Yahoo Lifestyle Everything you need to know about anxiety disorders
Photo: Thinkstock
Education is key to removing the stigma around mental health.
Here, we share the facts you need to know about the mental health condition that affects nearly 14 per cent of Australians.
1. What are the different types of anxiety disorders?
There are many different types of anxiety disorders. The 3 most common types are generalised anxiety disorder (GAD), social anxiety disorder (also known as social phobia) and panic disorder. Other types include obsessive compulsive disorder (OCD) and posttraumatic stress disorder.
The cause of anxiety can be very different for each person and may be associated with stress (e.g. work, relationship), a health condition (e.g. heart attack), the side effect of a medicine or deeper personal issues.
People with an anxiety disorder can also have other mental health conditions, such as another type of anxiety disorder, depression, or alcohol or drug abuse.
Signs and symptoms:
Symptoms of anxiety disorders vary and can be extremely debilitating. They involve different combinations of physical or psychological symptoms that impair how well you function, or that cause you significant distress.
Anxiety disorders generally cause us to have feelings of dread, fear, unease or angst. Other symptoms may include:
• Sleep problems (insomnia)
• Feeling faint or dizzy
• Heart palpitations or racing heart
• Sweating
• Chest discomfort
• Numbness in hands/feet
• Dry mouth
• Shortness of breath
• Stomach ache
• Diarrhoea
• Inability to control thinking.
What is generalised anxiety disorder (GAD)?
If you have GAD, you may worry about the same things as other people, such as health issues, money, family problems, or difficulties at work, but struggle with identifying your specific fear and controlling your worries. As a result your fear is usually unrealistic in the context of your situation.
What is social anxiety disorder?
Social anxiety disorder (social phobia) results in an intense, irrational fear of being judged by others or behaving in a way that might cause embarrassment or public scrutiny. This often leads you to avoiding specific social situations, such as speaking to strangers, eating at restaurants, or going to parties.
What is panic disorder?
Panic disorder causes you to have unexpected and recurrent episodes of intense fear along with repeated panic attacks. These panic attacks can include physical symptoms such as shortness of breath, sweating and chest pain, and may make you feel like you’re having a heart attack , dying or going insane.
Diagnosis:
If you think you have an anxiety disorder, it’s a good idea to discuss your concerns with a general practitioner (GP).
Your GP will chat to you about your symptoms, check your medical history, and conduct or arrange any necessary medical tests or physical examinations. They can also provide you with treatment or refer you to another health professional that specialises in mental health conditions (e.g. a psychiatrist or psychologist) to ensure who will make an accurate diagnosis).
How do you treat anxiety disorders?
There are several treatment options available for anxiety, and each has its pros and cons. If you have an anxiety disorder, finding the right treatment involves careful thought, and maybe also sometimes trial and error. The most appropriate treatment for you may depend on lots of things, including:
• the type of anxiety disorder you have;
• the severity of your symptoms;
• your own personal preferences; and
• the cost and accessibility of options available to you.
To help we’ve included some general information about the common treatment options for anxiety disorders. However, you should speak to your GP or other health professional before making a decision about these treatments for your particular type of anxiety disorder. People seeking support can also contact Beyond Blue and Lifeline.
Lifestyle and other approaches:
Some forms of counselling known as ‘psychological therapies’ (e.g. cognitive behavioural therapy [CBT]) and other non-medicine strategies are tried first for most anxiety disorders (see box below for examples). You can undertake these therapies with the guidance of a health professional, but some can also be done on your own. Many of these therapies are also useful in treating depression.
Psychological therapies include:
• Cognitive behavioural therapy (CBT):
• Individual or group (face-to-face, by telephone or online [e.g.CRUfADclinic, eCentreClinic], MoodGYM).
• Self-directed (e.g. bibliotherapy [such as The SANE Guide to Anxiety Disorders)
• Emotional-regulation approaches (e.g. mindfulness-based meditation)
• Exposure-based therapy (confronting imagined and real-life fears)
• Structured problem-solving therapy
• Relapse prevention approaches (e.g. coping skills to deal with any future problems)
Other non-medicine strategies include:
• Education and information about anxiety [print and electronic resources e.g. CRUfAD online treatment manuals, SANE factsheets and podcasts)
• Relaxation therapy (e.g. meditation, progressive muscle relaxation, deep breathing techniques)
• Social skills training
• Community support organisations/self-help groups
What about counselling?
Psychological therapies help by changing certain behaviours, beliefs and thinking patterns that contribute to anxiety. Many people prefer psychological therapies to medicines.
While psychological therapies can involve a lot of time and effort — for example, you may need to start with 8–20 hours of CBT, or continue it for months under the guidance of a health professional — the benefits are usually maintained for at least 12 months after stopping therapy, and possibly for as long as you apply the skills learned.
Some GPs have training in psychological therapies but will often refer to another health professional who specialises in mental health conditions. Medicare may subsidise your psychological therapy if you have a GP referral to a psychologist and a GP Mental Health Care Plan.
Traditional medicine-based treatment:
If psychological therapies and other non-medicine strategies do not provide sufficient benefit or are unsuitable, an antidepressant may be prescribed. Not all antidepressants have been studied in all anxiety disorders. Those that are often used in treatment come from a group of antidepressants called selective serotonin reuptake inhibitors (SSRIs). These antidepressants include the active ingredients escitalopram (in brands like Esipram and Lexapro), fluoxetine (e.g. Prozac), fluvoxamine (e.g. Luvox), paroxetine (e.g. Aropax) and sertraline (e.g. Zoloft).
Other types of antidepressants that are used for some types of anxiety disorders include clomipramine (e.g. Anafranil), moclobemide (e.g. Aurorix) and venlafaxine (e.g. Efexor).
It’s impossible to know in advance how each person will respond to a particular medicine. Many people find they cannot tolerate the side effects of the first antidepressant they try, or that it does not work for them, so you may need to try different medicines before finding one that works best.
An antidepressant may work as well as CBT for some people with anxiety (e.g. those with GAD or generalised social anxiety disorder). However, up to 40% of people relapse 6–12 months after stopping their medicine — in the long term, psychological therapies are more likely to be effective in managing an anxiety disorder.
Once you start a course of antidepressants, it may take at least 12 weeks for your anxiety to be relieved. It’s important that you talk to your doctor if you feel your medicine is not working, is causing you side effects, or if your anxiety returns after you’ve stopped the medicine.
What about other medicines?
Benzodiazepine medicines like diazepam (the active ingredient in brands like Valium) are sometimes prescribed when psychological therapies, other non-medicine strategies or antidepressants aren’t working.
Benzodiazepines should only be taken in these circumstances on a short term basis. This is because they can cause adverse effects like dependence — especially if you’ve been dependent on alcohol or other drugs in the past — and withdrawal symptoms can occur after you stop treatment. Antidepressants are also more effective than benzodiazepines for treating the uncontrollable worry associated with GAD.
Other medicines may also be prescribed on an as needed basis. For example, some people may take a beta-blocker medicine (e.g. propranolol, the active ingredient in brands like Inderal) before a social event or performance to control symptoms like a racing heart.
