What is Anxiety?
There is a difference between experiencing "normal" anxiety and having generalized anxiety disorder (GAD).
One study found that lesbian and bisexual women may have a higher prevalence of GAD than heterosexual women.1 A survey of households throughout the United States found that individuals who reported 1 or more same-sex partners in the past 5 years experienced higher rates of mental disorders, including anxiety and mood disorders.2
Given the stresses of modern life, it is normal to experience occasional anxiety. However, people with GAD suffer from persistent worry and tension that is much worse than the anxiety most people experience from time to time. The high level or chronic state of anxiety associated with GAD can make ordinary activities difficult or even impossible.
The main symptom of GAD is an exaggerated or unfounded state of worry and anxiety, occurring more days than not for at least six months, about a number of events or activities, which may include such everyday matters as health, money, family, or work. Although people with GAD may realize that their anxiety is excessive or unwarranted, they are unable to simply "snap out of it"-for them, the mere thought of getting through the day can provoke anxiety.
The persistent worry characteristic of GAD is hard to control, and interferes with daily life. Many GAD sufferers seem unable to relax, and may startle easily. In addition, GAD is often accompanied by physical symptoms, such as fatigue, headaches, and muscle tension.
GAD does not appear suddenly; it develops over time. To be diagnosed with GAD, you must have had anxiety more days than not for at least 6 months. The anxiety must also be associated with at least 3 of the following symptoms:
- Restlessness or feeling keyed up or on edge
- Fatigue
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Difficulty falling or staying asleep, or restless unsatisfying sleep
- Symptoms will vary from person to person, and you don't need to have all the above symptoms in order to have GAD.
- GAD can be difficult to diagnose. Some patients with GAD first decide to go to see their physicians because of stress-related complaints such as headaches or problems sleeping.
Depression and GAD Often Coexist
Depression often is accompanied by anxiety, and it is not uncommon for depressed people also to be diagnosed with GAD. Similarly, GAD occurs with or without depression. The symptoms of these disorders often overlap, and you may suffer from one, the other, or both.
If you think you may have GAD, take the GAD Self-Screener a simple, anonymous test you can complete in the privacy of your own home. Based on your results, you may want to make an appointment with a doctor or healthcare provider to discuss your answers so your condition can be diagnosed properly.
References: 1. Cochran SD, Sullivan JG, Mays VM. Prevalence of mental disorders, psychological distress, and mental services use among lesbian, gay, and bisexual adults in the United States. J Consult Clin Psychol. 2003;71:53-61 2. Gilman SE, Cochran SD, Mays VM, et al. Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey. Am J Public Health. 2001;91:933-939.
IMPORTANT SAFETY INFORMATION: Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Antidepressants increased the risk of suicidality (suicidal thinking and behavior) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of antidepressants in children, adolescents or young adults must balance the risk to clinical need. Patients of all ages started on antidepressant therapy should be closely monitored and observed for clinical worsening, suicidality or unusual changes in behavior, especially at the beginning of therapy or at the time of dose changes. This risk may persist until significant remission occurs. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Lexapro is not approved for use in pediatric patients.
Lexapro is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs), pimozide (see DRUG INTERACTIONS: Pimozide and Celexa), or in patients with hypersensitivity to escitalopram oxalate. As with other SSRIs, caution is indicated in the coadministration of tricyclic antidepressants (TCAs) with Lexapro. SSRIs and SNRIs (including Lexapro) and other psychotropic drugs that interfere with serotonin reuptake may increase the risk of bleeding events. Concomitant use of aspirin, NSAIDs, warfarin and other anticoagulants may add to the risk. Patients should be cautioned about these risks. SSRIs and SNRIs have been associated with clinically significant hyponatremia. Elderly patients or patients taking diuretics or who are otherwise volume-depleted appear to be at a greater risk. Discontinuation of Lexapro should be considered in patients with symptomatic hyponatremia and appropriate medical intervention should be instituted. The most common adverse events with Lexapro versus placebo (approximately 5% or greater and approximately 2x placebo) were nausea, insomnia, ejaculation disorder, somnolence, increased sweating, fatigue, decreased libido, and anorgasmia.
