by Bonnie Hill, APNP, DNP, FNP-BC

Everyone knows the feeling of butterflies in your stomach before a big presentation. This anxiety is normal and is driven by your body’s fight-or-flight system. It’s no surprise that symptoms of anxiety involve feeling like you’re on a survival mission. Unhealthy anxiety often involves feeling like something terrible is about to happen. Some people feel like they’re losing control, with chest pain or an elevated heart rate. A heightened anxiety state will help you rush out of a burning building and survive, but living in a constant state of anxiety wears on our physical and emotional state over time. Clinical treatment for anxiety with therapy or medications may be appropriate if you struggle with a moderate to high level of anxiety most days of the week.

Generalized Anxiety Disorder

The hallmark symptom of anxiety disorder involves dread or anxiety about a variety of life factors that prevent you from living a normal daily life¹. Talking to your primary care doctor can help you sort out whether behavioral and lifestyle changes, therapy, medication, or a combination of these treatment options is the best choice for you depending on how long these symptoms have affected you.

Symptoms

Generalized anxiety disorder can cause some or all of the following symptoms:

• Nagging feelings of worry or persistent feeling that something awful will happen
• No interest or pleasure in doing things you normally enjoy
• Feelings of fatigue or tiredness
• Irritability
• Inability to relax or let down
• Difficulty concentrating on daily activities
• Trouble falling asleep, staying asleep, or sleeping too much²

Treatment Options

The path to recovery from anxiety that interferes with your daily life looks a little different from person to person, so it’s important to talk to your doctor about which options are best for you. In general, there are three approaches to treatment that can be helpful.

Lifestyle Changes to Relieve Anxiety

Relaxation

Relaxation techniques such as patterned breathing can be beneficial at increasing your blood oxygen levels to help calm your body down from an anxious state. Taking a deep breath in for five seconds, holding that breath for five seconds, and then exhaling for five seconds to then repeat this pattern for several cycles helps slow down your heart rate.

Meditation

Meditation and mindfulness are lifestyle habits that can incorporate breathing to help you focus your mind on what will go right instead of rehearsing the possible worst-case scenarios that could go wrong in recurrent anxious thoughts. To meditate, start by closing your eyes to shut out distracts. Then, pick one positive thought or something you appreciate about your life today. Next, consider how that breath you are taking, your spouse, your pet, or the rain falling outside makes your day better. What is one thing you can do for yourself today? Think about that for a moment, be specific, and set the intention to go out and do that. Repeating this process using an app such as Calm or various meditation podcasts available for free may be helpful.

Journaling

Spending 3-5 minutes journaling or meditating daily can help retrain your brain to shift from an anxious mindset to a mental space that is more calming. Journaling is one way to hone in on the specific factors of your life, your mood, a relationship, or a stressful situation that repeatedly trigger anxiety. What are you afraid might happen? How often do you have these thoughts? What’s the worst-case scenario that may result? Is that awful thing likely to happen? What things help you calm down and relax? Sometimes working through these questions through journaling or talking to a friend is the first step in truly overcoming anxiety. Therapy may be helpful if you feel this process is overwhelming or if you’ve attempted these techniques without success in identifying specific triggers and coping mechanisms that work for you.

Nutrition, Over the Counter Drugs, and Supplements

The foods, drinks, and chemicals we put in our bodies can have a significant impact on anxiety. Caffeine, alcohol, nicotine in cigarettes or vaping, and other stimulants such as phenylephrine (found in common over-the-counter decongestants) can amplify anxiety, stimulate your central nervous system, and interfere with sleep.

Start by doing a diet journal to evaluate the foods and drinks you take in over a 24-hour period. Be honest with yourself about the time of day you eat and drink these items. Timing of caffeine intake within 4-6 hours of bedtime, for example, can impair your sleep. Talk with your doctor about the vitamins, supplements, recreational drugs, and prescription medications you use daily to identify any patterns or areas when improvements can be made to reduce your anxiety.

Therapy

Talking to a trusted medical professional, a friend, or a loved one is often the first step in identifying whether therapy would be helpful for you. Virtual or in-person therapy sessions can help a professional review your history of anxiety and then work with you to identify coping strategies to successfully face life’s challenges without overwhelming or debilitating anxiety. Insurance coverage for therapy can sometimes be a challenge, but your insurance carrier can provide you with coverage details and a list of in-network providers. If you do not have insurance, check with therapists in your area to find out if they offer discounts for paying for services yourself.

Medication

Persistent anxiety that lasts for more than six consecutive months and interferes with your daily quality of life often requires therapy or medication or both modalities for success. Various antidepressants are typically the first medication options for anxiety treatment to help increase the amount of serotonin in the body and thus reduce anxiety symptoms. Drugs such as escitalopram, sertraline, fluoxetine, and a variety of other SSRIs and SNRIs may be appropriate for you.

Other drug classes have been shown to help with anxiety treatment. Xanax (also known as alprazolam) is a prescription medication for fast-acting anxiety relief but its use is limited to specific situations for safety reasons. This medication is part of the benzodiazepine drug family. Be aware that alprazolam can become habit-forming, meaning that once it’s used to help manage anxiety, some find it becomes more difficult to manage anxiety attacks without this medication. Alprazolam and benzodiazepines should not be used with alcohol and if you have a history of addiction to any substances, your doctor needs to be made aware to help determine if it is safe for you. In general, other medications for anxiety are better tolerated, safer, and can help with long-term success compared with short-term relief medications like alprazolam.

Talk to your doctor about underlying health conditions or mental health concerns to choose a safe and appropriate medication for you. All medications have risks and benefits. The goal of your primary care provider is to help you develop a plan that fits your personal needs and lifestyle.

If you have any thoughts of self-harm or have a plan to end your life, the next step is to text or call 988 to reach the National Suicide Hotline or to go to a local emergency room immediately for help.