When Anxiety Strikes—Who’s At Risk, How’s It Treated?

Posted by Medical Board on October 9, 2018 in Hormones Men Women
When Anxiety Strikes—Who’s At Risk, How’s It Treated?

Fearful thoughts, obsessive thinking, increased heart rate, and tightness in the gut…these are just a few of things many of us experience when faced with the unknown, or the lack of control over an outcome. Once a problem has been resolved, or our circumstances change, equilibrium is restored, and we move on to once again manage life more effectively.

For a few of us however, extreme, persistent, or intense fear and worry plague us for longer periods of time. These feelings are manifested in the form of phobias, panic disorder, posttraumatic stress, obsessive-compulsive disorder, or generalized anxiety disorder.[1]

Untreated, prolonged anxiety can leave us feeling helpless, hopeless, and depressed.

Anxiety Facts—You’re Not Alone

While occasional bouts of anxiety are a normal part of everyday living, nearly one-third of all adults will experience a diagnosable anxiety disorder at some point in their lives., according to a recent survey conducted by the National Institute of Mental Health. Further, over 19% of Americans have reported suffering with an anxiety disorder, this past year alone. And while both sexes are vulnerable to serious anxiety issues, about 10% more women suffer with anxiety disorders than their male counterparts (23.4% to 14.3%).[6]

What Anxiety Feels Like

The symptoms of anxiety vary from person to person and range from mild internal discomfort to severe debilitating effects.

Many individuals report one or more of the following:

  • Nervous feeling, tension
  • Sense of doom, danger, or panic
  • Elevated heart rate
  • Rapid breathing
  • Sweating
  • Trembling
  • Weak feeling
  • Difficulty concentrating
  • Persistent worry
  • Sleep difficulty
  • Gastrointestinal (GI) issues
  • Avoidant behaviors of anxiety triggers[3]

Occasional Anxiety vs. Anxiety Disorder—How to Tell the Difference

Occasional anxiety from time to time is a normal part of living, for most of us. Stress from unanticipated circumstances, worry over health issues, employment changes, and relational or financial difficulties, all have the power to cause anxiety at times. These bouts of anxiety are only temporary however, and eventually resolve over time, as circumstances change.

Anxiety disorders are pervasive and diagnosable, and may require treatment from a medical doctor or mental health professional.

Several major anxiety disorders exist, each involving specific symptoms and features.[4]

  • Generalized Anxiety Disorder (GAD)—Generalized anxiety disorder is characterized by persistent worry for a period of six months or more. While many symptoms exist in adults, a child may only exhibit one of the following: edginess, marked fatigue, difficulty concentrating, irritability, tense muscles, sleep disturbances, change in appetite, profuse sweating, or gastrointestinal disturbance.
  • Obsessive-Compulsive Disorder (OCD)—OCD involves pervasive reoccurring thoughts (obsession) and/or repetitive behavior (compulsion). Repetitive hand washing, counting, checking, stepping, or cleaning are common rituals maintained as a way to prevent or manage unwanted thoughts. Failure to perform compulsive behaviors usually causes increased, marked anxiety.
  • Panic Disorder—Intense and unexpected fear, together with physical symptoms including heart palpitations, shortness of breath, dizziness, chest pain, abdominal discomfort, or feelings of choking are related to panic disorder.
  • Post-Traumatic Stress Disorder (PTSD)—PTSD generally occurs after exposure to traumatic events such as military combat, physical or verbal assault, natural disaster or an accident. Current events may trigger previous stressors while symptoms emerge.
  • Social Phobia (or Social Anxiety Disorder)—This involves the extreme fear of social situations and events causing excessive preoccupation with the self and how an individual appears to others. This may be limited to specific social situations or behaviors such as speaking, or eating and drinking in front of others.
  • Agoraphobia—This type of anxiety involves the intense fear of places outside the home that may lead to feelings of entrapment or helplessness.
  • Anxiety disorder Due to Medical Condition—A physical health problem may accompany feelings of extreme panic and anxiety.
  • Selective mutism—The inability to speak in front of others at school or work when speaking easily with family members and at home.
  • Phobias—Anxiety occurs when individuals are exposed to a specific object, person, or situation. The desire to avoid these triggers is very strong.
  • Substance-induced anxiety disorder—Illicit drugs, toxic substances, or withdrawal from drugs may cause extreme anxiety in some individuals.

What’s causing my anxiety? Risk Factors for Anxiety Disorders

A combination of genetics, brain structure and function, and environmental factors appear to put individuals at risk for developing anxiety disorders.

Genetics/Biology

Anxiety disorders run in families and the risk for developing one is increased if a close family member suffers from depression or anxiety, as well. An overactive thyroid may also contribute to anxiety or anxiety disorders.

Brain structure and Function

Research indicates that the amygdala, the emotion center of the brain, may be involved in he development of an anxiety disorder.

Environmental Factors

These include:

  • Smoking or nicotine withdrawal
  • Breathing difficulties such as asthma
  • Alcohol withdrawal or medication withdrawal
  • Stressful life events in childhood/adulthood
  • Death of a loved one, divorce, isolation, abuse
    caffeine, diet medications, and allergy medication[2]

What’s happening in my brain when I’m anxious?

While we know that the fear response is hardwired into the amygdala region of the brain, a complex series of neuroendocrine, neurotransmitter, and neuroanatomical disruptions are responsible for mood and anxiety disorders in individuals. Within the limbic circuitry, brain stem, and higher cortical areas of the brain, complex chemical and biological processes are at play. The interconnectivity of neurotransmitter and neuropeptide activity often makes it difficult to isolate and identify specific mechanisms for anxiety and anxiety disorders, however.[5]

Many Pathways to Anxiety Treatment

Several approaches for the treatment of anxiety exist. Because of this, one or many medical or mental health professionals may be involved. Treatment is dependent on several factors such as, the type of anxiety, whether or not it is accompanied by depression or other mental health conditions, and the severity and duration of the condition. Treatment approaches include a variety of techniques, strategies and modalities including counseling and therapy, pharmaceutical support, and complementary and alternative treatments.

Counseling and Therapies

Acceptance and Commitment Therapy (ACT)
This type of therapy focuses on acceptance, mindfulness, and living in the moment to help individuals cope with and accept unwanted thoughts and feelings. Anxiety sufferers gain important skills to manage anxiety on their own.
Dialectical Behavioral Therapy (DBT)
DBT therapy combines meditation and deep relaxation with individual and group therapy to help individuals learn important interpersonal skills, and emotion regulation.
Interpersonal Therapy (IPT)
IPT therapy is short-term and involves intensive individual therapy that targets depression and interpersonal experience.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR helps the brain reinterpret intense or disturbing information and memories by desensitizing individuals to past events and memories.

Medication

Four classes of medication are effective for the treatment of anxiety.

Selective Serotonin Reuptake Inhibitors (SSRIs)—These help treat anxiety by blocking the reuptake of serotonin in the brain. This allows more serotonin to be available to help improve and modulate mood.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)—These medications block the reuptake of both serotonin and norepinephrine in the brain. These medications have been proven to be effective in the treatment of anxiety as well. SSRI’s are preferred over SNRI’s in the treatment of OCD, however.

Benzodiazepines—These medications promote deep relaxation and reduce muscle tension in users. These are commonly prescribed for short-term relief and as an additional treatment for anxiety. These medications are not productive or effective in the treatment of posttraumatic stress disorder, however.

Tricyclic Antidepressants—Tricyclic antidepressants are effective for the treatment of some anxiety disorders, however they are not proven effective for the treatment of social anxiety disorder. These antidepressants, though effective, often come with a number of uncomfortable side effects.

Complementary & Alternative Treatments

Complementary and alternative treatments may be used in conjunction with other treatment methods for anxiety. Numerous techniques and treatments have been proven to help.

Stress and Relaxation Techniques

These may be effective for individuals with long-term health problems, those with concurrent mental health conditions, and older individuals.

Meditation

Mindful relaxation and deep breathing is proven to be moderately successful for the management of anxiety.

Yoga

This combines physical postures, controlled breathing and meditation to help manage symptoms of anxiety and depression.

Acupuncture

This ancient, Eastern practice of inserting needles into the body to influence the flow of energy can effectively be used in the treatment of anxiety.[7]

While experiencing occasional bouts of anxiety is a normal part of everyday living, repeated, intense, or long-term anxiety may be associated with an anxiety disorder. Fortunately, effective diagnosis, management and treatment of anxiety is available.

References

1“Anxiety.” MedlinePlus, U.S. National Library of Medicine, 19 July 2018, medlineplus.gov/anxiety.html.
2“Anxiety Disorders.” Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services, www.samhsa.gov/treatment/mental-disorders/anxiety-disorders.
3“Anxiety Disorders.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 May 2018, www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961.
4Digital Communications Division. “What Are the Five Major Types of Anxiety Disorders?” HHS.gov, US Department of Health and Human Services, 21 Aug. 2015, www.hhs.gov/answers/mental-health-and-substance-abuse/what-are-the-five-major-types-of-anxiety-disorders/index.html.
5Martin, Elizabeth I. “The Neurobiology of Anxiety Disorders: Brain Imaging, Genetics, and Psychoneuroendocrinology.” US National Library of Medicine National Institutes of Health, National Centr for Biological Technology Information.
6“Transforming the Understanding and Treatment of Mental Illnesses.” National Institute of Mental Health, US Department of Health and Human Services, www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml.
7“University Health Service.” Ten Things You Can Do for Your Mental Health | University Health Service, uhs.umich.edu/anxietypanic.

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