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Anxiety disorders



Related terms
Background
Treatment
Author information
Bibliography
Causes
Types of anxiety

Related Terms
  • Adrenal, agoraphobia, angina, antidepressants, arrhythmias, asthma, azapirones, benzodiazepines, beta blockers, bipolar disorder, bruxism, CFS, chronic fatigue syndrome, cortisol, depression, diabetes, DSM-IV-TR, ephedra, epilepsy, epinephrine, fatigue, GABA, GAD, gamma-amino butyric acid, generalized anxiety disorder, hypochondriac, hypoglycemia, IBS, irritable bowel syndrome, migraine headaches, mitral valve prolapse, norepinephrine, obsessive compulsive disorder, OCD, palpitation, panic attacks, panic disorder, phobias, post traumatic stress disorder, PTSD, restless leg syndrome, RLS, SAD, separation anxiety, serotonin, sleep apnea, sleep disorders, social anxiety disorder, tension headaches, thyroid disorders, trauma, trichotillomania, vertigo.

Background
  • Anxiety is an unpleasant complex combination of emotions often accompanied by physical sensations such as heart palpitations (irregular heart beat), nausea, angina (chest pain), shortness of breath, tension headache, and nervousness.
  • The National Institute of Mental Health (NIMH) estimates that anxiety disorders affect about 40 million American adults age 18 years and older (about 18%) in a given year. Only about one-third of those suffering from an anxiety disorder receive treatment. Anxiety disorders are reported to cost the United States more than $42 billion a year.
  • Unlike the relatively mild, brief anxiety that can be caused by a stressful event (such as testing, a job interview, the death of a loved one, or public performance/speaking), anxiety disorders last at least six months and can become worse if not treated.
  • Anxiety disorders can commonly occur along with other mental or physical illnesses, including alcohol or substance abuse, depression, or bipolar illness, which may mask anxiety symptoms or make them worse.
  • According to the Anxiety Disorders Association of America (ADAA), individuals with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than non-sufferers.

Treatment
  • Psychotherapy techniques:
  • Generally, anxiety disorders are treated with medications, specific types of psychotherapy, or both. Treatment choices depend on the symptoms and the preference of the doctor and patient.
  • Psychotherapy: Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor, to discover what causes an anxiety disorder and how to deal with its symptoms.
  • Cognitive-Behavior Therapy (CBT): Many therapists use a combination of cognitive and behavior therapies, this is often referred to as CBT. Cognitive-behavioral therapy is based on the scientific fact that thoughts cause feelings and behaviors, not external things, like people, situations, and events. The benefit of this fact is that an individual can change the way they think to feel and act better even if the situation causing the problem does not change.
  • Relaxation Techniques: Relaxation Techniques help individuals develop the ability to more effectively cope with the stresses that contribute to anxiety, as well as with some of the physical symptoms of anxiety. The techniques taught include breathing re-training and exercise.
  • Anti-anxiety medications:
  • Benzodiazepines: Benzodiazepines are fast-acting sedatives that typically relieve anxiety symptoms within 30 minutes to one hour. The rapid relief when using benzodiazepines makes them very effective when taken during a panic attack or another overwhelming anxiety episode.
  • Unfortunately, benzodiazepines can be addictive. If taken regularly for more than a couple of weeks, physical and psychological addiction is likely to occur. Benzodiazepine may create tolerance, with larger doses needed to achieve the same effect, and serious withdrawal symptoms can occur when going off the medication, including increased anxiety, depression, and insomnia. Some benzodiazepines, including diazepam (Valium®) have a longer half-life in the body, meaning they stay in the body longer. The addictive potential is why benzodiazepines are usually recommended only for short-term. To minimize the withdrawal reaction, it is important to slowly taper off these medications.
  • Some examples of benzodiazepines include alprazolam (Xanax®), chlordiazepoxide (Librium®), clonazepam (Klonopin®), clorazepate (Tranxene®), lorazepam (Ativan®), oxazepam (Serax), diazepam (Valium). Clonazepam (Klonopin®) is commonly used for social phobia and GAD, lorazepam (Ativan®) is used for panic disorder, and alprazolam (Xanax®) is useful for both panic disorder and generalized anxiety disorder (GAD).
  • Most common side effects include drowsiness, impaired coordination, fatigue, confusion and disorientation, dizziness, decreased concentration, short-term memory problems, dry mouth, blurred vision, and irregular heart beat.
  • Azapirones: Azapironeswere developed more recently than benzodiazepines, and are anti-anxiety drugs prescribed for GAD and obsessive compulsive disorder (OCD). Compared to benzodiazepines, the azapirones are slow acting, taking from two to four weeks to provide anxiety symptom relief. Advantages of these drugs over benzodiazepines include less sedation and effects on coordination, and less memory impairment. Withdrawal effects with azapirones are minimal compared to benzodiazepines. Buspirone (Buspar®) is the only azapirone approved for medical use.
  • Side effects may include nausea, headaches, dizziness, drowsiness, upset stomach, constipation, diarrhea, and dry mouth. Azapirones are not to be taken with monoamine oxidase inhibitors (MAOIs, a type of antidepressant) due to the increase risk of life-threatening high blood pressure.
  • Antidepressant medications:
  • Selective serotonin reuptake inhibitors (SSRIs): SSRIs are antidepressants that alter the levels of the neurotransmitter serotonin in the brain. SSRIs have been used to treat panic disorder, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD). They are often prescribed because they have less severe side effects than the older antidepressants.
  • Some SSRIs used in anxiety disorders include fluoxetine (Prozac®), sertraline (Zoloft®), escitalopram (Lexapro®), paroxetine (Paxil®), and citalopram (Celexa®) which are commonly prescribed for panic disorder, OCD, PTSD, and social phobia. SSRIs are also used to treat panic disorder when it occurs in combination with OCD, social phobia, or depression. SSRIs generally are started at low doses and gradually increased until they have a beneficial effect.
  • Tricyclic antidepressants (TCAs): TCAs are older antidepressants that may be prescribed for panic disorder, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD). Tricyclics can also be prescribed for anxiety disorders co-occurring with depression. The tricyclics typically take around two weeks to provide symptom relief.
  • Tricyclics include imipramine (Tofranil®), which is prescribed for panic disorder and GAD, and clomipramine (Anafranil®), which is the only tricyclic antidepressant useful for treating OCD.
  • Monoamine oxidase inhibitors (MAOIs): MAOIs are the oldest class of antidepressant medications.
  • The MAOIs most commonly prescribed for anxiety disorders are phenelzine (Nardil®), followed by tranylcypromine (Parnate®), and isocarboxazid (Marplan®), which are useful in treating panic disorder and social phobia.
  • Atypical antidepressants:
  • There are several newer atypical antidepressants which target other neurotransmitters either alone or in addition to serotonin. Some of the brain chemicals they affect include norepinephine and dopamine.
  • Venlafaxine (Effexor®), an atypical antidepressant, is used to treat GAD.
  • Antidepressants take up to four to six weeks to begin relieving symptoms, so they aren't helpful if first taken during a panic attack.
  • Antidepressants are often prescribed instead of benzodiazepines because the risk for dependency and the abuse is less.
  • Antidepressant can cause loss of sexual desire, nausea, insomnia, sweating, nervousness, dizziness, weight gain or weight loss, dry mouth, constipation, and blurred vision. MAOIs also have severe interactions with certain foods, drinks, and medications. When an individual takes an MAOI, he or she must carefully monitor what is eaten and what drugs are taken. Items that are restricted include many cheeses, chocolate, wine, and beer.
  • Beta-blockers:
  • Beta blockers are type of drug used to treat high blood pressure and heart problems. In anxiety, beta blockers can help control physical symptoms such as nervousness, rapid heart rate, trembling voice, sweating, dizziness, and shaky hands. Beta blockers are prescribed off label for anxiety.
  • Because they don't affect the emotional symptoms of anxiety such as worry, beta blockers are most helpful for phobias, particularly social phobia and performance anxiety (such as a speech or being in front of an audience).
  • Examples of beta blockers include propranolol (Inderal®), metoprolol (Lopressor®) and atenolol (Tenormin®).
  • Side effects include light-headedness, sleepiness, short-term memory loss, unusually slow pulse, fatigue, insomnia, diarrhea, cold hands and feet, and sexual side effects.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Anxiety Disorders of America. .
  2. Mental Health America. .
  3. National Institute of Mental Health. .
  4. Natural Standard: The Authority on Integrative Medicine. .

Causes
  • Brain chemistry: Studies suggest that an imbalance of the brain's neurotransmitters (chemical messengers) such as serotonin, gamma-amino butyric acid (GABA), epinephrine, and norepinephrine may contribute to anxiety disorders. Abnormalities in the stress hormone cortisol, produced by the adrenal glands, have also been found. Most medications prescribed for anxiety disorders aim to readjust the brain's chemical balance.
  • Trauma: An anxiety disorder may develop in response to a traumatic event, such as a car accident or a marital separation. Anxiety may also have its roots in early life abuse or developmental trauma. Trauma in infancy and early childhood can be particularly damaging, leaving a pervasive and lasting sense of helplessness that can develop into anxiety or depression in later life.
  • Medications: Some prescription and non-prescription medications may cause symptoms of anxiety, including caffeine and other stimulants, drugs such as heroin, cocaine, and amphetamines, over-the-counter medications such as decongestants, steroids such as cortisone and prednisone, inhalers and other respiratory medications, some herbal supplements such as ephedra (no longer available on the U.S. market), Citrus aurantium, yerba mate tea, and guarana, weight loss products, high blood pressure medications, withdrawal from alcohol, ADHD medications (Ritalin®, Adderall®, Dexedrine®), withdrawal from benzodiazepines (Xanax®, Valium®), and hormones such as birth control pills and thyroid medications.
  • Medical conditions: Many medical conditions can cause or mimic symptoms of anxiety disorders. They include thyroid disorders, diabetes, hypoglycemia (low blood sugar), asthma, sleep disorders, adrenal disorders, epilepsy (seizures), heart conditions including arrhythmias (irregular heart beat), migraine headaches, certain psychiatric illnesses, such as bipolar disorder (characterized by mania and depression) and depression.
  • Nutritional deficiencies: Nutritional deficiencies stemming from poor diet and/or digestion can also contribute to anxiety. Depleted levels of minerals, especially magnesium and zinc, have been linked to the presence of anxiety. A deficiency of B vitamins, especially vitamin B-12, can be a significant contributing factor to the development of anxiety disorders.

Types of anxiety
  • Generalized Anxiety Disorder (GAD): Most people experience anxiety at some point in their lives and some nervousness in anticipation of a real situation. However, if a person cannot shake unwarranted worries, or if the feelings are jarring to the point of avoiding everyday activities, he or she most likely has an anxiety disorder. GAD is characterized by excessive, unrealistic worry that lasts six months or more. In adults, the anxiety may focus on issues such as health, money, or career. Physical symptoms may also appear such as nervousness or heart palpitations. GAD affects about 5% of Americans in the course of their lives and is more common in women than in men. Some experts believe that it is under diagnosed and more common than any other anxiety disorder. GAD usually begins in childhood and often becomes a chronic ailment, particularly when left untreated. Depression in adolescence may be a strong predictor of GAD in adulthood. Depression commonly accompanies this anxiety disorder.
  • Obsessive compulsive disorder (OCD): In OCD, individuals are plagued by persistent, recurring thoughts (obsessions) that reflect exaggerated anxiety or fears. Typical obsessions include worrying about being contaminated with germs or fears of behaving improperly or acting violently. The obsessions may lead an individual to perform a ritual or routine (compulsions) such as washing hands, repeating phrases, or hoarding. Obsessive-compulsive disorder occurs equally in men and women, and it affects about 2-3% of people over a lifespan. About 80% of people who develop OCD show signs of the disorder in childhood, although the disorder usually develops fully in adulthood.
  • Panic attacks and panic disorder: Panic disorder is characterized by repeated, unexpected panic attacks. These panic attacks strike without warning and usually last a terrifying 15-30 minutes. Panic disorder may also be accompanied by agoraphobia, which is a fear of being in places where escape or help would be difficult in the event of a panic attack. Agoraphobia is characterized by individuals likely to avoid public places such as shopping malls or confined spaces such as an airplane. Studies indicate that the prevalence of panic disorder among adults is between 1.6-2% and is much higher in adolescence, 3.5-9%. In one study, 18% of adult patients with panic disorder reported the onset of the disorder before ten years of age. In general, however, panic disorder tends to begin in late adolescence and peaks at around 25 years of age.
  • Post traumatic stress disorder (PTSD): PTSD can follow an exposure to a traumatic event such as a sexual or physical assault, witnessing a death, the unexpected death of a loved one, or natural disaster. There are three main symptoms associated with PTSD: "reliving" of the traumatic event (such as flashbacks and nightmares); avoidance behaviors (such as avoiding places related to the trauma) and emotional numbing (detachment from others); and physiological arousal such as difficulty sleeping, irritability or poor concentration. Researchers now know that anyone, even children, can develop PTSD if they have experienced, witnessed, or participated in a traumatic occurrence-especially if the event was life threatening. Studies estimate a lifetime risk for PTSD in the United States of up to 8%. People exposed to traumatic events, of course, are at highest risk, but many people can go through such events and not experience PTSD. Studies also estimate that 6-30% or more of trauma survivors develop PTSD, with children and young people being among those at the high end of the range. Women have the twice the risk of PTSD as men. PTSD can also occur in people not directly involved with a traumatic event.
  • Phobias: A phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that in reality presents little to no danger. Common phobias include fear of animals such as snakes and spiders, fear of flying, and fear of heights. In the case of a severe phobia, one might go to extreme lengths to avoid the thing feared.
  • Separation anxiety: Separation anxiety is a normal part of child development. It consists of crying and distress when a child is separated from a parent or away from home. If separation anxiety persists beyond a certain age or interferes with daily activities, it may be a sign of separation anxiety disorder.
  • Social anxiety / social phobia: Social anxiety disorder (SAD) is characterized by extreme anxiety about being judged by others or behaving in a way that might cause embarrassment or ridicule. This intense anxiety may lead to avoidance behavior. Physical symptoms associated with this disorder include heart palpitations, faintness, blushing and profuse sweating. Performance anxiety (better known as stage fright) is the most common type of social phobia. Social phobia is currently estimated to be the third most common psychiatric disorder in the United States. Studies have reported a prevalence of 7-12% in Western nations.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.



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