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Anxiety

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Special Considerations
• Supporting Research

Anxiety is a general feeling of being worried, and everyone occasionally experiences anxiety. People with generalized anxiety disorder (GAD), however, feel anxious frequently or excessively, not necessarily due to a particular situation.

Signs and Symptoms

• Muscle tension, trembling
• Fast heartbeat (tachycardia)
• Fast or troubled breathing (dyspnea)
• Dizziness or impaired concentration
• Palpitations
• Headache
• Sweating
• Fatigue
• Irritability
• Sleep disturbances

What Causes It?

Anxiety can result from many specific causes, such as an underlying medical condition or drugs you are taking. However, there may be no specific cause. Factors such as genetics and early life experiences may play a role.

What to Expect at Your Provider's Office

Your health care provider will talk to you about when you feel anxious and what it feels like. He or she will take your medical history, give you a physical examination, and may take blood or urine samples for laboratory tests. Sometimes, you will have an electrocardiogram (EKG) to rule out heart problems.

Treatment Options

Treatment Plan

If a physical cause is identified as the reason for your anxiety, your health care provider can make a treatment plan for you. There are also several ways to treat anxiety that has no physical cause. Short-term counseling can boost your self-esteem and help you learn coping strategies and problem-solving techniques. Your health care provider may also suggest trying a method of relaxation, such as deep breathing techniques. Occasionally, your health care provider may prescribe drugs to help until you have mastered these techniques.

Drug Therapies

Prescription

Antianxiety Medications

• Benzodiazepines -- a group of drugs that help reduce anxiety and have sedating effects. They may cause drowsiness, constipation, or nausea. Do not take these drugs if you have narrow-angle glaucoma, a psychosis, or are pregnant.
• Buspirone (BuSpar) -- an anti-anxiety drug that does not appear to cause drowsiness. However, you must take it for 2 weeks before feeling any effect. Side effects include insomnia, nervousness, light-headedness, upset stomach, nausea, diarrhea, and headaches.

Antidepressant Medications

• Tricyclic antidepressants -- a group of drugs that relieve depression (which can accompany anxiety). These medications tend to have numerous side effects.

Over the Counter

N/A

Complementary and Alternative Therapies

Mind-body techniques, nutrition, exercise, and herbs may treat anxiety. Progressive muscle relaxation, diaphragmatic breathing, biofeedback, meditation, and self-hypnosis can help you relax and reduce your anxiety. A regular program of exercise can help treat generalized anxiety disorder and panic attacks. Talk with your health care provider about these techniques.

Nutrition

• Avoid caffeine, alcohol, nicotine, sugar, and refined foods,. Cut down on foods that are known to cause allergies. Common food allergens are dairy, soy, citrus, peanuts, tree nuts, wheat, fish, wheat, fish, eggs, corn, food colorings, and additives. Eat more fresh vegetables, whole grains, and protein to nourish your nervous system,.
• Calcium (1,000 mg per day), magnesium (400 to 600 mg per day), and B complex (50 to 100 mg per day) help support the nervous system and minimize the effects of stress.

Herbs

Herbs can be a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not use tinctures. Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures singly or in combination as noted.

A tea (3 to 4 cups per day) or tincture (10 to 20 drops 4 to 6 times per day) from the following herbs will help reduce anxiety and strengthen the nervous system.

• Kava kava (Piper methysticum) for mild to moderate anxiety. The FDA has issued a warning concerning kava's effect on the liver. In rare cases, severe liver damage has been reported. If you take kava, do not use it for more than a few days, and tell your doctor before taking it.
• Valerian ( Valeriana officinalis ) and lemon balm ( Melissa officinalis ), or valerian combined with St. John's wort (Hypericum perforatum) for mild to moderate anxiety. Valerian may interact with other drugs that have a sedative effect, such as benzodiazepines; barbiturates, narcotics; antidepressants; and antihistamines. Do not take valerian if you are pregnant or nursing. Valerian can also affect the liver, so do not take it if you have liver problems. St. John's wort can affect other drugs you may be taking, including antidepressants, birth control, or other medications. You should avoid St. John's wort while pregnant or nursing. Talk to your doctor before using St. John's wort with any other medications.
• Other herbs sometimes suggested for anxiety include passionflower (Passiflora incarnata), ginger (zingiber officinalis), chamomile (Matricaria chamomilla), lemon balm, and licorice (glycyrrhiza glabra). Avoid licorice if you have heart failure, heart disease, kidney or liver disease, or high blood pressure. Do not take licorice if you take a diuretic, blood thinner, or anti-depressant such as Prozac.

You may take kava kava (100 to 200 mg 2 to 4 times a day) and valerian (150 mg 2 to 3 times per day) as a dried extract to maximize its effect on moderate anxiety.

Essential oils of lemon balm, bergamot, and jasmine are calming, and you can use them as aromatherapy. Place several drops in a warm bath or atomizer, or on a cotton ball.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of anxiety based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Aconitum -- for anxiety accompanied by irregular or forceful heartbeat, shortness of breath, or fear of death.
• Arsenicum album -- for excessive anxiety that has no clear cause and is accompanied by restlessness, especially after midnight. It also may be used for perfectionists, including children, who worry about everything.
• Phosphorus -- for an impending sense of doom and anxiety when alone. It also may be used for impressionable adults and children who are easily influenced by the anxiety of others.
• Lycopodium -- for performance and other types of anxiety in those who are insecure, yet hide their low self-esteem with arrogance and bravado. It also may treat children with anxiety accompanied by bedwetting.
• Gelsemium -- for performance anxiety resulting in diarrhea, headache, dizziness, weakness, shakiness and trembling, or trouble speaking.
• Argentum nitricum -- for performance anxiety (such as before tests in school-age children) with rapid heart rate, feeling of faintness, diarrhea, or flatulence.

Acupuncture

Some evidence shows that acupuncture can help reduce the symptoms of anxiety, particularly when combined with behavioral desensitization (including psychotherapy). One study showed that benefits continued as long as one year after treatment. Acupuncturists treat people with anxiety based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. With anxiety, a qi deficiency is often detected in the kidney or spleen meridians. In addition to performing needling techniques, acupuncturists may also employ lifestyle and breathing techniques as well as herbal and dietary therapy.

Massage

Therapeutic massage can help reduce anxiety and alleviate stress.

Following Up

Follow your health care provider's instructions, and practice relaxation techniques as needed.

Special Considerations

Be sure to tell your health care provider if you are pregnant. Call your provider if you experience any significant side effects from prescribed medications.

While the herbal tea suggested above is safe during pregnancy, you should avoid the dried extracts of kava kava, valerian and St. John's wort if you are pregnant or nursing.

Supporting Research

Akhondzadeh S, Naghavi HR, Vazirian M, et al. Passionflower in the treatment of generalised anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther 2001;26:362-367.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

Andreoli TE, Bennett JC, Carpenter CCJ. Cecil Essentials of Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 1993.

Barker LR, Burton JR, Zieve PD, eds. Principles of Ambulatory Medicine. 4th ed. Baltimore, Md: Williams & Wilkins; 1995:139-154.

Bilia AR, Gallon S, Vincieri FF. Kava-kava and anxiety: growing knowledge about the efficacy and safety. Life Sci . 2002;70:2581-2597.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:422,463-464.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3 ^rd ed. New York, NY: Penguin Putnam; 1997:334-338.

Davidson JR, Connor KM. St. John's Wort in generalized anxiety disorder: three case reports. J Clin Psychopharmacol 2001;21:635-636.

Goldberg RJ. Anxiety reduction by self-regulation: theory, practice, and evaluation. Ann Intern Med. 1982;96:483.

Guizhen L, Yunjun Z, Linxiang G, Aizhen L. Comparative study on acupuncture combined with behavioral desensitization for treatment of anxiety neuroses. Am J Acupunct. 1998;26:117-120.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996:250.

Kennedy DO, Little W, Haskell CF, Scholey AB. Anxiolytic effects of a combination of Melissa officinalis and Valeriana officinalis during laboratory-induced stress. Phytother Res. 2006;20(2):96-102.

Kohnen R, Oswalkd D. The effects of valerian, propranolol, and their combination on activation, performance and mood of healthy volunteers under social stress conditions. Pharmacopsychiatry . 1988;21:447-448.

Mantani R, Cimino A. A primer of comlentary and alternative medicine and its relevance in the treatment of mental health problems. Psychiatr Q 2002;73:367-381.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:4,40,293.

Olukoga A, Donaldson D. Liquorice and its health implications. J R Soc Health . 2000;120:83-89.

Panijel M. Treatment of moderately severe anxiety states. Therapiewoche . 1985;35:4659-4668.

Petruzzello SJ, Landers DM, Hatfield BD, et al. A meta-analysis on the anxiety-reducing effects of acute and chronic exercise: outcomes and mechanisms. Sports Med. 1991;11:143-182.

Pittler MH, Ernst E. Kava extract for treating anxiety [Cochrane Review]. The Cochrane Library, Issue 1, 2003.

Stein JH, ed. Internal Medicine. 4th ed. St. Louis, Mo: Mosby-Year Book; 1994.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992:44-45.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995:309.

Volz HP, Kieser M. Kava kava extract WS 1490 versus placebo in anxiety disorders—a randomized placebo controlled 25 week outpatient trial. Pharmacopsychiatry. 1997;30:1-5.

Wang SM, Kain ZN. Auricular acupuncture: a potential treatment for anxiety. Anesth Analg. 2001;92:548-553.

• Review Date: 6/15/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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