Decoding Anxiety: Unraveling the Origins, Varieties, and Steps Towards Well-Being

• What is Anxiety?
• What are the Different Types of Anxiety Disorders?
  • Generalized Anxiety Disorder (GAD)
  • Social Anxiety Disorder (SAD)
  • Panic Disorder (PD)
  • Post-traumatic Stress Disorder (PTSD)
  • Acute Stress Disorder
  • Adjustment Disorder
  • Depression
• Screening Tests for Anxiety Disorders
• What Causes Anxiety Disorders?
• What Are My Treatment Options?
  • How do I Know if I am Dependent or Addicted to Benzodiazepines?
• How do I Find Help for Anxiety?
• How do I Get Help if I am Suicidal?
• Summary

Key Takeaways

• Anxiety only becomes problematic when it happens for no reason or interferes with everyday life.
• Factors contributing to the development of anxiety disorders include genetics, traumatic experiences, neurological factors, and certain medical conditions.
• Treatment Options for anxiety disorders include:
  • Self-Help and Lifestyle Changes: Exercise, relaxation techniques, and engaging in positive activities.
  • Psychotherapy: Various forms, with cognitive-behavioral therapy (CBT) being particularly effective.
  • Medication: Both maintenance medications (like SSRIs) and short-term use medications (like benzodiazepines) can help.

What is Anxiety?

Anxiety is a feeling of worry or fear. There are many situations where this is perfectly normal. For example, if you see a wild animal running towards you, it is normal and healthy for you to feel anxiety. This feeling is what gets you running to safety!

When you feel anxious, your body releases stress hormones like adrenaline and cortisol from your adrenal glands. If a wild animal attacked you, adrenaline would make your heart beat faster and give you the energy to run away. So, anxiety is sometimes necessary.

Anxiety is a problem when it happens for no reason or gets in the way of your everyday life.

An anxiety attack may look like this: Your heart is racing, your palms are sweaty. There are beads of sweat on your forehead. You feel all the same things you would if a wild animal was chasing you, but they’re not. You’re just sitting at home, trying to relax.

Another source of anxiety may be a job interview or presentation. This is normal. However, when your anxiety makes your thoughts ramble, your voice quivers, and you fail to communicate effectively, this is problematic.

These occurrences may signal an anxiety disorder.

What are the Different Types of Anxiety Disorders?

Here are the most common types of anxiety disorders and some other problems that feature a lot of anxiety.

These other problems are not exactly called anxiety disorders, but we’ll give you some information about each one.

If you think you have an anxiety disorder, you should see a doctor or a mental health professional for proper diagnosis and treatment.

Generalized Anxiety Disorder (GAD)

If you spend most days worrying excessively and have trouble controlling your worry, then you may have GAD. GAD is one of the most common mental health disorders. It is approximately twice as common in females than in males. The risk increases if someone in your immediate family has GAD or depression. It’s also more common in people with chronic physical illness.

GAD is one of the most common mental health disorders, affecting females twice as commonly as males.

It is not uncommon for people who have GAD to also experience other mental health conditions, such as phobias, panic disorder, depression, substance abuse, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).

Social Anxiety Disorder (SAD)

As the name implies, in SAD, the social event triggers the anxiety. Social gatherings or performing a presentation may cause intense emotions of fear and anxiety. Fear of being rejected or judged by others intensifies Social Anxiety Disorder (SAD).

Some anxiety is expected in these social situations. But if you have SAD, it is severe enough to impair your function. For many people with this condition, they avoid these situations altogether, which can affect their ability to work and have normal relationships with others.

SAD is a common disorder and more common in females and persons with a family history of the disorder.

Panic Disorder (PD)

A panic attack is a sudden episode of intense fear that develops out of the blue and lasts several minutes to an hour.

If you have a panic disorder, you may have recurrent panic attacks. This creates a cycle of worry about the next attack, which leads to avoidance, to prevent such attacks. A common source of panic attacks is fear of crowded events – agoraphobia.  Large public gatherings are particularly frightening for those suffering from agoraphobia because it is difficult to physically remove themselves if an attack occurs.

Panic attacks may also occur in other anxiety disorders where there has been trauma. Objects or memories of the trauma can trigger these attacks.

Panic disorder is twice as common in females than in males.

The rate of panic disorders drops for those over the age of 60.

It is not uncommon to see GAD, SAD, PTSD, depression, substance abuse, or bipolar disorder in a person who has panic disorder.

Post-traumatic Stress Disorder (PTSD)

While PTSD is now classified as a Trauma or Stress-Related Disorder, at one point, it was considered an anxiety disorder.

Women are more likely to develop PTSD than men. Experiencing or witnessing a traumatic event can cause you to experience PTSD. The types of traumatic events that lead to PTSD are generally serious and involve actual or threatened death, serious injury, or sexual violence.

Anxiety is only one component of PTSD. However, it is a significant part of the disorder, so we’ve included it here. The same holds true for Acute Stress Disorder and Adjustment Disorders.

Women are more likely to develop PTSD than men. You can develop PTSD if you experience or witness a serious traumatic event, such as those involving actual or threatened death, serious injury, or sexual violence.

If you have PTSD, you likely have distressing dreams, recurrent and disturbing memories, or flashbacks about the event. Reminders of the event may trigger intense psychological distress or physical reactions. This can affect your mood or thought process. As a result, you avoid those reminders to prevent negative physical and emotional responses.

Acute Stress Disorder

Acute Stress Disorder is similar to PTSD. They are both related to a traumatic event and have similar symptoms. However, in  Acute Stress Disorder, your symptoms resolve about a month after the event.

Prompt resolution of symptoms is aided by psychotherapy treatment initiated shortly after the occurrence. Symptoms lasting more than a month may indicate PTSD.

About half of the people with acute stress disorder go on to have PTSD.

Adjustment Disorder

Adjustment disorder is an emotional or physical response to a life stressor. This may occur in an otherwise healthy person with no prior history of mental illness.

Life events that can trigger an adjustment disorder include:

• Divorce
• Death of a loved one
• Financial stress or work problems
• Moving to a new home
• Life-threatening medical diagnosis such as cancer in yourself or a loved one.

Life stressors for children and teens include:

• Family Problems such as fighting within the family
• Problems in school
• Issues of identity

Symptoms of adjustment disorders can include:

• Feeling depressed or hopeless
• Difficulty socializing
• Defiant or reckless behavior
• Thoughts of suicide
• Feeling worried, anxious, or afraid

With adjustment disorder, you may experience anxiety symptoms predominantly, while others experience depression symptoms predominantly. An adjustment disorder does not last more than six months after the stress of the event is over.

Adjustment disorder can occur in an otherwise healthy person with no prior history of mental illness.

Depression

There is a significant overlap in symptoms of depression and anxiety. Most people with depression have some degree of anxiety, and many people with anxiety have some depressive symptoms.

Sometimes, it can be challenging to determine the primary problem, and your doctor or mental health provider can help you with this.

Screening Tests for Anxiety Disorders

While a screening test isn’t a complete evaluation, it can help you and your doctor to know the cause of your symptoms and help them decide on the next steps.

Many screening tests are available. The following is an example of a screening test for GAD:

Please answer the following:

Yes    No	Do you experience excessive worry?
Yes    No	Is your worry excessive in intensity, frequency, or amount of distress it causes?
Yes    No	Do you find it difficult to control the worry (or stop worrying) once it starts?
Yes    No	Do you worry excessively or uncontrollably about minor things such as being late for an appointment, minor repairs, homework, etc.?

If you answered “Yes” to more than one of these questions, you need further evaluation for an anxiety disorder and should talk to your doctor or mental health provider.

What Causes Anxiety Disorders?

While we don’t know everything about what causes anxiety disorders, some factors increase your risk, including the following:

1. Genetics. If someone in your family has an anxiety disorder or major depression, you may be at higher risk.
2. Traumatic Experiences. GAD and SAD are associated with a high level of traumatic experiences in childhood.
3. Neurological Factors. Research has shown differences in some brain factors between people who have anxiety and other mental health disorders and those who don’t. These neurological factors include:
4. Neurotransmitters (the chemicals your nerves use to communicate with each other)
5. Hormone levels produced by your pituitary and hypothalamus (small glands at the base of your brain)
6. Your brain circuitry (for example, how different parts of your brain respond to stress)

However, we still don’t know much about these factors. It’s unclear if they cause the disorders or happen because of them.

Anxiety disorders probably come from a mix of different things. Not everyone with a genetic predisposition or a traumatic life event will get it. However, having both a genetic susceptibility and having endured traumatic life events places you at high risk for developing an anxiety disorder.

 

Your natural personality might also matter. The way you were brought up and what you learned about dealing with emotional stress can affect your mental health.

Research happening now and in the future will give us more answers.

4. Medical Conditions. Sometimes, other medical conditions can mimic emotional symptoms. It’s important to consider current illnesses if you develop anxiety problems.

The following is a list of medical conditions that can cause symptoms of anxiety or panic. Your doctor may want to rule these out before deciding that your anxiety is a primary anxiety disorder:

a. Endocrine or Hormonal Conditions. The most common endocrine condition that causes anxiety symptoms is high thyroid levels (hyperthyroidism).

A less common cause is too much parathyroid hormone production (hyperparathyroidism).

A rare cause of anxiety symptoms is a neuroendocrine tumor formed when adrenal glands secrete too much adrenaline (pheochromocytoma).

Sometimes, very low or high blood sugar, such as with diabetes, can cause anxiety symptoms.

b. ­Heart and Lung Conditions. Abnormal heart rhythms, or arrhythmias, can be common.

You may feel anxious when you have an irregular heart rhythm. It is expected to occasionally feel a flutter or irregularity in your heartbeat.

However, if you feel this irregular heartbeat often, such as with exercise, and if you have other symptoms, such as shortness of breath, chest pain, lightheadedness, or panic, these could be signs of a more serious condition. A heart condition called atrial fibrillation or other serious heartbeat disturbances (arrhythmia).

Atrial fibrillation is an electrical abnormality in the heart where the upper portions of the heart (atria) are not beating regularly. Rather than a nice strong contraction and relaxation, the upper chamber (atria)  quivers, creating flutter-like movements. This is called atrial fibrillation. The lower heart chambers, called ventricles, beat regularly.

Because the upper (atria) and lower (ventricle) chambers are not synchronized in their movement, insufficient blood is passed into the ventricles. The blood in the upper chamber (atria) does not flow as it should. This leads to stagnation (stasis), which creates blood clots. Small pieces of blood clot flow from the heart to the brain, causing a stroke.

Sleep apnea and COPD (chronic obstructive pulmonary disease) are lung conditions with symptoms that mimic anxiety. If you aren’t getting enough air in or out, it will cause you to feel very panicky.

c. Neurological Disorders. Rarely, certain types of epilepsy, or a transient ischemic attack (where a part of your brain temporarily doesn’t get enough oxygen, also called a “mini-stroke”), can be mistaken as an anxiety disorder.

d. Side Effects from Drugs. Any stimulant can cause anxiety symptoms.

Anxiety side effects as a result of medication use are dose-dependent. The higher the dose, the more likely you’ll experience anxiety as a result.

Stimulants that can cause anxiety symptoms include caffeine, guarana, ginseng, and ephedrine, which are all found in most energy drinks.

Anxiety symptoms can occur after taking prescription medications for:

• Attention Deficit Hyperactivity Disorder (ADD or ADHD), for example, methylphenidate or dextroamphetamine/amphetamine
• hypothyroidism (low thyroid), for example, levothyroxine
• asthma rescue inhalers, for example, albuterol
• weight loss medications, for example, phentermine
• cardiac medications, for example, digitalis
• decongestants, for example, pseudoephedrine

Substances, usually stimulants, that commonly cause anxiety symptoms include:

• Amphetamines
• MDMA (street name of Ecstasy)
• PCP (street name of Angel Dust)
• Cocaine
• Methamphetamine
• MDPV (street name of Bath Salts)
• Marijuana
• Alcohol- you may use alcohol to relax, and it works in the short term, but over time, it increases anxiety symptoms.

Withdrawal from any medication or drug that is habit-forming can lead to anxiety symptoms.

This can be further complicated because many people with underlying mental health problems, including anxiety disorders, use drugs or alcohol to self-medicate.

Stopping a drug that you are addicted to may cause withdrawal symptoms, which mimic anxiety.

Lab Testing. Your doctor may want to do lab work to look for some of the common medical causes of anxiety.

Tests that your doctor might consider doing are listed below.

a. Complete Blood Count (CBC). This looks at all your blood cell parameters and will show if your red blood cell (RBC) and white blood cell (WBC) counts are too high or too low.

The CBC can reveal problems such as anemia (low RBC count), polycythemia (high RBC count), bone marrow disorders, blood cancers, and signs of infection.

b. Chemistry Panel (CMP, C14, C20, BMP). There are different panels, but most look at your electrolytes like sodium, potassium, calcium, and blood sugar or glucose.

Often, this includes kidney function and sometimes liver function tests. This type of panel can show kidney or liver problems and diabetes. It can also indicate that you may have adrenal or parathyroid problems that require further evaluation.

c. Thyroid Function Tests (Usually TSH and/or Free T4). These tests can determine if you have hyper- or hypothyroidism, which are high or low thyroid hormone levels.

d. Urinalysis (UA). This test examines your urinary system. It looks for abnormalities like high protein, glucose (sugar), and red and white blood cells. It also checks for abnormal concentrations of urine, which can indicate a kidney problem, diabetes, infection, urinary cancers, and adrenal problems.

e. Urine Drug Screen. This looks for commonly misused drugs.

What Are My Treatment Options?

There are many different options to treat anxiety disorders. The main treatment categories are:

• self-help or lifestyle changes
• counseling or psychotherapy
• medications

While you may find that one thing, like medication or working with a counselor, makes your anxiety better, scientific studies show that many times, a combination of methods works better. Therefore, your doctor or therapist may recommend multiple treatments.

Also, it can be challenging to know what treatment will be the most helpful. Some trial and error is required. So, if one treatment isn’t working for you, don’t give up on treatment altogether.

Self-Help or Lifestyle Changes

Many self-help options for anxiety treatment are helpful for more than anxiety disorders. They can also be a part of the treatment regimen for mild depression.

Most lifestyle recommendations are healthy ideas. Even if you aren’t anxious, you can still do them to support your mental health. Below are some recommendations you may get from your doctor or therapist:

1. Exercise. You can do either aerobic exercise or resistance training. Aerobic exercise includes cycling, swimming, running, and brisk walking. For resistance training, you can do upper and lower-body weight lifting.

While any amount of exercise you do will have benefits, recommendations encourage 150 minutes (2.5 hours) of moderate physical activity per week. These 150 minutes can be divided into whatever combination works for you. A popular approach is working out 30 minutes daily for five days weekly. Again, the focus should be finding what works for you and your schedule.

If 150 minutes is too much to commit to, start with whatever you are comfortable with – perhaps walking slowly for 10 minutes daily.

Think of exercise like taking a prescribed medication. For your medicine to work, it must be taken regularly as prescribed. The same holds true for any lifestyle treatment option. Consistency is key. With time you will find it easier to increase your exercise duration and intensity.

You should talk to your doctor before starting a vigorous exercise program if you are:

• concerned about underlying medical problems
• male and over 45
• female and over 55
• diagnosed with serious underlying health problems such as heart, kidney, lung disease, or vascular or circulation problems such as arthritis or diabetes.

Give your lifestyle treatment option (such as exercise)  the same discipline you would with medications. You would need to take your medications consistently for them to work. The same is true for whatever lifestyle treatment regimen you are incorporating.

2. Relaxation and Mindfulness. Relaxation and mindfulness techniques can help anxiety symptoms. These include progressive muscle relaxation and guided imagery or visualization.

Progressive muscle relaxation is a technique where you contract and relax the muscles in your body, one at a time, moving from one end to the other.

Visualization can involve creating an image of a relaxing or peaceful setting, such as lying in a hammock on the beach.

Mindfulness usually involves meditation, a technique where you focus on the present moment and, over time, train your mind to be calmer. It can help you learn not to get caught up in anxious thinking.

These techniques are often easier to learn with the help of a therapist, but you can also find books and apps to teach you.

3. Behavioral Activation. Behavioral activation is simply engaging in positive activities. For example, participating in events that make you feel good or relaxed and doing things you enjoy.

You may find that you aren’t doing these things as often as you did due to your anxiety. However, you shouldn’t wait until you are feeling better to resume these activities. If you “force yourself” to start doing one of your activities, you may find that it helps your anxiety improve. Again, like exercise, you may have to schedule this like a prescription, at least at first, to help you get going with it.

And again, like exercise, if this is a challenge, start small. If woodwork is your thing, rather than diving into a whole new project,  spend 30 minutes one day working on a small item or part of a project.

If you like to garden, spend 30 minutes one day working on whatever your garden needs that day- watering, weeding, or trimming some plants. Then, do it again in a few days and gain momentum.

Don’t be hard on yourself if you are having difficulty getting started. If 30 minutes is too much, start with 10 minutes or whatever amount works for you. If it is an activity that causes anxiety, you may need to start slower with just a couple minutes of that activity, or you may need to wait and do this with the help of your mental health provider.

Push yourself to start activities that lift your spirit even when you’re still feeling down. Don’t wait until you feel better before engaging in positive activities.

Psychotherapy. This is also known as “talk therapy.” Therapy is particularly important in anxiety disorders to help gain skills to have better control over your anxiety throughout your life.

Different types of talk therapy can help with anxiety disorders. Cognitive-behavioral therapy (CBT) is effective for anxiety disorders such as generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder (PD) in clinical studies.

Other types of talk therapy do not have enough evidence from studies to prove they are effective, but some people find them helpful.

There is a growing availability of online or virtual therapy. Therefore, therapist availability is now less of an issue than it used to be when it was all in person.

Cognitive Behavioral Therapy (CBT) for anxiety disorders involves:

• education about anxiety
• learning to self-monitor your anxiety
• relaxation training
• cognitive restructuring (learning skills that help you identify and change thought and behavior patterns contributing to anxiety)
• imagery exposure (learning to cope with anxiety-producing situations)
• exposure to anxiety-provoking situations
• relapse prevention

Another emerging therapy is Eye Movement Desensitization and Reprocessing (EMDR). EMDR is typically used for the treatment of trauma-related anxiety and occurs in phases. A simplified version of this process is this. During EMDR, the therapist helps you recall the traumatic event. They then have you visually focus on their rapidly moving fingers. The painful sting of the traumatic event is reprocessed and diminished. When the event is later recalled, the trauma you experience is reduced.

You and your therapist will decide what to work on together. Remember, you are always in control of your therapy!

Various medical and mental health professionals offer therapy. They include psychiatrists, psychologists, licensed professional counselors, licensed social workers, licensed marriage and family therapists, or psychiatric nurses.

Psychiatrists, who are medical doctors, can also prescribe medications, as can mental health nurse practitioners. Most other therapists cannot prescribe medications. If you need medication, your primary care doctor, such as a family practice or internal medicine doctor, can also prescribe it for you.

“Psychotherapist” is a general term and not a title. Before you see a therapist, checking their background to ensure they meet state certification and licensing requirements is a good idea.

You may hesitate to engage in therapy. After all, discussing personal matters creates vulnerability. By checking your therapist’s background, you will at least be reassured that they have the qualifications, training, and skills to help you. You can ask your primary care doctor for a referral or recommendation. In fact, a referral from your primary care provider may be the best place to start.

Depending on your needs, your therapy might focus on different things. Common benefits include:

1. Learning coping skills for dealing with stress and difficult situations.
2. Addressing problems in your relationships and improving your skills for relating to others, such as family, friends, and co-workers.
3. Replacing negative or unhealthy beliefs with positive ones.
4. Healthy conflict resolution techniques.

You and your therapist will discuss your goals and needs. Being open and honest will help facilitate meaningful discussions. However, if you aren’t comfortable discussing specific issues, that’s fine too. It is important to go at a pace you’re comfortable with.

It will take a few sessions for you and your therapist to get to know each other. Consider switching if you are uncomfortable and not feeling connected after several sessions.

Some people only need a few sessions to get the help they need; for others, it will require more time. Try to stick with it and be patient, but let your therapist know if your sessions are not beneficial or if you want to go in a different direction.

Sometimes, depending on the issues involved, therapy can be emotionally challenging and feel like hard work. If so, let your therapist know so they can help you cope with these feelings.

Therapy is confidential. Your therapist will never discuss anything you say or any part of your care without your permission. Like all rules, there are exceptions. The exceptions to the confidentiality rule are if there is an immediate threat of safety to yourself or someone else or when required by law. Ask your therapist if you have any questions about confidentiality.

Therapy doesn’t take away the stress in your life, but it can help you find and learn the skills you need to cope with stress healthily and feel better about yourself and your life.

Medication. Not everyone with anxiety needs medication. Often, if you have mild anxiety, lifestyle changes, and therapy can be enough to improve your symptoms. However, if those non-medication treatments don’t work, your doctor may consider prescribing medication.

If your anxiety is moderate or severe, such as affecting your daily function, your provider is more likely to recommend medication. Ultimately, the decision to take medication is one you need to make in partnership with your doctor.

There are many different anxiety medications available. Some are taken daily for maintenance to decrease anxiety levels. Some acute medications are only taken when needed for severe anxiety.

Maintenance Medications. Maintenance medications may be recommended for any anxiety disorder, including generalized anxiety disorder (GAD), panic disorder (PD), and social anxiety disorder (SAD). The medicines are categorized by which brain chemicals (neurotransmitters) they affect.

Neurotransmitters are the chemicals the nerves use to communicate with each other and other brain and body parts. For example, SSRIs (Selective Serotonin Reuptake Inhibitors) affect your serotonin level. Other medications affect norepinephrine or dopamine levels, which are different neurotransmitters.

Doctors used to think that changing these neurotransmitter levels and rebalancing them back to normal is how medications improve anxiety. However, ongoing research suggests that other factors than neurotransmitters may influence how these medications work.

Many of these medications are the same as those used for depression. While the symptoms of anxiety and depression are different, there is some overlap. Their underlying mechanisms in the body are similar.

For example, two people from the same family who are exposed to the same stresses may develop different mental health problems. One might develop anxiety, and the other may develop depression. And they both could respond to the same anti-anxiety, anti-depressant medication.

Medications used for anxiety and depression may take a little while to work. Most take at least 1-2 weeks to start to show an effect and can take 6-12 weeks to be closer to a full effect. These meds will need to be taken every day, whether or not you are having anxiety at the time.

Because medications that treat anxiety take some time to start to work, you will need to be patient to see the full effect. If you would like to stop your medication, you should call your doctor right away to discuss alternatives rather than just stopping it on your own.

Even though these medications change neurotransmitter levels fairly quickly, seeing a change in your symptoms still takes time. We are not sure why there is a lag in symptom response. Research suggests that the delay may be due to the time needed to heal the nerve cells.

No anti-anxiety medication is better than another. Your doctor will choose one based on your symptoms and other factors, which may include your other medical conditions, the potential for interactions with your other medications, potential side effects, cost, your response to antidepressants in the past, and the response of close family members to similar meds.

Most of the time, your doctor will start you on a low dose and increase it slowly if needed. Over time, your doctor may change your medication, increase or decrease your dose, or add a second medication, depending on how you respond.

Side effects vary based on the medication. Common side effects include dry mouth, constipation, insomnia, drowsiness, agitation, lightheadedness, nausea, diarrhea, weight gain, and sexual dysfunction.

In children and teenagers, antidepressants may worsen suicidal thoughts. This is less common in adults. Still, you need to let your doctor know at any time if you are feeling even more anxious, depressed, or suicidal, especially after starting a new medication.

Short-term (Acute) Medications. The majority of medications that you might be prescribed for the short-term treatment of anxiety are in a family of medications called benzodiazepines. Short-term medicines work in 20-30 minutes. These medications usually wear off within several hours. While very effective for reducing anxiety, their potential side effects limit their use.

Benzodiazepines (benzos) can be habit-forming, meaning you are at risk for addiction and misuse of the drug. You can also develop a benzodiazepine tolerance. Tolerance means that the medicine dose needs to be increased over time to have the same effect.

Over time, benzos can cause depression and cognitive problems, such as memory lapse, and increase your risk of injury due to falls. The risks of these medications are even higher if you are over age 65.

The habit-forming potential includes becoming physically or psychologically dependent on the medication and becoming addicted to the medication.

The risk of these problems is higher if you have a history of substance abuse, including alcohol addiction. You should never mix benzodiazepines with alcohol or other recreational drugs, as the risk of overdose increases significantly. You also should not drive when you have taken benzos as they impair your ability to drive a car and cause drowsiness.

While doctors often recommend avoiding or limiting benzodiazepines for anxiety, there are times when they are considered appropriate. If anxiety levels are severe, benzodiazepines will be used in the first few weeks in addition to a maintenance anxiety medication. Benzos provide immediate relief while waiting for the maintenance medication to start working.

Benzodiazepines are also used for panic attacks and social anxiety. In panic disorder, they can be used alone if the panic attacks are infrequent. If the panic attacks are frequent, then a maintenance medication is usually recommended. In this case, benzodiazepines may still be used for breakthrough panic attacks.

For social anxiety, these meds are used only for performance-related social anxiety. For example, if you occasionally do public speaking, which triggers your anxiety, you might be prescribed a benzodiazepine to take before the speaking events.

Some short-term (acute) medications that are not habit-forming can also be used. One of those is hydroxyzine. Hydroxyzine causes drowsiness, so you should not drive or drink alcohol when taking this drug. However, it is not habit-forming.

A group of drugs called beta-blockers is another treatment option for performance-related social anxiety. Beta-blockers are commonly used for the treatment of high blood pressure. They decrease your body’s response to adrenaline, a stress hormone produced by your adrenal glands. They do not cause drowsiness and are not habit-forming. Thus making them a popular option for a short-term treatment option.

How do I Know if I am Dependent or Addicted to Benzodiazepines?

Some of the symptoms you might have if you have developed a benzodiazepine use disorder include the following:

• Difficulty in cutting back or stopping the medication.
• Cravings to use benzos.
• Spending a lot of time trying to get benzodiazepines.
• Social problems develop from your use of the medication. This could include problems at work, home, or relationships.
• Continuing to take these medications when it isn’t safe, such as when driving or operating heavy or dangerous machinery or mixing it with alcohol.
• Having to take more of the medication for it to work.
• Withdrawal symptoms if you cut back or abruptly stop the medication.

Symptoms of withdrawal include anxiety and insomnia in the first few days after stopping the drug. In addition to anxiety and insomnia, over the next two weeks, you might also experience the following symptoms:

• Irritability
• Tremor
• Sweating
• Difficulty concentrating
• Nausea and vomiting
• Palpitations
• Headache or muscle aches.

The most severe symptoms of withdrawal, which can be life-threatening in severe benzodiazepine withdrawal, include seizures and psychosis (severe confusion where you lose your sense of reality).

Therefore, it is always important to wean off of benzodiazepines rather than stop them suddenly. Talk to your doctor about how to stop these if you take them regularly. Let your doctor know if you are taking more than the prescribed amount. It may mean that you are developing dependency or addiction related to the medications, or it may simply mean that your anxiety disorder isn’t well controlled. Your doctor may need to adjust your other medications to help better control your anxiety.

Risk factors for severe withdrawal with seizures include:

• prior brain damage
• history of seizures
• alcoholism
• high doses or more prolonged use of benzodiazepines
• stopping the medication suddenly rather than a slow taper

Tell your doctor if you have any of these risk factors before you cut back or stop your medication so they can give you the best advice and plan on how to do that safely.

Some maintenance medications can produce symptoms that seem like withdrawal symptoms, even though they are not addictive medications. This is called “discontinuation syndrome” and is different from a withdrawal.

Most of the time, these symptoms are mild and resolve on their own after one to two weeks.

Talk to your doctor before you stop any anxiety medication. They may have you wean slowly to avoid discontinuation syndrome. Let them know if you experience any problems after stopping your medication.

How do I Find Help for Anxiety?

An excellent place to start is with your primary care doctor. They can help you directly or refer you to a mental health professional.

If you do not have a doctor but have health insurance, try calling the customer service number on the back of your insurance card. Tell them that you need to see a mental health provider, and they should be able to give you names of providers in your area that your insurance covers.

If you do not have insurance, your area may have low-cost options. The American Academy of Family Physicians Neighborhood Navigator can help you find mental health and other resources in your area.

How do I Get Help if I am Suicidal?

If you are feeling suicidal now or at any other time, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Someone is available 24/7 to provide support. This is free, confidential, and available throughout the United States.

If you are concerned that a friend or family member is considering suicide, please encourage them to call the  National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Reach out right away,  even if you feel the danger is not imminent.  Trained counselors can provide support and resources within the community. If you or someone you know is in immediate danger, call 911.

Summary

Like most mental health conditions, anxiety is caused by a chemical imbalance in the brain. Having an anxiety disorder is not a sign of weakness. Treatment through therapy, lifestyle changes, and medications can go a long way in reducing your anxiety symptoms and allow you to enjoy life that much more.

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Written by: myObMD physician writing team | Editor: Jennifer Abayowa and Dr. Dayna Smith, MD | Reviewed: February 13, 2024 | Copyright myObMD, Inc. 2024.

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