- Author : Dr. Anusha M N. MBBS, MD, Senior Resident, Department of Psychiatry, BGS Medical College & Hospital
What are anxiety disorders?
Anxiety and fear are normal emotional responses to potential or actual threat. In Anxiety Disorders (Ads), these responses are dysregulated or exaggerated or prolonged in a manner that is disturbing to one’s life. Ads being the most common mental disorders generally include Generalized Anxiety Disorder, Panic Disorder and Phobias with GAD having a lifetime prevalence of 5% begins in the late teens with female sexual preponderance.
What is the neuroscience behind anxiety disorders?
It is important to understand the neurobiological basis of fear and anxiety for an individual to be receptive to the treatment offered. It is known that an exposure to a fear inducing stimuli or any perceived threat the human body responds by ‘fight-or-flight’ reaction characterized by increased vigilance, recall of potentially dangerous elements and rapid physiologic response including increased pupillary dilatation, increased heart rate and rapid breathing. This is an adaptive mechanism to prepare the individual/organism for an impending danger. It is the over generalization of fear-learning to harmless stimuli which is thought to characterize anxiety disorders.
What are the most common presentations of anxiety disorders?
Early clinicians delineated three different spheres of anxiety:
1. Context-dependent fears- Phobias
2. Context-independent fears- Generalized Anxiety
3. Panic disorders
Phobias are fears of specific objects or situations, such as of heights or blood etc., which go beyond the true threat of the stimulus causing avoidance and functional impairment. By rule, the phobia lasts longer than 6 months. It is interesting to note that many patients have multiple phobic stimuli.
In patients with Generalized Anxiety Disorders (GADs) there is an uncontrollable worry usually not lasting for more than 6 months associated with other symptoms like restlessness, easy fatigue, difficulty in concentration, irritability, muscle tension, sleep disturbance.
Panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and can be associated with pounding heart, sweating, trembling, sensations of shortness of breath, feelings of choking, chest discomfort, nausea, abdominal distress, dizziness, numbness, fear of losing control or fear of dying. There will be persistent concern or worry about additional panic attacks or their consequences.
What are the medications available to treat anxiety?
The most commonly used drugs that are found to be effective in the pharmacological management of anxiety disorders include the following:
1. Benzodiazepenes
- used to provide rapid symptomatic relief only in acute states of anxiety
- used at the lowest effective dosage for shorter duration of time considering the propensity of dependence to the same.
2. Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
- Modest benefit is usually seen within 6 weeks
- Optimal duration of treatment though has not been determined should be at least for one year.
3. Pregabalin
- Better efficacy and tolerability
- However, severe withdrawal syndrome including seizures
Can anxiety be treated without medications?
Yes. Psychological therapy is found to be more effective than pharmacological therapy and can be used as first-line of management. However, there is some evidence which says that initial drug therapy may be required to help the patient become more receptive to psychological inputs. On the other hand, there are also studies which suggest that optimal outcome is achieved by combining psychological and pharmacological therapies.
Hence, a stepped care approach is always recommended to choose the most effective intervention to the patient when the degree of distress and functional impairment caused by the anxiety disorder is significant.
How to manage the symptoms of anxiety with psychotherapy?
The theory explaining the psychological treatment of anxiety disorders in Emotional Processing, which refers to the changes in a pathological element of a fear structure that result in long-term fear reduction and hence resolution of the anxiety disorder.
Psychotherapeutic approaches include:
- Exposure therapy
- Stress Inoculation training
- Cognitive therapy
- Acceptance & Mindfulness-Based Training
- Interpersonal Skills Training
- Relaxation Techniques in acute states of anxiety
