My Doctor Online The Permanente Medical Group

Anxiety

Overview

Everyone feels anxiety at times – it is a normal reaction to stress.

When overwhelming feelings of anxiety and worry do not go away, or they interfere with your ability to function, we recommend you be screened for an anxiety disorder.

Anxiety disorders are very common – 25 to 30 percent of people will develop an anxiety disorder over the course of their lifetime. The most common forms of anxiety disorders include social anxiety, chronic worry, panic, and phobias. There are effective treatments for anxiety disorders involving cognitive-behavioral therapy and medication.

Depression is also very common and can be related to anxiety. For women, one of the principal symptoms of postpartum depression can be anxiety. There are effective treatments for depression, including postpartum depression.

Symptoms

There are several different types of anxiety disorders. Although anxiety is common to all anxiety disorders, each one has different symptoms. Symptoms can include overwhelming feelings of tension, worry, or panic or obsessions that do not go away. You may also have other symptoms that could include the following:

• Restlessness 
• Fatigue 
• Irritability or edginess 
• Muscle tension 
• Sleep problems 
• Shortness of breath 
• Stomachaches 
• Diarrhea 
• Dizziness 
• Difficulty controlling the worry 
• Compulsive behaviors 
• Using alcohol or other drugs to manage these symptoms

You may even have feelings of wanting to harm yourself or others. If anxiety often disrupts your home or work life, you should seek help.

Anxiety disorders often make people vulnerable to alcohol and other substances in a belief that turning to them will relieve your symptoms. Unfortunately, the alcohol and substances themselves will make the anxiety symptoms worse, have harmful effects on a person's physical health, and cause significant disruption in your work and relationships. One goal of treatment may include reducing use of alcohol or any substance that may be worsening your symptoms.

Types

Anxiety disorders are the most common mental health issue in the U.S. They will affect about one-third of all U.S. residents at some point during their lives. Social anxiety disorder alone may affect as many as 13 percent over their lifespan. Types of anxiety disorders include the following:

Generalized anxiety disorder (GAD)

Generalized anxiety disorder consists of overwhelming worry that occurs on most days and that lasts 6 months or more. Although the worry is focused on everyday aspects of life such as health, finances, family, work, or school, for those with GAD the worry is excessive in intensity and experienced as hard to control. It may be accompanied by physical symptoms such as restlessness, muscle tension, stomachaches, dizziness, sleep problems, or other physical aches and pains.

Social anxiety disorder (SAD)

Social anxiety disorder manifests as a pronounced fear of being negatively judged in a variety of social situations. You may fear being embarrassed or ridiculed by others, which causes you to avoid social activities. As a result of this social anxiety, you may also have physical symptoms such as blushing, sweating, rapid heartbeat, or feeling faint.

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder can be the result of a traumatic experience that happens to you or someone else. Witnessing or being a victim of a traumatic event such as a physical or sexual assault, violence, or death can have serious effects. People with PTSD can develop the following:

• Repeating or "re-experiencing" the trauma in flashbacks or dreams 
• Feeling emotionally numb 
• Having difficulty relating to other people 
• Avoiding the place or places where the traumatic event took place 
• Having difficulty sleeping or concentrating 
• Feeling irritable

Panic disorder

Panic disorder involves the experience of recurring, unexpected panic attacks.  A person with panic disorder will often have persistent concern about having additional attacks, worry about the implications of the attack (for example, think they will lose control or are “going crazy”), or experience a significant change in behavior related to the attacks.

Panic attacks involve a sudden intense feeling of fear accompanied by physical symptoms such as chest pains, the feeling that you cannot breathe, smothering, sweating, trembling, tingling of the hands or feet, dizziness, or nausea. These symptoms can be so severe that some people mistake them for a heart attack. A panic attack can happen at any time – it can even wake you from sleep. The symptoms usually peak within 10 minutes, but it may take much longer for all the symptoms to go away.

Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder leads people to feel very anxious or fearful. It is driven by repetitive disturbing thoughts or impulses (obsessions) that cause people to repeat certain behaviors (compulsions) in order to quiet the thoughts. For instance, you might feel that you are contaminated by germs, and this may lead you to wash your hands over and over again. You may worry that objects are not placed quite right and that something bad might happen if you do not spend excessive time arranging things to be "just right." If you feel that you spend more than an hour a day having seemingly unreasonable and intrusive thoughts, and/or performing unneeded repetitive actions, you may benefit from an evaluation for OCD.     

Specific phobia

Specific phobia (also known as simple phobia) consists of unreasonable, excessive fears of specific objects or situations, such as driving a car over a bridge, using an elevator, or flying in a plane. You may have difficulties in confined spaces or feel claustrophobic. Just thinking about or approaching the feared situation or object can trigger anxiety. In this disorder, the person’s anxiety or avoidance of the feared situation or object has a significant impact on their normal routine, relationships, or general functioning.

Causes

Anxiety disorders result from complex interactions between life experiences and biology. People may find ways to limit the anxiety while not learning to confront the fear underlying it, thus creating a cycle of fear and avoidance. This cycle causes the anxiety disorder to continue. Various factors may contribute to anxiety disorders.

• Genetic. Anxiety disorders seem to run in families, so genes may play some part in whether a person develops an anxiety disorder.
• Life experiences. Children who experience traumatic events may have more risk of developing anxiety disorders when they get older. Adults who experience stressful life situations such as divorce, death, illness, or financial pressures feel tension and worry, which can spark an anxiety disorder.
• Neurological development. The parts of the nerves and brain involved in the fear response are more active in people with anxiety disorders. This enhanced activity is probably due both to genes and behavior.

Screening and Diagnosis

Tell us if you are feeling more than the usual amount of anxiety. We will ask you questions about your anxieties and worries, how long you have been experiencing them, and what physical symptoms you might have. We will also ask about your medical history to make sure that your symptoms are not the result of a physical illness. A diagnosis of anxiety disorder includes the following:

• Overwhelming anxiety or worry every day for at least 6 months
• Difficulty managing your anxiety
• Other symptoms such as difficulty concentrating, sleeping, or making decisions; restlessness; or stomach pains

Lifestyle Management

Learning to successfully manage your anxiety takes practice. Anxiety can affect many parts of your life including relationships with friends and family and how you perform at work or school. There are actions you can take to reduce your anxiety: 

• Exercise. Physical activity is calming. When you begin to feel anxious, take a walk around the block or do another activity that you enjoy.
• Make healthy lifestyle choices. Get enough rest, eat a healthy balanced diet, participate in activities that you enjoy, and reduce or eliminate caffeine, nicotine, and alcohol.
• Be consistent with the recommended treatment plan.
• Socialize with close family and friends. They can be a source of support and encouragement. Avoid isolating yourself from others.
• Learn relaxation techniques. Deep relaxation exercises, yoga, or meditation can help reduce your anxiety.

 

Treatments

There are effective treatments for anxiety. We recommend either medication, therapy, or both. People with generalized anxiety disorder, social anxiety, panic disorder, PTSD, obsessive-compulsive disorder, and other anxiety disorders can benefit from one of several types of therapy, medication, or both.

People with generalized anxiety disorder (GAD), panic disorder, or social anxiety disorder usually benefit from one of several types of therapy, including:

• Cognitive-behavioral therapy (CBT) helps you recognize and change your negative thought patterns into healthy thought patterns. Discouraging or irrational automatic thoughts can cause you to feel bad. When you replace negative thoughts with healthy positive ones, you become calmer and can also change the way you react to situations that cause anxiety.
• Relaxation techniques help you become aware of tension in your body. You learn how to relax, which reduces your feelings of anxiety. Techniques such as those used in yoga and other relaxation practices include deep breathing exercises and methods to relax specific muscles. 
• Guided imagery is a technique in which you learn how to use your imagination to reduce anxiety and stress. 
• Exposure response prevention therapy (ERP) involves systematic and controlled exposure to the situations or objects that are causing panic attacks or other anxiety symptoms. Initially, this exposure is through visualization, but, frequently, the treatment involves actual exposure to the anxiety-provoking stimulus. This type of therapy is excellent for specific phobias (i.e., a fear of spiders), panic disorder, and obsessive-compulsive disorder.

There are many medication options for treating anxiety. We will work with you to decide which options are right for you, including: 

• Benzodiazepines help reduce anxiety. However, this kind of medication can be addictive, so we prescribe it only for short periods of time. Benzodiazepines are commonly known as Xanax, Librium, Ativan, and Serax.
• Antidepressants are approved by the Food and Drug Administration (FDA) to treat depression and/or anxiety. Some antidepressants we may prescribe for general anxiety disorder are Prozac (fluoxetine), Celexa (citalopram), Zoloft (Sertraline), Paxil (paroxetine), and Effexor (venlafaxine). Antidepressant medication takes 2 to 6 weeks to be fully felt. You may need to try different medications before you find the one that works best for you.
• Buspirone (BuSpar). This medication can take up to 2 weeks before you feel its full effect.

Medications during pregnancy and breastfeeding

Many anxiety medications can be used safely in pregnancy and while breastfeeding. If you are considering getting pregnant and are already on anxiety medications we can review whether you should stay on this medication, switch to another medication, or stop your current therapy. Although there may be some risk to the baby associated with these medications, the risks are minimal and should be weighed against the risks of stopping treatment.

Related Health Tools:

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.