Worry never robs tomorrow of its sorrow, it only saps today of its joy.

Leo Buscaglia

Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. These disorders fill people's lives with overwhelming anxiety and fear. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.

Fear and anxiety are a normal--even essential--part of life. They prepare us for danger, creating physiological changes that enable us to effectively respond to a threat. Fear is very straightforward. It arises in response to immediate danger, so it is usually unexpected, very intense, and limited to the situation at hand. Your response to the fear, such as jumping out of the path of an oncoming car, quickly resolves the situation.

Anxiety, on the other hand, is more general and complex. It is felt in anticipation of danger, and is associated with the ability to predict, prepare for, and adapt to change. Often, it lasts a long time, and its cause remains ill-defined. For example, someone uneasy about public speaking may experience a tightness in the stomach for days before a scheduled talk.

As long as there's a good reason for fear or anxiety, and it doesn't interfere with the ability to work, play, and socialize, it is not considered a problem. But when anxiety takes on a life of its own and begins to disrupt everyday activities, the situation is no longer normal. A genuine emotional disorder is now at work... and it's time to see a doctor.

Biochemical theory suggests that biologic imbalances, perhaps among the neurotransmitters in the brain, may be the primary cause of anxiety disorders. Indeed, in one study researchers were able to trigger a panic attack in some people simply by infusing certain chemicals. Many scientists involved in anxiety research now argue that correcting biochemical imbalances with medication should be the first goal of treatment. Other studies suggest that biochemical changes can also be achieved through the psychological and behavioral changes produced by psychotherapy.

Learning theory views anxiety as a learned behavior that can be unlearned. This theory posits that a person's anxiety can be reduced by persistently confronting the feared situation or object. And some people do, in fact, change their thinking and experience significant relief without any medication.

There's little doubt that all our thoughts and feelings are rooted in transmissions between nerve cells in the brain. These signals are passed from cell to cell by chemical neurotransmitters released at the synapse (tiny gap) between one cell and the next.

An imbalance in these neurotransmitters can cause a corresponding shift in our thoughts. But is the reverse also true? Can a determined change in our thinking alter the chemistry in the brain? Many experts are convinced this is true; and behavioral therapy aimed at changing our reactions does, in fact, cure many problems. Indeed, for some disorders, such as phobias, this type of therapy remains the most effective alternative.

Although it's uncommon, certain medical problems can mimic the symptoms of anxiety, or even produce it. The palpitations and shortness of breath caused by an irregular heartbeat can easily be mistaken for anxiety. A clot in the lung (pulmonary embolism) often causes unexplained feelings of anxiety. Neurological problems such as epilepsy and brain disorders can be responsible for symptoms of anxiety. So can anemia, diabetes, thyroid disease, and adrenal problems. In general, these symptoms will disappear when the underlying disease is brought under control, although the anxiety sometimes requires separate treatment.

The anxiety associated with taking or discontinuing medications and other substances can usually be easily relieved once the cause is recognized. It's therefore essential to provide your doctor with a complete run-down of your medicines--including over-the-counter products and of your eating and drinking habits.

Also, research indicates that other brain parts called the basal ganglia and striatum are involved in obsessive-compulsive disorder.

By learning more about brain circuitry involved in fear and anxiety, scientists may be able to devise new and more specific treatments for anxiety disorders. For example, it someday may be possible to increase the influence of the thinking parts of the brain on the amygdala, thus placing the fear and anxiety response under conscious control.

Scientists are also conducting clinical trials to find the most effective ways of treating anxiety disorders. For example, one trial is examining how well medication and behavioral therapies work together and separately in the treatment of obsessive-compulsive disorder. Another trial is assessing the safety and efficacy of medication treatments for anxiety disorders in children and adolescents with co-occurring attention deficit hyperactivity disorder. For more information about clinical trials, for example the National Library of Medicine's clinical trials database.

Before treatment can begin, the doctor must conduct a careful diagnostic evaluation to determine whether your symptoms are due to an anxiety disorder, which anxiety disorder(s) you may have, and what coexisting conditions may be present. Anxiety disorders are not all treated the same, and it is important to determine the specific problem before embarking on a course of treatment. Sometimes alcoholism or some other coexisting condition will have such an impact that it is necessary to treat it at the same time or before treating the anxiety disorder.

In many instances, medications are essential. If you suffer from mania, a major depression, or a paranoid disorder, medications may actually be able to restore you to your normal self. For other conditions, such as schizophrenia, medications control and modify symptoms to the degree that a person can stay in his community. Medications also ease the more distressing symptoms, allowing a person to engage in a therapeutic relationship and re-engage in the activities of her daily life. Sometimes a drug is a useful additional measure during particularly stressful times, perhaps in the initial stage of treatment or at a time of crisis. Those patients with thought disorders or hallucinatory experiences can be maintained only with appropriate antipsychotic medications.

Psychopharmacology, the treatment of psychiatric disorders and emotional distress with medication, has developed over the last fifty years, as our understanding of the workings of the brain has increased in sophistication. When medication is prescribed for mental and emotional illness, the most frequent goal is to restore the chemical balance within the brain, thereby restoring equilibrium to the entire system. Certain drugs function to address certain symptoms, such as when sedatives are prescribed for insomnia. Medications can work to slow disease processes, such as when anti-oxidants are used to treat Alzheimer's. Still other drugs control cravings and curb other problematic behaviors, such as taken to control alcoholism.

Medication is most helpful when there is clear disorder or, sometimes, a specific target symptom for a particular drug. Usually, a pattern of symptoms point to a specific chemical imbalance. Whenever an imbalance appears evident through a person's disordered behavior and emotional state, medication centers on modifying the strength of the signal or readjusting the balance among them.

If you, or someone you know, has symptoms of anxiety, a visit to the family physician is usually the best place to start. A physician can help determine whether the symptoms are due to an anxiety disorder, some other medical condition, or both. Frequently, the next step in getting treatment for an anxiety disorder is referral to a mental health professional.

Remember, though, that when you find a health care professional that you're satisfied with, the two of you are working together as a team. Together you will be able to develop a plan to treat your anxiety disorder that may involve medications, cognitive-behavioral or other talk therapy, or both, as appropriate.

You may be concerned about paying for treatment for an anxiety disorder. If you belong to a Health Maintenance Organization or have some other kind of health insurance, the costs of your treatment may be fully or partially covered. There are also public mental health centers that charge people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan.

Definitions and terms on this page

Anxiety

• A state of uneasiness and apprehension, as about future uncertainties.


• Worry or tension in response to real or imagined stress, danger, or dreaded situations. Physical reactions such as fast pulse, sweating, trembling, fatigue, and weakness may accompany anxiety.

Anxiety disorder

• A psychiatric disorder involving the presence of anxiety that is so intense or so frequently present that it causes difficulty or distress for the individual.

Anxiety disorders

• Any of various disorders in which anxiety is either the primary disturbance or is the result of confronting a feared situation or object; they include obsessive-compulsive disorder and posttraumatic stress disorder.

Fear

• Fear is an unpleasant feeling of perceived risk or danger, whether it be real or imagined.

Depression

• In psychiatry, a symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection.

Mental health

• A state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life.


• The psychological state of someone who is functioning at a satisfactory level of emotional and behavioral adjustment.

Stress

• A state of extreme difficulty, pressure, or strain.


• A physical and psychological response that results from being exposed to a demand or pressure.

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