How to Diagnose and Treat Generalized Anxiety Disorder? - Insights from Dr Sanil Rege (Psychiatrist)

Dr Sanil Rege discusses the diagnosis and management of Generalised anxiety disorder (GAD).

GAD is characterized by persistent feelings of fear and worries about everyday things that are difficult to control. GAD is on average only diagnosed 10 years after onset at which point the patient has gone to the doctors due to comorbid issues such as panic disorder, depression, or chronic pain disorders. Therefore, all patients that are diagnosed with anxiety should be screened for depression as well.

The initial assessment should address behaviour and somatic symptoms; the evaluation of psychosocial stress and developmental issues in the context of past medical history can be used to exclude other organic causes.
As with all disorders across the anxiety spectrum, a pragmatic approach that includes psychoeducation and information on lifestyle factors (e.g. healthy lifestyle choices concerning diet, exercise, and sleep) is encouraged.

SSRIs (e.g. sertraline, paroxetine, and escitalopram) and SNRIs (e.g. venlafaxine and duloxetine) are supported by RCT data to reduce symptoms and remission rates, respectively. 

Clinicians should be aware of the myriad of comorbid disorders that often present with GAD. Evidence suggests psychoeducation and lifestyle changes as well as CBT as the most effective forms of therapy. SSRIs /SNRIs are effective medications that can be considered first-line or if CBT is ineffective.

[jakematt]

Dose anyone feels tired and want to fall asleep but can’t because of the weir feeling in your chest, and whenever you are alone the feeling got worse.

[beep_boop]

Last night I had a panic attack because I was overthinking. I was overthinking and overwhelmed about the idea that I might have anxiety. It seems so strange to me. I also have panic attacks about schoolwork and relationships. The particular thoughts I was having last night were: “What if I have anxiety? How will I tell my parents? What if they think I’m overreacting? How can I tell? I’m probably just self-diagnosing myself.” And then I had a panic attack. My muscles locked up and I couldn’t breathe very well. I also have a tendency to bite my nails and tap my toes in synchronized movements because it calms me. Does this sound like anxiety to you? I’m afraid I’m overreacting. Sorry for the rant, it just felt good to get this off my chest.

[LucidSteve]

Excellent! Your channel is like nothing else on youtube.

[rickr]

This is an excellent video, I watched it several times. Thank you.

[Devlins]

I'm the anxiety and rumination king. Literally. Lol

[Idmoment]

Excellent review. Please consider adding a presentation on common preliminary lab work up for initiating antipsychotics- lithium- Depakote etc. thank you

[archanadeshpande]

Thank you so much Doctor. This video helped in revising my knowledge and bring clarity in certain aspects.

[Boldly_Beautiful]

GAD is killing me slowly.
I need help.

[animaniacs]

Do you have to have racing heart and shortness of breath for it to be considered anxiety?

[sabirmirza]

Hello sir, why do antidepressants cause diabetes if a patient takes them for 2 years or longer

[fuzzlebuzzles]

Some anxiety symptoms are similar to ADHD, how do you tell the difference? Some of the symptoms of anxiety like lack of concentration and fidgeting are similar to symptoms of ADHD.

[arvindahirwar]

Amazing and nice video i love this video

[hfnjufi]

tbh I was expecting something about neuroinflammation, role of the cytokines, microglia inhibitors and etc in GAD, but nothing. This information could be really useful in many treatment-resisting GAD cases.

[pritamshil]

Sir, can physical pain tolerance and mental pain tolerance give psychological strength and power?

[annaberg]

I have GAD and can't take medications. I'm dying slowly

[BoredT-Rex]

As you mentioned anxiety and depression can be secondary to mdd and gad, but could it be plausible to diagnose both disorders mdd and gad at the same time?

[joierm]

Hello dr...i have severe GAD and my psychiatrist gave me SSRI(escitalopram) and SNRI(cymbalta) together.When i took it my body really went down..the side effects are horrible and all sensations in body really scarry..im more aggitated and more panics.my BP went down 70/35.i called my doctor and tell him and he told me to double my dose of cymbalta..im more scared and discontinue my meds and didnt go back to him.im taking benzo at this time.i felt hopeless😔

[jocs]

How do SNRIs work for anxiety as noradrenaline is high in that condition isn't it?

[orsolyalazar]

Do these anxieties / worries need to be specific? In other words, should the person know what they are worried about? Or can it just be a "feeling" that takes over, without a specific worry.

[parvezmujawar]

Scared of talking, mind going blank infront of people, irratated by smell, and always thinking that people are staring at you are these related to mental health??