Anxiety is a general feeling of being worried. Everyone experiences anxiety from time to time as a result of life experiences, but those with generalized anxiety disorder feel anxious frequently or excessively, not necessarily as a result of a particular situation.

• Muscle tension, trembling
• Fast heartbeat (tachycardia)
• Fast or troubled breathing (dyspnea)
• Dizziness or impaired concentration
• Palpitations
• Sweating
• Fatigue
• Irritability
• Sleep disturbances

Anxiety can result from many specific causes, such as an underlying medical condition or drugs you are taking. However, there may be no specific cause. Factors such as genetics and early life experiences may play a role.

Your healthcare provider will talk to you about when you feel anxious, what it feels like, and your medical history. He or she will give you a physical examination and may take blood or urine samples for laboratory tests. In some cases, you will have an electrocardiogram (EKG) to rule out heart problems.

Sometimes anxiety has a specific physical cause. A treatment plan can be made once the cause is identified. However, there are a variety of ways to treat anxiety that has no physical cause. Short-term counseling can boost your self-esteem and help you learn coping strategies and problem solving techniques. Your healthcare provider may also suggest trying a method of relaxation such as deep breathing techniques. In some cases, your healthcare provider will prescribe drugs to help you until you have mastered these techniques.

Antianxiety Medications

• Benzodiazepines—a group of drugs that help to reduce anxiety and have sedating properties; may cause drowsiness, constipation, or nausea; do not take if you have narrow-angle glaucoma, a psychosis, or are pregnant

Antidepressant Medications

• Tricyclic antidepressants—a group of drugs that relieve depression (which can accompany anxiety); these medications tend to have numerous side effects

N/A

Mind-body techniques, nutrition, and herbs may be an effective way to treat anxiety. Progressive muscle relaxation, diaphragmatic breathing, biofeedback, meditation, and self-hypnosis can help you relax and reduce your anxiety. Talk with your health care provider about these techniques.

• Avoid caffeine, alcohol, sugar, refined foods, and cut down on foods that are known to cause allergies (common food allergens are dairy, soy, citrus, peanuts, tree nuts, wheat, fish, wheat, fish, eggs, corn, food colorings, and additives). Fresh vegetables, whole grains, and protein nourish the nervous system, so eat more of these.
• Calcium (1,000 mg per day), magnesium (400 to 600 mg per day), and B complex (50 to 100 mg per day) help support the nervous system and minimize the effects of stress.

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to work with your provider on getting your problem diagnosed before you start any treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. Tinctures may be used singly or in combination as noted.

A tea (3 to 4 cups per day) or tincture (10 to 20 drops four to six times per day) from the following herbs will help to reduce anxiety and strengthen the nervous system.

• Kava kava (Piper methysticum) for mild to moderate anxiety.
• St. John's wort (Hypericum perforatum) for anxiety associated with depression.
• Passionflower (Passiflora incarnata) for anxiety with insomnia.
• Oatstraw (Avena sativa) nourishes the nervous system.
• Lemon balm (Melissa officinalis) for anxiety with depression and heart palpitations.
• Lavender (Lavandula angustifolia) for nervous exhaustion and restoring the nervous system.
• Skullcap (Scutellaria lateriflora) relaxes and revitalizes the nervous system.

Kava kava (100 to 200 mg two to four times a day) and St. John's wort (300 mg two to three times per day) may be taken as dried extracts to maximize effectiveness in moderate anxiety.

Essential oils of lemon balm, bergamot, and jasmine are calming and may be used as aromatherapy. Place several drops in a warm bath or atomizer, or on a cotton ball.

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of anxiety based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Aconitum -- for anxiety accompanied by irregular or forceful heartbeat, shortness of breath, or fear of death
• Arsenicum album -- for excessive anxiety that has no clear cause and is accompanied by restlessness, especially after midnight; also for perfectionists, including children, who worry about everything
• Phosphorus -- for an impending sense of doom and anxiety when alone; also for impressionable adults and children who are easily influenced by the anxiety of others
• Lycopodium -- for performance and other types of anxiety in those who are insecure, yet hide their low self-esteem with arrogance and bravado; also for children with anxiety accompanied by bedwetting
• Gelsemium -- for performance anxiety resulting in diarrhea, headache, dizziness, weakness, shakiness and trembling, or trouble speaking
• Argentum nitricum -- for performance anxiety (such as before tests in school-age children) with rapid heart rate, feeling of faintness, diarrhea, or flatulence

Many people report feeling less stressed after receiving acupuncture therapy. This finding has led researchers to speculate that acupuncture may have some beneficial effect when used to treat anxiety directly. In a study of 55 healthy volunteers, acupuncture applied to a "relaxation" point in the ear led to a greater reduction in anxiety than sham acupuncture (needling inactive points). Acupuncturists treat people with anxiety based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of anxiety, a qi deficiency is usually detected in the kidney or spleen meridians. In addition to performing needling techniques, acupuncturists may also employ lifestyle and breathing techniques as well as herbal and dietary therapy.

Therapeutic massage can be helpful in reducing anxiety and alleviating stress.

Follow your health care provider's instructions, and practice relaxation techniques as needed.

Be sure to tell your health care provider if you are pregnant. Call your provider if you experience any significant side effects from prescribed medications.

While the herbal tea suggested above is safe during pregnancy, you should avoid the dried extracts of kava kava and St. John's wort if you are pregnant.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

Andreoli TE, Bennett JC, Carpenter CCJ. Cecil Essentials of Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 1993.

Barker LR, Burton JR, Zieve PD, eds. Principles of Ambulatory Medicine. 4th ed. Baltimore, Md: Williams & Wilkins; 1995:139-154.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:422, 463-464.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3^rd ed. New York, NY: Penguin Putnam; 1997: 334-338.

Goldberg RJ. Anxiety reduction by self-regulation: theory, practice, and evaluation. Ann Intern Med. 1982;96:483.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 250.

Jussofie A, Schmiz A, Hiernke C. Kavapyrone enriched extract from Piper methysticum as modulator of the GABA binding site in different regions of the rat brain. Psychopharmacology. 1994;116:469-474.

Kinzler E, Kromer J, Lehmann E. Effect of a special kava extract in patients with anxiety-, tension-, and excitation states of non-psychotic genesis. Double blind study with placebos over four weeks [in German]. Arzneimforsch. 1991;41:584-588.

Lehmann E, et al. Efficacy of special kava extract (Piper methysticum) in patients with states of anxiety, tension and excitedness of non-mental origin: a double blind placebo controlled study of four weeks treatment. Phytomedicine. 1996;3:113-119.

Lindenberg Von D, Pitule-Schodel H. D, L-Kavain in comparison with oxazepam in anxiety states. Double-blind clinical trial. Forschr Med. 1990;108:50-54.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:4, 40, 293.

Stein JH, ed. Internal Medicine. 4th ed. St. Louis, Mo: Mosby-Year Book; 1994.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 44-45.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 309.

Volz HP, Kieser M. Kava kava extract WS 1490 versus placebo in anxiety disorders—a randomized placebo controlled 25 week outpatient trial. Pharmacopsychiatry. 1997;30:1-5.

Wang SM, Kain ZN. Auricular acupuncture: a potential treatment for anxiety. Anesth Analg. 2001;92:548-553.