Anxiety disorders

Overview

What a worry

Everyone experiences some anxiety. It's a natural response to situations that are stressful or frightening. Up to a point, anxiety can help people prepare for a crisis and function better.

Anxiety disorders, however, are psychological conditions that carry the feelings of anxiety to extremes. Symptoms persist and disrupt life. Sleeplessness, emotional exhaustion, trembling, difficulty concentrating, and an increase in stress-related illnesses all indicate that anxiety is adversely affecting your daily life.

Subtypes of anxiety disorders — such as generalized anxiety, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and specific phobias — each have particular qualities or sources of anxiety. Doctors can treat all forms of anxiety with combinations of medication, psychotherapy, and self-help techniques.

Detailed Description

Anxiety is a general term that has many connotations in our culture. Anxiety is sometimes associated with fear. Some anxiety in response to life's stress is normal and may even be productive. Anxiety becomes a medical issue, however, when it persists and interferes with daily living, becomes overwhelming, and emerges without connection to clear sources. When this happen, doctors classify the anxiety as a psychiatric disorder. Varieties of anxiety include:

• Generalized anxiety disorder. Anxious mood and underlying anxiety with symptoms of tension, hyperactivity, and being overly vigilant.
• Panic disorder. Recurring panic attacks usually last several minutes and occur without an obvious trigger. They can include a wide array of physical symptoms, including heavy sweating, shortness of breath, trembling, and rapid heartbeat. The attack usually causes concerns about additional attacks, and significant changes in behavior.
• Post-traumatic stress disorder. Frequent flashbacks or nightmares of catastrophic or traumatic events by survivors of trauma.
• Specific phobias. Intense frequent fear of an object or situation that causes extreme anxiety. People with phobias will try hard to avoid these situations or objects.
• Obsessive-compulsive disorder. Behavioral patterns that interfere with daily life, due to persistent unwanted and disturbing thoughts.

Periods of normalcy often follow periods of high anxiety. Because the condition is different in each person, doctor cannot predict its course in a generalized way.

How Common Are Anxiety Disorders?

Up to 20 million people in the United States each year have an anxiety disorder, making the disorders the country's most common category of mental illness. Anxiety disorders primarily affect adults, mostly between ages 20 and 45, and affect women more than men.

Conventional Treatment

Goals of Treatment

The goal of treatment for all anxiety disorders is to reduce the anxiety to a point where it no longer interferes with your daily life. Drug therapy's goal is not to cure the disorder, but to reduce the symptoms; psychotherapy and lifestyle changes are important to effectively treat anxiety.

Treatment Overview

Doctors commonly use psychotherapy, anti-anxiety drugs, and antidepressants to treat anxiety disorders. They should base treatment on carefully considered identification of your anxiety disorder, including the subtype, the specific cause, and your history. Usually you won't need to stay in the hospital for treatment. If you have a history of substance abuse, you should tell your doctor; you will need to avoid treatment with benzodiazepine medications.

Drug therapies can successfully treat many people. Treatments also include nonpharmaceutical approaches such as:

• Education from health professionals, support groups, and self-help materials
• Relaxation techniques including progressive relaxation, biofeedback, and hypnotherapy
• Desensitization and behavioral therapy
• Psychotherapy
• Cognitive therapy

For short-term anxiety disorders, such as panic disorder, changing your lifestyle and taking care of yourself are the first steps in treatment. Medication and psychotherapy may also help you work through the issues connected to the disorder. Active treatment can usually overcome these disorders.

Anxiety disorders that have longer-term symptoms, such as obsessive-compulsive disorder and post-traumatic stress disorder, are harder to treat. Treatment may involve long-term medication, psychotherapy and attention to lifestyle stresses.

Drug Therapy

If you are on drug therapy, do not suddenly stop taking the drug; ease off by slowly decreasing the dosage. Otherwise you may have significant side effects, such as stomach upset, insomnia, headaches, or seizures, in addition to potential return of symptoms of the anxiety disorder.

The benzodiazepine class of drugs is very addictive; doctors should administer them with caution. If you suspect that you have developed dependency on the drug, notify your physician.

Drugs most commonly prescribed
For generalized anxiety disorder:
BuSpar
Lexapro http://www.nmihi.com/e/escitalopram.html
Seroquel
Cymbalta
Lyrica
Paxil http://www.nmihi.com/p/paroxetine.html
Effexor http://www.nmihi.com/u/venlafaxine.html
Benzodiazepines
Valium (Diazepam)
Xanax (Alprazolam)
For panic attacks:
Tricyclic antidepressants (TCAs)
Tofranil
Pamelor
Anafranil
Benzodiazepines
Xanax (Alprazolam)
Klonopin (Clonazepam)
Alprazolam
Ativan (Lorazepam)
Selective serotonin reuptake inhibitors (SSRIs)
Luvox
Celexa
Paxil
Prozac
Zoloft http://www.nmihi.com/s/sertraline.html
For post-traumatic stress disorder:
Luvox (Fluvoxamine)
Paxil (Paroxetine)
Amitriptyline http://www.nmihi.com/a/amitriptyline.html
Desyrel
Others
Strattera http://www.nmihi.com/a/atomoxetine.html
Tenormin

Healthcare Professionals Who May Be Involved in Treatment

Healthcare professionals who may treat anxiety include:

• Internists
• Pediatricians
• Family medicine physicians
• Psychiatrists
• Psychologists

Activity & Diet Recommendations

Doctors not only allow you full activity, they recommend it as part of the treatment. Reducing connections to people or normal life activities is counterproductive in overcoming anxiety disorders. Physical exertion and regular exercise helps to reduce anxiety in people of all ages.

To keep from hyperventilating — a common experience during panic attacks — hold a paper bag to your mouth and breath in and out of it. This helps restore a normal balance of oxygen and carbon dioxide, relieving the symptoms of dizziness and palpitations that hyperventilation can cause.

Since caffeine is itself a stimulant, consume less of it. Also, avoid alcohol, especially when using medication.

Monitoring the Condition

Since treatment may involve highly addictive drugs, your doctor must monitor your medications closely to avoid dependency. Other recommendations include:

• Regular follow-up visits
• Monitoring blood pressure and heart rate when using tricyclic medications
• Knowing and understanding the side effects from your medications

Possible Complications

Unattended anxiety disorder could lead to complications such as social/work impairment and panic attacks. Medication use may lead to drug dependency and heart problems (associated with tricyclic medications).

Quality of Life

People with anxiety suffer great distress that may interfere with their daily lives. Moreover, external sources can trigger anxiety. Take a step back and identify the cause of your anxiety. If anxiety is greatly affecting your normal life, seek treatment promptly. Anxiety and problems with daily life can reinforce each other and cause a downward spiral.

Considerations for Women

Pregnancy

Do not take benzodiazepines — medications commonly prescribed for anxiety management — during the first trimester of pregnancy, and use them with caution later in pregnancy.

There is some evidence of fetal risk with tricyclic antidepressants (TCAs), especially during the first trimester.

Taper off and discontinue selective serotonin reuptake inhibitors (SSRIs) during the first trimester of pregnancy. You may continue them later in the pregnancy.

Nursing mothers

Use benzodiazepines with caution. If you take benzodiazepines regularly or in high doses, avoid breastfeeding since the drugs may cause lethargy and weight loss in nursing infants.

Considerations for Older People

When diagnosing older people, doctors must consider that emotional highs and lows can be greater in later years, and that some fluctuation in mood is normal. Deaths of friends and family members may cause anxiety; doctor should consider this when examining the elderly person's emotional state. Older people usually receive a reduced dosage of medications for anxiety.

Self care & Prevention

Self-Care Measures

Because anxiety is a symptom of severe stress, one of the primary ways you can avoid anxiety is to manage stress in your daily life. Take precautions so that you don't overburden yourself with more than is healthy or feasible. Set aside "just-for-me" time every day. Some other strategies for reducing stress include:

• Breathe deeply. Deep breathing is fundamental to meditation and many stress-relieving regimens.
• Take a hot bath or shower. When you feel stressed, warmth can sooth and relax you.
• Work up a sweat. Any vigorous exercise releases endorphins, the body's own mood-elevating stress relievers. Relaxing forms of exercise include walking, dancing, gardening, swimming, yoga, and tai chi.
• Limit your intake of caffeine. Coffee and other caffeinated items increase irritability and anxiety.
• Have a good laugh. Laughter is a great antidote to anxiety, reducing levels of the stress hormone, cortisol. Watch a comedy video or movie, or read a funny book.
• Talk to a friend. Social isolation is stressful, and social ties are relaxing, so don't forget to reach out to others.
• Care for a pet. Many studies show that pets help reduce stress. Dogs provide unconditional love. Cats purr on your lap. Even non-cuddly pets — for example, fish — can help calm you.