Anxiety is an emotion characterized by feeling worried and tense, along with physical symptoms like increased blood pressure. People with anxiety often worry about the future and may avoid certain situations. 

According to the Anxiety & Depression Association of America, anxiety disorders affect almost 20% of adults in the U.S. every year. The term anxiety disorder includes:

• Generalized anxiety disorder: ongoing anxiety that interferes with daily life
• Panic disorder: people with panic disorder experience panic attacks of overwhelming fear, along with physical symptoms like shortness of breath and a racing heartbeat
• Agoraphobia: fear of being in a place or situation that may cause panic or embarrassment
• Specific phobia: an intense but irrational fear of something that is actually harmless
• Social anxiety disorder: fear of social situations
• Post-traumatic stress disorder (PTSD): a condition that develops after experiencing or witnessing a traumatic or terrifying event
• Obsessive-compulsive disorder (OCD): a condition where unreasonable thoughts and fears (obsessions) lead to repetitive behavior (compulsions)
• Separation anxiety disorder: fear of separation from a family member or caregiver

Anxiety Symptoms

Symptoms of anxiety may be emotional and/or physical. While symptoms vary based on the diagnosis, some common symptoms may occur.

Emotional/behavioral anxiety symptoms

• A feeling of panic, fear, worry, or uneasiness
• Irritability 
• Nightmares or difficulty sleeping
• Thoughts or flashbacks about past traumatizing events
• Feeling a sense of impending doom or danger
• Obsessive thoughts that cannot be controlled, along with compulsive behaviors such as washing hands constantly
• Avoiding things or situations that cause fear
• Difficulty concentrating or remaining calm and still

Physical anxiety symptoms

• Cold, sweaty hands
• Dry mouth
• Feeling like the heart is racing or pounding
• Nausea
• Headache
• Stomach pain
• Numbness and tingling 
• Tense muscles
• Sweating 
• Shaking 
• Difficulty breathing (shortness of breath)

When to See a Doctor

If you are experiencing symptoms of anxiety such as the ones listed above, you should see a healthcare provider. You can see your primary care provider or a mental health professional such as a psychiatrist, psychologist, or licensed clinical social worker. 

What Causes Anxiety?

Although experts do not know what exactly causes anxiety, they believe a combination of factors may play a role, including:

• Chemical imbalance due to severe or long-lasting stress
• Environmental factors like experiencing a traumatic event
• Genetics (anxiety tends to run in families)

How is Anxiety Diagnosed?

If you have anxiety symptoms, your primary care provider will perform a physical exam and may also order bloodwork to help determine if another medical condition is causing your anxiety symptoms. They’ll also take a detailed family history and medical history, including a list of medications you take, in case medication may be contributing to your symptoms. 

Your healthcare provider may also complete a psychological evaluation, diving deeper into your symptoms and possibly having you fill out a questionnaire to evaluate how your symptoms affect your quality of life. 

How is Anxiety Treated?

Although there is no official cure for anxiety, treatment with a combination of methods, including prescription medication and therapy, can help keep symptoms under control.

Natural Anxiety Treatment

Although not a substitute for prescription medication and therapy when prescribed/recommended, there are some natural methods you can try to help alleviate symptoms of anxiety, such as:

• Exercise (consult your doctor before beginning a new exercise program) 
• Meditation or deep breathing
• Acupuncture
• Massage therapy
• Taking time for relaxation and self-care
• Weighted blankets
• Eating a healthy diet and avoiding or limiting caffeine, alcohol, and smoking
• Although more research needs to be done to establish the role of CBD for anxiety, some people may find it to be helpful for generalized anxiety disorder. 

Anxiety Medications

The medication prescribed will depend on individual factors, including symptoms and diagnosis, potential side effects and drug interactions, and other considerations. Below is a list of commonly prescribed medications for anxiety.

• Antidepressants: Antidepressants are the first choice of treatment for anxiety, especially SSRIs and SNRIs. Selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) or Lexapro (escitalopram) work by increasing levels of serotonin in the brain. Serotonin-norepinephrine reuptake inhibitors (SNRIs) like Effexor (venlafaxine) or Pristiq (desvenlafaxine) increase levels of serotonin and norepinephrine in the brain. Tricyclic antidepressants such as Elavil (amitriptyline) are less popularly prescribed due to their side effect profile. Antidepressants are generally prescribed as a long-term treatment. 

• Benzodiazepines: Benzodiazepines work by slowing down the central nervous system, having a relaxing and calming effect. This drug class includes popularly prescribed medications like Xanax (alprazolam), Ativan (lorazepam), and Valium (diazepam). Benzodiazepines are not recommended as the first choice of treatment because they are not considered more effective than antidepressants, and they have many potential side effects. They are also controlled substances, which means there is a risk of abuse and dependence. 

• Non-benzodiazepine antianxiety medications: Some drugs are used for anxiety but are not classified as antidepressants or benzodiazepines. This includes drugs like Atarax (hydroxyzine HCl), Vistaril (hydroxyzine pamoate), and BuSpar (buspirone). 
• Beta-blockers: A beta-blocker such as Inderal (propranolol) may be prescribed to help with physical symptoms of anxiety, such as a racing heartbeat or shaking. 

While benzodiazepines work quickly, other anxiety medications, such as antidepressants, take longer to work. If you take an SSRI or SNRI antidepressant, it may take several weeks to notice an improvement in symptoms and up to several months to see the full benefit of the medication. 

If anxiety symptoms worsen or do not improve, reach out to your healthcare provider. If you have thoughts of harming yourself, call 911 and go to the nearest emergency room, or call 988 to reach the 988 Suicide & Crisis Lifeline. Help is available 24/7.