Anxiety

Anxiety disorders are the most common emotional disorder and affect more than 25 million Americans. Fear and anxiety are part of life, but anxiety disorders involve more than temporary worry or fear. For people with anxiety disorders, the anxiety does not go away and it gets worse over time. People may have chest pains or nightmares, or they may even be afraid to leave home.

This anxiety can interfere with daily activities such as job performance, school work, and personal relationships. Untreated anxiety disorders make people avoid situations that trigger or worsen their symptoms. People with anxiety disorders are likely to suffer from depression, and they also may abuse alcohol and other drugs in an effort to gain relief from their symptoms.

Symptoms of anxiety disorders may include:

• Overwhelming feelings of panic and fear
• Uncontrollable obsessive thoughts
• Painful, intrusive memories
• Recurring nightmares
• Physical symptoms such as feeling sick to your stomach, “butterflies” in your stomach, heart pounding, startling easily, and muscle tension

There are several types of anxiety disorders: panic disorder, phobias, and generalized anxiety disorder. Each type of anxiety has distinct triggers, symptoms, and treatments. Most anxiety disorders can be treated with combinations of medications and therapy.

Severe anxiety that lasts at least 6 months is generally considered to be problem that might benefit from evaluation and treatment. Each anxiety disorder has different symptoms, but all the symptoms involve excessive, irrational fear and dread.

Anxiety disorders can occur along with other mental or physical illnesses, including alcohol or substance abuse, which may mask anxiety symptoms or make them worse. In some cases, these other problems need to be treated before a person can respond well to treatment for anxiety.

Some symptoms, such as fear and worry, occur in all anxiety disorders, but each disorder also has distinct symptoms.

• Panic Disorder. The main symptom of panic disorder is the panic attack, an overwhelming combination of physical and psychological distress. Sometimes, symptoms of a panic attack are so severe that many people with panic disorder believe they are having a heart attack or other life-threatening illness. An attack may include the following symptoms:
  • Pounding heart or chest pain
  • Sweating, trembling, shaking
  • Shortness of breath, sensation of choking
  • Nausea or abdominal pain
  • Dizziness or lightheadedness
  • Feeling unreal or disconnected
  • Fear of losing control, “going crazy,” or dying
  • Numbness
  • Chills or hot flashes
• Phobias. A phobia is excessive and persistent fear of a specific object, situation, or activity. These fears cause such distress that some people go to extreme lengths to avoid what they fear. There are three types of phobias:
  • Specific phobia. An extreme or excessive fear of an object or situation that is generally not harmful. Patients know their fear is excessive, but they cannot overcome it. Fear of flying or fear of spiders are examples of common phobias.
  • Social phobia (also called social anxiety disorder). Significant anxiety and discomfort about being embarrassed or looked down on in social or performance situations. Public speaking, meeting people, or using public restrooms are examples of common social phobias.
  • Agoraphobia. The fear of being in situations where escape may be difficult or embarrassing or help might not be available in the event of panic symptoms. Untreated agoraphobia can become so serious that a person may refuse to leave the house.
• Generalized Anxiety Disorder . People with generalized anxiety disorder (GAD) have ongoing, severe tension that interferes with daily functioning. They worry constantly and feel helpless to control these worries. The worries often focus on job responsibilities, family health, or minor matters such as chores, car repairs, or appointments. They may have problems sleeping, muscle aches or tension, feel shaky and weak, and have headaches. People with GAD can be irritable and often have problems concentrating and working effectively.

The exact causes of anxiety disorders are unknown, but areas of the brain that control fear responses may have a role in some anxiety disorders. Anxiety disorders can run in families, which suggests that a combination of genes and environmental stresses can produce the disorders. The role of brain chemistry is also being investigated.

To diagnose anxiety disorders, a physical evaluation is recommended to determine whether the anxiety is associated with a physical illness. If anxiety is diagnosed, the pattern of symptoms should be identified, as well as any coexisting conditions, such as depression or substance abuse. These conditions should be treated with appropriate therapies.

With proper treatment, many people with anxiety disorders lead normal, fulfilling lives. If you think you have an anxiety disorder, seek help from a mental health professional who has particular expertise in diagnosing and treating anxiety.

You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere. Once you find a clinician with whom you are comfortable, you will work together to create an individualized treatment plan for your anxiety disorder.

Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Talking with a trusted friend or family member can also provide support, but it is not necessarily a sufficient alternative to care from an expert clinician.

Anxiety disorders are treatable. If you think you or someone you care about has an anxiety disorder, talk to your doctor.

Although each anxiety disorder has its own unique characteristics, most respond well to 2 types of treatment: psychotherapy and medications. These treatments can be given alone or in combination. Treatment can provide significant relief from symptoms, but it does not always provide a complete cure.

Medication that reduces the symptoms of anxiety disorders include:

• Antidepressants such as amitriptyline (Elavil), Citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), imipramine (Tofranil, Surmontil), nortriptyline (Pamelor, Aventyl), paroxetine (Paxil), protriptyline (Vivactil), sertraline (Zoloft), trimipramine (Surmontil), and venlafaxine (Effexor XR)
• Anti-anxiety drugs such as alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan)
• Beta-blockers such as metoprolol (Toprol XL, Lopressor), carvedilol (Coreg), bisoprolol (Zebeta), betaxolol (Kerlone), nebivolol (Bystolic), propranolol (Inderal, Pronol)

Psychotherapy involves talking with a trained clinician, such as a psychiatrist, psychologist, social worker, or counselor, to understand the symptoms and triggers of an anxiety disorder and how to manage it. It can be useful in treating anxiety disorders by helping people change the thinking patterns that support the fears and anxieties and changing the way they react to anxiety-provoking situations.

Stress management and relaxation techniques, including meditation, yoga, exercise, and other alternative treatments can help people with anxiety disorders stay calm and may enhance the effects of therapy. Caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, these substances should be avoided. Check with your physician or pharmacist before taking any additional medications.

Friends and family are an important part of the recovery of a person with an anxiety disorder. The family should be supportive and not help perpetuate their loved one’s symptoms. Family members should not trivialize the disorder or demand improvement without treatment.