Anxiety is a normal reaction to stress, but for some people, anxiety can become excessive and difficult to control. It may negatively affect their daily lives.
Anxiety disorders affect about 40 million American adults age 18 years and older (about 18%) each year. Women are 60% more likely than men to experience an anxiety disorder during their lifetime. About eight percent of teens ages 13–18 have an anxiety disorder, but only 18% receive care for it.
There are several types of anxiety disorders. Each has different physical and emotional symptoms but all share the emotions of excessive, irrational fear and dread that occur more days than not for at least six months. It is not just the symptoms of an anxiety disorder that are disruptive to your life. How you respond to those symptoms can also impact how you live your life. Anxiety disorders can get worse if not treated.
Types of anxiety disorders include:
- Generalized Anxiety Disorder (GAD)
- Obsessive-Compulsive Disorder (OCD)
- Panic Disorder
- Post-Traumatic Stress Disorder (PTSD)
- Social Phobia or Social Anxiety Disorder
Causes of Anxiety Disorders
Anxiety disorders may be caused by combination of biological, psychological, life experiences and environmental factors. Most people with these disorders seem to have a biological vulnerability to stress, which can cause fundamental changes to the brain, making them more susceptible to environmental stimuli than the rest of the population.
Studies suggest that an imbalance of certain substances (neurotransmitters) may contribute to anxiety disorders which act as chemical messengers in the brain. These neurotransmitters are gamma-amino butyric acid (GABA), serotonin, dopamine, and epinephrine. Serotonin appears to be specifically important in feelings of well-being. Serotonin deficiencies are linked to anxiety and depression.
Stress hormones such as cortisol also play a role. For example, traumatic events cause cortisol to be released by the hypothalamus in higher levels during the body's “fight or flight” response to stress. This gives a person the short-term heightened vigilance, an energy burst, lower sensitivity to pain needed to quickly respond to threats in the surrounding environment. But in people who are more vulnerable to stress, vigilance levels remain high long after the stressful situation has ended.
How is an Anxiety Disorder Diagnosed?
There is no one test to diagnose an Anxiety Disorder. Your healthcare or mental health provider can diagnose it based on your answers to questions about your symptoms. Your healthcare provider may run laboratory tests to rule out other physical problems which may cause similar symptoms.
Treatment of Anxiety Disorders
Anxiety disorders usually are treated with medication, counseling, such as Cognitive-behavioral therapy (CBT) or a combination of these. Treatment choices depend on the problem and the person's preference.
Cognitive-behavioral therapy (CBT)
The National Association of Cognitive Behavioral Therapists describes Cognitive-behavioral therapy as “based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. The benefit of this fact is that we can change the way we think to feel/act better even if the situation does not change.”
The “cognitive” part helps people recognize and change the thinking patterns that support their fears, and the “behavior therapy” part helps people change the way they react to anxiety-provoking situations.
- Recognize and gain control of distorted views of things that cause stress, such as other people's behavior or life events.
- Replace panic-causing thoughts to help one feel more in control.
- Manage stress and learn how to relax when symptoms occur.
- Avoid magnifying minor problems into major ones.
There are four major classes of medications are used in the treatment of anxiety disorders:
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin is a neurotransmitter, which is a chemical substance that carries messages between nerve cells. Serotonin affects mood, sleep, temperature, learning, memory, social behavior and several other functions. When used for treating obsessive compulsive disorder, SSRIs correct serotonin imbalances by reducing the re-uptake (re-absorption) of serotonin into the brain and enabling it to build up. Increasing the level of serotonin in the brain increases brain activity, which in turn boosts mood in people with OCD, depression, and some types of anxiety disorders. Common side effects include insomnia or sleepiness, sexual dysfunction, and weight gain. They are considered an effective treatment for all anxiety disorders, although the treatment of obsessive-compulsive disorder, or OCD, typically requires higher doses.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs increase the levels of the neurotransmitters serotonin and norepinephrine by inhibiting their reabsorption into cells in the brain. As with other medications, side effects may occur, including stomach upset, insomnia, headache, sexual dysfunction, and a minor increase in blood pressure. These medications are considered as effective as SSRIs, so they are also considered a first-line treatment, particularly for the treatment of generalized anxiety disorder.
This class of drugs is frequently used for short-term management of anxiety. Benzodiazepines (alprazolam, clonazepam, diazepam, and lorazepam) are highly effective in promoting relaxation and reducing muscular tension and other physical symptoms of anxiety. Long-term use may require increased doses to achieve the same effect, which may lead to problems related to tolerance and dependence.
Concerns about long-term use of the benzodiazepines led many doctors to favor tricyclic antidepressants (amitriptyline, imipramine, and nortriptyline). Although effective in the treatment of anxiety, they can cause significant side effects, including orthostatic hypotension (drop in blood pressure on standing), constipation, urinary retention, dry mouth, and blurry vision.