Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. These disorders fill people's lives with overwhelming anxiety and fear. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.

Anxiety, on the other hand, is more general and complex. It is felt in anticipation of danger, and is associated with the ability to predict, prepare for, and adapt to change. Often, it lasts a long time, and its cause remains ill-defined. For example, someone uneasy about public speaking may experience a tightness in the stomach for days before a scheduled talk.

Both fear and anxiety send signals through the body that prepare all systems for possible danger. Hormones, such as adrenaline and catecholamine, are released in what is known as the "fight or flight" response. The sudden increase in hormone levels speeds up the heart and increases the amount of blood being pumped. At the same time, the muscles tighten, increasing the individual's ability to fight or flee from danger. The intensity of these physiological responses varies according to the seriousness of the event or thought that sparked the emotion, the strength of the individual's fear or anxiety, and his or her previous experience and genetic makeup.

As long as there's a good reason for fear or anxiety, and it doesn't interfere with the ability to work, play, and socialize, it is not considered a problem. But when anxiety takes on a life of its own and begins to disrupt everyday activities, the situation is no longer normal. A genuine emotional disorder is now at work... and it's time to see a doctor.

Many organizations today supports research into the causes, diagnosis, prevention, and treatment of anxiety disorders and other mental illnesses. Studies examine the genetic and environmental risks for major anxiety disorders, their course--both alone and when they occur along with other diseases such as depression--and their treatment. The ultimate goal is to be able to cure, and perhaps even to prevent, anxiety disorders.

Using brain imaging technologies and neurochemical techniques, scientists are finding that a network of interacting structures is responsible for these emotions. Much research centers on the amygdala, an almond-shaped structure deep within the brain. The amygdala is believed to serve as a communications hub between the parts of the brain that process incoming sensory signals and the parts that interpret them. It can signal that a threat is present, and trigger a fear response or anxiety. It appears that emotional memories stored in the central part of the amygdala may play a role in disorders involving very distinct fears, like phobias, while different parts may be involved in other forms of anxiety.

In addition, with new findings about neurogenesis (birth of new brain cells) throughout life, perhaps a method will be found to stimulate growth of new neurons in the hippocampus in people with post-traumatic stress disorder.

Scientists are also conducting clinical trials to find the most effective ways of treating anxiety disorders. For example, one trial is examining how well medication and behavioral therapies work together and separately in the treatment of obsessive-compulsive disorder. Another trial is assessing the safety and efficacy of medication treatments for anxiety disorders in children and adolescents with co-occurring attention deficit hyperactivity disorder. For more information about clinical trials, for example the National Library of Medicine's clinical trials database.

If you have been treated previously for an anxiety disorder, be prepared to tell the doctor what treatment you tried. If it was a medication, what was the dosage, was it gradually increased, and how long did you take it? If you had psychotherapy, what kind was it, and how often did you attend sessions? It often happens that people believe they have "failed" at treatment, or that the treatment has failed them, when in fact it was never given an adequate trial.

In many instances, medications are essential. If you suffer from mania, a major depression, or a paranoid disorder, medications may actually be able to restore you to your normal self. For other conditions, such as schizophrenia, medications control and modify symptoms to the degree that a person can stay in his community. Medications also ease the more distressing symptoms, allowing a person to engage in a therapeutic relationship and re-engage in the activities of her daily life. Sometimes a drug is a useful additional measure during particularly stressful times, perhaps in the initial stage of treatment or at a time of crisis. Those patients with thought disorders or hallucinatory experiences can be maintained only with appropriate antipsychotic medications.

Psychopharmacology, the treatment of psychiatric disorders and emotional distress with medication, has developed over the last fifty years, as our understanding of the workings of the brain has increased in sophistication. When medication is prescribed for mental and emotional illness, the most frequent goal is to restore the chemical balance within the brain, thereby restoring equilibrium to the entire system. Certain drugs function to address certain symptoms, such as when sedatives are prescribed for insomnia. Medications can work to slow disease processes, such as when anti-oxidants are used to treat Alzheimer's. Still other drugs control cravings and curb other problematic behaviors, such as taken to control alcoholism.

Medication is most helpful when there is clear disorder or, sometimes, a specific target symptom for a particular drug. Usually, a pattern of symptoms point to a specific chemical imbalance. Whenever an imbalance appears evident through a person's disordered behavior and emotional state, medication centers on modifying the strength of the signal or readjusting the balance among them.

It's important that you feel comfortable with the therapy that the mental health professional suggests. If this is not the case, seek help elsewhere. However, if you've been taking medication, it's important not to discontinue it abruptly, as stated before. Certain drugs have to be tapered off under the supervision of your physician.

Remember, though, that when you find a health care professional that you're satisfied with, the two of you are working together as a team. Together you will be able to develop a plan to treat your anxiety disorder that may involve medications, cognitive-behavioral or other talk therapy, or both, as appropriate.

Definition explaining

Anxiety

• A state of uneasiness and apprehension, as about future uncertainties.


• Worry or tension in response to real or imagined stress, danger, or dreaded situations. Physical reactions such as fast pulse, sweating, trembling, fatigue, and weakness may accompany anxiety.

Anxiety disorder

• A psychiatric disorder involving the presence of anxiety that is so intense or so frequently present that it causes difficulty or distress for the individual.

Anxiety disorders

• Any of various disorders in which anxiety is either the primary disturbance or is the result of confronting a feared situation or object; they include obsessive-compulsive disorder and posttraumatic stress disorder.

Fear

• Fear is an unpleasant feeling of perceived risk or danger, whether it be real or imagined.

Depression

• In psychiatry, a symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection.

Mental health

• A state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life.


• The psychological state of someone who is functioning at a satisfactory level of emotional and behavioral adjustment.

Stress

• A state of extreme difficulty, pressure, or strain.


• A physical and psychological response that results from being exposed to a demand or pressure.

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