fear reaction, and you'll feel anxious."

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GAD affects almost 7 million Americans--and around twice as many women as men. (This may be because of interactions between sex hormones and brain chemistry, or because women are more likely to have suffered abuse as children.) And a study published earlier this year at the Indiana University School of Medicine by Kurt Kroenke,

THE ANXIETY DRUGSTORE

If your symptoms feel overwhelming or are impairing your ability to function, you may need to complement natural treatments with prescription medications. The following drugs are currently available.

SELECTIVE SEROTONIN REUPTAKE INHIBITORS

(SSRIs) are antidepressants that increase brain levels of the calming neurotransmitter serotonin. They include Prozac (fluoxetine), Lexapro (escitalopram), and Zoloft (sertraline). "Depression and anxiety often go together, and SSRIs can be effective for both," says Mark Goulston, M.D., a psychiatrist in Los Angeles and author of Post-Traumatic Stress Disorder for Dummies (For Dummies, 2007). Side effects, which are often temporary, can include stomach upset, sleep problems, weight gain, and sexual dysfunction.

TRICYCLIC ANTIDEPRESSANTS (TCAs) such as Tofranil (imipramine) and Elavil (amitriptyline) are also prescribed for anxiety. They affect a wider range of neurotransmitters than the newer SSRIs but may cause more side effects and are usually prescribed for people who don't tolerate SSRIs well.

BETA-BLOCKERS prevent adrenaline and noradrenaline from stimulating the sympathetic nervous system, resulting in a slower pulse and lower blood pressure. Originally used to treat heart problems, they're now prescribed for occasional anxiety and post-traumatic stress disorder, as well as for stage fright and performance anxiety. Side effects can include dizziness or a tendency toward depression.

BENZODIAZEPINES such as Xanax (alprazolam) and Ativan (Iorazepam) are minor tranquilizers that slow the nervous system by modulating gamma-aminobutryic acid (GABA) receptors, and they're frequently prescribed for serious anxiety. While benzodiazepines are very effective, they can be addictive.

BUSPIRONE (sold as BuSpar and other brands) affects serotonin, dopamine, and possibly other neurotransmitters in the brain. It works more slowly against anxiety than benzodiazepines, but it's less likely to cause side effects or addiction. Side effects can include dizziness or nausea.

HERBAL REMEDIES can provide short-term help for mild anxiety but haven't proven effective against GAD. However, if you're uncomfortable taking pharmaceuticals and your doctor doesn't think prescription drugs are necessary, herbs may be helpful in conjunction with other therapies. (Be sure to discuss with your doctor any herbs or supplements you choose to take--they can cause unwanted effects or interact with drugs.) To deal with symptoms of anxiety, Edmund J. Bourne, Ph.D., recommends valerian, passionflower, chamomile, and theanine, the relaxing component in green tea. While there have been questions about the safety of kava, modern supplements made from only the root are safe for occasional use, according to Bourne.