Anxiety

Anxiety

 Definition:

Anxiety happens as a normal part of life. It can even be useful when it alerts you to danger. But for some people, anxiety persistently interferes with daily activities such as work, school or sleep. This type of anxiety can disrupt relationships and enjoyment of life, and over time it can lead to health concerns and other problems.

In some cases, anxiety is a mental health condition that requires treatment. Generalized anxiety disorder, for example, is characterized by persistent worry about major or minor concerns. Other anxiety disorders — such as panic disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) — have more-specific triggers and symptoms. Sometimes, anxiety results from a medical condition that needs treatment.

Whatever form of anxiety you have, lifestyle changes, counseling or medications — or a combination of these approaches — can help.

Symptoms:

Common anxiety signs and symptoms include:

• Feeling apprehensive
• Feeling powerless
• Having a sense of impending danger, panic or doom
• Having an increased heart rate
• Breathing rapidly (hyperventilation)
• Sweating
• Trembling
• Feeling weak or tired

Several types of anxiety disorders exist:

• Panic attacks can start suddenly and cause apprehension, fear or terror. You may have feelings of impending doom, shortness of breath, heart palpitations or chest pain. You may feel as if you're choking, being smothered or that you're "going crazy."
  
• Agoraphobia is anxiety about, or avoidance of, places or situations where you might feel trapped or helpless if you start to feel panicky.
  
• Specific phobias are characterized by major anxiety when you're exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.
  
• Social phobias are characterized by major anxiety provoked by exposure to certain types of social or performance situations and a desire to avoid them.
  
• Obsessive-compulsive disorder (OCD) includes persistent, recurring thoughts, images or impulses (obsessions) or an irresistible desire to perform irrational or seemingly purposeless acts or rituals (compulsions). Often it involves both obsessive and compulsive behavior.
  
• Post-traumatic stress disorder (PTSD) includes the feeling that you're re-experiencing an extremely traumatic event. It causes intense emotions and physical reactions along with a desire to avoid anything that might remind you of the event.
  
• Acute stress disorder includes symptoms similar to those of PTSD that occur immediately after an extremely traumatic event.
  
• Generalized anxiety disorder includes at least six months of persistent and excessive anxiety and worry about small or large concerns. This type of anxiety disorder often begins at an early age. It frequently occurs along with other anxiety disorders or depression.
  
• Anxiety disorder due to a medical condition includes prominent symptoms of anxiety that are directly caused by a physical health problem.
  
• Substance-induced anxiety disorder is characterized by prominent symptoms of anxiety that are a direct result of abusing drugs, taking medications or being exposed to a toxic substance.
  
• Separation anxiety disorder is a childhood disorder characterized by anxiety related to separation from parents or others who have parental roles.
  
• Anxiety disorder not otherwise specified is a term for prominent anxiety or phobias that don't meet the exact criteria for any of the other anxiety disorders but are significant enough to be distressing and disruptive.

When to see a doctor
See your doctor if:

• You feel like you're worrying too much and it's interfering with your work, relationships or other parts of your life
• You feel depressed, have trouble with alcohol or drug use, or have other mental health concerns along with anxiety
• You think your anxiety could be linked to a physical health problem
• You have suicidal thoughts or behaviors (seek emergency treatment immediately)

Your worries may not go away on their own, and they may actually get worse over time if you don't seek help. See your doctor or a mental health provider before your anxiety gets worse. It may be easier to treat if you address it early.

Causes:

As with many mental health conditions, the exact cause of anxiety disorders isn't fully understood. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to becoming anxious. Inherited traits also are a factor.

Medical causes
For some people, anxiety is linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators that you have a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order lab tests and other tests to look for signs of a problem.
Physical problems that can be linked to anxiety include:

• Heart disease
• Diabetes
• Thyroid problems (such as hypothyroidism or hyperthyroidism)
• Asthma
• Drug abuse
• Alcohol withdrawal
• Withdrawal from anti-anxiety medications (benzodiazepines)
• Rare tumors that produce certain "fight-or-flight" hormones
• Muscle cramps or spasms
• Tingling, burning or prickling sensations that may have no apparent cause

It's more likely that your anxiety may be due to an underlying medical condition if:

• Your anxiety symptoms started after age 35
• You don't have any blood relatives (such as a parent or sibling) with an anxiety disorder
• You didn't have an anxiety disorder as a child
• You don't avoid certain things or situations because of anxiety
• No events have occurred in your life that were triggered by significant anxiety
• Medications used to treat feelings of panic (such as benzodiazepines) don't ease your anxiety symptoms

Complications:

Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical health conditions, such as:

• Depression (which often occurs with anxiety disorder)
• Substance abuse
• Trouble sleeping (insomnia)
• Digestive or bowel problems
• Headaches
• Teeth grinding (bruxism)

Treatments and drugs:

When anxiety is severe, disrupts your day-to-day life, causes panic attacks or doesn't get better over time, you may have a disorder that needs to be diagnosed and treated.
The two main treatments for anxiety disorders are behavior therapy (psychotherapy) and medications. You may benefit most from a combination of the two. It may take some trial and error to discover exactly what treatments work best for you.

Psychotherapy
Also known as behavior or talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for anxiety.
Cognitive behavioral therapy is one of the most effective forms of psychotherapy for anxiety disorders. Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to gradually return to the activities you have avoided because of anxiety. Through this process, your symptoms improve as you build upon your initial success.

Medications
Several different types of medications are used to treat anxiety disorders, including those below. Talk with your doctor about benefits, risks and possible side effects.

• Antidepressants. These medications influence the activity of brain chemicals (neurotransmitters) thought to play a role in anxiety disorders. Examples of antidepressants used to treat anxiety disorders include fluoxetine (Prozac), imipramine (Tofranil), paroxetine (Paxil, Pexeva), sertraline (Zoloft), and venlafaxine (Effexor XR). Citalopram (Celexa) and escitalopram (Lexapro) also can be effective, but dosages of about 40 milligrams (mg) a day of citalopram or 20 mg a day of escitalopram warrant discussion of risks versus benefits.
  
• Buspirone. An anti-anxiety medication called buspirone may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective.
  
• Benzodiazepines. In limited circumstances your doctor may prescribe one of these sedatives for relief of anxiety symptoms. Examples include alprazolam (Niravam, Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan). Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these medications aren't a good choice if you've had problems with alcohol or drug abuse.