Anxiety disorders first became recognized as abnormal or pathological behaviour at the end of the 19th century, and have since been classified into continuous and episodic anxiety disorders. Anxiety disorders can be divided into generalized anxiety, phobic anxiety, and panic disorders. Also, there are four types of behaviour exhibited by individuals affected by anxiety disorder, which include mental apprehension, physical tension, physical symptoms, and dissociative anxiety. Standardized clinical tests, such as Zung Self-Rating Anxiety Scale, are generally used to assess and diagnose the condition.
Diagnosis of Anxiety Disorders
Anxiety disorders are generally crippling emotional states, with an onset at an early age or after an unexpected triggering event. These disorders are known to be accompanied by headaches, increased perspiration, muscle spasms, palpitations and hypertension, all of which are known to lead to fatigue and exhaustion. In clinical terms, ‘anxiety’ stands for an uncomfortable emotional state provoked by unidentifiable elements, while ‘fear’ is an uncomfortable emotional state brought upon by a distinguishable foreign threat. Both fear (phobia), as well as anxiety, are included in the concept of ‘anxiety disorders’. Making a proper diagnosis is particularly challenging because anxiety disorders are usually comorbid with clinical depression. The symptoms of the two overlap, and both are triggered by similar stimuli, which results in high rates of comorbidity. In addition, sexual dysfunction often goes hand in hand with anxiety, in particular with panic disorders, but it is difficult to conclude whether anxiety causes the dysfunction or they are both triggered by the same stimuli.
Treatment for Anxiety Disorders
When it comes to treating anxiety, it is of crucial importance to diagnose it early, as many patients only start to seek help after the onset of clinical depression or substance abuse problems. Therapy choices include lifestyle changes, psychotherapy, in particular cognitive therapy, and pharmaceutical therapy. Research has shown that the best results are yielded by combining cognitive therapy elements with medication.
In treating panic disorders and social phobias, cognitive behavioral therapy has been highly beneficial. The cognitive component forces the patient to question the certainty with which particular stimuli will trigger an unwanted response, whereas the behavioral component focuses on changing people’s reactions when faced with the troubling stimuli. One of the key elements of this type of therapy is gradual exposure, or forcing of the individual to constantly face the feared situation until the he or she learns to perceive it and react to it differently. Therapy is also organized around keeping a
journal for recording past and current patterns in behavior, which are then analyzed with the help from a therapist.
Combining psychotherapy with medications can be highly advantageous for certain individuals suffering from anxiety disorders. Venlafaxine, benzodiazepines, phenelzine, and tranylcypromine are known to be effective. There is also evidence that some of the more recent drugs, such as antidepressants mirtazapine and pregabalin, can also help. Finally, imipramine along with some antipsychotics such as quetiapine, and hydroxyzine are sometimes prescribed as well. One should always keep in mind that any kind of medication needs to be used with extreme caution and only under the guidance of a therapist.
Selective Serotonin Reuptake Inhibitors (SSRIs) and Other Drugs
Selective serotonin reuptake inhibitors (SSRIs), a kind of antidepressants, are usually the first choice of many therapists as they have repeatedly proven as highly favorable. The first such medication approved by the Food and Drug Association in the US was Paxil, which brought about a lower risk of tolerability and dependency than some of the older drugs. As with any medications there are side effect, and these include headaches, nausea, insomnia, and change is sexual behavior. Other than SSRIs, a therapist may prescribe benzodiazepines, such as alprazolam and clonazepam, which are both used for short-term aid during severe anxiety episodes. Benzodiazepines are only recommended for those who do not respond well to SSRIs, as these medications can lead to the development of tolerance and dependency. In addition, the recent antidepressant mirtazapine has been used rather successfully and frequently to treat social anxiety disorders, considering that it produces fewer side effects compared to SSRIs. However, meta-analysis suggests that the best results will be produced if a patient is subjected to both psychotherapy and pharmacotherapy.
Alternative Medicine for Dealing with Anxiety Disorders
Manageable things that can be done at home, or in particular without the supervision of a therapist, but that are also important in dealing with anxiety disorders are regular aerobic exercise, improving sleep, and reducing caffeine intake. Some herbal medications, and natural remedies, such as kava, have also been tested and proven effective. Inositol also has moderate effects on people suffering from panic disorder or obsessive-compulsive disorder.
Finally, it should be noted that anxiety disorders have about 29% lifetime prevalence in the United States, and they are also the most frequent and generally accepted factor producing disability in the workplace.