An Integrative Medicine Approach to Generalized Anxiety Disorder (GAD) in Adolescents

Anxiety disorders are the most common mental health disorders in adolescence, affecting approximately 32% of adolescents 13-18 years old. Generalized anxiety disorder (GAD) specifically affects approximately 3-5% of teenagers. Despite the prevalence of anxiety disorders, many adolescents do not utilize mental health services (17). Untreated, chronic anxiety can result in social, academic and familial challenges as well as lead to other problems including depression, substance abuse, and self-harm.

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What is Generalized Anxiety Disorder?

Generalized anxiety disorder (GAD) is characterized by excessive and uncontrollable worry. It differs from normal feelings of anxiety in that adolescents with GAD will worry more often and more intensely than other children experiencing similar circumstances. Adolescents with GAD will have prominent anxiety symptoms that are less specific than those seen in other anxiety disorders, like social anxiety disorder or separation anxiety disorder. A mental health professional can diagnose GAD using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) criteria, which include: excessive anxiety and worry that patients have difficulty controlling, anxiety symptoms present on more days than not for at least 6 months, and symptoms must cause distress or functional impairment. Adolescents with GAD, unlike adults, often do not understand on their own that the anxiety they experience is more extreme than what would be considered normal.

Presentation will vary, but common symptoms include: (16, 18, 19)

• Significant worrying about friends, school, and activities 
• Frequent stomach aches or headaches
• Muscle tension
• Tiredness (fatigue)
• Difficulty concentrating
• Irritability
• Sleep disturbances

What Are The Possible Causes of Generalized Anxiety in Adolescents?

As with many other mental health conditions, the exact cause of generalized anxiety disorder is unknown, but it is believed to be caused by a combination of genetic, biological/chemical, and environmental factors. There is a moderate genetic risk of inheriting GAD, with heritability estimated to be approximately 30% (20). Family environment, significant life events, and chronic stress can also increase the risk of developing GAD. Adverse childhood experiences (ACEs) are defined as traumatic experiences that occur before a child reaches the age of 18. These can include incidents of abuse, neglect, household dysfunction, food insecurity, housing instability, and experiences of discrimination. The greater the number of ACEs a child experiences, the more likely it is that the child will experience mental health concerns, including anxiety. (21, 22). The brain contains chemicals called neurotransmitters that control how we feel. Serotonin, norepinephrine, and GABA are three neurotransmitters in particular that play a role in anxiety when disrupted (18). Certain areas of the brain, like the amygdala, are involved in our fear and anxiety responses  and can be overactivated in adolescents with GAD. (27). Lifestyle factors like screen time, physical activity, and intake of ultra-processed foods like sugary beverages can also impact anxiety levels.

Functional Medicine Labs to Test for Root Cause of Generalized Anxiety in Adolescents

The development of GAD in adolescence is multifactorial. Functional labs can be used to help practitioners understand which imbalances might be contributing to symptoms of anxiety.

Comprehensive Stool Test

Alterations in the gut microbiome have been associated with mental health conditions, including anxiety (9). Certain bacteria in the gut can facilitate the synthesis of neurotransmitters, like serotonin and GABA, that affect our mood. (10) A comprehensive stool analysis like Genova’s GI Effects provides a glimpse into the relative amounts of gut bacteria to see if dysbiosis is present.

Nutrient Testing

Nutrients like B vitamins, vitamin C, magnesium, and zinc play an important role in regulating stress responses and producing neurotransmitters. Vitamin D also plays a role in mood and low levels have been associated with mood disorders, like depression and anxiety. Spectracell’s Micronutrient Test evaluates the levels of 30 vitamins and minerals to assess for any insufficiencies that might be contributing to symptoms of anxiety. (4, 25)

Hormone Testing

Chronic stress can lead to dysregulation in the hypothalamic-pituitary-adrenal (HPA) axis. Generally, cortisol is released from the adrenal glands following a diurnal rhythm. Chronic stress can lead to irregularities in the rhythm of cortisol release. Some adolescents with anxiety disorders show irregularities in cortisol production. The AdrenoCortex Stress Profile with CAR uses timed saliva samples to measure cortisol’s daily pattern.

Neurotransmitter Testing

Hormones, like cortisol, and neurotransmitters are interconnected. Both can be measured to identify the causes of anxiety. The NeuroBasic Profile uses a 24-hour urine collection to identify any neurotransmitter imbalances associated with mood disorders. 

Additional Labs To Test 

Certain medical conditions are associated with anxiety, like hyperthyroidism and hypoglycemia, and blood tests can be used to assess for these conditions. A thyroid panel can identify hyperthyroidism, and a metabolic panel measures blood glucose levels.

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Conventional Treatment for Generalized Anxiety Disorder in Adolescents

Cognitive behavioral therapy (CBT)  is a form of psychotherapy used to treat a variety of mental health conditions, including GAD. It has two main components: changing thinking patterns and changing behavioral patterns. Strong evidence supports the use of CBT for treatment of adolescents with mild-moderate symptoms of GAD. Pharmacologic treatment can also be considered in more severe cases or cases in which CBT has not been successful. SSRI’s are considered first-line treatment for adolescents requiring medication for GAD. CBT and pharmacotherapy can also be combined, with research showing that combination treatment is superior to CBT or pharmacological treatment alone. (24)

Functional Medicine Treatment for Generalized Anxiety Disorder in Adolescents

Functional medicine treatments aim to address some of the root causes of anxiety that were discussed earlier in this article. These treatments can often be used alongside conventional treatments under the supervision of an integrated medicine team.

Nutritional Recommendations

The fact that our diets affect our physical health is well-recognized. There is also evidence supporting the effect of diet on our mental health. The Mediterranean diet is a way of eating in which vegetables, fruit, beans, lentils, nuts, and healthy fats from olive oil and fish are emphasized. It limits processed and sugary foods. Research has shown that adolescents who adhere strongly to a Mediterranean diet exhibit lower anxiety levels (26). 

Supplements & Herbs

Omega-3 fatty acids are essential for proper cell functioning and are found in especially high amounts in the eyes and brain. Research shows that supplementing with doses of at least 2,000mg daily can help to reduce symptoms of anxiety.

Vitamin C is an antioxidant that plays a role in anxiety, stress, and other mood states. Oxidative stress can contribute to neuropsychological disorders. Research has shown that a dose of 500mg daily can help to reduce anxiety symptoms.

Some herbs also show anxiolytic effects in the treatment of GAD, such as ginkgo biloba, kava kava, and passionflower. Some herbs can interact with medications. So please discuss herbal options with your practitioner, especially if you are also taking medications.

Complementary and Integrative Medicine

Acupuncture is part of the ancient practice of Traditional Chinese medicine (TCM), in which small needles are used to penetrate the skin at specific points on the body. According to TCM, the body has over 2000 points connected by pathways or meridians that allow for the flow of energy, or Qi, throughout the body. The disruption of Qi is thought to cause disease. Using acupuncture helps to balance the flow of Qi, thereby improving health. Acupuncture shows promise in treating anxiety disorders, including in adolescent patients. (1, 4, 31)

Mindfulness practices, like meditation, can also be helpful in reducing anxiety. Practicing meditation helps us to engage the parts of our brain that regulate thoughts and emotions, to better control negative thoughts and worry.

Physical activity, both light-intensity and moderate-vigorous activity, can also help to reduce anxiety symptoms. It is hypothesized that exercise improves anxiety by manipulating neurotransmitter levels, promoting neuronal cell growth in areas of the brain that influence mental health, influencing oxidative stress and inflammatory pathways, and improving self-esteem, autonomy, and self-efficacy.

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Summary

Generalized anxiety disorder is a relatively common mental health disorder in adolescents. If left untreated, it leads to a greater risk of developing other mental health disorders in adulthood. Integrative medicine allows for a more holistic approach to treatment to address multiple factors that lead to its development. Using functional medicine tests, integrative medicine practitioners can create personalized treatment plans combining conventional therapies, dietary changes and supplements, and other complementary therapies to improve quality of life and reduce the risk of developing further mental health disorders in the future.