Anxiety: signs, treatment and getting help

What is anxiety, and when does it become a problem?

Feeling anxious now and then is a normal part of life. Generalised anxiety disorder, or GAD, is a long-term condition in which a person feels anxious most days, about a wide range of situations rather than one event. That worry gets in the way of daily life.

What are the signs?

Alongside worry, symptoms can include feeling restless, trouble concentrating or sleeping, tiredness, irritability, muscle tension, dizziness and heart palpitations (a pounding or fluttering heartbeat). Because many of these also occur in other conditions, a GP can help work out what is going on.

What causes it?

The exact cause of GAD is not fully understood, and several factors probably combine. Factors named in the sources include inherited genes, past stressful or traumatic experiences, a long-term painful health condition, and past drug or alcohol misuse.

What happens at the GP appointment?

NICE advises a comprehensive assessment that looks at the number, severity and duration of symptoms, and also at the degree of distress and the effect on daily functioning. Where another condition such as depression is also present, NICE says the more severe disorder is generally treated first. A short two-question screen about feelings of anxiety and the ability to control worry may be used.

What does treatment involve?

Adults are usually advised to try psychological treatment before medication. Cognitive behavioural therapy, or CBT, is a talking therapy that looks at how thoughts, feelings and actions affect one another. CBT and applied relaxation are both talking therapies available on the NHS for GAD. NICE describes CBT-based self-help as a low-intensity step, with written or electronic materials worked through systematically over several weeks. If talking therapy is not enough, medicine is the next option, and the usual first choice is an SSRI, a type of antidepressant. NICE sets out treatment in steps, offering the least intrusive, most effective option first. Step 4 is for complex, treatment-resistant anxiety with marked impairment or a high risk of self-harm, and involves specialist care.

What can people do themselves?

NHS self-help ideas include regular exercise, cutting back on caffeine, which may help reduce anxiety, and eating a healthy diet. The NHS suggests drinking alcohol in moderation and stopping smoking as part of looking after physical health. Many books and courses can teach ways of coping with anxiety.

When should someone see a GP?

The NHS says to speak to a GP if anxiety is hard to cope with and self-help is not enough. A GP can talk through treatment and refer on, and people can also refer themselves directly to an NHS talking therapies service. Charities such as Mind, Rethink Mental Illness and Anxiety UK also offer support.

Where can someone get urgent help?

Anxiety is common and treatable, and there are several routes to help. If you or someone else is in immediate danger, call 999 or go to A&E. For urgent help that is not an emergency, NHS 111 has a mental health option (option 2), which local NHS trusts describe as free and available at any time. Samaritans listen at any time of day or night, and the number, 116 123, is free to call.