How to stop anxiety attack?

How to Stop an Anxiety Attack

If you’re reading this article, chances are you’ve had an anxiety attack or saw one happen to someone you care about.

That can be a cue to think about remedies. Then, if it happens again, you will be prepared.

Psychologists speak of panic attacks rather than anxiety attacks. Anxiety is ongoing. A panic attack is when your fear is acute and for a short period, you can’t function normally. During a panic attack, your heart is racing, or you might feel weak, faint, or dizzy. Your hands and fingers may tingle or feel numb. You’re sweating or getting chilled. Your stomach churns or aches. You may have chest pains or pant. You feel dread or are overwhelmed.

If you have panic disorder, the panic attacks come repeatedly and may be unpredictable. Nearly 5 percent of American adults and more than 2 percent of teens experience panic disorder at some point. The trouble runs in families and may be involved with another anxiety problem. For example, someone with obsessive-compulsive disorder (OCD) may have a panic attack if they can’t engage in a ritual like checking the door handle repeatedly to see that the door is closed. If you’re afraid of heights, you might have a panic attack on a mountaintop.

How to stop an anxiety attack: Try these techniques in advance and when you feel panic coming on, choose one to do in the moment. You might do two or more in a sequence.

  1. If you learn a breathing technique in advance, you can bring it out when you’re panicking. You might learn alternate nostril breathing. In another approach, you breathe in through your nose for a count of five, hold it for five and breathe out through your mouth for a count of five. You might breathe in for a count of five and breathe out while counting to ten. You might breathe slowly through your belly, rather than your chest. This is especially important if you are breathing fast—hyperventilating—which makes the panic worse.
  2. Close your eyes if you think you are being triggered by the environment.
  3. Remember a time or place you associate with peacefulness and summon the sensations in detail.
  4. Focus on relaxing the fingers in your hand, then your wrists, then your arms, moving through your body slowly.
  5. If panic is coming from your thoughts, direct your mind outwards. Notice your environment. Focus on one thing and see if you can notice it in great detail, making new observations. Or you could look for four things you can see, three things you can touch, two that smell, and one you can taste.
  6. Distract yourself. You could count backward, starting from 100. You could add up all the loose change in your wallet. The point is to give yourself a task hard enough that it requires focus, but not so hard you trigger more fear.
  7. Play with ice. It’s easiest if you keep gel packs in your freezer. You can take one out and hold it, or hold one in each hand. You might put one on your lower belly if you can lie down.
  8. After consulting a mental health professional, take a benzodiazepine like Klonopin. Anti-anxiety drugs often work quickly. But they are addictive so it’s important to learn other techniques and work towards lowering your overall anxiety, rather than relying on the prescription.

A version of this story appears on Your Care Everywhere.

What can panic attacks actually do to you?

Panic attacks can feel like imminent death, insanity, fainting, or some other terrible loss of control. So it’s helpful to know something about what a panic attack can, and can’t, do to you.

If you have anxiety attacks and phobias, it can be very hard to believe that you’re not in danger. Panic is an effective Trick, and is very good at convincing you that you are in danger.

Don’t struggle to be sure. That’s not the way out of the panic problem. If you try to be 100% sure, with no doubts or “what if…” thoughts in your mind, you will never get there. Panic attacks create worry within you, but just because you worry, doesn’t mean you’re in danger.

Read through this material and keep an open mind. Compare it to your history with panic. Don’t struggle with it. If you find it hard to believe, leave room for your doubts. Browse through other parts of the site, and come back to have another look in the near future.

Let’s consider the typical fears of a person having an anxiety attack.

Fear of Dying

You think you are dying of a heart attack, or perhaps from lack of air. It feels that way, as best you can tell, since you haven’t died before, but neither one happens. This is what makes a visit to the Emergency Room with a panic attack such an unsatisfactory experience. It’s not a life threatening emergency, just an imitation of one.

The chest pain you experience during an anxiety attack is real, not imagined. But it’s pain in your chest muscles, not your heart. Those muscles hurt because you’ve been breathing in a way which makes them tight and tense.

The sensation of not getting enough air is also due to the shallow breathing. It’s uncomfortable, but not dangerous. You have ample air to live on, and even to talk.

The way to soothe these symptoms is by switching to belly breathing.

Fear of Going Crazy

Many people think that, if you get afraid or anxious enough, you will “go crazy”. But you won’t. Veterans of hundreds of attacks can tell you, they believed it each time and it never happened.

If you have an anxiety disorder, you will experience recurrent episodes of anxiety until you’ve found a solution. But that’s what you will have, anxiety. You don’t graduate and move on to something else. It doesn’t matter how many anxiety attacks you have, you don’t accumulate enough credits to trade up to psychosis. You won’t “get promoted” to schizophrenia!

Fear of Fainting

This is a very common fear among people suffering from panic attacks. First, here’s a little background.

People think of fainting as belonging to the same category as heart attacks – a terrible physical calamity. But fainting is actually a valuable way the body protects itself.

Do you know what causes a person to faint?

It’s caused by a sudden, significant drop in blood pressure. When blood pressure drops this way, there is a chance the brain won’t get enough blood, because it’s at the highest point of the body. That’s no good – your brain needs a steady supply of the oxygen the blood carries. So when your body can’t get enough blood to your brain because of low blood pressure, it protects you by bringing your brain down to the blood. The faint ensures a blood supply to the brain by bringing your head down to the ground.

If we had our brains in our feet, there wouldn’t be any such thing as fainting, but tap dancing would probably be banned.

Here’s the key point: What do you think is happening to your blood pressure during a panic attack?

It’s going up. Probably not a lot, but it’s doing the opposite of what you need to faint. So it’s extremely difficult to faint during a panic attack. In order to faint during a panic attack, you need to have some other physical circumstance or condition which lowers your blood pressure to such a degree that it overcomes the increase.

It’s not impossible, but extremely rare. Some people have a condition, called a syncope, which can result in a faint during panic. If you have such a condition, you would probably have a history of actual faints (not “almost fainting”, actual faints) by the time you’re in your thirties. Some people have what’s called a Blood Phobia, and they can faint when they see blood. That’s not an uncommon condition, but it’s very different from Panic Disorder.

In more than 20 years of treating patients with Panic Disorder, I’ve seen four who had actual fainting episodes. Certainly it was of little comfort to them that it was so rare and, if you have a history of actual fainting episodes, you have to learn how to manage them and protect yourself. But if what you have is a history of fearing a faint, of feeling like you were about to faint, of thinking you just narrowly dodged a faint, and so on, in the absence of any actual fainting episodes, then what you are troubled by is a fear of fainting in the absence of any actual fainting.

While fainting almost never occurs, the fear of fainting is extremely common among people with Panic Disorder. This is because people often feel dizzy and lightheaded during a panic attack, and mistakenly associate this with fainting. People who have never fainted in their lives will say “it feels like fainting”. That’s part of the Panic Trick. These sensations are the result of shallow, labored breathing, and have nothing to do with fainting. A good belly breathing exercise will quickly clear up these sensations of feeling lightheaded and dizzy.

Public Humiliation

People with Panic Disorder often fear that they will act in such a crazy, “out of control” manner that others will fear and loathe them, and avoid them thereafter.

However, there’s usually very little about a panic attack that’s visible. While you may feel like you’re “out of control”, you’re probably still walking in an ordinary way toward the exit of the supermarket, or the theater, or wherever you happen to be.

In my experience, most people having a panic attack continue to act in an ordinary and amiable way, showing no particular sign of external distress, even as the panic rages within them. It’s usually hard to tell when a person is having a panic attack. If they don’t tell you, you probably won’t notice.

This often causes conflict in the family, when loved ones say things like “You look okay to me”, but this is why these fears of public displays typically don’t come to pass. You may well feel embarrassed. You may feel sure that others are secretly laughing at you, or thinking that you’re weird. You may worry that you will look, and act, so bizarrely as to be driven out of society and left to live with wolves. But this is another part of the Panic Trick.

What Can Panic Attacks
Actually Do to You?

They scare you. You get scared, real scared. They fill you with Discomfort, and trick you into reacting as if you’re in Danger.

And if you don’t get some good information about Panic Disorder shortly after the first attack, you’re likely to start developing ongoing fears of having more attacks, and to develop phobias.

That’s the real danger of Panic Disorder. It can lead you to become so fearful and phobic that you give up many ordinary and enjoyable parts of life.

Back to Panic Disorder from What Can Panic Attacks Do to You
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Last updated on January 13, 2020

What You Fear The Most Cannot Happen

A panic attack is a horrible and terrifying experience, but it is not in any sense “dangerous”. Panic disorder is actually a natural bodily reaction that is occurring OUT OF CONTEXT.

For example, when we feel our survival is somehow threatened, all mammals have an instinctual response to either fight or flee. This response produces a sudden surge of adrenaline, accompanied by strong feelings of anxiety and panic, and a very intense urge to flee or escape the fearful situation or circumstance.

It is interesting that the intensity of the reaction and the strong urge to flee are things that would ensure your survival if you were truly in danger.

The flow of adrenaline and the resulting extra blood flow increases your strength and awareness of the danger. This extra “awareness” of the perceived danger may cause all sorts of feelings, such as dizziness, nausea, hyperventilation, heart palpitations, confusion, lack of control, unreality, being dazed, shaking, trembling, and sweaty palms, among others.

During a panic attack, your body goes through the same physical processes as it would if you were in real danger. The DIFFERENCE, of course, is that although you feel you are in danger, you really ARE NOT. That you undergo panic attacks — without knowing why — only makes the situation much more frightening.

Because of these feelings of panic, it’s very common to “invent” or attribute danger to the accompanying bodily symptoms. Remember, though, that NO ONE has ever had these things happen to them as a result of a panic attack:

“I’M GOING CRAZY”

No one with panic attacks and anxiety has ever gone “crazy”. In fact, because you realize that you have panic attacks, this is just another indication that you are not going crazy. People that “go crazy” lose contact with reality. Anxiety people are TOO much in contact with reality. Thus, people with panic and anxiety problems NEVER “go crazy”. It simply cannot happen.

“I’M GOING TO PASS OUT”

Temporary dizziness leads people with panic to feel that they may pass out. This is not possible because, during panic, your heart beats faster, and your blood pressure rises. As the blood pressure rises, it becomes impossible for you to “pass out”. When people faint or “pass out”, it’s because of a sudden DROP or lowering in blood pressure.

“I’M HAVING A HEART ATTACK”

When the heart begins to beat quickly and people experience “palpitations”, they sometimes feel a heart attack is occurring. In the first place, the heart can beat quickly and continuously for a long period of time without causing any damage. Although heart palpitations seem to occur in the left side of the chest, there are many DIFFERENCES between panic attack and a real heart attack. During a real heart attack, the primary symptom is a crushing sensation inside the chest and a pain that is continuous. During a panic attack, the attention is focused on the quick and rapid beating of the heart itself. (“I can hear my heart beating even in my ears!”) People having panic attacks are NOT experiencing heart problems. A real heart attacks produces crushing internal pain that doubles people up and drops them to the floor. They DO NOT hear their heart beating nor do they care. The intense, crushing pain is the only thing they can pay attention to.

“I WILL STOP BREATHING AND SUFFOCATE”

Sometimes panic people feel that because they can’t catch their breath (and are hyperventilating), they will suffocate. This is impossible because you cannot pass out and suffocate. It feels like you can, because the mixture of oxygen and carbon dioxide in your bloodstream is out of proportion. That is why people feel weak, dizzy, lightheaded, and faint. Suffocation is not a possibility during a panic attack. In a few moments, as the body gradually calms down, breathing returns to normal, and the other symptoms gradually go away.

“I’M LOSING CONTROL”

Experiencing many anxiety symptoms all at once can cause a person to feel that they are “losing control” of themselves. Sometimes the fear is of acting nervous and foolish in public where others will be able to notice. Sometimes the fear is of being rushed to the hospital in an emergency vehicle. For other people, it is the fear that losing all control proves they are crazy and may have to be institutionalized. Actually, the fact that you think you could “lose control” guarantees that this is not really possible. The only people who really “lose control” are people who are not aware of this and are not ever concerned or bothered by “losing control”.

Although the thoughts and feelings of anxiety and panic are all too real, the brain is being tricked into thinking that you are somehow in danger — when actually you are not. Part of effective therapy includes realizing this, and slowly changing ingrained thought patterns. Another part of therapy is in actually tapping the emotional side itself — to quiet and relax the mind so that anxiety and panic will have no choice but to eventually disappear.

Active, cognitive/behavioral therapy has been shown by research to be the most effective therapy in dealing with the anxiety problems. Usually, there is no reason to rehash the past and analyze it to death. In fact, the more you think and analyze your problems, the worse you make your condition. (Analysis = paralysis). Instead, a focus on making the present better so that the future is anxiety-free is the best and most permanent course of action to take.

Today, panic is being successfully treated in the vast majority of cases. Active cognitive-behavioral therapy plus a strong motivation and persistence on the part of the client are the essential ingredients in overcoming this major anxiety disorder.

Anxiety & Fainting: Can Anxiety Cause You To Faint?

Losing consciousness is one of the greatest fears that people have about their health. As long as you’re alert you can make decisions and contact help if something is wrong. When you’re unconscious, you’re no longer in control. The prospect of fainting is one of the most frightening things that can happen to someone, with or without anxiety.

So it’s no wonder that feeling faint is considered by many to be one of the most frightening symptoms of anxiety. During anxiety – especially intense anxiety – it can feel as though you’re about to pass out, and this can spark a fury of panic that is hard to stop.

Fainting and Feeling Faint

Only a doctor can diagnose the cause of feeling faint and fainting. There are physical issues that can lead to fainting, such as a heart condition. If you actually faint for no apparent reason, or if you feel like you are going to faint (such as lightheadedness), seeing a doctor is a smart decision, even if you believe you have anxiety.

But feeling like you’re going to faint is often a symptom of anxiety, especially if you suffer from panic attacks.

What Causes Feeling Faint?

When you suffer from anxiety, feeling faint is almost exclusively caused by hyperventilation. Also known as “over-breathing,” hyperventilation occurs when you unintentionally breathe out too much carbon dioxide as a result of unhelpful breathing habits.

Interestingly, hyperventilation feels like the exact opposite – when you’re hyperventilating, it often feels as though you’re not getting enough oxygen. So those that are hyperventilating have a tendency to try to take even deeper breaths – breathing in more oxygen to compensate.

This makes it worse. The abundance of oxygen and the depletion of CO2 causes your blood vessels to constrict, which reduces blood flow to the brain. When your brain doesn’t feel like it’s getting enough blood to your brain, it responds by dropping you to the floor, because the easiest way to make sure blood flow reaches your brain is when you’re on the the ground.

Feeling Faint Isn’t Dangerous

Of course, when people hear that their brain isn’t getting enough blood, they get worried. Rest assured that feeling faint from anxiety isn’t dangerous in the slightest, and can’t cause any long-term health issues.

That said, if you are fainting regularly you should make sure that you see a doctor to rule out medical issues. Also, while fainting is not in itself unsafe, although fainting in dangerous places can put you at risk for hitting your head on sharp objects, and feeling faint while driving can impair driving ability.

Why Do You Hyperventilate?

Hyperventilation is caused by breathing changes – breathing changes that are extremely common in those with anxiety. The most well-known type of hyperventilating occurs during moments of intense panic, when you find yourself breathing in and out at a fast rate.

But that’s not the only way that people hyperventilate. You may also simply be breathing at a rate that is too shallow. This is especially true of those that tend to breathe through their chests – a common issue with those that have anxiety.

Also, many people with anxiety think about their breathing. When you focus on your breathing, you start to consciously control it. Your body doesn’t need that much oxygen, and often takes very small, slow breaths to compensate. So small and so slow that those that think about their breathing often take deeper breaths than they need. This also can cause hyperventilation.

Other Causes of Faint From Anxiety

Another cause of fainting comes from phobias. For example, there are those that faint at the sight of a needle or blood. This type of fainting is known as vasovagal syncope. It involves a sudden and rapid loss in blood pressure that causes the person to immediately drop to the ground as a result.

Fascinatingly, only blood, needles, and a fear of injury are linked to this type of fainting. Other types of phobias are associated with an increase in blood pressure, where fainting is unlikely.

How to Stop Feeling Faint

It’s not that common for those with non-phobia anxiety to actually faint in relation to anxiety. It’s possible, and it does happen in cases of extreme hyperventilation, but it’s fairly rare. If you faint without a clear medical cause, it may be due to some of the other causes of fainting:

  • Overexertion from exercise.
  • Overheating (hot showers after exertion can cause faint).
  • Standing up too quickly (can cause low blood pressure to the brain).

Remember, there’s no harm in seeing the doctor if you’re concerned. Your doctor can easily rule out most of the dangerous causes of feeling faint. But it is an anxiety symptom. If you have reason to believe you’re suffering from anxiety, it’s highly likely that your experience is the result of hyperventilation.

If you’re feeling faint, the first step is to go against your instinct and try not to take in more air than you can handle. You need to add more CO2 to your bloodstream. You can do this by taking slower breaths and trying to breathe in through your stomach, rather than your chest. Also, once you’ve breathed in, hold your breath for a few seconds before slowly exhaling.

Often you’ll notice your feeling faint comes with other symptoms as well. All of these symptoms represent signals that your body is giving you about your anxiety.

Pay attention to these symptoms, and if you believe you have severe anxiety, seek treatment. Anxiety disorders are a highly treatable condition. But only a fraction of those with anxiety seek some type of treatment. Between cognitive behavioral therapy, medications, and self-help, managing your anxiety is possible. You just need to take the first step.

People who experience generalized anxiety disorder (GAD) exhibit excessive concern about multiple events or activities most days of the week. While it is not unusual for people to experience some stress as they go about their daily lives, GAD sufferers rarely get a break from worrying.

Although some of the symptoms and reactions may be similar to those of a phobia (an extreme, irrational fear), GAD is not a direct response to a specific situation or experience. Sufferers experience unease that casts a shadow over all of their activities.

While not nearly as intense as a panic attack, the unease lasts much longer and almost doesn’t let up, according to the National Institute of Mental Health (NIMH).

“It is just a constant feeling of dread,” said Thelma Duffey, professor and chairwoman of the Department of Counseling at the University of Texas at San Antonio, a licensed counselor and president-elect of the American Counseling Association. “Patients have a constant feeling of tension and anxiety that never goes away. They worry about things that have not yet even happened.”

GAD affects about 6.8 million American adults, and strikes twice as many women as men, according to the Anxiety and Depression Association of America (ADAA).That translates to about 3.1 percent of the adult population suffering from the disorder, and about one-third of those cases can be classified as severe.

Symptoms of GAD

Though people who suffer from GAD worry about the same things that other people do — relationships, money, health, work, etc. — they have a much higher level of worry that is nearly constant. The level of concern is not in sync with reality and is greatly magnified. Most people with GAD realize that their concerns are overblown, but they cannot seem to shake their anxiety, according to the NIMH.

Duffey said GAD patients are aware that their anxiety level is high compared to that of others, but they feel shame and embarrassment to address the problem. “They know better, but they can’t help the negative thoughts,” she said.

Both children and adults can develop GAD, and symptoms can come on slowly, according to the Mayo Clinic. But in some instances, a major life event, such as a change in health, or a life transition such as a divorce, can trigger the onset of GAD, Duffey told Live Science.

“GAD patients have always been anxious to some degree, but an event such as a car accident, poor grades, relationship or work difficulties can enhance their anxiety,” she said.

The symptoms tend to ebb and flow but can be exacerbated during times of stress. What sets the worry of GAD suffers apart from normal stress is that the worry is intrusive, excessive, debilitating and persistent — lasting for more than six months, according to the NIMH.

Fatigue, nausea, muscle tension, nervousness, sweating, irritability and trembling are some of the physical symptoms of GAD, according to the Mayo Clinic.

Sleeplessness is another sign of GAD, because people with the disorder often feel as if they can’t stop their mind from racing, Duffey said. People with GAD can also be very indecisive or have a fear of making the wrong decision, can overthink and have difficulty concentrating or have the feeling that their minds are “going blank”

Like those with panic disorder, GAD sufferers have difficulty with everyday tasks, the NIMH noted. However, people with GAD are not gripped by an overwhelming fear and are typically able to function. However, some may be unable to perform even routine tasks during times when their symptoms are the worst, according to the NIMH.

Causes

GAD may run in families, although as with all mental-health issues, the causes are typically a combination of biological and environmental factors, according to the Mayo Clinic.

“It is likely due to a combination of stress and environmental factors that contribute to the expression of genes in individuals who are born with the risk/vulnerability to develop the condition,” said Dr. Andrew Gilbert, a psychiatrist and medical director at the Hallowell Center in New York. “Since GAD can emerge in adolescence, there are some interesting developmental/pediatric studies suggesting that individuals born with particular temperaments and/or wiring in their brains may be more vulnerable to develop GAD.”

An imbalance of naturally occurring brain chemicals — such as serotonin, dopamine and norepinephrine — is often seen in people with GAD and could be an indicator of a propensity to develop the disorder, according to the Mayo Clinic. An imbalance of these chemicals, called neurotransmitters, can impact emotional stability and mental well-being.

Enduring a trauma, especially during childhood, is also linked to GAD, according to the Mayo Clinic. Those who experienced abuse or trauma as a child, including witnessing a traumatic event, are at higher risk of developing generalized anxiety disorder.

Connection to addiction

Those with anxiety disorders are two to three times more likely than the general population to abuse alcohol or other substances at some point in their lives, according to the ADAA. About 20 percent of Americans with an anxiety or mood disorder, such as depression, have an alcohol or other substance-abuse disorder, according to the ADAA.

GAD sufferers are cautioned to avoid alcohol and drug use, even nicotine and caffeine, which can increase anxiety, according to the Mayo Clinic. However, as quitting can also cause anxiety, they recommend you see a doctor for a treatment program or support group that can help.

Treatment

GAD can be treated with psychotherapy, medication or both, according to the NIMH.

A type of psychotherapy called cognitive behavioral therapy (CBT) is a common method used to treat GAD and can be very helpful, according to the NIMH. This therapy teaches a patient new ways of thinking, behaving and reacting to situations.

“Numerous studies have found CBT effective treatment for GAD in children, adolescents and adults,” Gilbert said.

Many GAD sufferers also benefit from self-help and support groups, where they can share their challenges and discuss coping mechanisms, according to the ADAA.

Various types of medications can also be useful for treating GAD, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Duffey said that while medication can be helpful for some GAD patients, she advocates for treatment that emphasizes lifestyle factors, such as nutrition, exercise and establishing a routine.

“I focus on knowledge, as knowledge is power and can provide a sense of hope and safety, as well as self-empowerment and self-acceptance,” Duffey said.

“Don’t give up on treatment too quickly. Both psychotherapy and medication can take some time to work, ” the NIMH website states. “A healthy lifestyle can also help combat anxiety. Make sure to get enough sleep and exercise, eat a healthy diet, and turn to family and friends who you trust for support.”

Additional resources:

  • More information on anxiety disorders, from NIMH.
  • What is Anxiety? From Anxiety.org
  • Tips for dealing with anxiety, from ADAA.

This article is for informational purposes only and is not meant to offer medical advice. This article was updated on Nov. 6, 2018 by Live Science Staff Writer, Yasemin Saplakoglu.

Parkinson’s Disease Complicated by Anxiety

A 39-year-old man had a history of idiopathic Parkinson’s disease, which had begun with a rest tremor of the left arm and leg. This disorder progressed for 6 years and ultimately resulted in a generalized slowness in all activities, diminished speed of fine motor movements, sialorrhea, loss of facial expression, diminished arm swing, a rest tremor, rigidity of all four extremities, and a festinating gait. The patient also had had a lifelong history of anxiety disorders. As a youngster, he had had an intense fear of public speaking that had caused poor scholastic performance and intermittent truancy; subsequently, this fear prevented him from attending college.

Social anxiety had caused him to withdraw from sports in high school. Over the years, he had also complained of symptoms consistent with panic attacks, and he had had numerous psychiatric consultations because of symptoms of anxiety. The patient described himself as having rigid, perfectionistic personality traits.

After Parkinson’s disease was diagnosed, the patient experienced a worsening of his psychiatric difficulties. Panic attacks, characterized by shaking, palpitations, tachypnea, flushing, nausea, headache, and diarrhea, developed. The attacks were associated with fear and an urge to escape the present situation when such an attack occurred. These episodes were precipitated by his being watched by others, driving a car, entering crowds, or going into public places in general. Because of his fears, he eventually became confined to his home and was unable to work. In addition, he was ruminative, was self-conscious, and had terminal insomnia. He suffered from anhedonia, decreased energy, decreased libido, loss of appetite, and vague suicidal ideation. After Parkinson’s disease was diagnosed and his symptoms of anxiety worsened, he had been treated with sedatives (alprazolam and lorazepam) and antidepressants (doxepin, amitriptyline, trimipramine, maprotiline, and imipramine) in doses that, retrospectively, were probably subtherapeutic. He failed to benefit from these treatments.

After referral to our facility for neurologic and psychiatric care, the patient was hospitalized on an open psychiatric unit. At the time of admission, he was taking trimipramine (50 mg at bedtime), diphenhydramine (100 mg at bedtime), lorazepam (2 mg three times daily), and Sinemet (carbidopa-levodopa, 25 mg:100 mg, 2 1/2 tablets six times daily). Physical examination at the time of admission revealed a coarse tremor of all four extremities, shuffling gait, hypokinetic speech, bradykinesia, mild rigidity, and decreased facial expressions. He was mildly anxious and dysphoric. Assessment of the mental status disclosed no other abnormalities. Screening laboratory studies showed findings within normal limits. Results of testing of a urine specimen for heavy metals and a drug abuse survey of the urine were negative or within normal limits.

During hospitalization of the patient, we noted that situations such as group psychotherapy, conjoint sessions with his wife, or planned visits to his workplace provoked subjective feelings of anxiety, consistent with a panic attack; during these situations, his parkinsonian symptoms were notably worse. Extra doses of carbidopa-levodopa did not control the worsened symptoms. When the stressful factors were removed, the patient’s anxiety and neurologic status returned to baseline in hours to days. The relationship between increased subjective anxiety and worsened parkinsonian symptoms persisted throughout the hospitalization.

So that use of lorazepam could be safely discontinued, a regimen of chlordiazepoxide hydrochloride was begun at 125 mg daily and tapered during a 10-day period. Use of trimipramine maleate was discontinued, and desipramine therapy was started. The dosage of desipramine was gradually increased to 300 mg daily. This dosage yielded a blood level of 106 ng/ml (therapeutic range, 125 to 275 ng/ml), but attempts to increase it failed because of side effects. Carbidopa-levodopa therapy was continued at the admission dosage, but the dosage of diphenhydramine was decreased to 75 nig at bedtime because of anticholinergic side effects. A behavioral program was begun to help the patient cope with his phobic avoidance of various environmental stimuli. An overall improvement was noted in the patient’s psychiatric and neurologic conditions before dismissal—the vegetative symptoms gradually remitted, anxiety decreased, mood and affect brightened, and socialization increased; moreover, the parkinsonian symptoms were well controlled. When the patient experienced anxiety, however, it was always associated with a worsening of his parkinsonian symptoms. The patient noticed the association between his anxiety and parkinsonian symptoms and became convinced that he was suffering from an anxiety disorder only and not Parkinson’s disease. Consequently, the patient claimed that he secretively reduced his dosage of carbidopa-levodopa to 1 1/2 tablets six times daily for an unknown duration. Interestingly, this alteration in his medication was not associated with a recognizable increase in his symptoms of parkinsonism.

After 30 days of hospitalization, the patient was dismissed with a diagnosis of Parkinson’s disease, agoraphobia and associated panic attacks, social phobia, and psychologic factors affecting a physical condition. The depressive symptoms were thought to be attributable to the anxiety disorders or Parkinson’s disease.

Mental-health Resources

One way to understand anxiety is to consider anxiety as a normal emotion. In fact, it is a normal response when someone is truly in danger. For instance, pausing before you cross the road is a good thing. That pause allows you to be wise in a dangerous situation. When we are in danger, our brains and bodies react in a fight, flight or freeze response. We either want to run, become aggressive, or freeze. These are survival responses when we are in true danger. Yet, anxiety causes people to be in this state of high alert a lot of the time. In this way, it is like a fire alarm is going off in your mind and yet often there is no real danger.

In discerning a possible anxiety disorder from normal anxiety, consider the source of the worry and fear, and then reflect on whether your response and experience is proportional to it. For instance, it is natural to have some degree of anxiety about snakes and spiders — but for some people, the anxiety assumes such a large role in their lives that they may never go outside again. Other times, discerning between a possible anxiety disorder and normal anxiety is more quiet and subtle. It can involve excessive fears and worry that play over and over again in your mind, yet those fears are less visible in terms of your behavior. In this way, it is possible to suffer from an anxiety disorder in silence, with no one even really knowing the degree to which it affects your life.

Symptoms of anxiety include emotional symptoms such as feeling tense, feelings of dread, irritability and restlessness, and being watchful for any signs of danger. Physical symptoms include shortness of breath, feeling your heart racing, sweating, trembling, headaches, fatigue, nausea, and an upset stomach. Other symptoms include having trouble concentrating or thinking about anything other than the impending worry, having trouble sleeping, and having the urge to avoid things that trigger anxiety.

What causes anxiety?

Anxiety is often caused by a multitude of factors. Many of these factors are interconnected, as our mind, emotions and body are all so integrally connected to one another. These factors include the following:

  • Environment: Stressful events, especially chronic stress or traumatic events, often lead to the development of an anxiety disorder. Unrelenting life stress activates stress hormones such as cortisol, leading to a state of high alert all the time. This high activation of stress hormones actually suppresses the immune system, which then can cause more stress and anxiety.

  • Brain chemistry: Many anxiety disorders involve disruptions to hormones and electrical signals in the brain. In addition, chronic stress and trauma alter brain structure and function in such a way that a person reacts strongly to various triggers that would not normally have caused anxiety.

  • Genetics: Studies support that anxiety may be more common in families when other relatives suffer from an anxiety disorder.

  • Medical factors: Other medical conditions may lead to the development of an anxiety disorder. This can be directly, for example through side effects of medication, or indirectly, through significant stress caused by a serious medical condition with significant pain and lifestyle adjustments.

  • Use of or withdrawal from an illicit substance: Substance use may trigger anxiety. Also, when someone is trying to quit using drugs or alcohol, they may find themselves experiencing a great deal of anxiety that might have been numbed and not felt as much while using substances.

What are the different types of anxiety?

The most common type of anxiety disorder is Generalized Anxiety Disorder (GAD) which causes chronic worry about everyday life. The worry is so significant that it may actually make it difficult for someone to concentrate and finish tasks. The worry is persistent and exhausting.

Several other types of adult anxiety disorders exist, including the following:

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