Anxiety

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W​hat is Anxiety?

Anxiety is a natural response to stress, characterized by feelings of fear, apprehension, and unease. While occasional anxiety is a normal part of life, persistent, excessive worry that interferes with daily functioning may indicate an anxiety disorder. Anxiety disorders affect millions of individuals worldwide, influencing their emotional, cognitive, and physical well-being (American Psychiatric Association [APA], 2022).

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Types of Anxiety

Anxiety disorders encompass several distinct conditions, including:

• Generalized Anxiety Disorder (GAD)

  • Persistent and excessive worry about various aspects of life (APA, 2022).

• Panic Disorder

  • Sudden and repeated episodes of intense fear, often accompanied by physical symptoms (APA, 2022).

• Social Anxiety Disorder

  • Extreme fear of social situations and potential judgment by others (APA, 2022).

• Obsessive-Compulsive Disorder (OCD)

  • Recurrent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) (APA, 2022).

• Trichotillomania (Hair-Pulling Disorder)

  • Recurrent, irresistible urges to pull out one's hair, leading to noticeable hair loss and emotional distress (APA, 2022).

• Excoriation (Skin-Picking) Disorder

  • Repeated picking at one's skin, causing wounds and significant distress or impairment in functioning (APA, 2022).

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Symptoms of Anxiety

Anxiety symptoms vary in intensity and presentation but often include:

• Emotional Symptoms

  • Excessive worry, irritability, and difficulty concentrating (APA, 2022).

• Physical Symptoms

  • Increased heart rate, sweating, dizziness, shortness of breath, muscle tension, and gastrointestinal discomfort (APA, 2022).

• Behavioral Symptoms

  • Avoidance of anxiety-provoking situations, compulsive behaviors, and restlessness (APA, 2022).

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Causes of Anxiety

Genetic Factors

Research indicates a hereditary component to anxiety disorders, with family studies showing higher prevalence among first-degree relatives (Smoller, 2016). Specific genetic markers may increase susceptibility to anxiety conditions.

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Brain Chemistry and Structure

Neurotransmitter imbalances, particularly involving serotonin, dopamine, and gamma-aminobutyric acid (GABA), contribute to anxiety symptoms. Functional neuroimaging studies suggest abnormalities in the amygdala and prefrontal cortex play a role in anxiety regulation (Shin & Liberzon, 2010).

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Environmental Factors

Life experiences, such as trauma, chronic stress, or adverse childhood experiences, can trigger anxiety disorders. Social environment, parenting styles, and learned behaviors also shape anxiety responses (McLaughlin et al., 2015).

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How is Anxiety Diagnosed?

Diagnoses of anxiety disorders are based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) after a thorough evaluation (APA, 2022). This process includes gathering comprehensive information through psychiatric evaluation, clinical interviews, screening tools, and ruling out other potential medical or psychological causes. A clinician assesses symptom patterns, duration, severity, and impact on daily functioning to ensure an accurate diagnosis and appropriate treatment plan.

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How is Anxiety Treated?

Blood Tests

May include:

• General Health and Metabolic Function

  • CBC, CMP

• Nutritional and Micronutrient Status

  • Vitamin D, Vitamin B12 & Folic Acid Panel, Vitamin B6

• Methylation and Neurological Health

  • Homocysteine, Methylmalonic Acid

• Thyroid Function and Autoimmunity

  • Thyroid Panel (TSH, FT3, FT4, Anti-Thyroid Antibodies)

​It is essential to rule out underlying medical conditions that could mimic or exacerbate psychiatric symptoms, such as thyroid dysfunction, nutrient deficiencies, or metabolic imbalances. Identifying medical contributors ensures that symptoms are not misattributed solely to a psychiatric disorder, allowing for a more comprehensive and accurate diagnosis. Additionally, baseline and ongoing monitoring are crucial when prescribing medications, as many psychiatric treatments can impact metabolic health, liver and kidney function, thyroid levels, and cardiovascular risk factors. Regular lab assessments help optimize treatment safety, prevent adverse effects, and support overall physical and mental well-being.

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Genetic Testing

Genetic testing, offered by companies like Genesite and Genomind, helps personalize medication management by identifying how an individual metabolizes and responds to psychiatric medications, reducing the need for trial-and-error prescribing. For those who have struggled with ineffective treatments or intolerable side effects, pharmacogenetic testing can guide medication selection, optimize dosing, and improve treatment outcomes, leading to a more targeted and tolerable approach. However, genetic testing is only a tool to help guide treatment and does not definitively determine which medications will or will not work for an individual.

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Genova Diagnostic Testing

Genova diagnostic testing offers comprehensive functional medicine assessments to uncover underlying contributors to mental health symptoms, such as gut health imbalances, nutritional deficiencies, hormone dysregulation, and inflammation. By analyzing biomarkers related to digestion, metabolism, neurotransmitter function, and oxidative stress, these tests provide a deeper understanding of how physiological factors impact mental well-being. This personalized approach can guide targeted interventions, optimizing treatment strategies beyond symptom management. While Genova testing offers valuable insights, it is just one tool in a holistic evaluation and should be interpreted alongside clinical history and other diagnostic considerations.

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Medication Management

May include:

• Selective Serotonin Reuptake Inhibitors (SSRIs)

  • First-line treatment for GAD, panic disorder, and social anxiety (e.g., Prozac, Zoloft) (APA, 2022).

• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

  • Useful for GAD and panic disorder (e.g., Effexor, Cymbalta) (APA, 2022).

• Benzodiazepines

  • Short-term relief for severe anxiety but risk dependency (e.g., Xanax, Ativan) (APA, 2022).

• Beta-Blockers

  • Reduce physical symptoms of anxiety, particularly in performance anxiety (e.g., Propranolol) (APA, 2022).

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Supplements + Nutraceuticals

May include:

Several natural compounds support anxiety reduction, including:

• GABA (Gamma-Aminobutyric Acid)

  • Helps calm nervous system overactivity (Clapp et al., 2017).

• Passionflower

  • Supports GABA function, reducing racing thoughts and tension (Clapp et al., 2017).

• L-Theanine

  • Found in green tea, helps promote relaxation without sedation (Clapp et al., 2017).

• Magnesium Glycinate

  • Reduces muscle tension and promotes restful sleep (Clapp et al., 2017).

• Ashwagandha

  • An adaptogen that helps reduce cortisol levels (Clapp et al., 2017).

• Omega-3 Fatty Acids

  • Support brain health and reduce inflammation linked to anxiety (Clapp et al., 2017).

• Probiotics

  • The gut-brain axis influences mood regulation (Clapp et al., 2017).

​Before starting any supplement, consultation with a healthcare provider is recommended.

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Therapy

May include:

• Acceptance and Commitment Therapy (ACT)

  • Helps individuals develop psychological flexibility by encouraging acceptance of anxious thoughts rather than avoiding them. This approach reduces the struggle with distressing emotions and promotes engagement in meaningful activities (APA, 2022).

• Cognitive Behavioral Therapy (CBT)

  • Focuses on identifying and modifying negative thought patterns and behaviors that contribute to anxiety. By restructuring maladaptive thoughts, individuals can develop healthier coping mechanisms and reduce anxiety symptoms (APA, 2022).

• Motivational Interviewing (MI)

  • Uses a client-centered, goal-oriented approach to enhance motivation for change. It helps individuals explore and resolve ambivalence toward treatment, fostering commitment to anxiety-reducing strategies (APA, 2022).

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Lifestyle + Diet

May include:​​

• Caffeine & Alcohol Moderation

  • Reduces anxiety-provoking stimulants (APA, 2022).

• Regular Exercise

  • Reduces stress hormones and enhances mood-regulating neurotransmitters (APA, 2022).

• Balanced Diet

  • Whole foods, lean proteins, and anti-inflammatory nutrients support mental health and prevent blood sugar spikes and crashes (APA, 2022).

• Sleep Hygiene

  • Proper sleep patterns reduce anxiety symptoms (APA, 2022).

• Mindfulness and Meditation

  • Lowers sympathetic nervous system overactivation, improves emotional regulation, and decreases stress (APA, 2022).

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Resources

• National Institute of Mental Health (NIMH) - Anxiety Disorders

  • Link: https://www.nimh.nih.gov/health/topics/anxiety-disorders

    • The NIMH provides evidence-based information on anxiety disorders, including symptoms, risk factors, and treatment options. It’s a trusted government source for mental health education.

• Anxiety & Depression Association of America (ADAA)

  • Link: https://adaa.org/understanding-anxiety

    • The ADAA offers comprehensive information on different types of anxiety disorders, coping strategies, and research-backed treatment approaches. It also includes resources for finding support.

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References

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

• Clapp, M., Aurora, N., Herrera, L., Bhatia, M., Wilen, E., & Wakefield, S. (2017). Gut microbiota's role in anxiety and depression. International Journal of Molecular Sciences, 18(6), 1223. https://doi.org/10.3390/ijms18061223

• McLaughlin, K. A., Colich, N. L., Rodman, A. M., & Weissman, D. G. (2015). Mechanisms linking childhood trauma exposure and psychopathology: A transdiagnostic model. Annual Review of Clinical Psychology, 11(1), 93-124. https://doi.org/10.1146/annurev-clinpsy-032814-112910

• Shin, L. M., & Liberzon, I. (2010). The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology, 35(1), 169-191. https://doi.org/10.1038/npp.2009.83