Stress and anxiety

Considerations

Stress is a normal part of life. In small quantities, stress is helpful -- it can motivate you and help you be more productive.

However, too much stress, or a strong response to stress, is harmful. It can set you up for general poor health, as well as physical and psychological illnesses like infection, heart disease, and depression. Ongoing stress can lead to anxiety and unhealthy behaviors like overeating and abuse of alcohol or drugs.

Emotional states like grief or depression, and health conditions like an overactive thyroid, low blood sugar, or heart attack can also cause stress-like symptoms.

Anxiety is often accompanied by physical symptoms, including:

• Abdominal pain (this may be the only symptom of anxiety, especially in a child)
• Diarrhea or frequent need to urinate
• Dizziness
• Dry mouth or difficulty swallowing
• Headaches
• Muscle tension
• Rapid breathing
• Rapid or irregular heart rate
• Sweating
• Twitching or trembling

Sometimes other symptoms occur with anxiety:

• Decreased concentration
• Fatigue
• Irritability, including loss of your temper
• Sexual problems
• Sleeping difficulties, including nightmares

Anxiety may occur as part of an anxiety disorder. Anxiety disorders are a group of psychiatric conditions that involve excessive anxiety. They include:

• Generalized anxiety disorder
• Obsessive-compulsive disorder
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Social anxiety disorder
• Specific phobias

Causes

Certain drugs, both recreational and medicinal, can lead to symptoms of anxiety due to either side effects or withdrawal from the drug. Such drugs include:

• ADHD medications, especially amphetamines
• Alcohol
• Benzodiazepines (during withdrawal)
• Bronchodilators (for asthma and certain other breathing disorders)
• Caffeine
• Cocaine
• Cold remedies
• Decongestants
• Diet pills
• Marijuana
• Nicotine
• Thyroid medications

A poor diet -- for example, low levels of vitamin B12 -- can also contribute to stress or anxiety. In very rare cases, a tumor of the adrenal gland (pheochromocytoma) may cause anxiety or stress-like symptoms. The symptoms are caused by an overproduction of hormones responsible for the feelings of anxiety.

Home Care

The most effective solution is to find and address the source of your stress or anxiety. This can be difficult, because the cause of the anxiety may not be conscious. A first step is to take an inventory of what you think might be making you "stressed out," trying to be as honest with yourself as possible:

• What do you worry about most?
• Is something constantly on your mind?
• Is there something that you fear will happen?
• Does anything in particular make you sad or depressed?
• Keep a diary of the experiences and thoughts that seem to be related to your anxiety. Are your thoughts adding to your anxiety in these situations?

Then, find someone you trust (friend, family member, neighbor, clergy) who will listen to you. Often, just talking to a friend or loved one is all that you need to relieve anxiety. Most communities also have support groups and hotlines that can help. Social workers, psychologists, and psychiatrists can be very effective in helping you reduce anxiety through therapy or medication.

Also, find healthy lifestyle choices to help you cope with stress. For example:

• Don't use nicotine, cocaine, or other recreational drugs.
• Eat a well-balanced, healthy diet. Don't overeat.
• Exercise regularly.
• Find self-help books at your local library or bookstore.
• Get enough sleep.
• Learn and practice relaxation techniques like guided imagery, progressive muscle relaxation, yoga, tai chi, or meditation.
• Limit caffeine and alcohol.
• Take breaks from work. Make sure to balance fun activities with your responsibilities. Spend time with people you enjoy.

When to Contact a Medical Professional

Your doctor can help you determine if your anxiety would be best evaluated and treated by a mental health care professional.

Call 911 if:

• You have crushing chest pain, especially with shortness of breath, dizziness, or sweating. These symptoms might be caused by a heart attack, which can also cause feelings of anxiety.
• You have thoughts of suicide.

Call your health care provider if:

• You have dizziness, rapid breathing, or a racing heartbeat for the first time, or if it is worse than usual.
• You are unable to work or function properly at home because of anxiety or other symptoms.
• You do not know the source or cause of your anxiety.
• You have a sudden feeling of panic.
• You have an uncontrollable fear -- for example, of getting infected and sick if you are out, or a fear of heights.
• Your anxiety is triggered by the memory of a traumatic event.
• You have tried self care for several weeks without success, or you feel that your anxiety will not go away without professional help.

Ask your pharmacist or health care provider if any prescription or over-the-counter drugs you are taking can cause anxiety as a side effect. Do not stop taking any prescribed medicines without your doctor's instructions.

What to Expect at Your Office Visit

Your doctor will take a medical history and perform a physical examination, paying close attention to your pulse, blood pressure, and breathing rate.

To help better understand your anxiety or stress, your doctor may ask the following questions:

• When did your feelings of stress, tension, or anxiety begin? Do you attribute the feelings to anything in particular, like an event in your life or a circumstance that scares you?
• Do you have physical symptoms along with your feelings of anxiety? What are they?
• Does anything make your anxiety better?
• Does anything make your anxiety worse?
• What medications are you taking?
• Do you use alcohol or drugs?

Diagnostic tests may include blood tests and possibly an electrocardiogram (ECG).

If the anxiety is not accompanied by any worrisome physical signs and symptoms, your doctor may refer you to a mental health care professional.

Psychotherapy (also called talk therapy), such as cognitive-behavioral therapy (CBT) or psychodynamic therapy has been shown to significantly decrease anxiety. In some cases, medications such as antidepressants may be appropriate.

See: Generalized anxiety disorders for more information.

Alternative Names

Anxiety; Feeling uptight; Stress; Tension; Jitters; Apprehension

References

Larzelere MM, Jones GN. Stress and health. Prim Care. 2008;35:839-856.

Ahmed SM, Lemkau JP. Psychosocial influences on health. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 4.

Update Date: 2/22/2010

Updated by: David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.