Most people feel anxious from time to time. However, anxiety can become abnormal if it interferes with your day-to-day activities. Anxiety is a symptom of various anxiety disorders which are discussed below. They can often be treated. Treatments include various talking treatments, and medication.
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, you might have a fast heart rate, a thumping heart (palpitations), feeling sick, shaking (tremor), sweating, dry mouth, chest pain, headaches, fast breathing.
The physical symptoms are partly caused by the brain which sends lots of messages down nerves to various parts of the body when you are anxious. The nerve messages tend to make the heart, lungs, and other parts of the body work faster. In addition, 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, or before an important race. The burst of adrenaline and nerve impulses which we have in response to stressful situations can encourage a ‘fight or flight’ response.
Anxiety is abnormal if it:
- Is out of proportion to the stressful situation; or
- Persists when a stressful situation has gone, or the stress is minor; or
- Appears for no apparent reason when there is no stressful situation.
What is the treatment for anxiety disorders and phobias?
The main aim of treatment is to help you to reduce symptoms so that anxiety no longer affects your day-to-day life.
The treatment options depend on what condition you have, and how severely you are affected. They may include one or more of the following:
Understanding the cause of symptoms, and talking things over with a friend, family member or health professional may help. In particular, some people worry that the physical symptoms of anxiety, such as a thumping heart (palpitations), are due to a physical illness. This can make anxiety worse. Understanding that you have an anxiety disorder is unlikely to cure it, but it often helps.
This may help some people with certain conditions. For example, counselling which focuses on problem-solving skills may help if you have GAD (Generalised Anxiety Disorder).
Anxiety management courses
These may be an option for some conditions. The courses may include: learning how to relax, problem-solving skills, coping strategies, and group support.
Cognitive and behavioural therapy
These therapies can work well for persisting anxiety disorders and phobias.
These are commonly used to treat depression, but also help to 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 straightaway. It takes 2-4 weeks before their effect builds up and the anxiety symptoms are helped. A common problem is that some people stop the medicine after a week or so, as they feel that it is doing no good. This is often too soon to know if the medication will work.
- Antidepressants are not tranquillisers, and are not usually addictive.
- There are several types of antidepressants, each with various pros and cons. They may differ in their possible side-effects. However, selective serotonin reuptake inhibitor (SSRI) antidepressants are the ones most commonly used for anxiety disorders. Two examples of SSRIs are escitalopram and sertraline.
- Note: after first starting an antidepressant, in some people the anxiety symptoms become worse for a few days before they start to improve. Your doctor or practice nurse will want to keep a check on you in the first few weeks of treatment to see if you have any problems.
Benzodiazepines such as diazepam used to be the most commonly prescribed medicines for anxiety. They were known as the minor tranquilisers, but they do have some serious known side-effects. They often 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. Now they are not used much for persistent anxiety conditions. A short course of up to two weeks may be an option for anxiety which is very severe and short-term, or now and then to help you over a bad spell if you have persistent anxiety symptoms.
Buspirone is sometimes prescribed to treat GAD. It is an anti-anxiety medicine, but different to the benzodiazepines and is not thought to be addictive. It is not clear how it works. It is thought to affect serotonin, a brain chemical which may be involved in causing anxiety symptoms.
A beta-blocker, for example propranolol, can ease some of the physical symptoms such as trembling and a thumping heart (palpitations). They do not directly affect the mental symptoms such as worry. However, some people relax more easily if their physical symptoms are eased. These tend to work best in short-lived (acute) anxiety. For example, if you become more anxious before performing in a concert then a beta-blocker may help to ease ‘the shakes’.
In some cases a combination of treatments such as cognitive therapy and an antidepressant may work better than either treatment alone.
Alcohol and anxiety
Although alcohol may ease symptoms in the short term, don’t be fooled that drinking helps to cure anxiety. In the long run, it does not. Drinking alcohol to ‘calm nerves’ can lead to problem drinking and may make problems with anxiety and depression worse in the long term.More