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What causes an Anxiety Disorder?

There are several theories about what causes anxiety disorders. They include the following:

• conflicts or discomforts experienced during childhood
• a chemical imbalance in your body
• family history
• emotional stress
• trauma

Who has it?

Almost nine percent of Americans experience some sort of anxiety disorder in any six-month period. A survey by the National Institutes of Mental Health found that obsessive-compulsive disorder affects more than two percent of the population. Generalized anxiety disorder, characterized by excessive worry, has been estimated to affect almost seven percent of people during their lifetimes. Panic attacks have a reported lifetime rate of 10 percent.

Different types of phobias are more common than others. These include:

• Agoraphobia, a fear of open spaces and crowds, which affects three percent of the population;
• A simple phobia, a fear of an object or situation, which affects seven percent of the population; and,
• Social phobia, a fear of social situations, which affects two percent of the population.

Approximately one-third of all money spent for the treatment of mental illnesses goes toward anxiety disorders. An overwhelming 50% of the $42 billion attributed to anxiety disorders is due to lost or reduced productivity. Anti-anxiety drugs have an economically beneficial effect by allowing workers to continue in their jobs and avoid absences due to anxiety symptoms.

What are the risk factors?

Risk factors are characteristics that can predispose you to developing a condition. Common risk factors for anxiety disorders are:

• a prior history of having an anxiety disorder yourself
• a family history of anxiety disorders
• major types of stress or trauma, such as physical abuse or natural disasters

• medical conditions, such as heart or thyroid problems
• medications
• caffeine use
• monosodium glutamate (MSG), a flavor-enhancer sometimes found in restaurant food
• drug abuse
• withdrawal after discontinuing some medications

What are the symptoms of Anxiety Disorders?

The symptoms of anxiety usually fall within one of three basic categories:

1. Mental symptoms, which include feelings or thoughts of nervousness, dread, foreboding or panic;
2. Physical symptoms, which include dizziness, sweating, dry mouth, shortness of breath, chest pain and a racing heart; and,
3. Behavioral symptoms, which include avoidance, foot tapping or pacing.

How is Anxiety Treated?

A wide range of medications are used to treat anxiety disorders. Doctors have found specific disorders respond to a particular kind of drug, and it is important that the clinician carefully assess the patient's condition and response to various anti-anxiety medications. Each drug has advantages and disadvantages. Some work faster than others; some remain in the bloodstream longer. Dietary restrictions are necessary when taking some drugs, and some medications may be off-limits to avoid dangerous interactions with other drugs a patient is taking. Older people may react differently than younger individuals to the same medication, and a woman may respond differently than a man.

Most people can take medications commonly used to treat anxiety disorders without difficulty, but sometimes there are side effects. These vary with the drug, but they can range from minor annoyances like dry mouth, drowsiness, or blurred vision, to more troubling reactions like irregular heartbeat. Most side effects go away after several weeks of treatment. If they persist, the doctor may change dosages or try a different medication.

The treatment of anxiety depends on the type of anxiety being treated. For an acute anxiety attack, short-term treatment with benzodiazepines is generally used first. To help prevent episodes of anxiety, selective serotonin reuptake inhibitors and 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.

Helping Yourself

Psychotherapy may involve:

• Supportive Therapy - consists of listening to your symptoms, educating you about them and encouraging you to develop strategies for coping with future episodes of anxiety.
  
• Behavioral Therapy - teaches you how to modify and gain control over an unwanted behavior. Deep breathing exercises are often used for a calming effect and to decrease the rapid heartbeat that often accompanies anxiety. You may also be taught how to control your fears by gradually confronting frightening situations with guidance from your healthcare professional.
  
• Cognitive Therapy - teaches you how to react differently to anxiety but concentrates on understanding how your thought processes contribute to your symptoms. Once you learn to recognize an inappropriate or unrealistic thought, you may be better able to replace it with one more appropriate to the situation.

What is on the horizon?

Most of the current drugs used to treat anxiety disorders have been available for many years and still work well for a large number of people. Current benzodiazepines, in particular, are effective and typically affordable. And, some of the newer antidepressants have also been found to help treat certain anxiety disorders. The focus of most of today's research is to identify the chemicals in the brain that contribute to anxiety and develop new drugs based on those findings.

References

Kirkwood CK, Melton ST. Anxiety Disorders. In: Dipiro JT, et al. Pharmacotherapy: A Pathophysiologic Approach. 5th ed., 1289-1310.

Anxiety Disorders of America: Statistics and Facts About Anxiety Disorders. http://www.adaa.org/mediaroom/index.cfm.American Psychiatric Association: Anxiety Disorders. http://www.psych.org/public_info/anxiety.cfm

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders.4th ed. Washington, DC: American Psychiatric Association Press, 1994.

Buspirone: An alternative to benzodiazepines in anxiety-related disorders. Drugs & Therapy Perspectives 1997;9(10):1-5.

Information about anxiety disorders: Consumer's guide to treatment. updated 1997; http://www.nimh.nih.gov/anxiety/index.htm

National Institutes of Mental Health. Anxiety disorders. National Institutes of Health. Publication No. 02-3879. 2002; http://www.nimh.nih.gov/anxiety/anxiety.cfm.

National Institute of Mental Health. Panic disorder consensus statement. September 1991. http://odp.od.nih.gov/consensus/cons/085/085_statement.pdf

Rapee R. Craske M. Barlow D. The causes of anxiety and panic attacks. http://www.algy.com/anxiety/files/barlow.html

Shaw K. Anxiety and depression. Current Therapies: http://www.forthepharmacist.com/current/currentmn.htm

Simon G. Ormel J. VonKorff M. Barlow W. Healthcare costs associated with depressive and anxiety disorders in primary care. American Journal of Psychiatry 1995;152(3):352-57

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Reviewed: 02/2006