Anxiety

If you feel overwhelmed with anxiety and stress you are certainly not alone! Anxiety disorders are one of the most commonly diagnosed psychiatric disorders. According to the National Institute of Mental Health, over 31% of adults meet the criteria for an anxiety disorder at some point in their lives and nearly 20% have experienced one within the past year (and yes, this was prior to 2020!).* A normal level of anxiety and stress is normal and even healthy; it helps ensure our survival by motivating us to make positive changes or avoid dangerous situations. However, if anxiety reaches a level where it begins to impair your ability to function optimally in everyday life, treatment is likely necessary to in order to get your life back on a positive track.
*(NIMH included PTSD and OCD in this category for their statistics).

Symptoms

Not everyone experiences the same set of symptoms but here are a few of the many: Chronic generalized worrying, mind going blank or freezing in stressful situations, muscle tension, difficulty concentrating, feeling restless or on edge, easily fatigued, irritable, feelings of impending doom or fear of imminent death. Fear of losing control or “going crazy.” New mothers often report excessive and irrational fear about the safety or well-being of their child. Racing thoughts, apprehension (or avoidance) of going places or interacting with people, rumination; replaying the days events in ones head repeatedly and perhaps thinking about what they wish they had said or done differently, difficulty sleeping due to racing thoughts or rumination. Anxiety may also cause physical symptoms such as nausea, diarrhea, sweating, trembling, palpitations, shortness of breath, dizziness, tingling in fingers or toes, and so on. While not everyone who experiences anxiety also suffers from depression, they are commonly diagnosed and treated together.

Common Anxiety Types - Can You Identify?

Note: These disorders are being greatly oversimplified for the purpose of presenting easy to understand information to those without a medical/psychiatric background. Accurately diagnosing these disorders is complex. Someone may have every diagnostic symptom of a disorder and still not actually have that disorder. Any diagnosis should be determined by a licensed provider.

  • Generalized Anxiety Disorder – Constant or nearly constant feelings of anxiety or worry that impairs optimal daily functioning for at least 6 consecutive months.
  • Social Anxiety Disorder – Significant fear of social situations or interactions that lasts for at least 6 months. Individuals may worry about being judged and scrutinized by others or fearful of doing something that leads to embarrassment and humiliation.
  • Panic Disorder – Extremely intense, abrupt surges of panic with physical symptoms and possibly fear of impending death or of “going crazy.” These attacks often occur unexpectedly and individuals may begin to develop more chronic anxiety about the possibility of future panic episodes or plan ways to avoid future episodes.
  • Performance Anxiety/Public Speaking – Most people loathe public speaking and experience a significant amount of anxiety that they ultimately work through. For some individuals however, the prospect of public speaking can be extremely debilitating, causing apprehension and dread for a long period of time prior to public speaking. As the time of the event nears they may display many physical symptoms such as sweating, nausea, diarrhea, blushing, heart palpitations, freezing or mind going blank, dry mouth, trembling, and so on. A poor performance can lead to embarrassment that reinforces the perceived level of fear.
  • Anxiety caused by substance use or an underlying disorder – Many individuals with psychiatric disorders attempt to self-medicate with drugs and alcohol, which makes the anxiety worse over time.

What Causes Anxiety?

Assuming there is not an underlying medical cause for the anxiety disorder and it is a legitimate psychiatric disorder: The cause of anxiety can be extraordinarily complex and variable. It is often believed to be caused at least in part by hyperactivity in areas of the brain responsible for analyzing and responding to fear. Early life stressors or trauma, along with genetics likely play a role in this development. Left unchecked this hyperactive fear response may become stronger over time whereas the mechanisms in the brain responsible for keeping this fear in check become weaker. Medications, therapy, and lifestyle changes can help shutter and potentially even reverse this hyperactive fear response. High levels of unrelenting stress hormones are also believed to contribute to numerous medical problems in addition to being neurotoxic, making treatment important.

Treatments: Medication, Therapy, Lifestyle Changes, or Alternative Treatments?

Before determining whether medications, therapy, or lifestyle changes are the appropriate course of treatment: It is very important to rule out medical causes. This is an important though often overlooked or minimized step. This is done by taking a thorough personal and family history, discussion of both medical and psychiatric symptoms, and sometimes ordering lab (blood) work. This is very important because neither therapy, medications, or lifestyle changes will correct a medical disorder. Even worse these treatments may mask a medical disorder allowing it to become worse before being discovered and treated. Medical causes of anxiety disorders include but are not limited to: thyroid disorders, Lyme disease, tumors, electrolyte imbalances, vitamin deficiencies, substance abuse, some prescription medications, some OTC medications or herbal preparations, and many other medical conditions or substances may cause or contribute to an anxiety disorder.

The following is a generalization or starting point to help guide individuals toward the resources that would best serve them and reduce the risk that they will waste their time, money, and energy on a mismatched service. With this being said, it should be a licensed clinician who guides any treatment plans and the following is not intended to be medical advice:

Medication: If anxiety exists in the absence of situational stressors, exists to a much more serious degree than it should in the face of situational stressors, therapy has been ineffective, or anxiety has been life-long, medication may be appropriate. A family history of anxiety can also be a sign that medication may be helpful, particularly if other family members have benefited from medication.

Therapy: If anxiety is solely caused by situational stressors and the level of anxiety is appropriate for the stressors experienced, medication is usually not appropriate. Therapy would be the optimal treatment modality in this case and can also be useful in cases of more significant anxiety when combined with medication. Among therapy modalities, cognitive behavioral therapy or “CBT” seems to have the strongest research backing its efficacy for treating anxiety.

Medication and therapy: If medication is warranted, combining therapy and medication may have a cumulative effect and definitely cannot hurt. For anxiety disorders this can be a very powerful treatment combination. Unfortunately receiving both treatment types is often prohibitively expensive even under the best of circumstances. Luckily, many individuals are able to do well with one type alone.

Lifestyle changes: These changes may require effort and commitment to maintain but they typically cost little to nothing and can often be incorporated quickly. These include but are not limited to: reduction or elimination of drug or alcohol use, practicing good sleep routines and habits known as “sleep hygiene,” exercising, eating right, finding time for hobbies and activities one enjoys, incorporating meditation or relaxation methods, and so on. If someone experiencing significant anxiety drinks large amounts of caffeinated beverages reducing or eliminating caffeine consumption is usually ideal.

Herbal Medications or Alternative Treatments: To avoid posting duplicate content on our website, if you would like to check out alternative or herbal treatment options for anxiety, please click here to read our guide on depression. Many of the treatment options discussed in section IV of this article for depression are also viable for anxiety, except ECT, TMS, and bright light therapy – these are only approved for depression.

References:

National Institutes of Mental Health. (2017, November). Any anxiety disorder. Retrieved from https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml