Anxiety

Generalized anxiety disorder (GAD) is much more than the normal anxiety people experience day to day. It’s chronic and fills a person’s day with exaggerated worry and tension, even though there is little or nothing to provoke it. Having this disorder can mean always anticipating disaster, often worrying excessively about health, money, family, school, or work. Sometimes, though, the source of the worry is hard to pinpoint.

Worries are usually accompanied by physical symptoms, such as fatigue, headaches, muscle tension and aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flashes. People with GAD may feel lightheaded, out of breath, nauseated, and easily startled. Concentration and sleep problems are also common.  

Social phobia is characterized by an intense fear of situations, usually social or performance situations, where the risk of embarrassment is present. It can disrupt normal life, interfering with school, work, or social relationships. It’s not uncommon for people with social phobia to worry for days or weeks in advance of a social or performance situation. Physical symptoms often accompany anxious feelings and include blushing, profuse sweating, trembling, nausea, shortness of breath, racing heart, and difficulty talking.  

A specific phobia is an intense fear of something that poses little or no actual danger. Some of the more common specific phobias are centered around closed-in places, heights, escalators, tunnels, highway driving, water, flying, dogs, and injuries involving blood. Facing, or even thinking about, the feared object or situation can bring on a panic attack or considerable anxiety, even when the person recognizes how irrational the fear is.

People with panic disorder experience sudden episodes of intense fear that occur without any warning or apparent reason. They can’t predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next one will occur. A panic attack is marked by a group of symptoms that can include dizziness, racing heart, perspiring, shortness of breath, tingling hands, fear of dying, or “going crazy.” Attacks usually last no more than about 10 minutes.

Post-traumatic stress disorder (PTSD) can develop following a terrifying event that a person experienced or witnessed. Whatever the source of the problem, some people with PTSD repeatedly relieve the trauma in the form of nightmares and disturbing memories during the day. Other symptoms may include sleep problems, feelings of detachment or numbness, hypervigilance, irritability, and aggressiveness. Some people avoid certain places or situations that are reminders of the trauma, and anniversaries of the event are often especially difficult. Ordinary events can trigger flashbacks or intrusive images. A person having a flashback, which can come in the form of images, sounds, smells, or feelings, may lose touch with reality and believe that the traumatic event is happening all over again.

Obsessive-compulsive disorder, or OCD, involves having distressing thoughts or rituals that are time-consuming and excessive. Distressing thoughts or images, such as worries about germs or dirt are called obsessions, and the rituals that are performed to try to prevent or get rid of these anxious thoughts, such as the washing of hands over and over are called compulsions. The more common compulsions involve washing and cleaning, counting, repeating, or checking actions. A lot of healthy people can identify with some of the symptoms of OCD, such as checking to see if the stove is turned off before leaving the house. But for people with OCD, such activities consume at least an hour a day, are very upsetting, and interfere with daily life. 

Depression often accompanies anxiety and, when it does, it needs to be treated as well. Symptoms of depression include feelings of sadness, hopelessness, changes in appetite or sleep, low energy, and difficulty concentrating. There are effective treatments for depression. 

Some individuals can manage their anxiety on their own through self-help techniques. Others benefit greatly from professional attention. If you think you have an anxiety problem, please don’t hesitate to discuss this with a healthcare professional who can evaluate your concerns. Several effective treatments for anxiety are available and can provide relief from symptoms immediately or in just weeks. The most common treatments are psychotherapy, medication, or a combination of the two. A specific type of psychotherapy, cognitive behavioral therapy, is particularly effective in managing symptoms of anxiety.

Individuals respond differently to treatment, and you may need to try more than one type before you find the right one. However, before considering other options, give the treatment plan a fair chance. It’s important not to get discouraged and stop attending psychotherapy sessions and/or taking the medications before they have had a chance to be effective. 

Research has shown that a form of psychotherapy that is effective for several anxiety disorders is cognitive-behavioral therapy (CBT). A major aim of CBT is to reduce anxiety by eliminating beliefs or behaviors that help to maintain the anxiety disorder. The cognitive component helps people change thinking patterns that keep them from overcoming their fears. Specifically, this therapy identifies unrealistic beliefs and helps individuals develop more objective ways of thinking that make stress and anxiety more manageable. For example, a person with panic disorder can learn that panic attacks are not heart attacks as previously feared. The behavioral component seeks to change people’s reactions to anxiety-provoking situations. A key element of this component is exposure, in which people confront the things they fear. A person with social phobia, for example, may be encouraged to spend gradually increasing time in feared social situations without giving in to the temptation to flee. In some cases, the individual will be asked to deliberately make what appear to be slight social blunders and observe other people’s reactions. Generally, through exposure techniques, real-life outcomes are not nearly as harsh as feared, and the person’s social anxiety diminishes.  

Several medications that were originally approved for treating depression are effective for anxiety disorders as well. If your healthcare professional prescribes an anti-depressant, you will need to take it for at least a few weeks before symptoms begin to fade. Some of the newest of these antidepressants are called Selective Serotonin Reuptake Inhibitors (SSRIs). These medications act in the brain on a chemical messenger called serotonin. Some people report feeling mildly nauseated or jittery when they first begin taking SSRIs, but those symptoms usually disappear over time and are lessened by gradual increases in dosage. Others may experience sexual or other side effects on these medications. Adjusting the dosage or switching to another SSRI is usually helpful in these circumstances. 

Tricyclics and monoamine oxidase inhibitors (MAOIs) are two other groups of antidepressant medications that have been around longer than SSRIs and may be prescribed for various anxiety disorders, though side effects are more frequent in general. Other newer antidepressants, for example, venlafaxine (Effexor), with similar side effects to the SSRIs, may be effective as well.

Benzodiazepines can relieve anxiety symptoms relatively quickly and have few side effects, although drowsiness can be a problem. They are sometimes used to treat generalized anxiety disorder, panic disorder, and social phobia. Benzodiazepines may be useful for short-term treatment, but because of the potential for decreased effectiveness over time and the risk of physical dependence, they are not generally appropriate for ongoing use. 

Buspirone (BuSpar), a member of a class of drugs called azapirones, is a newer anti-anxiety medication that is used to treat generalized anxiety disorder. Possible side effects include dizziness, headaches, and nausea. Unlike benzodiazepines, buspirone must be taken consistently for at least two weeks to achieve an anti-anxiety effect.   

Beta-blockers, such as propranolol, are often used to treat heart conditions but have also been found to be helpful in certain anxiety disorders, mainly social phobia or performance anxiety. When a feared situation, such as giving an oral presentation, is known in advance, a beta-blocker may be taken beforehand to help keep your heart from pounding, your hands from shaking, and other physical symptoms from developing. Regular, daily doses of beta-blockers are not recommended due to the risk of side effects. Also, they don’t address the psychological components of anxiety.  

When you undergo treatment for an anxiety disorder, you and your healthcare professionals will be working as a team. Together, we will find the approach that is best for you. If one treatment doesn’t work, the odds are good that another one will.