Psychiatry · Condition guide
Anxiety and panic
Anxiety becomes a problem when it is out of proportion, hard to control, and getting in the way of life. It is one of the most treatable conditions in psychiatry.
When worry becomes an anxiety disorder
Everyone feels anxious sometimes. An anxiety disorder is different: the worry or fear is more intense than the situation warrants, lasts for weeks or months, and affects work, sleep, relationships or health.1
Common types
- Generalised anxiety disorder: constant, hard-to-control worry about many things, with tension, restlessness, poor sleep and tiredness.
- Panic disorder: sudden surges of intense fear with a racing heart, breathlessness, chest tightness, dizziness or tingling, often with fear of dying or losing control, and worry about the next attack.
- Social anxiety: intense fear of being judged or embarrassed in social or work situations.
- Health anxiety: persistent fear of having a serious illness despite reassurance.
Many people with panic attacks first go to an emergency department believing they are having a heart attack. Having your heart checked is right; once it is clear, the panic itself deserves treatment.
How anxiety affects sex and relationships
Anxiety commonly causes erectile difficulty, premature ejaculation and low desire, and it strains relationships through irritability and avoidance. I assess these together. See Sexual performance anxiety.
How I assess it
- A detailed history of symptoms, triggers, and how anxiety affects your life.
- A validated questionnaire, the GAD-7, repeated at follow-up to track progress.2
- Checks for physical causes where relevant, such as thyroid overactivity, and for caffeine, alcohol or other substances.
- Screening for depression, which often accompanies anxiety.
Treatment
Both therapy and medicines work well, and many people do best with a combination.1,3,4
- Cognitive behavioural therapy (CBT), the best-studied psychological treatment for anxiety and panic.
- Medicines. Certain antidepressants are first-line medicines for anxiety disorders. They are not habit-forming, and take a few weeks to work.3,4
- Sedative medicines are used sparingly and only for short periods, because of the risk of dependence.3
- Lifestyle steps: regular exercise, sleep, and cutting down caffeine and alcohol.
When choosing medicines, I take sexual side effects into account from the start, so treatment is something you can stay on.
Common questions
Is a panic attack dangerous?
A panic attack is very frightening but not dangerous in itself. Chest pain or breathlessness should still be checked by a doctor, especially the first time.
Will I become dependent on anxiety medicines?
The first-line medicines for anxiety are not habit-forming. Sedative medicines can cause dependence, which is why they are used only briefly, if at all.
How long does treatment take?
Many people notice improvement within a few weeks. Medicines are usually continued for several months after you feel better, to reduce the chance of relapse.
Can I have therapy instead of medicine?
Yes, for many people. CBT is effective on its own for mild to moderate anxiety. We decide together based on severity and your preference.
Related guides
References
- National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (CG113). 2011, updated 2020.
- Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097.
- Gautam S, Jain A, Gautam M, Vahia VN, Gautam A. Clinical practice guidelines for the management of generalised anxiety disorder (GAD) and panic disorder (PD). Indian J Psychiatry. 2017;59(Suppl 1):S67–S73.
- Bandelow B, Sher L, Bunevicius R, et al. Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care. Int J Psychiatry Clin Pract. 2012;16(2):77–84.
This page is general information and does not replace a consultation with a doctor who has assessed you. Read how these pages are written in our editorial policy.
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