Health Series: Anxiety

What is Anxiety?

Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe.

Everyone has feelings of anxiety at some point in their life. For example, you may feel worried and anxious about sitting an exam or having a medical test or job interview.

During times like these, feeling anxious can be perfectly normal.

But some people find it hard to control their worries. Their feelings of anxiety are more constant and can often affect their daily lives.

Generalized Anxiety Disorder (GAD) is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event.

People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed.

As soon as one anxious thought is resolved, another may appear around a different issue.

GAD can cause both psychological (mental) and physical symptoms.

REMEMBER

Anxiety is abnormal if it:

• Is out of proportion to the stressful situation; or
• Persists when a stressful situation has gone, or the stress is minor; or

Appears for no apparent reason when there is no stressful situation.

What are other anxiety disorders?

Generalized anxiety disorder often occurs along with other mental health problems, which can make diagnosis and treatment more challenging. Some mental health disorders that commonly occur with generalized anxiety disorder include:

• Phobias
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Depression
• Suicidal thoughts or suicide
• Substance abuse

What are the symptoms of GAD?

Psychological symptoms of GAD

You may have GAD if:

• your worrying significantly affects your daily life, including your job and social life
• your worries are extremely stressful and upsetting
• you worry about all sorts of things and have a tendency to think the worst
• your worrying is uncontrollable
• you have felt worried nearly every day for at least 6 months

GAD can cause a change in your behaviour and the way you think and feel about things. Your symptoms may cause you to withdraw from social contact (seeing your family and friends) to avoid feelings of worry and dread.

You may also find going to work difficult and stressful and may take time off sick. These actions can make you worry even more about yourself and increase your lack of self-esteem.

Physical symptoms of GAD

GAD can also have a number of physical symptoms, including dizziness, tiredness, palpitations, muscle aches, excessive sweating, difficulty falling or staying asleep.

What are the risk factors for developing this?

GAD is slightly more common in women. It can occur at any time in life and is common in all age groups, including children and older people, although on average it starts around 30 years of age and is more common in people from the ages of 35 to 59.

The following factors may increase the risk of developing generalized anxiety disorder:

• Personality. A person whose temperament is timid or negative or who avoids anything dangerous may be more prone to generalized anxiety disorder than others are.
• Genetics. Generalized anxiety disorder may run in families.

Experiences. People with generalized anxiety disorder may have a history of significant life changes, traumatic or negative experiences during childhood, or a recent traumatic or negative event. Chronic medical illnesses or other mental health disorders may increase risk.

When to see a doctor?

See your doctor if:

• You feel like you’re worrying too much, and it’s interfering with your work, relationships or other parts of your life
• You feel depressed or irritable, or you have other mental health concerns along with anxiety
• You have suicidal thoughts or behaviours — seek emergency treatment immediately

Your worries are unlikely to simply go away on their own, and they may actually get worse over time. Try to seek professional help before your anxiety becomes severe — it may be easier to treat early on.

What can you expect from your doctor/GP?

GAD is treatable and seeking professional support is the first step towards recovery. There are two main types of effective treatments for GAD; psychological treatments will generally be the first line of treatment. In some severe cases, medication can also be effective.

To help with the diagnosis, your GP may carry out a physical examination or blood tests to rule out other conditions that may be causing your symptoms, such as anaemia (a deficiency in iron or vitamin B12 and folate) and an .

What can you do to make to make the condition better?

There are several steps you can take to make yourself feel better:

1. Social support Understanding the cause of symptoms and talking things over with a friend, family member or health professional may help.
2. Counselling, anxiety management courses and Cognitive behavioural therapy (CBT)
3. Good sleeping routine
4. Exercise regularly Regular exercise, particularly aerobic exercise, may help you combat stress and release tension. It also encourages your brain to release serotonin, which can improve your mood. Examples of good aerobic exercises include walking fast or jogging, swimming, cycling, tennis, hiking. You should aim to do at least 150 minutes of moderate intensity exercise a week. Moderate-intensity exercise should raise your heart rate and make you breathe faster.
5. Keep a journal.Keeping track of your personal life can help you and your mental health professional identify what’s causing you stress and what seems to help you feel better.
6. Prioritize issues in your life.You can reduce anxiety by carefully managing your time and energy.
7. Optimize your diet There aren’t any diet changes that can cure anxiety but watching what you eat may help.

• Eat a breakfast that includes some protein. Eating protein at breakfast can help you feel fuller longer and help keep your blood sugar steady so that you have more energy as you start your day.
• Eat complex carbohydrates. Carbohydrates are thought to increase the amount of serotonin in your brain, which has a calming effect. Eat foods rich in complex carbohydrates. Steer clear of foods that contain simple carbohydrates, such as sugary foods and drinks.
• Drink plenty of water. Even mild dehydration can affect your mood.
• Pay attention to food sensitivities. In some people, certain foods or food additives can cause unpleasant physical reactions. In certain people, these physical reactions may lead to shifts in mood, including irritability or anxiety.
• Try to eat healthy, balanced meals.  Eat lots of fresh fruits and vegetables, and don’t overeat. It may also help to eat fish high in omega-3 fatty acids, such as salmon, on a regular basis.

Be patient, as it may take some time before these changes have an effect on your anxiety.

Authored by:
Dr Zaineb Mohsin
MBBch, MSc in Critical care (UK), MRCP(UK)
Qualified as a physician, trained in Endocrinology and Diabetes from Imperial NHS Trust and currently working as a research fellow in Metabolic bone disease at Oxford University