Anxiety:

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Chances are almost all of us will experience anxiety atleast once in our lives, this might take different forms and could be for many reasons such as an exam, driving test or something that would normally make us nervous. You may experience the "butterflies" sensation in your stomach or fell nausious or just a little bit funny. This is normal anxiety and usually passes after a few minutes or after the event in which we were anxious about passes. 

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However long term anxiety is classed as a medical condition or a "mental health disorder/condition" that will require long term medical treatment which normally includes medications and or therapy.

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The five major types of anxiety disorders are:

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• Generalized Anxiety Disorder
  Generalized Anxiety Disorder, GAD, is an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it.

• Obsessive-Compulsive Disorder (OCD)
  Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as hand washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety.

• Panic Disorder
  Panic disorder is an anxiety disorder and is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.

• Post-Traumatic Stress Disorder (PTSD)
  Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.

• Social Phobia (or Social Anxiety Disorder)
  Social Phobia, or Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation - such as a fear of speaking in formal or informal situations, or eating or drinking in front of others - or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people.

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Me personally I suffer with GAD or Generalized Anxiety Disorder, I was diagnosed almost 12 years ago and still to this day face a daily battle against it. Below I describe what GAD is like for me and its symtoms:

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Imagine waking up in the middle of the night your room is pitch black you cant see a thing, your sweating and your heart beat is racing a hundred miles an hour, your hands arms and legs are shaking violently beyond control and you feel weakness in all your limbs, you feel that is hard to breathe and theres a lump in your throat that feels like its getting bigger by the second, your stomach is knotted so tight, You feel like you are dying and that you have something majorly wrong with you! "do I call an ambulance?" "I need to get out of here" "I am going to die!" are some of the most common thoughts rushing through your head. You are scared beyond anything you have experienced before and you feel like you are going to pass out. Then after a few minutes..... NOTHING! it all starts to calm down, your breathing starts to return to normal your heart rate starts to settle, the feelings in your limbs start to come back and your lying there in the bed thinking "what the hell is wrong with me?" This is GAD.

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Lets ake a look at the some of the common symptoms of GAD and why we have this inbuilt into us:

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• Feelings of panic, fear and uneasiness

• Uncontrollable, obsessive thoughts

• Repeated thoughts or flashbacks of traumatic experiences

• Nightmares

• Ritualistic behaviours, such as repeated hand washing

• Problems sleeping

• Cold or sweaty hands and/or feet

• Shortness of breath

• Palpitations

• An inability to be still and calm

• Dry mouth

• Numbness or tingling in the hands or feet

• Nausea

• Muscle tension

• Dizziness

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To be honest with you the list is never ending, over the 12 years I have had GAD new symptoms develop on a regular basis which even includes visual disturbances like "orbs" floating in my vision or white lines. If there is something you are particulary worried about then please do go and see your GP. It is ALWAYS worth getting it checked out!

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So lets look at the history of anxiety disorders and why we have this built in to our bodies and minds:

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Recently, there has been more media on the prevalence of Anxiety, panic attacks and Anxiety Disorders. As more people become aware of the presence of anxiety disorders, there is more interest in the appropriate treatment of these disorders. Anxiety Disorders carry less stigma now as more-and-more people from all walks of life report to their health professionals for treatment.

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It was often thought that Anxiety Disorders and panic attacks were a "women's problem." This is certainly untrue. Although men are more hesitant to present for treatment, both women and men are affected by these Disorders.

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Although Anxiety Disorders have been on recently officially recognized, they have existed throughout the history of mankind. Many great and influential people in history have reported experiencing panic attacks and Anxiety Disorders.

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The various treatments that they received is diverse and sometimes humorous. In many cases, the treatments offered were ineffective, and sometimes quite dangerous to the person. Some treatments that were used previously were various herbs and balms (in the medieval/ ancient times), bathing in extremely cold rivers and streams, hydropathy (applying extreme temperatures to the body), health spas, blood letting (with the use of leeches). With the dawn of psychoanalysis and Freud, many people turned to the therapist's couch as a solution to their experience with an Anxiety Disorder. With the advent of pharmaceuticals, drugs were prescribed heavily for people presenting with an Anxiety Disorder (although it was not called an Anxiety Disorder at this time).

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There have been suggestions that anxiety disorders existed as long back as the cave men days where in actual fact they were useful to them to help escape the dinosaurs and keep themselves aware of the dangers surrounding them. Unfortunatley today we dont have use for this as we dont have such dangers in modern life so our "flight or flight" system activates for no apparent reason.

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Anxiety disorder treatments:

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Before you begin any form of treatment, your GP should discuss all your treatment options with you. They should outline the pros and cons of each and make sure you're aware of any possible risks or side effects.

With your GP, you can make a decision on the most suitable treatment, taking into account your personal preferences and circumstances.

If you have other problems alongside GAD, such as depression and drug or alcohol misuse, these may need to be treated before having treatment specifically for GAD.

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Initial treatment

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At first, your GP may suggest trying an individual self-help course for a month or two, to see if it can help you learn to cope with your anxiety.

This usually involves working from a book or computer programme on your own (you'll be given advice before you start), with only occasional contact with your doctor.

Alternatively, you may prefer to go on a group course where you and a few other people with similar problems meet with a therapist every week to learn ways to tackle your anxiety.

See self-help tips for anxiety for more information on these treatments.

If these initial treatments don't help, you'll usually be offered either a more intensive psychological treatment or medication. These are described below.

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Psychological treatment

If you've been diagnosed with GAD, you'll usually be advised to try psychological treatment before you're prescribed medication.

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Cognitive behavioural therapy (CBT) is one of the most effective treatments for GAD. Studies of different treatments for GAD have found that the benefits of CBT may last longer than those of medication, but no single treatment is best for everyone.

CBT helps you to understand how your problems, thoughts, feelings and behaviour affect each other. It can also help you to question your negative and anxious thoughts, and do things you would usually avoid because they make you anxious.

CBT usually involves meeting with a specially trained and accredited therapist for a one-hour session every week for three to four months.

Your therapist should carry out CBT in a standardised way according to a treatment manual, and they should receive regular supervision to support them in providing the most effective treatments.

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Mindfulness and applied relaxation

Mindfulness and applied relaxation are alternative types of psychological treatment that can be as effective as CBT in treating GAD.

Mindfulness works by focusing your awareness on the present moment and by acknowledging and accepting certain feelings. Being mindful can reduce anxiety caused by the fear of actual situations or sensations, or anticipated ones. It helps to counter the sense of "tunnel vision" that may develop during anxiety. Although mindfulness originates from Buddhism, it doesn't require you to change or take on any religious beliefs.

Applied relaxation focuses on relaxing your muscles in a particular way during situations that usually cause anxiety. The technique needs to be taught by a trained therapist, but generally involves:

• learning how to relax your muscles

• learning how to relax your muscles quickly and in response to a trigger, such as the word "relax"

• practising relaxing your muscles in situations that make you anxious

As with CBT, applied relaxation therapy will usually mean meeting with a therapist for a one-hour session every week for three to four months.

Medication

If the psychological treatments above haven't helped or you would prefer not to try them, you'll usually be offered medication.

Your GP can prescribe a variety of different types of medication to treat GAD. Some medication is designed to be taken on a short-term basis, while other medicines are prescribed for longer periods.

Depending on your symptoms, you may need medicine to treat your physical symptoms, as well as your psychological ones.

If you're considering taking medication for GAD, your GP should discuss the different options with you in detail before you start a course of treatment, including:

• the different types of medication

• length of treatment

• side effects and possible interactions with other medicines

You should also have regular appointments with your doctor to assess your progress when you're taking medication for GAD. These will usually take place every two to four weeks for the first three months, then every three months after that.

Tell your GP if you think you may be experiencing side effects from your medication. They may be able to adjust your dose or prescribe an alternative medication.

The main medications you may be offered to treat GAD are described below.

Selective serotonin reuptake inhibitors (SSRIs)

In most cases, the first medication you'll be offered will be a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). This type of medication works by increasing the level of a chemical called serotonin in your brain.

Examples of SSRIs you may be prescribed include:

• sertraline

• escitalopram

• paroxetine

SSRIs can be taken on a long-term basis but, as with all antidepressants, they can take several weeks to start working. You'll usually be started on a low dose, which is gradually increased as your body adjusts to the medicine.

Common side effects of SSRIs include:

• feeling agitated 

• feeling or being sick

• indigestion

• diarrhoea or constipation 

• loss of appetite and weight loss

• dizziness

• blurred vision 

• dry mouth

• excessive sweating 

• headaches

• problems sleeping (insomnia) or drowsiness

• low sex drive

• difficulty achieving orgasm during sex or masturbation

• in men, difficulty obtaining or maintaining an erection (erectile dysfunction)

These side effects should improve over time, although some – such as sexual problems – can persist.

If your medication isn't helping after about two months of treatment, or if it's causing unpleasant side effects, your GP may prescribe an alternative SSRI.

When you and your GP decide it's appropriate for you to stop taking your medication, you'll normally have your dose slowly reduced over the course of a few weeks to reduce the risk of withdrawal effects. Never stop taking your medication unless your GP specifically advises you to.

Serotonin and noradrenaline reuptake inhibitors (SNRIs)

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 (SNRI). This type of medicine increases the amount of serotonin and noradrenaline in your brain.

Examples of SNRIs you may be prescribed include:

• venlafaxine

• duloxetine

 

Common side effects of SNRIs include: 

• feeling sick 

• headaches

• drowsiness 

• dizziness 

• dry mouth 

• constipation 

• insomnia 

• sweating

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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 – such as feeling sick, an upset stomach, problems sleeping and feeling agitated or more anxious – are more common in the first one or two weeks of treatment, but these usually settle as your body adjusts to the medication.

Pregabalin

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If SSRIs and SNRIs aren't suitable for you, you may be offered pregabalin. This is a medication known as an anticonvulsant, which is used to treat conditions such as epilepsy. However, it's also been found to be beneficial in treating anxiety.

Side effects of pregabalin can include:

• drowsiness

• dizziness

• increased appetite and weight gain

• blurred vision

• headaches

• dry mouth

• vertigo

Pregabalin is less likely to cause nausea or a low sex drive than SSRIs or SNRIs.

Benzodiazepines

Benzodiazepines are a type of sedative that may sometimes be used as a short-term treatment during a particularly severe period of anxiety, because they help ease the symptoms within 30 to 90 minutes of taking the medication.

If you're prescribed a benzodiazepine, it will usually be diazepam.

Although benzodiazepines are very effective in treating the symptoms of anxiety, they can't be used for long periods of time because they can become addictive if used for longer than four weeks. Benzodiazepines also start to lose their effectiveness after this time.

For these reasons, you won't usually be prescribed benzodiazepines for any longer than two to four weeks at a time.

Side effects of benzodiazepines can include: 

• drowsiness

• difficulty concentrating

• headaches

• vertigo

• tremor (an uncontrollable shake or tremble in part of the body)

• low sex drive

As drowsiness is a particularly common side effect of benzodiazepines, your ability to drive or operate machinery may be affected by taking this medication. You should avoid these activities during treatment.

Referral to a specialist

If you've 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: 

• psychiatrists

• psychiatric nurses

• clinical psychologists

• occupational therapists

• social workers

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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 two different medications.

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The advice given on this web page is not a replacment for the treatment and advice given by a medical proffessional, if you have any of the symtoms detailed above then please see your GP or medical practioner as soon as possible to get your diagnosis.

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