Anxiety Disorders

Anxiety is a normal response to stress, but for some people, anxiety can be excessive and difficult to control and can have a negative impact on their daily lives.

Anxiety disorders affect about 40 million American adults age 18 years and older (about 18% of the population) each year. Women are 60% more likely than men to suffer from an anxiety disorder during their lifetime. About eight percent of teens between the ages of 13 and 18 suffer from an anxiety disorder, but only 18% receive treatment.

There are different types of anxiety disorders. Each has different physical and emotional symptoms, but all share the emotions of excessive, irrational fear and dread occurring for at least six months. It is not just the symptoms of an anxiety disorder that disrupt your life - how you respond to these symptoms can also affect how you live your life. Untreated, anxiety disorders can worsen.

Types of anxiety disorders include:

Causes of Anxiety Disorders

Anxiety disorders can be caused by a combination of biological, psychological, life experience, and environmental factors. Most people with these disorders appear to have a biological susceptibility to stress that can cause fundamental changes in the brain, making them more susceptible to environmental stimuli than the rest of the population.

Studies suggest that an imbalance of certain neurotransmitters, which act as chemical messengers in the brain, can contribute to anxiety disorders. These neurotransmitters include gamma-aminobutyric acid (GABA), serotonin, dopamine and adrenaline. Serotonin seems to be particularly important for well-being. Serotonin deficiency is associated with anxiety and depression.

Stress hormones such as cortisol also play a role. Traumatic events, for example, cause cortisol to be released by the hypothalamus at higher levels during the body's "fight or flight" against stress. This gives a person the short-term increased alertness, energy burst, lower sensitivity to pain needed to quickly respond to threats in the 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 single test to diagnose an anxiety disorder. Your healthcare professional or psychiatrist can diagnose anxiety based on your answers to questions about your symptoms. Theyalso  can perform laboratory tests to rule out physical problems with similar symptoms.

Treatment of anxiety disorders

Anxiety disorders are usually treated with medication, counseling, such as cognitive-behavioral (CBT) or a combination of these three treatment options. Treatment choices depend on the problem and the preferences of the person.

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 to recognize and change the patterns of thinking that support their fears, and the "behavioral" part helps people to change the way they respond to anxiety-provoking situations. 

CBT seeks to help patients:

  • Recognize and gain control over distorted views of things that cause stress, such as other people's behavior or life events

  • Replace panicked thoughts to feel more in control

  • Manage stress

  • Learn how to relax when symptoms of stress occur

  • Avoid magnifying minor problems into large ones

Medications

There are four major classes of medications are used in the treatment of anxiety disorders:

Selective serotonin reuptake inhibitors (SSRIs)

Serotonin is a neurotransmitter, a chemical substance that transmits messages between nerve cells. It affects mood, sleep, temperature, learning, memory, social behavior, and several other functions. 

SSRIs correct serotonin imbalances by reducing serotonin reuptake in the brain and enabling it to build up. Increasing serotonin levels in the brain increases brain activity, which in turn increases mood in people with OCD, depression, and some types of anxiety disorders. 

Common side effects include insomnia or drowsiness, sexual dysfunction, and weight gain. SSRIs are considered effective in treating all anxiety disorders, although treatment for obsessive-compulsive disorder usually requires higher dosages.

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs increase levels of the neurotransmitters serotonin and norepinephrine by inhibiting their reabsorption into brain cells. As with other medications, side effects can occur, including stomach upset, insomnia, headaches, sexual dysfunction, and a slight increase in blood pressure. 

These medications are considered to be as effective as SSRIs, so they are also considered as initial treatment, especially for treating generalized anxiety disorder.

Benzodiazepines

This class of drugs is often used to treat short-term anxiety. Benzodiazepines (alprazolam, clonazepam, diazepam, and lorazepam) are highly effective in promoting relaxation and reducing muscle tension and other physical anxiety symptoms. 

To achieve the same effect, long-term intake may require increased doses, which can lead to problems related to tolerance and dependence.

Tricyclic antidepressants

Concerns about the long-term use of benzodiazepines have led many doctors to favor tricyclic antidepressants (amitriptyline, imipramine, and nortriptyline). 

Although effective in treating anxiety, these medications can cause significant side effects, including orthostatic hypotension (drop in blood pressure while standing), constipation, urinary retention, dry mouth, and blurred vision.