Anxiety is what someone feels when they are worried, tense, or afraid. It can be mild or severe. People experience anxiety as thoughts, feelings, and physical sensations.

Neuraxpharm provides medication alternatives for anxiety and once your doctor has determined your specific needs, they can prescribe the product that best adapts to your needs and condition.

Find out more about what anxiety is, the symptoms, and how it can be managed and treated.

What is anxiety?

Anxiety is the body’s natural response to a potentially dangerous or challenging situation. It is a feeling of unease, worry, fear or dread about what is going to happen. It is entirely normal to feel anxious from time to time, and it can even be beneficial. Anxiety can help us prepare for specific situations, making sure we pay attention and stay alert to any dangers.


However, some people find it hard to control their anxiety. High levels of anxiety maintained over a long time that impact normal, day-to-day activities could mean someone has an anxiety disorder.

What are the main types of anxiety?

Everyone experiences anxiety in different ways. However, anxiety disorders are different from normal feelings of nervousness and stress, and involve excessive anxiety or fear. People often say that anxiety disorders are a feature of modern day living, but there is no evidence that prevalence rates have changed over the years. The most frequently diagnosed anxiety disorders include generalised anxiety disorder, panic disorder, phobias, social anxiety disorder (social phobia) and separation anxiety disorder:
  • Generalised anxiety disorder: A chronic (long-term) condition that causes people to have regular feelings of anxiety about a wide range of issues or situations in their everyday lives. Its psychological and physical symptoms vary from person to person, but may include worry, trouble concentrating or sleeping, dizziness, and heart palpitations.
  • Panic disorder: Sudden and repeated attacks of intense fear that can last for several minutes or longer. Sometimes these attacks happen for no apparent reason. A person having a panic attack experiences a rush of mental and physical symptoms. They may feel as though they are losing control, having a heart attack, or even dying.
  • Phobias: An overwhelming, extreme fear of an object, animal, place, situation, or feeling. Examples include agoraphobia (fear of open spaces or being unable to escape) and acrophobia (intense fear of heights).
  • Social anxiety disorder (social phobia): A fear or dread of social situations. It is much more than a feeling of apprehension about a social event; it involves excessive worry about everyday social activities, such as meeting people, starting conversations, speaking on the phone, going shopping, or working.
  • Separation anxiety disorder: Intense fear of being separated from a particular person, people, or pet/s. While many people associate separation anxiety disorder with children, adults can also suffer from the condition.
  • Post-traumatic stress disorder (PTSD): Someone with PTSD has experienced a very stressful, frightening, or distressing event. The condition often involves nightmares and ‘flashbacks’ in which the person relives the traumatic event. People with PTSD often have feelings of guilt, isolation, and irritability.
Some people with anxiety disorders are affected by more than one anxiety or psychiatric disorder at a time (known as ‘comorbidity’). For example, generalised anxiety disorder and PTSD could be associated with other psychiatric conditions including depression or major depressive disorder (MDD), bipolar disorder (BD), and substance use disorder (SUD).

How many people have anxiety?

Statistics show that anxiety disorders are prevalent across the globe. The World Health Organization estimates that around 284 million people (3.6% of the world’s population) have experienced an anxiety disorder. About 63% (179 million) are female, compared with 105 million males.
According to the Institute for Health Metrics and Evaluation (IHME), more than one in six people (nearly 84 million people) across the EU had a mental health problem in 2016. Across EU countries, the most common mental disorder is anxiety disorder, with an estimated 25 million people (equating to 5.4% of the population) living with anxiety disorders.

Symptoms

Everyone experiences anxiety differently. The physical and mental effects can vary from one person to the next.

What are the symptoms of anxiety?

The body reacts to anxiety in a particular way, releasing stress hormones such as adrenaline and cortisol. These hormones put someone experiencing anxiety into a high-alert state in which they look for potential threats, and activate their fight-or-flight responses. As a result, some common symptoms of anxiety include:

Mental effects:
  • Feeling tense, nervous, and restless
  • Having a feeling of dread or panic, or a sense of being in danger
  • Feeling constantly ‘on edge’
  • Feeling out of control
  • Having difficulty focusing or thinking clearly
  • Feeling disconnected, or worrying about being out of touch with reality
  • Being irritable
  • Having uncontrollable, obsessive thoughts
  • Having nightmares
Physical effects:
  • A fast, thumping, irregular heartbeat (palpitations)
  • Rapid breathing
  • Shortness of breath
  • Dizziness or light-headedness
  • Dry mouth
  • Sweating or hot flushes
  • Churning feeling in the stomach, or nausea
  • Sore stomach
  • Trembling or shaking
  • Needing the toilet frequently
  • Inability to sit still
  • Headaches
  • Muscular aches and pains or tension in the muscles
  • Pins and needles
  • Problems sleeping (insomnia)

What are the different levels of anxiety?

Anxiety levels tend to be categorised by the amount of distress experienced and the physical effects on the body. Typically, there are three categories:
  • Mild anxiety: This is the most common level of anxiety. Nearly everyone experiences mild anxiety at some point in their lives. Situations that may trigger mild anxiety include exams, waiting for test results, or running late for an important appointment. Mild anxiety does not last very long, and people tend to make a quick recovery.
  • Moderate anxiety: Someone with moderate anxiety levels has more frequent or persistent symptoms than a person with mild anxiety. Psychological symptoms of moderate anxiety include being on edge, being unable to relax, and worrying excessively. Physical symptoms may include light-headedness, sweating and hot flushes, nausea, a short temper, and muscular aches or pains. People suffering from moderate anxiety may find that it disrupts daily life, leading to more severe anxiety levels. Managing anxiety with self-help strategies or advice from a doctor may help.
  • Severe anxiety: This level of anxiety is extremely debilitating. Symptoms of severe anxiety are frequent and persistent. They may include increased heart rate, feelings of panic, ‘jittery’ or unusual behaviour, anger, and withdrawal from other people. Severe anxiety symptoms can result in people being unable to work or go about their normal day-to-day activities. Sometimes people with severe anxiety turn to alcohol or drugs as a means to cope with their symptoms. Specialist help is required to help people suffering from severe anxiety.

What are the early signs of anxiety?

The early signs of anxiety are sometimes not very obvious and often develop slowly over time. The symptoms vary from person to person. One of the most common early signs of anxiety is excessive worrying about everyday situations. Symptoms sometimes start in childhood or the teenage years and continue into adulthood.

Causes, risk factors and life expectancy

Many different situations or experiences can bring on anxiety. Sometimes it can be challenging to know what is causing the anxiety, and this can result in further stress or upset

What causes anxiety?

Difficult or traumatic events experienced in the past – during childhood, adolescence, or adulthood – often trigger anxiety problems. Some common examples that can result in anxiety issues include:
  • Physical or emotional abuse
  • Separation or divorce
  • Bereavement
  • Being bullied or socially excluded
Current issues or life problems can also trigger anxiety, such as:
  • Pressures at work
  • Working long hours
  • Money issues
  • Relationship problems
  • Exhaustion
  • Feeling lonely or isolated
  • Losing a loved one
  • Dealing with a severe illness or injury
  • Being bullied, harassed, or abused
  • Experiencing other mental health problems, such as depression
Sometimes people have underlying medical issues that can affect their anxiety levels. Examples of medical conditions that are linked to anxiety include:
  • Heart disease
  • Diabetes
  • Irritable bowel syndrome
  • Thyroid problems
  • Respiratory conditions such as chronic obstructive pulmonary disease (COPD)
Certain drugs can also trigger anxiety, including psychiatric medications, some medicines used to treat certain physical health conditions, and recreational drugs and alcohol.

Is anxiety hereditary?

Research shows that having a close family member with anxiety issues can increase the chances of someone experiencing problems with anxiety. More research is needed to understand whether genetic factors contribute to someone developing anxiety, or whether some people are more susceptible to developing anxiety because of behaviour they learned from parents and relatives while growing up.

Who gets anxiety?

Anyone can get anxiety, although anxiety disorders often start when people are teenagers. Women are twice as likely to be affected as men.

How long can you live with anxiety?

Anxiety is not a life-threatening condition. However, research published in The British Journal of Psychiatry shows that anxiety disorders can significantly increase the risk of death (mortality). Comorbidity (when two disorders are experienced at the same time) of anxiety disorders and depression plays an essential part in the increased mortality risk.

Diagnosis

Anxiety is not a simple diagnosis; it can sometimes be difficult for doctors to diagnose whether someone has an anxiety disorder or depression with anxiety as a symptom.

How is anxiety diagnosed?

To diagnose anxiety accurately, a doctor needs to rule out certain physical illnesses that may be causing the symptoms. They may ask questions about:

  • Any physical or psychological symptoms
  • How long the symptoms have been an issue
  • Any significant worries, fears, or issues
  • The individual’s personal life

It can be difficult to talk to a doctor about emotions, feelings, and personal issues. Still, the doctor must understand the symptoms and circumstances to make an accurate diagnosis.


To help with the diagnosis, the doctor may also make a physical examination and do some blood tests to rule out conditions such as anaemia (iron deficiency) or an overactive thyroid.

Test to diagnose anxiety

There are no laboratory tests to diagnose anxiety. If a doctor cannot find any medical reason for certain physical and mental symptoms, they may make a referral to a mental health specialist, such as a psychiatrist or psychologist.


A mental health specialist will ask further questions about symptoms, feelings and emotions, and make a clinical assessment using questionnaires to gauge anxiety levels. Some examples of anxiety assessment questionnaires include the Hamilton anxiety rating scale (HAM-A), or the Beck Anxiety Inventory (BAI), which measures the severity of anxiety in adults and adolescents.

Treatment and medication

Treatment and medication for anxiety can relieve the symptoms and make the condition easier to live with.

Medication

Doctors use a range of medications to help people manage their anxiety symptoms. However, drugs should not be the only treatment option offered. Instead, doctors often need to work with individuals to find the right medication, dosage, and therapy that works best.

Some medications are only used on a short-term basis, while others can be prescribed for more extended periods.

Depending on the person’s symptoms, medication may treat the physical symptoms of anxiety and the psychological effects.

Some of the most commonly prescribed medications to treat anxiety include:

  • Anti-depressants: In most cases, an anti-depressant will be the first medication offered, and it is usually a type of drug known as a ‘selective serotonin reuptake inhibitor’ (SSRI). These drugs work by increasing the level of a chemical called serotonin in the brain. Serotonin plays a vital role in the brain, boosting feelings of wellbeing and happiness, and aiding thinking, memory, sleep, digestion, and circulation. SSRIs can be taken on a long-term basis, but it can take a few weeks for them to start working. Another type of anti-depressant that may be offered is known as a ‘serotonin and noradrenaline reuptake inhibitor’ (SNRI). This type of medication works by increasing the amounts of serotonin and noradrenaline in the brain. It makes specific changes in the brain and the nerve cells to regulate mood.
  • Anti-seizure drugs: Certain anti-seizure medications (also known as anti-convulsant drugs) used to treat epilepsy can also be an effective anxiety treatment. They work by decreasing excessive outputs in parts of the brain that control fear.
  • Benzodiazepines:Sometimes benzodiazepines, a type of sedative, are used as a short-term treatment during a severe period of anxiety, sometimes alongside other medication. People taking sedative drugs can feel very drowsy, so doctors can sometimes recommend not driving or operating machinery while taking them.

Therapy

Several psychological therapies (psychotherapy) can be useful in treating anxiety, including:

  • Guided self-help: A doctor or mental health specialist may suggest trying a guided self-help course to manage anxiety levels and teach coping techniques to deal with anxiety daily. This may involve going through a workbook or an online course with a therapist’s support.
  • Cognitive behavioural therapy (CBT): This form of therapy helps someone question their anxious thoughts or negative feelings. It can help improve focus and concentration and reduce the need to avoid doing things that cause anxiety. CBT usually involves meeting with a specially trained and accredited therapist every week for several months.
  • Applied relaxation:This approach involves a trained therapist teaching someone how to relax their muscles and to practise this during situations that make them feel anxious.

Intervention

It is vital that anyone whose anxiety is affecting their daily life gets medical advice early to prevent their condition from worsening.

People with a suspected anxiety disorder should be offered psychological intervention as a first-line treatment.

A qualified mental health professional who knows how to treat anxiety effectively will help individuals learn critical coping strategies to deal with their anxiety disorder.

Diet

People with anxiety should try to eat a regular, healthy, well-balanced diet. It is also vital to eat regularly and avoid skipping meals, which may result in the blood sugar dropping, making people feel ‘jittery’ or on edge and worsening the underlying anxiety.

Eating foods rich in complex carbohydrates, such as whole grains – for example, oatmeal, quinoa, and wholegrain bread and cereals – is thought to increase the amount of serotonin in the brain, which has a calming effect.

Alcohol and caffeine should be limited or avoided. Both can make people feel on edge or nervous and can interfere with sleep patterns.

Exercices

Exercise can be very beneficial for people with anxiety. It produces brain chemicals known as endorphins that act as natural painkillers and improve the ability to sleep, which reduces feelings of stress and anxiety.

Scientists have found that regular exercise can decrease tension levels, elevate and stabilise mood, improve sleep, and improve self-esteem. Just five minutes of aerobic exercise can begin to produce anti-anxiety effects.

Any physical exercise can help reduce anxiety, but researchers say aerobic exercise that gets the heart rate up is the most beneficial. Some aerobic exercises that can help manage anxiety are:

  • Swimming
  • Cycling
  • Running or jogging
  • Brisk walking
  • Tennis
  • Dancing
Even short bursts of exercise (just 10–15 minutes) can improve fitness levels and mood.

Prevention

There is no way to accurately predict what will cause someone to develop problems with anxiety. However, steps can be taken to reduce the impact of related symptoms:

  • Seek help early: Anxiety can be harder to treat if it is left too long.
  • Live a healthy lifestyle: Exercise can help boost mental health and relieve feelings of anxiety.
  • Try to be as active as possible: Taking part in activities and hobbies can improve feelings of self-worth and take the mind off worries. Social interaction can prevent feelings of isolation.
  • Avoid alcohol and drug use: Alcohol and drug use can cause anxiety or make existing anxiety worse.

Scientific studies

Research is continuing into anxiety, the potential risks for developing anxiety disorders, and effective treatment options. There have been significant advances in understanding the parts of the brain involved with experiencing fear and anxiety. For example, scientists have found that the amygdala region appears to be involved in learning about fear, danger, and safety. People with anxiety disorders seem to have a more reactive amygdala.


Another critical study has looked at how a receptor involved in the brain’s reward system may be a target for treating anhedonia (lack of pleasure), a symptom of several anxiety disorders. The research has significant implications for the development of medications to target specific areas of the brain and will hopefully lead to more informative clinical trials in the future.


One area that has seen significant progress is the role of genetics in various diseases and conditions. Current research is looking at how genes and environments might work together to contribute to the development of anxiety disorders. For example, a child with a genetic predisposition to being shy and sensitive might become a target for bullies. In turn, being bullied (an environmental factor) might increase their anxiety levels.


Research is continuing into treatment options for anxiety because the medication available to help people suffering from anxiety disorders has not changed significantly over the years. Scientists are now working to develop new medicines that could replace current anti-anxiety drugs, which are not effective for all patients. Some are known to have potential side effects and safety concerns (for example, a risk of abuse and dependency).


However, there is optimism in the scientific community that more advances are on the horizon. The future treatment for anxiety will look very different from today’s care.

Referenced sources

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  2.  OECD/European Union. Health at a Glance: Europe 2018: State of Health in the EU Cycle. OECD Publishing, Paris/European Union, Brussels. 2018. Accessed February 2021. https://doi.org/10.1787/health_glance_eur-2018-en.
  3.  Mind. Anxiety and panic attacks. Accessed February 2021. https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/causes-of-anxiety/
  4.  Anxiety and Depression Association of America. Facts and statistics. Accessed February 2021. https://adaa.org/about-adaa/press-room/facts-statistics
  5.  Meier SM, Matthiesen M, Mors O, Mortensen PB, Laursen TM, Penninx BW. Increased mortality among people with anxiety disorders: total population study. Br J Psychiatry. 2016;209(3):216-21. doi:10.1192/bjp.bp.115.171975
  6.  West London NHS Trust. Diagnosis of anxiety disorder. Updated January 2021. Accessed February 2021.  
  7.  Naidoo U. Nutritional strategies to ease anxiety. Harvard Health Publishing. Published April 13, 2016. Accessed February 2021. https://www.health.harvard.edu/blog/nutritional-strategies-to-ease-anxiety-201604139441.
  8.  Anxiety and Depression Association of America. Exercise for stress and anxiety. Accessed February 2021. https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety.
  9.  Everyday Health. How exercise eases anxiety. Published June 2009. Accessed February 2021.https://www.everydayhealth.com/anxiety/anxiety-and-exercise.aspx
  10.  Schumann CM, Bauman MD, Amaral DG. Abnormal structure or function of the amygdala is a common component of neurodevelopmental disorders. Neuropsychologia. 2011;49(4):745-759. doi:10.1016/j.neuropsychologia.2010.09.028
  11.  Krystal AD, Pizzagalli DA, Smoski M, et al. A randomized proof-of-mechanism trial applying the ‘fast-fail’ approach to evaluating κ-opioid antagonism as a treatment for anhedonia. Nat Med. 2020;26(5):760-768. doi:10.1038/s41591-020-0806-7
  12.  Craske MG, Stein MB, Eley TC, et al. Anxiety disorders [published correction appears in Nat Rev Dis Primers. 2017 Dec 14;3:17100]. Nat Rev Dis Primers. 2017;3:17024. doi:10.1038/nrdp.2017.24
  13.  Singh S. The future of anxiety treatment will be drastically different. Life Science Leader. Published September 2020. Accessed February 2021. https://www.lifescienceleader.com/doc/the-future-of-anxiety-treatment-will-be-drastically-different-0001.
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