Anxiety Disorders
Treatment for excessive or persistent anxiety that interferes with daily life
What is anxiety disorders?
Anxiety itself is normal and useful. It becomes a disorder when it is out of proportion to the situation, keeps going when the situation has passed, and starts deciding what you will and will not do.
It takes several forms. In some people worry is general and attaches itself to whatever is available, running most days for months. In others it is tied to being watched or judged by other people, or to one specific thing such as travel, injections, lifts or examinations. The pattern matters because treatment is shaped around it.
The causes are mixed. Anxiety disorders run in families, temperament plays a part, and sustained stress brings them out. Several ordinary things feed them: caffeine, nicotine, alcohol and the rebound the morning after it, disturbed sleep, some prescribed medicines, an overactive thyroid and an irregular heart rhythm. Your doctor will look for those before settling on a plan.
What you might notice
- Worry that will not switch off
- Difficulty falling or staying asleep
- A racing or skipping heartbeat
How it is diagnosed
Diagnosis is clinical and comes out of a detailed conversation. Your doctor is working out how long this has been going on, whether it runs most days or comes in episodes, what sets it off, what you have stopped doing because of it, and how much sleep and concentration have been affected.
They will ask about caffeine, tobacco, alcohol and any supplements or medicines, because these are frequently part of the picture and are the easiest part to change.
Where the physical side has been prominent, thyroid function is checked and the heart rate and rhythm examined, since an overactive thyroid and certain rhythm disturbances can produce a very similar experience. A normal result is genuinely useful information and often reduces the anxiety about the anxiety. Your doctor will also ask about low mood and about alcohol, since both commonly travel alongside.
Recovery
Structured talking treatment is the mainstay and works over roughly eight to sixteen weekly sessions, with most people noticing a shift by the fourth or fifth. It asks for practice between sessions, and the people who do that practice improve faster.
Where medicine is used, allow four to six weeks at an adequate dose before judging it. Anxiety symptoms can sharpen for the first week or two of a new medicine before settling; your doctor will warn you about it and usually start at a low dose for that reason.
You can work throughout in almost every case. Avoided situations are returned to in steps over weeks, which is deliberate: going back gradually is what retrains the response, and waiting until you feel ready tends to postpone it indefinitely. Treatment is usually continued for six to twelve months after you are well.
If it is left untreated
Anxiety left alone does not damage the body, and for some people it does subside when a stressful stretch of life ends.
The usual course without treatment is a slow narrowing. Each situation avoided becomes harder to face next time, so the list of places you do not go and things you do not do grows year by year until it is shaping your job, your travel and your relationships. Sleep goes. Alcohol or sedatives get used to take the edge off in the evening, and dependence on them is a common and avoidable second problem.
Depression frequently develops on top of long-standing untreated anxiety, and that combination takes longer to treat than either alone. Persistent physical symptoms also lead to repeated tests and emergency visits that keep coming back normal. If the anxiety has reached the point where you cannot leave the house, cannot work, or have begun thinking of harming yourself, it needs medical attention now and not at a convenient time.
Questions about anxiety disorders
Can anxiety damage my heart?
Anxiety produces real physical sensations through adrenaline, and a racing heart, chest tightness and breathlessness are among the commonest of them. Those sensations are not damaging the heart, and an anxiety attack does not cause a heart attack. That said, chest pain should be assessed properly the first time it happens, particularly if you are over forty, smoke, or have diabetes, high blood pressure or a family history of heart disease, since the two can feel alike. Once the heart has been checked and found normal, that result is worth holding on to, because repeating the tests tends to feed the worry.
Do I have to take tablets, or can talking treatment be enough?
For mild and moderate anxiety a structured talking treatment on its own is often enough, and it has the advantage that the skills stay with you afterwards. Medicine is added when symptoms are severe, when sleep and functioning have collapsed, or when depression is present alongside. Many people use both for a period and then continue with the skills alone. Your doctor will set out what each option asks of you, including the time commitment of weekly sessions, and the choice is made with you at the consultation.
Will it come back after treatment?
It can return, particularly during a period of heavy stress, and that is why treatment is usually continued for six to twelve months after you are well and then reduced gradually. What protects you most is the practice built during treatment, since the skills for handling avoidance and physical symptoms remain usable years later. Cutting caffeine and alcohol, keeping regular sleep and staying physically active all lower the chance of a relapse. If symptoms start building again, an early review is far shorter than a full course of treatment.
Other psychiatry treatments
Assessment and treatment of persistent low mood, loss of interest and related emotional or physical symptoms
Day CareManagement of recurring panic attacks and fear of further attacks
Day CareTalk to a care coordinator about anxiety disorders
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one