ANXIETY: Symptoms, Causes, and Cures

Key facts about anxiety:

• Anxiety is an emotion or sense of fear, worry, and nervousness. Occasional anxiety is common, e.g., on the first day of your job, and you could be anxious/nervous about it.
• Anxiety disorders are among the most common conditions around the globe. According to research conducted in 2017, 284 million people worldwide suffer from anxiety, and about 40 million adults suffer from anxiety in the USA[1].
• Women are 60% more likely to have anxiety than men, primarily due to fluctuating hormone levels during different phases of life[2].
• Though anxiety is treatable in 90% of cases, only one-third of patients seek medical help, and the rest suffer.
• Anxiety can cause severe health problems and even lead to death.

Overview:

Anxiety is an involuntary response to fear and/or distress. Anxiety is normal in certain situations, the first day of a job, moving to a new place, the first day of school, before an exam, etc., but these feelings are temporary and go away with the situation. Anxiety is considered a disorder if these emotions of fear persist for a more extended period (usually more than six months) and to the extent that they disturb your daily life, e.g., job performance, relationships, and studies. Anxiety can be frustrating; constant fear makes the patient stressed and fatigued[3]. Anxiety is a mental condition with prominent physical signs such as sweat, trembling, tachycardia, hypoxia, blurred vision, and even insomnia. Anxiety can start as early as childhood.

There are different anxiety disorders, namely generalized anxiety disorder (GAD), panic disorder, and phobias-related anxiety disorders[4].

• Generalized anxiety disorder: Patients are said to have GAD if their anxiety symptoms are present for at least six months. The fear factors of such patients revolve around their personal life like health, work, social life, and social interaction. Common symptoms include irritability, fatigue, loss of concentration, perspiration, tensed muscles, and insomnia.
• Panic disorders: Panic disorders are attacks characterized by palpitations, shortness of breath, chest pain, sweating, etc. These symptoms result from an extreme fear that peaks within minutes and then subsides.
• Phobias-related anxiety: Phobias are an intense fear of a specific thing/situation. These include fear of heights, specific arthropods or animals, closed spaces, flying, and even gaining weight.
• Post-Traumatic Stress: Post-Traumatic Stress Disorder results when you have experienced a traumatic situation, leading to flashbacks of the scenario and even insomnia or panic attacks.

Risk factors/ Causes:

Anxiety is not related to any malfunctioning of the brain. Instead, it could be genetic due to some underlying medical conditions or medication[5]

• Genetics: Anxiety could be inherited; you are most likely to develop it if your parents have/had anxiety.
• Underlying Medical Conditions: Anxiety could result from already underlying medical conditions. These medical conditions include cardiac diseases, thyroid gland malfunctioning, respiratory infections, chronic pain, diabetes, etc.
• Medication: Anxiety can also be developed as an adverse effect of some medications. These medications include stimulants, antidepressants, corticosteroids, nasal decongestants, caffeine-containing drugs, and thyroid medications.

Certain factors can increase the risk of anxiety in an individual[6]:

• Drug Abuse: drug abuse or alcohol intake increases the chances of anxiety.
• Other mental disorders: certain mental conditions, e.g., depression and ADHD, can also cause anxiety.
• Stressful life events: any trauma or bad experience, e.g., sexual abuse, can also lead to anxiety.
• Other underlying diseases: cardiac diseases, and hormonal imbalance, can also lead to anxiety.

Diagnosis:

• Psychological evaluation by an expert can help diagnose anxiety. The specialist can inquire about your symptoms, how they started if you had any traumatic events in your life, and your family history related to anxiety[7].
• A blood test can also identify any underlying disease causing anxiety.
• Complete information on any medication the patient takes is also required to ensure anxiety is not an adverse effect of any medicine

Treatment:

Treatment of anxiety includes:

1. Psychotherapy: Cognitive Behavioral Therapy (CBT) is the most common psychotherapy technique. CBT involves counseling sessions with therapists in which a warm relationship and trust are built between the patient and the therapist. The therapist then tries to discover the genesis, evolution, and maintenance of anxiety over time. Finally, patients are taught techniques to reduce their anxiety by motivating them to self-control and self-reduce their fears[8].
2. Pharmacotherapy: Several drugs are used depending on factors like age and any underlying physical/mental health condition[9]. Commonly used medications are:

• Selective Serotonin Reuptake Inhibitors (SSRIs): Fluoxetine, Citalopram, Sertraline, Escitalopram, Fluvoxamine, and Vilazodone.
• Serotonin-Norepinephrine Reuptake Inhibitors: they include Venlafaxine, Desvenlafaxine, and Duloxetine.
• Benzodiazepines: they include Alprazolam and Clonazepam.
• Tricyclic Antidepressants: due to their potential side effects and withdrawal symptoms, they are used rarely. Clomipramine is an example of TCA used for anxiety.

Other ways to deal with Anxiety:

In addition to psychotherapy and pharmacotherapy, there are certain ways to reduce anxiety in a patient, including lifestyle changes. These techniques are considered coping mechanisms essential in making psychotherapy or pharmacotherapy effective. The following are some of them:

• Knowing your Stress:

 Identifying the stress sources is a positive approach to reducing anxiety. Knowing about the stressors will help you tackle your fears, and also, you can avoid those factors that stress you out.

• Social bonding:

 Hanging out with family and friends (unless they are the source 😊) reduces anxiety levels. The feeling of being loved has a significant impact on mental health. Also, taking yourself out of self-isolation and keeping company with those who motivate you helps a lot.

• Relax:

Morning walks, yoga, meditation, and exercise also play a part in reducing anxiety.

• Healthy eating:

A nutritionally balanced diet is also essential. Also, avoiding energy drinks, fizzy drinks, alcohol, caffeine, and chocolate will help reduce stress and anxiety.

References:

• Strine, Tara W., et al. “Depression and anxiety in the United States: findings from the 2006 behavioral risk factor surveillance system.” Psychiatric services 59.12 (2008): 1383-1390.
• Lewinsohn, Peer M., et al. “Gender differences in anxiety disorders and anxiety symptoms in adolescents.” Journal of abnormal psychology 107.1 (1998): 109.
• Kierkegaard, Søren. The concept of anxiety. Princeton University Press, 2013.
• Joseph, Betty. “Different types of anxiety and their handling in the analytic situation.” International Journal of Psycho-Analysis 59 (1978): 223-228.
• Shri, Richa. “Anxiety: causes and management.” The Journal of Behavioral Science 5.1 (2010): 100-118.
• Vink, Dagmar, Marja J. Aartsen, and Robert A. Schoevers. “Risk factors for anxiety and depression in the elderly: a review.” Journal of affective disorders 106.1-2 (2008): 29-44.
• Shri, Richa. “Anxiety: causes and management.” The Journal of Behavioral Science 5.1 (2010): 100-118.
• Deacon, Brett J., and Jonathan S. Abramowitz. “Cognitive and behavioral treatments for anxiety disorders: A review of meta‐analytic findings.” Journal of clinical psychology 60.4 (2004): 429-441.
• Farach, Frank J., et al. “Pharmacological treatment of anxiety disorders: Current treatments and future directions.” Journal of anxiety disorders 26.8 (2012): 833-843.