Anxiety is a natural phenomenon that occurs in anticipation of danger and is characterized by a state of fear and unease. It becomes pathological when it affects your day to day life due to frequent occurrence. Anxiety disorders are one of the commonest mental health disorders globally.
Risk Factors for AnxietyThe exact cause of anxiety disorder is not known yet concretely. These disorders appear to be caused by an interaction between various biopsychosocial factors. Vulnerable genes interact with stressful or traumatic situations produce clinically significant syndromes affecting day to day life.
Potential factors include:
- Positive family history for the presence of anxiety disorders.
- Substance abuse and withdrawal
- Unpleasant experiences and abuse sustained during childhood strained relationship and difficulties at work
- Altered levels of brain chemicals (hormones) and electric signals (neurotransmitters) in your brain
- Presence of various chronic diseases.
- People who are timid and lack self-esteem are prone to developing anxiety
Clinical features of anxiety disorder:
- Nervousness and restlessness
- Having a feeling of impending doom
- An increase in heart rate
- Fast breathing
- Excessive sweating and chills
- Difficulty in concentration and making decisions.
- The feeling of weakness and lethargy
- Insomnia- difficulty sleeping or hypersomnia- excessive sleeping
- High irritability
- A feeling of fear, worry, and apprehension in absence of serious threat that is uncontrollable
- Marked tendency to avoid factors triggering anxiety
DiagnosisThe diagnosis of anxiety is based mainly upon clinical history. The history aims at ruling out the presence of any comorbid condition causing anxiety and the presence of environmental stressors and alcohol and drug abuse. Physical examinations and various investigations may be required to rule out other conditions mimicking anxiety. There are various scales to assess the severity of anxiety once confirmed which include the Zung Self-Rating Anxiety Scale and Hamilton Anxiety scale.
Management of AnxietyBenzodiazepine group of drugs are used to treat acute incidences of anxiety. Combined drug therapy with psychotherapy is required for treating chronic anxiety disorders.
Drug therapy: Different groups of drugs have shown to be effective in treating anxiety disorders
Antidepressants: Various groups of antidepressant drugs are shown to be effective in the treatment of anxiety. Selective serotonin reuptake inhibitors (SSRIs): This group of antidepressant drugs is considered first-line treatment options. These drugs increase the levels of serotonin in the brain which has a good influence on your mood, emotion, and sleep. Serotonin and norepinephrine reuptake inhibitors (SNRIs- Venlafaxine) and tricyclic antidepressants (Amitriptyline, imipramine) have shown to be effective in treating different anxiety disorders but the latter is associated with significant side effects.
Benzodiazepines: Drugs like Lorazepam and clonazepam are used to treat acute cases of anxiety as these drugs are fast-acting and highly effective. Its use in long-term therapy is however not recommended as it has shown to increase dependence and tolerance to the drug.
Buspirone: This anti-anxiety drug has been shown to reduce symptoms of anxiety and is less sedative and addictive as compared to benzodiazepines.
Beta-blockers: Beta-blockers like propranolol and atenolol have shown to be effective in treating physical symptoms of anxiety including excess sweating, dizziness, rapid breathing, and rapid heart rate among others.
Psychotherapy: It involves multiple counseling sessions with your therapist to reduce anxiety symptoms. Cognitive Behavioral Therapy (CBT) a form of psychotherapy is effective in teaching new skills to improve symptoms. By gradually exposing you to your anxiety triggers CBT helps you build confidence and tackle situations of anxiety better.