Psychiatry
Generalized Anxiety Disorder
범불안장애
Excessive worry/anxiety lasting ≥6 months
- How common
- Lifetime 5–6%
- Typical age
- Mean onset 30s
What is it?
GABA deficiency, 5-HT/NE dysregulation, amygdala hyperactivity, PFC underregulation.
Commonly affected: Amygdala, BNST, PFC, thalamus
How it develops
- Genetic/temperamentBehavioral inhibition, family history
- Amygdala hyperactivityThreat appraisal circuit hyperactive
- GABA/5-HT dysfunctionReduced inhibitory signaling
- Worry reinforcementAvoidance gives short relief, long-term worsening
Symptoms
- Excessive worryMultiple domains, hard to control
- RestlessnessFeeling on edge
- Muscle tensionShoulder/neck/jaw pain
- Sleep disturbanceDifficulty falling asleep, frequent waking
- Fatigue/poor concentrationEasy fatigue, distractibility
How it is examined
- DSM-5 GAD criteria≥6 months + ≥3 of 6 symptoms
- GAD-7 screening0–21, ≥10 moderate GAD
- TSH/caffeine workupRule out hyperthyroidism, caffeinism
Imaging
Imaging not diagnostic; fMRI shows amygdala hyperactivity.
- Amygdala hyperactivity
PET: reduced GABA receptor binding reported.
- Reduced GABA binding
Non-surgical care
- SSRI/SNRI first-lineEscitalopram, venlafaxine (4–6 wk)
- CBTWorry exposure, cognitive restructuring, relaxation
- BuspironeSSRI augmentation, no dependence
- Short-term benzodiazepineAcute/crisis 2–4 wk (dependence risk)
- Exercise/mindfulness3x/wk aerobic, 8-wk MBSR
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Treatment-resistant GAD
Procedures that may be discussed
- Pregabalin
- Combination therapy
- ACT (Acceptance & Commitment Therapy)
Outlook
Chronic relapsing. 60–70% improve with SSRI+CBT combo.