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Anxiety
Anxiety Overview
Anxiety is a feeling of apprehension, fear, or worry. Some fears and
worries are justified, such as worry about a loved one. Anxiety may
occur without a cause, or it may occur based on a real situation, but
may be out of proportion to what would normally be expected. Severe
anxiety can have a serious impact on daily life.
Anxiety can be accompanied by a variety of physical symptoms. Most
commonly, these symptoms are related to the heart, lungs, and nervous
system. You may feel as if you are having a heart attack.
Anxiety Causes
Anxiety may be caused by a mental condition, a physical condition, the
effects of drugs, or from a combination of these. The doctor’s
initial task is to see if your anxiety is caused by a medical condition.
Common causes of anxiety include these mental conditions:
Panic disorder: In addition to anxiety, common symptoms of panic
disorders are palpitations (feeling your heart beat), dizziness, and
shortness of breath. These same symptoms also can be caused by coffee
(caffeine), amphetamines ("speed" is the street slang for amphetamines
when they are not prescribed by a doctor), an overactive thyroid,
abnormal heart rhythms, and other heart abnormalities (such as mitral
valve prolapse).
Generalized anxiety disorder
Phobic disorders
Stress disorders
These common external factors can cause anxiety:
Stress at work
Stress from school
Stress in a personal relationship such as marriage
Financial stress
Stress from an emotional trauma such as the death of a loved one
Stress from a serious medical illness
Side effect of medication
Use of an illicit drug, such as cocaine
Symptom of a medical illness
Lack of oxygen - In circumstances as diverse as high altitude sickness,
emphysema, or pulmonary embolism (a blood clot with the vessels of the
lung)
The doctor has the often-difficult task of determining which symptoms
come from which causes. For example, in a study of people with chest
pain that could be heart disease but turned out not to be heart related,
43% were found to have a panic disorder—a common form of anxiety.
Anxiety Symptoms
Panic disorders - Separate and intense periods of fear or feelings of
doom developing over a very short time frame—10 minutes—and
associated with at least 4 of the following:
Palpitations
Sweating
Trembling
Shortness of breath
Sense of choking
Chest pain
Nausea
Dizziness
A feeling of being detached from the world (derealization)
Fear of dying
Numbness or tingling
Chills or hot flushes
Generalized anxiety disorder - Excessive and unrealistic worry over a
period of at least 6 months associated with 3 of the following:
Restlessness
Easy fatigue
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbances
Phobic disorders - Intense, persistent, and recurrent fear of certain
objects (such as snakes, spiders, blood) or situations (such as heights,
speaking in front of a group, public places). These exposures may
trigger a panic attack.
Stress disorders - Anxiety (also known as post-traumatic stress
disorder) caused by the exposure to either death or near-death
circumstances such as fires, floods, earthquakes, shootings, automobile
accidents, or wars, for example. The traumatic event is re-experienced
in thoughts and dreams. Common behaviors include the following:
Avoiding activities, places, or people associated with the triggering
event
Difficulty concentrating
Difficulty sleeping
Being hypervigilant (you closely watch your surroundings)
Feeling a general sense of doom and gloom with diminished emotions such
as loving feelings or aspirations for the future
Symptoms such as chest pain, shortness of breath, palpitations,
dizziness, fainting, and weakness generally should not be attributed to
anxiety and require evaluation by a doctor.
When to Seek Medical Care
Call your doctor when the signs and symptoms of anxiety are not easily,
quickly, and clearly diagnosed and treated.
If the symptoms are so severe that you believe medication may be needed
If the symptoms are interfering with your personal, social, or
professional life
If you have chest pain, shortness of breath, headaches, palpitations,
dizziness, fainting spells, or unexplained weakness
If you are depressed and feel suicidal
When the signs and symptoms suggest that anxiety may have been present
for a prolonged period (more than a few days) and appear to be stable
(not getting worse rapidly), you may be able to make an appointment with
your doctor for evaluation. But when the signs and symptoms are severe
and come on suddenly, they may represent a serious medical illness that
needs immediate evaluation and treatment in a hospital’s emergency
department.
Exams and Tests
The doctor will take a careful history, perform a physical
examination, and order laboratory tests as needed.
If you have another medical condition that you know about, there may be
an overlap of signs and symptoms between what is old and what is new.
Just determining that anxiety is psychological does not immediately
identify the ultimate cause. Often, determining the cause requires the
involvement of a psychiatrist, clinical psychologist, or other mental
health professional.
Anxiety Treatment
Self-Care at Home
In certain cases, you may treat anxiety at home without the involvement
of a doctor. These are limited to anxiety attacks of short duration in
which you know the cause, the anxiety is short, it goes away by itself,
and the cause can be eliminated. For example, you may be anxious over an
upcoming public performance, a final exam, or a pending job interview.
In such circumstances, stress may be relieved by such actions as these:
Talking with a supportive person
Meditation
Watching TV
Taking a long warm bath
Resting in a dark room
Deep breathing exercises
Medical Treatment
Treatment depends on the cause.
When the cause of anxiety is a physical ailment, treatment is directed
toward eliminating that ailment. For example, if your thyroid gland were
overactive and causing anxiety, the treatment might involve surgery and
various thyroid-regulating medications.
When the cause is psychological, the underlying cause needs to be
discovered, and, if possible, eliminated or controlled. For example, if
the cause is difficulty in a marriage, the doctor may suggest marital
counseling.
Sometimes, the cause cannot be identified. In such cases, the only
treatment option is control of symptoms.
In the past, anxiety was treated with drugs in a class known as
benzodiazepines. These include familiar names:
Diazepam (Valium)
Alprazolam (Xanax)
Lorazepam (Ativan)
A newer anti-anxiety drug is buspirone (BuSpar).
More recently, drugs of the SSRI class (selective serotonin reuptake
inhibitors, often also used to treat depression) are prescribed and
include the following:
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluoxetine (Prozac)
Venlafaxine (Effexor)
In addition, psychotherapy may be useful. Combinations of medication and
counseling are usually advisable.
Next Steps
Follow-up
Anxiety should be addressed and treated with your doctor. Establish an
ongoing relationship. By knowing your own doctor and by having follow-up
on a regular basis, you may cope with your problems and resolve them
more effectively. These steps may also help you deal with medical
conditions that might otherwise go undiagnosed and untreated.
Prevention
Prevention of anxiety essentially involves an awareness of life's
stresses and your own ability to cope with them. This can often be a
difficult task in our busy and hectic 21st century.
In essence, you might develop coping mechanisms for all of life's
stresses. Strategies might include these:
Exercise
Meditation
Relaxation exercises including deep breathing
Visualization
Interpersonal skills in dealing with difficult people and situations or
parenting skills training in dealing with your children
Prevention also includes diet, regular exercise, rest, and the basics in
terms of preventive health care maintenance. Diet is a large factor.
Caffeine, stimulants, lack of rest, and lack of exercise all are factors
that influence anxiety.
Outlook
When the cause of anxiety is identified and treated, complete recovery
is often made. Where no cause can be readily identified, you may feel
anxiety for a long time, perhaps your entire life. Excellent medications
are available to help many of the symptoms. Counseling with mental
health professionals can be highly successful.
Synonyms and Keywords
panic attack, panic disorder, fear, worry, nerves, post-traumatic stress
disorder, posttraumatic stress disorder, PTSD, panic disorder,
generalized anxiety disorder, phobic disorder, phobia, stress disorder,
anxiety, stress
Authors and Editors
Author: Christopher J Minas, MD, Founder, CEO, and Medical Director,
Belmar Medical Offices of New Jersey, Inc. Editors: Scott H Plantz,
MD, FAAEM, Research Director, Assistant Professor, Department of
Emergency Medicine, Mount Sinai School of Medicine; Francisco Talavera,
PharmD, PhD, Senior Pharmacy Editor, eMedicine; Anthony Anker, MD,
FAAEM, Attending Physician, Emergency Department, Mary Washington
Hospital, Fredericksburg, VA.
© 2003 - 2005 eMedicine.com, Inc.
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