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.

While both fear and anxiety can provoke an arousal response, their other effects diverge. Very intense fear sometimes serves to "freeze" the body to protect it from harm, causing little or no change in heart rate and blocking the impulse to move. In anxiety, the physical changes caused by arousal lead to a second stage marked by thought patterns such as worry, dread, and mental replays of anxiety-arousing events.

Thousands of scientific studies over the past several years show that high blood pressure, ulcers, migraine headaches, strokes, alcoholism, depression, anger, fatigue, drug addiction and many other medical conditions are often due to the long-term effects of stress.

Depressed people will seem sad, or "down," or may be unable to enjoy their normal activities. They may have no appetite and lose weight (although some people eat more and gain weight when depressed). They may sleep too much or too little, have difficulty going to sleep, sleep restlessly, or awaken very early in the morning. They may speak of feeling guilty, worthless, or hopeless; they may lack energy or be jumpy and agitated. They may think about killing themselves and may even make a suicide attempt. Some depressed people have delusions (false, fixed ideas) about poverty, sickness, or sinfulness that are related to their depression. Often feelings of depression are worse at a particular time of day, for instance, every morning or every evening.

Feelings associated with anxiety include impatience, apprehensiveness, irritability, and decreased ability to concentrate. People suffering from anxiety may also worry, for no particular reason, that something bad is going to happen to themselves or their loved ones. Individuals with anxiety disorders may make such statements as: - I always thought I was just a worrier, but I would worry about things for days, to the point where I couldn't even sleep. - I had a very strong feeling of impending doom, like I was losing control in an extreme way. - I was always worried that if I didn't do certain things, my parents were going to die. - I felt as if my heart was going to explode, and I couldn't calm down.

The hallmark of this problem is chronic worry and tension with no apparent cause. People suffering from generalized anxiety disorders may worry excessively about health, money, family, or work, often anticipating disaster. Although they are usually aware that their anxiety is more intense than necessary, they can't seem to let it go. Constant worrying contributes to trouble sleeping and relaxing. People with anxiety disorders may startle easily and have trouble concentrating. Generalized anxiety disorder often leads to depression.

If you have been excessively worried about a number of everyday problems for at least six months and have at least six of the common symptoms of anxiety listed earlier, you may have generalized anxiety disorder. Check with your family physician or mental- health professional. Generalized anxiety disorder is highly treatable.

Among the professionals who can help are psychiatrists, psychologists, social workers, and counselors. However, it's best to look for a professional who has specialized training in cognitive-behavioral therapy and/or behavioral therapy, as appropriate, and who is open to the use of medications, should they be needed.

You may be concerned about paying for treatment for an anxiety disorder. If you belong to a Health Maintenance Organization or have some other kind of health insurance, the costs of your treatment may be fully or partially covered. There are also public mental health centers that charge people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan.

Experts have yet to agree on the root cause of anxiety disorders. In fact, most concede that several factors may be at work in each case.

There's little doubt that all our thoughts and feelings are rooted in transmissions between nerve cells in the brain. These signals are passed from cell to cell by chemical neurotransmitters released at the synapse (tiny gap) between one cell and the next.

1. Remember that though your feelings and symptoms are very frightening, they are not dangerous or harmful. 2. Understand that what you are experiencing is an exaggeration of your normal bodily reactions to stress. 3. Do not fight your feelings or try to wish them away. The more you are willing to face them, the less intense they will become. 4. Do not add to your panic by thinking about what "might" happen. 5. Stay in the present. Notice what is really happening to you as opposed to what you think might happen. 6. Label your fear level from zero to 10 and watch it go up and down. Notice that it does not stay at a very high level for more than a few seconds. 7. When the fear begins to trigger "what if" thinking, focus on and carry out a simple and manageable task such as counting backwards from 100 by threes or snapping a rubber band on your wrist. 8. Notice that when you stop adding frightening thoughts to your fear, it begins to fade. 9. When the fear comes, expect and accept it. Wait and give it time to pass without running away from it. 10. Be proud of the progress you make, and think about how good you will feel when you succeed this time.

Effective treatments for each of the anxiety disorders have been developed through research. In general, two types of treatment are available for an anxiety disorder--medication and specific types of psychotherapy (sometimes called "talk therapy"). Both approaches can be effective for most disorders. The choice of one or the other, or both, depends on the patient's and the doctor's preference, and also on the particular anxiety disorder. For example, only psychotherapy has been found effective for specific phobias. When choosing a therapist, you should find out whether medications will be available if needed.

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.

Unrestrained anxiety can lead to any of several emotional disorders, all characterized by an unpleasant and overwhelming mental tension with no apparent identifiable cause. While most people with anxiety disorders are completely aware that their thoughts and behavior are irrational and inappropriate, this insight gives them no help in controlling their symptoms.

Each anxiety disorder has its own distinct features, but they are all bound together by the common theme of excessive, irrational fear and dread.

Stress management techniques and meditation may help you to calm yourself and enhance the effects of therapy, although there is as yet no scientific evidence to support the value of these "wellness" approaches to recovery from anxiety disorders. There is preliminary evidence that aerobic exercise may be of value, and it is known that caffeine, illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of an anxiety disorder. Check with your physician or pharmacist before taking any additional medicines.

Studies show that antidepressants have been effective in treating depression. A type of medicine called selective serotonin reuptake inhibitors (SSRIs) is most often prescribed by doctors. In "talk" therapy, the patient and therapist talk about the patient's experiences, relationships, events, and feelings. Two of the approaches found to be effective for treating depression are interpersonal therapy and cognitive- behavioral therapy.

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.

Like heart disease and diabetes, the brain disorders are complex and probably result from a combination of genetic, behavioral, developmental, and other factors.

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.

Although there are numerous chemicals that perform vital functions within the brain, three basic chemicals, or neurotransmitters, seem most critical in regulating this process and maintaining balance: serotonin, which is related to anxiety, depression, and aggression; dopamine, which affects reality perception and pleasurable experiences; and norepinephrine, which affects attention, concentration, and mood.

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.

Terms and definitions on this page

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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