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What is anxiety and what cause it? Types of anxiety. Best medical treatment.

What is anxiety?

Anxiety disorders are a group of mental disorders characterized by extremely intense feelings of anxiety and fear. Anxiety is a worry about future events, while fear is a reaction to what is happening at the present moment in time. These feelings can cause physical symptoms such as palpitations and unsteadiness.

Anxiety is an individual psychological feature of a person, manifested in his tendency to often worry about relatively small things.

In everyday discourse, the words "anxiety" and "fear" are often used interchangeably. In clinical usage, they have different meanings: "anxiety" is defined as an unpleasant emotional state, the cause of which is either not easily identified, or is perceived as uncontrollable or inevitable; "fear", in turn, is an emotional and physiological response to a recognized external threat. The term "anxiety disorder" includes fears (phobias) as well as anxieties.

Anxiety disorders are:

  • generalized anxiety disorder
  • phobic disorders
  • panic disorder
  • agoraphobia (fear of open space)
  • social anxiety disorder
  • post-traumatic stress disorder
  • emotional disorders, the onset of which is specific to childhood
  • situational anxiety
  • obsessive-compulsive disorder
  • selective mutism (loss of the ability to speak in certain situations)

Anxiety disorders are caused by a combination of genetic and environmental factors. Risk factors include a history of child abuse, a family history of mental disorders, and poverty. Anxiety disorders often co-occur with other psychiatric disorders, especially major depressive disorders, personality disorders, and substance use disorders.

As a rule, symptoms can be diagnosed if they have been present for at least six months and lead to a decrease in a person's functioning. Problems that can lead to these symptoms include hyperthyroidism (an endocrine thyroid disease), heart disease, caffeine, alcohol or cannabis (cannabis) use, and withdrawal from certain drugs.

Without treatment anxiety disorders persist in most cases. Disease management may include lifestyle changes, counseling (cognitive behavioral therapy), and medications.In particular, medications such as antidepressants, benzodiazepines, and beta-blockers can improve a patient's condition.

About 12% of people suffer from an anxiety disorder, and 5-30% of people only experience anxiety at some point in their lives. The condition is twice as common in women as in men and usually begins before age 25. The most common are phobic disorders and social anxiety disorder. They mostly affect people between the ages of 15 and 35 and become less common after age 55.

Causes of the disease

Abuse of narcotic drugs and psychoactive substances

Anxiety and depression can be caused by alcohol abuse. Even moderate, sustained drinking can increase anxiety levels in some people. Dependence on caffeine, alcohol, and benzodiazepines may worsen or cause anxiety and panic attacks. Anxiety usually occurs during the acute alcohol withdrawal phase (complete withdrawal or reduction of alcohol after prolonged use) and may persist for up to two years as part of the post-acute withdrawal syndrome in about a quarter of people recovering from alcoholism.

There is evidence that chronic exposure to organic solvents in the work environment may be associated with anxiety disorders. During painting, varnishing and other work during which a person is significantly exposed to organic solvents, the development of an anxiety disorder may occur.

Caffeine intake can cause or exacerbate anxiety disorders, including panic disorder. In some foreign classifications, an anxiety disorder caused by caffeine is considered a disorder caused by a substance / drug. However, this subtype should not be classified as an addictive substance disorder.

Endocrine diseases

Sometimes an anxiety disorder can occur as a side effect of an underlying endocrine disorder that causes an overactive nervous system. These diseases include pheochromocytoma (a hormone-active tumor of the medulla) and hyperthyroidism (an overactive thyroid gland).


Anxiety disorders can occur in response to life stresses such as a financial crisis or chronic physical illness. Anxiety among adolescents and young adults is a common disorder due to the stresses of social interaction and lifestyle. Anxiety is also common among older people with dementia. On the other hand, anxiety disorder is sometimes misdiagnosed among the elderly, with doctors misinterpreting physical symptoms (such as palpitations due to cardiac arrhythmias) as signs of anxiety.

Chronic anxiety

Low anxiety levels are good. In fact, the hormonal response to anxiety is beneficial as it helps people respond to dangers. Evolutionary medicine believes that this adaptation allows a person to become aware of the presence of a potential threat and act accordingly to provide the greatest opportunity for protection. Studies have shown that people with low levels of anxiety have a higher risk of death than people with moderate levels of anxiety. This is because the lack of fear can lead to injury or death. In addition, patients with anxiety and depression were found to have a lower proportion of morbidity than those with depression.

The functional significance of symptoms associated with anxiety includes greater vigilance, faster preparation for action, and a reduction in the likelihood of the absence of threats. In the wild, for example, vulnerable people (pregnant or ill) have a lower threshold for anxiety, making them more alert. This indicates a long evolutionary history of the anxiety response.

Classification and stages of anxiety disorder

Generalized anxiety disorder

Generalized anxiety is a common disorder characterized by long-term anxiety that is not focused on any one object or situation. People suffering from generalized anxiety disorder experience non-specific persistent fear and are overly concerned about daily activities.

Generalized anxiety is “characterized by chronic excessive anxiety accompanied by the following symptoms (at least three of the following must be present for such a diagnosis): restlessness, fatigue, trouble concentrating, irritability, muscle tension, and sleep disturbance.”

Generalized anxiety is the most common anxiety disorder among the elderly. Anxiety may be a symptom of another medical condition or may occur in connection with substance abuse problems, which should be taken into account by the physician in the diagnosis. The person may have trouble making daily decisions and remembering commitments due to lack of concentration/preoccupation. Outwardly, the patient looks tense, sweating of the hands, feet and armpits is increased. The person may be tearful, indicating depression. Before making a diagnosis of an anxiety disorder, a physician must rule out drug anxiety and other medical causes. In children, this type of anxiety disorder can be associated with headaches, anxiety, abdominal pain, and palpitations. It usually begins at the age of 8-9 years.

Phobic disorders

The single largest category of anxiety disorders are phobias, which include all instances where fear and anxiety are triggered by a specific stimulus or situation. Between 5% and 12% of the population worldwide suffer from phobic disorders. Patients tend to foresee the horrifying consequences of encountering the object of their fear, which can be anything from an animal to a public place. Common phobias: air travel, blood, water, driving, tunnels. When people are exposed to a phobia, they may experience shaking, shortness of breath, or a rapid heartbeat. People understand that their fear is out of proportion to the actual danger, but still they cannot overcome it.

Panic disorders

In panic disorder, a person has brief episodes of intense fear and anxiety, often marked by trembling, confusion, dizziness, nausea, and/or difficulty breathing. These panic attacks, defined as fear or discomfort that come on suddenly and peak in less than ten minutes, can last for several hours. Attacks can be triggered by stress, irrational thoughts, general fear, or fear of the unknown. However, sometimes the trigger is unclear and therefore attacks can occur without warning. To prevent an attack, the trigger must be avoided. However, not all attacks can be prevented.

In addition to recurring unexpected panic attacks, a diagnosis of panic disorder requires that these attacks have chronic consequences: either worry about the potential consequences of the attacks, a persistent fear of future attacks, or significant changes in behavior associated with the attacks. Often, the normal changes in heartbeat noticed by patients make them think that something is wrong with their heart, and they may have another recurring panic attack.


Agoraphobia is the fear of crowded places and open spaces. It is closely related to panic disorder and is often caused by fear of a panic attack. Manifested by the need to find a door or other escape route in a constant field of view. In addition to the fears themselves, the term agoraphobia is often used to refer to the avoidance behavior that often develops in patients with panic disorder. For example, after a panic attack while driving, a person suffering from agoraphobia may develop anxiety about driving and therefore avoid driving. This avoidance behavior can often have serious consequences and increase fear.

Social anxiety disorder

Social phobia describes intense fear and avoidance of negative societal controls, feelings of embarrassment, humiliation, or social interaction. This fear may occur in specific social situations (such as during public speaking) or generally in most (or all) social interactions. Social anxiety often presents with specific physical symptoms, including blushing, sweating, and difficulty speaking. As with all phobic disorders, those people who suffer from social anxiety will often try to avoid the source of the anxiety. In the case of social anxiety, this is especially problematic, and in severe cases, it can lead to complete social isolation.

Post Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) was previously classified as an anxiety disorder (now, according to the foreign classification of mental disorders, PTSD has moved to traumatic and stressor-related disorders). It is the result of a traumatic experience. PTSD can be the result of an extreme situation such as a struggle, a natural disaster, rape, hostage situations, child abuse, bullying, or even a major car accident. Anxiety disorder can also result from long-term (chronic) exposure to severe stress (for example, soldiers who endure individual battles but cannot cope with continuous combat).[19] People may experience sleep disturbances.[20] There are a number of treatments that form the basis of an anxiety care plan for those suffering from PTSD. Such treatments include cognitive behavioral therapy, psychotherapy, and support from family and friends.

Situational anxiety

Situational anxiety arises in connection with new situations or changing events. It can also be caused by various events that cause a person some discomfort. This type of TR is quite common. Most often in specific situations, a person will experience panic attacks or high anxiety. A situation that makes one person anxious may not affect another person at all. For example, some people become restless in crowds or tight spaces, so being in a crowded vehicle or store can cause them extreme anxiety and possibly a panic attack. Others may experience anxiety when major life changes occur, etc.

Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) , like post-traumatic stress disorder, was previously classified as an anxiety disorder according to the Foreign Classification of Mental Disorders. OCD is a condition in which a person has obsessions (anxious, persistent, and intrusive thoughts or images) and/or compulsions (compulsions to perform certain actions or rituals repeatedly) that are not caused by drugs or physical influences. Such a state arouses anxiety or social dysfunction. Compulsive rituals are personal, individual rules to follow in order to alleviate anxiety. OCD affects approximately 1-2% of adults (more women than men) and less than 3% of children and adolescents.

Selective mutism

Selective mutism is a disorder in which a person who is able to talk does not speak in certain situations or when in contact with specific people. Selective mutism usually coexists with shyness and social anxiety.[28] People with selective mutism remain silent even when the consequences of their silence include shame, social ostracism (exile), or even punishment. Selective mutism affects about 0.8% of people at some point in their lives.

Diagnosing and treatment

Anxiety disorders are often severe chronic conditions that can occur at an early age or start suddenly after a trigger event. They are capable of flaring up during times of high levels of stress and are often accompanied by physiological symptoms such as headache, sweating, muscle spasms, tachycardia, palpitations and hypertension, which in some cases lead to fatigue.

Diagnosis of anxiety disorders is difficult because objective biomarkers do not exist, and is based on symptoms, which should typically be present for at least six months or longer than would be expected in a particular situation and reduce social functioning. To detect anxiety symptoms, questionnaires such as the Beck Anxiety Scale, the Tsung Self-Assessed Anxiety Scale, and the Taylor Anxiety Scale are used.[60] Other questionnaires combine the measurement of anxiety and depression - the Hamilton Anxiety Rating Scale, the Hospital Anxiety and Depression Scale (HADS), and the Patient Health Assessment (PHQ).

The goal of treatment is to reduce anxiety symptoms and improve the patient's quality of life.

Choice of treatment

Treatment options include lifestyle changes, therapies, and medications. Currently, there is no evidence of which particular treatment method is most effective. Therefore, the choice of treatment method depends on the patient. In most cases, people with anxiety disorders first resort to therapeutic methods.

Lifestyle changes

Lifestyle changes include exercising, improving sleep, reducing caffeine intake, and stopping smoking. Smoking cessation has a greater benefit in treating anxiety than medication.

Cognitive Behavioral Therapy

Cognitive behavioral therapy is effective in treating anxiety disorder and is the first line of treatment. It equally has a positive effect both in a direct therapy session with a patient (in person) and in remote therapy (via the Internet).

Family therapy is a form of treatment in which a child meets with a therapist along with primary caregivers and siblings. Each family member can visit the doctor individually, but family therapy is usually a form of group therapy. Art and play therapy is also used. Art therapy is most often used when a child is unwilling or unable to communicate verbally (the latter may be caused by an injury or disability that causes the child to lose the ability to communicate). Participation in artistic activities allows the child to express what he or she would not otherwise be able to convey to others. During play therapy, the child is allowed to play as he pleases, as long as the therapist is watching him. The therapist may from time to time make a question, comment, or suggestion. These methods are effective if the child's family plays a role in his treatment.

Medical treatment of anxiety

The following types of medications are used to treat anxiety:

  • antidepressants - selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • benzodiazepines are psychoactive substances with hypnotic and sedative effects.

Treatment with antidepressants

From the moment the diagnosis is established, monotherapy with SSRIs - Paroxetine, Sertraline, Citalopram, Escitalopram or SNRIs - Venlafaxine, Duloxetine, Milnacipran is recommended.

Monotherapy with antidepressants begins with minimal dosages and is gradually adjusted to therapeutic ones. The clinically pronounced effect of taking SSRIs develops only after 2-6 weeks of admission, and to achieve a stable remission, the drug should be taken for at least 6-12 months. A therapeutic response is defined as a 50% or more decrease in the total score on the anxiety scale. During the course of treatment, it is worth monitoring the effectiveness and tolerability of therapy - on days 7, 14 and 28, and then once every four weeks.

Patients who have not achieved remission while taking SSRIs are recommended to be treated with tricyclic antidepressants (TCAs) for 6-12 months.

If first-line therapy fails, second-line therapy is used:

  • increasing the dosages of antidepressants to the maximum
  • changing the drug to another first-line drug
  • combination therapy with antidepressants and benzodiazepines, atypical antipsychotics.

Treatment with benzodiazepines

If antidepressant monotherapy has not resulted in symptom relief, combination therapy with antidepressants and benzodiazepines for three weeks is recommended, provided that benzodiazepines were not taken at the initial stage of therapy. Benzodiazepines can be used in acute conditions when symptoms appear abruptly and require immediate intervention. However, the appointment of benzodiazepines at the request of a patient with panic disorder can lead to the formation of negative conditioned reflex reactions or to an excessive increase in the dose of the drug. Benzodiazepines should not be prescribed for more than one month - unlike antidepressants, they form drug dependence.

Most effective medication to treat anxiety


Xanax or alprazolam is an anti-anxiety drug, a medium-acting benzodiazepine derivative, which is used to treat panic disorders, anxiety disorders such as anxiety disorder or social phobia.

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Valium or diazepam belongs to the group of drugs that can eliminate anxiety. It has a wide spectrum of action and is used both in psychiatric practice and in general medicine.

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Ativan or lorazepam is used for the short-term treatment of anxiety and insomnia due to an anxiety disorder, as a sedative for premedication before an upcoming surgery.

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