What anxiety is
Everyone feels anxious sometimes, before an exam, an interview or a big family event. This is a normal reaction that helps us prepare. Anxiety becomes a disorder when the worry is out of proportion to the situation, hard to control, lasts for weeks or months, and interferes with work, studies, sleep or relationships.
Anxiety disorders are among the most common mental health conditions, affecting children, adults and older people. They are real medical conditions, not a weakness of character or a lack of willpower. With the right help, including therapy, self-help skills and sometimes medicine, most people feel much better and can return to normal life.
Types of anxiety
Many people have more than one type, and anxiety often occurs together with depression, sleep problems or alcohol misuse. Knowing the type helps the doctor choose the right treatment, and the plan is matched to how severe your symptoms are and how much they affect your daily life.
- Generalised anxiety disorder: constant worry about many everyday things such as health, money or family
- Panic disorder: sudden attacks of intense fear with a racing heart, breathlessness and a feeling of dying or losing control
- Social anxiety: strong fear of being judged or embarrassed in front of others
- Phobias: intense fear of a specific thing, such as heights or injections
- Obsessive-compulsive disorder and post-traumatic stress disorder, which are related conditions
Symptoms in body and mind
Anxiety affects both the mind and the body. Mental symptoms include constant worry, restlessness, feeling on edge, difficulty concentrating, irritability and trouble sleeping. Many people start avoiding places or situations that make them anxious, such as crowds, travel or meetings, which can gradually shrink their life.
Physical symptoms are very common and often lead people to see a doctor first. These include a fast or pounding heartbeat, chest tightness, shortness of breath, sweating, trembling, dizziness, headaches, stomach upset and frequent urination. Because these can also come from heart, thyroid or other illnesses, a medical check is important.
Anxiety: causes and risk factors
Anxiety usually develops from a mix of factors. These include family history, personality, stressful life events such as job loss, exam pressure, relationship problems or bereavement, childhood difficulties, and long-term illness. Heavy use of caffeine, alcohol, tobacco or other substances can trigger or worsen anxiety, and withdrawal from them can too.
Some medical conditions, such as an overactive thyroid, anaemia, low blood sugar and irregular heart rhythms, can cause anxiety-like symptoms. Some medicines, including certain asthma inhalers, decongestants and steroids, can also do this. This is why a doctor usually checks for physical causes before confirming an anxiety disorder.
Diagnosis and treatment
A doctor will talk with you about your symptoms and may use a short questionnaire. Blood tests such as thyroid function, blood sugar and haemoglobin, and sometimes an ECG, help rule out physical causes. Diagnosis is based on the pattern of symptoms and how they affect your life.
Talking therapy, especially cognitive behavioural therapy (CBT), is a first-line treatment and teaches practical ways to manage worry and panic. For moderate to severe anxiety, doctors may prescribe antidepressants such as SSRIs, which are not habit-forming, only on a doctor's prescription. Sedatives like benzodiazepines are used only briefly, if at all, because they can cause dependence.
Self-help that works
These steps help most people and work well alongside professional treatment. Practise them daily, not only when anxiety is high. Pregnant and breastfeeding women, children and older adults should always discuss any medicine with a doctor before starting, because some anxiety medicines need special care in these groups.
- Practise slow breathing: breathe in gently, then breathe out slowly for longer
- Exercise regularly; a brisk daily walk reduces anxiety
- Cut down on tea, coffee, energy drinks, alcohol and smoking
- Keep a regular sleep routine
- Talk to someone you trust instead of keeping worries to yourself
- Face feared situations step by step rather than avoiding them
When to see a doctor for anxiety
See a doctor if anxiety lasts more than a few weeks, stops you from doing everyday things, or causes panic attacks. Do not start or stop anxiety medicines on your own, and never take sleeping pills or sedatives borrowed from others. A doctor or pharmacist can guide you to safe treatment, and a counsellor or psychiatrist can offer further help.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- SSRIs such as sertraline or escitalopramReduce anxiety and panic over weeks by balancing brain chemicals.Only on a doctor's prescription; take time to work and must not be stopped suddenly.
- SNRIs such as venlafaxine or duloxetineAnother option for generalised anxiety disorder.Only on a doctor's prescription; BP may need monitoring.
- Benzodiazepines such as clonazepam or alprazolamGive quick, short-term relief from severe anxiety.Only on a doctor's prescription for short periods; habit-forming and risky with alcohol.
- Beta blockers such as propranololControl physical symptoms like pounding heart and trembling in some situations.Only on a doctor's prescription; not suitable for people with asthma.
See a doctor urgently if
- See a doctor urgently if you have thoughts of harming yourself or ending your life.
- See a doctor urgently if you have chest pain, especially with sweating or pain spreading to the arm, to rule out a heart problem.
- See a doctor soon if panic attacks happen repeatedly.
- See a doctor soon if you are using alcohol or pills to cope with worry.
- See a doctor soon if anxiety stops you from going to work, school or leaving home.
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.