What Is Anxiety?
 

Anxiety is an unpleasant emotion with psychological and physical symptoms. Symptoms may include:
 

• Excessive worry

• Feeling restless or on edge

• Fatigue

• Difficulty concentrating

• Irritability

• Muscle tension

• Sleep disturbances

• Increased heart rate

• Shortness of breath

• Stomach discomfort

• Dizziness
   

What Causes Anxiety?
 

Anxiety develops from one's polygenetic biological baseline and a combination of general factors including:
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• Psychosocial and environmental stressors

• Sleep disturbances

Secondary causes include:
 

• Medical conditions (hyperthyroidism, sleep apnea, cardiac arrhythmias, epilepsy, Cushing's syndrome, pheochromocytoma)

• Substance use (methamphetamine, cocaine, marijuana, etc.)

• Medications (stimulants, caffiene, bronchodilators, corticosteroids, psychiatric medications, 

Anxiety vs. Anxiety Disorder

Anxiety becomes a disorder when it meets certain criteria, usually related to its duration and severity. 

The DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders) is the most reputable reference for providing the specific criteria for anxiety disorders. 

Generalized Anxiety Disorder (GAD) is diagnosed when a person experiences excessive, hard-to-control worry about various everyday issues for at least 6 months on more days than not. This worry must cause noticeable distress or disruption to daily life and be accompanied by at least three (or one for pediatrics) physical or cognitive symptoms—such as muscle tension, fatigue, restlessness, irritability, poor concentration, or sleep trouble. Finally, a clinician must rule out other underlying medical issues, substances, or another mental health condition.

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Social Anxiety Disorder is diagnosed when a person experiences marked fear or anxiety about social situations where they might be scrutinized, judged, or humiliated by others (such as public speaking, meeting new people, or eating in public). The individual fears acting in a way or showing anxiety symptoms that will be negatively evaluated. This fear or anxiety must be out of proportion to the actual threat, almost always triggered by the situation, consistently avoided or endured with intense distress, and present for at least 6 months, causing significant life disruption.

Specific Phobia is diagnosed when an individual experiences an intense, irrational fear or anxiety about a specific object or situation (such as flying, heights, needles/blood, or specific animals). The phobic trigger almost immediately provokes fear, is actively avoided or endured with severe distress, and the reaction is disproportionate to the actual danger posed. To meet the criteria, this persistent pattern of avoidance or distress must last for at least 6 months, causing significant life disruption.

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Panic Disorder is diagnosed when a person experiences recurrent, unexpected panic attacks—sudden surges of intense fear that peak within minutes and trigger severe physical symptoms (like a racing heart, chest pain, shortness of breath, dizziness, or fear of losing control). Following at least one attack, the individual must experience at least 1 month of persistent worry about having additional attacks (or their consequences) or make significant maladaptive changes in behavior related to the attacks (such as avoiding unfamiliar places or physical exertion).


Common Treatments
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• Lifestyle modifications (physical activity, stress reduction techniques, etc.)

• Psychotherapy

• Medications

• Addressing secondary causes

                                                                 Medications
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Selective Serotonin Reuptake Inhibitors (SSRIs) - Sertraline (Zoloft), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil), Citalopram (Celexa)

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) - Venlafaxine extended-release (Effexor XR), Duloxetine (Cymbalta)

Partial serotonin 5-HT1A agonist - Buspirone (Buspar)

First-Generation Antihistamine - Hydroxyzine (Vistaril, Atarax)

Benzodiazepines - Alprazolam (Xanax), Lorazepam (Ativan), Clonazepam (Klonopin), Diazepam (Valium)

Tricyclic Antidepressants - Clomipramine (Anafranil), Imipramine (Tofranil), Doxepin (Sinequan)

Beta blockers (off-label) - Propranolol (Inderal)

Alpha-2 Adrenergic Agonists (off-label) - Clonidine (Catapres), Guanfacine (Intuniv)

How Loria Mobile Medicine Can Help

Accurate & Comprehensive Diagnosis - I first perform a thorough evaluation to identify underlying causes and rule out conditions that frequently mimic or worsen symptoms, such as thyroid imbalances, vitamin deficiencies, sleep disorders, or other metabolic health issues. Then, I use diagnostic criteria to ensure an appropriate diagnosis. 

Safe & Informative Management - I ensure you fully understand potential side effects and black-box warnings so you can make informed decisions about your health. I also rigorously screen for relative and absolute contraindications for specific medications, including psychosis, bipolar disorder, serotonergic medication use, uncontrolled hypertension or severe cardiovascular disease, heart dysrhythmias, a history of seizures or eating disorders (especially with bupropion), severe renal or hepatic impairment, uncorrected narrow-angle glaucoma, active substance use or withdrawal, pregnancy or breastfeeding, difficulties with urination or defecation, cognitive problems, elderly, and asthma

*Benzodiazepines are generally not recommended as long-term treatment for most anxiety disorders because they can lead to tolerance, physical dependence, withdrawal symptoms, impaired memory and concentration, falls, motor vehicle accidents, and increased overdose risk when combined with opioids or alcohol. Therefore, I do not typically prescribe benzodiazepines for the long-term management of anxiety. If you are currently taking a benzodiazepine, your medication regimen will be carefully reviewed, and any changes will be made thoughtfully and safely. Any discontinuation will be done slowly to prevent serious withdrawal symptoms, including seizures.