Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. These disorders fill people's lives with overwhelming anxiety and fear. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.

Anxiety, on the other hand, is more general and complex. It is felt in anticipation of danger, and is associated with the ability to predict, prepare for, and adapt to change. Often, it lasts a long time, and its cause remains ill-defined. For example, someone uneasy about public speaking may experience a tightness in the stomach for days before a scheduled talk.

Both fear and anxiety send signals through the body that prepare all systems for possible danger. Hormones, such as adrenaline and catecholamine, are released in what is known as the "fight or flight" response. The sudden increase in hormone levels speeds up the heart and increases the amount of blood being pumped. At the same time, the muscles tighten, increasing the individual's ability to fight or flee from danger. The intensity of these physiological responses varies according to the seriousness of the event or thought that sparked the emotion, the strength of the individual's fear or anxiety, and his or her previous experience and genetic makeup.

Although it's uncommon, certain medical problems can mimic the symptoms of anxiety, or even produce it. The palpitations and shortness of breath caused by an irregular heartbeat can easily be mistaken for anxiety. A clot in the lung (pulmonary embolism) often causes unexplained feelings of anxiety. Neurological problems such as epilepsy and brain disorders can be responsible for symptoms of anxiety. So can anemia, diabetes, thyroid disease, and adrenal problems. In general, these symptoms will disappear when the underlying disease is brought under control, although the anxiety sometimes requires separate treatment.

Prescription drugs and those purchased over the counter also can cause anxiety symptoms. Cold medicines, diet pills, antispasmodic medications, stimulants, digitalis, thyroid supplements, and, paradoxically, antidepressants given to reduce panic all may cause anxiety. Discontinuing a variety of drugs, including tranquilizers, sleeping pills, and certain blood-pressure medicines can lead to withdrawal symptoms that often include anxiety.

Before treatment can begin, the doctor must conduct a careful diagnostic evaluation to determine whether your symptoms are due to an anxiety disorder, which anxiety disorder(s) you may have, and what coexisting conditions may be present. Anxiety disorders are not all treated the same, and it is important to determine the specific problem before embarking on a course of treatment. Sometimes alcoholism or some other coexisting condition will have such an impact that it is necessary to treat it at the same time or before treating the anxiety disorder.

If you have been treated previously for an anxiety disorder, be prepared to tell the doctor what treatment you tried. If it was a medication, what was the dosage, was it gradually increased, and how long did you take it? If you had psychotherapy, what kind was it, and how often did you attend sessions? It often happens that people believe they have "failed" at treatment, or that the treatment has failed them, when in fact it was never given an adequate trial.

Stress management techniques and meditation may help you to calm yourself and enhance the effects of therapy, although there is as yet no scientific evidence to support the value of these "wellness" approaches to recovery from anxiety disorders. There is preliminary evidence that aerobic exercise may be of value, and it is known that caffeine, illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of an anxiety disorder. Check with your physician or pharmacist before taking any additional medicines.

Most people with depression can get help from treatment. For most people, spotting depression early and getting it treated might cut down on how long and how serious the depression is. The most common treatments are antidepressant medicines, "talk" therapy, or a combination of both. You and your doctor can work together to decide on the right depression treatment for you.

Feelings associated with anxiety include impatience, apprehensiveness, irritability, and decreased ability to concentrate. People suffering from anxiety may also worry, for no particular reason, that something bad is going to happen to themselves or their loved ones. Individuals with anxiety disorders may make such statements as: - I always thought I was just a worrier, but I would worry about things for days, to the point where I couldn't even sleep. - I had a very strong feeling of impending doom, like I was losing control in an extreme way. - I was always worried that if I didn't do certain things, my parents were going to die. - I felt as if my heart was going to explode, and I couldn't calm down.

Not everyone who is depressed has all depression's symptoms, but everyone who is depressed has at least some of them, co-existing, on most days. Depression can range in intensity from mild to severe. Depression can co-occur with other medical disorders such as cancer, heart disease, stroke, Parkinson's disease, Alzheimer's disease, and diabetes. In such cases, the depression is often overlooked and is not treated. If the depression is recognized and treated, a person's quality of life can be greatly improved.

The hallmark of this problem is chronic worry and tension with no apparent cause. People suffering from generalized anxiety disorders may worry excessively about health, money, family, or work, often anticipating disaster. Although they are usually aware that their anxiety is more intense than necessary, they can't seem to let it go. Constant worrying contributes to trouble sleeping and relaxing. People with anxiety disorders may startle easily and have trouble concentrating. Generalized anxiety disorder often leads to depression.

Symptoms of this disorder are often mild, and do not interfere with work or social situations. If symptoms are severe, however, they can disrupt daily activities. Because people with generalized anxiety disorder often have another physical or emotional disorder, such as depression, there has been much learned debate as to whether anxiety disorder exists on its own. But recent studies indicate that there really is such a disorder, and that it can be helped by diagnosis and treatment. The symptoms of generalized anxiety disorder usually begin in youth and may go untreated for decades. However, they tend to diminish with age. One study found that only 3 percent of cases of generalized anxiety disorder began in those 65 and over. The problem is more common among women than men and often runs in families.

Psychologists, social workers, and counselors sometimes work closely with a psychiatrist or other physician, who will prescribe medications when they are required. For some people, group therapy is a helpful part of treatment.

Remember, though, that when you find a health care professional that you're satisfied with, the two of you are working together as a team. Together you will be able to develop a plan to treat your anxiety disorder that may involve medications, cognitive-behavioral or other talk therapy, or both, as appropriate.

Many organizations today supports research into the causes, diagnosis, prevention, and treatment of anxiety disorders and other mental illnesses. Studies examine the genetic and environmental risks for major anxiety disorders, their course--both alone and when they occur along with other diseases such as depression--and their treatment. The ultimate goal is to be able to cure, and perhaps even to prevent, anxiety disorders.

By learning more about brain circuitry involved in fear and anxiety, scientists may be able to devise new and more specific treatments for anxiety disorders. For example, it someday may be possible to increase the influence of the thinking parts of the brain on the amygdala, thus placing the fear and anxiety response under conscious control.

Scientists are also conducting clinical trials to find the most effective ways of treating anxiety disorders. For example, one trial is examining how well medication and behavioral therapies work together and separately in the treatment of obsessive-compulsive disorder. Another trial is assessing the safety and efficacy of medication treatments for anxiety disorders in children and adolescents with co-occurring attention deficit hyperactivity disorder. For more information about clinical trials, for example the National Library of Medicine's clinical trials database.

Unrestrained anxiety can lead to any of several emotional disorders, all characterized by an unpleasant and overwhelming mental tension with no apparent identifiable cause. While most people with anxiety disorders are completely aware that their thoughts and behavior are irrational and inappropriate, this insight gives them no help in controlling their symptoms.

Anxiety disorders are surprisingly frequent, and affect more Americans than does any other emotional disorder. They are more common than depression, manic depression, or abuse of alcohol and other substances. According to the American Psychiatric Association, while depressive disorders affect one person in 20, one in 12 suffers an anxiety disorder. Because consumers and doctors alike are less attuned to anxiety disorders than other emotional problems, these disorders often go unrecognized. This is unfortunate, because most cases of anxiety can be treated successfully. In fact, anxiety disorders are considered the most treatable of all emotional problems.

Experts have yet to agree on the root cause of anxiety disorders. In fact, most concede that several factors may be at work in each case.

Biochemical theory suggests that biologic imbalances, perhaps among the neurotransmitters in the brain, may be the primary cause of anxiety disorders. Indeed, in one study researchers were able to trigger a panic attack in some people simply by infusing certain chemicals. Many scientists involved in anxiety research now argue that correcting biochemical imbalances with medication should be the first goal of treatment. Other studies suggest that biochemical changes can also be achieved through the psychological and behavioral changes produced by psychotherapy.

Stress, trauma, uncertainty. Most theorists agree that, other factors aside, stress, trauma, and uncertainties can play a role in the development of anxiety disorders. Studies show a relationship between anxiety and stress, which can be defined as a consequence of adapting to a change. Challenges such as the death of a loved one require a major adaptation that can contribute to the development of an anxiety disorder. Uncertainty during transitions, or about the future, can also produce anxiety. Some studies have found that a stressful event precedes the appearance of many anxiety disorders, though this result is not yet conclusive. The influence of these factors appears to vary with the disorder. In post-traumatic stress syndrome, such factors play a major role, whereas in obsessive- compulsive disorder, brain chemistry appears to be the primary culprit.

An imbalance in these neurotransmitters can cause a corresponding shift in our thoughts. But is the reverse also true? Can a determined change in our thinking alter the chemistry in the brain? Many experts are convinced this is true; and behavioral therapy aimed at changing our reactions does, in fact, cure many problems. Indeed, for some disorders, such as phobias, this type of therapy remains the most effective alternative.

Psychopharmacology, the treatment of psychiatric disorders and emotional distress with medication, has developed over the last fifty years, as our understanding of the workings of the brain has increased in sophistication. When medication is prescribed for mental and emotional illness, the most frequent goal is to restore the chemical balance within the brain, thereby restoring equilibrium to the entire system. Certain drugs function to address certain symptoms, such as when sedatives are prescribed for insomnia. Medications can work to slow disease processes, such as when anti-oxidants are used to treat Alzheimer's. Still other drugs control cravings and curb other problematic behaviors, such as taken to control alcoholism.

It is not entirely clear why psychotropic medications work; yet, it appears that they reestablish balance within the chemistry of the brain. Behavior is determined through messages transmitted within the brain from one nerve cell to another through various chemicals. These chemicals are called neurotransmitters. Through the millions of nerve cells within the brain, chemicals trigger memories, sleep patterns, perceptions, feelings, moods and thoughts. The electric current that carries the messages are received by nerve ends, called synapses, which then release the neurotransmitter. These chemicals, in turn, propagate the message by stimulating the next nerves in line to send on the electrical message. Once used, the neurotransmitter chemical is returned and stored in the nerve end. This recycling process is called reuptake. When this signaling process goes askew, the effects are seen in a person's behavior and experienced in his emotions, perceptions, sensations, and ideas.

Terms interpreting

Anxiety

• A state of uneasiness and apprehension, as about future uncertainties.


• Worry or tension in response to real or imagined stress, danger, or dreaded situations. Physical reactions such as fast pulse, sweating, trembling, fatigue, and weakness may accompany anxiety.

Anxiety disorder

• A psychiatric disorder involving the presence of anxiety that is so intense or so frequently present that it causes difficulty or distress for the individual.

Anxiety disorders

• Any of various disorders in which anxiety is either the primary disturbance or is the result of confronting a feared situation or object; they include obsessive-compulsive disorder and posttraumatic stress disorder.

Fear

• Fear is an unpleasant feeling of perceived risk or danger, whether it be real or imagined.

Depression

• In psychiatry, a symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection.

Mental health

• A state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life.


• The psychological state of someone who is functioning at a satisfactory level of emotional and behavioral adjustment.

Stress

• A state of extreme difficulty, pressure, or strain.


• A physical and psychological response that results from being exposed to a demand or pressure.

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