Anxiety Overview

IMPORTANT INFORMATION:

As with all articles on this site this article is a brief overview of Anxiety, Medication, and Interventions. It is meant as an insightful article giving further understanding and awareness of issues that might be affecting you. At all times medical advice and intervention should be sought if you are in need or just want to talk, medical interventions are always changing and the information in this article may need updating.

Anxiety Overview

Anxiety is a feeling of apprehension, fear, or worry. Some fears and worries are justified, such as worry about a loved one. Anxiety may occur without a cause, or it may occur based on a real situation, but may be out of proportion to what would normally be expected. Severe anxiety can have a serious impact on daily life.

Anxiety can be accompanied by a variety of physical symptoms. Most commonly, these symptoms are related to the heart, lungs, and nervous system. You may feel as if you are having a heart attack.

Anxiety Causes

Anxiety may be caused by a mental condition, a physical condition, the effects of drugs, or from a combination of these. The doctor’s initial task is to see if your anxiety is caused by a medical condition.

Common causes of anxiety include these mental conditions:

Panic disorder: In addition to anxiety, common symptoms of panic disorders are palpitations (feeling your heart beat), dizziness, and shortness of breath. These same symptoms also can be caused by coffee (caffeine), amphetamines ("speed" is the street slang for amphetamines when they are not prescribed by a doctor), an overactive thyroid, abnormal heart rhythms, and other heart abnormalities (such as mitral valve prolapse).

Generalized anxiety disorder
Phobic disorders
Stress disorders
These common external factors can cause anxiety:
Stress at work
Stress from school
Stress in a personal relationship such as marriage
Financial stress
Stress from an emotional trauma such as the death of a loved one
Stress from a serious medical illness
Side effect of medication
Use of an illicit drug, such as cocaine
Symptom of a medical illness

Lack of oxygen - In circumstances as diverse as high altitude sickness, emphysema, or pulmonary embolism (a blood clot with the vessels of the lung)
The doctor has the often-difficult task of determining which symptoms come from which causes. For example, in a study of people with chest pain that could be heart disease but turned out not to be heart related, 43% were found to have a panic disorder—a common form of anxiety.

Anxiety Symptoms

Panic disorders - Separate and intense periods of fear or feelings of doom developing over a very short time frame—10 minutes—and associated with at least 4 of the following:

Palpitations
Sweating
Trembling
Shortness of breath
Sense of choking
Chest pain
Nausea
Dizziness
A feeling of being detached from the world (derealization)
Fear of dying
Numbness or tingling
Chills or hot flushes

Generalized anxiety disorder - Excessive and unrealistic worry over a period of at least 6 months associated with 3 of the following:

Restlessness
Easy fatigue
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbances

Phobic disorders - Intense, persistent, and recurrent fear of certain objects (such as snakes, spiders, blood) or situations (such as heights, speaking in front of a group, public places). These exposures may trigger a panic attack.
Stress disorders - Anxiety (also known as post-traumatic stress disorder) caused by the exposure to either death or near-death circumstances such as fires, floods, earthquakes, shootings, automobile accidents, or wars, for example. The traumatic event is re-experienced in thoughts and dreams. Common behaviors include the following:

Avoiding activities, places, or people associated with the triggering event
Difficulty concentrating
Difficulty sleeping
Being hypervigilant (you closely watch your surroundings)
Feeling a general sense of doom and gloom with diminished emotions such as loving feelings or aspirations for the future

Symptoms such as chest pain, shortness of breath, palpitations, dizziness, fainting, and weakness generally should not be attributed to anxiety and require evaluation by a doctor.

When to Seek Medical Care

Call your doctor when the signs and symptoms of anxiety are not easily, quickly, and clearly diagnosed and treated.

If the symptoms are so severe that you believe medication may be needed
If the symptoms are interfering with your personal, social, or professional life
If you have chest pain, shortness of breath, headaches, palpitations, dizziness, fainting spells, or unexplained weakness
If you are depressed and feel suicidal

When the signs and symptoms suggest that anxiety may have been present for a prolonged period (more than a few days) and appear to be stable (not getting worse rapidly), you may be able to make an appointment with your doctor for evaluation. But when the signs and symptoms are severe and come on suddenly, they may represent a serious medical illness that needs immediate evaluation and treatment in a hospital’s emergency department.

Exams and Tests

The doctor will take a careful history, perform a physical examination, and order laboratory tests as needed.

If you have another medical condition that you know about, there may be an overlap of signs and symptoms between what is old and what is new.
Just determining that anxiety is psychological does not immediately identify the ultimate cause. Often, determining the cause requires the involvement of a psychiatrist, clinical psychologist, or other mental health professional.

Anxiety Treatment

Self-Care at Home

In certain cases, you may treat anxiety at home without the involvement of a doctor. These are limited to anxiety attacks of short duration in which you know the cause, the anxiety is short, it goes away by itself, and the cause can be eliminated. For example, you may be anxious over an upcoming public performance, a final exam, or a pending job interview. In such circumstances, stress may be relieved by such actions as these:

Talking with a supportive person
Meditation
Watching TV
Taking a long warm bath
Resting in a dark room
Deep breathing exercises

Medical Treatment

Treatment depends on the cause.
When the cause of anxiety is a physical ailment, treatment is directed toward eliminating that ailment. For example, if your thyroid gland were overactive and causing anxiety, the treatment might involve surgery and various thyroid-regulating medications.

When the cause is psychological, the underlying cause needs to be discovered, and, if possible, eliminated or controlled. For example, if the cause is difficulty in a marriage, the doctor may suggest marital counseling.

Sometimes, the cause cannot be identified. In such cases, the only treatment option is control of symptoms.

In the past, anxiety was treated with drugs in a class known as benzodiazepines. These include familiar names:
Diazepam (Valium)
Alprazolam (Xanax)
Lorazepam (Ativan)
A newer anti-anxiety drug is buspirone (BuSpar).
More recently, drugs of the SSRI class (selective serotonin reuptake inhibitors, often also used to treat depression) are prescribed and include the following:
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluoxetine (Prozac)
Venlafaxine (Effexor)
In addition, psychotherapy may be useful. Combinations of medication and counseling are usually advisable.

Next Steps

Follow-up

Anxiety should be addressed and treated with your doctor. Establish an ongoing relationship. By knowing your own doctor and by having follow-up on a regular basis, you may cope with your problems and resolve them more effectively. These steps may also help you deal with medical conditions that might otherwise go undiagnosed and untreated.

Prevention

Prevention of anxiety essentially involves an awareness of life's stresses and your own ability to cope with them. This can often be a difficult task in our busy and hectic 21st century.

In essence, you might develop coping mechanisms for all of life's stresses.
Strategies might include these:
Exercise
Meditation
Relaxation exercises including deep breathing
Visualization

Interpersonal skills in dealing with difficult people and situations or parenting skills training in dealing with your children

Prevention also includes diet, regular exercise, rest, and the basics in terms of preventive health care maintenance. Diet is a large factor. Caffeine, stimulants, lack of rest, and lack of exercise all are factors that influence anxiety.

Outlook

When the cause of anxiety is identified and treated, complete recovery is often made. Where no cause can be readily identified, you may feel anxiety for a long time, perhaps your entire life. Excellent medications are available to help many of the symptoms. Counseling with mental health professionals can be highly successful.