ANXIETY DISORDER There are many types of anxiety disorders that include panic disorder, obsessive compulsive disorder,

post-traumatic stress disorder, social anxiety disorder, specific phobias, and generalized anxiety disorder. Anxiety is a normal human emotion that everyone experiences at times. Many people feel anxious, or nervous, when faced with a problem at work, before taking a test, or making an important decision. Anxiety disorders, however, are different. They can cause such distress that it interferes with a person's ability to lead a normal life. An anxiety disorder is a serious mental illness. For people with anxiety disorders, worry and fear are constant and overwhelming, and can be crippling. Phobias -- See What Makes Some People Afraid What Are the Types of Anxiety Disorders? There are several recognized types of anxiety disorders, including: Panic disorder: People with this condition have feelings of terror that strike suddenly and repeatedly with no warning. Other symptoms of a panic attack include sweating, chest pain, palpitations (irregular heartbeats), and a feeling of choking, which may make the person feel like he or she is having a heart attack or "going crazy." Obsessive-compulsive disorder (OCD): People with OCD are plagued by constant thoughts or fears that cause them to perform certain rituals or routines. The disturbing thoughts are called obsessions, and the rituals are called compulsions. An example is a person with an unreasonable fear of germs who constantly washes his or her hands. Post-traumatic stress disorder (PTSD): PTSD is a condition that can develop following a traumatic and/or terrifying event, such as a sexual or physical assault, the unexpected death of a loved one, or a natural disaster. People with PTSD often have lasting and frightening thoughts and memories of the event and tend to be emotionally numb. Social anxiety disorder: Also called social phobia, social anxiety disorder involves overwhelming worry and self-consciousness about everyday social situations. The worry often centers on a fear of being judged by others, or behaving in a way that might cause embarrassment or lead to ridicule. Specific phobias: A specific phobia is an intense fear of a specific object or situation, such as snakes, heights, or flying. The level of fear is usually inappropriate to the situation and may cause the person to avoid common, everyday situations. Generalized anxiety disorder: This disorder involves excessive, unrealistic worry and tension, even if there is little or nothing to provoke the anxiety.

What Are the Symptoms of an Anxiety Disorder? Symptoms vary depending on the type of anxiety disorder, but general symptoms include:

 Feelings of panic, fear, and uneasiness Uncontrollable, obsessive thoughts Repeated thoughts or flashbacks of traumatic experiences Nightmares Ritualistic behaviors, such as repeated hand washing Problems sleeping Cold or sweaty hands and/or feet Shortness of breath Palpitations An inability to be still and calm Dry mouth Numbness or tingling in the hands or feet Nausea Muscle tension Dizziness What Causes Anxiety Disorders? The exact cause of anxiety disorders is unknown; but anxiety disorders -- like other forms of mental illness -- are not the result of personal weakness, a character flaw, or poor upbringing. As scientists continue their research on mental illness, it is becoming clear that many of these disorders are caused by a combination of factors, including changes in the brain and environmental stress. Like certain illnesses, such as diabetes, anxiety disorders may be caused by chemical imbalances in the body. Studies have shown that severe or long-lasting stress can change the balance of chemicals in the brain that control mood. Other studies have shown that people with certain anxiety disorders have changes in certain brain structures that control memory or mood. In addition, studies have shown that anxiety disorders run in families, which means that they can be inherited from one or both parents, like hair or eye color. Moreover, certain environmental factors -- such as a trauma or significant event -- may trigger an anxiety disorder in people who have an inherited susceptibility to developing the disorder. How Common Are Anxiety Disorders? Anxiety disorders affect about 19 million adult Americans. Most anxiety disorders begin in childhood, adolescence, and early adulthood. They occur slightly more often in women than in men, and occur with equal frequency in whites, African-Americans, and Hispanics. How Are Anxiety Disorders Diagnosed? If symptoms of an anxiety disorder are present, the doctor will begin an evaluation by asking you questions about your medical history and performing a physical exam. Although there are no lab tests to specifically diagnose anxiety disorders, the doctor may use various tests to look for physical illness as the cause of the symptoms. If no physical illness is found, you may be referred to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for an anxiety disorder. The doctor bases his or her diagnosis on the patient's report of the intensity and

duration of symptoms -- including any problems with daily functioning caused by the symptoms -- and the doctor's observation of the patient's attitude and behavior. The doctor then determines if the patient's symptoms and degree of dysfunction indicate a specific anxiety disorder. How Are Anxiety Disorders Treated? Fortunately, much progress has been made in the last two decades in the treatment of people with mental illnesses, including anxiety disorders. Although the exact treatment approach depends on the type of disorder, one or a combination of the following therapies may be used for most anxiety disorders: Medication: Drugs used to reduce the symptoms of anxiety disorders include antidepressants and anxiety-reducing drugs. Psychotherapy: Psychotherapy (a type of counseling) addresses the emotional response to mental illness. It is a process in which trained mental health professionals help people by talking through strategies for understanding and dealing with their disorder. Cognitive-behavioral therapy: People suffering from anxiety disorders often participate in this type of psychotherapy in which the person learns to recognize and change thought patterns and behaviors that lead to troublesome feelings. Dietary and lifestyle changes Relaxation therapy Can Anxiety Disorders Be Prevented? Anxiety disorders cannot be prevented; however, there are some things you can do to control or lessen symptoms: Stop or reduce consumption of products that contain caffeine, such as coffee, tea, cola, energy drinks, and chocolate. Ask your doctor or pharmacist before taking any over-the-counter medicines or herbal remedies. Many contain chemicals that can increase anxiety symptoms. Seek counseling and support after a traumatic or disturbing experience. What Causes Anxiety? Anxiety disorders may be caused by environmental factors, medical factors, genetics, brain chemistry, substance abuse, or a combination of these. It is most commonly triggered by the stress in our lives. Usually anxiety is a response to outside forces, but it is possible that we make ourselves anxious with "negative selftalk" - a habit of always telling ourselves the worst will happen.

Environmental and external factors Environmental factors that are known to cause several types of anxiety include: Trauma from events such as abuse, victimization, or the death of a loved one Stress in a personal relationship, marriage, friendship, and divorce

Stress at work Stress from school Stress about finances and money Stress from a natural disaster Lack of oxygen in high altitude areas

Medical factors Anxiety is associated with medical factors such as anemia, asthma, infections, and several heart conditions. Some medically-related causes of anxiety include: Stress from a serious medical illness Side effects of medication Symptoms of a medical illness Lack of oxygen from emphysema, or pulmonary embolism (a blood clot in the lung)

Substance use and abuse It is estimated that about half of patients who utilize mental health services for anxiety disorders such as GAD, panic disorder, or social phobia are doing so because of alcohol or benzodiazepine dependence. More generally, anxiety is also know to result from: Intoxication from an illicit drug, such as cocaine or amphetamines Withdrawal from an illicit drug, such as heroin, or from prescription drugs like Vicodin, benzodiazepines, or barbiturates Genetics It has been suggested by some researchers that a family history of anxiety increases the likelihood that a person will develop it. That is, some people may have a genetic predisposition that gives them a greater chance of suffering from anxiety disorders.

Brain chemistry Research has shown that people with abnormal levels of certain neurotransmitters in the brain are more likely to suffer from generalized anxiety disorder. When neurotransmitters are not working properly, the brain's internal communication network breaks down, and the brain may react in an inappropriate way in some situations. This can lead to anxiety. How is anxiety diagnosed? A psychiatrist, clinical psychologist, or other mental-health professional is usually enlisted to diagnose anxiety and identify the causes of it. The physician will take a careful medical and personal history, perform a physical examination, and order laboratory tests as needed. There is no one laboratory test that can be used to diagnose anxiety, but tests may provide useful information about a medical condition that may be causing physical illness or other anxiety symptoms. To be diagnosed with generalized anxiety disorder (GAD), a person must:

 Excessively worry and be anxious about several different events or activities on more days than not for at least six months Find it difficult to control the worrying Have at least three of the following six symptoms associated with the anxiety on more days than not in the last six months: restlessness, fatigue, irritability, muscle tension, difficulty sleeping, difficulty concentrating Generally, to be diagnosed with GAD, symptoms must be present more often than not for six months and they must interfere with daily living, causing the sufferer to miss work or school. If the focus of the anxiety and worry is confined to a particular anxiety disorder, GAD will not be the diagnosis. For example, a physician may diagnose panic disorder if the anxiety is focused on worrying about having a panic attack, social phobia if worrying about being embarrassed in public, separation anxiety disorder if worrying about being away from home or relatives, anorexia nervosa if worrying about gaining weight, or hypochondriasis if worrying about having a serious illness. Patients with anxiety disorder often present symptoms similar to clinical depression and vice-versa. It is rare for a patient to exhibit symptoms of only one of these.

Antidepressant Antidepressants are a popular treatment choice for those with moderate or severe depression. Although antidepressants may not cure depression, they can reduce your symptoms. The first antidepressant you try may work fine. But if it doesn't relieve your symptoms, or it causes side effects that bother you, you may need to try another. But don't give up. A number of antidepressants are available, and chances are you'll be able to find one that works well for you. Finding the right antidepressant There are a number of antidepressants available that work in slightly different ways and have different side effects. Most work equally well to relieve depression, so choosing the right one generally involves subtle differences. When prescribing an antidepressant that's likely to work well for you, your doctor may consider: Your particular symptoms. Symptoms of depression can vary, and one antidepressant may relieve certain symptoms better than another. For example, if your depression symptoms include low energy, an antidepressant that's slightly stimulating may be the best choice. On the other hand, if you have trouble sleeping, an antidepressant that's slightly sedating may be a good option. Possible side effects. Side effects of antidepressants vary from one medication to another and from person to person. Bothersome side effects can make it difficult to stick with treatment. Sexual side effects are a particularly common reason people stop taking an antidepressant. Whether it worked for a close relative. How a medication worked for a first-degree relative, such as a parent or sibling, can indicate how well it might work for you. Interaction with other medications. Some antidepressants can cause dangerous reactions when taken with other medications. Whether you're pregnant or breast-feeding. Many antidepressants may not be safe for your baby when taken during pregnancy or later when you're breast-feeding. Work with your doctor to find the best way to manage your depression when you're expecting. Your other health conditions. Some antidepressants may cause problems if you have certain mental or physical health conditions. On the other hand, certain antidepressants may help treat other physical or mental health conditions along with depression. For example, bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL) may relieve symptoms of both attentiondeficit/hyperactivity disorder (ADHD) and depression. Cost and health insurance coverage. Some antidepressants can be very expensive, especially if there's no generic version available.

Types of antidepressants

Certain brain chemicals called neurotransmitters are associated with depression, particularly the neurotransmitters serotonin (ser-oh-TOE-nin), norepinephrine (norep-ih-NEF-rin) and dopamine (DOE-puh-mene). Most antidepressants relieve depression by affecting these neurotransmitters. Each type (class) of antidepressant affects these neurotransmitters in slightly different ways. Selective serotonin reuptake inhibitors (SSRIs) Many doctors start depression treatment by prescribing an SSRI. SSRIs are safe and relieve depression for most people. However, like many antidepressants, they can cause sexual side effects most commonly failure to achieve orgasm in women and delayed ejaculation in men. SSRIs include: Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac, Prozac Weekly, Sarafem) Fluvoxamine (Luvox, Luvox CR) Paroxetine (Paxil, Paxil CR, Pexeva) Sertraline (Zoloft)

Serotonin and norepinephrine reuptake inhibitors (SNRIs) SNRIs include: Venlafaxine (Effexor XR). Venlafaxine may work for some people when other antidepressants haven't. It can cause side effects similar to those caused by SSRIs. Venlafaxine can raise blood pressure, and overdose can be dangerous or fatal. Desvenlafaxine (Pristiq). Desvenlafaxine is similar to venlafaxine and causes similar side effects. Studies haven't proven any advantage to desvenlafaxine over venlafaxine, and since venlafaxine is available in a generic form, it's generally a more affordable option. Duloxetine (Cymbalta). Duloxetine may help relieve physical pain in addition to depression but it isn't clear yet whether it works better than other antidepressants for pain relief. Duloxetine can cause a number of side effects. Nausea, dry mouth and constipation are particularly common. You shouldn't take duloxetine if you're a heavy drinker or you have certain liver or kidney problems.

Atypical antidepressants These medications are called "atypical" because they don't fit neatly into other categories. Generally, atypical antidepressants cause fewer sexual side effects than other antidepressants do. Atypical antidepressants include: Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL) has few sexual side effects. It may also suppress appetite, and it may help you stop smoking if you're trying to quit. People with seizure disorders or who have bulimia or anorexia shouldn't take bupropion. Trazodone (Oleptro). This mild antidepressant is often prescribed as a sleep aid because it can be very sedating.

Mirtazapine (Remeron, Remeron SolTab). Like trazodone, mirtazapine can be sedating. It may increase lipid levels and cholesterol. Nefazodone. This antidepressant is effective, but isn't commonly prescribed because it has been linked to dangerous liver problems.

Tricyclic and tetracyclic antidepressants These older antidepressants are effective, but are usually not a first-choice treatment for depression because of numerous side effects such as dry mouth, constipation, difficulty urinating, sedation, weight gain and sexual side effects. In some cases, a low dose of a cyclic antidepressant may be added to another antidepressant, such as an SSRI, to increase the antidepressant effect. Overdosing on a cyclic antidepressant can be deadly. These medications are not usually given to older adults or people who have low blood pressure or certain heart problems. Tricyclic and tetracyclic antidepressants include: Amitriptyline Clomipramine (Anafranil) Doxepin (Silenor, Zonalon) Imipramine (Tofranil, Tofranil-PM) Trimipramine (Surmontil) Desipramine (Norpramin) Nortriptyline (Pamelor, Aventyl) Protriptyline (Vivactil) Amoxapine Maprotiline Monoamine oxidase inhibitors (MAOIs) Monoamine oxidase inhibitors are used as a last resort because of numerous bothersome and potentially dangerous serious side effects. However, MAOIs can be effective for some forms of depression when other medications haven't worked. Side effects can include dizziness, dry mouth, upset stomach, difficult urination, twitching muscles, sexual side effects, drowsiness and sleep problems. MAOIs can cause potentially fatal high blood pressure when combined with certain foods and beverages and certain other medications. MAOIs include: Isocarboxazid (Marplan) Phenelzine (Nardil) Tranylcypromine (Parnate) Selegiline (Emsam, Eldepryl, Zelapar) Emsam is a type of MAOI that you stick on your skin (transdermal patch). It appears to have fewer side effects than MAOIs in pill form have, and with lower dose patches, dietary restrictions may not be needed.

Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful. Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects. ECT is much safer today and is given to people while they're under general anesthesia. Although ECT still causes some side effects, it now uses electrical currents given in a controlled setting to achieve the most benefit with the fewest possible risks.

What is Prozac?

Prozac (fluoxetine) is a selective serotonin reuptake inhibitors (SSRI) antidepressant. Prozac affects chemicals in the brain that may become unbalanced and cause depression, panic, anxiety, or obsessive-compulsive symptoms. Prozac is used to treat major depressive disorder, bulimia nervosa (an eating disorder) obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD). Prozac is sometimes used together with another medication called olanzapine (Zyprexa). to treat depression caused by bipolar disorder (manic depression). This combination is also used to treat depression after at least 2 other medications have been tried without successful treatment of symptoms. Prozac may also be used for purposes not listed in this medication guide. Important information about Prozac You should not use Prozac if you also take pimozide or thioridazine, or if you are being treated with methylene blue injection. Do not use Prozac if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine. You must wait at least 14 days after stopping an MAO inhibitor before you can take Prozac. You must wait 5 weeks after stopping Prozac before you can take thioridazine or an MAOI. Treatments for depression are getting better everyday and there are things you can start doing right away. Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using Prozac. Your family or other caregivers should also be alert to changes in your mood or symptoms. Before taking Prozac You should not use Prozac if you are allergic to Prozac, if you also take pimozide or thioridazine, or if you are being treated with methylene blue injection. Do not use Prozac if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine. You must wait at least 14 days after stopping an MAO inhibitor before you can take Prozac. You must wait 5 weeks after stopping this medicine before you can take thioridazine or an MAOI. Tell your doctor about all other antidepressants you take, especially Celexa, Cymbalta, Desyrel, Effexor, Lexapro, Luvox, Oleptro, Paxil, Pexeva, Symbyax, Viibryd, or Zoloft. To make sure Prozac is safe for you, tell your doctor if you have: cirrhosis of the liver;

 kidney disease; diabetes; glaucoma; seizures or epilepsy; bipolar disorder (manic depression); or a history of drug abuse or suicidal thoughts. Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using Prozac. Your family or other caregivers should also be alert to changes in your mood or symptoms. FDA pregnancy category C. Taking an SSRI antidepressant during pregnancy may cause serious lung problems or other complications in the baby. However, you may have a relapse of depression if you stop taking your antidepressant. Tell your doctor right away if you become pregnant while taking Prozac. Do not start or stop taking this medicine during pregnancy without your doctor's advice. Fluoxetine can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby. Do not give this medication to anyone under 18 years old without medical advice. How should I take Prozac? Take Prozac exactly as prescribed by your doctor, Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended. Do not crush, chew, break, or open an extended-release capsule. Swallow it whole. Measure liquid medicine with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one. It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve. Do not stop using Prozac suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine. To treat premenstrual dysphoric disorder, the usual dose of Prozac is once daily while you are having your period, or 14 days before you expect your period to start. Follow your doctor's instructions. Store at room temperature away from moisture and heat. What happens if I miss a dose? Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. If you miss a dose of Prozac Weekly, take the missed dose as soon as you remember and take the next dose 7 days later. However, if it is almost time for the next regularly scheduled weekly dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.

What should I avoid while taking Prozac? Avoid taking tryptophan while you are taking Prozac. Drinking alcohol can increase certain side effects of Prozac. This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Prozac side effects Get emergency medical help if you have any of these signs of an allergic reaction to Prozac: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. Call your doctor at once if you have: very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out; agitation, hallucinations, overactive reflexes, nausea, vomiting, diarrhea; headache, slurred speech, severe weakness, muscle cramps, loss of coordination, feeling unsteady, seizure (convulsions), shallow breathing (breathing may stop); or severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling. Common Prozac side effects may include: drowsiness, yawning; tremors, sweating, feeling anxious or nervous; dry mouth, upset stomach, mild nausea; sleep problems (insomnia), strange dreams;; mild rash; changes in weight or appetite; decreased sex drive, impotence, or difficulty having an orgasm; or cold symptoms such as stuffy nose, sinus pain, sore throat.

What other drugs will affect Prozac? Taking Prozac with other drugs that make you sleepy or slow your breathing can increase these effects. Ask your doctor before taking Prozac with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures. Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with Prozac may cause you to bruise or bleed easily. Many drugs can interact with fluoxetine. Not all possible interactions are listed here.

Tell your doctor about all your medications and any you start or stop using during treatment with Prozac, especially: any other antidepressant or medication to treat mental illness; fentanyl, tramadol; lithium; St. John's Wort; tryptophan (sometimes called L-tryptophan); vinblastine; a blood thinner (warfarin, Coumadin); heart medication--digitoxin, flecainide, propafenone, and others; medicine to treat anxiety--alprazolam, buspirone, diazepam; migraine headache medicine--almotriptan, frovatriptan, sumatriptan, naratriptan, rizatriptan, zolmitriptan; or seizure medication--carbamazepine, phenytoin. This list is not complete and many other drugs can interact with Prozac. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.