Anxiety Treatment

What is Anxiety?

Anxiety is a medical condition characterized by excessive worrying and fear about upcoming events.  There are various forms of anxiety such generalized anxiety disorder, phobias, and panic attacks.  Obsessive-compulsive disorder is also considered a form of anxiety.  People with anxiety often feel stressed or worried, have muscle tension, and experience symptoms such as palpitations and trouble breathing.  They also frequently have trouble sleeping (insomnia).

Severe anxiety is associated with an increased risk of suicide.  Due to the importance of this condition, it is critical that patients understand its causes, symptoms, and treatment.  By the end of this article, you will have the answers to these essential questions:

What causes Anxiety?

Anxiety originates from genetic and environmental factors.  This condition frequently runs in families and is associated with other psychiatric disorders such as depression.  Symptoms occur due to inappropriate or exaggerated activation of the sympathetic nervous system.  The sympathetic nervous system is beneficial in flight or fight situations – but in patients with anxiety, this system is excessively activated resulting in undesirable symptoms.  Long-term, this results in low serotonin levels in the brain.

The condition results from a combination of factors such as stressors during your upbringing, current work or social stressors, and substance abuse.  It can be triggered by situations such as speaking in front of large audiences, standing in an elevator, driving on the freeway, or functioning in social situations.  In severe cases, patients will avoid leaving their home due to fear of open places – agoraphobia.

The most common risk factors include:

  • Family history
  • Other psychiatric condition –PTSD, bipolar disorder, schizophrenia
  • Alcohol or drug dependence
  • Traumatic brain injury
  • Stroke
  • Other medical conditions (e.g., systemic lupus erythematosus, heart disease)

How common is Anxiety?

Anxiety is a common condition that is frequently evaluated in the primary care clinic.  Severe cases often require referral to a psychology or psychiatry specialist.

Panic disorder and obsessive-compulsive disorder have an approximately 2% lifetime prevalence in the United States.  Social phobia has about a 2-16% lifetime prevalence, whereas generalized anxiety disorder has a 3%-30% prevalence.

Anxiety disorders usually affect people age 25 to 44 years and are more common in divorced and widowed individuals.  There is a lower prevalence in people age >65 years.

What are the symptoms and signs of Anxiety?

The most common symptom of include:

  • Fear of losing control
  • Fear of death
  • Palpitations & tachycardia
  • Chest tightness
  • Difficulty breathing
  • Muscle tension
  • Epigastric discomfort
  • Nausea

 Sometimes the symptoms of a panic attack can resemble that of a heart attack.  Symptoms that are more suggestive of heart attack include chest pain/pressure characterized as an elephant sitting on the chest.  Trouble breathing, nausea/vomiting, and sweating are other concerning signs.  If you experience these symptoms and you have cardiovascular risk factors - advanced age, smoking history, high blood pressure, hypercholesterolemia, diabetes, or history of heart attack/stroke – you should consider calling 911 or going to the nearest emergency department.

How is Anxiety diagnosed?

Anxiety is diagnosed based on symptoms and physical examination.

Your doctor will also likely order blood tests to rule out medical causes of your symptoms.  These tests typically include such as a CMP (comprehensive metabolic panel), CBC (complete blood cell count), and thyroid function (TSH, free T4).  They may also perform a urine drug screen to evaluate for substances such as cocaine or amphetamines.

If you have cardiovascular risk factors and your doctor is concerned about a possible heart attack, they may obtain a EKG (electrocardiogram) and refer you to the nearest emergency department for further evaluation.

How is Anxiety treated?

Acute episodes of anxiety and panic attacks may require the use of benzodiazepines.  These may include the following:

  • Ativan (lorazepam)
  • Xanax (alprazolam)
  • Klonopin (clonazepam)
  • Valium (diazepam)
  • Librium (chlordiazepoxide)

These drugs should generally be used at the lowest doses possible and for the shortest period of time as they may lead to dependence and drug withdrawal.

Patients with anxiety are often treated with long-acting agents to reduce the frequency of symptoms and reliance on benzodiazepines.

The most commonly prescribed drugs include:

These medications work by increasing serotonin levels in the brain – which seems to improve symptoms in anxious patients.  Patients with anxiety may also benefit from psychotherapy with a psychologist – the incorporation of certain behavioral techniques can help improve symptoms.

Anxiety Patient Summary:

  • Anxiety is a psychiatric condition characterized by excessive worrying and fear about upcoming events
  • Anxiety disorders usually affect people age 25 to 44 years and are more common in divorced and widowed individuals. 
  • There are various forms of anxiety such generalized anxiety disorder, phobias, and panic attacks.  Obsessive-compulsive disorder is also considered a form of anxiety. 
  • Anxiety is caused by genetic and environmental factors.  This condition frequently runs in families and is also associated with other psychiatric conditions such as depression.
  • Family history, other psychiatric conditions (e.g., PTSD, bipolar disorder, schizophrenia, alcohol/drug dependence), traumatic brain injury, stroke, or other medical conditions
  • The most common symptoms are fear of losing control, fear of death, palpitations & tachycardia, chest tightness, difficulty breathing, muscle tension, epigastric discomfort, and nausea.
  • Anxiety is diagnosed based on symptoms and physical examination - your doctor will also likely order blood tests to rule out medical causes of your symptoms. 
  • These tests typically include a CMP (comprehensive metabolic panel), CBC (complete blood cell count), and thyroid function studies (TSH, free T4).  They may also perform a urine drug screen to evaluate for substances such as cocaine or amphetamines.
  • Treatment of acute episodes of anxiety and panic attacks may require the use of benzodiazepines.  These may include the following: Ativan (lorazepam), Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), and Librium (chlordiazepoxide).
  • Patients with anxiety are often treated with long-acting agents to reduce the frequency of symptoms and reliance on benzodiazepines.
  • The most commonly prescribed drugs include selective serotonin reuptake inhibitors (SSRIs) such as Zoloft (sertraline), Prozac (fluoxetine), Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine).
  • Your doctor may also recommend Cymbalta (duloxetine).

References:

  1. Locke AB, Kirst N, Shultz CG. Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician. 2015 May 1;91(9):617-24.
  2. Bystritsky A, Khalsa SS, Cameron MECurrent diagnosis and treatment of anxiety disorders. P T. 2013 Jan;38(1):30-57.

Anxiety Medication List

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.