Generalized Anxiety Disorder (GAD)

We have all been ‘stressed’ at some point or another about various upcoming events like deadlines at work or emotional upsets in our private life. Feeling stressed can be totally normal and has benefits such as the fight and flight response which can set in motion a physiological response to protect you from harm.

This stress response is particularly important in a life or death situation often experienced by our hunter-gatherer ancestors when being faced with a predator like a lion, these physiological changes such as a faster heart rate and increase glucose to the skeletal muscles enabled them to either run away or fight for survival.

This is an example of an acute stress response and once the threat is over, hormones involved in this response (ephedrine,dopamine and norephidrine) return to normal levels and we return to a state of rest.
 
In today’s modern age stress is often not that simple or fleeting, with the stress responses often becoming chronic and repetitive (high volume and stressful work load, upcoming deadlines or an abusive relationship where the stressor becomes chronic). Stress can motivate us to get up from the couch and sit down in front of our desk and get some urgent work done, but it can also trigger the chronic stress response called the Hypothalamic-Pituitary-Adrenal axis, which causes chronically elevated levels of cortisol that floods your system and has adverse health effects.
 
For most people the stress response is fleeting and once the ‘threat’ has been dealt with, we can stop worrying. For people with GAD, the worry does not go away, and they feel stressed for prolonged periods of time without there always being a clear reason for their worry or concern.
 
Steadman’s medical dictionary defines anxiety as: “Vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often non-specific or unknown to the individual); a feeling of apprehension caused by an anticipation of danger.”
 
According to the Diagnostic and Statistical manual 5th edition, an individual can be diagnosed with GAD if they have:
 
A.  Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities,
B. The person finds it difficult to control the worry,
C. The anxiety and worry are associated with three or more of the following six symptoms:

1. Restlessness or feeling on edge,
2. Being easily fatigued or more tired than usual,
3. Difficulty concentrating,
4. Irritability (that may or may not be observed by others),
5. Increased muscle aches and pains,
6. Poor quality of sleep (difficulty falling or staying asleep, or restless unsatisfying sleep).

The DSM-V further stipulates that the disturbance cannot be better explained by another mental disorder, nor is it due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism). Lastly the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The exact cause of anxiety is poorly understood, but scientists believe that there are various contributing factors such as a genetic predisposition to develop anxiety as well as environmental factors (which can be current conditions or a past traumatic experience).

The human genome project was completed in 2003 and has identified several genes that are believed to play a significant role in the development in GAD. These genetic markers include, but are not limited to:
1. Catechol-O-Methyltransferase (COMT) gene: The COMT gene is responsible for encoding the COMT enzyme which plays an important role in regulating dopamine levels in the prefrontal cortex of the brain. COMT Val158Met snippet plays a very important role in the way dopamine is metabolised. The Met/Met variant produces less of the COMT enzyme which translates to decreased metabolism of dopamine. Higher than normal dopamine levels are associated with increased anxiety and anxiety related disorders.
2. Brain derived neurotrophic factor (BDNF): Researches believe that this gene plays a role in the regulation of the stress response. The BDNF Val66Met snippet is believed to play a role in the stress response, individuals with decreased levels of BDNF in the cerebrospinal fluid are more likely to develop an anxiety related order following a psycho-social stress response.
 
Natural treatment protocols for the management of GAD:
1. Supplementation:

• Magnesium: Magnesium is a co-factor which can become depleted if the COMT gene is working over time during high stress load stages. Supplementation with magnesium can assist with optimal functioning of the COMP gene and metabolism of excess dopamine levels in the pre-frontal cortex.

• Aswhaganda: This herbal adaptogen can help regulate the stress response by nourishing over taxed adrenal glands (which secrete cortisol). Chronically elevated levels of cortisol is thought to contribute to the development of anxiety related disorders.
• Taraxicum, Carduus Mar and Chelidonium: These herbal tinctures play an important role in the liver during phase 1 and phase 2 detoxification of oestrogen, which help reduce the load on the COMT gene (which is also involved with the metabolism of oestrogen)
• Valerian root, Lavender and Passiflora: These are calming agents that can help manage the symptoms of anxiety.

2. Diet and lifestyle:

• 5-7 Servings of fruit and vegetables per day: The anti-oxidant and phytonutrient properties of fruit and vegetables assist the body in rewiring its biochemical pathways to favour healthy enzymatic function.
• Avoid stimulants such as caffeine and alcohol. Stimulants can increase the load on the liver, which puts extra stress on the COMT gene.
• Regular exercise: 20-30 minutes of exercise 3-4 times per week can help manage the symptoms of GAD
• Get enough sleep: 7-8 hours per night, 1-2 hours being REM sleep. Even partial sleep deprivation activates the Hypothalamic-Pituitary-Adrenal (HPA) axis, causing increased cortisol levels which can exacerbate symptoms of anxiety.
• Yoga, meditation and breathing exercises: Research suggests that these relaxation modalities can assist in the symptomatic treatment of GAD

3.  Psychotherapy is an important facet in the treatment protocol for individuals that suffer from GAD.  According to Kevin Fourie (Counselling psychologist in Pretoria), cognitive behavioural therapy (CBT) can assist in mediating cognitions facilitating anxiety. He also recommends clinical hypnotherapy that can assist in a number of ways including analysing and reframing the origin of environmental stressors or development of resource states through ego-strengthening or other techniques. In addition - specific active interventions such as Eye movement desensitization and reprocessing (EMDR) or Brain working recursive therapy (BWRT) that can modify the autonomic anxiety response at the source in what is sometimes referred to as the reptilian complex in the brain stem and midbrain.  

4. Homeopathy: A carefully selected single similimum remedy that can mimic the symptoms associated with GAD, can treat the underlying cause without the harmful side effects of commonly prescribed anti-anxyolitics.
 
GAD is a serious mental health disorder that requires medical attention just like any other health condition. Treatment of GAD should be a holistic approach with a multidisciplinary approach as well as the necessary diet and lifestyle interventions to restore optimal health and mental well-being.
 
“It is time to tell everyone who is dealing with a mental health issue that they are not alone and that getting support is not a sign of weakness but a sign of strength.” -Michelle Obama-
 
Contact details:
DNAnalysis and genetic testing or Homeopathic consultations for GAD:

Dr. Chantell Groenewald (M. tech Hom UJ)
The Naturopathic Health are Center.
012 460 9216
[email protected]
 
Psychotherapy for GAD:
 
Kevin & Elise Fourie
Counselling Psychologists / Voorligtingsielkundiges
MA Counselling Psychology (Stell) // MA Voorligtingsielkunde (Stell)
 
Tel: (012) 348-7393 / 1342
Fax to mail: 0866 749 636
Email: [email protected]
Elise: 082 600 5812
Kevin: 083 448 9436
 
*Disclaimer. This article in no way serves as a diagnosis or treatment for GAD, nor does it serve to replace a consultation with a registered health care professional. Opinions in this article are those of Dr. Chantell Groenewald based on her own research and professional training. Individuals who suspect they may be suffering from GAD should seek attention from a qualified practitioner before using any supplementations or therapy protocols mentioned in this article. GAD is a serious medical condition and requires profession health care.