anxiety Telemedicine

Are anxiety symptoms interfering with my daily life?

The most common type of anxiety disorder is Generalized Anxiety Disorder and is  characterized by experiencing fear and tension regarding a matter without any particular reason for feeling that fear. Having increased anxiety when experiencing stress is normal. However, when the level of anxiety starts to interfere with your ability to do normal every-day tasks then it may be time to seek treatment (Curth et al., 2020). The mean age of onset for generalized anxiety disorder is 30 years old however anxiety disorder may manifest with an emergence of symptoms across the lifespan, and are typically chronic in nature (Zhen Wang et al., 2017).

What are some symptoms of anxiety?

  • Feeling on edge, tense, or restless
  • Having a feeling of oncoming danger, doom, or panic
  • Fast heart rate
  • Fast breathing
  • Perspiration
  • Shaking or trembling
  • Feeling fatigued or tired
  • Feeling unfocused and difficulty concentrating
  • Loss of sleep
  • Having nausea or other stomach upset
  • Difficultly controlling worry
  • Avoidance to things that trigger anxiety

What are the different types of anxiety?

  • Agoraphobia is feelings of fear from certain environments causing avoidance of the places or situations which causes a rise of anxiety symptoms. For example, a feeling of panic may triggered from large spaces.

 

  • Anxiety disorder secondary from a medical condition. It is imperative to be medically checked prior to seeking treatment for anxiety as it may be caused from a medical rather than psychiatric illess. For example, diabetic patients may experience increased anxiety when their blood sugar drops.

 

  • Panic disorder involves sudden episodes of intense anxiety, worry, or terror that reach a peak within minutes (panic attacks). Common symptoms include feelings of imminent doom, shortness of breath, chest pain, rapid heart rate (heart palpitations). Panic attacks might cause fear of anticipation of repeated attacks and the experiencer may avoid situations or places in which they’ve occurred.

 

  • Selective mutism is a condition which consistent failure to talk in situations which they are not comfortable. Environments such as public places can certainly interfere with functioning (Zhen Wang et al., 2017).

 

  • Separation anxiety is noted when a person experiences increased anxiety when their parental figure is removed, separation anxiety may also occur with others who hold parental roles (Zhen Wang et al., 2017).

 

  • Social anxiety disorder (social phobia) involves increased levels of anxiety, fear and avoiding social situations due to feelings of self-doubt, self-consciousness about being judged or viewed in a negative way by others.

 

  • Substance-induced anxiety disorder is characterized by symptoms of intense anxiety or panic that resulting from misuse of drugs, taking medications, commonly occurs during the withdrawal from drugs or alcohol.

 

  • Phobias are specific intense fears of a particular object or scenario such as immense fear of spiders or heights.

 

  • Unspecified anxiety disorder occurs when the anxiety symptoms are not specific to a single classification above but are impairing functionality in some regard.

What causes anxiety?

Some variations of anxiety are typical and appropriate response when the symptoms do not interfere with ability to function. Anxiety may also be a either a primary or secondary diagnosis. The primary manifestation is most commonly due to genetic or environmental factors (Curth et al., 2020). The secondary diagnosis may be attributed to conditions such as ADHD, Panic Disorder, PTSD, Insomnia, or chronic stress. For example, a person experiences a traumatic car accident, subsequently they experience overwhelming fear of going into cars which impacts their ability to use transportation.

Primary diagnosis genetic component assumption may consist of a person recalling this “My mother was very anxious and so is my brother, it just runs in my family.” When evaluating your own anxiety, a consideration would be to take in your current surroundings and weigh your level of stress at that particular moment. Do you recognize any specific trigger? Did you get adequate sleep last night? Are you anxious only in certain situations?

What are some non-medication treatment options for anxiety symptoms?

Generalized anxiety disorder is typically treated by a counselor first, the counselor will typically teach coping skills to help you manage your anxiety (Curth et al., 2020). This process takes time and requires you to be compliant with follow up appointments and to implement the treatment offered.

Supplemental anxiety treatments are activities such as mediation and yoga. Many free materials are located online for both modalities. Mediation requires the subject to be grounded in the moment by an anchor such as breath and over time helps keep the person in the present moment and not fixate on thoughts. Medication management along with counseling has been proven to be more effective than either treatment alone in most psychiatric conditions including anxiety disorder (Curth et al., 2020).

What are some different types of anxiety medications or anti-anxiety medications?

There are two different treatment approaches for anxiety disorder when choosing medication for anxiety. One approach requires daily dosing of a medication which will regulate serotonin over time. Typically, the medication is fully effective by 8 weeks however improvement should be seen in as little as two weeks, typical medications include Selective Serotonin Reuptake Inhibitor (SSRI) or serotonin-norepinephrine reuptake Inhibitor (SNRI) medications (Perna et al., 2016). Another approach may be as needed anxiety medication taken either before anxiety symptoms are anticipated or during the onset of anxiety symptoms (Perna et al., 2016).

Treatment options for as needed medication include Vistaril which elicits a histamine reaction similar to Benadryl, beta-blockers which have been shown to decrease physical symptoms associated with anxiety Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline, some medications in the class of neurological agents used off label (Perna et al., 2016).

Benzodiazepines have been proven to be effective however are not recommended as monotherapy (Rosenbaum, 2020). Additionally, benzodiazepines can have addictive potential if used regularly and long-term use can lead to seizures if the medication is suddenly stopped (Rosenbaum, 2020). Benzodiazepines must be slowly tapered down over the course of weeks to months if the patient has been taking medication daily long-term.

Can my anxiety symptoms be caused by another disorder?

In the spectrum of mental health co-occuring disorders are quite common. When evaluating your present symptoms your provider will evaluate you to determine and appropriate diagnosis or diagnoses. Depending on the patient the provider may determine different levels of severity for each disorder if more than one is present (Arias-Horcajadas et al., 2017). One common and rational target approach is to treat the most significant impairing diagnosis at a time.

During the course of symptom improvement of the primary disorder may lead to improvement in the other less severe manifestations of symptoms (Arias-Horcajadas et al., 2017). In the case with ADHD or attention deficit disorder and anxiety it is commonly reported, which is largely is attributed due to performance, improves as the symptoms of ADHD are lessened without need for additional medication (Vélez-Pastrana, 2020). The same has been noted for anxiety in depression, anxiety and PTSD, anxiety and insomnia, and others (Vélez-Pastrana, 2020).

Rosenbaum, J. F. (2020). Benzodiazepines: A Perspective. American Journal of Psychiatry, 177(6), 488–490. https://doi.org/10.1176/appi.ajp.2020.20040376

Curth, N. K., Brinck-Claussen, U. Ø., Hjorthøj, C., Davidsen, A. S., Mikkelsen, J. H., Lau, M. E., Lundsteen, M., Csillag, C., Christensen, K. S., Jakobsen, M., Bojesen, A. B., Nordentoft, M., & Eplov, L. F. (2020). Collaborative care for depression and anxiety disorders: results and lessons learned from the Danish cluster-randomized Collabri trials. BMC Family Practice, 21(1), N.PAG. https://doi.org/10.1186/s12875-020-01299-3

Zhen Wang, Whiteside, S. P. H., Sim, L., Farah, W., Morrow, A. S., Alsawas, M., Barrionuevo, P., Tello, M., Asi, N., Beuschel, B., Daraz, L., Almasri, J., Zaiem, F., Larrea-Mantilla, L., Ponce, O. J., LeBlanc, A., Prokop, L. J., & Murad, M. H. (2017). Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders: A Systematic Review and Meta-analysis. JAMA Pediatrics, 171(11), 1049–1056. https://doi.org/10.1001/jamapediatrics.2017.3036

Perna, G., Alciati, A., Riva, A., Micieli, W., & Caldirola, D. (2016). Long-Term Pharmacological Treatments of Anxiety Disorders: An Updated Systematic Review. Current Psychiatry Reports, 18(3), 1–16. https://doi.org/10.1007/s11920-016-0668-3

Arias-Horcajadas, F., Basurte, I., Vega, P., & Mesias, B. (2017). Madrid Study (Spain) on the Prevalence and Characteristics of Outpatients With Dual Disorders. Addictive Disorders & Their Treatment, 16(4), 187–200. https://doi.org/10.1097/adt.0000000000000119

Vélez-Pastrana, M. C., González, R. A., Ramos-Fernández, A., Ramírez Padilla, R. R., Levin, F. R., & Albizu García, C. (2020). Attention Deficit Hyperactivity Disorder in Prisoners: Increased Substance Use Disorder Severity and Psychiatric Comorbidity. European Addiction Research, 26(4–5), 179–190. https://doi.org/10.1159/000508829

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