If you have an anxiety disorder, you’re not alone. Each year, tens of millions of Americans of all ages suffer from long-term anxiety. Among children, anxiety disorders are the most common form of mental illness—one they may carry into adulthood.
Anxiety is an uneasy feeling that something may harm you or a loved one. This feeling can be normal and sometimes even helpful. If you’re starting a new job or taking a test, it might make you more alert and ready for action. But sometimes anxiety can linger or become overwhelming. When it gets in the way of good health and peace of mind, it’s called an anxiety disorder.
“Everybody has anxiety,” says Dr. Daniel Pine, a psychiatrist and an NIH neuroscientist. “The tricky part is how to tell the difference between normal and abnormal anxiety.” For those with anxiety disorders, fears, worries, and anxieties can cause so much distress that they interfere with daily life. The anxiety grows out of proportion to the stressful situation or occurs when there is no real danger.
Anxiety activates the body’s stress response. Nearly all the cells, tissues, and organs in your body go on high alert. This stress response can wear your body down over time. People with chronic (long-term) anxiety have a higher risk of both physical and mental health problems. Some people visit their doctors because of headaches, racing heart, or other physical complaints without realizing that these symptoms may be connected to how anxious they feel.
NIH-funded researchers are working to learn more about anxiety disorders. They have discovered that these conditions are caused by some combination of your genes and your environment. However, the precise events that lead to anxiety disorders are still unknown. Scientists are also searching for better ways to diagnose, prevent, and treat these conditions.
Treatment for anxiety disorders usually includes both medication and cognitive behavioral therapy (CBT). CBT is a form of talk therapy. It helps people change both the thinking patterns that support their fears and the way they react to anxiety-provoking situations. Current treatments can be highly effective for most people.
Anxiety disorders are treatable. If you think you have an anxiety disorder, talk to your doctor.
Sometimes a physical evaluation is advisable to determine whether a person's anxiety is associated with a physical illness. If anxiety is diagnosed, the pattern of co-occurring symptoms should be identified, as well as any coexisting conditions, such as depression or substance abuse. Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety should wait until the coexisting conditions are brought under control.
If your doctor thinks you may have an anxiety disorder, the next step is usually seeing a mental health professional. It is advisable to seek help from professionals who have particular expertise in diagnosing and treating anxiety. Certain kinds of cognitive and behavioral therapy and certain medications have been found to be especially helpful for anxiety.
You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere. Once you find a clinician with whom you are comfortable, the two of you should work as a team and make a plan to treat your anxiety disorder together.
In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the type of disorder, the person's preference, and the expertise of the clinician.
Most insurance plans, including health maintenance organizations (HMOs), will cover treatment for anxiety disorders. Check with your insurance company and find out.
There are several kinds of anxiety disorders. The major types include:
- Generalized anxiety disorder (GAD). All of us worry about things like health, money, or family problems. But people with generalized anxiety disorder (GAD) are extremely worried about these and many other things, even when there is little or no reason to worry about them. They are very anxious about just getting through the day. They think things will always go badly. At times, worrying keeps people with GAD from doing everyday tasks.
- Panic disorder. People with panic disorder have sudden and repeated attacks of fear that last for several minutes. Sometimes symptoms may last longer. These are called panic attacks. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger. A person may also have a strong physical reaction during a panic attack. It may feel like having a heart attack. Panic attacks can occur at any time, and many people with panic disorder worry about and dread the possibility of having another attack.
- Social anxiety disorder (social phobia). Social phobia is a strong fear of being judged by others and of being embarrassed. This fear can be so strong that it gets in the way of going to work or school or doing other everyday things. Everyone has felt anxious or embarrassed at one time or another. For example, meeting new people or giving a public speech can make anyone nervous. But people with social phobia worry about these and other things for weeks before they happen.
Closely related to anxiety disorders, but now considered categories of their own, are obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
- Obsessive-compulsive disorder. OCD is persistent, upsetting thoughts (obsessions) and repetitive rituals (compulsions), like hand washing, counting, checking, or cleaning. These behaviors are done in the hope of preventing the thoughts or making them go away.
- Post-traumatic stress disorder. PTSD is caused by trauma. This condition leads to flashbacks, nightmares, and insomnia. Often accompanied by depression or substance abuse, post-traumatic stress disorder can occur at any age, including childhood.
What medications are used to treat anxiety disorders?
Medication does not necessarily cure anxiety disorders, but it often reduces the symptoms. Medication typically must be prescribed by a doctor. A psychiatrist is a doctor who specializes in mental disorders. Many psychiatrists offer psychotherapy themselves or work as a team with psychologists, social workers, or counselors who provide psychotherapy. The principal medications used for anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers. Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.
Choosing the right medication, medication dose, and treatment plan should be based on a person's individual needs and medical situation, and done under an expert's care. Only an expert clinician can help you decide whether the medicine's ability to help is worth the risk of a side effect. Your doctor may try several medicines before finding the right one.
Antidepressants
Antidepressants were developed to treat depression, but they also help people with anxiety disorders. They are commonly prescribed for panic disorder, OCD, PTSD, and social anxiety disorder.
Some tricyclic antidepressants work well for anxiety. Monoamine oxidase inhibitors (MAOIs) are also used for anxiety disorders.
Benzodiazepines (anti-anxiety medications)
The anti-anxiety medications called benzodiazepines can start working more quickly than antidepressants.
Beta-blockers
Beta-blockers control some of the physical symptoms of anxiety, such as trembling and sweating.
Cognitive Behavioral Therapy (CBT)
CBT (sometimes called "talk therapy" or psychotherapy) involves talking with a trained clinician, such as a psychiatrist, psychologist, social worker, or counselor, to understand what caused an anxiety disorder and how to deal with it.
To be effective, therapy must be directed at the person's specific anxieties and must be tailored to his or her needs.
CBT can be useful in treating anxiety disorders. It can help people change the thinking patterns that support their fears and change the way they react to anxiety-provoking situations.
For example, CBT can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.
Exposure-based treatment has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face. Sometimes the therapist will accompany the person to a feared situation to provide support and guidance. Exposure exercises are undertaken once the patient decides he is ready for it and with his cooperation.
To be effective, therapy must be directed at the person's specific anxieties and must be tailored to his or her needs. A typical "side effect" is temporary discomfort involved with thinking about confronting feared situations.
CBT may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social phobia. Often "homework" is assigned for participants to complete between sessions. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time.
Medication can be combined with psychotherapy for specific anxiety disorders, and combination treatment has been found to be the best approach for many people.
Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms might also be useful in this regard, but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each other and false identities are common. Talking with a trusted friend or member of the clergy can also provide support, but it is not necessarily a sufficient alternative to care from an expert clinician.
Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, avoiding them should be considered. Check with your physician or pharmacist before taking any additional medications.
The family can be important in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive but not help perpetuate their loved one's symptoms. Family members should not trivialize the disorder or demand improvement without treatment.