You wake up one morning with a few butterflies in your stomach and a vague sense of nervousness. You’ve got a big deadline at work, and you’re not sure you can meet it. Once you finish the project, however, those butterflies disappear. You had a simple case of the jitters.

Anxiety Disorders

But what does it mean when nervous, anxious feelings last for weeks – without reason? When normal aspects of life – such as choosing what to wear in the morning – fill you with worry?

Such feelings signal that you may be suffering from an anxiety disorder, the most common and most misunderstood type of mental health disorder.

Anxiety disorders occur in more than 7 percent of American adults at any point in time, and generally in twice as many women as men. The condition may cause emotional upset or be accompanied by physical symptoms such as fatigue, trembling, muscle tension, headache, or nausea. Within this group of mental disorders are:

• Panic disorder: sudden intense feelings of terror for no obvious reason.
• Phobias: dread of specific harmless objects, situations, or activities.
• Obsessive-compulsive disorder: repeated unwanted thoughts or rituals (such as hand-washing).
• Post-traumatic stress disorder: re-experiencing terrible events, as nightmares or flashbacks, or a decreased interest in daily life following a severe trauma.
• Generalized anxiety disorder (GAD): chronic anxiety that is marked by unrealistic worries or fears about health, money, work, or the safety of themselves or loved ones.

  What causes anxiety disorders? Physical problems, such as a heart condition, overactive thyroid, or respiratory disease, can produce anxious feelings, as can caffeine, alcohol withdrawal, vitamin deficiencies, or a drug side effect.

  But for true anxiety disorders, more and more research points to the importance of a biological component. In fact, scientists have found that the production of certain brain chemicals can stimulate or suppress anxiety. Similarly, increased activity in a part of the brain called the locus ceruleus is linked to many anxiety symptoms.

  But sufferers should be hopeful because new medications are often quite effective when used alone or in combination with behavior therapy. Treatments include medications that affect the brain chemicals researchers have been studying. Some examples: selective serotonin reuptake inhibitors (SSRIs) such as clomipramine (Anafranil) or fluoxetine (Prozac). Also used are medications that alter locus ceruleus activity, including benzodiazepines like alprazolam (Xanax) or diazepam (Valium), or another type of drug, called clonidine (Catapres).

  Other preferred medications for the treatment of most anxiety disorders include buspirone (BuSpar) and tricyclic antidepressants such as imipramine (Tofranil) and desipramine (Norpramin). A monoamine oxidase (MAO) inhibitor, such as phenelzine (Nardil), may be prescribed in certain circumstances. Medications such as propranolol (Inderal) and atenolol (Tenormin), and antihistamines, such as hydroxyzine (Atarax), are sometimes used to block physical symptoms of phobias, such as chest pain, throat tightness, and shortness of breath.

  Depression

  Anxiety disorders are different from another widespread mental health problem, clinical depression. But it’s not uncommon to experience both at the same time. Symptoms of clinical depression, which affect up to 30 percent of all Americans at some point in life, typically include mood and sleep changes, deep sadness, self-loathing, extreme irritability, difficulty concentrating, and memory loss. It may be nearly impossible to eat, dress, work, or interact with friends and family.

  Like anxiety disorders, depression was once considered strictly a psychological illness. Now, doctors understand that changes in brain chemicals may be to blame and that the underlying cause is usually a mix of factors, including heredity. Medical illness, such as stroke or thyroid problems, can contribute. Many medications also play a role in depression.

  Consult your doctor if your distress is enduring or severe, or if your feelings and thoughts interfere with day-to-day functioning. If you have recurrent thoughts of death or harming yourself, call a suicide hotline, psychologist, physician, or nearby hospital immediately.

  A popular approach to battling depression includes the use of talk therapy along with medications known as antidepressants. These usually take four to six weeks to have a therapeutic effect, and as long as six months to offer significant relief. You may have to try several before you find the best one. Antidepressants are most effective when taken consistently and properly, and should be used only under the supervision of a physician. Commonly prescribed antidepressants include:

• SSRIs, which are the drugs of choice for mild or moderate depression. They include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). These drugs are also being used to treat PMS, anorexia, and bulimia.
• Tricyclic antidepressants, which are often the initial choice for treatment of depression severe enough to require hospitalization. These include amitriptyline (Elavil) and imipramine (Tofranil).
• Atypical antidepressants, which are used for patients who do not tolerate or respond to SSRIs. These include nefazodone (Serzone), venlafaxine (Effexor), and bupropion (Wellbutrin).
• MAOs, which are reserved for patients who do not respond to or cannot tolerate other therapies. These include phenelzine (Nardil) and tranylcypromine (Parnate).

  For more information, contact the National Mental Health Association Information Center at 1021 Prince St., Alexandria, VA 22314; or call 1-800-969-NMHA.

  

  Getting Help for Anxiety Disorders

• Find the right doctor. If you think you have an anxiety disorder, talk with your primary care doctor and consider seeing a psychiatrist who is trained in both behavior therapy and the best use of medications for treating mental health problems.

• Have a complete physical examination so that any coexisting problems can be recognized and treated.

• Consider a support group. The Anxiety Disorders Association of America has an Anxiety Disorders Self-Help Group Network. For information, write to them at 6000 Executive Boulevard, Rockville, MD 20852.

• Be informed. For free information about anxiety disorders from the National Institute of Mental Health, call toll-free at 1-888-8-ANXIETY.

  

  News Flash!

  The FDA recently approved mirtazapine (Remeron) for the treatment of depression. The drug represents a new class of antidepressants because it stimulates the release of the brain chemicals norepinephrine and serotonin, while blocking serotonin receptors.

  

  Medication Smarts

• Take medications exactly as prescribed. Don’t increase the dosage or stop taking the medication without your doctor’s permission.
  Inform your doctor of all other medications you take, including over-the-counter (OTC) remedies and vitamins.

• Take medication with food to prevent nausea unless otherwise directed.

• Have regular checkups.

• Avoid alcohol and caffeine.

  

  Mood-Lifting Strategies

• Avoid being alone. Go to a movie, invite a friend to dinner, or join in other social activities.

• Exercise. Swimming, walking, biking, and similar activities have powerful mood-lifting effects.

• Eat healthy, well-balanced meals. Some people find that high-carbohydrate foods relieve symptoms.

• Rest. But sleep no more than 8 to 10 hours per night.

• Read self-help books. Studies show they can help significantly.