Anxiety

Alternative names

anxiety disorder, general anxiety disorder (GAD)

Description

For some people, the world can feel like a terrifying place. Around every corner lie stress, worry, and fear. It’s difficult to cope with the challenges that life throws at them, and it’s difficult to know which stressors in life will result in a triggering of the “fight or flight” response.

This stress response, which is typically characterized by a rapid heart rate, sweating and a general feeling of fear, is necessary to human survival. Usually, this response is triggered by events that are or could be dangerous, allowing us to make fast decisions, move quickly, or perform unusual feats of strength.

For people with a diagnosis of anxiety, this stress response is overactive, causing them to feel fear in situations that most would consider non-threatening or even throughout the day with no clear trigger. In time, an anxiety disorder can significantly decrease a person’s quality of life and make it difficult to perform daily activities of living.

In addition to generalized anxiety, other disorders that fall under the heading of anxiety disorders include:

• Panic disorder, which results in more pronounced and dramatic symptoms
• A variety of phobias, including social phobias
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)

Anxiety disorder is often treated with a combination of medication and mental health counseling.

Causes

Some anxiety disorders are believed to be genetic in nature while others, such as PTSD, are triggered by events – although the person in question may already have a physical predisposition toward anxiety. About 40 percent of people with generalized anxiety disorder have close family members with the disorder.

A number of neurotransmitters in the brain contribute to our feelings and emotions, and when an anxiety disorder is present, these neurotransmitters are typically out of balance. Scientists have linked imbalances in the neurotransmitters serotonin, dopamine, gamma-aminobutyric acid (GABA) and epinephrine to anxiety disorder. Serotonin appears to be one of the most important neurotransmitters when it comes to regulating feelings of well-being. The hormone cortisol also appears to play an important role.

Symptoms

The symptoms of anxiety disorders can vary depending on the specific disorder, but the typical symptoms of generalized anxiety include:

• A sense of uneasiness or fear
• Sudden feelings of panic
• Obsessive thoughts that can’t be controlled
• Nightmares
• Difficulty sleeping
• Sweating hands or feet
• Coldness in the extremities
• Shortness of breath
• A racing heart or palpitations
• Difficulty remaining still or calm
• Dry mouth
• Nausea
• Tension in the muscles
• Dizziness

Risk Factors

As noted, genetic predisposition plays a strong role in developing an anxiety disorder. Many factors for developing an anxiety disorder are out of a patient’s control including:

• Being female
• Experiencing childhood trauma
• Having a serious illness
• Stressful life events
• Certain personality types as well as personality disorders

Another risk factor for developing anxiety that may be within the patient’s control is substance abuse. Drug and alcohol abuse both increase the risk for anxiety disorder, and caffeine and nicotine have also been linked to the disorder.

Tests and Examinations

Anxiety disorders are usually diagnosed by qualified mental health professionals such as psychiatrists. The patient is also likely to receive a complete medical examination, including laboratory testing, to rule out an underlying condition that could mimic some of the symptoms of anxiety disorder such as a problem with the thyroid.

The provider will also conduct a thorough evaluation using specialized questionnaires to learn more about the symptoms, how long the patient has been experiencing them, and what may be triggering them.

Diagnosis

To be diagnosed with general anxiety disorder or one of the other anxiety disorders, the patient must meet a certain set of criteria as determined by the Diagnostic and Statistical Manual of Mental Disorders. The criteria for general anxiety disorder include:

• Difficulty controlling worrying thoughts or emotions
• Excessive fear or worry about a range of activities that occurs most days of the week and has lasted for at least six months
• These troubling feelings are having a debilitating effect on the patient’s daily life
• The feelings can’t be attributed to a specific mental health condition such as PTSD
• Three of the following symptoms are present: fatigue, difficulty concentrating, restlessness, sleeping problems, muscle tension or irritability

Treatment

Anxiety is typically treated using a combination of psychotherapy with a qualified mental health practitioner and medication. Psychotherapy is also known by the names psychological counseling and “talk therapy.” The goal of this therapy is to look at the underlying causes of anxiety, work through those stressors and triggers, and learn how to make behavioral changes.

Medications that treat anxiety disorder fall into two basic classes: medications that rebalance the neurotransmitters in the brain and medications that provide quick relief from anxiety symptoms.

Antidepressants used to treat this disorder by rebalancing the neurotransmitters include buspirone, paroxetine, sertraline, and venlafaxine. These medications must be taken daily and may take two weeks or more to build up in the system. Patients are usually started at a lower dose and build up to a therapeutic dose.

Medications known as benzodiazepines effectively provide quick, temporary relief of symptoms to help a patient get through a particularly stressful time. Some medications in this class include lorazepam, diazepam and alprazolam. These medications often have noticeable side effects that include drowsiness and impairment of muscle coordination, balance and memory. Patients taking these medications should not drive. Additionally, benzodiazepines can be habit-forming.

Prognosis

While anxiety disorder can be a lifetime condition, with counseling and medication, most patients see a quick improvement of their symptoms in less than a month. It’s important to continue to take medications exactly as prescribed and not change a dose without consulting the provider since these medications work to rebalance chemicals in the brain, and without the medication, the neurotransmitters may once again become unbalanced.

In time, a person with anxiety disorder may be able to discontinue medication and truly recover from their condition. It will be important to work carefully with a mental health professional who can determine whether the patient has made a full recovery.

Complications

Untreated anxiety disorder can have severe ramifications. The condition may cause physical disorders including teeth grinding, headaches, insomnia and digestive distress.

Anxiety can also lead to other mental health concerns including depression, phobias and substance abuse. In its most severe cases, anxiety disorder may make it difficult for a patient to maintain relationships or hold a job, and it may even eventually lead to death by suicide.

When to Contact a Health Professional

A person who is experiencing the physical symptoms of anxiety disorder or who has found that fear and worry appear to be running their life should contact their general provider or a mental health practitioner immediately. A general provider can usually provide a referral to a recommended and qualified mental health provider.

Prevention

Because it’s impossible to predict what could cause a person to develop an anxiety disorder, there is no specific way to prevent the disorder. If the patient is aware that a family history of anxiety exists, they should be vigilant and tell a doctor about any concerning symptoms right away.

Some steps that patients can take to prevent or lessen the severity of anxiety or panic attacks include:

• Taking medications exactly as they are prescribed and working through any exercises recommended by a mental health practitioner
• Keeping a journal of symptoms and triggers to make it easier to avoid those triggers
• Learning deep breathing exercises or meditation to better cope with stress
• Avoid using substances linked to anxiety disorder such as drugs, alcohol and nicotine

Associated Medications