Noone has defined the accurate aetiology of anxiety disrders, yet there do exist many theories. Similarly to other psychiatric disorders, anxiety disorders have their root onto biological, psychological, social and environmental parameters with variable degrees.

Panic disorder for example, can be caused from over secretion of stress hormones ( like adrenaline and nor-adrenaline) thus introducing an alarm state in brain. Deficient balance of a neurochemical substance called serotonin in different cerebral structures contributes to the aetiology of both the Depressive disorders and Anxiety disorders as well.

Some people may inherit predisposition towards an anxiety disorder. This genetic diathesis can be triggered or further exacerbated by distorted beliefs and learnt behaviors. For example, fear of future panic attacks (or even the fear of fear itself) can distort the cognition of body’s proper function. Thus, psychologically healthy people do not get bothered by their increasing sweat in a hot day neither by a small change in their heart rate when attracted by woman. But someone with anxiety disorder may interpret these physiological changes as precursor of catastrophe. Researchers have also found that Life Stressful Events, such as death of beloved, divorce or residence transfer can lead to or exacerbate symptoms of anxiety disorder.

Accordng to the official American system of classification of mental health disorders, a panic episode includes 4 or more of the following symptoms:

• Palpitations
• Sweatening
• Tremor
• Breathlessness
• Sense of suffocation
• Chest pain
• Nausea
• Derealisation
• Fear of getting crazy
• Fear of dying

A separate and only panic attack may not be of major concern. But consecutive episodes of panic attacks should be investigated by a mental health specialist.

Nearly a third of those experiencing panic attacks will evolve to agoraphobia, which is a state of phobia of a place or circumstances, from where in case of anxiety escalation, escape is thought to be difficult or distressing.

Obsessive–compulsive disorder (OCD) is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear or worry (obsessions), repetitive behaviors aimed at reducing the associated anxiety (compulsions), or a combination of such obsessions and compulsions. Symptoms of the disorder include excessive washing or cleaning, repeated checking, extreme hoarding, preoccupation with sexual, violent or religious thoughts, relationship-related obsessions, aversion to particular numbers and nervous rituals such as opening and closing a door a certain number of times before entering or leaving a room.

Generalized anxiety disorder is an anxiety disorder that is characterized by excessive, uncontrollable and often irrational worry that is, apprehensive expectation about events or activities. This excessive worry often interferes with daily functioning, as individuals suffering from GAD typically anticipate disaster, and are overly concerned about everyday matters such as health issues, money, death, family problems, friendship problems, interpersonal relationship problems, or work difficulties. Individuals often exhibit a variety of physical symptoms, including fatigue, fidgeting, headaches, nausea, numbness in hands and feet, muscle tension, muscle aches, difficulty swallowing, bouts of difficulty breathing, difficulty concentrating, trembling, twitching, irritability, agitation, sweating, restlessness, insomnia, hot flashes, rashes and inability to fully control the anxiety.

Therapy of anxiety disorders consists of 2 basic pillars, psychotherapy

and pharmacotherapy or their combination.

Research has shown that should an anxiety disorder be diagnosed in early stage, up to 80 % can be successfully treated.In cases of moderate and severe intensity of symptoms a combined therapy of both psychotherapy and medication has proven particularly efficacious.

In case of pharmacotherapy anxiolytics and antidepressants are the commonest practices. Most commonly used anxiolytics are the benzodiazepines whereas with regard to antidepressants the SSRI’s and the SNRI’s are most commonly prescribed. As far as the psychotherapy used in anxiety disorders, Cognitive Behavioral therapy is thought to be considered as the most utilized form of psychotherapy.

Regarding the medications, those for the treatment of anxiety disorders can be purely anxiolytics belonging to the category of benzodiazepines. They can also belong to the antidepressant category since they have proven their efficacy to anxiety states as well.

Benzodiazepines

Purely anti-anxiety drugs that belong to the class of benzodiazepines are widely prescribed and given for the symptomatic treatment of anxiety as well as sleep disorders. The most common of these medications are diazepam (Stedon), alprazolam (Xanax), lorazepam (Tavor), klorazepat (Tranxene), prazepam (Centrac), bromazepam (Lexotanil).

Common side effects are:

• Sedation
• Dizziness
• Confusion
• Instability

CAUTION benzodiazepines are prescribed by physicians in other specialties (excluding psychiatrists) who are not trained in the treatment of anxiety disorders. The result is an anxiety disrder not diagnosed and treated properly. Towards this outcome contributes the fact that benzos decreases in a spectacular degree anxety, but only temporarily. Eventually, this effect pushes people to “consume” increasingly larger amounts of benzos leading to psychological and physical dependence as these drugs in prolonged use can be addictive.

Buspirone

Buspirone, although anxiolytic, acts differently than benzodiazepines. It is not suppressing nor drowsy, nor is relaxant. In addition it does not cause dependency in case of long-term dosing.

Common side effects are:

• Headache
• Nausea
• Dizziness
• Anxiety

Antidepressants

Depending on the duration and severity of depression, the psychiatrist, if necessary, apart from psychotherapy, may prescribe antidepressants. These are chemicals that act in the brain as messengers and aim at restoring the chemical equilibrium between neurobiological brain nerve cells. All legally prescribed agents can be effective. But they do not work in an exactly same manner on every man because the neurobiologikal mechanisms of human beings differ from each other. Sometimes you may need to test several types of medication or combinations to find relief from depressive symptoms. Antidepressant medications need 2-4 weeks to implement their antidepressant action.

SSRIs

The SSRIs or serotonin reuptake inhibitors, increase levels of a substance, called serotonin, in the brain that improves mood. Well-known SSRIs is paroxetine (seroxat) fluvoxamine (Dumirox), citalopram (seropram), s-citalopram (cipralex, entact), sertraline (Zoloft). The SSRIs apart from depressive disorders can help in anxiety disorders as well, such as obsessive-compulsive disorder, social phobia, panic disorder, generalized anxiety disorder. These drugs generally have few side effects; most of them resolving with time when continuously administered. If however you are concerned about any adverse reactions do not hesitate to contact your doctor.

Common side effects of SSRIs are:

• Tremor
• Anxiety
• Trouble concentrating
• Nausea
• Diarrhea
• Dry mouth
• Change in body weight
• Αλλαγή στο σωματικό βάρος
• Weakness
• Sweating
• Problems sleeping
• Sexual dysfunction

SNRIs 

The SNRIs or serotonin and noradrenaline reuptake inhibitors work in a similar way to the SSRIs except that they increase not only serotonin’s but noradrenaline’s brain levels; the later knowon for its antidepressant effect. Known SNRIs are venlafaxine (Efexor), Duloxetine (Cymbalta, Xeristar). These medicines are also newer and considered to impact effectively both on depressive and anxiety disorders.

Common side effects of SNRIs are:

• Headache
• Anxiety
• Nausea
• Constipation
• Problems sleeping
• Increase of blood pressure
• Sexual dysfunction

They most commonly are transient and abate.

Tricyclic

Tricyclic antidepressant drugs category is older but they are more likely in relation to the SSRIs and SNRIs to cause side effects such as sedation, dry mouth and constipation. Tricyclic medications target the neurotransmitters serotonin and noradrenaline, but not as selectivelly as the newer drugs. Some tricyclics are amitriptyline (Saroten), Doxepin (Sinequan), nefazodone (Nefirel), chlorimipramine (Anafranil). These side effects may be:

• Dizziness
• Dry mouth
• Sedation
• Blurry vision
• Constipation
• Trembling limbs
• Sweating
• Headache
• Tachycardia
• Hypotension
• Weight gain
• Sexual dysfunction

MAOIs 

Because monoaminooxidase inhibitors, MAOIs, can have life-threatening interactions with other drugs or with specific foods, they are rarely prescribed in patients. Their prescription tend to limit to cases where reatment of depression with other categories of antidepressants has failed. Moclobemide is characteristically referred as a typical MAO.

CAUTION

If you are on MAO let your doctor know, especially should he prescribe to you another medication for any other condition. Also ask your doctor to advise you about the foods that you should avoid (rich in tyramine such as various types of cheese, pickles, chocolate, wine, avocados etc.)

CAUTION

• If you are on other antidepressants as well as formulations with anxiolytic action such as St. John wort, Ecstasy or other analgesics, let your doctor knw. There is a risk of dangerous interactions.
• Patients who are being treated with antidepressants should be constantly checked for possible paradoxical increase of suicidal thoughts and behaviors, especially when changing to another medication or dose.