Today’s column deals with a common condition but one that many are embarrassed to discuss—anxiety disorder, also known as “panic attacks.” They are described as a persistent, excessive, and difficult to control worry that produce symptoms of muscle tension, sleep disturbances and difficulty concentrating. There can also be secondary effects such as increased heart rate, and GI involvement such as nausea and abnormal bowel symptoms.
The onset of symptoms can occur at anytime during one’s lifetime, but it is usually in the thirties, and females are affected more often than men. Although the exact cause has not been pinpointed, it is thought that the condition is due to abnormalities in neurotransmitters such as serotonin, norepinephrine and GABA, which are commonly implicated in depression as well.
There appears to be a genetic factor and certain risk factors have been identified, including Caucasian race, stress, medical illness, disability, unemployment, childhood trauma and depression. In some cases, there are associated conditions such as major depressive disorder, bipolar disorder, alcohol or drug abuse, smoking during adolescence, social anxiety disorder and eating disorders.
Diagnosis of anxiety disorder is usually made by taking a thorough history and evaluation. The condition should have been present for more than 6 months, and at least 3 additional symptoms should be present to make the diagnosis. These symptoms should include the following: restlessness or feeling on edge, fatigue, difficulty concentrating or mind “going blank,” irritability, muscle tension, sleep disturbances, persistent worry which causes significant distress or impairment in social or occupational functioning.
There are also physical symptoms, which may be reported, including shortness of breath, heart palpitations, sweating, nausea, tremor, and diarrhea or chest pain. On examination, there may be evidence of irritability, bitten fingernails, tremor or clammy hands.
Once other physical sources of the symptoms have been eliminated through blood work and other diagnostics, treatment can be started. First line medications are antidepressants, which are usually well tolerated, with the more common ones being Paxil, Lexapro, Cymbalta, or Effexor. Second line treatment include the use of medication such as Klonopin, Valium, Ativan, or Xanax, which all work very well in the short term, but are less effective in the long term and may pose an addiction risk. Patients can also help their anxiety by limiting caffeine intake, and participating in regular exercise.