How can I keep my anxiety under control?

Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert Answer

Dear Lori,

Let me start by saying that all I know about you is the two worrisome sentences of your question. I don't know how old you are or what has been going on in your life, either in terms of stress or medical illness. Also, I don't know if your anxiety is pretty much with you all the time or whether you are having severe bouts of anxiety that are known as panic attacks.

Because I don't know these things about you, I cannot give you any definitive advice about what is the best thing to do for your anxiety. But I hear an urgency in your question that strongly suggests to me that you should see a mental health professional as soon as you can. Severe anxiety is perhaps the single most unpleasant emotional state a human can experience, and you don't want to expose yourself to it for one day more than you have to.

Having said all this, let me talk to you a little bit about anxiety in general. Whenever I hear an adult say that he or she has had a sudden onset of persistent anxiety, I know that very often the underlying problem is usually not anxiety -- as strange as that sounds.

Rather, whenever anxiety strikes an adult, it is more likely to be major depression than anxiety per se. Why? Because anxiety is usually chronic --something that troubles a person for years, not something that comes up over a month's time. When I talk to adults who develop anxiety fairly suddenly, it usually is a reflection of an underlying depression.

In fact, almost everyone who becomes depressed has anxiety, and the anxiety is often more unpleasant than the feeling of depression itself. The older a person is when he/she becomes depressed, the more likely it is that anxiety will be a real problem.

If any of this sounds relevant to your situation, let me tell you that the other common depression symptoms are sadness and/or a feeling that life is empty of pleasure, trouble sleeping, eating too little or too much, feeling worthless and guilty, suicidal thoughts, trouble thinking and concentrating, and loss of energy. If you've got any combination of these you probably have developed a depression.

One anxiety disorder that does often develop suddenly in adulthood is panic disorder. While people with panic disorder can develop chronic anxiety, the key features of this illness are recurrent panic attacks and an uncontrollable fear of having panic attacks. Generally panic attacks are characterized by the very rapid onset of crippling anxiety or terror, accompanied by any number of physical symptoms such as shortness of breath, tightness in the chest, chest pain, dizziness, nausea and sweating.

Finally, although it is rare until people are elderly, sometimes the sudden onset of anxiety is a symptom of a physical illness that has not yet been diagnosed. This is yet another reason why it is so important that you see a medical doctor, given your current situation.

I hope these thoughts have helped you a little bit in identifying what might be going on with you. Fortunately, effective treatments -- both pharmacological and behavioral (i.e. certain specific psychotherapy techniques) -- are available for major depression and panic disorder. It is of utmost importance that you get your condition treated as quickly as possible.