Anxiety Disorder

February 1, 2017

Everyone has feelings of anxiety at some point in life, whether it is about preparing for a job interview, meeting a partner’s family for the first time, or the thought of parenthood. While many, associate anxiety with alterations to the mental state, experienced as worry or apprehension perhaps, and physical symptoms such as raised heart rate and adrenaline, it is also understood that it is likely to affect a person only temporarily until the source of the anxiety has passed or the person has learnt to cope with it. Without anxiety, we would have no way of anticipating difficulties ahead and preparing for them.

Anxiety becomes a disorder when the symptoms become chronic and interfere with our daily lives and our ability to function. An anxiety disorder is a serious mental illness. For people with anxiety disorders, worry and fear are constant and overwhelming, and can be crippling. People suffering from chronic anxiety often report the following symptoms –

  • Muscle tension
  • Physical weakness
  • Poor memory
  • Sweaty hands
  • Fear or confusion
  • Inability to relax
  • Constant worry
  • Shortness of breath
  • Palpitations
  • Upset stomach
  • Poor concentration

These symptoms are severe enough to make individuals feel extremely uncomfortable, out of control and helpless.

Types of Anxiety Disorders

The term “anxiety disorders” describes this group of conditions –

  • Generalized Anxiety Disorder (GAD) – persistent, excessive, and unrealistic worry about everyday things
  • Obsessive-Compulsive Disorder (OCD) – unwanted and intrusive thoughts (obsessions) and ritualistic behaviors and routines (compulsions) conducted to ease anxiety
  • Panic Disorder – spontaneous, seemingly out-of-the-blue panic or “anxiety” attacks and the preoccupation with the fear of a recurring attack
  • Posttraumatic Stress Disorder (PTSD) – an anxiety disorder triggered by an extremely traumatic event in which grave physical harm occurred or was threatened or witnessed
  • Social Anxiety Disorder (social phobia) – an intense fear of being scrutinized and negatively evaluated by others in social or performance situations
  • Specific Phobias – seemingly excessive and unreasonable fears in the presence of or in anticipation of a specific object, place, or situation

Each of these anxiety disorders is distinct in some ways, but they all share the same hallmark features –

  • Irrational and excessive fear
  • Apprehensive and tense feelings
  • Difficulty managing daily tasks and/or distress related to these tasks

 

More than 40 million adults in the United States over the age of 18 suffer from at least one anxiety disorder, and anxiety disorders are the most common mental health illness in children. Researchers are learning that anxiety disorders run in families, and that they have a biological basis, much like allergies or diabetes and other illnesses. Anxiety is the main symptom of several conditions, including panic disorder, phobias, post-traumatic stress disorder and social anxiety disorder (social phobia).

Symptoms

The following examples of anxiety symptoms may indicate an anxiety disorder:

Cognitive – Anxious thoughts (e.g., “I’m losing control”), anxious predictions (e.g., “I’m going to fumble my words and humiliate myself”) and anxious beliefs (e.g., “Only weak people get anxious”).

Physical – Excessive physical reactions relative to the context (e.g., heart racing and feeling short of breath in response to being at the mall). The physical symptoms of anxiety may be mistaken for symptoms of a physical illness, such as a heart attack.

Behavioural – Avoidance of feared situations (e.g., driving), avoidance of activities that elicit sensations similar to those experienced when anxious (e.g., exercise), subtle avoidances (behaviours that aim to distract the person, e.g., talking more during periods of anxiety) and safety behaviours (habits to minimize anxiety and feel “safer,” e.g., always having a cell phone on hand to call for help).

Symptoms vary depending on the type of anxiety disorder, but general symptoms include –

  • Feelings of panic, fear, and uneasiness
  • Problems sleeping
  • Cold or sweaty hands and/or feet
  • Shortness of breath
  • Heart palpitations
  • An inability to be still and calm
  • Dry mouth
  • Numbness or tingling in the hands or feet
  • Nausea
  • Muscle tension
  • Dizziness

 

 

 

Causes

Like most mental health problems, anxiety disorders appear to be caused by a combination of biological factors, psychological factors and challenging life experiences, including:

  • stressful or traumatic life events
  • a family history of anxiety disorders
  • childhood development issues
  • alcohol, medications or illicit substances
  • other medical or psychiatric problems

Biological Factors – The biological causes and effects of anxiety disorders include problems with brain chemistry and brain activity; genetics; and medical, psychiatric and substance use issues. Three major neurotransmitters are involved in anxiety – serotonin, norepinephrine

  • Serotonim – Plays a role in the regulation of mood, aggression, impulses, sleep, appetite, body temperature and pain.
  • Norepinephrine – It involved in the fight or flight response and in the regulation of sleep, mood and blood pressure. Acute stress increases the release of norepinephrine. In people with anxiety disorders, especially those with panic disorder, the system controlling the release of norepinephrine appears to be poorly regulated.

 

Genetic Factors – Studies suggest that genetic factors play a role in the development of anxiety disorders. People are more likely to have an anxiety disorder if they have a relative who also has an anxiety disorder. The incidence is highest in families of people with panic disorder, where almost half have at least one relative who also has the disorder.

Medical Factors – Alcohol, medications and illicit substances use may induce anxiety symptoms, either while the person is intoxicated or when the person is in withdrawal. The substances most often associated with generalized anxiety or panic symptoms are stimulants, including caffeine, illicit drugs such as cocaine, and prescription drugs such as methylphenidate (e.g., Ritalin).

Other factors – Studies show that people who are anxious tend to have an irregular pattern of breathing, alternating from hyperventilation to holding their breath. This pattern of breathing contributes to further symptoms (e.g., lightheadedness, dizziness and possibly fainting) and increases the feelings of anxiety. Breathing retraining techniques can help these people cope or manage anxiety symptoms.

 

Treatment

Therapies – Cognitive-behavioral therapy and exposure therapy are types of behavioral therapy, meaning they focus on behavior rather than on underlying psychological conflicts or issues from the past.

  • Cognitive-behavior therapy focuses on thoughts—or cognitions—in addition to behaviors. In anxiety disorder treatment, cognitive-behavioral therapy helps to identify and challenge the negative thinking patterns and irrational beliefs that fuel anxiety.
  • Exposure therapy for anxiety disorder treatment encourages confronting the fears in a safe, controlled environment. Through repeated exposures to the feared object or situation, either in the imagination or in reality, a person may gain a greater sense of control. As he/she face fear without being harmed, hence anxiety gradually diminishes.

Medications – Medical treatments for anxiety utilize several types of drugs. If the cause of the anxiety is a physical ailment, treatment will be designed to eliminate the particular ailment. This might involve surgery or other medication to regulate a physical anxiety trigger. Often, however, medicines such as antidepressants, benzodiazepines, tricyclics, and beta-blockers are used to control some of the physical and mental symptoms.

Benzodiazepines – Anxiety historically has been treated with a class of drugs called benzodiazepines. Their use has declined, however, due to their addictive nature. These drugs tend to have few side-effects except for drowsiness and possible dependency. Some common benzodiazepines include –

  • Diazepam (Valium)
  • Alprazolam (Xanax)
  • Lorazepam (Ativan)
  • Clonazepam (Klonopin)

Anti-depressants – those in the class of serotonin reuptake inhibitors (SSRI) – are also commonly used to treat anxiety even though they were designed to treat depression. SSRIs have fewer side effects than older anti-depressants, but they are still likely to cause jitters, nausea, and sexual dysfunction when treatment begins. Some anti-depressants include –

  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Escitalopram (Lexapro)
  • Citalopram (Celexa)
  • Venlafaxine (Effexor)

Tricyclics are a class of drugs that are older than SSRIs and have been shown to work well for most anxiety disorders other than obsessive-compulsive disorder. These drugs are known to cause side-effects such as dizziness, drowsiness, dry mouth, and weight gain. Two types of tricyclics include –

  • Imipramine (Tofranil)
  • Clomipramine (Anafranil)

Additional drugs used to treat anxiety include monoamine oxidase inhibitors (MAOIs), beta-blockers, and buspirone. MAOIs, such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan), are an older type of anti-depressant that is used to treat some anxiety disorders.

Alternative Treatment

Chromium – Chromium may also have a direct effect on brain receptors for serotonin.. Chromium may help free up serotonin receptors. It is already popular as a dietary supplement. It’s marketed to athletes as a muscle-builder and touted as a treatment for weight loss and diabetes.

DHEA (5-Dehydroepiandrosterone) is a natural steroid produced in the adrenal glands, the gonads and the brain. It is the most abundant circulating steroid in humans. DHEA supplementation may help with depression. DHEA levels in the blood correlate with mood, memory and functional abilities

Omega 3 – Studies suggest that there is promising evidence for omega-3s in the treatment of depression. The prevalence of depression in a society is inversely related to that society’s consumption of fish – the more that people eat fish, the healthier the population, both physically and mentally. It has been theorized that omega-3 essential fatty acids may reduce the development of depression, since anxiety and depression patients show significant depletion of omega-3s.

Magnesium is another important nutrient that helps the body to relax. It’s also commonly deficient and depleted by chronic stress, as is vitamin C. Magnesium not only relaxes the mind, it relaxes the muscles. Symptoms of deficiency therefore include muscle aches, cramps and spasms, as well as anxiety and insomnia. Low levels are commonly found in anxious people and supplementation can often help.

Supplement GABA and Taurine –

GABA (gamma-amino-butyric acid) is the main inhibitory or calming neurotransmitter. It not only switches off stress hormones, it also affects serotonin, thereby affecting the mood. For these reasons, having enough GABA in the brain is associated with being relaxed and happy, while having too little is associated with anxiety, tension, depression and insomnia. GABA is not only a neurotransmitter, it’s also an amino acid. This means it’s a nutrient and, by supplementing it, you can help to promote normal healthy levels of GABA in the brain.

Taurine is another relaxing amino acid, similar in structure and effect to GABA. Many people think taurine is a stimulant because it is used in so-called ‘energy drinks’, but it is not. It helps to relax and unwind from high levels of adrenalin, much like GABA.

B-Complex Vitamins also help even out the blood sugar. In addition, the metabolism of just about everything to digest hinges on one or more of this group of B-vitamins. Taken together, they are especially safe and effective.

Niacin – Vitamin B-3 is so effective against actual psychoses that half of all mental ward inmates in the South were able to be released once a depression-era deficiency of this vitamin was corrected. Niacin in appropriate doses acts as a natural tranquilizer and induces relaxation or sleep. It is non-addictive, cheap, and safer than any pharmaceutical product. Dosage varies with condition.

Lecithin – A food supplement that is high in phosphatidyl choline. The body is able to make acetylcholine, a neurotransmitter, out of this. This has a sedating effect. It is interesting to note that one third of your brain, by dry weight, is lecithin.

Relaxing herbs – valerian, hops and passion flower –

  • Valerian is an excellent anti-anxiety herb (Valeriana officinalis). As a natural relaxant it is useful for several disorders such as restlessness, nervousness, insomnia and hysteria, and it has also been used as a sedative for ‘nervous’ stomach. Valerian acts on the brain’s GABA receptors, enhancing their activity and thus offering a similar tranquillising action as the Valium-type drugs but without the same side-effects.
  • Hops (Humulus lupulus) are an ancient remedy for a good night’s sleep and probably included in beer for that reason. Hops help to calm nerves by acting directly on the central nervous system, rather than affecting GABA receptors.
  • Passion flower (Passiflora incarnata) was a favourite of the Aztecs, who used it to make relaxing drinks. It has a mild sedative effect and promotes sleep much like hops, with no known side-effects at normal doses. Passion flower can also be helpful for hyperactive kids.
  • Kava – Kava appeared to be a promising treatment for anxiety, but reports of serious liver damage even with short-term use caused several European countries and Canada to pull it off the market. The Food and Drug Administration has issued warnings but not banned sales in the United States.

Herbs such as chamomile and catnip make a soothing tea.

 

Complementary Treatment

Stress and Relaxation Techniques – Relaxation techniques may produce modest, short-term reduction of anxiety in people with ongoing health problems such as heart disease or inflammatory bowel disease, and in those who are having breast biopsies, dental treatment, or other medical procedures. These techniques have also been shown to be useful for older adults with anxiety. In people with generalized anxiety disorder, studies indicate that cognitive-behavioral therapy is more effective over the long term than relaxation techniques. For symptoms of depression they may have modest benefit, but they are not as effective as cognitive-behavioral therapy (CBT) or other psychological treatment. Find out more.

Meditation – Moderate evidence suggests that meditation is useful for symptoms of anxiety and depression in adults.

Yoga – Yoga, which combines physical postures, breathing exercises, meditation, and a distinct philosophy, is one of the top ten CAM practices. Studies suggest that practicing yoga (as well as other forms of regular exercise) might confer health benefits such as reducing heart rate and blood pressure, and it may also help alleviate anxiety and depression.

Acupuncture – Evidence for the use of acupuncture – the Chinese practice of inserting needles into the body at specific points to manipulates the body’s flow of energy – to treat anxiety disorders is becoming stronger.

 

 

Reference

http://www.adaa.org/

http://www.nhs.uk/Conditions/Anxiety/Pages/Symptoms.aspx

http://www.health.com/health/gallery/0,,20646990_2,00.html

http://www.healthline.com/health/anxiety/generalized-anxiety-disorder#Overview1

http://www.medicalnewstoday.com/info/anxiety/what-causes-anxiety.php

http://www.webmd.com/anxiety-panic/guide/mental-health-anxiety-disorders?page=3

http://www.adaa.org/finding-help/treatment/complementary-alternative-treatment

http://www.health.com/health/gallery/0,,20669377,00.html

http://www.takingcharge.csh.umn.edu/conditions/anxiety-depression

http://www.medscape.com/viewarticle/568309_1

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