Anxiety Disorders: Your GoodRx Guide

The basics

Anxiety is when you fear or worry about certain future situations. Sometimes, this fear is triggered by a real threat, and in these cases, worry can be life-changing or life-saving. If you are standing in the middle of the road and a truck is speeding toward you, fear will tell you to “Run! Get out of the way!” If you have hit financial hardship, then worry for the future can push you to make radical changes and plan for the future.

But if you have extreme fear in non-life-threatening situations, when most people feel only a little fear, then this could be a sign of an anxiety disorder. Maybe you experience anxiety that never goes away, even when there is nothing to be anxious about.

Severe anxiety like this can stop you from living a fulfilling life and can affect your physical health. If this sounds familiar, then you might have an anxiety disorder.

Do you have an anxiety disorder?

Anxiety disorders are a family of disorders that share a common theme: severe or persistent worry that interferes with normal life and causes physical symptoms.

Anxiety disorders are the most common psychiatric disorder. Around 40 million U.S. adults, or 19% of all adults, have some form of anxiety disorder. They are more common in women than men. Most of these disorders typically first appear in childhood, when they affect boys and girls equally.

We don’t know what causes anxiety disorders. They tend to run in families and can be triggered by negative or stressful life events. This combination of your genes and the environment you were raised in is most often the reason for developing an anxiety disorder.

The most common anxiety disorder is generalized anxiety disorder (GAD), but there are others, too:

• Social anxiety disorder (SAD)

• Panic disorder (PD)

• Specific phobia

• Separation anxiety disorder

• Agoraphobia

If you have an anxiety disorder, it is important that you get professional help to get on top of it. Treatment is different depending on the type of anxiety you have.

So if you think you might have an anxiety disorder but you’re not sure which or how to tell, here’s a guide to decoding your anxiety.

Generalized anxiety disorder

Generalized anxiety disorder (GAD) is worry that is excessive and difficult to control. To be diagnosed with GAD, you usually must have had symptoms on most days of the week for at least 6 months. Your worries can be about things such as school, work, family, or health. These feelings usually cause problems in different areas of your life such as work, school, or relationships.

Does this describe you?

• Feeling restless, wound-up, or on edge


• Easily fatigued


• Difficulty concentrating; mind going blank


• Feeling irritable


• Having muscle tension


• Difficulty controlling feelings of worry


• Difficulty falling asleep or staying asleep, restlessness, or having poor quality sleep


The bottom line: It is normal to worry in certain situations. People with GAD have a hard time controlling their worries, and their worries interfere with their daily functioning.

Social anxiety disorder

If you feel extreme anxiety or excessively self-conscious in social situations, you might have social anxiety disorder (SAD), previously known as “social phobia.” You may only feel this type of anxiety in specific situations such as public speaking. Performance anxiety, commonly known as “stage fright,” is a type of SAD. You may also get symptoms of SAD any time you are around other people. In either case, your symptoms mean that you avoid situations that trigger your anxiety.

Does this describe you?

• You feel intense fear in social or performance situations.

• You worry that you will act in an embarrassing or humiliating way.

• You get anxiety or panic attacks in social or performance situations.

• You know that your anxiety is exaggerated for the situation (although this may not be true for kids).

• Your symptoms interfere with your daily life such as your work, school, or relationships.

The bottom line: People with SAD have severe anxiety in situations where they feel that they are being criticized or judged by other people. They often take extreme measures to avoid these situations.

Panic disorder

Panic attacks are episodes of overwhelming physical and psychological distress that come on out of the blue, peak within 10 minutes, and then go away. If you have unexpected and repeated panic attacks, you may have panic disorder. Some people have such severe panic attacks that they believe they are having a life-threatening medical emergency such as a heart attack.

Does this describe you?

• Experiencing palpitations, pounding heart, or fast heartbeat

• Sweating

• Trembling or shaking

• Feeling breathless

• Feeling of choking

• Chest pain or discomfort

• Nausea or abdominal pain

• Feeling dizzy, unsteady, light-headed, or faint

• Feel chilly or hot

• Numbness or tingling

• Feelings of unreality or being detached from yourself

• Fear of losing control or “going crazy”

• Fear of dying

The bottom line: Having one panic attack does not mean that you have panic disorder. Panic disorder is when you have repeated unexpected panic attacks with at least 4 of the above symptoms all at once.

Specific phobia

Specific phobias are an intense fear of specific objects, situations, or activities that are generally not harmful. If you experience phobias, you most likely recognize that your fears are excessive. You might go to extreme lengths to avoid your feared object, situation, or activity.

Does this describe you?

• You have irrational or excessive worry about encountering the feared object or situation.

• You take active steps to avoid the feared object or situation.

• You experience immediate, intense anxiety upon encountering the feared object or situation.

• You feel intense anxiety around your feared object, situation, or activity.

The bottom line: People with specific phobias have such severe fears that they adapt their lives to avoid the thing that they fear. Some common phobias include flying, heights, getting shots, seeing blood, and specific animals such as spiders, dogs, or snakes.

Separation anxiety disorder

Separation anxiety disorder usually affects children, but adults can have it, too. People with separation anxiety disorder fear being separated from the people they are attached to. They might fear that something bad will happen to the person they are attached to, or they might take extreme measures to avoid being separated from that person. To be diagnosed with separation anxiety disorder, you will usually have experienced symptoms for at least 6 months.

Does this describe you?

• You feel excessive distress when you anticipate or experience separation from someone you feel attached to.


• You worry excessively about losing someone you are attached to or about harm coming to them (like an accident or an illness).

• You worry excessively about a major event separating you from someone you feel attached to (like an accident or illness).

• You avoid leaving home, such as for work or school, because you fear being separated from someone you feel attached to.

• You are excessively fearful of being alone.

• You are reluctant to or refuse to sleep away from home or go to sleep without being near someone you feel attached to.

• Your have repeated nightmares with themes of separation.


• You get frequent physical symptoms such as headaches, stomach aches, nausea, or vomiting when separated from someone you feel attached to.

The bottom line: Both adults and children can experience separation anxiety disorder. The fear of being separated from someone they feel attached to can lead to extreme feelings of distress and anxiety.

Agoraphobia

People with agoraphobia fear being in spaces where escape might be difficult, embarrassing, or where they may not have help if panic symptoms develop.

You might have been in a crowded space like a public bus and felt uncomfortable. This is something many people feel who don’t have agoraphobia. What is different about agoraphobia is that the distress is out of proportion to the actual situation.

To be diagnosed with agoraphobia, you must have had at least two of the symptoms listed below for at least 6 months, and they caused disruption to your daily life.

Does this describe you?

• You feel fear on any public transportation.

• You feel fear in open spaces.

• You feel fear in enclosed places.

• You feel fear standing in line or being in a crowd.

• You feel fear being outside the home alone.

The bottom line: It is a misconception that agoraphobia is only in open spaces. Agoraphobia can be experienced in a variety of settings. People with agoraphobia actively avoid situations that might trigger their fear.

So you have an anxiety disorder — now what?

Once you have been diagnosed with an anxiety disorder, you will probably be encouraged to start “talk therapy” or psychotherapy. For many types of anxiety disorders, talk therapy might be the only treatment needed.

The two most common types of talk therapies for treating anxiety disorders are cognitive behavioral therapy and acceptance commitment therapy. During therapy, you may examine the beliefs that surround your fears. Your therapist might also help to gradually expose you to things that you are afraid of to help you overcome your fear.

Another common type of therapy is psychodynamic psychotherapy. In this type of therapy, your therapist will explore the roots of your anxiety with you. You might talk about your childhood or other life experiences that might help you understand your anxiety disorder.

Lifestyle changes can also be an important part of treating your anxiety disorder. Sleep, exercise, and eating a well-balanced diet can play an important part in preventing and managing anxiety symptoms.

What if therapy alone isn’t enough?

Sometimes, in addition to therapy, your provider might recommend medication. While medications can be taken without doing therapy, it is generally recommended that you try therapy before or at the same time you take medication.

First-choice medications

Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors

How they help: These are the medications that your provider might start with to treat your anxiety disorder. They are often chosen first because they have the most research evidence supporting their use. They can help you feel less fearful, have fewer anxiety episodes, and may help lessen some of the other symptoms that are part of anxiety disorders, such as muscle tightness.

Second-choice medications

Sometimes, the first-choice medications may not completely treat your symptoms. You might have side effects when you take SSRIs or SNRIs and need to try a different medication. In this case, your provider might recommend adding a second medication or switching to a different medication altogether.

Benzodiazepines

How they help: Your doctor might prescribe a benzodiazepine medication to help stop anxiety symptoms that start suddenly. The benefits of these medications are that they can work quickly and are very effective in relieving sudden anxiety symptoms. Your doctor might start a benzodiazepine at the same time as another medication because they kick in more quickly.

Keep this in mind: Some people become dependent on benzodiazepines. If you take benzodiazepines for a long period of time, you might get withdrawal symptoms if you try and stop them suddenly. Because of these risks, it is important to only take benzodiazepines as prescribed under the close supervision of your provider.

Examples of benzodiazepines are:

• Lorazepam (Ativan)

• Alprazolam (Xanax)

• Diazepam (Valium)

• Clonazepam (Klonopin)

• Oxazepam (Serax)

Tricyclic antidepressants and monoamine oxidase inhibitors

How they help: Your doctor might suggest that you try an older antidepressant medication such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). These medications may be prescribed when other medications are not doing a good enough job treating your anxiety symptoms. While these work well for some people, many people have difficulties with the side effects of these medications.

Examples of these medications are:

TCAs

• Clomipramine (Anafranil)

• Doxepin (Adapin)

• Imipramine (Tofranil)

• Amitriptyline (Elavil)

MAOIs

• Phenelzine (Nardil)

• Isocarboxazid (Marplan)

Keep this in mind: Some of these medications require lab tests or electrocardiograms because of the risks of certain side effects. If you take an MAOI, you will also need to avoid certain foods. Your provider or pharmacist can tell you more.

Antipsychotics

How they help: Sometimes, doctors might recommend that you add an antipsychotic medication to your anxiety medication to help it work better. For some people, these medications can be very helpful even if they don’t have psychotic symptoms.

Examples of these medications are:

• Quetiapine (Seroquel)

• Aripiprazole (Abilify)

• Risperidone (Risperdal)

• Olanzapine (Zyprexa)

Keep this in mind: For some people, side effects like weight gain, sleepiness, and unusual movements can be problematic. Your provider will want to monitor your weight and order regular lab tests to help prevent side effects.

Other medications

• Hydroxyzine (Vistaril/Atarax) is an antihistamine that can help calm anxiety quickly.

• Propranolol (Inderal) is a medication called a beta blocker. It helps slow a rapidly beating heart or ease chest tightness associated with stage fright or performance anxiety.

• Buspirone (Buspar) and gabapentin (Neurontin) are sometimes prescribed as add-on therapies if anxiety symptoms are severe and haven’t improved with usual treatment.

Obsessive compulsive disorder and post-traumatic stress disorder

Obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are closely related to anxiety disorders but are classified separately, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the International Statistical Classification of Diseases and Related Health Problems (ICD-10). They both have anxiety as a main feature, and they both have a significant impact on peoples’ daily lives. But both disorders have features that are unique to that disorder, so they aren’t included in the same bucket as other anxiety disorders. For example, people with PTSD (and often OCD) have experienced or witnessed a traumatic event. People with OCD also engage in very specific compulsive, repetitive behaviors — another unique feature.