Introduction
Most of us have experienced symptoms of anxiety at some point in our lives. A pounding heart, tense muscles, rapid breathing, perfuse sweating, or an upset stomach characterize a few of the many symptoms associated with the condition. Perhaps you have felt anxious when you have given a speech, taken a test, or driven in heavy traffic. While this kind of tension may have felt uncomfortable, it also helped you cope. You had a reason to be anxious, and the tension it caused kept you aware and ready to react. Now imagine feeling anxious for no apparent reason.
What is it?
Generally, anxiety is a complex, a normal emotional state that occurs when an individual senses an unclear danger. When anxiety ceases being a protective response, the person suffering from an anxiety disorder. Anxiety disorders may arise from an individual's brain chemistry, genetics, personality, and life events. Within the brain, cells communicate with one another through the intake and discharge of chemical substances known as neurotransmitters. Imbalances in neurotransmitter production may produce the severe symptoms that accompany anxiety disorders. The neurotransmitters that are associated with anxiety disorders are norepinephrine, serotonin, and gamma-aminobutyric acid (GABA).
There are five general types of anxiety:
- Obsessive-Compulsive Disorder
- Generalized Anxiety Disorder
- Exaggerated Fears (Phobias)
- Panic Disorder
- Post-Traumatic Stress Disorder
There are several theories about what causes anxiety disorders. They include the following:
- Family history
- Drug use or withdrawal
- Traumatic events
- Severe or long-lasting stress
- Medical or psychiatric illnesses
According to the National Institutes of Mental Health, 40 million Americans 18 years and older suffer from anxiety disorders every year. Of those 40 million, 6.8 million suffer from Generalized Anxiety Disorder, GAD, while 6 million American adults suffer from panic disorder. GAD and panic disorder affect twice as many women as men.
Specific phobias, which are intense and irrational fears of specific things or situations, affect 19.2 million American adults. Specific phobias are twice as common in women as men. Social phobia affects approximately 15 million American adults per year, whereas agoraphobia (fear and anxiety of any place or situation where escape might be difficult) affects 1.8 million American adults per year.
Obsessive-compulsive disorder affects both genders equally and is seen in about 2.2 million American adults. Though it is seen in about 7.7 million American adults, Post-Traumatic Stress Disorder, PTSD, can occur at any age and affects more women than men.
What are the risk factors?
Risk factors are characteristics that increase the likelihood that you will develop a particular condition. Common risk factors for anxiety disorders are:
- a family history of anxiety disorders
- past negative experiences (e.g. family conflict or sexual abuse)
- buildup of stress
- medical illness, such as heart or respiratory ailments
- psychiatric illness, such as depression or dementia
- medication use or discontinuation
- withdrawal after discontinuing certain substances, such as alcohol
- drug abuse
What are the symptoms?
Physical symptoms include blushing, sweating, dizziness, abdominal discomfort, sleep disturbances, shortness of breath, heart palpitations (a sensation of rapid or pounding heartbeats), chest pain, and fatigue.
Mental symptoms include poor concentration, feeling out of control, sense of fear or dread, and feelings of panic.
Behavioral symptoms include inability to be still or calm, avoidance of stressful situations, and poor coping skills.
How is it treated?
Anxiety disorders are treated with specific types of psychotherapy, medications, or a combination of both. A number of different medication classes are used to treat anxiety disorders, but will not cure them. Certain drug classes have greater effectiveness on specific anxiety disorders than others. For an acute anxiety attack, short-term treatment with benzodiazepines is generally used first. To help prevent episodes of anxiety, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, or buspirone are generally tried first. Other choices may include tricyclic antidepressants, beta-blockers, and, rarely, monoamine oxidase inhibitors. Some of these drugs may be used together if needed to control anxiety.
Each drug class has their benefits and risks. For instance, elderly individuals may have to take different doses compared to younger individuals due to changes in how the body metabolizes medications. Some medications may have dietary restrictions, while other medications may have important drug interactions that the patient needs to be aware of. In addition, there are sometimes side effects with the use of anti-anxiety medications. With all of these precautions, doctors must carefully evaluate the individual's condition before prescribing an anti-anxiety medication. Additionally, because treatment may take several weeks to work best, the doctor should closely monitor the individual's condition and treatment strategy for effectiveness, side effects, and toxicity.
Drug classes used to treat Anxiety
- Benzodiazepines
- Beta Blockers
- Miscellaneous Anxiolytics
- Monoamine Oxidase Inhibitors
- Selective Serotonin Reuptake Inhibitors
- Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRI)
- Tricyclic Antidepressants
What is on the horizon?
A new study funded by the National Institute for Mental Health is investigating the cost and benefits of excluding benzodiazepines, a common class of drugs used in anxiety, from the new Medicare Part D plans. When Medicare Part D formularies were developed, benzodiazepines were excluded from coverage because it was felt that they contributed to worsening overall health in the elderly by increasing falls and fractures and worsening conditions such as emphysema and depression. This research aims to uncover how the exclusion of benzodiazepines has affected overall health, as well as the treatment of anxiety disorders, in older adults. It is not clear at this time whether the results of this study could change the formulary decisions for Medicare Part D.
Today, SSRIs are usually the 1st line medications for most anxiety disorders. Current research focuses on developing new drugs that will correct imbalances in the chemistry of the brain causing anxiety disorders. Around 50% of persons with anxiety can be treated with an SSRI. The question remains, how should the others be treated? Many drugs are being tested for their use in anxiety. Strattera is a drug that has been used for Attention Deficit Hyperactivity Disorder (ADHD), and is currently being studied for the possible treatment of anxiety. Seroquel, an antipsychotic is also being studied for its potential benefits for major depression and generalized anxiety disorder. For alcoholics who suffer from anxiety, levetiracetam (Keppra), an anti-seizure medication, is also being tested.
New drugs such as AZD7325 is in phase II trials for generalized anxiety; AA21004 is in phase III trials for mood and anxiety disorders.
Researchers have also found that there may be a potential link between anxiety and balance problems in children. Although not all children with anxiety have balance problems, but the ones with balance problems do exhibit symptoms of anxiety. The study found that through a 12 week sensory-motor intervention, children were able to improve their balance skills and also helped to reduce anxiety to normal levels; they also found that as their balance and anxiety issues improved, their self-esteem also increased. Cognitive therapy is more difficult with children due to maturity levels and lack of operational thinking; therefore, researchers are exploring the role of occupational therapy in these children.
