How to Diagnose and Treat Generalized Anxiety Disorder? - Insights from Dr Sanil Rege (Psychiatrist)
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- Опубликовано: 17 июл 2024
- 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.
Full article: psychscenehub.com/psychinsigh...
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.
Me
me too
It happens....
You're afraid of being alone
It's a thing. Gad makes you so tired.. And it's hard for me to move from my parents' house and live alone even at 33. You are the most of the time on bed or sofa unable to sleep but unable to work either. This disease is exhausting, I hate it. Drugs help though.
Thank you so much Doctor. This video helped in revising my knowledge and bring clarity in certain aspects.
Thank you for your feedback. 🙏🏼
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.
Sorry to hear. It isn't easy to diagnose without a formal assessment but in general - symptoms such as these can be due to medical conditions, insomnia due to anxiety or agitation, anxiety disorder etc. It is particularly important to differentiate between agitation and anxiety as agitation can present with racing thoughts and significant insomnia. Please see a doctor for a full assessment. Hope you feel better soon.
Excellent! Your channel is like nothing else on youtube.
Thank you for your feedback 🙏
Excellent review. Please consider adding a presentation on common preliminary lab work up for initiating antipsychotics- lithium- Depakote etc. thank you
This is an excellent video, I watched it several times. Thank you.
Thanks for the feedback 🙏🏼
GAD is killing me slowly.
I need help.
You take medication
I also GAD
@@nirmalmeena9174 how r u now?
Please seek help
This is because we don't trust in ourselves. If we built self confidence and face everything no matter how hard it will be we can face it.
Amazing and nice video i love this video
Do you have to have racing heart and shortness of breath for it to be considered anxiety?
Anxiety consists of a constellation of symptoms. So anxiety can occur without a racing heart and shortness of breath. The basis of anxiety is disproportionate worry about certain themes. A panic attack is the most extreme manifestation of anxiety. You can read more here : psychscenehub.com/psychinsights/generalised-anxiety-disorder-diagnosis-and-management-2/
I'm the anxiety and rumination king. Literally. Lol
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.
You are correct that Neuroinflammation can play a role in treatment resistant disorders including GAD. We haven’t covered it in this video as the focus was on GAD first line options - though we have covered medical exam required in evaluation. For neuroinflammation we have covered it in more detail in this video - ruclips.net/video/TobQ0wMgkZs/видео.html
Sir, can physical pain tolerance and mental pain tolerance give psychological strength and power?
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?
Yes it is not uncommon and they can frequently coexist.
Hey Doctor 👋 How can i get a proper diagnosis for Anxiety/depression? Should i visit a local hospital first or is there a specific specialist i should go to first?
Initially see you general practitioner. They can refer you to a psychiatrist if further evaluation is needed. Or one can start off with a psychiatrist evaluation.
Hello sir, why do antidepressants cause diabetes if a patient takes them for 2 years or longer
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.
Anxiety is characterised by preoccupations - worries usually about specific themes about something going wrong - what if ? And associated with avoidance or doing the feared situation reluctantly . Themes could be relationship , finances , social situations etc. panic attacks may be present . This should be differentiated from hyperarousal and agitation ( this has a more significant physical component than anxiety and stress affects sleep and day time functioning ; usually difficult to control .
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.
Good question. Anxiety has specific features - Preoccupation about ‘what if ‘ usually related to future & avoidance with some physical Sx. In general sleep is disturbed mainly with regards to falling asleep. The hyperactivity with ADHD tends to have a greater ‘can’t control - difficulty inhibiting responses ‘ type and sometimes without worries. Hyperarousal is present with vivid dreams or nightmares . Agitation is the most sever form with racing thoughts with overt physical over activity that can’t be controlled . So differentiating anxiety (more cognitive) vs hyperarousal ( more physical) vs agitation ( both severe) . In many first two can coexist.
I have GAD and can't take medications. I'm dying slowly
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😔
Combination of SSRI and SNRI can lead to serotonin syndrome and is not recommended. This can be a serious condition. Please discuss this with your doctor or seek specialist advice or symptoms are severe please visit the emergency department. Wish you well
@@PsychiatrySimplified i did went to neurologist he prescribed me sertraline 50 and thru phone call with his colleage psychiatrist and for 3 days i took it..3 days i dont eat,my stomach are worst and cant explain.. hot flashes non stop.i just dont get it...i called them and ask whys and they just told me to continue without explainations.the worst part is i dont have family support😭i send you e mail in ur fb page...pls read doctor...need an advise😭
@@joierm8779 we can’t provide medical advice from a distance due to medicolegal reasons. Have you seen a psychiatrist for this ? Which country are you based?
@@PsychiatrySimplified yes i do..the first psych that gave me cymbalta and escitalopram that seems not to work not maybe because of meds but my body cant tolerate..and the second psych gave me sertraline but again it didnt work for me.coz i dint eat for 3 days even drink.im here in egypt😔i understand medicolegal...sorry doctor...i felt im waiting only for my body to give up.i have auto immune disease(Ankylosing Spondylitis )and we have hx of anxiety which my mother has.
@@PsychiatrySimplified your replys are really means a lot to me..i feel someone cares😭😭😭thnk u doctor,🙏god bless u always...
Can I do a consultation with you. I have ocd unwanted thoughts and fear of my dad passing I have ocd and general anxiety disorder. I have anger resentment and guilt. Im on medication done ect nothing seems to be working. What kind of brain scan can I do to get to the root of the problem. 4 years ago I was diagnosed clinical depression and gad and I did ect ketamine tms and ect it worked. It worked this time nothing is working this time
Sorry to hear. Have you seen a psychiatrist for this again? This would be the right step
@@PsychiatrySimplified yeah and I did ect but it didn’t work as my Anxiety was very severe. I had ptsd with depression and anxiety. Dr I would like you to look into sgb injections for patients who have ptsd I had the injection done last week on right side and left side of neck.I would say that I have 95% improved and it’s made a huge difference.. the person behind this phenomenon is dr lipov who’s based in America but he will be available on RUclips. I had mine done in Bristol uk. Please have look as it can save thousands of people 🙏 you’re a good physicist and thank you for posting videos you helped me a lot to understand how the brain functions 🙏🙏 have a great day
@@nimitaghelani8498 thank you for sharing this personal experience
Sir I am 23-25 yrs old before 2years I had a panic attack i treat my self soo much but not feeling well till date I consult heart spacilist nero psycratic general physician but really when I take anxiety medicine anxiety raised day by day But I have a same saytoms like GAD But now last 1 year I have chest pain after goes in right kidney side then concentration diverted about this pain then same like GAD saytoms .I am only feeling heart attack will bee happened with my self suffocation....Day by day I am feeling distress uncountable ..Sir please suggest me what can I do now?
Sorry to hear. It would be good to get an evaluation from a psychiatrist. Anxiety disorders are treatable.
Sir can u tell me about tofisopom long term use?
Atypical benzodiazepine - not commonly used in Australia. Best to discuss this with your doctor.
Loving the shirt
Ha ha thanks 🙏🏻 😁
How do SNRIs work for anxiety as noradrenaline is high in that condition isn't it?
Good question - It is linked to extracellular NA levels and presynaptic receptors.
3 points:
1. Noradrenaline combined with 5HT provides the benefit; not noradrenaline increase on its own.
2. NA is anxiogenic via the alpha 1 receptor (stress, etc)
3. to Rx anxiety, we want improved prefrontal cortex inhibition of the amygdala & alpha 2 presynaptic activation via adequate NA levels in the synapse. Alpha 2 is a feedback mechanism - if too much, it will reduce - if too little it will try to increase. Detail below
So when levels of NA are high - NA increase can lead to an anxiogenic effect. Anxiogenic effect mediated by alpha 1 and beta (palpitations). Alpha 2 presynaptic reduces hyperarousal. Alpha 2 postsynaptic improves cognition by acting on PFC. Etc.
Individuals with depression likely have low baseline levels of tonic NA, which is associated with reduced α -adrenergic receptor-mediated inhibitory tone (inability to reduce hyperarousal). NARIs improve this tone. And hence help with the reduction of hyperarousal. They also activate alpha 2 in PFC, which helps with anxiety as PFC control inhibits the amygdala. But NARIs alone do not help in anxiety (so only increasing NA will not help in most cases.). The 5HT component - serotonin 5HT2A receptors synapse onto NA neurons on the amygdala, and 5HT2A activation by increasing serotonin reduces NA amygdala firing - this reduces anxiety. So SNRI is better than NARI alone in anxiety Mx. Hope this makes sense.
@@PsychiatrySimplified why then do antipsychotics that block 5ht 2a not cause anxiety if 2a activation by ssri/snri reduces anxiety? Do you mean snri by activating 5ht2a down regulate these receptors when using SNRIs?
@@jocs8824 because antipsychotics have a Dopamine antagonism which significantly counteracts any mesolimbic activation. Also the 5HT2A antagonism is direct - not like SSRI & SNRI which is indirect agonist activity with time for desensitization of receptor.
@@PsychiatrySimplified would using Prazosin during the worst part of this downregulation of hyperarousal cause no downregulation to occur eventually? i.e. does alpha 1 need to be functioning normally (unblocked by no prazosin) to provide feedback to alpha 2 for alpha 2 to then reduce noradrenaline? And is all the noradrenaline made in the adrenals and within brain (does not cross blood brain barrier) & other parts of body?
@@PsychiatrySimplified you mention low baseline NA tone associated with inability to reduce hyperarousal. So the NA needs to be higher to activate alpha 2 auto pre synaptic receptor because it has higher affinity to post receptors or are there insufficient pre synaptic receptors(could they have down regulated perhaps)?
Can low catecholamines lead to high cortisol doctor ? I suffer from anhedonia, depression + irritability. It seems as my body is always in fight and flight. I retain a lot of water after exercise and get irritable. Benzos or things that increase serotonin make me more irritable.
One of the functions of CORTISOL is to dampen noradrenaline so it does not lead to an excessive stress response. We covered this in the video on how stress affects the brain. Symptoms of Symptoms of depression, flight and a flight require an assessment to identify why hat might be the case including ruling out medical conditions. Hope you feel better. Please do see a doctor.
@@PsychiatrySimplified thx for your kind words. I came across this study:
Dextroamphetamine and Cortisol in Depression
Morning Plasma Cortisol Levels Suppressed
" Since noradrenalin normally inhibits hypothalamic corticotropin releasing factor (and adrenocorticotropic hormone) secretion, a noradrenergic deficit may account for cortisol hypersecretion in depression; amphetamine may transiently "correct" this deficit in depressed patients, thereby reducing their cortisol secretion."
I suspect I suffer from some kind of catecholamine deficiency due to prolonged chronic stress and of course genetics.
I have been on a dozen of antidepressants but nothing worked. It have been 2 years since I took my last antidepressant and I have been getting better lately since I have stopped taking them (stopped as well drinking, smoking etc.) but I´m still depressed. The main problem I have is the irritability. It seems like I´m always on edge but as I already wrote benzos make me even more irritable. I´m 34 years and otherwise in good health conditions.
@@fdddff47 there are different kinds of ‘depressions’. The important thing is to initially establish the kind of depression and then target the medication appropriately. For example some depressions respond better to non-SSRIs such as agents that increase dopamine and NA ( dexamphetamine increases both) e.g bupropion, SNRIs, agomelatine, vortioxetine etc. These agents are useful in targeting Sx such a loss of motivation, drive, pleasure etc. So it would be helpful to discuss this in more detail with your doctor. At the same time medical conditions should be ruled out including checking cortisol and other biochemical indicators. Usually NA AND DA decreases in frontal lobe and aub cortical circuits are associated with Sx described earlier and also cognitive issues ( executive function) - ADHD is also something to rule out as it frequently can present with depression in adults. We did a video on the clinical evaluation of ADHD on this channel.
One other condition that can result in AD resistance is mixed features in depression which can present with irritability, mood swings, agitation, racing thoughts etc any of these Sx could indicate mixed state. Again we have done a video on this. As you will appreciate there are many differentials to take into account when evaluating deprrssion. All of this is of course not advice and you should discuss this with your doctor. Good luck.
@@PsychiatrySimplified thx for your advice. I will look into this video.
@@fdddff47 here is the video on mixed features ruclips.net/video/hVMObsNmnf4/видео.html
How can I get ur appointment??
Dr Rege is based at vitahealthcare.com.au - the clinic has several psychiatrists who can offer residents treatment. Generalised anxiety is a condition that is treated by many GPs and psychiatrists so that you can avail help in your local area as well. We wish you well.
I have tried all these medications but nothing works for me I have anxiety since childhood what can I do?
A diagnostic assessment should be carried out to identify is the symptoms are of anxiety disorder or is it due to other disorders mimicking anxiety. For example - sleep disturbances with vivid dreams and nightmares indicate hyperarousal - can occur as part of stress or trauma - early morning awakening may indicate agitation as part of depression , Racing thoughts may indicate mixed features , attention and concentration issues with anxiety may indicate ADHD - these are just a few examples and they require different treatments and anti anxiety treatments on their own will not work. We have done some videos on these conditions.
@@PsychiatrySimplified I have a type of anxiety which is very different from other people because I don’t have worries and other thoughts but my main problem is tremors, severe palpitations especially after sleep in the morning, lack of concentration, sometimes severe social anxiety, sometimes agitation, restlessness, angry without any reason and I think the root cause go back to my childhood where I had a lot of bad experiences especially overprotective parents, so can it be cured? And what should I do I have seen multiple psychiatrist they all just prescribe me SSRIs, antipsychotics and other anxiety medications. Can you suggest me anything that help me?
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??
They could be - please see a doctor for an evaluation.
Fuck pills sadness is a needed emotion
Very true but there's a difference between sadness and a feeling of impending doom
Dr Rege. This makes no sense. You talk about giving people medicine that causes anxiety. Now you talk about helping people with anxiety.
There are some medications that can increase anxiety. there are medications that treat anxiety. Hence why an appropriate diagnosis and targeted treatment is important.
Great video. All three kinds of anxiety disorders explained extensively.
I was born in 1985, uptil 2006 I was perfectly alright without any kind of anxiety or panic disorder. I used to smoke marijuana and alcohol until I got sick with jaundice in 2006.
Since last 17 years I'm suffering anxiety and panic disorder. I have extreme separation anxiety. I cant drive alone beyond 20km ( my safety zone ), this has caused an immense stigma.
Iv been taking Venlafaxine 150mg for last 8+ years. Is there any procedure that can be done on my brain that my illness gets fixed for good ?
Just like a heart, or any other transplant. I heard anxiety and panic has got alot to do with amygdala.
(Sorry for such a long post, but I want to LIVE a NORMAL life and travel around the world 😓)
I’m sorry to hear. Neurosurgical procedures are indicated in severe treatment resistant OCD , but not usually for anxiety disorders. As anxiety disorders can respond to medication, psychotherapy combinations. However it’s important to differentiate between anxiety, hyperarousal and agitation. The latter two are more severe and do not respond to typical anxiety Rx. This requires alternate approach. Hyperarousal is associated usually with nightmares and vivid dreams , while agitation is all day, internal restlessness that’s difficult to control , early morning awakening. Amygdala has a high concentration of noradrenergic neurons which mediates anxiety, hyperarousal and agitation. There are other approaches to target amygdala.
If anyone needs some motivation, please check the Forwago. I started using it a year ago, and I wish I started using it even earlier.
thanks a lot
Psychedelics has been the keywords on everyone's lips nowadays cos of its health benefits.i got my life back from severe depression and anxiety after Microdosing with shrooms chocolate bars. He’s also a therapist cus I’ve done several therapy sessions with him. Thanks to him on Instagram. He’s a reliable source 😊
""@_mycorabbi_""
On I.G