Generalized Anxiety Disorder


Generalized anxiety disorder (GAD) is one of the most common anxiety disorders, and is characterized by excessive worry about activities and life events. GAD can interfere with daily functioning personal relationships, and often causes significant distress. At TMS & Brain Health, we offer personalized treatment plans for individuals struggling with GAD that include alternative treatment options like ketamine, TMS, and neurofeedback.

What is Generalized Anxiety Disorder (GAD)?

GAD is a mental and behavioral disorder that is defined as ongoing and consistent worry about events and activities in everyday life. Most people have worries about life events, but with GAD worry is described as uncontrollable, excessive, or irrational. Individuals may be consumed with concern over everyday matters such as health, finances, relationships, work, or family. Anxiety associated with GAD can cause significant distress and interfere with one's ability to function to carry out daily activities.

Signs and Symptoms of Generalized Anxiety Disorder


Generalized anxiety disorder can cause a wide variety of mental, emotional, and physiological symptoms. To be diagnosed with GAD (according to the DSM-5), symptoms must occur most days for at least six months, and must include:

  • Excessive anxiety or worry involving multiple concerns
  • An inability to manage worries
  • At least three of the following symptoms: irritability, difficulty concentrating, muscle tension, restlessness, fatigue, trouble sleeping
  • Significant distress in functioning
  • Symptoms not caused by a substance use disorder, medical condition, or prescription medication

Specific symptoms from GAD can vary widely; the ICD-10 lists a different set of symptoms for the disorder that fall into a number of different categories.

Autonomic arousal symptoms: sweating, trembling or shaking, dry mouth, palpitations or heart pounding

Chest and abdomen symptoms: difficulty breathing, chest pain or discomfort, nausea, feeling of choking

Brain and mind symptoms: feeling faint, dizzy, or light-headed, derealization or depersonalization, fear of dying, fear of losing control, passing out, or going crazy

General symptoms: cold chills or hot flashes, tingling or numbing sensations

Tension symptoms: restlessness, inability to relax, muscle tension, pains, or aches, feeling on edge, difficulty with swallowing or a sensation of a lump in the throat

Everyone’s experience with anxiety is different; individuals can experience many different combinations of symptoms that can be caused by generalized anxiety disorder.

Risk Factors for GAD

The specific causes of GAD are not well understood, but there are several potential risk factors that can increase one's likelihood for developing generalized anxiety disorder, including:

Genetics: GAD is thought to have a significant hereditary component. The disorder can run in families, and first-degree relatives of an individual with GAD are more likely to develop the disorder themselves. Studies suggest the genetic component accounts for only 30-40% of development causes.

Stressful life events: Traumatic events, such as abuse, loss of a loved one, or a major life change, can increase the risk of developing GAD.

Personality: People who are naturally more anxious or who have a tendency to worry excessively may be more at risk for GAD.

Other mental health conditions: People with other mental health conditions, such as depression or substance abuse, may be at increased risk for developing GAD.

Medical conditions: Certain medical conditions, such as chronic pain or a hormonal imbalance, may increase the risk of GAD.

Substance abuse: Substance abuse, particularly the abuse of alcohol or stimulant drugs, can increase the risk of developing GAD.

It is important to note that these risk factors do not necessarily cause GAD and that many people with these risk factors do not develop the disorder.

Comorbidity with Depression


Generalized anxiety disorder is often comorbid with major depression. In fact, research shows that over half of individuals diagnosed with GAD also meet diagnostic criteria for depression. There are several potential reasons for the high comorbidity between GAD and depression. Both conditions may have a genetic component, and they may also share common risk factors, such as a history of trauma or abuse. In addition, the excessive worry and anxiety associated with GAD can lead to feelings of hopelessness and despair, which are common symptoms of depression. With mental health treatment, it’s important to address all symptoms and treat the whole individual rather than just the disorder.

Treatment Options for Generalized Anxiety Disorder


Individuals with generalized anxiety disorder have many treatment options. The conventional treatment for GAD is a combination of medication and therapy. Anti-anxiety drugs or antidepressants should relieve your symptoms so that you can focus on exploring and resolving your fears and developing coping strategies in therapy.

The most commonly used therapy to treat GAD is cognitive behavioral therapy, or CBT. CBT involves working with a therapist to identify and modify negative thought patterns and behaviors that contribute to anxiety. It involves identifying and challenging negative thoughts, learning coping skills and relaxation techniques, and gradually exposing the person to their feared situations in a controlled way. Other therapies used to treat generalized anxiety disorder include:

Acceptance and commitment therapy (ACT): ACT focuses on helping people to accept their thoughts and feelings without judgment, and to take action towards their values and goals.

Mindfulness-based therapy: This involves learning mindfulness techniques, such as meditation and deep breathing, to help a person focus their attention on the present moment and reduce anxiety.

Interpersonal therapy (IPT): IPT focuses on helping a person to improve their relationships and communication skills.

Exposure therapy: This therapy involves gradually exposing a person to their feared situations in a controlled way in order to help them overcome their fears.


Standard medication options for GAD include:

Selective serotonin reuptake inhibitors (SSRIs): SSRIs work by increasing levels of the neurotransmitter serotonin in the brain, which can help to reduce anxiety. Examples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).

Serotonin-norepinephrine reuptake inhibitors (SNRIs): SNRIs work by increasing levels of both serotonin and norepinephrine in the brain, which can help to reduce anxiety. Some common SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta).

Benzodiazepines: These medications work by calming the central nervous system, which can help to reduce anxiety. Examples of benzodiazepines include lorazepam (Ativan) and clonazepam (Klonopin).


Standard medication doesn’t always work the way it’s expected to, or you might experience intolerable side effects. At TMS & Brain Health, we offer a number of alternative treatment options for relieving anxiety:

Transcranial magnetic stimulation (TMS): TMS is a non-invasive brain stimulation treatment that uses magnetic pulses to stimulate neural activity. It was approved by the FDA for the treatment of depression in 2008, and there is a growing body of research that suggests TMS is effective in treating anxiety as well. During TMS treatment, some people may experience a knocking sensation or sensitivity on their scalp, as well as a mild headache that typically goes away within a few hours. At TMS & Brain Health, we offer Express TMS, a specialized form of TMS that can be completed in just a few minutes per session.

Ketamine: Ketamine is a medication that is being increasingly used as a treatment for depression and anxiety. It is known for its unique ability to promote neuroplasticity and cause lasting changes in brain chemistry, which can lead to transformative change and long-term symptom relief. In 2019, the esketamine nasal spray (called Spravato) became FDA-approved. At TMS & Brain Health, we offer a range of ketamine treatment methods, including infusions, Spravato, intramuscular shots, and rapid-dissolve tablets.

Neurofeedback: Neurofeedback, or biofeedback, is a non-invasive process that uses real-time feedback to help a person learn to self-regulate their brain activity. It involves measuring brain waves using sensors placed on the scalp, and then providing feedback to the person through a visual or auditory display. The person is then able to learn to control their brain activity by making changes to their thoughts and behaviors in response to the feedback. A number of studies have shown that neurofeedback is a promising treatment option for generalized anxiety disorder.

TMS & Brain Health Helps You Overcome Anxiety


At TMS & Brain Health, we begin with a comprehensive evaluation to learn about your symptoms, lifestyle, and overall health. Then, after we diagnose your condition and understand your needs, we create a personalized treatment plan to relieve your symptoms and help you manage your negative thoughts. Our treatment plans can include a number of traditional therapies and group therapies, as well as treatment alternatives like TMS, ketamine, and neurofeedback.

If anxiety is disrupting your quality of life, call TMS & Brain Health or request a consultation online today.

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TMS & Brain Health is not a healthcare provider and does not render any psychiatry or other medical services, including but not limited to TMS, Ketamine, or Neurofeedback. IOP services are rendered through a separate, affiliated entity. Rather, TMS & Brain Health performs administrative services for various psychiatrists and/or psychiatry and/or medical practices.  Further, this website does not provide medical advice, diagnosis, or treatment. More information can be found at our disclaimer page.