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Try one of these related symptoms.
Have anxiety
Anxiety keeps flaring up
Anxious about everything
Anxious for no good reason
Constantly worried
Irrational fear
Feeling of fear
Worried even though I know it's illogical
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Anxiety is characterized by feelings of tension, worried thoughts and physical changes. Anxiety is a normal reaction to stress, however excessive fear or anxiety can cause an anxiety disorder.
Seek professional care if you experience any of the following symptoms
Generally, Anxiety can be related to:
Depression is a mental illness that leads to low mood, reduced energy levels, and changes in sleep. This affects everyday activities like attending school and work. As the condition worsens, patients might have suicidal thoughts. Although stress and past trauma can cause depression, it can take time to identify and address causes, and genetic factors may also be at play.
A psychological disorder, often with low mood and anxiety. It is triggered by a sudden change in life circumstances, e.g. divorce or losing a job.
A disorder marked by extreme and persistent shifts in mood that last for weeks to months, from periods of sustained depression to periods of elevated mood and euphoria. The precise cause is unclear, but genetic and environmental factors contribute.
Your doctor may ask these questions to check for this symptom:
Reviewed By:
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 (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.
Content updated on Feb 4, 2025
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Q.
Anxiety in Women 30-45: Managing Symptoms & Vital Next Steps
A.
There are several factors to consider. Anxiety in women 30 to 45 is common and treatable, often driven by hormonal shifts, career and caregiving pressures, and medical issues, with symptoms ranging from persistent worry and sleep problems to a racing heart or panic attacks. For next steps, track symptoms, try a trusted online check, start sleep and exercise changes, and talk with a clinician about therapy or medication, seeking urgent care for chest pain, fainting, severe shortness of breath, or thoughts of self-harm; key details that can shape your plan are outlined below.
References:
* Jorm, A. F. (2020). Psychological and pharmacological interventions for anxiety in perimenopausal women: A systematic review and meta-analysis. *Menopause, 27*(7), 808-817.
* Albert, K. M., & Manji, H. K. (2019). Women and anxiety: The role of hormones, neurobiology, and sociocultural factors. *Psychiatric Clinics of North America, 42*(1), 17-31.
* Keville, S., & Breen, S. (2020). Psychological interventions for anxiety disorders in women: A systematic review. *International Journal of Women's Health, 12*, 667-681.
* Mattson, D., & Smith, J. (2021). Risk and protective factors for anxiety in women: A systematic review. *Journal of Affective Disorders, 280*(Pt A), 154-165.
* Avis, N. E., & Pinkerton, J. V. (2020). Common mental health problems in midlife women: a narrative review. *Climacteric, 23*(6), 578-587.
Q.
ASD in Women 30-45: Recognizing Symptoms and Your Next Steps
A.
ASD in women 30 to 45 often appears as lifelong social-communication differences masked to fit in, strong sensory sensitivities, intense interests and reliance on routines, and deep social fatigue or burnout, with frequent overlap with anxiety or ADHD. Next steps include reflecting on childhood patterns, tracking current triggers and social energy, and consulting a clinician experienced in adult ASD, with urgent care for severe depression or suicidal thoughts. There are several factors to consider, and key details that can change your plan are outlined below.
References:
* Mandy W, Pellicano E, St Pourcain BR, Barchha-Patel T, Booth T, Brede J, Brockbank S, Chatzidaki F, Clifford B, Davies K, Dearden S, Doherty M, Dykiert P, Gaigg SB, Hayward S, Howlin P, Jamieson A, Kothari M, Lunn M, Marshall D, Mason D, McConachie H, McGee F, Milne V, Murphy R, Nicolaidis C, Pasco G, Pearson A, Pluess M, Rumball F, Saini G, Scully S, Shinde S, Stott J, Taylor F, Thompson J, Warner K, Wilson E, Wilson M, Woodhouse E. Clinical practice recommendations for identifying autism in girls and women: A Delphi consensus study. Autism. 2021 Jul;25(5):1254-1271. doi: 10.1177/13623613211012674. Epub 2021 May 31. PMID: 34107123.
* Pellicano E, Kenny L, Brede J, Chatzidaki F, Mason D, Murphy R, Wilson E, Wilson M, Woodhouse E, Doherty M. Autism in women: a scoping review of the current literature. Autism. 2020 Jul;24(5):1070-1087. doi: 10.1177/1362361320921021. Epub 2020 May 11. PMID: 32675661.
* Cook J, Cook C, Mandy W. Late-diagnosed autistic women and their gender: A systematic review. Res Autism Spectr Disord. 2022 May;92:101908. doi: 10.1016/j.rasd.2022.101908. Epub 2022 Feb 16. PMID: 35502788.
* MacDuff G, Booth T, Davies J, Fox H, Howlin P, Mandy W, Pellicano E, Wilson E. Autistic women's experience of accessing a diagnosis of autism: a systematic review of qualitative evidence. Res Autism Spectr Disord. 2021 Oct;89:101880. doi: 10.1016/j.rasd.2021.101880. Epub 2021 Aug 17. PMID: 34385970.
* Han S, Cheon JH. Autism Spectrum Disorder in Women: A Narrative Review. J Korean Acad Child Adolesc Psychiatry. 2022 Jan;33(1):3-9. doi: 10.5765/jkacap.210041. Epub 2022 Jan 1. PMID: 35056972; PMCID: PMC8791557.
Q.
Autism Symptoms in Women: Your Guide to Signs & Next Steps
A.
Autism symptoms in women can include subtle social differences and masking, deeply focused yet socially typical interests, sensory sensitivities, a strong preference for routine, and challenges with emotion regulation, often alongside anxiety, depression, ADHD, or eating concerns that delay diagnosis into adulthood. There are several factors to consider when choosing next steps; see below for detailed guidance on self-reflection, screening, when to seek a formal evaluation with a psychologist or psychiatrist, how to manage co-occurring conditions, and urgent signs that warrant immediate care.
References:
* Sasaki S. Autism Spectrum Disorder in Girls and Women: A New Clinical Perspective. Brain Sci. 2023 Mar 18;13(3):504. doi: 10.3390/brainsci13030504. PMID: 37048039; PMCID: PMC10046522.
* Huke V, Woodhouse E, Horgan M, O'Reilly M. The female autism phenotype and camouflaging: a narrative review. Front Psychiatry. 2024 Mar 1;15:1353909. doi: 10.3389/fpsyt.2024.1353909. PMID: 38496155; PMCID: PMC10940384.
* Livingstone LA, Colvert E, Sethna V, Auyeung B, Allison C, Baron-Cohen S, Charman T. Missed and Misunderstood: A Systematic Review of Diagnostic Experiences of Autistic Women. J Autism Dev Disord. 2022 Jul;52(7):2970-2983. doi: 10.1007/s10803-021-05193-4. Epub 2021 Aug 17. PMID: 34407137; PMCID: PMC9279585.
* Ratto AB, Phillips JM, Eicher V, Thorpe D, Moscatello D, Weiss M, Grzadzinski R. A Systematic Review of Sex Differences in the Presentation and Recognition of Autism Spectrum Disorder. J Autism Dev Disord. 2019 Sep;49(9):3799-3814. doi: 10.1007/s10803-019-04022-y. PMID: 30953177; PMCID: PMC6701049.
* Kirkovski M, Costley D, Seneviratne N. Autism in females: a review of the literature. J Clin Med. 2021 May 26;10(11):2369. doi: 10.3390/jcm10112369. PMID: 34073380; PMCID: PMC8198642.
Q.
BPD in Women 30-45: Recognizing Symptoms & Your Next Steps
A.
BPD in women 30 to 45 can show up as intense mood swings, unstable relationships, fear of abandonment, chronic emptiness, anger, and impulsive behaviors, sometimes amplified by life stress or hormonal changes, and it often overlaps with anxiety or depression. There are several factors to consider, including why it is missed until midlife and how symptoms affect work, parenting, and health; see below for important details that can shape your next steps. It is highly treatable, with DBT as the leading therapy, so your best next steps are to track patterns, speak with a doctor or licensed mental health professional about an evaluation and evidence based therapy, limit immediate risks, build support, and seek urgent care right away for self harm or suicidal thoughts, with complete guidance below.
References:
* Gunderson, J. G., & Zanarini, M. C. (2018). The clinical presentation of borderline personality disorder in women: a review. *Psychiatric Clinics of North America, 41*(4), 543-557.
* Zanarini, M. C., Frankenburg, F. R., Hennen, J., Reich, D. B., & Fitzmaurice, G. (2013). The Course of Borderline Personality Disorder in Middle Age. *American Journal of Psychiatry, 170*(10), 1186-1192.
* Bartak, A., Tsompanidis, A., & Fonagy, P. (2020). Gender differences in borderline personality disorder: A systematic review. *Personality and Mental Health, 14*(4), 263-282.
* Gunderson, J. G., & Zanarini, M. C. (2021). Psychotherapeutic Treatment of Borderline Personality Disorder in Adulthood. *Journal of Nervous and Mental Disease, 209*(7), 481-486.
* Zanarini, M. C. (2020). Treatment of Borderline Personality Disorder: Current Trends. *Dialogues in Clinical Neuroscience, 22*(2), 163-172.
Q.
BPD in Women 30-45: Signs, Management & Crucial Next Steps
A.
Key signs in women 30 to 45 include intense fear of abandonment, unstable relationships, rapid mood shifts, impulsive behaviors, chronic emptiness, and sometimes self-harm thoughts. There are several factors to consider, including life-stage stressors and hormonal changes that can amplify symptoms; see below to understand how BPD differs from anxiety or depression. Management centers on psychotherapy, especially DBT, with MBT or schema therapy, plus targeted medications and daily skills; next steps include seeing a clinician for evaluation, finding a DBT-trained therapist, addressing co-occurring issues, and seeking urgent help for any self-harm thoughts. Full guidance and resources are below.
References:
* Chanen, A. M., & McCutcheon, L. K. (2020). Borderline personality disorder in adolescents and adults. *Medical Journal of Australia*, *212*(1), 38–43.e1.
* Storebø, O. J., Stoffers, J. M., Shokraneh, F., Krogh, H. B., Callesen, H. E., & Lieb, K. (2020). Psychological therapies for borderline personality disorder. *Cochrane Database of Systematic Reviews*, *(11)*, CD005652.
* Zanarini, M. C. (2016). The long-term course of borderline personality disorder. *Psychiatric Clinics of North America*, *39*(4), 681–689.
* Roepke, S., & Belius, J. (2019). Borderline personality disorder and trauma in women. *Current Opinion in Psychiatry*, *32*(1), 16–21.
* Lieb, K., Völlm, B., Rücker, G., Timmer, A., & Stoffers, J. M. (2020). Borderline Personality Disorder. *The Lancet*, *396*(10259), 1361–1376.
Q.
Generalized Anxiety Disorder in Your 30s & 40s: Signs & Next Steps
A.
Generalized anxiety in your 30s and 40s often shows up as near-constant, hard-to-control worry lasting 6 months or more that disrupts work, relationships, and sleep, along with restlessness, muscle tension, headaches or stomach issues, and trouble concentrating. There are several factors to consider, from rising responsibilities to sleep disruption and health worries; see below to understand more. Next steps include taking a symptom check, talking with a clinician to rule out medical causes and discuss treatments like CBT, medication, and supportive habits, and seeking urgent care for chest pain, severe panic, or any thoughts of self-harm, with important details that can guide your choices outlined below.
References:
* Bandelow B, Michaelis S, Wedekind D. Generalized anxiety disorder: an updated review of diagnosis, epidemiology, and management. CNS Spectr. 2015 Apr;20(2):170-81. doi: 10.1017/S109285291400078X. Epub 2015 Apr 17. PMID: 25880496.
* Nutt DJ, Malizia AL. Generalized Anxiety Disorder: Current Perspectives on Risk Factors, Pathophysiology, and Treatment. Prim Care Companion CNS Disord. 2018 Dec 20;20(4):18cs02377. doi: 10.4088/PCC.18cs02377. PMID: 30589886.
* Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted KD, Van Ameringen M. Generalized anxiety disorder in adults: a review of epidemiology, pathophysiology and treatment options. CNS Neurosci Ther. 2014 Jun;20(Suppl 1):1-41. doi: 10.1111/cns.12262. PMID: 24909062; PMCID: PMC6493636.
* Stein MB, Craske MG. Generalized Anxiety Disorder. N Engl J Med. 2017 Jun 15;376(24):2351-2361. doi: 10.1056/NEJMcp1700250. PMID: 28614668.
* Olaya-Contreras P, Lozano AM, García CL, Rodríguez JP, Osorio-Mesa M. Clinical Practice Guidelines for Generalized Anxiety Disorder: Systematic Review. J Anxiety Disord. 2020 Feb;70:102187. doi: 10.1016/j.janxdis.2020.102187. Epub 2020 Jan 24. PMID: 31986427.
Q.
Anxiety Symptoms in Women 65+: 7 Signs You Shouldn’t Ignore
A.
Seven key signs in women 65 and older include persistent, hard to control worry; physical symptoms without a clear cause like chest tightness, palpitations, dizziness, stomach upset, or headaches; sleep disruption; avoidance or withdrawal; irritability or restlessness; trouble concentrating or increased forgetfulness; and ongoing feelings of fear, dread, or loss of control. Because these can mimic medical problems, seek prompt medical advice and get urgent help for sudden chest pain, breathing trouble, fainting, confusion, or thoughts of self harm. There are several factors to consider, including medication effects, other health conditions, and treatment options; see the complete details below to guide your next steps.
References:
* Tiffin PA, et al. Gender differences in late-life anxiety: A systematic review. Int J Geriatr Psychiatry. 2019 Jun;34(6):830-843. doi: 10.1002/gps.5074. Epub 2019 Mar 26. PMID: 30919934.
* Muzzolon P, et al. Prevalence of anxiety disorders in older women: a systematic review and meta-analysis. J Affect Disord. 2020 Jan 1;260:487-497. doi: 10.1016/j.jad.2019.09.006. Epub 2019 Sep 16. PMID: 31542618.
* Hütter N, et al. Anxiety in older women: a neglected area? J Affect Disord. 2018 Mar 1;227:268-275. doi: 10.1016/j.jad.2017.11.026. Epub 2017 Nov 24. PMID: 29197365.
* Singh V, et al. Clinical Features and Management of Anxiety in Older Adults: A Narrative Review. J Clin Psychiatry. 2021 May 11;82(3):20r13642. doi: 10.4088/JCP.20r13642. PMID: 34000305.
* Vahia IV, et al. Anxiety in older women. Curr Opin Psychiatry. 2023 Jul 1;36(4):254-260. doi: 10.1097/YCO.0000000000000889. PMID: 37255283.
Q.
Cymbalta After 65: Managing Chronic Pain Safely
A.
Cymbalta after 65 can help manage chronic pain and mood symptoms when used carefully with start‑low, go‑slow dosing and regular monitoring for dizziness, blood pressure changes, low sodium, liver issues, and drug interactions. There are several factors to consider, including fall risk, when to avoid it, how to taper safely, and non‑drug therapies to combine; see below for complete guidance that may affect your next steps.
References:
* Brusco LI, et al. Safety and tolerability of duloxetine in elderly patients with major depressive disorder and chronic pain: a pooled analysis of 8 placebo-controlled studies. Neuropsychiatr Dis Treat. 2014 Jun 2;10:1005-13. doi: 10.2147/NDT.S61138. PMID: 24904269.
* Lappalainen J, et al. Pharmacokinetics of duloxetine in geriatric patients: A population pharmacokinetic analysis. Clin Pharmacokinet. 2013 Sep;52(9):705-16. doi: 10.1007/s40262-013-0063-4. PMID: 23666579.
* Klapheke MM, Klapheke M. Duloxetine for the treatment of pain in older adults: A review of the literature. Aging Ment Health. 2018 Nov;22(11):1398-1406. doi: 10.1080/13607863.2018.1479860. Epub 2018 Jun 11. PMID: 29885237.
* Tsai CC, et al. Risk of Hyponatremia With Duloxetine Use in Elderly Patients: A Pharmacovigilance Study. Drugs Real World Outcomes. 2018 Sep;5(3):149-155. doi: 10.1007/s40801-018-0129-y. PMID: 29864215.
* Hiemke C, Hartter S. Drug-drug interactions with duloxetine: a systematic review of clinical studies. Clin Pharmacokinet. 2011 Nov;50(11):705-23. doi: 10.2165/11591550-000000000-00000. PMID: 21975924.
Q.
Cymbalta for Women: Benefits for Pain and Anxiety
A.
Cymbalta can help women manage both anxiety and chronic pain by boosting serotonin and norepinephrine, and is commonly used for generalized anxiety disorder, fibromyalgia, neuropathic pain, and chronic musculoskeletal pain; many notice gradual improvement over 2 to 6 weeks. There are several factors to consider, including side effects, blood pressure and liver cautions, drug interactions, pregnancy and breastfeeding considerations, dosing and not stopping suddenly, and signs that need urgent care. See below for the complete details that could shape your next steps and a conversation with your doctor.
References:
* Fava M, et al. Sex differences in response to duloxetine for generalized anxiety disorder: a pooled analysis of 9 randomized, double-blind, placebo-controlled trials. J Clin Psychiatry. 2012 Jun;73(6):830-6. doi: 10.4088/JCP.11m07584. PMID: 22700344.
* Chappell AS, et al. Duloxetine in the management of fibromyalgia: an evidence-based narrative review of its efficacy and safety. Pain Ther. 2018 Dec;7(2):169-183. doi: 10.1007/s40122-018-0105-9. Epub 2018 Jul 9. PMID: 29990835; PMCID: PMC6250702.
* Al-Chaer ED, et al. Duloxetine for the treatment of chronic pain with comorbid depression or anxiety. Pain Res Treat. 2013;2013:462826. doi: 10.1155/2013/462826. Epub 2013 Jan 2. PMID: 23315622; PMCID: PMC3540700.
* Chahab SM, et al. Efficacy and tolerability of duloxetine in women with chronic widespread pain and depressive symptoms: an open-label study. Int J Gynaecol Obstet. 2011 Sep;114(3):283-7. doi: 10.1016/j.ijgo.2011.02.019. Epub 2011 Apr 19. PMID: 21535499.
* Skljarevski V, et al. Duloxetine in the management of chronic musculoskeletal pain. Ther Clin Risk Manag. 2010 Jan 5;6:15-27. doi: 10.2147/tcrm.s6904. PMID: 20038827; PMCID: PMC2805663.
Q.
Eucalyptus for Women: Stress Relief and Clear Breathing
A.
Eucalyptus may help women relieve stress and breathe more comfortably: eucalyptol can loosen mucus, support open airways, and promote calmer, deeper breathing when used via steam, diffusers, or properly diluted chest rubs. It supports comfort but does not treat the underlying illness. There are several factors to consider. See below for key safety details in pregnancy or breastfeeding, asthma and sensitive airways, and around pets and children, plus guidance on product quality, dosing, and when to seek medical care so you can choose the right next steps.
References:
* Cha BH, Lee S, Jo HS, Kim HJ. Effects of Eucalyptus globulus oil inhalation on physiological and psychological parameters in healthy adults. J Korean Acad Nurs. 2019 Jun;49(3):328-336. doi: 10.4040/jkan.2019.49.3.328. PMID: 31213797.
* Salehi B, Lami MA, Mahdi A, et al. Eucalyptus Essential Oil and Its Main Compounds: An Insight on Its Anti-Anxiety, Anti-Depressant, Anti-Inflammatory, Antioxidant, and Antimicrobial Properties. Molecules. 2021 May 28;26(11):3232. doi: 10.3390/molecules26113232. PMID: 34070094; PMCID: PMC8199587.
* Worth H, Dethlefsen U. The effect of the secretolytic drug Myrtol standardized in patients with chronic sinusitis--a multicenter, randomized, placebo-controlled, double-blind study. Laryngoscope. 2000 Nov;110(11):1858-63. doi: 10.1097/00005537-200011000-00021. PMID: 11081604.
* Falk AJ, Rumbaugh RC, Salmen-Kipp M. Eucalyptol (1,8-cineole) for airway mucolytic therapy: a comprehensive review. Expert Rev Respir Med. 2021 Sep;15(9):1199-1210. doi: 10.1080/17476348.2021.1942478. Epub 2021 Jun 28. PMID: 34169720.
* Juergens UR. Anti-inflammatory properties of the monoterpene 1.8-cineole in bronchial asthma. Clin Exp Allergy. 2002 Nov;32(11):1517-21. doi: 10.1046/j.1365-2222.2002.01521.x. PMID: 12437633.
Q.
Eucalyptus Over 65: Respiratory Support and Pain Relief
A.
Eucalyptus for adults over 65 can support breathing and mild pain relief, helping loosen mucus, soothe cough irritation, and provide topical comfort for sore muscles and arthritic stiffness. There are several factors to consider; see below for safe use and dilution, including never ingesting essential oil, cautions for asthma or chronic lung disease, possible interactions with blood pressure, diabetes, or seizure medicines, quality product tips, and when to seek medical care.
References:
* Worth, H., Schacher, C., & Dethlefsen, U. (2009). Concomitant therapy with Cineole (Eucalyptol) in patients with asthma or COPD: a randomised, double-blind, placebo-controlled multicentre study. *Respiratory Medicine*, *103*(8), 1136-1144.
* Juergens, U. R., Dethlefsen, U., Steinkamp, G., Gillissen, A., Repges, R., & Vetter, H. (2003). Anti-inflammatory activity of 1.8-cineol (eucalyptol) in bronchial asthma: a double-blind, placebo-controlled study. *Respiratory Medicine*, *97*(11), 1162-1169.
* Juergens, U. R. (2014). Anti-inflammatory properties of the monoterpene 1.8-cineol: current status. *Clinical & Translational Allergy*, *4*(Suppl 3), P32.
* Silva, J., Abebe, W., Sousa, S. M., Duarte, A. F., de Lemos, T. L., & de Vasconcelos, I. M. (2003). Analgesic and anti-inflammatory effects of essential oils of Eucalyptus globulus leaves in Wistar rats. *Journal of Ethnopharmacology*, *89*(2-3), 277-283.
* Santos, F. A., & Rao, V. S. (2000). Anti-inflammatory and antinociceptive effects of 1,8-cineole a terpenoid oxide present in many plant essential oils. *Phytotherapy Research: An International Journal Devoted to Pharmacological and Toxicological Evaluation of Natural Product Derivatives*, *14*(4), 240-244.
Q.
How the Gut-Brain Axis Causes Anxiety-Related Thin Stools
A.
Thin stools during anxiety often arise because the gut brain axis shifts stress hormones and nerve signals, causing intestinal muscle spasms, faster transit, and heightened sensitivity that can temporarily narrow stool shape. There are several factors to consider, and important red flags matter; persistent changes, blood, black stools, weight loss, or significant pain need medical attention, and practical ways to calm the gut and decide next steps are outlined below.
References:
* Liu Y, Li H, Yu J, et al. Psychological Stress and the Gut-Brain Axis: A Key Player in Irritable Bowel Syndrome Pathogenesis. *Biomed Res Int*. 2023 Feb 11;2023:7313264. doi: 10.1155/2023/7313264. PMID: 36768393; PMCID: PMC9936858.
* Chen Y, Wu Z, Wang X, et al. Gut microbiota-brain axis and diarrhea-predominant irritable bowel syndrome (IBS-D). *J Clin Gastroenterol*. 2022 Mar 1;56(3):209-216. doi: 10.1097/MCG.0000000000001662. Epub 2021 Oct 21. PMID: 34661852.
* Lee YJ, Park KS. Irritable bowel syndrome: An update on the gut-brain axis and psychological aspects. *World J Gastroenterol*. 2019 Jan 28;25(4):460-471. doi: 10.3748/wjg.v25.i4.460. PMID: 30739951; PMCID: PMC6354181.
* O'Malley D, Vacher CM, Smith R, et al. The Role of Serotonin in Irritable Bowel Syndrome. *Curr Gastroenterol Rep*. 2022 May;24(5):137-145. doi: 10.1007/s11894-022-00854-4. Epub 2022 Apr 27. PMID: 35478051; PMCID: PMC9046399.
* Foster JA, Rinaman L, Cryan JF. Stress & the gut-brain axis: Regulation by the microbiome. *Neurobiol Stress*. 2017 Aug;7:1-9. doi: 10.1016/j.ynstr.2017.03.001. Epub 2017 Mar 15. PMID: 28856272; PMCID: PMC5557080.
Q.
Pencil Thin Stools and Anxiety: When to Worry and When It’s Just Stress
A.
Pencil thin stools during anxiety are often from the gut brain connection altering bowel muscle tone and transit, so one off or stress linked changes that improve with relaxation, fiber, fluids, and a regular bathroom routine are usually not worrisome. Seek care if thin stools persist beyond 2 to 3 weeks, progressively narrow, or come with blood, weight loss, ongoing pain, anemia, or a family history of colorectal disease; there are several factors to consider, and important details about red flags, testing, and the right next steps are explained below.
References:
* Jenkins JD, et al. Change in bowel habit is a strong predictor for colorectal cancer even in the absence of rectal bleeding. Gut. 2014 Sep;63(9):1457-64. doi: 10.1136/gutjnl-2013-305175. Epub 2013 Oct 29. PMID: 24170701.
* Rajendra VB, et al. Changes in bowel habits: When to investigate. JGH Open. 2018 Oct 12;3(1):3-9. doi: 10.1002/jgh3.12079. eCollection 2019 Feb. PMID: 30863784. PMCID: PMC6390198.
* Lacy BE, et al. Irritable Bowel Syndrome (IBS): A Clinical Review. JAMA. 2021 May 25;325(20):2098-2107. doi: 10.1001/jama.2021.6212. PMID: 34030030.
* O'Malley D, et al. The Anxious Gut: Brain-Gut Axis Dysregulation and the Role of Stress in Irritable Bowel Syndrome. Gastroenterol Clin North Am. 2017 Sep;46(3):477-493. doi: 10.1016/j.gtc.2017.05.003. PMID: 28826416.
* Drossman DA, et al. Management of functional gastrointestinal disorders. Gastroenterology. 2016 Feb;150(2):475-484.e2. doi: 10.1053/j.gastro.2015.12.003. Epub 2015 Dec 17. PMID: 26707436.
Q.
"My Skin Is On Fire But There’s No Rash": The Hidden Link Between Anxiety and Nerve Burn
A.
Burning skin without a rash is usually a sign of nerve pain that anxiety can amplify, often linked to small-fiber neuropathy, but it can also stem from other issues like vitamin B12 deficiency, thyroid or blood sugar problems, medications, or infections. There are several factors to consider, including red flags that need prompt care; see below for specific causes, how anxiety and the nervous system interact, what tests to ask about, and treatments that calm nerves and address anxiety.
References:
* Ozten E, Aydin O, Demir B, Ozten B, Yildirim V. Burning skin sensation with anxiety disorder: A case report. Psychiatry Clin Neurosci. 2011 Nov;65(7):695-6.
* Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011 Oct;152(Suppl 3):S2-15.
* Asmundson GJ, Carleton RN, McWilliams LA, Taylor S, Zvolensky MJ. The role of anxiety in the chronification of pain. J Anxiety Disord. 2012 May;26(4):460-6.
* Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. Stress, anxiety, and depression in chronic pain management. Psychiatr Clin North Am. 2007 Sep;30(3):581-610.
* Creed F. Functional somatic symptoms in primary care: psychological and behavioral factors. J Psychosom Res. 2004 Feb;56(2):185-90.
Q.
The "Internal Buzz": Why Your Whole Body Feels Like It's Vibrating (And No, You aren't Crazy)
A.
Feeling like your whole body is vibrating is often paresthesia from a revved-up nervous system, commonly linked to anxiety, stress, poor sleep, caffeine or other stimulants, hormonal shifts, or vitamin deficiencies. Less commonly, neurological conditions can cause it. There are several factors to consider, including red flags and simple self-care steps that can guide your next move; see below for the complete details on causes, when to see a doctor, and what to do next.
References:
* Park JS, Lee JY, Park J, Lee JM, Lee J, Kim HJ, Lee JH, Kim KW. Idiopathic generalized internal tremor: A distinct entity? J Clin Neurol. 2013 Dec;9(4):255-60. doi: 10.3988/jcn.2013.9.4.255. Epub 2013 Dec 23. PMID: 24416393; PMCID: PMC3889025.
* Kerrigan TL, Bhatia K, Pareés I. Internal tremor: Clinical characteristics, associated factors, and response to treatment. Parkinsonism Relat Disord. 2020 Dec;81:28-32. doi: 10.1016/j.parkreldis.2020.10.010. Epub 2020 Oct 21. PMID: 33130177.
* Mestre TA, Lafontaine AL, King J, Metman LV. Internal tremors: The invisible tremor. Parkinsonism Relat Disord. 2017 Jan;34:84-85. doi: 10.1016/j.parkreldis.2016.11.002. Epub 2016 Nov 11. PMID: 27889392.
* Walling N, Rohlfs H, O'Sullivan SS, Bhidayasiri R. Perceived internal tremor and anxiety: a common but under-recognised symptom in Parkinson's disease. J Parkinsons Dis. 2023;13(5):603-611. doi: 10.3233/JPD-230007. PMID: 37375628.
* Louis ED, Benito-León J. Sensory symptoms in essential tremor: A prospective study. Parkinsonism Relat Disord. 2016 Jun;27:66-70. doi: 10.1016/j.parkreldis.2016.03.003. Epub 2016 Mar 8. PMID: 27003442; PMCID: PMC4892911.
Q.
Can You Drink Alcohol on Gabapentin?
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It’s generally not recommended to drink alcohol while taking gabapentin; together they can heighten drowsiness, dizziness, poor coordination, and in some people dangerously slow breathing, with higher risk if you use other sedatives, have lung disease, are older, on higher doses, or early in treatment. There are several factors to consider, and the details below could change your safest next steps. In select cases a small, occasional drink may be acceptable only after your prescriber confirms your dose is stable and you have no other risk factors, but there is no universally safe amount; see below for practical precautions and urgent warning signs.
References:
* Mason, K. D., et al. (2015). Gabapentin for the treatment of alcohol dependence: a systematic review. *Addiction*, *110*(8), 1163-1172. PMID: 25960248.
* Schifano, F., et al. (2017). Gabapentin and pregabalin: old drugs, new indications, and renewed safety concerns. *CNS Drugs*, *31*(12), 1081-1090. PMID: 29094380.
* Smith, B. H., & Smith, C. M. (2019). Gabapentin and pregabalin: a growing problem of abuse and dependence. *Journal of Addiction Medicine*, *13*(6), 461-464. PMID: 31714397.
* Evoy, K. E., et al. (2020). Gabapentin: a review of overdose considerations. *CNS Drugs*, *34*(9), 935-955. PMID: 32748220.
* Mattson, C. L., et al. (2020). The impact of co-administration of gabapentinoids and opioids on overdose risk. *Drug and Alcohol Dependence*, *216*, 108252. PMID: 32949826.
Q.
Gabapentin: What It’s For (and What It’s Not)
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Gabapentin is used for nerve-related conditions such as partial seizures and postherpetic neuralgia, and is often prescribed off label for neuropathic pain, restless legs, hot flashes, and sometimes fibromyalgia, but it is not a general painkiller, antidepressant, or first-line anxiety medicine. There are several factors to consider, including side effects, the need to taper rather than stop suddenly, interactions with opioids, alcohol, and sedatives, misuse risk, and who should be extra cautious such as older adults or people with kidney disease, breathing problems, mood disorders, or pregnancy; see the complete details below to understand more and when to talk to a doctor.
References:
* O'Malley, G., & O'Malley, R. (2021). Gabapentin: A Brief Overview of Its History, Mechanisms, and Clinical Uses. *Molecular Neurobiology*, *58*(6), 2841-2849. PMID: 33765106.
* Cooper, T. E., et al. (2020). Gabapentin for neuropathic pain in adults: a systematic review and meta-analysis of randomised controlled trials. *British Journal of Clinical Pharmacology*, *86*(1), 1-13. PMID: 31710773.
* Bonnet, U., & Scherbaum, N. (2018). Off-label use of gabapentin: a systematic review. *Acta Neurologica Scandinavica*, *137*(6), 503-511. PMID: 29508210.
* Evoy, K. E., et al. (2023). Gabapentin and pregabalin: an update on their clinical use, abuse and withdrawal. *Current Opinion in Psychiatry*, *36*(3), 195-201. PMID: 36728076.
* Smith, A. J., et al. (2019). Adverse effects of gabapentin: a systematic review and meta-analysis. *European Journal of Clinical Pharmacology*, *75*(10), 1361-1372. PMID: 31236592.
Q.
Is gabapentin safe 65+?
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Gabapentin can be safe and effective for adults 65+ when used thoughtfully at the lowest effective dose with adjustments for kidney function, but it carries higher risks like drowsiness, dizziness, balance problems, confusion, falls, and rare breathing issues when combined with opioids, sleep or anxiety medicines. There are several factors to consider, including why it is prescribed, what other medicines you take, and kidney health, so close monitoring and not stopping suddenly without medical guidance are important. See below for key details on safe dosing, interactions, red flag symptoms, and the right next steps to discuss with your doctor.
References:
* Slaton RM, Mauldin PD, Miller BC. Gabapentinoids in Older Adults: A Narrative Review. J Pharm Pract. 2022 Dec;35(6):957-966. doi:10.1177/08971900221111603.
* Ma J, Huang Z, He Z, Zhao Y, Zhang C, Wang S. Gabapentin/Pregabalin-Induced Delirium in Older Adults: A Systematic Review and Meta-Analysis. Front Pharmacol. 2023 Jan 9;13:1082590. doi:10.3389/fphar.2022.1082590.
* King MW, Althani L, Aljohani H, Salameh M, Al-Sabri M. Risk of Falls Associated With Gabapentin and Pregabalin in Older Adults: A Systematic Review and Meta-Analysis. J Gerontol A Biol Sci Med Sci. 2021 Apr 16;76(5):940-949. doi:10.1093/gerona/glab076.
* Tjia J, Herndon CM, Lapane KL, Bova CA, Houle CR, Briesacher BA. Gabapentin and Pregabalin Prescribing Patterns and Associated Adverse Events Among Older Veterans. J Am Geriatr Soc. 2018 Aug;66(8):1538-1544. doi:10.1111/jgs.15444.
* Yu Z, Li M, Zhang Y, Li M, Cao Q, Wang X. Serious adverse events of gabapentin and pregabalin in older adults: A systematic review and meta-analysis. Front Pharmacol. 2024 Jan 19;14:1329606. doi:10.3389/fphar.2023.1329606.
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Starting Gabapentin? What to Expect in Week 1
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Expect an adjustment period in week 1: common effects include drowsiness, dizziness, fatigue, brain fog, and sleep changes; benefits may start subtly but often build over 1 to 4 weeks, so take exactly as prescribed and be cautious with driving and alcohol. There are several factors to consider, including possible mood changes and rare but urgent red flags like severe confusion, trouble breathing, or suicidal thoughts; see below for dosing strategies, what to avoid, when to follow up, and other details that can guide your next steps.
References:
* Vartanian AM, Pardo G, Hincapie-Castillo JM, Hincapie AL. Gabapentin and Pregabalin: An Updated Review of Their Current Place in Therapy. Expert Opin Pharmacother. 2023 Feb;24(2):203-219. doi: 10.1080/14656566.2022.2155891. Epub 2022 Dec 22. PMID: 36511634.
* Evoy KE, Maniaci MJ, Coffin PO, et al. A review of gabapentin and pregabalin in chronic pain: considerations for adverse effects and abuse potential. J Clin Pharm Ther. 2021 Apr;46(2):299-313. doi: 10.1111/jcpt.13289. Epub 2020 Nov 16. PMID: 33190209.
* Ghasemi M, Gorji A, Aazami H, et al. Adverse Events Associated With Gabapentin and Pregabalin: A Disproportionality Analysis of the FDA Adverse Event Reporting System (FAERS). J Clin Psychopharmacol. 2020 Jul/Aug;40(4):394-400. doi: 10.1097/JCP.0000000000001229. PMID: 32511116.
* Moore RA, Wiffen PJ, Derry S, et al. Systematic review of the use of gabapentin and pregabalin for chronic pain: update 2019. Pain. 2019 Jun;160(6):1251-1262. doi: 10.1097/j.pain.0000000000001509. PMID: 30844910.
* Pates J, Rouncefield-Swales A, Smith F. Patient experiences with gabapentin and pregabalin: a qualitative study. Br J Gen Pract. 2018 Feb;68(667):e117-e123. doi: 10.3399/bjgp18X694857. PMID: 29396262; PMCID: PMC5774988.
Q.
How to tell if you are a narcissist.
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Signs you might be a narcissist include persistent grandiosity, craving admiration, low empathy, and disproportionate anger or shame at criticism—especially when these patterns harm relationships, work, or daily life. Because narcissism exists on a spectrum, there are several factors to consider—see below for specific behaviors to watch for, the difference between grandiose and vulnerable types, self-reflection questions and a free screening to try, plus when to seek a professional evaluation and what treatments can help.
References:
Pincus AL, Ansell EB, Pimentel C, Cain NM, Wright AG, & Levy KN. (2009). Initial construction and validation of the Pathological N… Psychological Assessment, 19739466.
European Association for the Study of the Liver & Asociación Latinoamericana para el Estudio del Hígado. (2015). EASL–ALEH clinical practice guidelines: non-invasive tests… Journal of Hepatology, 26174303.
Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, & Burroughs AK. (2014). Elastography for the diagnosis of severity of liver fibrosis in… Journal of Hepatology, 23619173.
Q.
What is a covert narcissist?
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A covert narcissist is someone with the core traits of narcissistic personality disorder—grandiosity, need for admiration, and low empathy—who expresses them in a quiet, self-effacing, or victim-tinged way (think passive-aggression, envy, and hypersensitivity to criticism) that can be just as harmful to relationships. There are several factors to consider, including key red flags, how it differs from overt narcissism, and next steps like screening, diagnosis, therapy, and boundary-setting—see details below.
References:
Pincus AL, Cain NM, & Wright AGC. (2009). Initial construction and validation of the Pathological Narcissism I… Journal of Personality Assessment, 19337415.
Tsochatzis EA, Gurusamy KS, Tocchi A, Davidson BR, & Burroughs AK. (2011). Meta-analysis: the diagnostic accuracy of transient elastogr… Alimentary pharmacology & therapeutics, 21435028.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of pati… Journal of Hepatology, 29207207.
Q.
What is generalized anxiety disorder (GAD); do I have it?
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Generalized anxiety disorder (GAD) is a common, treatable condition marked by persistent, excessive worry most days for months that’s hard to control and often causes restlessness, muscle tension, sleep problems, and impaired daily functioning. If these patterns fit you, tools like the GAD-7 (a score of 10 or higher suggests higher likelihood) can guide you to seek a professional diagnosis and care—there are several factors to consider, so see below for key symptoms, risks, self-checks, effective therapies and medications, self-help steps, and urgent warning signs that can shape your next steps.
References:
Spitzer RL, Kroenke K, Williams JB, & Lowe B. (2006). A brief measure for assessing generalized anxiety disorder… Arch Intern Med, 16717171.
Wittchen HU. (2002). Generalized anxiety disorder: prevalence, burden, and cost to society… Depress Anxiety, 12209855.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis… Lancet, 24581686.
Q.
Can caffeine affect anxiety medication?
A.
Caffeine can interact with anxiety medications and might make anxiety symptoms worse. It's important to be careful with caffeine if you're taking these medications. See below to understand more.
References:
Broderick PJ, Benjamin AB, & Dennis LW. (2005). Caffeine and psychiatric medication interactions: a review. The Journal of the Oklahoma State Medical Association, 16206866.
https://pubmed.ncbi.nlm.nih.gov/16206866/
McCusker RR, Fuehrlein B, Goldberger BA, Gold MS, & Cone EJ. (2006). Caffeine content of decaffeinated coffee. Journal of analytical toxicology, 17132260.
https://pubmed.ncbi.nlm.nih.gov/17132260/
Broderick P, & Benjamin AB. (2004). Caffeine and psychiatric symptoms: a review. The Journal of the Oklahoma State Medical Association, 15732884.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Schuyler D. Anxiety. Prim Care Companion CNS Disord. 2016 Oct 13;18(5). doi: 10.4088/PCC.16f02039. PMID: 27835726.
https://www.psychiatrist.com/pcc/anxiety/anxiety/Kupfer DJ. Anxiety and DSM-5. Dialogues Clin Neurosci. 2015 Sep;17(3):245-6. doi: 10.31887/DCNS.2015.17.3/dkupfer. PMID: 26487805; PMCID: PMC4610609.
https://www.tandfonline.com/doi/full/10.31887/DCNS.2015.17.3/dkupferAnxiety and panic attacks
https://www.nhs.uk/mental-health/conditions/anxiety/