Anxiety

Anxiety is an emotional state commonly caused by the perception of real or potential danger that threatens the security of the individual. Everyone experiences a certain amount of nervousness and apprehension when faced with a stressful situation. Usually, the response is reasonable and adaptive, and contains a built-in control mechanism to return to a normal physiologic state. For some people, however, anxiety is more than just a temporary discomfort. For these individuals anxiety can be debilitating. It is when anxiety states become excessive or prolonged, particularly if it produces such psychological and physical stress, that the person cannot perform the activities of daily living, that medical help should be sought.

In general, anxiety disorders are a group of illnesses that develop before age 30 and are more common in women and those with a family history of anxiety and depression. Anxiety disorders are among the most frequent mental disorders encountered in a clinical setting. Approximately 8% of the population will experience at least one anxiety disorder in their lifetime.(1) Unfortunately, the majority of people with anxiety disorders receive no professional treatment.(2) This is unfortunate because there is a great deal of success in treating anxiety disorders and a life that has been paralyzed can be renewed with appropriate treatment.

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) classifies anxiety disorders into several categories. The characteristics of these illnesses are anxiety and avoidance behavior and include: generalized anxiety disorder, panic disorder (with or without agoraphobia), agoraphobia without history of panic disorder, phobic disorders (social phobia or specific phobia), obsessive-compulsive disorder, post-traumatic stress disorder, and acute stress disorder.(3)

Research studies have shown that there is a difference between normal anxiety and pathologic anxiety states. This difference involves multiple brain structures and neurotransmitter systems. Current drug therapy centers around the use of drugs which alter activity of one or more neurotransmitters, or act at the neurochemical receptor site.

Anxiety Disorder Resource Centre, 2007.

• Anxiety disorders affect approximately 1 in 4 people worldwide at some point in their lives.
• Anxiety affects twice as many women as men.

• 6.8 million Americans have Generalized Anxiety Disorder.
• Approximately 40 million Americans suffer from all anxiety disorders combined.
• Approximately 6 million American adults ages 18 and older have panic disorder.
• Approximately 15 million American adults age 18 and over have social phobia.
• Approximately 19.2 million American adults age 18 and over have some type of specific phobia.

• Panic Disorder is twice as common among women as men.
• Age of onset is most common between late adolescence and mid-adult life.
• There appears to be no specific familial relationship associated with anxiety disorder.

• Social phobia - fear of social situations or performance areas
• Specific phobia - fear of an object or situation such as animals, water or enclosed places

Panic disorder is treated slightly differently than GAD. Individuals with panic disorder should be educated to avoid substances that may precipitate panic attacks including caffeine, drugs of abuse, and nonprescription stimulants.(8) If agoraphobia is present, cognitive-behavioral therapy is recommended to help the patient focus on correction of thoughts and behaviors. Panic disorder is effectively treated with several drugs including Benzodiazepines (alprazolam, clonazepam, diazepam, lorazepam), tricyclic antidepressants (imipramine, desipramine), MAO inhibitors (phenelzine), and Selective Serotonin Reuptake Inhibitors (fluoxetine, fluvoxamine, paroxetine, sertraline). These SSRIs are usually the first drug prescribed because they are well tolerated; however, they are significantly more expensive than tricyclic antidepressants and benzodiazepines.

Oral contraceptives are known to deplete vitamin B6, which may cause anxiety in susceptible women. In one particular study, administration of 40mg of vitamin B6 daily restored normal biochemical values and also relieved the clinical symptoms in the vitamin B6 deficient women taking oral contraceptives.(12) There are other drugs that deplete B6 in addition to oral contraceptives.

Stress reduction can take form in a variety of ways. Some of the more structured forms of anxiety relief include; counseling, tai chi, yoga, meditation, and deep breathing.