As of Tuesday, December 17, 2013
DEAR DOCTOR K: I worry a lot. Should I be worried that I worry too much?
DEAR READER: I’m a little worried that you’re worrying about worrying. But only a little.
Anxiety (worry) can be a healthy response to uncertainty and danger. But constant worry and nervousness may be a sign of a condition called generalized anxiety disorder (GAD).
GAD is characterized by debilitating worry and agitation about nothing in particular or anything at all. In contrast, other types of anxiety disorders, such as specific phobias, arise from particular situations. For example, some people become suddenly very worried if they see a spider — any spider, not just a black widow or a tarantula.
People with GAD tend to worry about everyday matters. They can’t shake the feeling that something bad will happen and they will not be prepared. They may worry to excess about missing an appointment, losing a job or having an accident. Like you, some people worry about worrying too much.
Physical symptoms are common in people with GAD. They can include a racing heart, dry mouth, upset stomach, muscle tension, sweating, trembling and irritability.
Does this sound like you? If so, see your doctor. He or she will probably ask you to describe exactly what you mean when you say that you feel anxious. Are you worried much of the time? Do you become frightened in particular situations? Do you have physical sensations, such as sweating or palpitations, along with emotional symptoms? The answers to these questions will help your doctor determine whether you have an anxiety disorder, and if so, which one.
As part of the checkup, the doctor will evaluate whether you have depression. That’s because anxiety and depression often coexist. He or she may order tests to check whether your symptoms have a medical cause.
Often a primary care physician will refer you to a psychiatrist or psychologist for a final diagnosis and treatment.
If you have GAD, therapy can help. Cognitive behavioral therapy (CBT) is particularly helpful. CBT helps people recognize when they are misinterpreting events, exaggerating difficulties and making overly negative assumptions. This form of therapy can help you learn new ways to respond to anxiety-provoking situations.
Medications can also be an important part of treatment. There are several widely prescribed anxiety medicines, too many to name in a short column, but the most common types of anxiety medicines are called benzodiazepines.
Doctors commonly prescribe antidepressant drugs to treat anxiety. There are even more anti-depressant medicines than anxiety medicines. They can be particularly effective when a person suffers both from anxiety and depression.
In my experience, many people suffer from GAD. They worry all the time, and it interferes with their lives — but they don’t seek help. I see them among my friends, family and colleagues. When it’s appropriate, I suggest they seek help. They don’t often take my advice. That’s a shame, because treatment really can be effective. So I hope you will seek help to relieve your anxiety.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)