Normal worry or anxiety disorder?

If we look at recent data for prescription medication use in the U.S., a few things are very clear: A lot of people are seeking relief for symptoms of anxiety, and too many of them end up abusing the medications that they are prescribed. Alprazolam (the generic name for Xanax) and lorazepam (also known as Ativan) were among the top four most frequently prescribed psychiatric drugs in 2011. Together, they accounted for almost 75 million prescriptions, and their use is on the rise over the past few years. A 2010 study by the National Institute on Drug Abuse (NIDA) reports that of 7 million prescription-drug abusers in the United States, 2.6 million of them abused drugs in the benzodiazepine category, which is used to treat anxiety. This category was second only to the abuse of narcotic pain medications such as Vicodin or OxyContin.

While the growing use and abuse of prescription medications is a topic that merits serious attention, I’d like to focus on the pervasiveness of anxiety that seems to be gripping so many of us. Have we become a nation of nervous wrecks for whom the only solution seems to be the chronic use of prescription medication? What some people are finding is that their main source of medical advice and care, their primary-care physician, no longer wants to prescribe such medications on a long-term basis. They want their patients to learn skills to effectively reduce anxiety symptoms on their own. They worry that their patients will become dependent on a substance that, initially at least, seems to provide a quick fix.

So what is anxiety?

Anxiety is a normal emotion that even the most psychologically healthy person feels at times. Anyone might feel nervous going for a job interview or waiting for some important medical test results. A manageable level of anxiety can even enhance our performance, as we might see with an elite athlete heading into competition or an actor about to go out on stage.

Anxiety disorders are different from this normal day-to-day anxiety. Too much anxiety can cause intense distress and impair a person’s ability to function. According to the National Institute of Mental Health, anxiety disorders affect about 40 million American adults each year, but only about one third of those people actually seek treatment. Mental health professionals break the category of anxiety disorders into many separate diagnosable conditions, including panic disorder, post-traumatic stress disorder (PTSD), phobias, generalized anxiety, and obsessive compulsive disorder. Some people may have anxiety that is so intense that they develop agoraphobia, so they rarely go out in public for fear of having a panic attack.

Anxiety symptoms

Common signs of anxiety may include:

Feeling nervous or apprehensive.
Having a sense of impending danger or doom.
Overwhelming feelings of panic or fear.
Physical symptoms such as racing heartbeat, rapid breathing, trembling, sweating or butterflies in the stomach.

Anxiety may interfere with your sleep. It may make it more difficult to perform at work or school, and it may disrupt your relationships with friends and family. Pervasive anxiety makes it harder to enjoy your life, even when you can see that your concerns are not particularly rational or realistic. Left untreated, anxiety may lead to depression or cause the sufferer to turn to alcohol or drug use to try to calm their nerves.

Causes of anxiety

There’s no single cause of anxiety — it differs depending on the individual. Sometimes, there’s a clear and identifiable trigger, as is the case with a crime victim or war veteran who develops PTSD. In other cases, we don’t really know the cause. Some of us may be more prone to anxiety based on our family history, which suggests that a combination of genetic and environmental factors increases the risk of developing an anxiety disorder. Certain medical conditions increase the risk of developing anxiety symptoms. Physical problems that are sometimes associated with anxiety include heart disease, thyroid problems, diabetes, and asthma. We also know that women are diagnosed with anxiety more often than men. Children who have experienced trauma or abuse are at greater risk for developing anxiety disorders later in life.

Seeking help

Given how unpleasant anxiety symptoms are, it’s understandable that a person experiencing them would be seeking relief as quickly as possible, and medication may well be part of the solution at some point. Seeing your primary-care physician is a good first step, since it’s wise to rule out any underlying illness that may need treatment. When you go to see your doctor, be ready to describe all of your anxiety symptoms and what seems to trigger them. Talk to your doctor about any current life stressors that may be feeding into your anxiety. Mention any other health problems you’re having and bring a list of all of the medications and over-the-counter vitamins or supplements you’ve been taking. Think about any steps that you have taken that seem to alleviate your anxiety symptoms.

Mental health treatment

Once any medical concerns have been addressed, the best route might be working with a psychotherapist and, in some cases, consulting with a psychiatrist about medication. There are a variety of therapeutic approaches that can be used to manage an acute attack of anxiety, as well as to reduce the intensity and frequency of anxiety symptoms over time. This does take some patience and repeated practice, but it’s well worth the effort to reclaim a sense of calm and control, and it can provide you with a new set of skills to use when anxiety crops up in the future. Just knowing that you have some effective coping strategies may help you to feel more confident and willing to venture into situations that you’ve previously avoided due to anxiety.