DO YOU HAVE GAD?

Do you worry about wor­ry­ing? Are you un­able to switch off and re­lax, even at week­ends or on hol­i­day? Do you have trou­ble sleep­ing or con­stantly check your phone and fret about mes­sages youmay have missed? You could be suf­fer­ing from gen­er­alised anx­i­ety di

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With our brains work­ing on over­drive, we have a 1,001 things to do, read and deal with dur­ing our wak­ing hours. De­mands come from all di­rec­tions – from our mobiles, lap­tops and com­put­ers as well as the old-fash­ioned type of in­ter­rup­tion or re­quest when a col­league drops by our desk or our fam­ily asks some­thing of us.

Some­times we’re so rushed off our feet we joke we’ll meet our­selves com­ing back, and for many peo­ple, mul­ti­task­ing is a way of life. Gone are the days when we went for a stroll to smell the roses. Th­ese days we would do a triathlon, then re­turn and nur­ture the roses, prune them and make them into a stun­ning hand-tied bou­quet, which we’d then drive 50km to de­liver!

We have be­come a gen­er­a­tion that lives on our nerves, day and night. Even when we’re eat­ing or watch­ing a movie, some of us can’t stop check­ing our phones for text mes­sages while oth­ers sleep with a mo­bile phone or iPad by their beds so they can re­ply to mes­sages through­out the night. On hol­i­day, we make sure our ho­tel room has Wi-Fi so we can keep up to date with emails. It seems im­pos­si­ble – and so­cially un­ac­cept­able – to switch off prop­erly. If we don’t re­ply to mes­sages in­stantly, peo­ple ask if we’re OK.

But liv­ing in such a per­ma­nently alert state has had a knock-on ef­fect on our men­tal health, and now in­creas­ing num­bers of peo­ple suf­fer from GAD, or gen­er­alised anx­i­ety disorder. While anx­i­ety is a feel­ing of un­ease, such as worry or fear about med­i­cal tests or our chil­dren’s exams or a job in­ter­view, and passes once the event is over, GAD is a long-term con­di­tion that causes us to feel anx­ious about a range of sit­u­a­tions and is­sues. When we suf­fer from GAD, we feel anx­ious most of the time and of­ten we can’t re­mem­ber the last time we felt re­laxed.

Dr Yaseen As­lam, a con­sul­tant psy­chi­a­trist at the Light­House Ara­bia in Dubai (www.light­house­ar­a­bia.com/ psy­chi­a­try), says many of us have ex­pe­ri­enced worry at some stage of our lives, but GAD is per­sis­tent worry and ap­pre­hen­sion. “In­di­vid­u­als ex­pe­ri­enc­ing GAD tend to worry about wor­ry­ing and of­ten the de­gree of wor­ry­ing and ap­pre­hen­sion is dif­fi­cult to con­trol,” says Dr As­lam. “Although GAD has many fea­tures in common with other psy­chi­atric con­di­tions such as pho­bic dis­or­ders and panic disorder, it is a dif­fer­ent con­di­tion.”

Ex­actly how many peo­ple suf­fer from GAD is still un­known, largely be­cause many don’t seek treat­ment. But a study in the UAE in 2000 found that of 254 pa­tients at an out­pa­tient walk-in clinic, 25.8 per cent of men and 47.1 per cent of women suf­fered from anx­i­ety. In the UK GAD is thought to af­fect one in ev­ery 25 peo­ple, while the Na­tional In­sti­tute of Men­tal Health in the US says about 6.8 mil­lion peo­ple suf­fer from it.

It can be­gin at any point, although the years be­tween child­hood and mid­dle age are the time of high­est risk.

“Some stud­ies in­di­cate that more women are af­fected than men and the con­di­tion is be­com­ing more common in the 35 to 55 age group,” says Dr As­lam.

UK-based Dr Mar­i­lyn Glenville, who spe­cialises in women’s health, says GAD is now much more common than we think and women, es­pe­cially, are feel­ing their lives are gov­erned by stress and ten­sion. “It af­fects women much more than men,” says Dr Glenville, au­thor of The Nu­tri­tional Health Hand­book for Women. “Women have al­ways been the car­ers, and busy think­ing about other peo­ple, so they have lit­tle or no time for them­selves. With ex­tra pres­sures and

the feel­ing there isn’t enough time, life is much faster now.”

But how can we tell if we or oth­ers are suf­fer­ing from GAD?

Ac­cord­ing to Dr As­lam the most common symp­toms are con­stant wor­ry­ing, even over the small­est mat­ters, feel­ing rest­less and ir­ri­ta­ble, hav­ing dis­turbed sleep and sweat­ing, nau­sea and vom­it­ing. Suf­fer­ers of­ten have mus­cu­lar ten­sion and pain and they have poor con­cen­tra­tion and mem­ory. They also have a strong sense of fore­bod­ing, as if some­thing neg­a­tive is about to hap­pen.

He adds, “I re­cently saw a 31-year-old se­nior ex­ec­u­tive who has long-stand­ing prob­lems with poor con­fi­dence and low self-es­teem due to child­hood trauma. He ex­pe­ri­enced marked GAD symp­toms after a re­la­tion­ship broke down. This, cou­pled with the stress of man­ag­ing a team in a high-pres­sure and com­pet­i­tive work en­vi­ron­ment, re­sulted in sig­nif­i­cant and per­sis­tent wor­ry­ing.”

Like this ex­ec­u­tive, many GAD suf­fer­ers have un­der­gone a stress­ful life event in ear­lier years, such as abuse or the death of a par­ent. But with GAD the “Caf­feine and sugar get peo­ple trapped in a vi­cious cir­cle,” says Dr Glenville. “They may give a mo­men­tary re­lief and sat­is­fac­tion, but they make us hy­per vig­i­lant. We think our lives are in dan­ger and we stay in a state of high alert.” When they sus­pect GAD, good psy­chi­a­trists will take a de­tailed his­tory of the symp­toms, and will pay par­tic­u­lar at­ten­tion to child­hood and the pa­tient’s per­sonal his­tory. Of­ten tests will be un­der­taken to rule out phys­i­cal con­di­tions that cause GAD – gas­troe­sophageal re­flux dis­ease, thy­roid con­di­tions and heart dis­or­ders are three ex­am­ples. A psy­chi­a­trist will also as­sess the risk of self-harm, if ap­pro­pri­ate.

Pa­tients are urged to follow a bal­anced diet, to ex­er­cise, and to en­sure they get ad­e­quate sleep

symp­toms per­sist once the trig­ger has gone, and suf­fer­ers may re­act to mi­nor stresses like the car break­ing down or the queue at the mall the way they re­acted to the ini­tial trauma.

Other causes are our ge­netic make-up and it’s thought anx­ious per­son­al­i­ties can run in fam­i­lies.

Fin­nish sci­en­tist Iiris Ho­vatta, who su­per­vised a study look­ing at the link be­tween ge­net­ics and anx­i­ety dis­or­ders, said en­vi­ron­men­tal fac­tors, such as stress­ful life events, may trig­ger an anx­i­ety disorder more eas­ily in peo­ple who have a ge­netic pre­dis­po­si­tion to the ill­ness.

Dr Glenville, who is a nu­tri­tion­ist, be­lieves our mod­ern life­style also fu­els GAD. She says our high in­take of caf­feine and sugar – which, iron­i­cally, we turn to when we’re feel­ing stressed – ac­tu­ally makes us more stressed be­cause they cause ups and downs in our blood sugar lev­els. This leads to adren­a­line and cor­ti­sol, our flightor fight hor­mones, be­ing re­leased, leav­ing us in a con­stant state of anx­i­ety.

GAD is a se­ri­ous is­sue, but there is hope for suf­fer­ers. While ex­perts say it can be a life­long con­di­tion, es­pe­cially if it goes un­treated, stud­ies have shown that most pa­tients im­prove sig­nif­i­cantly or re­cover once they have spe­cial­ist treat­ment.

Dr As­lam con­firms GAD is treat­able, and once there has been a di­ag­no­sis, it’s im­por­tant for the health prac­ti­tioner and pa­tient to work to­gether on a pro­gramme of treat­ment. He adds that cer­tain an­tide­pres­sant drugs such as SSRI med­i­ca­tions, which are li­censed to treat anx­i­ety dis­or­ders, are some­times used. “Psy­chi­a­trists also use other pre­scrip­tion con­trolled med­i­ca­tions such as bus­pirone,” says Dr As­lam. He adds that var­i­ous talk­ing psy­chother­a­pies such as coun­selling and cog­ni­tive be­havioural ther­apy have also proven to be ef­fec­tive.

Pa­tients are also urged to follow a bal­anced diet and ex­er­cise regime, to get ad­e­quate sleep and to use re­lax­ation tech­niques.

Dr Glenville says the first step we can take is to give up caf­feine and sugar, but she ac­knowl­edges that, in it­self, it isn’t easy.

“Some peo­ple have the per­son­al­ity that means they can stop hav­ing caf­feine and sugar in one go, but for oth­ers, it might be eas­ier to get off them in small stages,” she sug­gests.

“Caf­feine is a stim­u­lant and it makes peo­ple much more ag­i­tated, so if they can cut down or give it up, they’ll start to see a dif­fer­ence quite quickly. If they could also cut down on their choco­late bis­cuits and cakes dur­ing their breaks at work, for ex­am­ple, they will start to feel bet­ter almost im­me­di­ately.

“Feel­ing this good will en­cour­age them to carry on. It could take a good two weeks for the body to re­alise it isn’t ac­tu­ally un­der threat and that it is safe.”

Dr Glenville, who works with clients from all over the world by tele­phone and Skype, also rec­om­mends sup­ple­ments of B vi­ta­mins and mag­ne­sium, which is a calm­ing min­eral for the body.

“Cut­ting out caf­feine and sugar from your diet takes some com­mit­ment at first, but I’ve seen peo­ple do it so many times and if they get it right, their lives are trans­formed. They get a much bet­ter qual­ity of life and once their bod­ies are calmer, their GAD eases,” she says.

Be­ing con­stantly con­nected and per­ma­nently alert is per­haps the rea­son for the rise in GAD

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