How to treat gad
Generalized anxiety disorder - Care at Mayo Clinic
Generalized anxiety disorder care at Mayo Clinic
Experience
Mayo Clinic's highly skilled experts in psychiatry and psychology services treat more than 7,000 people each year with generalized anxiety disorder.
Team approach
Mayo Clinic experts in psychiatry and psychology services use a team approach to evaluate and diagnose anxiety disorders. Compassionate psychiatrists, psychologists and other mental health professionals listen patiently to thoroughly understand your concerns, health issues and experience with anxiety to create a treatment plan suited to your needs.
Innovative care design
Mayo Clinic mental health experts work within the primary care clinics to provide evidence-based psychological and medication treatments for anxiety disorders. Social workers, psychologists, psychiatrists and nurses work collaboratively with primary care teams to improve access to effective anxiety treatments.
Unique, successful program for children and teens
The Pediatric Anxiety Disorders Clinic at Mayo Clinic's campus in Minnesota is dedicated to the care of children and teens. The clinic provides advanced, evidence-based psychological and medical treatment for anxiety disorders. Parents are thoroughly involved in their children's diagnosis and treatment sessions from beginning to end. This treatment teaches children skills to manage their anxiety and teaches parents to effectively provide support.
Integrating practice and research
Mental health professionals are studying ways to improve the effectiveness of behavioral treatments for anxiety disorders within the primary care setting. The clinicians in the Pediatric Anxiety Disorders Clinic at Mayo Clinic's campus in Minnesota are conducting cutting-edge research into the treatment of childhood anxiety disorders and using that knowledge to deliver the highest quality care.
Top ranked
Mayo Clinic in Rochester, Minnesota, is ranked as one of the top psychiatry hospitals in the nation by U.
S. News & World Report.
Expertise and rankings
Outstanding ranking
Mayo Clinic in Rochester, Minnesota, is ranked as one of the top psychiatry hospitals in the nation by U.S. News & World Report.
Innovative care approach
Mayo Clinic mental health experts work within the primary care clinics to provide evidence-based psychological and medication treatments for anxiety disorders. Social workers, psychologists, psychiatrists and nurses collaborate with primary care teams to improve access to effective anxiety treatments.
Unique, successful program for children and teens
The Pediatric Anxiety Disorders Clinic at Mayo Clinic's campus in Minnesota provides special expertise in diagnosing and treating children and teens. The clinic provides advanced, evidence-based medical and psychological treatment for anxiety disorders.
New developments in the evaluation and treatment of anxiety
The Mayo Clinic research team has developed Mayo Clinic Anxiety Coach, an iPhone, iPad and iPod Touch app for anxiety management in children.
Researchers also developed an electronic assessment system for evaluating pediatric psychiatric symptoms.
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Treatment - Generalised anxiety disorder in adults
Generalised anxiety disorder (GAD) is a long-term condition, but a number of different treatments can help.
If you have other problems alongside GAD, such as depression or alcohol misuse, these may need to be treated before you have treatment specifically for GAD.
Psychological therapies for GAD
If you have been diagnosed with GAD, you'll usually be advised to try psychological treatment before you're prescribed medication.
You can get psychological therapies like cognitive behavioural therapy (CBT) and applied relaxation on the NHS.
You can refer yourself directly to an NHS psychological therapies service (IAPT) without a referral from a GP.
Or your GP can refer you if you prefer.
Guided self-help and cognitive behavioural therapy (CBT)
Your GP or psychological therapies service may suggest trying a self-help course to see if it can help you learn to cope with your anxiety.
Self-help courses for GAD are usually based on the principles of cognitive behavioural therapy (CBT).
CBT is a type of talking therapy that can help you manage your problems by changing the way you think and behave.
CBT is one of the most effective treatments for GAD.
There are several ways you may be offered self-help and CBT:
- you work through a CBT workbook or computer course in your own time
- you work through a CBT workbook or computer course with the support of a therapist who you see every 1 or 2 weeks
- you take part in a group course where you and other people with similar problems meet with a therapist every week to learn ways to tackle your anxiety
If these initial treatments don't help, you'll usually be offered more intensive CBT where you usually have weekly sessions with a therapist for 3 to 4 months, or another type of therapy called applied relaxation or medication.
Applied relaxation
Applied relaxation focuses on relaxing your muscles in a particular way during situations that usually cause anxiety.
The technique needs to be taught by a trained therapist and generally involves:
- learning how to relax your muscles
- learning how to relax your muscles quickly and in response to a trigger, such as the word "relax"
- practising relaxing your muscles in situations that make you anxious
As with CBT, applied relaxation therapy will usually mean meeting with a therapist for a 1-hour session every week for 3 to 4 months.
Relaxation therapy may not be available in all areas, so you might be offered CBT instead.
Video: Psychological therapies for stress, anxiety and depression
Animated video explaining self-referral to psychological therapies services for stress, anxiety or depression.
Media last reviewed: 14 March 2022
Media review due: 14 March 2025
Medication
If the psychological treatments above haven't helped or you'd prefer not to try them, you'll usually be offered medication.
Your GP can prescribe a variety of different types of medication to treat GAD.
Some medication is designed to be taken on a short-term basis, while others are prescribed for longer periods.
Depending on your symptoms, you may need medication to treat your physical symptoms, as well as your psychological ones.
If you're considering taking medication for GAD, your GP should discuss the different options with you in detail before you start a course of treatment, including:
- the different types of medication
- length of treatment
- side effects and possible interactions with other medicines
- which medication is best for you if you’re pregnant, planning a pregnancy or breastfeeding
You should also have regular appointments with your doctor to assess your progress when you're taking medication for GAD.
These will usually take place every 2 to 4 weeks for the first 3 months, then every 3 months after that.
Tell your GP if you think you may be experiencing side effects from your medication. They may be able to adjust your dose or prescribe an alternative medication.
Selective serotonin reuptake inhibitors (SSRIs)
In most cases, the first medication you'll be offered will be a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI).
This type of medication works by increasing the level of a chemical called serotonin in your brain.
Examples of SSRIs you may be prescribed include:
- sertraline
- escitalopram
- paroxetine
SSRIs can be taken on a long-term basis but, as with all antidepressants, they can take several weeks to start working.
You'll usually be started on a low dose, which may be gradually increased as your body adjusts to the medication.
Common side effects of SSRIs include:
- feeling agitated
- feeling or being sick
- indigestion
- diarrhoea or constipation
- loss of appetite and weight loss
- dizziness
- blurred vision
- dry mouth
- excessive sweating
- headaches
- problems sleeping (insomnia) or drowsiness
- low sex drive
- difficulty achieving orgasm during sex or masturbation
- in men, difficulty obtaining or maintaining an erection (erectile dysfunction)
These side effects should improve over time, although some may be related to your underlying condition.
Serotonin and noradrenaline reuptake inhibitors (SNRIs)
If SSRIs don't help ease your anxiety, you may be prescribed a different type of antidepressant known as a serotonin and noradrenaline reuptake inhibitor (SNRI).
This type of medication increases the amount of serotonin and noradrenaline in your brain.
Examples of SNRIs you may be prescribed include:
- venlafaxine
- duloxetine
Common side effects of SNRIs include:
- feeling sick
- headaches
- drowsiness
- dizziness
- dry mouth
- constipation
- insomnia
- sweating
- sexual problems, such as low sex drive or difficulty getting an erection
SNRIs can also increase your blood pressure, so your blood pressure will be monitored regularly during treatment.
As with SSRIs, some of the side effects (such as feeling sick, an upset stomach, problems sleeping and feeling agitated or more anxious) are more common in the first 1 or 2 weeks of treatment, but these usually settle as your body adjusts to the medication.
Stopping antidepressants
If your medication is not helping after about 2 months of treatment or it's causing unpleasant side effects, your GP may prescribe an alternative medication.
When you and your GP decide it's appropriate for you to stop taking your medication, you'll normally have your dose slowly reduced over the course of a few weeks to reduce the risk of withdrawal effects.
Never stop taking your medication unless your GP specifically advises you to.
Pregabalin
If SSRIs and SNRIs aren't suitable for you, you may be offered pregabalin.
This is a medication known as an anticonvulsant, which is used to treat conditions such as epilepsy, but it's also been found to be beneficial in treating anxiety.
Side effects of pregabalin can include:
- drowsiness
- dizziness
- increased appetite and weight gain
- blurred vision
- headaches
- dry mouth
- vertigo
Benzodiazepines
Benzodiazepines are a type of sedative that may sometimes be used as a short-term treatment during a particularly severe period of anxiety.
This is because they help ease the symptoms within 30 to 90 minutes of taking the medication.
If you're prescribed a benzodiazepine, it'll usually be diazepam.
Although benzodiazepines are very effective in treating the symptoms of anxiety, they can't be used for long periods.
This is because they can become addictive if used for longer than 4 weeks. Benzodiazepines also start to lose their effectiveness after this time.
For these reasons, you won't usually be prescribed benzodiazepines for any longer than 2 to 4 weeks at a time.
Side effects of benzodiazepines can include:
- drowsiness
- difficulty concentrating
- headaches
- vertigo
- an uncontrollable shake or tremble in part of the body (tremor)
- low sex drive
As drowsiness is a particularly common side effect of benzodiazepines, your ability to drive or operate machinery may be affected by taking this medication.
You should avoid these activities during treatment.
You should also never drink alcohol or use opiate drugs when taking benzodiazepine as doing so can be dangerous.
Referral to a specialist
If you have tried the treatments mentioned above and have significant symptoms of GAD, you may want to discuss with your GP whether you should be referred to a mental health specialist.
A referral will work differently in different areas of the UK, but you'll usually be referred to your community mental health team.
These teams include a range of specialists, including:
- psychiatrists
- psychiatric nurses
- clinical psychologists
- occupational therapists
- social workers
An appropriate mental health specialist from your local team will carry out an overall reassessment of your condition.
They'll ask you about your previous treatment and how effective you found it.
They may also ask about things in your life that may be affecting your condition, or how much support you get from family and friends.
Your specialist will then be able to devise a treatment plan for you, which will aim to treat your symptoms.
As part of this plan, you may be offered a treatment you haven't tried before, which might be psychological treatments or medication.
Alternatively, you may be offered a combination of a psychological treatment with a medication, or a combination of 2 different medications.
Hidradenitis: purulent inflammation of apocrine sweat glands
Hidradenitis - purulent inflammation of apocrine sweat glands. The disease develops gradually. The first few days, the inflamed gland is a dense, painful nodule the size of a pea.
After 5-7 days, it increases in size up to 2-3 centimeters and acquires a pear-shaped shape. The abscess outwardly resembles a nipple, which is why the people called the disease “bitch's udder”.
The armpits are predominantly affected. The inguinal region suffers less often: the labia majora in women and the scrotum in men, as well as the area around the anus. There are cases of inflammation of the sweat glands around the nipples and in the scalp.
Hydradenitis is never observed in children and the elderly. This is due to the fact that the functioning of the apocrine sweat glands begins only by puberty and fades in old age. Most of the diseases with hidradenitis (about 85%) occur in women aged 16 to 55 years. Most often, hidradenitis occurs during puberty, when a hormonal imbalance occurs, and in menopause.
Causes
The disease is most often caused by Staphylococcus aureus. But in some cases, streptococcus or E. coli can become the culprit of inflammation.
Bacteria enter the sweat gland through the duct from the surface of the skin through scratches, damage. Skin lesions can occur during shaving, when epilating or when scratching the skin due to itchy dermatoses. Constant wetting and maceration of the skin due to excessive sweating also leads to a decrease in its barrier function and the penetration of microorganisms.
Untidiness, poor body hygiene and excessive sweating are precipitating factors. They lead to inflammation of the sebaceous gland, which quickly increases in size and becomes like a cow's udder. Some other reasons can also cause hydradenitis, in particular, restructuring of the endocrine system or reduced immunity. If a patient is diagnosed with hidradenitis, treatment includes a whole range of methods - from general strengthening procedures to surgical intervention.
Symptoms
Among the main symptoms that allow diagnosing the disease, it should be noted: the appearance of a dense node that rises above the surface of the skin; constant itching in the area of inflammation, and sometimes sharp pains; increased body temperature; if left untreated, scars, fistulous passages and comedones (blackheads) are formed.
Diagnosis and treatment
Hidradenitis is diagnosed according to its characteristic clinical picture. For adequate selection of antibiotic therapy, the discharge is cultured with an antibiogram. Hidradenitis is dangerous with purulent complications up to the development of sepsis. Its timely and correct treatment avoids such complications, but does not exclude the recurrence of the disease.
The inflamed area is treated with disinfectant solutions and antiseptic preparations. Treatment should be accompanied by regular hygiene procedures and body care. In the later stages, surgical treatment is recommended for patients. It consists in opening and excising the affected tissue areas and removing the fistulous passages. Surgical methods are used in cases where conservative treatment does not lead to the expected results. Patients must be prescribed antimicrobial therapy. The course of treatment lasts about 14 days. If a person has recurrent hidradenitis, treatment involves specific immunotherapy, which uses gamma globulin and staphylococcal vaccines.
Treatment of adrenal dysfunction - prices for services at the clinic "Mother and Child" in Moscow
Adrenal glands is a paired endocrine organ located above the upper poles of the kidneys. The main tasks of the adrenal glands are the production of hormones that provide vital body processes that affect the regulation of metabolic processes and the body's adaptation to adverse conditions.
The adrenal gland consists of two structures: the cortex and the medulla. The medulla is a source of adrenaline and norepinephrine. The cortex produces hormones: mineralocorticoids (aldosterone), glucocorticoids (cortisol), sex hormones (androgens). With a pathological effect on the adrenal glands, either suppression of their function (insufficiency) or an increase in their work (hyperfunction) occurs. Hyperfunction is most often associated with hormonally active tumors of the adrenal glands (pheochromocytoma, corticosteroma, aldosteroma).
Treatment of adrenal dysfunction in Moscow:
Clinical hospital MD GROUP Clinical hospital Lapino-1 "Mother and Child" Clinic "Mother and Child" Savelovskaya Clinic "Mother and Child" Lefortovo
Increased adrenal pressure3 , increased sweating, increased body temperature, the appearance of edema, muscle weakness, convulsions, possibly an increase in body weight.
Often, cardiologists unsuccessfully begin to treat this condition, believing that it is hypertension, but the pressure rises, despite the countless list of antihypertensive drugs. Therefore, all patients with increased blood pressure should consult an endocrinologist!
With hypofunction of the adrenal glands , complaints of weakness, fatigue, loss of appetite, weight loss, lowering blood pressure appear. Such patients, under the guise of autonomic dysfunction, are unsuccessfully treated by neurologists. Therefore, all patients with low blood pressure should visit an endocrinologist!
When initial clinical manifestations appear, an urgent consultation with an endocrinologist is necessary, since aggravation of the work of the adrenal glands can lead to crises, when the above symptoms develop rapidly and hospitalization in the endocrinology department or even the intensive care unit is required.
At the stage of diagnosing diseases of the adrenal glands, you need to contact an endocrinologist, who will prescribe all the necessary examinations: general clinical, biochemical, hormonal tests, stress tests, ultrasound diagnostics, computed tomography, when planning surgical treatment, consult an endocrinologist surgeon.
