Generalized Anxiety-Causes, Symptoms and Treatment Approaches
- Victoria Wermers, RN,MSN,FNP, PMHNP
- Nov 15, 2024
- 11 min read
Updated: Aug 5
Generalized Anxiety: Causes, Symptoms, and Treatment Approaches
Anxiety is everywhere these days. Our environment is saturated with stress—from social and political tension to environmental challenges—and it’s taking a toll on our mental and physical health.
How Anxiety is Defined
Anxiety symptoms are, generally, a stress response. According to the DSM-5 (the official publication of psychiatric diagnoses), anxiety is diagnosed when:
It causes clinically significant distress and
Symptoms are NOT due to another condition, substance, or disorder.
Anxiety is “excessive worry and apprehension that occurs more days than not for at least six months about many events or activities.”
In addition, it is usually worry, focused on future outcomes or concerns, associated with a feeling of a lack of control or predictability. The trigger can be concrete (real), it can be perceived (an imagined situation or source), or it can be a random, free-floating (no known cause). Common features include uneasiness, tension, fear, or dread. Symptoms can range from mild to severe and debilitating.
Anxiety places both physical and mental demands on a person, resulting in mental anguish, often accompanied by physical manifestations:
Common Symptoms of Anxiety
Excessive worry
Restlessness
Irritability
Trouble concentrating
Tense muscles and headaches
Unexplained stomach problems like pain or discomfort, nausea, and sometimes diarrhea
Frequent urination
Hyperventilation, Numbness,, and tingling of extremities (often with hypoventilation)
Excessive sweating
Social isolation
Chronic pain including arthritis and fibromyalgia
Co-occurring depression and other mental health issues
Often-occurring substance abuse (self-treatment)
Suicidal ideation or attempt(s)
Weight gain or loss
Psoriasis and other skin problems
Understanding the Brain's Role in Anxiety: The Physiological and Neurological Response in Anxiety
Like many mood problems, the "feeling" and symptoms of anxiety are caused by variations in the neurochemical imbalances and impulses within the brain. Anxiety isn't about lacking willpower - it's about neurologic and chemical processes gone awry. Perhaps you have probably been in a frustrating situation where you or someone else was seriously anxious. It frustrates you because no matter how much you say “buck up” or “pull yourself up by the bootstraps,” it does not work - it is more frustrating because it simply cannot do that no matter how hard a person tries. You feel like that person has no backbone, but they do. Understand this: No one chooses to be anxious.
The following is a basic and brief discussion of current ideas in research about neurologic function in anxiety. This overview supports the broader topic of generalized anxiety: causes, symptoms, and treatment approaches. This information is provided to give you an elemental understanding of the complex process of anxiety, of the many things that can go wrong in the brain to cause anxiety, and how therapies and modern medicine help target those problems.
If you are not interested in what happens to your brain during generalized anxiety, feel free to skip down to the section below, "General Causes of Anxiety)
Stress and anxiety responses are functions of the prefrontal cortex and the limbic system in the brain. The neurologic transmissions go from sensation to reaction essentially by way of neurons (nerve cells) and neurotransmitters (chemicals that connect the neurons) in the following basic steps:
Initially, our senses - sight, smell, hearing, touch, and taste - initiate a signal in our brain via nerve cells and neurotransmitters:
Most of these impulses travel to the amygdala and/or thalamus (except smell, which is the only sense processed directly by the amygdala). The thalamus is the gatekeeper that sends information either to the cerebral cortex (to think things through) or the amygdala (major "fight or flight" emotional processing center).
If it goes to the cortex, a person thinks through further action, but if it is sent to the amygdala, the response is an immediate fight-or-flight/fear response that transmits neuronal impulses to the hypothalamus. At the same time, sometimes the amygdala might also send neurotransmission to the prefrontal cortex for consideration of further action in a threat.
The hypothalamus alerts the thyroid and adrenal glands, both of which unleash a cascade of neurotransmitters and hormones (epinephrine, norepinephrine, estrogen, testosterone) into the body. These chemicals are basically responsible for heart rate, hunger, blood pressure, glucose control for energy, sleep, respiratory rate, and temperature, among other things. It does this to prepare the mind and body to respond to potential dangers.
When done processing, both the amygdala and cortex send the information to the hippocampus, which is responsible for storing/retrieving memory, learning, and connecting memories to emotion.
Serotonin (a "happy' neurotransmitter) and dopamine (excitatory or inhibitory neurotransmitter) also have roles in emotional regulation of the amygdala.
Looking at all the pathways and responses in this complex process, it is not surprising that there are so many places where alterations can take place: Many neurons and neurotransmitter pathways can run amuck and cause anxiety: Problems with the thalamus (gatekeeper), the amygdala (emotion center), the hippocampus (where memories are made) the hypothalamus (triggers chemicals in fight or flight) and cerebral cortex (where thoughts are processed), the adrenal gland function, the actual neurons (nerve cells) or neurotransmitters (chemicals) that connect the neurons like bridges. Problems can also arise with the release and/or concentration of hormones epinephrine and norepinephrine.
Overall, most researchers label anxiety as an "overactive limbic system," but lots of things can affect that. For example:
Abnormal structure of neurons-caused by neurodegenerative diseases, substance abuse, genetic mutations, and even hormonal changes like those experienced with nutritional deficiencies, during pregnancy, menopause, and infection.
Others cite the cause as a possible misdirection of these neuronal impulses: Neurons and neurotransmitters, as well as certain hormones, can cause misdirection of an impulse; It gets off track.
If the amygdala sends an impulse to the prefrontal cortex and the latter does not respond with proper judgment because of damaged neurons, or altered neurotransmissions the limbic system can be affected.
If there is not enough GABA (the calming neurotransmitter) in the emotion-processing amygdala, there is nothing to calm it down: It becomes overactive and causes anxiety or there is too much glutamate (an excitatory neurotransmitter).
Prefrontal (cortex inhibition due to axon destruction and neurotransmission problems caused by chronic stress. This causes mismanagement of emotions: An inability to down-regulate emotional responses (i.e., anxiety).
Increased (chronic) length and intensity of stressors cause an increase in stress hormones, and catecholamines/neurotransmitters like epinephrine and norepinephrine. An increase in these in the hippocampus can cause negative development of nerve cells, which can cause learning and memory problems. Learning and memory dysfunction is known to impact mental health (anxiety or depression).
PTSD: It has been noted that in PTSD, there is a decreased size of the amygdala, increased activity of the amygdala (excitability), and decreased medial prefrontal volume.
Studies suggest that extreme or chronic stress can become a general anxiety disorder sometimes because perpetual or inordinate bombardment of stress hormones (cortisol, epinephrine, and norepinephrine) can actually damage the amygdala and disturb neurotransmission (change usual neural pathways). The result is generalized anxiety disorder and/or depression over time (as most people know, those who have one of these disorders- depression and anxiety, tend to go hand-in-hand). Amygdala dysfunction can cause a number of other mental health problems as well.
In essence, most researchers currently believe that anxiety is a disturbance in the neurons and neurotransmitters within the limbic system (the area of the brain that processes emotions) , and to a lesser degree, the frontal cortex (the area of the brain that gives us reasoning). So next time you tell someone to "buck up," remember - it is not that easy.
Can We Change the Patterns of Our Neurotransmission to Go in More Functional Directions?
One of the relatively newer and exciting concepts in neuroscience and mental health is that of neuroplasticity. From testing (MRIs), it has become clear that we all develop certain neural pathways in our brains that become ingrained because we use those pathways over and over again. This is particularly important in treatment: The brain can be rewired or retrained to take new, more functional pathways.
General Causes of Anxiety - Causes of Neurologic Disruption
Brain development - Vitamin B12, folic acid, and fatty acid deficiencies may contribute to neurodevelopmental problems that result in anxiety later in life. Maternal stress can also alter the neuronal development in the limbic system of the fetus,
Brain damage - Traumatic Brain Injury, Alzheimer's, temporal lobe epilepsy, chronic stress, lack of oxygen, among others. These problems can negatively impact neurons and neurotransmitters in the limbic area.
Diet - Vitamin B12 and extreme vitamin D deficiency can cause many psychiatric symptoms, including anxiety.
Genes - According to NIH, anxiety has a genetic heritability of 31.6%. Of course, many other environmental factors can come into play that can exacerbate or protect a person from anxiety.
Early family life - Interestingly, there are a lot of familial factors that can affect the amygdala (as well as other brain structures and connections). This, in turn, can contribute to anxiety as well as depression. Children exposed to chronic conflict, communication problems, rigid expectations, financial stress, parental abuse or neglect, divorce or separation, sibling rivalry, trauma or major life transitions, inconsistent or over-parenting, are all at risk for neurologic changes that lead to anxiety. The quality of care a child receives in their early years, including warmth, love, responsiveness, and consistency, plays a critical role in shaping the development of the limbic system.
Social and Relational Environment - Bullying, mental and/or physical abuse.
Chronic Stress/Trauma
Sleep Deprivation Causes an increase in cortisol, which can interfere with the prefrontal regulation of the amygdala
Age (risk factor)
Toxic Environmental Issues - Toxins can affect neurotransmitters and neural pathways in the limbic system: Carbon dioxide, chronic exposure to formaldehyde, lead, ozone, and organophosphate pesticides .
Treatments for Anxiety
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The fact that there are many different approaches to improving anxiety is good because not everyone will respond to one approach and not everyone will like the same approach. In serious cases, medication along with therapy is the best way to go but, again, not all people care for one or the other.
General Approaches to Anxiety
First of all, you want to try to attack this early, especially if it is increasing
Identify and acknowledge your feelings if you can
Staying in the present - in the moment
Relaxation and meditation exercises play a big role in reducing feelings of stress and anxiety. It is hard to think of two things at once so, often if you are focusing on your body, it will not allow your thinking to go to your mental state.
-Deep breathing exercises - These help release endorphins in your brain, which are "feel-good" hormones. This technique is practiced by taking a deep breath through your nose, using your diaphragm muscle located just beneath your lower ribs (instead of using neck, shoulder, and upper chest muscles), pausing and then releasing the breath, through your mouth. Repeat this several times.
-Progressive muscle relaxation techniques: This is done by tightening muscle groups for eight seconds then relaxing them for several seconds: Begin with facial muscles, with the face, moving to the scalp - tighten muscles eight seconds, then relax; then the neck, doing with each muscle group of the chest, back, pelvis, extremities and so on. This releases some tension and stress. If you do not have time to move through all of your muscle groups, do this with those muscles you believe have the most tension.
Mindfulness (which reportedly helps the fronto-limbic area of the brain
areas of the brain - as evidenced by MRIs),
Meditate
Yoga
Read self-help books
Find social support - Engage with family, friends, or groups
(even online)
Eat a healthy diet and exercise. Both of these factors may be involved in developing new
neuroplastic patterns - necessary in "re-forming" your thoughts and changing your anxious thoughts into more functional ones.
Journaling may help promote emotional awareness and help a person process their thoughts and feelings.
Do things you enjoy - or that you have enjoyed in the past.
Do something different - Attend a concert, go to a ball game.
Avoid alcohol and drugs (these are often a means of self-medication that are used by those who do not want to deal with therapy or other medications for mental health. Substances often turn out to have harmful physical and neurological effects over time.
Get enough sleep
Get Counseling. Sometimes we get into a rut and our brain keeps circulating the same anxious messages over and over age. Counseling can help you "retrain" your brain to take other pathways and learn other patterns; it can to see things from a different perspective. Some of these approaches include:
CBT - Cognitive behavioral therapy DBT - Dialectical Behavioral Therapy
ERT - Emotion Regulatory Therapy
EMDR (this is a really unusual treatment that involves repetitive eye movement patients report often helps). Among other things, it decreases activity in the amygdala (especially for trauma).
If you are not interested in traditional therapy or medications, and wish to approach this from a more philosophical standpoint there is a practice called Reiki which helps a person internalize positive energy, drawing from positive natural forces. For some, Reiki promotes mental, physical healing and overall wellbeing. There are people especially trained in this.
Poetry in a pill? For those looking for a unique source of comfort and emotional support, I was recently introduced to "poetry in a pill". A person can order capsules online that contain poetry focused on a particular mood.
Limit or avoid the news - try going tech-free for a while (a "digital detox"). Focus, instead, on the good things in life around you.
Focus on what you can do, instead of things you cannot do.
Over-the-Counter Approaches to Anxiety
There are no over-the-counter commercial treatments for anxiety, except that an antihistamine might help a person feel more relaxed (and sedated).
Benadryl/diphenhydramine as directed over the counter
Considered Alternative and Herbal Approaches to Anxiety
Kava kava
Aromatherapy (especially lavender, chamomile, and others)
5-HTP
Prescriptive Treatments for Anxiety
The following medications can work well alone, but usually work best if used in conjunction with therapy -
Barbiturates and benzodiazepines increase GABA, which calms activity in the amygdala (it also works in other areas of the brain, but the amygdala is the area of focus here). These work very well for significant episodes of anxiety but are also potentially very addictive and, because of this, should not be used on an ongoing or daily basis.
SSRIs - Selective serotonin reuptake inhibitors (common: Celexa/citalopram, Lexapro/escitalopram, Prozac/fluoxetine, Luvox/fluvoxamine, Paxil/paroxetine, Zoloft/sertraline, Trintellix/vortioxetine). These increase the availability of serotonin neurotransmitters for use in the brain. These work by enhancing cortical (thinking) processes (assists well with therapies). They help decrease excitation in the amygdala (emotion center). excoriation disorder or dermatillomania - skin picking
SNRIs - Serotonin-norepinephrine reuptake inhibitors - (common: Effexor /venlafaxine, Cymbalta/duloxetine, and Pristiq/desvenlafaxine). These medications help decrease activity in the amygdala.
Other Antianxiety Medications - Remeron/mirtazapine is used off-label for anxiety (not FDA approved for this problem). This medication actually causes greater production of serotonin in the brain. Buspar/buspirone increases serotonin and decreases dopamine (an excitatory neurotransmitter in the amygdala).
There are many medications and approaches that help with anxiety. If your anxiety is making your life uncomfortable, if it is causing unhappiness or making it hard to function, talk to someone to see if there might be something you can do to help yourself out of that rut.
Problem with Medications?
Are you having side effects? Many anti-anxiety and antidepressants can cause side effects, especially stomach symptoms in the beginning. Typically, these settle down. However, if your side effects are too bad, especially if you start feeling more anxiety or depression, talk to the person who prescribed them (ideally) or another healthcare provider.
The medications don't seem to be helping? It typically takes these medications about two to three weeks to start working well. Don't give up and be sure not to skip any doses (you might end up on an emotional roller coaster ride!). If it continues to be ineffective, you may need an increased dose, an add-on medication, or a switch.
Do you feel blunted? "I don't want to take these medicines. I don't don't seem to feel any emotion". This is a fairly common complaint about antianxiety (and antidepressant) medications. If this is occurring, and you think the loss of feelings is worse than your anxiety, you can have your prescriber change your medication to one that works in a different way, or you can try some therapy instead.
I feel great, I think I will come off my medications. Not a good idea. Don't just drop off your medication - it's probably helping. Speak to your prescriber about decreasing it slowly so you don't end up in "shock" (too much of an anxiety rebound). I have met a lot of people who just drop off their medications, and they realize how bad they feel without them.
