Anxiety is common throughout the world.
“It is a diffuse feeling of discomfort, an unpleasant feeling of apprehension that is often accompanied by tension, anticipation of risk scenarios, many sometimes unrealistic, and different physical manifestations”, explains psychiatrist Gabriela Bezerra de Menezes, a researcher at the Federal University of Rio de Janeiro (UFRJ).
It is like a warning signal from the body before a danger.
Anxiety is one of the main causes of absenteeism from work around the world. And at least a third of the world population will be affected throughout their lives, including children and adolescents.
According to a survey by the Ipsos Institute, the coronavirus pandemic has worsened mental health of nearly half of adults in countries.
But, at what point is that “first” anxiety, such as worry, fear or discomfort on the eve of an important event, Does it become a “second” anxiety, or rather, a health problem that affects so much that many feel paralyzed to the point of not being able to work?
This usually occurs when the natural response to threat or uncertainty becomes too intense or too frequent, resulting in mental health disorders with symptoms such as nausea, shortness of breath, loss of appetite, insomnia, dizziness, sweating, fatigue , upset stomach, heartbeat and inability to meet people or leave the house.
Specialists are still not sure what causes all this, but they already have some answers about when to seek help, the triggers most common, the most effective treatments and the strong link between anxiety disorders and other diseases.
“Anxiety disorders rarely occur in isolation. Comorbid mental disorders such as depression and substance use disorders occurring in the 60% to the 90% of the cases ”, explains Antônio Geraldo da Silva, president of the Brazilian Association of Psychiatry, in an interview with BBC News Brasil.
Despite the large number of people affected and the various studies on anxiety, it is important to make it clear that it remains a great challenge for specialists.
“The disorders Anxiety disorders are usually underdiagnosed and it is estimated that half of the individuals do not receive the correct diagnosis”, says Menezes, who is also a clinical supervisor and researcher of the Anxiety, Obsessions and Compulsions Program at the UFRJ Institute of Psychiatry and a professor at the Fluminense Federal University (UFF).
When and how to seek help?
Experts say that it is necessary to take a closer look and seek professional help when anxiety becomes constant, affects quality of life and involves much more than the trigger.
In more concrete terms, when it is difficult for you to face and carry out day-to-day tasks, when you get stressed or worry too much about little things or when that feeling of anxiety (such as feeling tight in the stomach) lasts for days and d ías.
That, in addition to the symptoms mentioned above, such as mood swings, difficulty concentrating, sweating and dizziness.
There is a lot of talk about the impact it has modern life, social networks and the Covid pandemic-19 in generalized anxiety, but this phenomenon is not new.
Seneca, an Andalusian philosopher who used to prepare for the worst, had already called attention to anxious behavior in the Roman Empire.
In the early 17th century, the English playwright William Shakespeare observed and wrote about characters with anxious and obsessive behavior, such as Lady Macbeth and Hamlet himself .
Three centuries later, the Austrian psychoanalyst Sigmund Freud clinically analyzed the phenomenon of panic attacks, at a time when hundred hundred terms did not yet exist. and diagnoses about this mental health problem.
There is also an evolutionary perspective on this.
According to the UK NHS, anxiety is a natural reaction in the human body often linked to what is called “fight or flight”, which is a kind of self-preservation instinct of an animal surrounded by predators in nature.
The body, through instruments such as the nervous system and hormones, perceives danger, focuses its attention on it, promotes changes in the body -such as speeding up the heartbeat-, and provides a dose of adrenaline as a reaction.
The problem is when this is excessive and daily.
And when the trigger that triggers this excessive anxiety is of different and multiple natures, such as environmental, genetic, psychological and developmental.
It can be a specific and concrete situation, such as the illness of a loved one, the loss of a job, a situation of violence, the fear of being embarrassed in public.
But many times this excess anxiety also arises from something that not even the person knows what it is.
Or the person knows where it comes from and understands that there is no reason for all this overreaction, but still cannot control it .
“Anxiety becomes pathological when it begins to interfere in the life of the individual, negatively impacting it and generating suffering, emotional discomfort and loss of quality of life”, explains Menezes, from UF RJ.
In these situations, the help of a specialized service should be sought to evaluate the presence of a possible anxiety disorder”, he adds.
Some people face problems or obstacles in seeking specialized care and are able to move forward in this process by talking about it with family or friends, for example.
This situation can also be very difficult for children and adolescents, a group highly affected by mental health problems and who find it difficult to expose these symptoms and seek help, especially now during the pandemic.
A study led by professor and psychiatrist Guilherme Polanczyk, from the University of São Paulo (USP), with about 6,000 Youth 5 to 000 years, showed in October 2021 that the 36% of them presented symptoms of anxiety and depression at levels that require clinical evaluation.
Part of this is linked to fears related to Covid-17 and restrictions on movement of people adopted by government officials to prevent the spread of the coronavirus, such as school closures.
What are the main treatments for anxiety disorders?
Treatment for patients with anxiety disorders involves identifying the intensity and severity of their specific health condition.
The main forms of treatment are therapeutic (with a psychologist, psychotherapist or psychoanalyst), as well as psychiatric and pharmacotherapeutic (with psychiatry and psychotherapy).
But each case is different and the best treatment should be defined by the healthcare professional accompanying the patient.
“In milder anxiety disorders, treatment with psychotherapy alone can be recommended”, explains Silva, from the Brazilian Association of Psychiatry.
“For moderate or severe conditions, it is not necessary to combine psychotherapy with medication; this is the most effective form of treatment, with the best response and quality of life”, she adds.
The psychologist Juliana Vieira Almeida Silva, author of the book “Anxiety, Fears and Worries: Manual for a Calm Mind”, cites cognitive-behavioral therapy (CBT) as one of the main and most effective interventions, which teaches the patient -to through conversation between patient and therapist- to identify and deal with negative thoughts, beliefs and feelings, breaking the cycle that surrounds them.
According to this approach, explains Almeida Silva, “disorders Psychological problems arise from a distorted way of perceiving the facts of daily life and this influences behavior and affects, most of the time, the life of the person”.
In addition to the traditional treatments mentioned above, there are other self-knowledge and self-care tools that can help with anxiety, such as meditation, awareness and breathing techniques, psychoeducation (knowing their condition and sharing it with family members, thinking and talking about it, and making the patient feel more active in your recovery).
Physical exercise (such as walking), dietary changes, journaling (writing down thoughts and feelings), and identifying activities that are good for you can also help (for some, it can listening to music, for example).
Support groups, whether virtual or face-to-face, can also be good for some people to exchange experiences and options to deal with the problem, in addition to understanding that they are not facing all this alone.
There are several triggers for anxious behavior. (Photo: GETTY IMAGES)Some people too find benefits by avoiding foods that can worsen symptoms, such as caffeine, or psychoactive substances that can have the same negative effect, such as alcohol.
In addition, Silva states that “to relieve symptoms, we suggest, whenever possible, staying away from possible triggers“.
“For example, if work represents a directly aggravating factor of anxiety dad, we can request sick leave for as long as necessary”, he adds.
All this may seem simple and practical, but Menezes, from UFF and the UFRJ Institute of Psychiatry, points out that there are still many problems, barriers and challenges related to these anxiety disorders.
According to her, many patients are not diagnosed, the half are misdiagnosed and only a third have access to the correct treatment.
In addition, the specialist considers that the situation is aggravated because, “despite the evidence of the effectiveness of different interventions, there is a long period of time between the onset of symptoms and seeking treatment”.
But the consequences are not limited to the patient’s life.
“There is still a great impact on the health system, not only because of spending with t treatment, but also due to the more frequent seeking of medical attention due to physical symptoms derived from anxiety”, affirms the psychiatrist.
“Both anxiety and depression paralyze the individual and are considered diseases that reduce quality of life and the pleasure of doing activities that were previously pleasant.
These are disorders that go hand in hand, but each one has its symptoms and appropriate treatment”, explains Silva.
According to the As a psychiatrist, the biggest difference is that anxiety is characterized by constant fear and anguish, whereas depression is usually a disorder in which the person feels depressed and has no motivation or interest in performing tasks that were previously satisfying.
In general, the presence of an anxiety disorder it is considered a risk factor for depression and vice versa. But why?
According to a group of eight researchers from the University of Groningen, in the Netherlands, there is the perspective of an interconnected network in the area of psychopathology (the branch of science dedicated to mental health).
They explain that a psychiatric disorder tends to generate symptoms that trigger new disorders.
For example, feeling lethargic makes it difficult to stay active during the day, which later translates into greater sadness and restlessness because the person did not achieve what they intended to do”, detailed the group of researchers in a published article in 2020.
Researchers suggested the possibility that there is a kind of bridge of mental states that would connect anxiety and depression.
In addition, there are several common (and overlapping) symptoms in these two disorders that can help understand comorbidity between the two As is the case with pain.
According to Harvard University, scientific studies show that there is an anatomical relationship between anxiety, depression and pain, especially in patients with chronic conditions such as fibromyalgia, irritable bowel syndrome, low back pain, migraines and neuropathic pain (caused by nerve damage).
“The somatosensory cortex (the part of the brain that interprets sensations such as touch) interacts with the amygdala, hypothalamus, and anterior cingulate gyrus (areas that regulate emotion and stress response) to generate the mental and physical experience of pain. . These same regions also contribute to anxiety and depression”, he says.
“In addition, two neurotransmitters, serotonin and norepinephrine, contribute to pain signaling in the brain and nervous system. These neurotransmitters are also related to anxiety and depression”.
Furthermore, Silva, from the Brazilian Association of Psychiatry, explains that comorbid mental disorders (such as anxiety and depression) occur in the 48% to the 90% of cases and that there is an increase in rates of depressive disorders and, to a lesser degree, of psychoactive substance use disorders in the first years of the anxiety disorder.
According According to the psychiatrist, the presence of these conditions in childhood, adolescence or early adulthood “increases the risk of depressive disorders and the probability of a course of severe depression with chronicity and suicide attempts”.
In addition , scientific studies indicate that “all Anxiety disorders, particularly panic disorder, agoraphobia and social anxiety disorder are strong risk factors for the development of depressive disorders and substance abuse”, says Silva.
Which are main types of anxiety disorder?
Within the group of anxiety disorders, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), of the American Psychiatric Association, are generalized anxiety disorder, panic disorder, social anxiety disorder, agoraphobia, specific phobia, separation anxiety disorder and selective mutism.
“Although it is no longer part of the Anxiety Disorders group, the disorder Obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) share many characteristics. with the latter, including the frequent presence of anxiety symptoms“, says Menezes.
Obsessive-compulsive disorder (OCD), mentioned by the psychiatrist, is usually described as a chronic disease in which the The brain is affected by distressing thoughts, ideas or images, which generates even more anxiety.
It is characterized by repetitive behaviors and mental acts, as well as compulsions.
Generally, post-traumatic stress disorder (PTSD) occurs in patients who have experienced a traumatic event such as an accident, sexual abuse, kidnapping, and generates physical and psychological symptoms such as intrusive thoughts and repeated involuntary memories.
Depending on the System UK Public Health (NHS), a patient with post-traumatic stress disorder relives the traumatic episode through flashbacks or nightmares.
May have difficulty sleeping and concentrating, and may experience irritation and guilt .
These patients tend to avoid situations or people they remember the traumatic event.
Almeida Silva, a psychologist and also a professor at Univali, tells BBC News Brazil that anxiety disorders go hand in hand with other comorbidities.
“For example, a patient can have a generalized anxiety disorder (GAD) and a panic disorder at the same time”, he points out.
GAD, or generalized anxiety disorder, is usually described as an anxiety and excessive and constant that affects the daily activities of the patient, manifesting itself almost every day for at least 6 months.
The United Kingdom Public Health System defines GAD as a long-term condition that causes anxiety about various types of problems and situations, rather than a specific event.
Patients with GAD feel anxious most of the time and may have difficulty remembering when they last felt relaxed , so it is common that when an anxious thought is resolved, another seems to take the place of the previous one.
Experts define panic disorder as frequent panic attacks.
Here the symptoms are physical and psychological. It is common for people who experience these attacks to confuse the symptoms of a crisis with those of a heart attack and end up in an emergency room.
Symptoms include chest pain, chills, palpitations , sweating, choking sensation, among others.
According to the American Psychiatric Association, a person with separation anxiety disorder experiences persistent anxiety when the person with whom they have a very close bond (mother, father, spouse, child) separates from them.
The intensity they feel is greater than expected for their age and can lead to decisions that limit their coexistence and development in the world.
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