Your Health - Anxiety

Anxiety

(Chronic Free-Floating Anxiety; Generalized Anxiety Disorder)

Definition

Anxiety is a normal state of dread, tension, and unease. It is considered a normal response to stress or uncertain situations. Prolonged or intense periods of anxiety may suggest an anxiety disorder. A disorder may also be indicated if anxiety:

Occurs without an external threat (“free-floating” anxiety)
Impairs daily functioning

The most common types of anxiety disorders are:

Anxiety is often complicated by the presence of alcohol or drug abuse and depression .

Causes

Anxiety may result from many factors including:

Appropriate response under stressful circumstances
Drugs that affect the nervous system, such as:
- Caffeine
- Alcohol
- Cocaine
- Nicotine
- Amphetamines (eg, “crystal meth”)
- Some herbal medications
Biological factors:
- Brain chemistry imbalances (eg, serotonin and norepinephrine)
- Personality traits
Faulty perceptions and irrational beliefs (eg, phobias)
Unresolved emotional conflicts

Risk Factors

A risk factor increases your chance of getting a disease or condition. Risk factors for anxiety include:

Sex: female
Family member with anxiety disorders
Stressful life events
Ineffective coping strategies
History of physical or psychological trauma

Symptoms

Psychological symptoms may include:

Worry or dread
Obsessive or intrusive thoughts
Sense of imminent danger or catastrophe
Fear or panic
Restlessness
Irritability
Impatience
Ambivalence
Trouble concentrating

Physical symptoms may include:

Rapid or irregular heartbeat
Sweating, especially the palms
Dry mouth
Flushing or blushing
Muscle tension
Shortness of breath
Lightheadedness or faintness
Difficulty sleeping
Shaking
Choking sensation
Frequent urination
Nausea or vomiting
Diarrhea
Constipation
Feeling of "butterflies" in the stomach
Sexual difficulties
Tingling sensations
Nail biting or other habitual behavior

Symptoms of Anxiety

Diagnosis

Your doctor will ask about your symptoms and medical history. A psychiatric evaluation will be done. Your doctor may also perform a physical exam and diagnostic tests. Usually the results of these tests are normal. You may be referred to a psychotherapist for further evaluation.

Treatment

Effective treatment usually involves a combination of interventions, including:

Lifestyle Changes

Get sufficient rest and sleep .
If you smoke, quit .
Reduce or eliminate caffeinated beverages.
Drink alcohol in moderation.
Avoid illicit drugs.
Reduce exposure to stressful environments.
Exercise regularly .

Relaxation Techniques

Deep breathing
Meditation
Deep muscle relaxation
Massage
Engaging in pleasurable activities
Yoga

Social Support

Strong support system of family and friends
Counseling to improve coping skills
Support groups

Psychotherapy

This therapy addresses thoughts, feelings, and behaviors that play a role in anxiety. It helps you work through traumas and conflicts.

Cognitive-behavioral therapy can help you identify negative thought patterns and behaviors. Over time, you can learn to retrain your thinking. This will help you choose better options in response to stress and anxiety.

Medication

For severe anxiety or anxiety disorder, medications may include:

Benzodiazepines
Buspirone
Tricyclic antidepressants
Selective serotonin reuptake inhibitors (SSRIs)

FDA Public Health Advisory for Antidepressants

The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose.

Although the warning is for all antidepressants, of most concern are the SSRI class such as:

Prozac ( fluoxetine ), Zoloft ( sertraline ), Paxil ( paroxetine ), Luvox ( fluvoxamine ), Celexa ( citalopram ), Lexapro ( escitalopram )

For more information, please visit: http://www.fda.gov/cder/drug/antidepressants/

If you are diagnosed with an anxiety disorder, follow your doctor's instructions .

Prevention

To help prevent anxiety, consider taking the following steps:

Avoid situations, occupations, and people that cause you stress.
If unavoidable, confront and overcome situations that provoke anxiety.
Find a relaxation technique that works for you. Use it regularly.
Develop and maintain a strong social support system.
Express your emotions when they happen.
Challenge irrational beliefs and counterproductive thoughts.
Correct misperceptions. Ask others for their views.
Work with a therapist .
Avoid using nicotine or other drugs. Drink alcohol in moderation

RESOURCES:

Anxiety Disorders Association of America
http://www.adaa.org/

Mental Health America
http://www.nmha.org/

CANADIAN RESOURCES:

Canadian Psychiatric Association
http://www.cpa-apc.org/

Canadian Psychological Association
http://www.cpa.ca/

References:

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 . Published May 22, 2009. Accessed July 15, 2009.

Generalized anxiety disorder. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/ . Accessed June 18, 2008.

Nietzel MT, Wakefield JC. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders . 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.

Tierney LM, McPhee SJ, Papadakis MA. Current Medical Diagnosis and Treatment . 45th ed. New York, NY: McGraw-Hill;2006.

12/4/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Javnbakht M, Hejazi Kenari R, Ghasemi M. Effects of yoga on depression and anxiety of women. Complement Ther Clin Pract. 2009;15(2):102-104.

Last reviewed November 2009 by Theodor B. Rais, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.