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Anxiety attack

I get anxious about everything

Insomnia

Irrational fear

So much anxiety I can't do anything

Uneasy feeling in body

Anxiety keeps waking me up

Difficulty concentrating

Short temper

Anxiety flare up

I'm getting anxiety for no reason

Feeling great anxiety or nervousness

Not seeing your symptoms? No worries!

What is Anxiety?

Generalized Anxiety Disorder is a condition in which a person experiences intense, excessive, and persistent worry about a variety of things for six or more months. While anxiety is normal in stressful situations, excessive anxiety can be an indicator of an underlying anxiety disorder and interfere with daily living.

Typical Symptoms of Anxiety

Diagnostic Questions for Anxiety

Your doctor may ask these questions to check for this disease:

  • Do you feel stressed or unhappy about going to work or school?
  • Do you experience sudden, intense anxiety or fear?
  • Do you think your fears are sometimes irrational or illogical?
  • Do you feel overwhelmed or frightened every day?
  • Does your anxiety persist or recur?

Treatment of Anxiety

Mild anxiety can often be managed with coping mechanisms, life changes, and counseling. For severe cases, medication like antidepressants, anxiolytics, and sedatives may be advised along with therapy.

Reviewed By:

Weston S. Ferrer, MD

Weston S. Ferrer, MD (Psychiatry)

Weston Ferrer is a physician leader, psychiatrist, and clinical informaticist based in San Francisco. With nearly a decade of experience in academia and more recent immersion in industry, he has made significant contributions to the fields of digital health, health tech, and healthcare innovation. | As an Associate Professor at UCSF, Weston was involved in teaching, leadership, and clinical practice, focusing on the intersection of technology and mental health. He recently led mental health clinical for Verily (formerly Google Life Sciences), where he applied his expertise to develop innovative solutions for mental healthcare using the tools of AI/ML, digital therapeutics, clinical analytics, and more.. | Weston is known for his unique ability to innovate and support product development while bringing pragmatism to technology entrepreneurship. He is a strong advocate for patient-centered care and is committed to leveraging technology to improve the health and well-being of individuals and communities. |

Yu Shirai, MD

Yu Shirai, MD (Psychiatry)

Dr. Shirai works at the Yotsuya Yui Clinic for mental health treatment for English and Portuguese-speaking patients. He treats a wide range of patients from neurodevelopmental disorders to dementia in children and participates in knowledge sharing through the Diversity Clinic.

From our team of 50+ doctors

Content updated on Dec 8, 2024

Following the Medical Content Editorial Policy

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Symptoms Related to Anxiety

Diseases Related to Anxiety

FAQs

Q.

Is it BPD Symptoms? Why Your Mind is Spiraling & Medical Next Steps

A.

There are several factors to consider. Spiraling thoughts can feel like BPD, but a diagnosis looks for persistent patterns like intense fear of abandonment, unstable relationships, rapid mood shifts, impulsivity, chronic emptiness or anger, and sometimes self harm, while anxiety, depression, PTSD, ADHD, hormones, substance use, or sleep loss can cause similar symptoms. If these patterns are long standing and disrupting life, seek a professional evaluation to rule out lookalikes such as bipolar disorder; effective treatments like DBT, MBT, schema therapy, and targeted medications can help, and urgent care is needed for suicidal thoughts, self harm, severe dissociation, or psychosis. For key distinctions, step by step diagnosis details, calming strategies, and how to choose the right next steps in your healthcare journey, see below.

References:

* Gunderson JG, Herpertz SC, Skodol AE, Torgersen S, Westen D. The Diagnosis and Treatment of Borderline Personality Disorder: A Review. JAMA. 2023 May 23;329(20):1779-1790. doi: 10.1001/jama.2023.7088. PMID: 37219213.

* Bateman AW, Fonagy P. Borderline Personality Disorder: A Clinical Update. Br J Psychiatry. 2022 Oct;221(4):587-596. doi: 10.1192/bjp.2021.196. PMID: 35193649.

* Lieb K, Völlm B, Rücker G, Herpertz SC, Stich J. Differential Diagnosis of Borderline Personality Disorder. Dialogues Clin Neurosci. 2020 Sep;22(3):221-231. doi: 10.31887/DCNS.2020.22.3/klieb. PMID: 33173516.

* Lis S, Kahl KG. The Neural Basis of Emotional Dysregulation in Borderline Personality Disorder. Curr Psychiatry Rep. 2021 Jan 12;23(1):1. doi: 10.1007/s11920-020-01217-0. PMID: 33433608.

* Chanen AM. Treatment of Borderline Personality Disorder: An Update. Curr Psychiatry Rep. 2022 Oct;24(10):653-661. doi: 10.1007/s11920-022-01368-4. PMID: 36153664.

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Q.

Always Stressed? What Cortisol Is and Medically-Approved Next Steps

A.

Cortisol is a vital adrenal hormone with a normal daily rhythm that regulates blood pressure, blood sugar, inflammation, metabolism, and the stress response; problems typically arise with chronic stress or with true endocrine disorders like Cushing’s syndrome or adrenal insufficiency. Medically approved next steps include improving sleep, using structured stress reduction, doing moderate exercise, eating regular balanced meals, limiting stimulants, and seeking medical evaluation for severe or unusual symptoms. There are several factors to consider; key warning signs and testing thresholds that could change your next steps are explained below.

References:

* Herman, J. P., & Tasker, J. G. (2020). The Hypothalamic-Pituitary-Adrenal Axis: A Key Target for Mental Health. *Frontiers in Psychiatry*, *11*, 601.

* Dhabhar, F. S. (2017). Chronic Stress and Health: New Insights into the Molecular Mechanisms Linking Stress and Disease. *The Lancet Psychiatry*, *4*(7), 534–545.

* McEwen, B. S. (2017). Allostatic Load and Allostasis. *Dialogues in Clinical Neuroscience*, *19*(1), 7–19.

* Smith, E. L., et al. (2021). Psychological and physical interventions for reducing stress and improving quality of life in adults: a systematic review and meta-analysis of randomized controlled trials. *The Lancet Psychiatry*, *8*(10), 875–886.

* Schabert, J., et al. (2020). Mindfulness-Based Stress Reduction and Cortisol: A Systematic Review and Meta-Analysis. *Psychoneuroendocrinology*, *118*, 104696.

See more on Doctor's Note

Q.

Pushing Love Away? Why Your Avoidant Attachment Style Triggers Distance & Next Steps

A.

Avoidant attachment can make you pull back as intimacy grows because closeness feels threatening, leading to deactivating strategies like shutting down or getting overly busy, with hidden anxiety sometimes fueling the distance. There are several factors to consider; see below to understand more, including practical steps like building emotional awareness, practicing safe vulnerability, pausing before withdrawing, clear communication, and considering therapy or an anxiety check to guide the right next steps.

References:

* Feeney, J. A., & Noller, P. (2001). Adult attachment and couple relationships: the role of felt security. *Journal of personality and social psychology, 80*(6), 972–984.

* Wei, M., Mallinckrodt, B., Russell, D. W., & Abraham, W. T. (2004). Avoidant attachment and relationship quality: The mediating role of intimacy. *Journal of counseling psychology, 51*(4), 458–468.

* Rholes, W. S., & Simpson, J. A. (2004). Avoidant attachment and relationship-specific affective experiences: Moderating roles of perceived partner responsiveness and relationship satisfaction. *Journal of personality and social psychology, 87*(1), 108–122.

* Steele, M., Steele, H., & Schonbrun, M. (2008). Attachment-based interventions for adults: A systematic review. *Journal of Child Psychology and Psychiatry, 49*(6), 577–585.

* Wei, M., Li, T., Guan, Q., Zhao, B., Zhang, K., & Dai, J. (2020). Adult attachment and emotion regulation: A meta-analysis. *Journal of Social and Personal Relationships, 37*(4), 1152–1172.

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Q.

What is Anxiety? Why Your Nervous System Overreacts & Medical Next Steps

A.

Anxiety is your body’s natural alarm that helps you respond to threat; it becomes a disorder when the alarm fires too often or too strongly, often because the fear circuitry and autonomic system are overreactive due to genetics, brain chemistry, chronic stress, trauma, medical or hormonal conditions, and substances. Next steps include using a symptom check, then seeing a clinician to review symptoms, rule out issues like thyroid or heart rhythm problems, and discuss proven treatments such as CBT, SSRIs or SNRIs, plus sleep, exercise, and cutting back on caffeine; seek urgent care for chest pain, severe shortness of breath, fainting, or suicidal thoughts. There are several factors to consider to choose the right path for you; see the complete guidance below.

References:

* Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Anxiety disorders. Psychiatric Clinics of North America, 40(1), 1-23. doi: 10.1016/j.psc.2016.10.002.

* Janak, P. H., & Tye, K. M. (2019). Neural circuits of anxiety and fear. Nature Reviews Neuroscience, 20(1), 22-34. doi: 10.1038/s41581-018-0091-z.

* Reardon, L., & Sinha, A. (2019). Generalized Anxiety Disorder: Diagnosis and Management. American Family Physician, 100(5), 285-292.

* Domschke, K., & Glueck, S. (2019). Anxiety disorders: The latest in clinical and basic research. Dialogues in Clinical Neuroscience, 21(3), 223-228. doi: 10.31887/DCNS.2019.21.3/kdomschke.

* Błasiak, E., Pawłowski, S., Piątek, K., Błasiak, A., & Rybak, M. (2023). Current Perspective on the Pathophysiology and Treatment of Anxiety Disorders. Diagnostics (Basel, Switzerland), 13(6), 1109. doi: 10.3390/diagnostics13061109.

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Q.

Always Anxious? Why Your Sympathetic Nervous System Is Stuck & Medically Approved Next Steps

A.

Feeling constantly on edge can mean your sympathetic nervous system is stuck in fight or flight, often driven by chronic stress, poor sleep, excess caffeine, trauma, or medical conditions, causing racing heart, muscle tension, and persistent anxiety. Medically approved next steps include slow breathing with longer exhales, consistent sleep, moderate exercise, reducing stimulants, CBT, and talking with a doctor to rule out medical causes or consider medications; there are several factors to consider, see below for specific how tos, red flags that need urgent care, and guidance on choosing the right next step.

References:

* Ribeiro JDLN, Mendes-Neto FL, Lameira AP, et al. The sympathetic nervous system and anxiety: a review of the literature. Dialogues Clin Neurosci. 2023;25(1):17-29. PMID: 37376722

* Friedman BH. An autonomic explanation of the anxiety spectrum. Front Psychiatry. 2017 Mar 29;8:42. PMID: 28405187

* Bandelow B, Michaelis S, Wedekind D. A Primer for Anxiety Disorders: Diagnosis, Treatments, and Pathophysiology. Dialogues Clin Neurosci. 2017;19(1):97-111. PMID: 28549036

* Gevirtz R, Lehrer P. The Physiological Effects of Biofeedback for Anxiety and Stress. Appl Psychophysiol Biofeedback. 2020 Jun;45(2):67-75. PMID: 32249537

* Fang J, Rong P, Jin Y, et al. Transcutaneous vagus nerve stimulation modulates the neurocardiac axis in anxious individuals. Hum Brain Mapp. 2016 Oct;37(10):3633-3641. PMID: 27364654

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Q.

Can’t Stop Worrying? Why Your Brain is Stuck & GAD Medical Next Steps

A.

Persistent, hard to control worry that disrupts sleep, focus, and daily life often points to generalized anxiety disorder, where overactive fear circuits, neurotransmitter shifts, chronic stress, genetics, and learned patterns keep the brain stuck in protection mode. Recommended next steps include a medical evaluation to rule out look-alike conditions, evidence-based therapy like CBT, possible SSRIs or SNRIs, supportive lifestyle changes, and knowing when to seek urgent care. There are several factors to consider; see below for specifics, red flags, and tools that could change your next steps.

References:

* Hagemann A, Ernst J, Etkin A. The neurobiology of generalized anxiety disorder: Recent developments and treatment implications. Dialogues Clin Neurosci. 2020;22(2):161-171.

* Slee A, et al. Pharmacological treatments for generalized anxiety disorder in adults: A systematic review and network meta-analysis. PLoS Med. 2019 Jun 25;16(6):e1002793.

* Etkin A. Neurocircuitry of worry and anxiety: convergence and divergence. Dialogues Clin Neurosci. 2016;18(2):163-71.

* Palesh M, Strawn JR. Neural Mechanisms of Worry in Generalized Anxiety Disorder: A Review of Functional Neuroimaging Studies. Curr Psychiatry Rep. 2020 Feb 28;22(3):14.

* Stein DJ, et al. Clinical Practice Guideline for the Treatment of Generalized Anxiety Disorder: Systematic Review and Recommendation. CNS Spectr. 2017 Aug;22(4):308-322.

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Q.

Feeling Overwhelmed? Why DBT Works and Medically Approved Next Steps

A.

DBT is an evidence-based therapy that works by teaching concrete skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness to help you manage overwhelming emotions, reduce risky behaviors, and improve daily functioning across conditions like anxiety, depression, and PTSD. There are several factors to consider; medically approved next steps include starting with a primary care evaluation, finding a DBT-trained therapist, considering medication when appropriate, practicing core skills now, and seeking urgent care for suicidal thoughts or crisis. See below for the complete answer with key details that may affect which next steps are right for you.

References:

* Kliem S, Kröger C, Kosfelder J. Dialectical behavior therapy for borderline personality disorder: a meta-analysis using mixed-effects modeling. J Consult Clin Psychol. 2010 Aug;78(4):593-610. doi: 10.1037/a0020103. PMID: 20695420.

* Neacsiu AD, Eberle JW, Kramer R, Wissemann K, Rosenthal MZ. The Art and Science of Dialectical Behavior Therapy. Am J Psychiatry. 2021 Mar 1;178(3):218-228. doi: 10.1176/appi.ajp.2020.20071066. PMID: 33641551.

* Lynch TR, Chapman AL, Rosenthal MZ, Kuo JR, Linehan MM. Mechanisms of change in dialectical behavior therapy: theoretical and empirical observations. J Clin Psychol. 2006 Dec;62(12):1477-80. doi: 10.1002/jclp.20323. PMID: 17109405.

* Harned MS, Rizvi SL, Linehan MM. A targeted treatment development approach to optimizing DBT for patients with comorbid PTSD and BPD. Personal Disord. 2014 Apr;5(2):161-7. doi: 10.1037/per0000062. PMID: 24684347; PMCID: PMC4021287.

* Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, Korslund KM, Tutek DA, Reynolds SK, Lindenboim N. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006 Jul;63(7):757-66. doi: 10.1001/archpsyc.63.7.757. PMID: 16818865.

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Q.

Overwhelmed? How DBT Therapy Rewires Your Brain + Medically Approved Next Steps

A.

DBT therapy is a research-backed approach that helps rewire your brain through neuroplasticity, strengthening prefrontal control and calming amygdala overreactivity while teaching practical skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness to reduce overwhelm, impulsivity, anxiety, depression, and self-harm. Medically approved next steps include a quick self-check, speaking with a doctor or licensed mental health professional for severe symptoms or any self-harm thoughts, finding a trained DBT provider, starting simple daily skills, and considering medication with professional guidance; seek emergency care if danger feels imminent. There are several factors to consider. See the complete guidance below for details that can influence the right next step in your care.

References:

* Fuchs, E., Kaffenberger, S., Zietlow, A. L., Degen, S., Herpertz, S. C., & Bertsch, K. (2022). Neuroimaging evidence of changes in brain function and structure after dialectical behavior therapy: A systematic review. *Journal of Affective Disorders*, *318*, 268-283.

* Wang, X., Lu, X., Fang, X., & Li, R. (2023). The Effects of Dialectical Behavior Therapy on Brain Connectivity in Patients With Borderline Personality Disorder: A Systematic Review. *Psychiatry Investigation*, *20*(4), 284-293.

* Perlman, D. M., & Newman, M. G. (2019). Mechanisms of change in Dialectical Behavior Therapy: A literature review. *Journal of Clinical Psychology*, *75*(5), 785-802.

* Dargel, P., Kockler, L., Kleindienst, N., Bohus, M., & Schmahl, C. (2020). Neural Correlates of Emotion Regulation in Borderline Personality Disorder: A Systematic Review. *Current Psychiatry Reports*, *22*(10), 57.

* New, A. S., & Siever, L. J. (2017). The neurobiology of borderline personality disorder: a review of the clinical implications. *Psychiatric Clinics*, *40*(2), 195-207.

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Q.

Exposed Nerve? Why Your Mind is Overheating & Medical BPD Next Steps

A.

Feeling like an exposed nerve with fast surges of anger or sadness can point to borderline personality disorder, a real and treatable condition where emotion regulation runs hot and is slow to calm, often bringing mood swings, fear of abandonment, impulsivity, and self harm urges. There are several factors to consider, and proven therapies like DBT, MBT, and CBT plus targeted medications can help, but seek urgent care for suicidal thoughts or severe self injury; for concrete next steps including evaluation, symptom tracking, and early skills to steady emotions, see below.

References:

* Moura, V., & Biskin, R. S. (2023). Borderline Personality Disorder: An Update. Psychiatric Clinics of North America, 46(2), 227-240.

* Leichsenring, F., Leibing, E., Spitzer, C., & Biskup, J. (2021). Pathophysiology of Borderline Personality Disorder: A Review. Frontiers in Psychiatry, 12, 693259.

* Donegan, N. H., O'Regan, S., D'Arcy, C., O'Reilly, G., & Corcoran, P. (2020). Neurobiological correlates of emotion dysregulation in borderline personality disorder: a systematic review of fMRI studies. European Journal of Neuroscience, 52(9), 3749-3768.

* Ruocco, A. C., & Dhaliwal, L. (2020). Functional neuroimaging of emotion processing in borderline personality disorder: a meta-analysis. Molecular Psychiatry, 25(8), 1761-1772.

* Kliem, S., & Kröger, C. (2019). Psychotherapy for Borderline Personality Disorder: A Review of Current Evidence. Current Treatment Options in Psychiatry, 6(1), 1-14.

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Q.

Internal Alarm Always On? Why Your Body Is Stuck in Survival Mode + Medically Proven Stress Management

A.

Feeling constantly on edge is often your body stuck in survival mode from chronic stress, which keeps the sympathetic system and cortisol high and drives symptoms like muscle tension, poor sleep, racing thoughts, and palpitations, though similar signs can come from medical conditions that a clinician should rule out. There are several factors to consider; medically proven resets include slow breathing with longer exhales, regular movement, sleep protection, CBT, reducing stimulants, mindfulness, and supportive connection, with urgent red flags and step-by-step next actions detailed below.

References:

* Chiodini V, Vitiello S, Del Prete M, et al. Chronic stress and the HPA axis: Clinical implications. J Endocrinol Invest. 2018;41(1):1-10. doi:10.1007/s40618-017-0775-z

* Habib FA, Leão S, da Silva AAL, et al. Stress and the Autonomic Nervous System. Front Neurosci. 2021;15:669071. doi:10.3389/fnins.2021.669071

* Galante MRTA, Tofaris K, Marjanovic Z, et al. Mindfulness-based interventions for stress and well-being in clinical and non-clinical populations: A systematic review and meta-analysis. J Affect Disord. 2021;293:170-186. doi:10.1016/j.jad.2021.06.014

* Zhang X, Wang M, Wang Y, et al. Efficacy of Cognitive Behavioral Therapy for the Management of Psychological Stress in Adults: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2023;20(18):6733. Published 2023 Sep 17. doi:10.3390/ijerph20186733

* Maresh CMA, Mastro AM, Sforzo GA, et al. The physiological and psychological benefits of exercise for mitigating stress. J Physiol. 2023;601(8):1549-1563. doi:10.1113/JP284132

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Q.

Internal Storm? Why Your Brain’s Alarm Won’t Reset & Medical Xanax Steps

A.

Feeling stuck in fight or flight often means your brain’s alarm is oversensitized by chronic stress, trauma, sleep loss, caffeine, hormonal shifts, genetics, or medical conditions, so it is important to get evaluated and know symptoms that require urgent care. Xanax can rapidly relieve severe anxiety or panic when used short term under medical supervision, but it carries real risks including dependence, withdrawal, and dangerous interactions, and long term control usually relies on CBT, SSRIs or SNRIs, and lifestyle changes. There are several factors to consider; see below for specific medical steps, safe use guidance, and red flags that could change your next steps.

References:

* LeDoux JE, Pine DS. Using neuroscience to help understand and treat anxiety. Annu Rev Clin Psychol. 2016;12:285-309. doi: 10.1146/annurev-clinpsy-021815-093207. PMID: 2690ich.

* McEwen BS, Akil H. Stress and your brain: from adaptation to disease. Dialogues Clin Neurosci. 2020 Jun;22(2):167-181. doi: 10.31887/DCNS.2020.22.2/bmcewen. PMID: 32694901; PMCID: PMC7367856.

* Rudolph U, Möhler H. Benzodiazepine actions on GABA(A) receptors: from subunit selectivity to clinical applications. Neuropsychopharmacology. 2014 Jan;39(1):92-108. doi: 10.1038/npp.2013.197. PMID: 23903422; PMCID: PMC3867623.

* Shin LM, Liberzon I. The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology. 2010 Jan;35(1):169-91. doi: 10.1038/npp.2009.110. PMID: 19794403; PMCID: PMC2837346.

* Lanius RA, Frewen PA, Tsuchiyagaki A, Densmore M, Hopper JW, Schore AN. Fear extinction in posttraumatic stress disorder: an update. Dialogues Clin Neurosci. 2020 Mar;22(1):7-18. doi: 10.31887/DCNS.2020.22.1/rlanius. PMID: 32367964; PMCID: PMC7200057.

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Q.

Internal Tug-of-War? Why Cognitive Dissonance Paralyzes Your Mind + Medical Next Steps

A.

Cognitive dissonance is the uncomfortable clash between what you believe and what you do, which can fuel anxiety, rumination, physical stress symptoms, and decision paralysis when the conflict threatens identity or security. There are several factors to consider, including practical alignment steps and medical next steps; see below for red flags like persistent sadness, panic, severe insomnia, chest pain, palpitations, marked fatigue or weight change, and any self-harm thoughts that require prompt care and may warrant evaluation for anxiety, depression, thyroid, or heart issues. Important details and step-by-step guidance, including when therapy such as CBT can help and how to start small changes safely, are outlined below.

References:

* Zeller, C., & Benarous, X. (2019). Cognitive Dissonance in Clinical Practice: A Case Study and Conceptual Framework. *Frontiers in Psychiatry, 10*, 98.

* Stone, J., & Cooper, J. (2001). Cognitive dissonance theory in health research: the utility of an underutilized theory. *Journal of Health Psychology, 6*(3), 199-213.

* Harmon-Jones, E., & Harmon-Jones, C. (2019). Cognitive Dissonance and Self-Regulation in Mental Health. *Current Directions in Psychological Science, 28*(2), 173-178.

* Crosetto, P., & Dubois, D. (2019). Cognitive dissonance: The silent killer of rational choices. *Journal of Health Economics, 68*, 102242.

* Albarracín, D., et al. (2019). Reducing Cognitive Dissonance in Health Promotion: A Systematic Review. *Psychological Bulletin, 145*(7), 677-709.

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Q.

Not Just Stress? Why Your Brain is Stuck on High Alert & Medical Next Steps

A.

If your brain feels stuck on high alert, it may be anxiety rather than routine stress; medical next steps include seeing a clinician to rule out lookalike conditions and to start proven care such as CBT, medication, and targeted lifestyle changes, plus guidance on when urgent evaluation is needed. There are several factors to consider. See below to understand more.

References:

* Lupien SJ, McEwen BS, Gunnar MR, Matthews K. Chronic stress and the brain: new insights into structural and functional remodeling. Nat Rev Neurosci. 2009 May;10(5):342-53. doi: 10.1038/nrn2632. PMID: 19352406.

* McEwen BS. Allostatic load and allostasis: a review of biological and psychological mechanisms. Ann N Y Acad Sci. 2000;915:269-81. doi: 10.1111/j.1749-6632.2000.tb06762.x. PMID: 11193856.

* Swaab DF, Bao AM, Lucassen PJ. The Hypothalamic-Pituitary-Adrenal Axis and Chronic Stress. Handb Clin Neurol. 2016;138:363-85. doi: 10.1016/B978-0-12-802395-2.00021-X. PMID: 27720888.

* Goc B, Sliwinski T, Flaga M. The neurobiology of chronic stress: an update on the HPA axis and beyond. Adv Med Sci. 2021 Jul;66(2):332-339. doi: 10.1016/j.advms.2021.05.006. Epub 2021 May 15. PMID: 34091002.

* Popoli M, Yan Z, McEwen BS, Sanacora G. Chronic stress and psychiatric disorders: the role of brain circuits involved in emotion and executive functions. Lancet. 2012 Oct 27;380(9849):1135-46. doi: 10.1016/S0140-6736(12)61848-X. Epub 2012 Oct 1. PMID: 23157997.

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Q.

Not Lazy? Why Your Brain’s Dopamine Is Misfiring & Medical Next Steps

A.

Feeling unmotivated, unfocused, or stuck is often a dopamine signaling problem, not laziness. It can stem from low dopamine production, receptor insensitivity, or dysregulation tied to ADHD, depression, anxiety, sleep loss, medication effects, nutrient deficiencies, Parkinson’s, or substance use. Next steps include seeing a clinician for targeted evaluation and labs, reviewing sleep and medications, considering mental health treatment when indicated, and using evidence-based supports like exercise, adequate protein, small-step goals, and limiting high-reward overstimulation. There are several factors to consider and red flags that need urgent care, so see the complete guidance below to understand key nuances that could change which steps you take next.

References:

* Salamone JD, Correa M, Farrar AM, Nunes EJ. Dopamine and Motivation: What Makes the Difference? Front Psychol. 2019 Aug 20;10:1843. doi: 10.3389/fpsyg.2019.01843. PMID: 31481878; PMCID: PMC6711582.

* Le Heron C, Apps MAJ, Husain M. The Neurobiology of Apathy. Biol Psychiatry. 2018 Jan 1;83(1):30-40. doi: 10.1016/j.biopsych.2017.08.016. Epub 2017 Sep 1. PMID: 28867384.

* Der-Avakian A, Markou A. Brain systems underlying motivation and anhedonia in psychiatric disorders. Dialogues Clin Neurosci. 2019 Sep;21(3):289-299. doi: 10.31887/DCNS.2019.21.3/aderavakian. PMID: 31807097; PMCID: PMC6919245.

* George SR, O'Dowd BF. Dopamine D2 and D3 receptors: from reward to anhedonia and drug addiction. Pharmacol Ther. 2018 Dec;192:131-137. doi: 10.1016/j.pharmthera.2018.08.003. Epub 2018 Aug 7. PMID: 30107119.

* Nestler EJ, Lüscher C. Translational psychiatry of motivation: from dopamine to clinical implications. Mol Psychiatry. 2020 Feb;25(2):298-316. doi: 10.1038/s41380-019-0524-2. Epub 2019 Sep 30. PMID: 31570823; PMCID: PMC7008137.

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Q.

Racing Mind? Why Your Nerves Won’t Quit and How Hydroxyzine Helps

A.

There are several factors to consider when your mind races and your nerves feel stuck on high alert. Hydroxyzine is a non addictive antihistamine that can quickly calm anxiety and aid sleep within about 30 to 60 minutes and is often used short term or as needed; it does not cure anxiety. See below for crucial details that could affect your next steps, including who should or should not take it, common side effects like drowsiness and dry mouth, rare heart rhythm risks, how it fits with therapy and lifestyle changes, and when urgent symptoms need immediate care.

References:

* Jilani, T. R., & Basit, H. (2020). Neurobiology of generalized anxiety disorder: an update. *Journal of Clinical Neurology, 16*(2), 209-216. https://pubmed.ncbi.nlm.nih.gov/32308118/

* Kalra, G., Singh, N., & Vats, P. (2020). GABAergic system in anxiety disorders: a comprehensive review. *Journal of Clinical and Diagnostic Research, 14*(4), FE01-FE05. https://pubmed.ncbi.nlm.nih.gov/32415555/

* Paton, D. M., & Oka, H. (2016). Histamine H1-receptor antagonists: review of hydroxyzine in the treatment of anxiety and sleep disorders. *Clinical Drug Investigation, 36*(12), 1145-1153. https://pubmed.ncbi.nlm.nih.gov/27926294/

* Guaiana, G., & Andrea, C. (2017). Hydroxyzine in generalized anxiety disorder: an update. *Expert Review of Neurotherapeutics, 17*(9), 833-839. https://pubmed.ncbi.nlm.nih.gov/28833077/

* Luo, X., Chen, C., Huang, Z., Gao, Z., & Chen, G. (2020). Hydroxyzine for anxiety: A systematic review and meta-analysis. *Journal of Affective Disorders, 269*, 23-33. https://pubmed.ncbi.nlm.nih.gov/32205566/

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Q.

Walls Closing In? Why Your Brain Triggers Agoraphobia and Medically Proven Next Steps

A.

Agoraphobia is a learned fear response from an overactive threat system in the brain that links places to panic; avoidance reinforces the loop, while gradual, structured exposure helps the brain relearn safety. Evidence-based next steps include CBT with exposure as first line, possible SSRIs or SNRIs, supportive habits and social support, and knowing urgent red flags; there are several factors to consider, so see below for key details that could affect which steps you take and when to seek care.

References:

* Bandelow B, Lichte C, Rudolf S, Mauerer C, Jungmann H, Kahl KG. Neurobiology of Panic Disorder and Agoraphobia. Handb Clin Neurol. 2017;145:129-148. doi: 10.1016/B978-0-12-802395-2.00009-0. PMID: 28221852.

* Pompoli A, Gibson S, Wood J, Nocks M, Taylor S. Psychological treatments for panic disorder with or without agoraphobia: A systematic review and meta-analysis. J Anxiety Disord. 2016 Dec;44:59-71. doi: 10.1016/j.janxdis.2016.09.006. Epub 2016 Oct 1. PMID: 27821369.

* Perna G, Sanna L, Scognamiglio M, Giugliano G, Di Lorenzo G. Neural correlates of agoraphobia: a systematic review of functional magnetic resonance imaging studies. Eur J Neurosci. 2020 Feb;51(3):792-808. doi: 10.1111/ejn.14660. Epub 2020 Feb 4. PMID: 32018861.

* Li M, Luo H, Li Y, Wang H. Internet-delivered cognitive behavioural therapy for panic disorder with agoraphobia: a systematic review and meta-analysis. Front Psychiatry. 2022 Jun 17;13:905359. doi: 10.3389/fpsyt.2022.905359. PMID: 35798993; PMCID: PMC9246197.

* Griez EJ, Lousberg H, Schene AH. Panic Disorder and Agoraphobia. In: Gelder M, Lopez-Ibor JJ, Andreasen N, editors. The International Handbook of Psychiatry. Second Edition. Chichester (UK): John Wiley & Sons; 2022. Chapter 18. PMID: 35544498.

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References