What Triggers Anxiety Attacks
Difficult experiences in childhood, adolescence or adulthood can lead to anxiety issues. Its likely that stress and trauma will have a big impact on you when youre young. Physical or emotional abuse can be experiences that can cause anxiety problems.
The Role Of Medication In Anxiety Treatment
When youre overwhelmed by heart-pounding panic, paralyzed by fear, or exhausted from yet another sleepless night spent worrying, youll do just about anything to get relief. And theres no question that when anxiety is disabling, medication may help. But are drugs always the best answer?
Many different types of medications are used in the treatment of anxiety disorders, including traditional anti-anxiety drugs such as benzodiazepines and newer options like SSRI antidepressants . These drugs can provide temporary relief, but they also come with side effects and safety concernssome significant.
They are also not a cure. In fact, there are many questions about their long-term effectiveness. According to the American Academy of Family Physicians, benzodiazepines lose their therapeutic anti-anxiety effect after 4 to 6 months of regular use. And a recent analysis reported in JAMA Psychiatry found that the effectiveness of SSRIs in treating anxiety has been overestimated, and in some cases is no better than placebo.
Whats more, it can be very difficult to get off anxiety medications without difficult withdrawals, including rebound anxiety that can be worse than your original problem.
With All These Options How Can You Choose
Your doctor can recommend the best medication to help control your anxiety. There are different types of anxiety disorders, so different medications may be better choices for your type. Your doctor will also consider your other health conditions and medications, and whether you have a family history of responding better to a certain medication. Since you might be taking medication long-term, you may want to factor in affordability.
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Getting The Help You Need
If youre battling anxiety and panic disorders, youre not alone. At Mango Clinic, were here to help you live and function normally. Contact us today to start your mental health and wellness journey or click the banner below to book your appointment.
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Drug Dependence And Withdrawal
When taken regularly, benzodiazepines lead to physical dependence and tolerance, with increasingly larger doses needed to get the same anxiety relief as before. This happens quicklyusually within a couple of months, but sometimes in as little as a few weeks.
If you abruptly stop taking your medication, you may experience severe withdrawal symptoms such as:
- Increased anxiety, restlessness, shaking.
- Depression, confusion, panic attacks.
- Pounding heart, sweating, and in severe cases, seizure.
Many people mistake withdrawal symptoms for a return of their original anxiety condition, making them think they need to restart the medication. Gradually tapering off the drug will help minimize the withdrawal reaction.
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How Is Panic Disorder Diagnosed
Medical or mental health providers can diagnose panic disorder. Your provider may diagnose panic disorder when you have repeated panic attacks and you:
- Persistently worry about having more panic attacks or their consequences.
- Obsess about losing control during a panic attack.
- Change your behaviors to avoid situations that may trigger a panic attack.
What Questions Should I Ask My Doctor
If you have panic attacks, you may want to ask your healthcare provider:
- Why am I having panic attacks?
- What is the best treatment for panic attacks?
- How long will I need therapy?
- How long do I need to take medications?
- Should I look out for medication side effects?
A note from Cleveland Clinic
Panic attacks can be extremely uncomfortable. Although theyre not physically harmful, they can take a toll on your mental health and stop you from doing the things you love. Dont be embarrassed to tell your healthcare provider that you have panic attacks. Your provider can help you overcome fears and anxieties that trigger attacks. You can get better with treatments like psychotherapy and medications.
Last reviewed by a Cleveland Clinic medical professional on 08/12/2020.
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What If My Anxiety Gets Better But My Depression Doesnt
SSRIs can help treat anxiety and depression, but they dont work the same for everyone. If increasing the dosage of that medication doesnt work, another medication may be added or used to replace the current treatment.
For example, Wellbutrin is a common antidepressant that tackles low mood and low energy, but it can increase feelings of anxiousness. Its one of the reasons why its often combined with an SSRI, says Dr. Shelton, if depression isnt alleviated completely.
Can Antidepressants Cause Anxiety
Dr. Shelton says that SSRIs typically dont cause anxiety symptoms. However, if a patient is very anxious its a good idea to start on a very low dose to allow the patient to adjust to the medication slowly.
Dr. Plummer says that a patient starting an SSRI may notice an initial increase in anxiety. It takes a minimum of two to four weeks, sometimes longer, for SSRIs to reach the serotonin levels needed to relieve the depression or anxiety, she says.
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Treatment Of Gad In Older Patients
With the exception of GAD, anxiety disorders are less common in patients over 65 years of age. Therefore, only a few studies for the treatment of GAD have been performed with older patients. Controlled studies have shown the efficacy of duloxetine, venlafaxine, pregabalin, and quetiapine in patients over 65 years old.27 In the elderly, an increased sensitivity to drug side effects and interactions must be considered, including anticholinergic effects, risk of orthostatic hypotension and cardiovascular events, risk of falling, and paradoxical reactions to benzodiazepines.
In the elderly, effect sizes for CBT tend to be somewhat smaller than those found in mixed-age populations.86 A meta-analysis of studies with older adults with GAD showed superiority of CBT to waitlist or treatment-as-usual conditions but not to active controls .87
Safety And Other Considerations
It’s also important to realize that the long term use of a mental health medication is going to have an effect on your wellbeing. Some cause digestion issues. Others cause extreme fatigue. These side effects can have a disruptive effect on your life.
Similarly, some anti-anxiety medications cause dependency with severe withdrawal symptoms if you stop taking it or miss too many doses. Some medications may also lose their effectiveness over time . Keep this in mind and discuss with your doctor when you are choosing the right medication for you.
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How Do I Know If I Have Generalized Anxiety Disorder
The first step is to rule out the possibility that your symptoms are being caused by a medical condition that is not psychiatric. Among the conditions that produce symptoms similar to those of anxiety are hyperthyroidism or other endocrine problems, too much or too little calcium, low blood sugar, and certain heart problems. Certain medicines also can sometimes cause anxiety. A thorough evaluation by your health care provider will determine if any of these conditions are the cause of your symptoms.
If no other medical culprit can be found and the symptoms seem out of proportion to any situation you are facing, you may be diagnosed with an anxiety disorder.
Referral To A Specialist
If you have tried the treatments mentioned above and have significant symptoms of GAD, you may want to discuss with your GP whether you should be referred to a mental health specialist.
A referral will work differently in different areas of the UK, but you’ll usually be referred to your community mental health team.
These teams include a range of specialists, including:
- occupational therapists
- social workers
An appropriate mental health specialist from your local team will carry out an overall reassessment of your condition.
They’ll ask you about your previous treatment and how effective you found it.
They may also ask about things in your life that may be affecting your condition, or how much support you get from family and friends.
Your specialist will then be able to devise a treatment plan for you, which will aim to treat your symptoms.
As part of this plan, you may be offered a treatment you haven’t tried before, which might be one of the psychological treatments or medications mentioned above.
Alternatively, you may be offered a combination of a psychological treatment with a medication, or a combination of 2 different medications.
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How Can I Treat Anxiety Naturally
Unless you experience adverse side effects, don’t be too quick to abandon treatment because it doesn’t provide instantaneous results. Weeks may pass before you detect improvement. Discuss all side effects with your mental health provider it’s often worth sticking with treatment and seeking out ways to reduce or eliminate any negative side effects. Importantly, never stop taking medication without consulting your doctor first because an abrupt stop may cause other health problems.
Differentiating Panic Attacks From Anxiety Attacks
Anxiety builds over time, while panic tends to be sudden. Anxiety attacks often arise from an intensified anxiety level, whereas panic attacks result from an intense sense of dread or fear. Those who suffer from anxiety attacks usually feel anxious before an attack occurs. On the other hand, those who experience anxiety attacks often feel fine until they encounter dreadful situations that make them panic.
Anxiety attacks usually take considerable time to build up and may last for some time. Conversely, panic attacks tend to last for a shorter period, usually 20 to 30 minutes. Typically, the attacks reach their most intense level of about ten minutes in.
When panic attacks become frequent, patients tend to develop panic disorder. This is an anxiety disorder characterized by recurrent panic attacks and the fear of having panic attacks. Even so, patients who dont have panic disorder may also experience panic attacks.
Can Panic Disorder Be Cured
Everyones experience with panic disorder is unique. However, there is no known cure for this condition. Thankfully, panic disorder is treatable, and you can control symptoms with medications, behavioral therapies, or a combination of both.
One study found that close to 65% of people with panic disorder experienced symptom remission within 6 months. But, of those who achieved remission, over 20% experienced a return of their symptoms. If your symptoms start again after having been under control for a while, discuss it with your healthcare provider, but know that this is common.
What Are The Complications Of Panic Attacks
Panic attacks are highly treatable. Unfortunately, many people put off seeking help because theyre embarrassed. Untreated panic attacks or panic disorder can interfere with your ability to enjoy life. You may develop:
- Anticipatory anxiety: The possibility of having a panic attack triggers extreme anxiety.
- Phobias: A phobia is an extreme, unreasonable fear of something specific. For instance, acrophobia is a fear of heights, while claustrophobia is a fear of enclosed spaces.
- Agoraphobia: Approximately two-thirds of people with panic disorder develop agoraphobia. This anxiety disorder makes you afraid to be in places or situations where a panic attack might happen. The fear can become so extreme that you become too afraid to leave your house.
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Psychological Therapies For Gad
If you have been diagnosed with GAD, you’ll usually be advised to try psychological treatment before you’re prescribed medication.
You can get psychological therapies like cognitive behavioural therapy and applied relaxation on the NHS.
You can refer yourself directly to an NHS psychological therapies service without a referral from a GP.
Or your GP can refer you if you prefer.
Do I Have An Anxiety Disorder
Common signs and symptoms of anxiety include nervousness, restlessness or tenseness, a sense of impending danger or doom, increased heart rate, breathing rapidly, sweating, trembling, feeling weak or tired, trouble concentrating or sleeping, stomach aches and headaches and the urge to avoid things that trigger anxiety.
Anxiety disorders often develop from a complex set of risk factors. The risk factors may include exposure to trauma, certain medical problems like thyroid disease or heart disease, stress due to a severe illness and other mental health disorders like depression. The use or misuse of drugs and alcohol can worsen symptoms of anxiety.
Anxiety disorders are best treated with a combination of therapy and medication, Alonzo said. It takes time to find the perfect combination for your symptoms. Your primary care provider is the best place to start that journey.
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What Other Treatments Can Help Manage Anxiety
Medications for anxiety are safe and effective and are good options for many people. But some people want to avoid medication, and some want to combine medication with other treatments. You can try:
- Psychotherapy. Cognitive behavioral therapy is a first-line treatment for anxiety, and phobias can respond to biofeedback and exposure therapy.
- Stress management techniques. You can learn breathing techniques and progressive muscle relaxation to reduce anxiety.
- Lifestyle modifications. Getting enough quality sleep, exercising, and avoiding alcohol, illicit drugs and excessive caffeine can help reduce anxiety.
- Support groups. Connecting with people who share your experiences can be valuable.
Selective Serotonin Reuptake Inhibitors
Selective serotonin reuptake inhibitors are a popular class of antidepressants prescribed to decrease symptoms of anxiety and depression. Serotonin is a naturally occurring neurotransmitter in the brain.
These medications work by influencing only serotonin and by preventing serotonin absorption by the nerve cells in the brain. By balancing serotonin functioning, SSRIs are able to reduce anxiety and improve mood.
Common SSRIs include:
Research has found that SNRIs are effective for treating anxiety disorders, particularly social anxiety disorder. Side effects can occur while taking SNRIs and may include fatigue, insomnia, changes in appetite, and changes in sexual function.
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Serotonin And Noradrenaline Reuptake Inhibitors
If SSRIs don’t help ease your anxiety, you may be prescribed a different type of antidepressant known as a serotonin and noradrenaline reuptake inhibitor .
This type of medicine increases the amount of serotonin and noradrenaline in your brain.
Examples of SNRIs you may be prescribed include:
SNRIs can also increase your blood pressure, so your blood pressure will be monitored regularly during treatment.
As with SSRIs, some of the side effects are more common in the first 1 or 2 weeks of treatment, but these usually settle as your body adjusts to the medication.
Ssri Antidepressants For Anxiety
Many medications originally approved for the treatment of depression are also prescribed for anxiety. In comparison to benzodiazepines, the risk for dependency and abuse is smaller. However, antidepressants take up to 4 to 6 weeks to begin relieving anxiety symptoms, so they cant be taken as needed. Their use is limited to chronic anxiety problems that require ongoing treatment.
The antidepressants most widely prescribed for anxiety are SSRIs such as Prozac, Zoloft, Paxil, Lexapro, and Celexa. SSRIs have been used to treat generalized anxiety disorder , obsessive-compulsive disorder , panic disorder, social anxiety disorder, and post-traumatic stress disorder.
Common side effects of SSRIs include:
- Increased sweating
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What Are The Treatments For Generalized Anxiety Disorder
Medication for Anxiety
Medication is useful for alleviating the symptoms of generalized anxiety disorder and is often prescribed in conjunction with other therapies. Some types of anxiety drugs can be habit-forming and are usually prescribed on a short-term or as-needed basis.
Different anxiety disorders have different medication regimens. Some are preventive and some are designed to cure the problem.
Antidepressants, particularly the selective serotonin reuptake inhibitors , are widely used to treat and prevent a variety of anxiety disorders. Examples of SSRIs that are commonly used to treat chronic anxiety include citalopram , escitalopram , fluoxetine , paroxetine , and sertraline . The antidepressantsduloxetine and venlafaxine , SNRIs which act on the brain chemicals serotonin and norephinephrine, and some of the tricyclic antidepressants like imipramine , may also help. Novel antidepressants such as mirtazepine are also prescribed at times.Ã
Another anti-anxiety drug is busprirone . It has fewer side effects than the benzodiazepines and is not associated with dependence. Buspar, however, can have its own side effects and may not always be as effective when a person has taken benzodiazepines in the past.
Therapy for Anxiety
Lifestyle Modifications to Alleviate Anxiety
Treating Children And Adolescents
Whereas specific phobias, SAD, and separation anxiety disorder are common in younger people, PDA and GAD are relatively rare. There are some randomized, placebo-controlled studies of pharmacotherapy for anxiety disorders in children and adolescents showing efficacy of sertraline, fluoxetine, and duloxetine in young patients with GAD, of venlafaxine and paroxetine in SAD, and of sertraline, fluvoxamine, and fluoxetine in mixed samples, including patients with separation anxiety disorder, GAD, and SAD.88 However, little is known about the value of long-term treatment.89 The combination of CBT and sertraline was found to be more effective than both treatment modalities alone.90
For children and youths with separation anxiety disorder, several treatment studies exist.95 However, no controlled studies on the treatment of adults with this disorder could be traced.
There is also a paucity of treatment studies for children with selective mutism. Small studies have shown that psychotherapeutic approaches were at least better than waitlist controls.96,97 One review indicated that only two very small placebo-controlled drug studies showed efficacy of the SSRIs fluoxetine and sertraline.98
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