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Anxiety Disorder

What is anxiety?

When you are anxious you feel fearful and tense. In addition you may also have one or more unpleasant physical symptoms. For example: a fast heart rate, palpitations, feeling sick, shaking (tremor), sweating, dry mouth, chest pain, headaches, fast breathing. Principally this is because you release stress hormones (such as adrenaline) into the bloodstream when you are anxious. These can also act on the heart, muscles and other parts of the body to cause symptoms.

Anxiety is normal in stressful situations, and can even be helpful. For example, most people will be anxious when threatened by an aggressive person. Some people are more prone to normal anxieties. For example, some people are more anxious before examinations than others. Anxiety is abnormal if it:

  • Is widely out of proportion to the stressful situation, or
  • Persists after a stressful situation has gone, or is minor, or
  • Appears for no apparent reason.
What are anxiety disorders?

There are various conditions (disorders) where anxiety is a main symptom.

What is generalized anxiety disorder?

If you have generalized anxiety disorder (GAD) you have a lot of anxiety on most days. The condition persists long-term. Some of the physical symptoms of anxiety as mentioned above may come and go.

As a rule, symptoms of GAD cause you distress and affect your day-to-day activities. In addition, you will usually have some of the following symptoms:

  • Feeling restless, irritable, or keyed up a lot of the time.
  • Tiring easily.
  • Difficulty concentrating.
  • Poor sleep (insomnia).
What causes generalized anxiety disorder?

The cause is not clear. Your genetic makeup may play a role. Some people have a tendency to have an anxious personality, which can run in families. Childhood traumas such as abuse, or death of a parent, may make you more prone. A major stress in life may trigger the condition. Some people who have other mental health problems such as depression or schizophrenia may also develop GAD.

How is generalized anxiety disorder diagnosed?

If the typical symptoms develop and persist for at least six months, then a doctor can usually be confident that you have GAD.

Some of the physical symptoms of anxiety can be caused by physical problems which can be confused with anxiety.

  • Drinking a lot of caffeine (in tea, coffee, and cola).
  • The side-effect of some prescribed medicines. For example, selective serotonin reuptake inhibitor (SSRI) antidepressants.
  • An overactive thyroid gland.
  • Taking some street drugs.
  • Certain heart conditions which cause palpitations, like valvular hear diseases, atrial fibrillation.
  • Low blood sugar level.
  • Tumors which make too much adrenaline and other similar hormones (pheochromocytomas).
What is the outlook?

Without treatment, GAD tends to persist throughout life. It is relatively mild in some cases, but for some it can be very disabling. The outlook was worse for people who had more than one anxiety disorder. The severity of symptoms tends to wax and wane. Symptoms may flare up and become worse for a while during periods of major life stresses.

People with GAD are more likely than average to smoke heavily, drink too much alcohol, and take street drugs. Each of these things may ease symptoms in the short-term. However, addiction makes things worse in the long-term.

What are the treatment options?

TALKING TREATMENTS (psychotherapy) AND OTHER NONDRUG TREATMENTS

  • Cognitive behavioral therapy (CBT)
  • This is probably the most effective treatment. It probably works for over half of people with GAD. Cognitive therapy is based on the idea that certain ways of thinking can trigger, or fuel, certain mental health problems such as anxiety. The therapist helps you to understand your current thought patterns - in particular, to identify any harmful, unhelpful, and false ideas or thoughts which you have that can make you anxious. They then help change your ways of thinking to avoid these ideas. Therapy is usually done in weekly sessions of about 50 minutes each, for several weeks. You have to take an active part, and are given homework between sessions.

    Behavioural therapy aims to change any behaviours which are harmful or not helpful. Various techniques are used, depending on the condition and circumstances. As with cognitive therapy, several sessions are needed for a course of therapy.

    Cognitive behavioral therapy (CBT) is a mixture of the two where you may benefit from changing both thoughts and behaviors.

  • Anxiety management courses
  • These may be an option if they are available in your area. Some people prefer to be in a group course rather than have individual therapy or counseling.

  • Self-help
  • You can get leaflets, books, tapes, videos, etc, on relaxation and combating stress. They teach simple deep breathing techniques and other measures to relieve stress, help you to relax, and may ease anxiety symptoms.

    MEDICATION

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

      Antidepressants do not work straight away. It takes 2-4 weeks before their effect builds up. Antidepressants are not tranquillizers, and are not usually addictive. Selective serotonin reuptake inhibitor (SSRI) antidepressants are the ones most commonly used for anxiety disorders.

      Note: after first starting an antidepressant, in some people the anxiety symptoms become worse for a few days before they start to improve.

    • Buspirone
    • This medicine is another option to treat GAD. It is not clear how it works, but it is known to affect serotonin, a brain chemical which may be involved in causing anxiety symptoms.It takes two weeks or more to begin to work.

      A common plan is to try an eight-week trial. If it does not help, it should be stopped and a different treatment tried. It is less likely to work if you have taken a benzodiazepine medicine such as diazepam within the previous 30 days.

    • Benzodiazepines such as diazepam, alprazolam
    • These used to be the most commonly prescribed medicines for anxiety. They usually work well to ease symptoms. 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.

    • Pregabalin
    • Pregabalin is a medication used for several conditions (principally epilepsy). It has been found useful in GAD. It tends to be considered for GAD if the other treatments mentioned above have been unhelpful. Hence it should rather be considered as a second line drug.

    • Betablocker medicines such as propranolol
    • These are sometimes used. They tend to work better in acute (short-lived) anxiety rather than in GAD. They may ease some of the physical symptoms such as trembling, but do not affect the mental symptoms such as worry.


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