Anxiety: Definition, Symptoms, Warning Signs, Causes, Medications, Treatment Options, Prevention, and Home Remedies

Reports from the American Psychiatric Association show that anxiety is the most common psychiatric disorder in the United States and the rest of the world. During the COVID-19 pandemics, the number of cases increased significantly as more and more people experienced anxious symptoms. Many reported their symptoms to their healthcare providers, but others did not. The official statistics based on diagnosed cases are high. But if we consider the number of undiagnosed cases, the numbers will still be higher. After reading this article, you will have a complete understanding of this problem. You will be able to distinguish anxiety from normal worries that happen in your everyday life. And you will have a brief review of how to treat this problem medically.

What is anxiety?

The best way to look for a reliable concept of anxiety is the DSM-5, the leading textbook for psychiatrists. The section under anxiety disorders shows that they all feature excessive fear associated with a given circumstance that should not trigger such an intense reaction. You can say that the intensity of the emotion does not correspond with the severity of the problem or situation at hand. So, anxiety is much more than worrying about an upcoming exam or paying your bills. It is about losing yourself and your nerves in these problems with an exaggerated emotional response.

Types of anxiety disorders

There is not only one type of anxiety. Instead, we have different variants. They include:

Separation anxiety disorder: As the name implies, it happens when you’re separated from someone or something you deeply care about.
Specific phobia: It is an irrational fear of something that does not intrinsically harm you.
Social anxiety disorder: It features intense anxiety when you’re in a social scenario. It features fear of feeling embarrassed in public, for example.
Panic disorder: It is also known as panic attacks because they are short episodes of intense anxiety and deep fear with physical symptoms such as shortness of breath and chest pain.
Generalized anxiety disorder: As the name implies, it features constant apprehension and fear, even when the situation does not involve any apparent trigger.
Substance-induced anxiety disorder: This one is triggered by illegal drugs, misuse of prescription medications, and withdrawal syndromes.

In the past, psychiatrists also included the following entities as anxiety disorders. They are technically not included but share a few similar features:

Obsessive-compulsive disorder: Features repetitive behaviors (compulsions) performed to relieve a sensation of discomfort triggered by recurrent ideas or thoughts (obsessions).
Post-traumatic stress disorder: This disorder happens in people with traumatic memories. They recreate the traumatic experience triggered by sounds or similar circumstances and experience intense fear and apprehension.

Causes of anxiety disorder

There is not a single cause of anxiety disorders. Instead, we have a conglomerate of factors, including a genetic predisposition and biopsychosocial elements that trigger an anxious response. Sometimes, the interaction with the environment, a situation of stress and trauma, triggers anxiety in predisposed patients. In other cases, the trigger may not be clearly recognized. Depending on the type of anxiety disorder, different triggers will be more common than others. The main structure associated with anxiety in the brain is called the amygdala. This central structure in the brain regulates emotions, especially fear and anxiety. Imaging studies show an increase in activity in the amygdala when patients feel anxious. Other areas in the prefrontal cortex are also activated during anxiety, mainly because they are connected to the amygdala. Thus, the biological cause is basically an activation and exaggerated response of the amygdala in front of a perceived source of danger. All of these brain regions are activated through chemical interactions. Thus, there is a neurotransmitter imbalance to consider, mainly involving GABA, serotonin, dopamine, and norepinephrine. You can also say this imbalance in brain chemicals causes anxiety and an extensive array of signs and symptoms. Specific causes vary depending on the type of anxiety disorder. For instance:

Genetic factors influence most anxiety disorders. It features a tendency to overestimate threats and potential sources of danger.
In panic disorder, the leading cause is related to the GABA-ergic tone in the brain. In other words, how this neurotransmitter works. These patients may also have an increased sensitivity to pain, tachycardia, and other symptoms that contribute to their apprehension. Direct triggers can include personal loss, conflicts, cannabis use, injuries and trauma, caffeine, and other stimulants.
In social anxiety disorder, there is usually a traumatic social experience in the past that originates the symptoms. This initial experience is reinforced with recurring episodes feeding a constant fear of rejection.
Specific phobias such as fear of heights are usually triggered by a traumatic experience, too. However, they have a decisive genetic factor as well.

What will happen to a person with anxiety?

Anxiety disorders are not life-threatening by themselves, and mortality is usually related to major depression and self-harm. However, anxiety disorders are undoubtedly associated with many psychiatric and physical manifestations. These patients are more likely to engage in heavy alcohol drinking, drug abuse, and depression. Since anxiety modulates brain activity, it also changes how specific brain centers work. These neuroendocrine changes in the brain can also lead to complications. For instance, hypertension, arrhythmia, and heart attack. That is why anxious patients usually have a higher cardiovascular risk when not properly treated. Another consequence of anxiety is an impairment in working or academic performance. This is particularly common in social anxiety disorder, which causes significant social limitations and reduces patient quality of life. In very severe cases, anxiety disorders are linked to major depression and can lead to suicide. Notably, patients do not always have depression when they decide to harm themselves. In many cases, suicidal thoughts and behavior come after acute stress, with or without mood disorders, for example, after a divorce or a significant financial loss. Another thing that usually happens to anxious patients is a comorbidity of anxiety disorders. In other words, patients with a type of anxiety typically have another. This is more common in the case of specific phobias. Patients can display multiple specific phobias to different elements. Also, agoraphobia is usually associated with panic disorders.

Signs and symptoms of anxiety disorders

The first thing we need to rule out when considering signs and symptoms is an alternative cause. For instance, a patient who recently consumed coffee or any other stimulant should not be diagnosed with anxiety disorders regardless of his symptoms. Only after their blood is clear from the stimulant can we reach conclusions with a new assessment of signs and symptoms. As noted above, there are different types of anxiety disorders. Each type has its own signs and symptoms, and we should study them separately. Covering the signs and symptoms of all anxiety disorders would take much time. But you will find next to the most important and representative of the group as a whole. Generalized anxiety disorder According to the criteria of generalized anxiety disorder, you should have three of these symptoms for six months or more to be diagnosed:

Restlessness: These patients often feel on edge and apprehensive, even when there’s no reason.
Fatigue and feeling tired quickly: It burns energy to maintain a high level of stress and anxiety. Your body pays the price. That’s why generalized anxiety disorder is tiredness and fatigue. The latter is a severe sensation of exhaustion, even after resting enough.
Difficulty to concentrate: Patients with generalized anxiety are easily aroused by almost any stimulus. Thus, their attention span is very difficult to maintain. Their ability to concentrate is weak, and they commonly go blank-minded.
Irritability: Anxious patients are always on the edge and hyperactive to stimuli. They usually have a strong emotional reaction to minor things, especially if they are negative or pose a threat to them.
Muscle tension: These individuals keep their muscles tense, even without realizing it. Usual areas of muscle tension include the shoulders and back, and the legs. In some cases, muscle tension translates into nervous tics.
Sleep disturbances: Insomnia is a common problem in patients with generalized anxiety disorder. They may have a mild condition, difficulty falling asleep, or waking up several times amidst anxious thoughts.

Social anxiety disorder

This disorder is only triggered in groups or when the individual is gathered with family, friends, or strangers. It usually happens with strangers, but almost any social interaction can be a trigger. Actually, the fact that anxiety happens with people we have known for years contributes to the diagnosis. The symptoms usually include:

Persistent fear of one’s performance: In social phobia, patients become very restless before, during, and after a social interaction. There is a constant fear of how one will perform socially.
Fear of scrutiny: Patients also fear being exposed to scrutiny. They don’t usually enjoy answering questions about themselves and limit themselves to short answers.
Impaired work and academic performance: Naturally, the difficulty patients experience in social circumstances impairs their performance at school and in working environments.
Avoidance behaviors: Patients can’t help but have avoidance behaviors in response to their fears. Even if they want to do something in particular or go out for fresh air, they would back away if that means interacting with someone else.

Panic disorder

In this anxiety disorder, the main signs and symptoms are limited to a short period. The episodes usually last a few minutes. The symptoms gradually increase in intensity, peak at 10 minutes, and resolve spontaneously. At first, the episodes are entirely unexpected. With time and experience, patients start to recognize the usual triggers and the warning signs and symptoms right before the acute attack. To diagnose panic disorder, patients should have experienced one or more attacks in the past. Additionally, they report fear of having another panic attack for one month or a more extended period. The signs and symptoms of a panic disorder episode include at least four of these symptoms:

Chest pain: Patients have physical symptoms during a panic attack. They often feel chest pain or an oppressive sensation similar to a heart attack. This only increases their worries and apprehension.
Dyspnea: This is the clinical term for the sensation of difficulty to breath. Shortness of breath is common, and patients feel they are running out of air, especially in spaces crowded with people.
Palpitations: Patients become more aware of their heartbeat, and they experience a rapid rhythm that feels like pounding in the chest.
Profuse sweating: The sympathetic nervous system activates during a panic attack. Thus, patients start sweating profusely, even in a cold temperature.
Shaking or trembling: This symptom also increases gradually and usually peaks after 10 minutes.
Gastrointestinal discomfort: Patients often feel sick during an episode of a panic attack. They may also feel abdominal discomfort or pain.
Lightheadedness or fainting: Patients may start feeling dizzy or unsteady during and before a panic attack. This sensation typically grows into lightheadedness and may reach the point of fainting in some cases.
Heat sensation: Patients often report feeling an increasing body temperature and chills in the acute episode.
Tingling and numbness: They are also known as paresthesias and can be associated with trembling limbs.
Depersonalization and derealization: In other words, patients feel they are not themselves or have become detached from their own bodies. They may also have a sensation of unreality.
Fear of becoming crazy or dying: During these episodes, patients have a sensation of sudden death. They become afraid of dying, especially if they have chest pain and feel they have had a heart attack. There’s also fear of losing control and becoming crazy. Patients feel the urge to escape and break free when they share an enclosed space with too many people.

Treatment options for anxiety disorder

After anxiety has been diagnosed, it usually requires prescription drugs to achieve better results in a shorter period. They are used in combination with psychotherapy. In some cases, only psychotherapy is enough to solve the problem. The type of drugs used to control anxiety disorders usually includes antidepressants. New antidepressant agents are very safe, have few reported adverse events in these patients, and are easier to use than tricyclic antidepressants. Still, not all antidepressants are approved by the FDA to treat anxiety, so the treatment should always be guided depending on your particular case and the latest recommendations. Psychological therapy and behavioral modifications are fundamental and show very high efficacy in studies. There is a type of psychologic therapy known as psychodynamic psychotherapy. It is oriented to create insight in patients and help them realize what they are doing and why. This type of psychotherapy is beneficial when phobias are found along with personality disorders. There is also interpersonal psychotherapy and other methods available depending on the subtype of anxiety you are experiencing. In 2019, cranial electrotherapy stimulation received FDA approval as a treatment for many brain chemistry disorders, including depression, insomnia, and anxiety. This therapy is particularly attractive because it is non-invasive and doesn’t require administering drugs. However, it should be used in combination with mainstream medical treatment. It delivers electromagnetic pulses to the brain cortex and makes changes in brain connections and neurotransmitter balance. This is a brief overview of treatment options, but the one used in each particular case depends on:

The type of anxiety disorder, because each is associated with different alterations in brain chemistry and function. Thus, each receives different treatments.
The severity of the diagnosis, because the dose and number of accompanying prescription drugs are modulated according to the patient’s needs.
The level of functioning before anxiety sets in because that is the baseline. Sometimes we have alterations in the baseline, and these patients may require additional treatment.
The patient’s motivation has to improve because some therapeutic agents only work when patients play their part. This is particularly the case with psychotherapy.

To give you an example of how treatment varies, we will examine some therapeutic considerations depending on the type of anxiety:

Acute anxiety

These acute episodes can be very distressing and sometimes cause cardiovascular complications. Thus, patients should be assisted with emergency anxiolytic treatment. This reduces their cardiovascular burden, especially for patients who already suffer from heart disease and circulation problems. In some cases, psychiatric consultation should be included as a part of emergency treatment when there is a risk of self-harm. During the treatment course, it is essential to facilitate a calm environment for the patient and provide as much social support as possible without overwhelming patients with social phobia. In some cases, follow-up is required with a psychiatrist when there’s a risk of chronic anxiety.

Generalized anxiety disorder

Treatment for this anxiety problem requires a combination of psychotherapy and medications. Cognitive-behavioral therapy is a valuable tool for these patients. In children, it may sometimes replace medications when patients receive a reward every time they solve a problem and go through a challenge with the right attitude. Still, we can also combine cognitive-behavioral therapy with medication in more complex patients. Patients with generalized anxiety disorder should be hospitalized in some cases, but this is not the most common scenario. So, if these patients have a suicidal risk or have significant functional impairment, they may need specialized attention. In these patients, the recent upsurge of emotional intelligence can be a valuable tool to learn about themselves and how to solve their anxiety problems.

Panic disorder

This is a more difficult problem to treat and requires medications and psychotherapy in combination to achieve better results. Pharmacotherapy involves using antidepressants, and the most commonly used types of psychotherapy are cognitive and behavioral psychotherapy. Patients should be reassured in the emergency room as they receive attention. Their panic attacks usually last a few minutes and typically resolve in half an hour. They are more likely to improve if they are resting in a calm environment.

Diet and herbal remedies for anxiety

We can always feel worried and anxious from time to time, and it does not mean that we have a disorder that requires medical treatment. In such cases, a few dietary recommendations and herbal remedies can help relieve these symptoms and achieve a therapeutic goal. They include:

Avoiding beverages and foods that contain caffeine. They include coffee, cola beverages, tea, and some sports drinks and supplements.
Look for the list of ingredients in your supplements and make sure that you are not consuming ephedrine. This ingredient is known to worsen anxiety.
If you’re not allergic to herbal preparations, plenty of them have soothing effects. For instance, chamomile is known to improve generalized anxiety disorder when consumed for 12 weeks. Valerian has a robust sleep-inducing effect and is a potent sedative for patients with sleep disorders. Lavender essential oil releases terpenes received in your brain receptors to trigger a soothing effect. Passionflower is also known to help patients with nervousness and anxiety with an effect comparable to some medications. In some countries, consumption of cannabidiol is legal and not restricted as long as it doesn’t have a high proportion of THC. These supplements may also reduce anxiety symptoms and sleep problems.

Conclusion

Feeling restless and worried is just another human experience. Anxiety is something else. It is an intense sensation of nervousness that does not correspond to the situation that you’re currently living. In other words, there is no reason to react with apprehension because there is no immediate or real threat. Instead of being only one, anxiety is a wide array of conditions grouped under the name anxiety disorders. They all share similar signs and symptoms but have their own variants and characteristics. Treating anxiety can be a challenge, mainly because there are many things to consider before establishing medical and psychological treatment. In many cases, a combination of therapy and prescription drugs is recommended to achieve better results faster and for a more extended period. We can also make some dietary changes and consume herbal remedies to control the symptoms. In many cases, herbal remedies and natural solutions are enough to soothe the nerves and improve the quality of life in these patients. In others, combination treatment is required and should not be avoided or postponed.