Anxiety is a normal part
of life. It can even be useful when it alerts us to danger. But for some
people, anxiety is a persistent problem that interferes with daily
activities such as work, school or sleep. This type of anxiety can
disrupt relationships and enjoyment of life, and over time it can lead
to health concerns and other problems.
In some cases, anxiety is a diagnosable mental health condition that
requires treatment. Generalized anxiety disorder, for example, is
characterized by persistent worry about major or minor concerns. Other
anxiety disorders — such as panic disorder, obsessive-compulsive
disorder (OCD) and post-traumatic stress disorder (PTSD) — have more
specific triggers and symptoms. In some cases, anxiety is caused by a
medical condition that needs treatment.
Whatever form of anxiety you have, medications, counseling or lifestyle changes can generally help.
Common anxiety symptoms include:
* Feeling apprehensive
* Feeling powerless
* Having a sense of impending danger, panic or doom
* Having an increased heart rate
* Breathing rapidly (hyperventilation)
* Feeling weak or fatigued
Specific anxiety disorders are broken down into several diagnosable mental health conditions:
* Panic attacks can start suddenly and cause apprehension, fear or
terror. You may have feelings of impending doom, shortness of breath,
heart palpitations or chest pain. You may feel as if you're choking,
being smothered or that you're "going crazy."
* Agoraphobia is anxiety about, or avoidance of, places or
situations where you might feel trapped or embarrassed to leave if you
start to feel panicky.
* Specific phobias are characterized by significant anxiety when
you're exposed to a specific object or situation and a desire to avoid
it. Phobias provoke panic attacks in some people.
* Social phobias are characterized by significant anxiety provoked
by exposure to certain types of social or performance situations and a
desire to avoid them.
* Obsessive-compulsive disorder (OCD) is characterized by
persistent, recurring thoughts, images or impulses (obsessions) or an
irresistible desire to perform irrational or seemingly purposeless acts
or rituals (compulsions). Often it involves both obsessive and
* Post-traumatic stress disorder (PTSD) is characterized by the
feeling that you are re-experiencing an extremely traumatic event. It
causes intense emotions and physical reactions along with a desire to
avoid anything that might remind you of the event.
* Acute stress disorder is characterized by symptoms similar to
those of post-traumatic stress disorder that occur immediately after an
extremely traumatic event.
* Generalized anxiety disorder is characterized by at least six
months of persistent and excessive anxiety and worry about small or
large concerns. This type of anxiety disorder often begins at an early
age. It frequently occurs along with other anxiety disorders or
* Anxiety disorder due to a medical condition is characterized by
prominent symptoms of anxiety that are directly caused by a physical
* Substance-induced anxiety disorder is characterized by prominent
symptoms of anxiety that are a direct result of abusing drugs, taking
medications or being exposed to a toxic substance.
* Separation anxiety disorder is a childhood disorder characterized
by anxiety related to separation from parents or others who have
* Anxiety disorder not otherwise specified is a term for prominent
anxiety or phobias that do not meet the exact criteria for any of the
other anxiety disorders but are significant enough to be distressing and
When to see a doctor
See your doctor if:
* You feel like you're worrying too much and it's interfering with your work, relationships or other parts of your life
* You feel depressed, have trouble with alcohol or drug use, or have other mental health concerns along with anxiety
* You think your anxiety could be linked to a physical health problem
* You have suicidal thoughts or behaviors (seek emergency treatment immediately)
Your worries may not go away on their own, and they may actually get
worse over time if you don't seek help. See your doctor or a mental
health provider before your anxiety gets worse. It may be easier to
treat if you address it early.
As with many mental health conditions, the exact cause of anxiety
disorders isn't fully understood. It's thought that anxiety disorders
may involve an imbalance of naturally occurring brain chemicals
(neurotransmitters) such as serotonin, dopamine or norepinephrine. Life
experiences such as traumatic events appear to trigger anxiety disorders
in people who are already prone to becoming anxious. Inherited traits
also are a factor.
For a significant number of people, anxiety is linked to an underlying
health issue. In some cases, anxiety signs and symptoms are the first
indicators that you have a medical illness. If your doctor suspects your
anxiety may have a medical cause, he or she may order blood or urine
tests or other tests to look for signs of a problem.
Physical problems that can be linked to anxiety include:
* Heart disease
* Thyroid problems (such as hypothyroidism or hyperthyroidism)
* Drug abuse
* Alcohol withdrawal
* Withdrawal from anti-anxiety medications (benzodiazepines)
* Rare tumors that produce certain "fight-or-flight" hormones
* Muscle cramps or spasms
* Tingling, burning or prickling sensations that may have no apparent cause
It's more likely that your anxiety may be due to an underlying medical condition if:
* Your anxiety symptoms started after age 35
* You don't have any blood relatives (such as a parent or sibling) with an anxiety disorder
* You didn't have an anxiety disorder as a child
* You don't avoid certain things or situations because of anxiety
* No events have occurred in your life that were triggered by significant anxiety
* Medications used to treat feelings of panic (such as benzodiazepines) don't ease your anxiety symptoms
Things that may increase your risk of developing an anxiety disorder include:
* Being female. Women are more likely than men to be diagnosed with an anxiety disorder.
* Childhood trauma. Children who endured abuse or trauma or
witnessed traumatic events are at higher risk of developing an anxiety
disorder at some point in life.
* Stress due to an illness. Having a chronic health condition or
serious illness such as cancer can cause significant worry about the
future, your treatment and possibly your finances.
* Stress buildup. A big event or a buildup of smaller stressful life
situations may trigger excessive anxiety — for example, ongoing worry
about finances or a death in the family.
* Personality. People with some personality types are more prone to
anxiety disorders than are others. In addition, some personality
disorders, such as borderline personality disorder, may be linked to
* Having blood relatives with an anxiety disorder. Anxiety disorders can run in families.
* Substance use. Drug or alcohol abuse can cause or worsen anxiety.
Having an anxiety disorder does more than make you worry. It can also
lead to, or worsen, other mental and physical health conditions,
* Depression (which often occurs with anxiety disorder)
* Substance abuse
* Trouble sleeping (insomnia)
* Digestive or bowel problems
* Teeth grinding (bruxism)
Preparing for your appointment
You may start by seeing your family doctor or a general practitioner.
However, you may need to see a psychiatrist or psychologist if you have
severe anxiety. A psychiatrist is a medical doctor who specializes in
diagnosing and treating mental health conditions. A psychologist and
certain other mental health providers can diagnose anxiety and provide
It may be best for you to start by seeing a medical doctor if you think
your anxiety could be health related. A medical doctor will be able to
check for signs of an underlying illness that may need diagnosis and
Because there's often a lot of ground to cover during your initial
appointment, it's a good idea to be well prepared. Here's some
information to help you get ready, and what to expect from your doctor
or mental health provider.
What you can do
To be prepared for your visit, it can be helpful to think about a few
things ahead of time, and write down some notes to take with you. Things
to write down include:
* A list of your symptoms. Include what your anxiety symptoms are,
when they occur and whether anything seems to make them better or worse.
Also note how much they affect your day-to-day activities such as work,
school or relationships.
* What's caused you stress. Include any major life changes or
stressful events you've dealt with recently. Also note any traumatic
experiences you've had in the past or as a child.
* Any other health problems you have. Include both physical conditions and mental health issues.
* A list of all medications you're taking. Be sure to write down the
doses, and include any vitamins or supplements you take.
Your time with your doctor is limited, so preparing a list of questions
will help you make the most of your time. List your questions from most
important to least important in case time runs out. Some basic questions
to ask your doctor include:
* What's the most likely cause of my anxiety?
* Are there other possible situations, psychological issues or
physical health problems that could be causing or worsening my anxiety?
* Do I need medical tests or other tests?
* Are there any restrictions or steps I need to follow?
* Should I see a psychiatrist, psychologist or other mental health provider?
* Would medication help? If so, is there a generic alternative to the medicine you're prescribing?
* Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor will do a physical examination and ask you a number of
questions. Being ready to answer them may reserve time to go over points
you want to spend more time on. Some questions the doctor may ask
* Exactly what are your symptoms, and how severe are they?
* Have you ever had a panic attack?
* Do you avoid certain things or situations because they make you anxious?
* Have your feelings of anxiety been occasional or continuous?
* When did you first begin noticing your feelings of anxiety?
* Does anything in particular seem to trigger your feelings of anxiety or make them worse?
* What, if anything, seems to improve your feelings of anxiety?
* What, if any, physical or mental health conditions do you have?
* What traumatic experiences have you had recently or in the past?
* Do you regularly drink alcohol or use illegal drugs?
* Do you have any blood relatives with anxiety or other mental health conditions such as depression?
Tests and diagnosis
To help diagnose an anxiety disorder and rule out other conditions, your
doctor or mental health provider may have you fill out a psychological
questionnaire. Your doctor will probably do a physical examination to
look for signs that your anxiety might be linked to a medical condition.
Anxiety that occurs during times of high stress or in the aftermath a
traumatic event is normal. In most cases, the disruption and stress
caused by this type of anxiety eases up on its own, when the underlying
cause is no longer an immediate concern. However, when anxiety is
severe, disrupts your day-to-day life, causes panic attacks or doesn't
get better over time, you may have a disorder that needs to be diagnosed
To be diagnosed with an anxiety disorder, you must meet criteria spelled
out in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
This manual is published by the American Psychiatric Association and is
used by mental health providers to diagnose mental conditions and by
insurance companies to reimburse for treatment. Symptoms — and
diagnostic criteria — differ for each specific anxiety disorder.
Anxiety disorders often occur along with other mental health problems —
such as depression or substance abuse — which can make diagnosis and
treatment more challenging.
Treatments and drugs
The two main treatments for anxiety disorders are medications and
psychological counseling (psychotherapy). You may benefit most from a
combination of the two. It may take some trial and error to discover
exactly what treatments work best for you.
Several different types of medications are used to treat anxiety disorders. These include:
* Antidepressants. These medications influence the activity of brain
chemicals (neurotransmitters) thought to play a role in anxiety
disorders. Examples of antidepressants used to treat anxiety disorders
include fluoxetine (Prozac), paroxetine (Paxil), escitalopram (Lexapro),
sertraline (Zoloft), venlafaxine (Effexor) and imipramine (Tofranil).
* Buspirone (BuSpar). This anti-anxiety medication may be used on an
ongoing basis. As with most antidepressants, it typically takes up to
several weeks to become fully effective. A common side effect of
buspirone is a feeling of lightheadedness shortly after taking it. Less
common side effects include headaches, nausea, nervousness and insomnia.
* Benzodiazepines. In limited circumstances your doctor may
prescribe one of these sedatives for relief of anxiety symptoms.
Examples include clonazepam (Klonopin), lorazepam (Ativan), diazepam
(Valium), chlordiazepoxide (Librium) and alprazolam (Xanax).
Benzodiazepines are generally used only for relieving acute anxiety on a
short-term basis. Because they can be habit-forming, these medications
aren't a good choice if you've had problems with alcohol or drug abuse
(making you more prone to addiction). They can cause side effects that
include drowsiness, reduced coordination, and problems with balance and
Also known as talk therapy and psychological counseling, psychotherapy
involves working out underlying life stresses and concerns and making
behavior changes. It can be an effective treatment for anxiety.
Cognitive behavioral therapy is one of the most common types of
psychotherapy for anxiety disorders. Generally a short-term treatment,
cognitive behavioral therapy focuses on teaching you specific skills to
identify negative thoughts and behaviors and replace them with positive
ones. Even if an undesirable situation doesn't change, you can reduce
stress and gain more control over your life by changing the way you
Lifestyle and home remedies
While most people with anxiety disorders need psychotherapy or
medications to get anxiety under control, lifestyle changes also can
make a difference. Here are a few things that you can do:
* Get exercise. Exercise is a powerful stress reducer; it can
improve your mood and keep you healthy. It's best if you develop a
regular routine and work out most days of the week. Start out slowly and
gradually increase the amount and intensity of the exercise you do.
* Eat well. Avoid fatty, sugary and processed foods. Include foods
in your diet that are rich in omega-3 fatty acids and B vitamins.
* Avoid alcohol and other sedatives. These can worsen anxiety.
* Use relaxation techniques. Visualization techniques, meditation
and yoga are examples of relaxation techniques that can ease anxiety.
* Make sleep a priority. Do what you can to make sure you're getting
enough quality sleep. If you aren't sleeping well, see your doctor.
* Quit smoking and cut back or quit drinking coffee. Both nicotine and caffeine can worsen anxiety.
Certain supplements may help relieve anxiety, although it isn't clear
how much they help or what possible side effects they might have. Some
supplements used to treat anxiety include:
* Kava. This herb is reported to relax you without making you feel
sedated. Some studies have linked kava to liver problems, so it isn't a
good idea to take it if you have a liver condition, drink alcohol daily
or take medications that affect your liver.
* Valerian. Most commonly used as a sleep aid, valerian has a
sedative effect. More research is needed to determine how well it works
for this purpose.
* B vitamins. These nutrients, particularly the B vitamin inositol,
may help relieve anxiety by affecting the production of certain brain
Talk to your doctor before taking herbal remedies or supplements to make
sure they're safe for you and won't interact with any medications you
Coping and support
To cope with anxiety disorder, here are some things you can do:
* Learn about your illness. Talk to your doctor or mental health
provider, look on the Internet, and talk to others who have similar
problems with anxiety. Find out what causes it and what treatments might
be best for your particular condition.
* Involve your family. As with any illness, asking your partner or family members for help is an important part of coping.
* Join an anxiety support group. Remember that you aren't alone.
Support groups offer compassion, understanding and shared experiences.
You may find support groups in your community, and there are several
available on the Internet. Two good places to start are the National
Alliance on Mental Illness and the Anxiety Disorders Association of
* Take action. Work with your mental health provider to figure out
what's making you anxious and address it. For example, if finances are
your concern, work toward drawing up a workable budget.
* Let it go. Don't dwell on past concerns. Change what you can and let the rest take its course.
* Break the cycle. When you feel anxious, take a brisk walk or delve
into a hobby to refocus your mind away from your worries.
* Stick to your treatment plan. Take medications as directed. Keep
therapy appointments. Consistency can make a big difference, especially
when it comes to taking your medication.
* Socialize. Don't let worries isolate you from loved ones or
activities. Social interaction and caring relationships can lessen your
There's no way to predict for certain what will cause someone to develop
an anxiety disorder in the first place, but you can take steps to
reduce the impact of symptoms if you're anxious:
* Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
* Keep a journal. Keeping track of your personal life can help you
and your mental health provider identify what's causing you stress and
what seems to help you feel better.
* Prioritize your life. You can reduce anxiety by carefully managing your time and energy.
* Avoid unhealthy alcohol or drug use. Alcohol and drug use can
cause or worsen anxiety. If you're addicted to any of these substances,
quitting can make you anxious. If you can't quit on your own, see your
doctor or find a support group to help you.