Medical What causes anxiety?

  1. I have a friend who suffers from severe anxiety, her mind tells her that bad things are going to happen, like sicknesses, or other things, and she sees actual pictures in her mind of bad things that she is afraid of happening. She knows that this is unrealistic, but is so afraid that if she doesn't take it seriously, the bad things will happen. How does this come about? And is there anything I can do to help her?
  2. jcsd
  3. Evo

    Staff: Mentor

    Most likely a chemical imbalance in her brain, it can usually be controlled with Selective serotonin reuptake inhibitors (SSRI's). You should suggest that she discuss her anxiety and fears with a doctor.
    Last edited: Jul 26, 2006
  4. It sounds like she is close to suffering from paranoia as well. Anxiety is a constant feeling of being in imminent danger, but paranoia is a judgment call that an unrealistic scenario of danger is emanent.

    For example, constantly worrying about becoming sick from eating poorly is anxiety, and may be corrected with the help of a change in diet. A paranoid equivalent is, "someone is trying to poison me." So, if she feels that she must take an unrealistic scenario seriously, that she knows is unrealistic, she's not strictly paranoid, but may be approaching borderline.

    I am guessing that, if the anxiety is as severe as you say, and she can "see actual pictures in her mind," then a psychologist may try to treat her symptoms with a dopamine inhibitor, or an antipsychotic.

    I have had some experience with the psychiatric pharmaceutical industry, and I recommend that, if your friend is offered antipsychotics, that she accept them as a last resort. You see, there are many many different kinds of antipsychotics, and in my opinion psychologists these days are pretty cavalier with using the wide variety of options to experiment on their patients to see which one works best. They do this because they are told that the drugs are safer than previous generations of drugs, which may true. But, in my opinion, it still amounts to treating the patient's mind and body as a mini-laboratory.

    The patient can get caught in a really unhelpful situation if she does not stand up for herself early and say, "no, I don't want drugs," or "these drugs aren't worth the side effects." Because once she's on drugs, the psychologist will actively discourage her from quitting treatment and even try to convince her to try a higher dosage to see if it will work. That's not a road anyone should go down hastily.

    Anyway, I don't mean to rant or anything. But please send my recommendation that she try talking to a doctor who will not push drugs on her first. It's very sad to see someone's already troubled life worsened by an insensitive practitioner, who doesn't know what it's like to be on the medication they offer.
    Last edited: Jul 27, 2006
  5. hypnagogue

    hypnagogue 2,195
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    Asking what the cause of anxiety is is a pretty broad question, and the answer almost certainly isn't as simple as "mere" chemical imbalances that can be treated neatly and easily with drugs (though of course it is possible that that may be a contributing factor in your friend's case). The type of answer you get for this question will depend on exactly what kind of anxiety you're talking about and what level of abstraction you choose to focus on, etc.

    Anyhow, what is more important than getting into the nuances of that question is finding an effective treatment that can help alleviate your friend's suffering. Drugs may be an effective option, but certainly not the only option and certainly not the very first option you would want to look in to.

    Cognitive behavioral therapy has been shown to be an effective treatment for anxiety problems. It does not involve medication, but rather involves a therapist working with a patient on changing her patterns of thought and behavior. I would suggest that you start by looking for available cognitive behavioral therapy practitioners in your area and go from there. Of course, it may turn out that what is most effective for your friend is a combination of CBT and medication, but CBT should really be the foundational aspect of treatment and medication a possible supplement, rather than vice versa. If nothing else, CBT teaches skills that can last indefinitely, which can help minimize the frequency and severity of relapses after treatment.
  6. Evo

    Staff: Mentor

    I have to disagree, no amount of therapy can reverse a chemical imbalance. Unfortunately there is no way to determine if there is a chemical imbalance except trying treatment.

    For symptoms as severe as in the case of the OP's friend, the best course of action, IMHO is to try SSRI's. If the symptoms are very mild, cognitive therapy might help them cope with the problem, but they will still have the problem.

    If you've ever known someone with a real chemical imbalance you would not be saying to put off treatment. Many of the members here are only able to lead normal lives thanks to medication.
    Last edited: Aug 6, 2006
  7. I myself have a chemical imbalance that induces problems, and I know from experience, 20 years in fact that therapy does nothing, I got therapy and then passed on to others because my condtion wasn't accepted as anything but a mental problem, and nothing in the way of help to be frank....Until I kicked up a fuss and demanded medication finally, but I'm exceptional, in a year my entire life was turned around by medication, I no longer had 3 months of every year where I would hibernate, sometimes quite literally, but it's different for everyone, and my condition wasn't accepted as a medical or physiological one until NIMH and various other bodies proved it was.

    I know how my condition makes me feel and I knew it for years, but could get nothing in the way of real treatment. I'm an exception though, so try getting a referal from your doctor, hopefully you wont have to wait 20 years for a treatment like I did.

    I take medication for six months now and the side effects are mitigated by experimentation. 6 months free and six months on is better than the crap I was fed for 20 years by people who didn't and couldn't have known any better.

    Anyway that's just me, advise your friend to seek help, what's the worst that can happen? Anxiety can be causal of their causal relation to there personal history, it can be causal of an imbalance, but the only people who can tell you that are clinical psychologists. Don't make the mistake I did and let your well being slide.
  8. If changes in environment or behavior are somehow impossible, perhaps. Anxiety usually persists for a reason. A patient may be in a school, career, relationship, and/or other circumstances that are consistently troubling but seemingly unchangeable. Factor in other directly chemical phenomena, such as food, air, and water quality, and one could have a perfect anxiety storm.

    Everybody has different chemical balances. There is no standard of balance by which to measure an imbalance. We're stimulated by different things, people, and places. We fit better in different environments and are suited for different tasks.

    New neurotransmitters are still being discovered as we speak, so there are undeniably other chemical balances that we're ignoring. The only way to make a science out of psycho-pharmaceuticals is to turn the patient into a laboratory and start experimenting. It does not strike me at all unreasonable, that a patient in such a position would feel even more anxious.

    One should try to find balance with their life before finding balance with their meds. Unfortunately, there are many families and schools of thought that discourage people form doing that, and instead encourage them to adjust. But, if life is such that nothing can be changed to improve the patient's well-being, then the patient has got himself into a real pickle, and meds are the only dutiful option.

    I'm concerned more about the possibility of antipsychotics here, though. SSRI's are child's play compared to dopamine inhibitors. They can remove a patient's ability to handle complex tasks along with his imagination. Baby right out with the bath water. I am not surprised to hear patients complain that they feel like robots or zombies, if they can no longer dream or imagine something as clearly as they could before, and then proceed to neglect taking their medication. Antipsychotics try to cure a disability by causing another disability.

    If that disability does not meaningfully exist in the first place, and the psychologist decides to administer antipsychotics to "see if they help"... well, that's not at all a good thing! :frown:
    Last edited: Aug 6, 2006
  9. Evo

    Staff: Mentor

    You're talking about a minor, temporary stress induced situation, not real clinical anxiety attacks. Have you ever had an anxiety attack? A REAL one, I don't mean worrying over a test. If you haven't, then you cannot understand the difference and should not be telling people that therapy can help, it can't.

    The problems we are discussing are not caused by external stimuli. The OP's friend sounds psychotic, which is why I suggested she see a doctor, her problems go well beyond simple anxiety.

    Most people end up in the emergency room when they have their first anxiety attack because they think they are dying.

    There are people on here that have it much worse. I know several that are schizophrenic and would not be able to live some semblance of a normal life without their medication.
    Last edited: Aug 6, 2006
  10. Well, I didn't mean to suggest that therapy can help. I meant to suggest changes in environment or behavior before experimenting with medication. (I have other opinions on the efficacy of a complete stranger attempting to be an expert on the mental functions of another complete stranger.)

    I definitely did not mean worrying about a test either. I meant to not only include attacks but the continuous long-term attack of living in a threatening or abusive environment. A school can be one such environment, especially given the fact that conventional schooling removes many of the mental and physical freedoms of individuals. I am not surprised by the high suicide rate of young people, given the unnatural environment we force them into. I do not know an intelligent person who did not consider suicide during their time in school.

    I know a schizophrenic as well. I also know someone who's not schizophrenic, but nonetheless given treatment designed for schizophrenics. It made his already troubled life incomparably worse, destroying his relationships and his talents, when he was barely 20-years-old. I know there are drug success stories, but there are also some totally unnecessary unmitigated failures, which could have been avoided simply by prolonging the start of treatment.

    I'm not against medication. I just think making one's mind a laboratory should be the last option. We're all complex beings. If people are going to the emergency room, then they're running out of options. It doesn't look like the OP's friend has visited the ER, so she should explore the options she still has left.
    Last edited: Aug 6, 2006
  11. somasimple

    somasimple 716
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    Unresolved stress.
  12. Evo

    Staff: Mentor

    That's why they should see a doctor, so he can ask the right questions and determine if it is an emotional problem (therapy), something caused by their situation (consultation and suggestions to get out of the bad environment), or a clinical problem (medication).

    I know ones that did go through with it.

    That's a case of a bad doctor, which is why if a serious diagnosis is made, at least two completely unrelated doctors should be seen.

    She's halucinating. She doesn't really have a lot of options. That's a sign of a rather serious condition. She may be schizophrenic. I'm not a doctor, but un-induced hallucinations can't be a good sign.

    I completely agree with you that people that are suffering normal stress are running and asking for pills. But SSRI's won't work if there isn't a condition for them to correct. Tranquilizers aren't a good long term solution for long term stressful situations. They need to get away from the bad situation, or if it's just school, learn to cope with stress.

    That's why I stress for people to see a doctor, see two. Don't suffer needlessly, there is medication that can help, if you need it, without it, it can drive people to suicide.
    Last edited: Aug 7, 2006
  13. hypnagogue

    hypnagogue 2,195
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    Anxiety disorders are not merely chemical imbalances. There are bottom-up components (on the level of neurotransmitters, etc) but also top-down components (how one thinks and behaves in response to the anxiety). The best treatments for more severe cases attack the problem on both levels.

    It is absolutely foolish to endorse the taking of medication without supplementing that with actual therapy. Cognitive behavioral therapy is not some ineffective Freudian nonsense; it has been empirically shown to work quite well as a treatment for anxiety disorders. And in many instances, properly coping with anxiety by taking the proper cognitive and behavioral measures is equivalent to preventing a more severe incident in the first place.

    I am not saying to put off treatment. I am saying that there are potentially negative side-effects to medication, whereas there are none that I know of for CBT. Furthermore, the latter can have lasting benefits after only a limited number of sessions with a therapist, whereas the former requires constant renewal. (If you forget to take your pills one morning, begin having a panic attack while driving to work, and do not know the relevant CBT techniques to help keep the attack under control, you're in trouble. Or if you forget to get your refills on time... etc.) Therefore, it behooves one to try CBT first and leave medication as a possible supplement that may or may not be needed later on, or at the very least to undergo both treatments at once. There is really no good excuse for not getting CBT treatment one way or the other.
  14. hypnagogue

    hypnagogue 2,195
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    The condition the OP described sounds a lot like mental imagery to me. Perhaps spontaneous, negative, and intrusive, but mental imagery nonetheless. Would you call someone who is prone to daydreaming a hallucinating schizophrenic? Speculations like this might cause undue worrying on the part of the OP or his/her relations, and so strike me as a bit irresponsible.
  15. Math Is Hard

    Math Is Hard 4,635
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    The symptoms described sounded very much like the obsessions in Obsessive Compulsive Disorder. Her doc will probably look for that among other things. I hope she will seek help.

    CBT is fascinating to me because we can see it working in fMRI imaging. It is truly mind over matter. Many people get relief from CBT alone or in conjunction with medication.
  16. People respond to environments in different ways. Continuing the schooling example, some people find conventional schooling to be extremely easy and others find it unbearable, and not necessarily because one is smarter than the other. So when you say, "if it's just school, learn to cope with stress," you're ignoring the possibility of switching to a different style of schooling, a profound life-change that could help profoundly.

    People do not have a shared environmental standard. What's ideal for one can be horrid for another. This is why determining a problem with the environment is so hard to do, and unlikely to be done when one sees a doctor, IMO. Doctors are concerned about problems with the body, and not necessarily problems with the environment.

    Some require an environment that's more stimulating in certain areas. A patient who appears psychotic may need more of his imagination challenged at work or school. Otherwise, his mind could respond to the lack of stimulation by creating problems to challenge it. This happens with starved talents. People who are very rapid critical thinkers may start criticizing other people and themselves needlessly, if their ability isn't satisfied elsewhere.

    People who don't use their natural abilities could feel like fish out of water, an animal equivalent of an anxiety attack if I've ever seen one.

    Medication drives people to suicide too. The guy I knew did not make an attempt until after he was put on antipsychotics. He felt that his mind and life were permanently altered by them. He lost his girlfriend, who he said he wanted to eventually marry, failed out of college, no longer felt creative, and couldn't even trust doctors to help him. Thankfully, there were circumstances that made it impossible for him to succeed. People who go to doctors are already weak, so something like a cavalier use of a drug can utterly destroy them.

    I'm not sure I think this, though... I think people are very different, and there's no real standard of "normal stress." What's normal stimuli to one person could be abnormal stimuli for another. It's also hard for me to think of people asking for pills, but I suppose it happens a lot more now.

    Well... yeah, they won't correct a condition if that condition isn't there, but they can cause other problems. Moreover, it's hard to determine whether suicide is a side effect.

    IIRC, though, the OP didn't mention suicide. And I was the one who mentioned that she may be approaching psychosis... so I appreciate you being concerned about that too. :redface:

    She may be hallucinating, but she may also just have a strong imagination that is working against her as she attempts to cope with stress.

    If she were unable to distinguish the images in her head form normal events, then that's more textbook style hallucination.

    There's more to her life then what we know from the OP, right? Let's hope that she does have options... :redface:
    Last edited: Aug 7, 2006
  17. hypnagogue

    hypnagogue 2,195
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    As far as the whole "chemical imbalances" thing goes, it's definitely an oversimplified view if nothing else. But looking into things a bit more I was somewhat surprised to find that there is scant evidence for the whole "chemical imbalances" idea in the first place, at least in the paradigmatic case of depression.

    See e.g. 1, 2

    Of course, that doesn't imply that certain drugs aren't useful in treating mental disorders, but it seems quite questionable that their usefulness lies particularly in reversing and restoring to order some pre-existing chemical imbalance or other physical disorder. See Do Antidepressants Cure or Create Abnormal Brain States? in PLoS Medicine :

    Last edited: Aug 7, 2006
  18. Evo

    Staff: Mentor

    I'm not talking about anti-depressants which. in my opinion, just temporarly mask things.

    I'm talking about SSRI's for the treatment of clinical (not emotionally induced) anxiety. It's not perfect. The doctor has to take a ful history on the person and if the person lies to the doctor about what in his life may be causing the anxiety, it can be a complete waste of time. SSRI's won't work if there is nothing to correct.

    But for the people that truly need them, they are a godsend.
  19. Oh, I thought SSRI's were antidepressants...?
    Last edited: Aug 8, 2006
  20. hypnagogue

    hypnagogue 2,195
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    But SSRIs are marketed as antidepressants as well, and the PLoS article I linked to specifically mentioned SSRIs and the "depression is caused by low serotonin" idea. Do you mean to say that SSRIs just temporarily mask depression but actually do correct the biological deficiency that causes clinical anxiety? That would dodge the evidence presented in the article (which only directly addresses depression), but I think the thrust of the article is to use depression as a specific example to make a more general point.

    Absolutely. Nonetheless, I don't think the benefits of something like CBT should be neglected, especially if one's case is severe enough to warrant medication in the first place. It strikes me as somewhat similar to e.g. giving someone medication for their diabetes but not teaching them how to watch their diet. Really, you should attack the problem from all angles.
  21. Evo

    Staff: Mentor

    That's how they are classified, which I think is misleading. They are not like valium. They are not "euphorics" They do not make you feel happy, they do work to normalize the functioning of neurotransmitters in the brain.

    I'll have to come back to explain more. I have to go to bed.
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