Generalized anxiety disorder

Audience: Patients and providers
Status: Clinical guide · patient + provider
Last updated: 2026-03-09

1. Clinical overview

Generalized anxiety disorder is persistent, difficult-to-control worry accompanied by physical and cognitive symptoms that often affects sleep, concentration, and daily function.

2. Common causes and risk factors

Persistent excessive worry with physiologic hyperarousal.
Often coexists with depression, trauma history, substance use, or sleep disorders.

3. Typical symptoms

Restlessness, tension, irritability, concentration/sleep disturbance, somatic symptoms.

4. Diagnosis and evaluation

Confirm diagnosis with guideline-based history, exam, and indicated testing.
Screen for severity, complications, and high-risk comorbid conditions.
Identify social or access barriers that could affect treatment success.

5. Treatment (non-pharmacologic)

CBT-based skills, mindfulness, sleep hygiene, caffeine/alcohol reduction.
Structured coping plan with exposure and relapse-prevention principles.

6. Treatment (pharmacologic)

First-line maintenance options commonly include escitalopram, sertraline, paroxetine, venlafaxine XR, or duloxetine.
Buspirone, hydroxyzine, pregabalin, or selected adjunctive approaches may fit the symptom profile and comorbidity pattern.
Benzodiazepines such as lorazepam or clonazepam should be limited in duration and used cautiously because of dependence, sedation, and fall risk.

7. Monitoring and follow-up

GAD-7 and functional impact, sedation/cognitive effects, misuse risk where relevant.

8. Practical counseling points

Give patients a clear “what to do today / when to call / when to seek urgent care” plan.
Use teach-back to confirm understanding of treatment goals and medication instructions.
Simplify regimens when possible to improve adherence and outcomes.

9. Red flags and escalation

Escalate care urgently for severe or rapidly worsening symptoms.
Reassess diagnosis if expected response does not occur within the anticipated timeline.

10. Guideline references

Note: Educational guide only; not a substitute for individualized medical care.