Anxiety

What is anxiety?

Anxiety is a natural response to feeling afraid or threatened. Anxiety can become a problem if we start worrying excessively about relatively harmless situations. When our anxiety feels intense or overwhelming, it starts to interfere with our daily life.

When you are anxious you feel fearful and tense. In addition you may also have one or more unpleasant mental or physical symptoms.

Anxiety symptoms

Physical symptoms of anxiety include:

• The sensation of having a 'thumping heart' (palpitations).

• A feeling of sickness (nausea).

• Shaking (tremor).

• Sweating.

• Dry mouth.

• Chest pain.

• Headaches.

• Fast breathing.

• Dizziness.

The physical symptoms are partly caused by the brain which sends lots of messages down nerves to various parts of the body when you are anxious. When you are anxious you release stress hormones, such as adrenaline (epinephrine), into the bloodstream. These act on the heart, muscles and other parts of the body to cause symptoms, such as a thumping heartbeat and sweaty palms.

Mental symptoms of anxiety include:

• Feeling tired.

• Feeling restless or irritable.

• Unable to concentrate or make decisions.

• Difficulty sleeping.

• Worrying about the past or thinking something bad will happen.

Behavioural symptoms of anxiety include:

• Sometimes there is a feeling of a need to be alone and avoiding friends and social situations.
  

• Selective mutism is when a child is unable to speak in certain situations, such as when at school, even when they can speak in other situations, such as at home with close family members.

• Compulsions may develop to get rid of negative, anxiety producing thoughts, such as compulsively washing hands because of a fear of germs.

• Sometimes anxiety can cause agoraphobia, ie a fear of leaving your home because of anxiety about what might happen if you leave your house.

• Unhealthy coping tools, such as alcohol misuse or substance abuse, which may initially dull the symptoms of anxiety but make the anxiety worse.

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Generalised anxiety disorder

People with generalised anxiety disorder (GAD) have increased anxiety levels on most days. This often causes people to feel fearful, worried and tense.

by Dr Philippa Vincent, MRCGP

What causes anxiety?

• Some people may be more prone to anxiety because of their genetics and there may be a chemical imbalance in the brain which makes them feel much more anxious.

• Difficult past experiences in childhood, adolescence or adulthood are a common trigger for anxiety problems.

• Current stressful life events/trauma can also trigger anxiety.

• Anxiety can sometimes be a medication side effect, such as some psychiatric medications, or due to using recreational drugs or alcohol.

• Anxiety may also be a symptom of other illness, particularly hyperthyroidism.

Is anxiety normal?

Feelings of anxiety are normal in stressful situations and can even be helpful. For example, most people will be anxious when threatened by an aggressive person, or before an important race. The burst of adrenaline (epinephrine) and nerve impulses which we have in response to stressful situations can encourage a 'fight or flight' response.

Anxiety is abnormal and can be classed as a mental health condition if it:

• Is out of proportion to the stressful situation; or

• Persists when a stressful situation has gone, or the stress is minor; or

• Appears for no apparent reason when there is no stressful situation.

Risk factors

There are a number of risk factors for anxiety, which include:

• Females are more often affected than males.

• Family history of anxiety, depression, or other psychiatric disorders.

• Childhood abuse or neglect, or parental mental health problems.

• Being a victim of bullying as a child.

• Sudden bereavement.

• Being separated, widowed, divorced.

• Being unemployed.

• Substance dependence or exposure to organic solvents.

• Chronic health conditions, eg, heart disease, cancer, respiratory disease, diabetes, or arthritis.

What are anxiety disorders?

You may have an anxiety disorder if anxiety symptoms interfere with your normal day-to-day activities, or if worry about developing anxiety symptoms affects your life. It is thought that about 1 in 20 people have an anxiety disorder at any one time.

There are various conditions (disorders) where anxiety is a main symptom. Some people have features of more than one type of disorder at the same time.

See the links below for more information on some of the main types of anxiety disorders:

• Social anxiety disorder.

• Panic attack and panic disorder.

• Generalised anxiety disorder.

• Acute stress reaction.

• Post-traumatic stress disorder.

• Phobias - eg, agoraphobia and other specific phobias.

• Obsessive-compulsive disorder (OCD).

Adjustment reaction is similar to an acute stress reaction but symptoms develop days or weeks after a stressful situation such as a divorce or house move. It is called an 'adjustment reaction' because it is caused by a reaction or adjustment to the problem. Symptoms are similar to acute reaction to stress but may include depression. The symptoms tend to improve over a few weeks or so.

Anxiety treatment

The main aim of anxiety treatment is to help you to reduce symptoms so that anxiety no longer affects your day-to-day life.

The treatment options depend on what condition you have and how severely you are affected. They may include one or more of the following:

NON-MEDICATION TREATMENTS

Understanding

Understanding the cause of symptoms and talking things over with a friend, family member or health professional may help. In particular, some people worry that the physical symptoms of anxiety, such as a 'thumping heart' are due to a physical illness - 'a heart problem'. This can make anxiety worse. Understanding that you have an anxiety disorder is unlikely to cure your symptoms but it often helps.

Counselling

This may help some people with certain conditions. For example, counselling which focuses on problem-solving skills may help if you have generalised anxiety disorder (GAD).

Anxiety management courses

These may be an option for some conditions, if courses are available in your area. The courses may include: learning how to relax, problem-solving skills, coping strategies and group support.

Cognitive behavioural therapy (CBT) for anxiety

This therapy, if available in your area, can work well for persisting anxiety disorders and phobias:

CBT is a type of therapy that deals with your current thought processes and/or behaviours and aims to change them, which may help you to manage your anxiety. See the separate leaflet called Cognitive Behavioural Therapy (CBT).

Self-help

There are various national groups which can help by giving information, advice and support. They, or your doctor or practice nurse, may also be able to put you in touch with a local support group for face-to-face support.

You can also get leaflets, books, CDs, DVDs, MP3s, etc, on relaxation and combating stress. They teach simple deep-breathing techniques and other measures to relieve stress, help you to relax and possibly ease anxiety symptoms.

MEDICATION

Antidepressant medicines

Selective serotonin reuptake inhibitors (SSRIs) are the group of antidepressants commonly used as anti-anxiety medications.

SSRIs often used for anxiety are:

• Escitalopram.

• Sertraline.

These are commonly used to treat depression but also help to reduce the symptoms of anxiety even if you are not depressed. They work by interfering with brain chemicals (also called neurotransmitters) such as serotonin which may be involved in causing anxiety symptoms. Antidepressants are not tranquillisers and are not usually addictive.

Other similar medications that can be used by your doctor to help manage anxiety are:

• Mirtazapine.

• Venlafaxine.

• Paroxetine. - this is now rarely prescribed by GPs.

Benzodiazepines

Benzodiazepines such as diazepam used to be the most commonly prescribed anxiety treatment. They were known as the minor tranquilisers but they do have some serious known side-effects. They often work well to ease symptoms in the short term.

The problem is they are addictive and can lose their effect if you take them for more than a few weeks. They may also make you drowsy. They are not used often for persistent anxiety conditions now.

A short course of up to two weeks may be an option for anxiety which is very severe and short-term, or now and then to help you over a bad spell if you have persistent anxiety symptoms.

Buspirone

Buspirone is sometimes prescribed to treat GAD. It is an anti-anxiety medicine but different to the benzodiazepines and is not thought to be addictive. It is not clear how it works. It is thought to affect serotonin, a brain chemical which may be involved in causing anxiety symptoms.

Beta-blocker medicines

A beta-blocker - for example, propranolol - can ease some of the physical symptoms such as trembling and a 'thumping heart' (palpitations). Beta-blocker medicines do not directly affect the mental symptoms such as worry.

However, some people relax more easily if their physical symptoms are eased. These tend to work best in short-lived (acute) anxiety. For example, if you become more anxious before a test (eg, a driving test or an exam) then a beta-blocker may help to ease 'the shakes'.

In some cases a combination of anxiety treatments such as cognitive therapy and an antidepressant may work better than either treatment alone.

Alcohol and anxiety

Although alcohol may ease symptoms in the short term, don't think that drinking helps to cure social anxiety. It does not.

Drinking alcohol to 'calm nerves' can lead to problem drinking and may make problems with social anxiety and depression worse in the long term. See a doctor if you are drinking alcohol (or taking street drugs) to ease anxiety.

When to see a doctor for anxiety

You should see a doctor if you're struggling to cope with anxiety, fear or panic, or if things you're trying yourself are not helping.

You can also get free talking therapies like cognitive behavioural therapy (CBT) on the NHS. You can refer yourself directly to an NHS talking therapies service without a referral from a GP (see 'Further Reading' below for the link.