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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
Nervousness
My anxiety won't go away
Feel anxious
Somehow anxious
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
Following the Medical Content Editorial Policy
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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.
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.
Q.
Feeling Off on Buspirone? Why Your Brain Reacts & Medically-Approved Next Steps
A.
Feeling off after starting buspirone is common as your brain adapts to serotonin changes, leading to temporary dizziness, nausea, sleep shifts, or a wired but tired feeling that often improves within 2 to 6 weeks; seek urgent care for severe symptoms or worsening mood. There are several factors to consider. See below to understand more. Medically approved next steps include taking it consistently with or without food, avoiding grapefruit and drug interactions, tracking symptoms, discussing dose adjustments with your doctor, and using supportive habits or therapy; do not stop suddenly without medical guidance. Full red flags, interaction risks, timelines, and when to consider switching are explained below.
References:
* Newton, R., Marunycz, J. D., & Wilson, J. J. (2018). Buspirone: a comprehensive review of clinical efficacy, pharmacokinetics, and tolerability. *Journal of Clinical Psychopharmacology*, *38*(4), 332–345.
* Wilson, K. C., & Trivedi, M. H. (2020). Buspirone. *Handbook of Experimental Pharmacology*, *264*, 361–373.
* Trivedi, M. H., & Wilson, K. C. (2021). Buspirone. In *Psychopharmacology and Addiction Research* (pp. 115-127). Springer.
* Barr, L. C., & Taylor, P. M. (2020). Management of Psychotropic Medication Side Effects. *Primary Care*, *47*(3), 441–453.
* Singh, H., Kumar, S., & Singh, R. (2020). A review on drug interactions with buspirone. *Current Drug Metabolism*, *21*(4), 324–330.
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.
Q.
Stuck in a Loop? Why Your Brain Stays Stuck and Medically Approved Steps
A.
Feeling stuck in mental loops is often driven by anxiety or obsessive compulsive disorder, where an overactive threat and error detection system pairs intrusive thoughts with rituals that briefly ease anxiety yet strengthen the cycle. Medically approved steps focus on retraining the brain with exposure and response prevention and cognitive behavioral therapy, sometimes paired with higher dose SSRIs or clomipramine, plus supportive habits like steady sleep, regular exercise, limiting caffeine, and mindfulness. There are several factors to consider for your specific situation, including red flags, why avoidance makes symptoms worse, and what recovery really looks like; see below for the complete guidance that can shape your next healthcare steps.
References:
* Marchetti, I. K. M., Koster, E. H. W., & De Raedt, R. (2012). The neural mechanisms of rumination: a review and proposal. Frontiers in Human Neuroscience, 6, 335.
* Fineberg, N. A., Apergis-Schoute, J., Baillieux, H., Broadbent, M., Dymond, S., ... & Chamberlain, S. R. (2018). Neural mechanisms of cognitive rigidity in psychiatric disorders. Translational Psychiatry, 8(1), 114.
* Lobo, M. K., & Nestler, E. J. (2019). Neurobiology of Habit Learning: Bridging Behavior to Circuits. Trends in Neurosciences, 42(6), 387-398.
* Watkins, E. R., & Nolen-Hoeksema, S. (2019). Repetitive negative thinking and functional brain networks in psychopathology: A systematic review. Clinical Psychology Review, 72, 101751.
* Yang, Z., Liu, D., Yin, H., Li, X., Wu, X., & Chen, G. (2021). The neural mechanisms of mindfulness-based cognitive therapy for rumination in depression: A systematic review. NeuroImage: Clinical, 30, 102604.
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.
Q.
Always Anxious? Why Your Limbic System Is Misfiring & Medical Steps to Heal
A.
Persistent, daily anxiety is often a sign that the limbic system is overactive and stuck in threat mode, creating real body symptoms; drivers can include chronic stress or trauma, poor sleep, hormonal or thyroid issues, inflammation, medications, and more. There are several factors to consider. Effective medical steps range from ruling out mimicking conditions to restoring sleep and blood sugar balance, regular movement, targeted therapies like CBT, exposure therapy, EMDR, and somatic work, paced breathing, and when appropriate medications such as SSRIs, SNRIs, buspirone, or beta blockers, plus knowing red flags that need urgent care; see the complete guidance below to choose the right next step.
References:
* Hariri, A. R., & Holmes, A. (2017). Neurobiological mechanisms of anxiety disorders: focus on the limbic system. *Dialogues in Clinical Neuroscience*, *19*(2), 195–205.
* Garakani, A., Murrough, J. W., Freire, R. C., Phillips, M. L., Mathew, S. J., Charney, D. S., & Davis, M. (2020). The neurobiology of anxiety disorders: a review of the neural circuits, genetic factors and treatment options. *Psychiatric Clinics of North America*, *43*(2), 173–193.
* Andero, R., & Ressler, K. J. (2021). Pharmacological modulation of the fear circuit: targeting the amygdala in anxiety disorders. *Molecular Psychiatry*, *26*(7), 2947–2961.
* Loo, C. K., & Sainsbury, A. (2022). Neuromodulation for anxiety disorders: a systematic review. *Translational Psychiatry*, *12*(1), 303.
* Tye, K. M. (2019). The neuroscience of anxiety: from basic mechanisms to treatment targets. *Nature Neuroscience*, *22*(8), 1192–1204.
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
Q.
Am I a Hypochondriac? Why Your Brain Triggers Pain & Medical Next Steps
A.
Health anxiety can make everyday sensations feel dangerous because the brain’s stress response can create and amplify real pain, palpitations, tingling, and fatigue even when tests are normal; the goal is balanced care that rules out danger and addresses anxiety-driven symptoms. There are several factors to consider, including red flag symptoms that need urgent care and proven treatments like CBT, medication when appropriate, and nervous system regulation, plus how to plan next steps with your doctor. See the complete guidance below to understand more and choose the right path forward.
References:
* Scarella, T. M., & Barsky, A. J. (2022). Somatic Symptom Disorder and Illness Anxiety Disorder. *FOCUS*, *20*(4), 415-423. [PubMed: 36397395]
* Olsson, H., & Philipsen, A. (2020). Illness anxiety disorder: a narrative review of classification, epidemiology, and treatment. *Journal of Clinical Medicine*, *9*(12), 3907. [PubMed: 33276495]
* Lumley, M. A., Schubiner, H., & Van Boxtel, B. A. (2021). Mind-Body Medicine for Chronic Pain: A Clinical Review. *Psychosomatic Medicine*, *83*(7), 633-644. [PubMed: 34460492]
* Harvie, D. S., Meulders, A., Madden, V. J., Moseley, G. L., & Murray, L. J. (2021). The role of threat in the development and maintenance of chronic pain. *The Clinical Journal of Pain*, *37*(6), 461-470. [PubMed: 33539097]
* Creed, F., & Barsky, A. (2020). Management of somatic symptom disorder. *BMJ*, *369*, m1567. [PubMed: 32414777]
Q.
Am I Autistic? Why You Feel Different & Medically Approved Next Steps
A.
There are several factors to consider. Autism is a lifelong neurodevelopmental condition that affects social communication, behavior patterns, and sensory processing; common signs include long-standing social differences, sensory sensitivities, and a need for routines or intense interests, yet anxiety, ADHD, and other conditions can look similar, and only a qualified clinician can diagnose. Medically approved next steps include speaking with a doctor or psychologist for a comprehensive evaluation, addressing co-occurring issues, avoiding self-diagnosis, and seeking urgent care for severe or dangerous symptoms; if diagnosed, supports and accommodations can help, and if not, other treatments may still improve well-being. For important details that could change which next steps are right for you, see the complete guidance below.
References:
* Mandy WPL, Lai MC, Baron-Cohen S, Buitelaar JK. Autism spectrum disorder in adults: A guide for general practitioners. BJGP Open. 2021 May 26;5(3):BJGPO.2020.0177. doi: 10.3399/BJGPO.2020.0177. eCollection 2021 May. PMID: 33858908. PMCID: PMC8154563.
* Russell G, Williams C, van der Gaag R, Ford T, Mandy W. The lived experience of autistic adults: a systematic review of qualitative evidence. Autism. 2022 Nov;26(8):1899-1912. doi: 10.1177/13623613221087854. Epub 2022 Mar 25. PMID: 35332560.
* Cage E, Di Monaco J, Newell V. Coping mechanisms and experiences of autistic adults with and without a formal diagnosis. Autism. 2022 May;26(4):948-959. doi: 10.1177/13623613211046465. Epub 2021 Sep 28. PMID: 34583151.
* Ruzich E, Leekam S, Mandy W. An Investigation of Self-Reported Autistic Traits and Mental Health in a Clinical Sample of Adults Referred for an Autism Spectrum Disorder Assessment. J Autism Dev Disord. 2023 Feb;53(2):568-577. doi: 10.1007/s10803-022-05466-9. Epub 2022 Mar 23. PMID: 35320579. PMCID: PMC9896796.
* Brugha TS, Koçak V, Mandy W, Santosh P. Challenges in diagnosing autism spectrum disorder in adults: a systematic review. Eur Child Adolesc Psychiatry. 2023 Apr;32(4):619-633. doi: 10.1007/s00787-022-02100-8. Epub 2022 Nov 22. PMID: 36412852. PMCID: PMC10057049.
Q.
Biopsy Anxiety? Why Your Tissue is Analyzed + Medical Next Steps
A.
Biopsy results explained: your tissue is analyzed by a pathologist to determine if it is normal, benign, precancerous, or malignant and to check for infection or inflammation, which then guides next steps such as monitoring, additional tests, or treatments like surgery, radiation, chemotherapy, targeted therapy, or immunotherapy. There are several factors to consider, including that many biopsies are benign and accurate, and that procedure type, sample adequacy, risks, aftercare, urgent symptoms, anxiety while waiting, and when to seek a second opinion can change your plan; see below for the complete details that can shape your personal next steps.
References:
* Ghaemmaghami F, Batey J, Scurrah K, et al. Psychological impact of breast biopsy: a systematic review. *Breast*. 2018 Jun;39:99-106. doi: 10.1016/j.breast.2018.04.004. Epub 2018 Apr 28. PMID: 29775086.
* Schaffer S, Williams CD, Murchie P, et al. Understanding Pathology Reports: A Scoping Review of Patient Resources and Preferences. *J Cancer Educ*. 2021 Oct;36(5):959-968. doi: 10.1007/s13187-020-01828-5. Epub 2020 Jul 16. PMID: 32675918.
* Pfeifer JD, Duncavage EJ. The role of pathology in precision medicine. *J Clin Invest*. 2019 May 1;129(5):1848-1857. doi: 10.1172/JCI126131. Epub 2019 May 1. PMID: 31041999.
* Balis UJ, Dintzis SM, Miller RT. Role of the pathologist in the multidisciplinary care of cancer patients. *Arch Pathol Lab Med*. 2016 Apr;140(4):307-16. doi: 10.5858/arpa.2015-0588-RA. PMID: 26979603.
* Elmore JG, Carney PA, Smith ML, et al. Communicating cancer pathology reports to patients. *JAMA Oncol*. 2018 May 1;4(5):603-604. doi: 10.1001/jamaoncol.2017.5135. PMID: 29555673.
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.
Q.
Can’t Stop Worrying? Why Your Brain Stays Anxious & Medical Next Steps
A.
Your brain’s threat system can get stuck on high alert, driving persistent worry from chronic stress, trauma, poor sleep, stimulants, genetics, or medical issues, and it may be an anxiety disorder when it is hard to control or disrupts daily life. There are several factors to consider; evidence-based next steps include calming techniques, better sleep, reducing stimulants, CBT, regular exercise, and sometimes medication, plus ruling out medical mimics and seeking urgent care for red flags like chest pain, fainting, severe shortness of breath, or an irregular racing heartbeat. See below for complete guidance and practical steps that can shape your next move with your clinician.
References:
* Craske, M. G., & Stein, M. B. (2017). Anxiety. *The Lancet*, *389*(10078), 1735-1746.
* Adhikari, A., & LeDoux, J. E. (2020). The circuit basis of anxiety: beyond the amygdala. *Neuron*, *106*(1), 22-37.
* Ströhle, A., et al. (2018). The neurobiology of anxiety disorders: from mechanisms to new treatments. *Biological Psychiatry*, *84*(6), 406-415.
* Baldwin, D. S., & Nero, P. A. (2022). Pharmacological management of anxiety disorders: from evidence to clinical practice. *Therapeutic Advances in Psychopharmacology*, *12*, 20451253221087859.
* Lavebratt, C., & Jansson, L. (2020). Biomarkers in anxiety disorders: a review of the literature. *International Journal of Molecular Sciences*, *21*(9), 3241.
Q.
Constant Sickness? Munchausen Syndrome & Medically Approved Next Steps
A.
Feeling constantly sick can have many causes, and while factitious disorder imposed on self (Munchausen syndrome) is rare, it warrants careful medical and psychological evaluation; effective care focuses on psychotherapy, treating coexisting conditions, and coordinated primary care. There are several factors to consider, including ruling out hard-to-diagnose physical illnesses, addressing anxiety, and knowing when to seek urgent care; for medically approved, step-by-step next actions such as what to bring to your visit, how to avoid doctor shopping, and a free anxiety symptom check, see below.
References:
* Moeti, R. M., & Booysen, L. E. (2023). Factitious Disorder Imposed on Self (Munchausen's Syndrome): A Systematic Review of Current Diagnostic Criteria, Management, and Treatment. *Cureus, 15*(12), e49767.
* Krahn, L. E., & Kelly, M. J. (2020). Factitious Disorder Imposed on Self: A Review of Clinical Aspects and Management. *Psychosomatics, 61*(1), 1–9.
* Karki, S., Poudel, A., Sharma, R., Thapaliya, P., Subedi, R., & Panta, R. (2023). Factitious disorder: An updated review. *Annals of Medicine and Surgery (2012), 85*(12), 6296–6301.
* Balakrishnan, D., & Pillai, A. (2020). Munchausen syndrome: from diagnosis to treatment. *Postgraduate Medical Journal, 96*(1141), 693–699.
* Lillie, J., & Patel, K. (2023). The Management of Factitious Disorder Imposed on Self (Munchausen Syndrome) and Factitious Disorder Imposed on Another (Munchausen Syndrome by Proxy). In *StatPearls*. StatPearls Publishing.
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.
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.
Q.
Still Stressed? The Science of CBD Gummies + Medically Approved Next Steps
A.
CBD gummies for stress can help some people feel calmer by acting on the endocannabinoid system, but evidence for store bought products is limited and research doses are often much higher, so they are not a first line treatment for anxiety. There are several safety and next step factors to consider, including drug interactions, product quality, and when to choose proven options like CBT, prescription medicines, and lifestyle changes. See the complete guidance below, including a step by step plan, urgent red flags, and tools to help you decide your best next move.
References:
* Linares IM, Guimaraes FS, Eckert C, Queiroz R, Crippa JA. Cannabidiol (CBD) in the treatment of anxiety disorders: A systematic review. J Affect Disord. 2020 Feb 1;262:76-83.
* Shannon S, Opila-Lehman J. Effectiveness of Cannabidiol Oil for Symptomatic Relief of Anxiety and Insomnia. Perm J. 2019;23:18-041.
* Silveira G, Zanin F, Resstel LBM, Guimarães FS, Joca SRL. Cannabidiol and its neuroprotective effects in psychiatric disorders. Braz J Psychiatry. 2022 Sep-Oct;44(5):455-460.
* Iffland K, Grotenhermen F. An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis Cannabinoid Res. 2017 Jun 1;2(1):139-158.
* Kaplan BL, Springs SL, Kaminski AE, Chen K, Limoncelli WA, Grzybowski MW, Jukic MA, Lydon LM, Darracott AL, Gentry RL, King BM, De Vivo MJ. A Pilot Study of Cannabidiol in the Treatment of Anxiety in Healthy Volunteers. J Diet Suppl. 2023;20(2):167-177.
Q.
Stuck in a Loop? Why Your Brain Spirals and Medically Approved CBT Next Steps
A.
There are several factors to consider: thought loops are often driven by the brain's threat system and learned distortions, commonly seen in anxiety and depression, and CBT offers evidence-based skills to interrupt and retrain these patterns. See below for step-by-step CBT methods you can try today, guidance on working with a therapist, red flags that need urgent medical care, and other key details that may change which next steps are right for you.
References:
* Nolen-Hoeksema, S. (2000). Rumination: a common mechanism in the comorbidity of depression and anxiety. *Annual Review of Psychology*, *51*(1), 109-131.
* Hamilton, J. P., et al. (2015). Neural correlates of rumination in major depressive disorder: A systematic review and meta-analysis. *Biological Psychiatry*, *78*(10), 735-745.
* Watkins, E. R., & Nolen-Hoeksema, S. (2014). Cognitive behavioral therapy for rumination: a systematic review and meta-analysis. *Journal of Consulting and Clinical Psychology*, *82*(3), 379-391.
* Spinhoven, P., et al. (2018). Neural mechanisms of repetitive negative thinking and its treatment with cognitive behavioral therapy: a systematic review. *Neuroscience & Biobehavioral Reviews*, *90*, 245-256.
* Segal, Z. V., et al. (2018). Mindfulness-based cognitive therapy for rumination in depression: A review and meta-analysis. *Clinical Psychology Review*, *59*, 270-281.
Q.
Always Stressed? Why Your Body Is Stuck in Survival Mode & Medical Steps to Lower Cortisol
A.
Chronic stress can trap your body in survival mode by keeping cortisol high, disrupting sleep, mood, weight, blood pressure, and immunity. Medically supported ways to lower it include improving sleep, daily breathing or mindfulness, moderate exercise with recovery, balanced meals to steady blood sugar, reducing caffeine and alcohol, addressing anxiety or trauma, and seeking evaluation for conditions like thyroid disease or Cushing’s when warning signs appear. There are several factors to consider. See below for step-by-step guidance, supplement cautions, red flags that need urgent care, and when to get testing, all of which can change your next healthcare steps.
References:
* Tsigos C, Chrousos GP. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res. 2016 Oct;89:39-44. doi: 10.1016/j.jpsychores.2016.08.019. Epub 2016 Aug 24. PMID: 27586273.
* McEwen BS. Allostatic load: When stress gets under the skin. J Psychosom Res. 2016 Oct;89:45-7. doi: 10.1016/j.jpsychores.2016.03.011. Epub 2016 Mar 17. PMID: 27586272.
* Dhabhar FS. A physiologically-based, scientifically-informed, and clinically-relevant overview of stress, stress-responses, and stress-related disorders. Stress. 2021 Jan;24(1):1-20. doi: 10.1080/10253890.2020.1837011. Epub 2020 Oct 30. PMID: 33131758; PMCID: PMC7876115.
* Staufenbiel SM, Penninx BWJH, De Rijk RH, Van Marwijk HWJ, Bosch JA, Vreeburg SA. A comprehensive review of the beneficial effects of different types of physical activity on mood, cognitive functions, and the HPA axis. Ment Health Phys Act. 2018 Sep;15:10-21. doi: 10.1016/j.mhpa.2018.06.002. Epub 2018 Jun 20. PMID: 30678279; PMCID: PMC6340654.
* Ratan Z. Effects of stress management interventions on salivary cortisol and alpha-amylase: A systematic review and meta-analysis. Front Psychol. 2022 Sep 27;13:968936. doi: 10.3389/fpsyg.2022.968936. PMID: 36262450; PMCID: PMC9553195.
Q.
Always Stressed? Why Your Type A Personality Risks Health & Medically Approved Next Steps
A.
Type A traits like drive, competitiveness, impatience, and time urgency can lock your body in high stress, elevating risks of high blood pressure and heart disease, anxiety and burnout, sleep disruption, weakened immunity, and digestive problems; there are several factors to consider, and the details below explain why hostility and chronic stress reactivity matter most. Medically approved next steps include scheduling recovery, exercising without overdoing it, protecting sleep, building emotional awareness, monitoring key metrics, and seeking prompt care for red flags such as chest pain, shortness of breath, severe anxiety, or ongoing insomnia, with additional nuances that could change your next steps outlined below.
References:
* Petticrew M, Lee K, Davey Smith G. Type A behaviour pattern, hostility and coronary heart disease: an updated review. J R Soc Med. 2008 Feb;101(2):77-83. doi: 10.1258/jrsm.2008.080007. PMID: 18245582; PMCID: PMC2246294.
* Suls J, Bunde J. Meta-analysis of hostility reduction in the treatment of coronary heart disease. Psychosom Med. 2005 Sep-Oct;67(5):669-76. doi: 10.1097/01.psy.0000174092.42845.a2. PMID: 16204423.
* Rutledge T, Reis VA, Hogan J, Groessl EJ, Linke S. Psychological interventions for coronary heart disease: A systematic review and meta-analysis. J Consult Clin Psychol. 2011 Apr;79(2):137-52. doi: 10.1037/a0022015. PMID: 21443313.
* Pal GK, Pal P, Nanda N, Lal V, Modi M, Singh S, Singh A. Association of stress and personality with cardiovascular disease: A systematic review. Indian Heart J. 2016 Jan-Feb;68(1):31-7. doi: 10.1016/j.ihj.2015.08.016. Epub 2015 Oct 13. PMID: 26898863; PMCID: PMC4769082.
* Khaleghparast-Ashtiani T. The Type A Personality: A Psychological Construction. Health Psychol Res. 2021 Mar 19;9(1):24784. doi: 10.5204/hpr.v9i1.24784. PMID: 33824968; PMCID: PMC7986845.
Q.
Feeling Lost? Why a Psychiatrist Near You is Your Medically Approved Next Step
A.
Seeing a psychiatrist near you is a medically approved next step when you feel overwhelmed or not like yourself, because psychiatrists are physicians who can assess the whole picture, rule out medical causes, make an accurate diagnosis, and deliver evidence-based care with safe medication management. There are several factors to consider, including urgent warning signs, how to choose the right clinician, what to expect at the first visit, and medication options. See the complete guidance below to decide your best next steps.
References:
* Zafar, F., Ahmed, K., Khan, M. F., Khawaja, S., & Naqvi, M. S. (2023). Efficacy of psychotherapeutic and psychopharmacological interventions in mental disorders: A systematic review and meta-analysis. *Frontiers in Psychiatry, 14*, 1184649. [PMID: 37492161].
* Rössler, W. (2017). Psychiatric treatment and its outcomes: A review of recent advances. *World Journal of Psychiatry, 7*(1), 1–10. [PMID: 28442907].
* Cuijpers, P., Reijnders, M., & Huibers, M. J. H. (2016). The effectiveness of psychological treatments for mental health disorders: A systematic review of reviews. *Clinical Psychology Review, 47*, 189–203. [PMID: 27450917].
* Kessler, R. C., Merikangas, K. R., & Wang, P. S. (2019). The burden of mental disorders: A review of global epidemiological data. *European Archives of Psychiatry and Clinical Neuroscience, 269*(2), 209–224. [PMID: 30456100].
* Sunderajan, P., & Unützer, J. (2019). Psychiatry's Role in Integrating Mental Health and General Medical Care. *Psychiatric Clinics of North America, 42*(3), 475–483. [PMID: 31395213].
Q.
Is it Anxiety? Why Your Brain is Stuck on High Alert & Medical Steps for Anxiety Disorder
A.
There are several factors to consider: feeling stuck on high alert with racing thoughts, chest tightness, poor sleep, and constant worry can signal an anxiety disorder, where the brain’s fight or flight alarm becomes overactive and hard to shut off. Medical evaluation matters because thyroid disease, heart rhythm problems, medication effects, and other conditions can mimic or worsen anxiety, and effective care often involves CBT, possible SSRIs or SNRIs, and targeted lifestyle changes. See below for complete guidance on what to do next, including when to seek urgent care and how to work with a clinician on a safe, stepwise plan.
References:
* Adamo, E. M., et al. (2022). The neurobiology of anxiety disorders: A focus on brain circuits, genetics, and epigenetics. *Frontiers in Neuroscience*, 16, 959300. PMID: 36045864. DOI: 10.3389/fnins.2022.959300
* Maron, A., et al. (2021). Treatment guidelines for anxiety disorders: current recommendations and recent developments. *Current Opinion in Psychiatry*, 34(6), 488-494. PMID: 34334693. DOI: 10.1097/YCO.0000000000000720
* Stein, C. P. B., et al. (2023). Anxiety Disorders: A Review of Epidemiology, Pathophysiology, and Treatment. *Psychiatric Clinics of North America*, 46(2), 269-286. PMID: 37217316. DOI: 10.1016/j.psc.2023.02.002
* O'Dowd, S. A. G., et al. (2021). Neurobiological circuits and mechanisms of anxiety disorders: a translational perspective. *Translational Psychiatry*, 11(1), 173. PMID: 33712530. DOI: 10.1038/s41398-021-01297-y
* Pommier, M. E. R., et al. (2021). Combined pharmacotherapy and psychotherapy for anxiety disorders: A systematic review and meta-analysis. *Journal of Affective Disorders*, 294, 693-703. PMID: 34474377. DOI: 10.1016/j.jad.2021.07.034
Q.
Is it Aspergers? Why Your Brain Feels Different & Medical Next Steps
A.
There are several factors to consider; what many call Aspergers is now diagnosed as Autism Spectrum Disorder, marked by lifelong social communication differences, intense interests, and sensory sensitivities, but overlapping conditions like anxiety, ADHD, OCD, depression, or trauma can look similar. See below for the complete guidance on how diagnosis works in teens and adults, strengths to leverage, when to seek urgent care, and concrete next steps like documenting symptoms, talking with a primary care clinician, getting referrals, therapy options, and school or workplace supports, with more important details that could impact which path you take.
References:
* Lundström, S., et al. "Autism spectrum disorder (ASD) in adults: diagnosis, differential diagnoses, and common comorbidities." European Archives of Psychiatry and Clinical Neuroscience, 2020; 270(1): 1-13.
* Varghese, M., et al. "The Neurodevelopmental Basis of Autism Spectrum Disorders: Bridging the Gap Between Genes and Brain." Biological Psychiatry, 2020; 87(4): 308-316.
* Happé, F., et al. "Understanding autism: Recent advances." The Lancet, 2017; 390(10089): 81-92.
* Cai, R. Y., et al. "Interventions for adults with autism spectrum disorder: a meta-analysis and systematic review." Journal of Autism and Developmental Disorders, 2018; 48(9): 3137-3151.
* Dixon, C. C., et al. "Late diagnosis of autism spectrum disorder in adults: The challenges of coping, feeling understood, and finding the right support." Journal of Intellectual Disability Research, 2021; 65(9): 744-754.
Q.
Racing Thoughts? Why Your Brain Is Overactive: GABA & Medical Next Steps
A.
Racing thoughts often reflect an overactive brain linked to low or disrupted GABA, the brain’s calming brake, and can be driven by anxiety, chronic stress, poor sleep, hormonal shifts, stimulants, or mood disorders. There are several factors to consider; see below for red flags, the mixed evidence on GABA supplements, and which lifestyle steps, CBT, and prescriptions that act on GABA may help. For next steps, optimize sleep, exercise, slow breathing, and cut stimulants, and see a clinician if symptoms disrupt life, occur with mood swings or impulsivity, or include suicidal thoughts, since evaluation for anxiety, bipolar disorder, thyroid issues, medication effects, or substances can change treatment; complete guidance is below.
References:
* Owji SM, Ebrahimi H. A review of the role of GABA in the pathophysiology of anxiety disorders and the clinical efficacy of GABAergic agents. Braz J Pharm Sci. 2022 Dec 22;58:e210138. doi: 10.1590/s2175-97902022e210138. PMID: 36557688.
* LeGates TA, Kvarta MD, Thompson SM. The role of GABAergic dysfunction in the pathophysiology of anxiety disorders. Psychopharmacology (Berl). 2019 Mar;236(3):813-827. doi: 10.1007/s00213-019-05202-z. Epub 2019 Jan 23. PMID: 30671607.
* Maras PM, Baccini M, Raddi M, Chiti L, Ricca V. The neurobiology of anxiety disorders: A review. J Psychiatr Res. 2023 Jan;157:245-257. doi: 10.1016/j.jpsychires.2022.10.043. Epub 2022 Oct 26. PMID: 36262497.
* Ma Q, Yu Y, Liu X, Yang X. The Involvement of the GABAergic System in the Pathophysiology and Treatment of Anxiety Disorders. Front Pharmacol. 2022 Jul 18;13:948924. doi: 10.3389/fphar.2022.948924. PMID: 35928646; PMCID: PMC9339947.
* Kim J, D'Aquino R, Kim D, Lee H. Neural circuits underlying anxiety-related behaviors. Exp Neurobiol. 2021 Jun;30(3):149-161. doi: 10.5607/en.2021.30.3.149. Epub 2021 Jun 22. PMID: 34298132; PMCID: PMC8290520.
Q.
Sativa Causing Anxiety? Why Your Brain Reacts & Medically-Approved Next Steps
A.
Sativa can trigger anxiety because THC overstimulates CB1 receptors and your stress response, a risk that rises with higher potency, personal anxiety history, poor sleep, or caffeine, leading to a racing heart, spiraling thoughts, or panic that usually passes within hours. Medically approved steps include lowering THC, choosing CBD balanced or high CBD products, avoiding use during high stress, using calming breathing and hydration, and stopping if episodes recur, with urgent care for chest pain, severe confusion, hallucinations, or self-harm thoughts. There are several factors to consider; see the complete guidance below to understand what applies to you and which next steps to take.
References:
* Marzo, V. D., & Morello, G. (2020). Cannabinoids and Anxiety. *Current Neuropharmacology*, *18*(7), 643-653. [PMID: 32620311]
* Linhart, R. P., Zvolensky, M. J., Buckner, J. D., & Vujanovic, A. A. (2019). Acute effects of cannabis on anxiety in a clinical sample of cannabis users. *Experimental and Clinical Psychopharmacology*, *27*(1), 16-23. [PMID: 30656002]
* Crippa, J. A. S., Guimarães, F. S., Campos, A. C., & Zuardi, A. W. (2018). Translational Investigation of the Therapeutic Potential of Cannabidiol (CBD): Toward a New Class of Anxiolytic Drugs. *Current Neuropharmacology*, *16*(2), 204-215. [PMID: 29019808]
* Van der Merwe, L. J., & van der Merwe, L. J. (2018). Cannabis use and anxiety disorders: a systematic review. *South African Journal of Psychiatry*, *24*, 1162. [PMID: 29994628]
* Moreno-Sanz, G. (2021). The endocannabinoid system and anxiety: what has been learned from pharmacological and genetic studies. *British Journal of Pharmacology*, *178*(15), 3043-3062. [PMID: 33749870]
Q.
Always Anxious? Why Your Brain Overproduces Norepinephrine + Medical Next Steps
A.
There are several factors to consider, and important details that could change your next steps are outlined below: feeling constantly on edge often means your brain is overproducing norepinephrine that locks you in fight or flight, usually from chronic stress, anxiety disorders, poor sleep, or stimulants, and less often from conditions like hyperthyroidism, severe sleep apnea, or pheochromocytoma. Medical next steps include a clinician review of medications, caffeine and sleep, checking blood pressure and thyroid, and treatments such as CBT, SSRIs or SNRIs, beta blockers, sleep optimization, and cutting stimulants, with urgent care if you have chest pain, fainting, severe shortness of breath, new or worsening high blood pressure, severe headaches, or an irregular heartbeat.
References:
* Correll CM, Anticevic A, Correll CU. The Locus Coeruleus-Norepinephrine System in Stress and Anxiety. Biol Psychiatry. 2018 Sep 15;84(6):e37-e39. doi: 10.1016/j.biopsych.2018.06.002. Epub 2018 Jul 11. PMID: 30040713.
* Murchison CF, Correll CM, Correll CU. Norepinephrine: A Key Neuromodulator in Stress, Anxiety, and Fear. Biol Psychiatry. 2022 Aug 1;92(3):149-151. doi: 10.1016/j.biopsych.2022.05.004. Epub 2022 May 11. PMID: 35921609.
* Brunel JM, D'Aquila P, Boumediene F, Muresan XL, Acher L, Kassis N. Adrenergic Receptors and Psychiatric Disorders. Molecules. 2021 Jun 25;26(13):3882. doi: 10.3390/molecules26133882. PMID: 34208451; PMCID: PMC8298711.
* Del-Valle-Torres ML, Antón-Aguirre D, Caba M, Méndez-Díaz M, Ruíz-Velasco B, Morán J. The Locus Coeruleus-Norepinephrine System in Stress and Anxiety: New Insights into Therapeutic Approaches. Int J Mol Sci. 2024 Jan 26;25(3):1458. doi: 10.3390/ijms25031458. PMID: 38317765; PMCID: PMC10856003.
* Marinho T, Pompili M, Moustafa A, Tofoli SM, Gouveia S, Quevedo J. Pharmacotherapy for Anxiety Disorders: A Comprehensive Review. J Clin Med. 2023 Feb 15;12(4):1588. doi: 10.3390/jcm12041588. PMID: 36836791; PMCID: PMC9959546.
Q.
Always Stressed? Why Your Body Won’t Reset & Medically Approved Next Steps
A.
Persistent stress happens when your body's alarm system does not reset because of ongoing pressures, poor sleep, stimulants, unresolved trauma, or medical issues, which can disrupt mood, sleep, digestion, immunity, and heart health. There are several factors to consider; evidence based next steps include a medical checkup and anxiety screening, improving sleep, slow breathing with longer exhales, daily movement, limiting caffeine and digital overload, and therapy, with urgent care for chest pain, shortness of breath, fainting, severe headache, or thoughts of self harm; see below for details that can guide the safest next step for you.
References:
* Mariotti A. The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication. Future Sci OA. 2015 Nov 1;1(3):FSO5. doi: 10.4155/fso.15.21. PMID: 28031802; PMCID: PMC5137920.
* Sterling P. Allostasis: a model of predictive regulation. Physiol Behav. 2012 Aug 1;106(5):5-14. doi: 10.1016/j.physbeh.2011.10.004. Epub 2011 Oct 14. PMID: 22008851.
* Slavich GM, Sacher J, Zoccola PM. The social environment and its impact on the stress response, mental health, and physical health: an integrative review. Compr Psychoneuroendocrinol. 2023 Feb;13:100147. doi: 10.1016/j.cpnec.2023.100147. Epub 2023 Feb 23. PMID: 36875931; PMCID: PMC9983949.
* Goyal M, Singh S, Sibinga EM, Gould NF, Rowland-Seymour A, Sharma R, Olansen Z, Galantino L, Gross CR, Haythornthwaite N, Spangler N, Schiepers J, Park HS, Busse JW, Tobian LA, Ziegler-Graham J, Speck RM, Ranasinghe PD, Mayo-Wilson A, Treisman SL, Free C, Sinha S, Haythornthwaite JA, Fitzgerald ML, Burish MJ, Paquin C, Sugarman J, Vostal A. Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis. JAMA Intern Med. 2014 Mar;174(3):357-68. doi: 10.1001/jamainternmed.2013.13018. PMID: 24395196; PMCID: PMC4142584.
* Sutanto A, Yudiarso A. The effectiveness of stress management interventions on physiological responses: A meta-analysis. Int J Nurs Pract. 2023 Oct 12. doi: 10.1111/ijn.13197. Epub ahead of print. PMID: 37827845.
Q.
Am I Autistic? Why Your Brain Is Different + Medically Approved Steps
A.
There are several factors to consider: autism is a neurodevelopmental difference, not a disease, with signs like social communication differences, sensory sensitivities, strong routines, and focused interests, largely shaped by genetics, bringing both strengths and challenges, and diagnosed through developmental history and assessments rather than a lab test; anxiety can overlap and some people mask traits. For medically supported next steps, see below, including tracking your experiences, seeking a professional evaluation, considering CBT, occupational and speech therapies, making sensory-friendly adjustments, learning about autistic burnout, and knowing urgent warning signs, with important details below that can guide which steps to take in your healthcare journey.
References:
* Sasaki Y, Kono M, Koyama T. Diagnostic Challenges of Autism Spectrum Disorder in Adulthood: A Systematic Review. J Autism Dev Disord. 2023 Feb 10. doi: 10.1007/s10803-023-05838-w. PMID: 36774438.
* Luo Y, Li D, Song J, Wu W, Zhang W, Jiang M, Liu K. Neuroimaging of Autism Spectrum Disorder: A Review of Structural, Functional, and Connectomic Alterations. Brain Sci. 2023 Sep 14;13(9):1321. doi: 10.3390/brainsci13091321. PMID: 37731778.
* Barton CW, Gurnell L, Davies EL, O'Callaghan F. Autism spectrum disorder in adults: a guide for the primary care physician. BMJ. 2022 Aug 2;378:e070868. doi: 10.1136/bmj-2022-070868. PMID: 35914652.
* Spain D, Rumball F, Happé F. Evidence-based interventions for adults with autism spectrum disorder: a narrative review. Curr Opin Psychiatry. 2023 Jul 1;36(4):255-264. doi: 10.1097/YCO.0000000000000874. PMID: 37240375.
* Botha M, Dibb B, Smith J. The neurodiversity concept and autism spectrum disorder: challenges and opportunities. Curr Opin Psychiatry. 2023 Jul 1;36(4):272-278. doi: 10.1097/YCO.0000000000000876. PMID: 37255167.
Q.
Anxious? Why Chamomile Calms Your Nerves + Medically Approved Next Steps
A.
Chamomile can gently ease mild anxiety and sleep troubles through apigenin’s action on GABA receptors, and it is generally safe as tea or standardized extract, but it is not a cure-all or a replacement for care when symptoms are moderate or severe. There are several factors to consider, including who should avoid it, safe dosing, and when to move to proven care like CBT, SSRIs or SNRIs, lifestyle changes, and urgent evaluation for red flag symptoms; see the complete guidance below for important details that could affect your next steps.
References:
* Srivastava JK, Shankar E, Gupta S. Chamomile: A herbal medicine of the past with bright future. Mol Med Rep. 2010 Nov-Dec;3(6):895-901. doi: 10.3892/mmr.2010.377. Epub 2010 Oct 14. PMID: 20427929; PMCID: PMC2995283.
* Amsterdam JD, Shamon SD, Newberg B, Myles A, Mao JJ. A Systematic Review and Meta-Analysis of Randomized Controlled Trials on the Efficacy of Chamomile (Matricaria recutita) for Anxiety Disorders. J Clin Psychopharmacol. 2021 May-Jun 01;41(3):360-367. doi: 10.1097/JCP.0000000000001404. PMID: 33945892.
* Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J. A randomized, double-blind, placebo-controlled trial of oral chamomile extract for generalized anxiety disorder. J Clin Psychopharmacol. 2009 Aug;29(4):378-82. doi: 10.1097/JCP.0b013e3181af563b. PMID: 19593179; PMCID: PMC2724652.
* Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J. Chamomile (Matricaria recutita) May Have Antidepressant Effects in the Treatment of Comorbid Anxiety and Depression. J Altern Complement Med. 2012 Aug;18(8):754-60. doi: 10.1089/acm.2012.0042. Epub 2012 Jul 12. PMID: 22566468; PMCID: PMC3388726.
* Miraj S, Parvez N, Kiani S. Anxiolytic and hypnotic activities of compounds from chamomile: An update. Electron Physician. 2016 Apr 25;8(4):2303-7. doi: 10.19082/2303. PMID: 27179007; PMCID: PMC4869151.
Q.
Is it Asperger Syndrome? Why Your Brain Is Different & Medical Next Steps
A.
There are several factors to consider if your brain feels different in social communication, sensory processing, need for routine, and deep interests; what many call Asperger syndrome is now part of Autism Spectrum Disorder and is identified through history and standardized clinical assessment, not lab tests. See below for specific signs, how to tell overlapping issues like anxiety or ADHD apart, step by step medical next steps from primary care referral to comprehensive evaluation and supports, what treatments can and cannot do, strengths to build on, and red flags that need urgent care.
References:
* Verheij F, de Nijs PF. Asperger syndrome: The history of a diagnosis. Eur Child Adolesc Psychiatry. 2018 Apr;27(4):423-431. doi: 10.1007/s00787-017-1099-x. PMID: 29665671.
* Lord C, Elsabbagh M, Charman G, Gotham K. The Neurobiology of Autism Spectrum Disorder. Annu Rev Psychol. 2020 Jan 4;71:81-104. doi: 10.1146/annurev-psych-010419-050722. PMID: 31548805.
* D'Amelio M, Ricceri L, Laviola G, Gulisano M. Autism Spectrum Disorder: An Overview of Neurobiological Bases and Clinical Perspectives. Genes (Basel). 2022 Jan 28;13(2):266. doi: 10.3390/genes13020266. PMID: 35149360.
* Hyman SL, Levy SE, Myers SM; COUNCIL ON CHILDREN WITH DISABILITIES, SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS. Clinical practice guideline for the assessment and diagnosis of autism spectrum disorder. Pediatrics. 2020 Jan;145(1):e20193448. doi: 10.1542/peds.2019-3448. PMID: 31843812.
* Kerns CM, Wood JJ, Wolk CB, Alexis DM. Interventions for Autism Spectrum Disorder: A Review of Research and Implications for Practice. J Autism Dev Disord. 2020 Jul;50(7):2313-2331. doi: 10.1007/s10803-020-04423-6. PMID: 32179979.
Q.
Is It Munchausen Syndrome? Why Your Brain Mimics Illness and Medically Approved Steps
A.
There are several factors to consider; Munchausen syndrome is a rare factitious disorder involving intentional symptom fabrication without external gain, while many people’s very real symptoms are caused by stress, anxiety, or trauma rather than deception. Start with a medical evaluation, then consider mental health care such as CBT and, if appropriate, medication; key red flags, how to tell this from health anxiety, and step by step next actions that could change your care plan are detailed below.
References:
* Block, C. B., & Zaidi, S. F. (2019). Factitious disorder: A review of the literature. *Journal of Psychosomatic Research, 124*, 109741. doi: 10.1016/j.jpsychores.2019.109741
* Moens, M., Moens, G. F., & Van Hoof, E. (2019). Factitious Disorder: An Updated Review. *Current Psychiatry Reports, 21*(11), 114. doi: 10.1007/s11920-019-1099-0
* Sharpe, M., & Carson, A. J. (2017). Somatic symptom disorder and related disorders: current concepts and future directions. *World Psychiatry, 16*(1), 100-101. doi: 10.1002/wps.20397
* Hallett, M., Stone, J., & Carson, A. (2020). Functional neurological disorder: recognition and treatment. *Journal of Neurology, Neurosurgery & Psychiatry, 91*(5), 450-459. doi: 10.1136/jnnp-2019-322394
* Kötter, T., Dambacher, M., Szabo, K., & Linde, K. (2017). Psychological treatments for medically unexplained symptoms: a systematic review and meta-analysis. *Psychological Medicine, 47*(2), 272-290. doi: 10.1017/S003329171600188X
Q.
Is it Narcissistic? The Clinical Reality of NPD and Your Medically-Approved Next Steps
A.
There are several factors to consider: everyday narcissistic traits are common, while Narcissistic Personality Disorder is a diagnosable, treatable condition defined by persistent, impairing patterns across settings beginning in early adulthood and best confirmed by a licensed clinician. Next steps can include reflecting without panic, assessing impact, screening for related issues, seeking professional evaluation and therapy, setting boundaries, and prioritizing safety with urgent care for threats or abuse; see the full guidance below, as important nuances there can affect which actions are right for you.
References:
* Ronningstam E. Narcissistic personality disorder: A current review. J Pers Disord. 2018;32(Suppl 1):71-84. doi:10.1521/pedi.2018.32.suppl.71. PMID:29927376.
* Caligor E, Kernberg OF, Yeomans FE. Current Perspectives on the Treatment of Narcissistic Personality Disorder. Psychiatr Clin North Am. 2015 Dec;38(4):755-61. doi:10.1016/j.psc.2015.07.002. PMID:26600458.
* Miller JD, Lynam DR, Widiger TA, et al. Conceptualization and Assessment of Narcissistic Personality Disorder: A Review of Key Issues. Curr Psychiatry Rep. 2017;19(5):29. doi:10.1007/s11920-017-0780-y. PMID:28439975.
* Kealy D, Ogrodniczuk JS. Pathological Narcissism: A Review of Clinical and Empirical Research. Curr Psychiatry Rep. 2019;21(3):14. doi:10.1007/s11920-019-1002-3. PMID:30739097.
* Pincus AL, Cain NM, Wright AGC. Narcissistic personality disorder: A conceptual framework and research agenda. J Pers Disord. 2014;28(Suppl):S6-S26. doi:10.1521/pedi.2014.28.sp.6. PMID:24810051.
Q.
Mind racing? Why your brain needs CBT + Medically approved next steps
A.
CBT is a first-line, evidence-based way to calm a racing mind by retraining the thoughts–emotions–behaviors loop that keeps anxiety going, not by forcing positive thinking. There are several factors to consider; see below to understand more. Medically approved next steps include tracking triggers, starting a structured CBT program in person or online, ruling out medical causes, improving sleep and caffeine habits, and discussing medication if needed, with urgent or severe symptoms requiring immediate care.
References:
* Roy-Byrne PP, Stang P, et al. Combined Pharmacotherapy and Cognitive Behavioral Therapy for Anxiety Disorders: What We Know and What We Need to Know. *J Clin Psychiatry*. 2019 Apr 30;80(3):null. PMID: 31050630.
* Slee A, Garrett A, et al. Pharmacological Treatment of Generalized Anxiety Disorder: A Systematic Review and Meta-analysis. *JAMA Psychiatry*. 2019 Jun 1;76(6):663-674. PMID: 31090875.
* Craske MG, Rauch SA, et al. Cognitive Behavioral Therapy for Anxiety Disorders: A Comprehensive Review. *Harv Rev Psychiatry*. 2020 Mar/Apr;28(2):98-109. PMID: 32267860.
* Kim JH, Han D. Neurobiology of Anxiety Disorders: A Review. *Curr Psychiatry Rep*. 2021 Sep 10;23(10):68. PMID: 34508492.
* Bandelow B, Chokka P, et al. Managing generalized anxiety disorder: evidence-based recommendations for diagnosis and treatment. *F1000Res*. 2022 Dec 19;11:1477. PMID: 36568285.
Q.
Anxiety? Why Your Brain Is on Edge & Medically-Approved Next Steps
A.
Feeling on edge often means your brain’s alarm system is stuck on, with amygdala overactivity, stress hormones, and neurotransmitter shifts driving persistent worry, physical symptoms, and sleep trouble; there are several factors to consider, including different anxiety disorders and medical conditions that can mimic them, so see the important details below. Medically approved next steps include starting with a symptom check, speaking with a clinician, using evidence-based therapy like CBT, considering medication when appropriate, and making targeted lifestyle changes, with emergency care for chest pain, severe shortness of breath, fainting, or self-harm thoughts, and the complete guidance is outlined below.
References:
* Maron, E., & Lichtenstein, P. (2018). Neurobiology of Anxiety Disorders: A Review. *Current Psychiatry Reports*, *20*(12), 105.
* Bandelow, B., Michaelis, S., & Wedekind, D. (2020). Pharmacological Treatment of Anxiety Disorders: A Comprehensive Review. *Dialogues in Clinical Neuroscience*, *22*(2), 147–156.
* Garakani, A., Grakani, N., & Vahia, I. V. (2022). Neurobiological Effects of Cognitive Behavioral Therapy in Anxiety Disorders: A Systematic Review. *Psychiatry Investigation*, *19*(10), 756–768.
* Toth, M., & Tsetsenis, T. (2023). Neural circuits of fear and anxiety. *Current Opinion in Neurobiology*, *80*, 102693.
* Küçük, B., Akkaya-Kalaycı, T., & Öztürk, O. (2021). Nonpharmacologic treatment of anxiety disorders: A critical review. *The Turkish Journal of Psychiatry*, *32*(4), 273–282.
Q.
Anxious and Confused? How Diazepam Works and Your Medically Approved Next Steps
A.
Diazepam is a fast-acting benzodiazepine that enhances GABA to quickly calm overactive brain activity for short-term relief of severe anxiety, muscle spasms, seizures, or alcohol withdrawal, but it is not a first-line long-term solution and carries dependence and safety risks, especially with alcohol or opioids, so it must be taken exactly as prescribed and never stopped abruptly. For medically approved next steps, talk with a clinician about whether short-term diazepam is right for you versus longer-term options like CBT or SSRIs, how to monitor side effects and avoid interactions, and which red flags require urgent care; there are several factors to consider, so see the complete guidance below.
References:
* Sigel E, Ernst M. The Benzodiazepine Binding Site on GABAA Receptors: Mechanisms of Modulation and Modulation by Disease. Cold Spring Harb Perspect Biol. 2018 Jul 2;10(7):a031641. doi: 10.1101/cshperspect.a031641. PMID: 29599292; PMCID: PMC6027961.
* Bandelow B, Lichte C, Rudolf S, Wedekind D. The Benzodiazepines in Panic Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, and Posttraumatic Stress Disorder. CNS Neurosci Ther. 2019 Apr;25(4):428-435. doi: 10.1111/cns.13092. Epub 2018 Dec 20. PMID: 30575191; PMCID: PMC6432420.
* Kishi T, Ikuta T, Iwata N. Benzodiazepine use and risk of cognitive decline in the elderly: a systematic review and meta-analysis. Transl Psychiatry. 2018 May 1;8(1):99. doi: 10.1038/s41398-018-0150-z. PMID: 29712952; PMCID: PMC5928135.
* Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Coryell WH, denys D, Domschke K, Doward L, Fineberg N, Hautzinger M, Himmighoffen S, Holtz W, Kasper S, Kjaer T, Lader M, Llorca PM, Lépine JP, Madsen H, Marazziti D, Montgomery SA, Nardi AE, Norden M, Pallanti S, Pini S, Regin M, Rihmer M, Ropeter AM, Schulte-Herbrüggen R, Stein DJ, van Ameringen M, van der Heijde M, van Veen T, Versiani M, Vreeswijk R, Waite J, Wiegand R. Evidence-based pharmacological treatment of generalized anxiety disorder, panic disorder and social anxiety disorder: A revision of the GAD, PD and SAD sections of the WFSBP guidelines. World J Biol Psychiatry. 2019 Apr;20(3):286-308. doi: 10.1080/15622975.2018.1491295. Epub 2018 Jul 13. PMID: 30009581.
* Gommoll C, Kuhlman J, Johnson JK, O'Donnell JM. Discontinuation of long-term benzodiazepine use in older adults: a systematic review. J Am Geriatr Soc. 2021 Apr;69(4):1122-1132. doi: 10.1111/jgs.17006. Epub 2021 Feb 23. PMID: 33621376.
Q.
Buspirone Not Working? Why Your Brain Is Adjusting & Medical Next Steps
A.
There are several factors to consider. Buspirone works gradually, often starting to help at 2 to 4 weeks and reaching full effect by 6 to 8 weeks, and it may require a higher divided dose to be effective, with benefits that feel subtle rather than like a quick calm. If there is little improvement after 6 to 8 weeks or symptoms are severe, talk to your clinician about dose adjustments, switching or adding medications, adding CBT, and checking for other anxiety types or medical contributors; seek urgent care for dangerous symptoms, including suicidal thoughts. See the complete details below to guide your next steps.
References:
* Azizi-Rad M, Sadeghnia HR, Nazeri Z, Abdolmaleki H, Alijanpour A, Salari S. Buspirone: mechanisms of action and clinical implications. J Anxiety Disord. 2022 Dec;92:102640. doi: 10.1016/j.janxdis.2022.102640. Epub 2022 Oct 26. PMID: 36340268.
* Garakani A, Jaffe RJ, Singh A, et al. Buspirone for the treatment of generalized anxiety disorder: a narrative review. J Affect Disord. 2020 Jan 1;260:44-53. doi: 10.1016/j.jad.2019.08.067. Epub 2019 Aug 23. PMID: 31487661.
* Bandelow B, Chokka P, Montani A, et al. Augmentation strategies for generalized anxiety disorder. Front Psychiatry. 2020 Jul 22;11:713. doi: 10.3389/fpsyt.2020.00713. eCollection 2020. PMID: 32774163.
* Azizi-Rad M, Abdolmaleki H, Alijanpour A, Salari S. Current pharmacokinetic and pharmacodynamic profiles of buspirone for anxiety disorders. Expert Opin Drug Metab Toxicol. 2023 Apr;19(4):255-266. doi: 10.1080/17425255.2023.2201931. Epub 2023 Apr 14. PMID: 37042831.
* Cuijpers P, Noma H, Karyotaki E, et al. Pharmacological treatment of generalized anxiety disorder: a systematic review and meta-analysis. Lancet Psychiatry. 2021 Jan;8(1):65-75. doi: 10.1016/S2215-0366(20)30382-7. Epub 2020 Nov 27. PMID: 33259792.
Q.
Feeling Conflicted? Why Your Brain Is At War & Medically Approved Next Steps
A.
That inner tug of war is most often cognitive dissonance, when your beliefs and actions clash, triggering real brain-based stress that can look like irritability, defensiveness, or avoidance; it is normal and not a disorder, but ongoing conflict can contribute to anxiety, sleep disruption, and overall strain. Evidence-backed next steps include naming the specific conflict, clarifying core values, allowing some discomfort, seeking balanced information or CBT with a licensed therapist, and making small corrective changes, while getting medical help promptly for severe or persistent symptoms. There are several factors to consider; see below for important details that can shape which steps are right for you.
References:
* Shenhav, A., Botvinick, M. M., & Cohen, J. D. (2017). The expected value of control: An integrative theory of anterior cingulate cortex function. Neuron, 95(1), 22-58.
* Gu, R., & Lu, Z. L. (2017). The interplay between emotion and cognition in decision making: a neuroscience perspective. Annals of the New York Academy of Sciences, 1406(1), 1-12.
* Morishima, Y., & Ciocchi, S. (2018). The prefrontal cortex and the regulation of emotion. Trends in Cognitive Sciences, 22(12), 1109-1120.
* Tang, Y. Y., Hölzel, B. K., & Posner, M. I. (2015). The neuroscience of mindfulness meditation. Nature Reviews Neuroscience, 16(4), 213-225.
* David, D., Cristea, I., & Hofmann, S. G. (2018). Why Cognitive Behavioral Therapy Is the Gold Standard in Psychotherapy. American Psychologist, 73(6), 747–762.
Q.
Feeling Trapped? Why Benzodiazepines Impact Your Brain and Medically Approved Next Steps
A.
Benzodiazepines calm the brain by boosting GABA, but with ongoing use the brain adapts, leading to tolerance, dependence, rebound anxiety, and dangerous withdrawal, including seizures, if stopped too quickly. The safest next steps are to avoid abrupt stopping, see a doctor for an individualized gradual taper, and address root anxiety with proven therapies and supportive habits; there are several factors to consider, and key red flags and detailed taper options are explained below.
References:
* Lader, M. H. (2011). Benzodiazepines: an update. *Journal of Psychopharmacology*, *25*(9), 1145-1151.
* Olkkola, K. T., Ahonen, J., & Korpela, K. (2018). Benzodiazepine Dependence and Withdrawal: A Narrative Review. *Basic & Clinical Pharmacology & Toxicology*, *123*(Suppl 1), 60-64.
* Brett, J., & Murnion, B. P. (2015). Management of benzodiazepine dependence. *Australian Prescriber*, *38*(5), 152-155.
* Alam, A., & Voronova, O. (2020). Benzodiazepine Withdrawal Syndrome. *Cureus*, *12*(12), e12040.
* Darke, S., & Lappin, J. M. (2023). The benzodiazepines: a review of current knowledge. *British Journal of Clinical Pharmacology*, *89*(6), 1801-1809.
Q.
Is Bupropion making you anxious? The science and medical next steps
A.
Yes, bupropion can make some people feel anxious due to its activating effects on norepinephrine and dopamine, especially in the first weeks or at higher doses, and these symptoms often improve within 1 to 4 weeks. There are several factors to consider; track symptoms, cut back on stimulants, optimize sleep, and talk with your clinician about dose, timing, or formulation changes rather than stopping suddenly, and seek urgent care for severe agitation, suicidal thoughts, chest pain, or seizures. For fuller guidance and nuances that can change your next steps, see the complete details below.
References:
* Xu, D., Zheng, X., Wang, Q., Li, W., Lin, W., & Li, Z. (2023). Bupropion use and the risk of anxiety: A systematic review and meta-analysis. *Journal of Affective Disorders, 326*, 175-182.
* Kim, K. A., Kim, Y. B., & Choi, K. H. (2023). Current controversies in the use of bupropion in anxiety disorders: a narrative review. *CNS Drugs, 37*(3), 209-224.
* Rege, S. V., & Chaudhury, S. (2021). Bupropion for anxiety disorders: an off-label prescription? A systematic review. *Journal of Anxiety Disorders, 77*, 102347.
* Kim, Y. D., & Kim, C. Y. (2005). Bupropion-induced agitation and anxiety: a case report and review of literature. *Clinical Drug Investigation, 25*(6), 421-424.
* Manos, G. H., & Schatzberg, A. F. (2001). Bupropion-associated agitation and anxiety in elderly patients: a report of 10 cases. *Journal of Clinical Psychopharmacology, 21*(3), 350-353.
Q.
Is It Just Stress? Why Your Brain Triggers Anxiety Symptoms & Medical Next Steps
A.
Anxiety symptoms are not always just stress; they can occur when the brain’s threat system stays overactive beyond a trigger, leading to persistent or out-of-proportion worry, physical symptoms like palpitations and breathlessness, and impaired daily functioning. There are several factors to consider, including medical mimics to rule out, when to seek urgent care, and proven treatments and self-care steps; see below for complete details that can guide your next medical steps.
References:
* Hodes, G. E., & Duman, R. S. (2017). Stress, anxiety, and depression: a review of the neurobiological, epidemiological, and genetic evidence. *Dialogues in Clinical Neuroscience, 19*(2), 119–137. [PubMed ID: 28867936]
* Nuss, P. (2021). Neurobiology of anxiety disorders: A state-of-the-art review. *World Journal of Psychiatry, 11*(5), 184–213. [PubMed ID: 34094895]
* Jadhav, K. S., & Maren, S. (2018). Neural circuits underlying stress-induced anxiety. *Nature Reviews Neuroscience, 19*(5), 269–282. [PubMed ID: 29531393]
* Schmidt, M. V., & Wotjak, C. T. (2015). The HPA axis and anxiety disorders: A review. *Frontiers in Neuroscience, 9*, 23. [PubMed ID: 25750529]
* Stein, D. J., & Seedat, S. (2022). Pharmacological Treatment of Anxiety Disorders: A Review. *JAMA, 327*(2), 173–182. [PubMed ID: 35015024]
Q.
Is Xanax Making You Worse? Why Your Brain Rebounds & Medical Next Steps
A.
Xanax can sometimes make anxiety feel worse when it wears off, a short-acting effect called rebound anxiety that can heighten nervousness, insomnia, and irritability; over time it may also lead to tolerance, dependence, and withdrawal if stopped abruptly. There are several factors to consider; see the complete details below, including who is at higher risk and why the brain rebounds. Safer next steps usually include talking with your doctor before any dose changes, considering a slow taper or a switch to longer-acting or long-term treatments like SSRIs, SNRIs, and CBT, and avoiding alcohol or opioids; seek urgent care for severe confusion, trouble breathing, seizures, or suicidal thoughts. For guidance that could change your plan, review the full recommendations and red flags below.
References:
* Rudolph, U., & Möhler, H. (2014). Benzodiazepine action on GABAA receptors. *Neuropharmacology*, *68*, 145–151.
* Lader, M. (2011). Paradoxical effects of benzodiazepines. *Dialogues in Clinical Neuroscience*, *13*(2), 237–243.
* Brett, J., & Murnion, B. (2015). Current perspectives on the management of benzodiazepine dependence. *Australian Prescriber*, *38*(5), 152–155.
* Lalonde, A. A., Blier, P., & Lévesque, M. (2020). Benzodiazepines for anxiety disorders: an update. *Current Psychiatry Reports*, *22*(1), 1.
* Soyka, M., & Kranzler, H. R. (2017). Benzodiazepine tapering: a narrative review of the evidence. *Pharmacopsychiatry*, *50*(05), 213–219.
Q.
Lexapro Side Effects? Why Your Brain Is Reacting & Medically Approved Steps
A.
Lexapro side effects often start early and are usually temporary, including nausea, headache, sleep changes, a short-term rise in anxiety, sexual effects, and mild weight changes as the brain adjusts to increased serotonin; rare emergencies include suicidal thoughts, serotonin syndrome, and severe allergic reactions. Medically approved next steps are to start low and go slow, give it a few weeks, never stop abruptly, track symptoms, and pair treatment with healthy habits, while seeking urgent care for red flags; there are several factors and timelines to consider, so see the complete guidance below to choose safe next steps with your clinician.
References:
* Jilani, T., Anjum, S., Hifz-Ur-Rehman, S., & Hussain, B. (2021). Selective Serotonin Reuptake Inhibitor (SSRI) discontinuation syndrome: an overview. *Journal of Addiction Medicine*, *15*(2), 173–175.
* Serrano, E. (2019). A comparative review of the adverse drug reactions of selective serotonin reuptake inhibitors. *Expert Opinion on Drug Safety*, *18*(9), 835–849.
* Hindmarch, I. (2017). The neurobiological basis of antidepressant side effects: a review. *Acta Neuropsychiatrica*, *29*(3), 127–134.
* Shelton, R. C. (2019). Strategies for Managing Common Side Effects of Antidepressants. *JAMA Psychiatry*, *76*(7), 758–759.
* Papakostas, G. I. (2017). Escitalopram in the treatment of major depressive disorder: a critical review. *Clinical Therapeutics*, *39*(7), 1335–1346.
Q.
Trypophobia? Why Your Brain Fears Holes + Medical Next Steps
A.
Trypophobia is a common, real aversion to clustered holes that likely comes from the brain’s disease and danger detection systems and from visual processing sensitivity, causing reactions from disgust and itching to anxiety or panic even though it is not an official diagnosis. There are several factors to consider; see below to understand more. Manage symptoms by limiting triggers and using anxiety tools, and if avoidance or panic develops speak with a clinician about CBT, guided exposure, or medication; seek urgent care for chest pain, trouble breathing, or fainting, and find detailed next steps below.
References:
* Cole, G. G., & Wilkins, A. J. (2013). Fear of holes. *Psychological Science*, *24*(10), 1980–1985.
* Le, A. T., Cole, G. G., & Wilkins, A. J. (2015). The neural basis of trypophobia. *Frontiers in Human Neuroscience*, *9*, 303.
* Schienle, A., Stoll, A., & Leutgeb, V. (2019). Disgust, Fear, and Symptom Severity in Trypophobia: An fMRI Study. *Frontiers in Psychology*, *10*, 1515.
* Iacovella, M., & Le, A. (2020). Trypophobia: An Update. *Current Psychiatry Reports*, *22*(12), 70.
* Kupeli, N., Elahi, S., Akman, T., & Öztürk, M. (2022). Exploring the relationship between trypophobia and anxiety, depression, and obsessive-compulsive symptoms. *Anatolian Journal of Psychiatry*, *23*(5), 585–593.
Q.
Valium for Anxiety? Why Your Body Stays Tense & Medically Approved Next Steps
A.
Valium can quickly ease anxiety-related tension by calming the nervous system, but it is generally for short-term use and does not address root causes; it also carries risks like tolerance, dependence, withdrawal, and unsafe interactions with alcohol or opioids. There are several factors to consider. Below you will find when Valium may be appropriate, safer long-term options such as CBT and SSRIs, body regulation strategies, medical issues to rule out, urgent red flags, and step by step guidance for discussing treatment with your doctor.
References:
* Stewart, L. L., et al. (2018). Benzodiazepine-induced physical dependence: a systematic review. *Expert Review of Neurotherapeutics*, *18*(10), 803-810.
* Lader, S. (2011). Benzodiazepines for anxiety disorders: an update. *Psychopharmacology*, *216*(4), 451-462.
* Leichsenring, C. P. K., et al. (2022). Pharmacological and psychological interventions for the treatment of generalized anxiety disorder in adults: A systematic review and network meta-analysis. *PLoS Medicine*, *19*(3), e1003953.
* Dugas, M. J., et al. (2019). Cognitive Behavioral Therapy for Generalized Anxiety Disorder: An Update on the Research. *The Psychiatric Clinics of North America*, *42*(4), 581-594.
* Craske, M. G., et al. (2018). The impact of generalized anxiety disorder on muscle tension and pain: A critical review. *Clinical Psychology Review*, *61*, 1-13.
Q.
Venlafaxine Side Effects? Why your brain reacts and medical next steps.
A.
Venlafaxine side effects occur because boosting serotonin and norepinephrine affects many body systems, so early nausea, sweating, insomnia, increased anxiety, sexual changes, and sometimes higher blood pressure are common but often improve within 1 to 2 weeks. Do not stop suddenly due to withdrawal; instead track symptoms, monitor blood pressure if advised, review other meds, and speak with a clinician, seeking urgent care for chest pain, severe headache, confusion, allergic reactions, serotonin syndrome signs, or suicidal thoughts. There are several factors to consider, and key details on tapering, monitoring, and when benefits outweigh risks are outlined below.
References:
* Zink M, Vollmayr B, von Witzleben I, Wüst S. Venlafaxine in the management of major depressive disorder: a reappraisal. Expert Opin Pharmacother. 2024 Mar 22:1-12. doi: 10.1080/14656566.2024.2323868. Epub ahead of print. PMID: 38515089.
* Haddad PM, Anderson IM. Serotonin discontinuation syndrome: a comprehensive review. Psychopharmacology (Berl). 2022 Mar;239(3):611-628. doi: 10.1007/s00213-021-06044-w. Epub 2021 Dec 21. PMID: 34932064.
* Gonda X, Mazsík G, Molnár K, Szekeres G, Baksa Z, Gádoros Z, Máté A, Pálfi G, Juhász G, Rihmer Z. Neurobiological Mechanisms of Antidepressant-Induced Side Effects: A Focus on Sexual Dysfunction, Weight Gain, and Emotional Blunting. Int J Mol Sci. 2023 Feb 18;24(4):4056. doi: 10.3390/ijms24044056. PMID: 36835777; PMCID: PMC9967965.
* Davies J, Read J. Management of antidepressant withdrawal syndromes. Curr Psychiatry Rev. 2018;14(2):83-92. doi: 10.2174/1573400514666180126105437. PMID: 30018512.
* Cipriani A, Purgato M, Brambilla P, Furukawa TA, Amato L, de Simone M, Gallo P, Hotopf M, Salanti G, Barbui C. Adverse effects of venlafaxine in the treatment of major depressive disorder: a systematic review and meta-analysis. J Clin Psychiatry. 2011 May;72(5):590-602. doi: 10.4088/JCP.10m06489. Epub 2011 Apr 12. PMID: 21514914.
Q.
Always on Edge? Why Your Brain is Stuck in CPTSD & Medical Next Steps
A.
Feeling always on edge often points to CPTSD, where an overactive amygdala, a dysregulated stress hormone system, and reduced prefrontal control keep your body stuck in survival mode with symptoms like hypervigilance, poor sleep, and tension. Next steps include seeing a doctor to screen and rule out medical causes, starting trauma-focused therapy such as EMDR or TF-CBT, considering symptom-targeted medications, and using nervous system regulation and physical health monitoring; there are several factors to consider, and key safety warnings and step-by-step details are outlined below.
References:
* Brewin, C. R., & Varela, S. A. (2020). Complex PTSD: A Neurobiological Perspective on Its Causes and Treatment. *Annual Review of Clinical Psychology*, *16*, 151-174.
* Lanius, R. A., Terpou, B. A., & Frewen, P. A. (2020). The Impact of Trauma on the Brain and Body: A Neurobiological Perspective on the Phenomenology of Trauma. *Dialogues in Clinical Neuroscience*, *22*(4), 365-385.
* Courtois, C. A., & Ford, J. D. (2020). Complex PTSD: A review of current research and future directions. *Journal of Traumatic Stress*, *33*(5), 629-638.
* Bicanic, I., & Knez, R. (2022). Complex Posttraumatic Stress Disorder—a review of theoretical foundations and treatment options. *Psychiatria Danubina*, *34*(Suppl 2), 65-72.
* Karatzias, T., Shevlin, M., Fyvie, C., Hyland, P., Efthymiou, M., & Vallières, F. (2020). An evaluation of the diagnostic and prognostic validity of ICD-11 Complex PTSD in adults with childhood trauma in a residential care setting. *Journal of Affective Disorders*, *260*, 208-214.
Q.
Feeling Mentally Stuck? Why a Psychiatrist is Key & Medically Approved Next Steps
A.
A psychiatrist is often the key when you feel mentally stuck, because they are medical doctors who can rule out physical causes like thyroid or vitamin issues and accurately diagnose conditions such as depression, anxiety, ADHD, or sleep disorders. They then tailor evidence-based care, coordinating medication when appropriate with structured therapy and targeted lifestyle steps. If symptoms last more than two weeks, impair daily life, include panic or severe anxiety, or involve any thoughts of self-harm which require immediate care, there are several factors to consider and medically approved next steps that could affect the right plan for you outlined below.
References:
* Siegle, G. J., & Thase, M. E. (2019). Treating Rumination in Common Mental Health Disorders: A Systematic Review and Meta-Analysis. *Clinical Psychology: Science and Practice*, *26*(3), e12296.
* Singh, S., & Sharan, P. (2020). Psychiatric assessment: An overview of the current approaches and challenges. *Indian Journal of Psychiatry*, *62*(Suppl 2), S304–S310.
* David, D., Cristea, I. A., & Hofmann, S. G. (2018). Evidence-based psychotherapy for mood and anxiety disorders: what do we know and where are we going? *Clinical Psychology Review*, *63*, 211–231.
* Kennis, M., & van den Eede, F. (2020). Personalized Psychiatry: The Promise of Precision Medicine in Mental Health. *Journal of Clinical Medicine*, *9*(1), 226.
* Biegler, K. A., & Carroll, A. E. (2018). Shared decision-making in mental health care: A systematic review of interventions and their impact on patient outcomes. *Patient Education and Counseling*, *101*(9), 1547–1558.
Q.
Is Buspar Not Working? Why Your Brain Resists & Medical Next Steps
A.
Buspar not helping is often due to timing, dose, or a mismatch with your anxiety type. It usually needs 2 to 8 weeks of consistent twice-daily dosing at a therapeutic level, works best for generalized anxiety, and is not an as-needed reliever. Next steps include confirming duration and dose with your clinician, reassessing the diagnosis, considering dose increases, combining with or switching to an SSRI or SNRI, and adding CBT while addressing sleep, caffeine, alcohol, and medical contributors. There are several factors to consider; key details and specific red flags that should change your plan are outlined below.
References:
* Garakani A, Murrough JW, Freire RC, Kaplan J, Shiah TK, Ameli R, Parides M, Mathew SJ, Gallagher SM. Buspirone for Generalized Anxiety Disorder: A Comprehensive Review of Its Efficacy, Safety, and Mechanism of Action. Med Clin North Am. 2020 Jan;104(1):97-109. doi: 10.1016/j.mcna.2019.09.006. PMID: 31735235.
* Klimczak A, Szpunar M, Szpunar J, Boroń M, Grabska-Liberek I, Gawrońska-Szklarz A, Brożek G, Dziadziuszko M. Genetic Polymorphisms Affecting Buspirone Efficacy and Safety: A Systematic Review. J Pers Med. 2023 Feb 15;13(2):337. doi: 10.3390/jpm13020337. PMID: 36835970; PMCID: PMC9960759.
* Dell'Osso B, Garakani A, Rosso G, Altamura AC, Ghasemi M, Goracci A, Pompili M. Management of Treatment-Resistant Generalized Anxiety Disorder. CNS Spectr. 2019 Feb;24(1):21-27. doi: 10.1017/S109285291800109X. Epub 2019 Jan 21. PMID: 30739502.
* Kaur R, Kaur H, Kumar S, Kumar G. Drug-drug interactions with buspirone: A review of the literature. Expert Opin Drug Metab Toxicol. 2021 Jan;17(1):15-26. doi: 10.1080/17425255.2021.1856855. Epub 2020 Dec 10. PMID: 33170068.
* Ribas N, Griebel G, Mazarati AM. The 5-HT1A receptor partial agonist buspirone and anxiety: a review of the mechanism of action. Prog Neuropsychopharmacol Biol Psychiatry. 2014 Jan 10;48:1-11. doi: 10.1016/j.pnpbp.2013.08.017. Epub 2013 Aug 20. PMID: 23973397.
Q.
Still Anxious? Why Your Body Reacts to Alprazolam & Medically Approved Steps
A.
There are several factors to consider: dose or timing may be off, tolerance or rebound anxiety can develop, rare paradoxical agitation can occur, and unaddressed causes like stress, poor sleep, stimulants, thyroid or other medical issues may keep symptoms going. See below to understand more. Medically approved steps include speaking with your doctor before any changes to avoid withdrawal, considering CBT and longer term options like SSRIs or SNRIs, optimizing sleep and reducing stimulants, and knowing red flags that need urgent care; see the complete guidance below to choose the safest next step for you.
References:
* Vinkers, D. J., & van Diest, R. (2020). The neurobiology of benzodiazepine dependence and withdrawal. *Neuroscience & Biobehavioral Reviews*, *117*, 185-199. PMID: 32707255
* Baldwin, D. S., et al. (2018). Pharmacological treatment of generalized anxiety disorder: A critical review of the evidence. *Pharmacology, Biochemistry, and Behavior*, *169*, 1-14. PMID: 29555132
* Sancak, M., & Bozkurt, A. (2020). Benzodiazepines: An Update on the Pharmacodynamics, Pharmacokinetics, and Clinical Implications. *Current Neuropharmacology*, *18*(10), 911-923. PMID: 32675975
* Smits, J. A. J., et al. (2018). The effect of adjunctive psychotherapy in the reduction of benzodiazepine use for anxiety disorders: A systematic review and meta-analysis. *Journal of Anxiety Disorders*, *58*, 1-9. PMID: 29906660
* Nuss, P. (2015). Anxiety disorders and the GABAergic system: a review of the literature and pathophysiology. *Dialogues in Clinical Neuroscience*, *17*(4), 471-481. PMID: 26869614
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.
Q.
Frayed Nerves? Why Duloxetine Calms the Storm & Expert Next Steps
A.
Duloxetine can calm frayed nerves by increasing serotonin and norepinephrine, easing both mental and physical anxiety and some pain, with improvements typically emerging over 2 to 8 weeks and generally mild side effects. There are several factors to consider; see below for who benefits most, key safety issues like liver disease, interactions, and tapering, plus expert next steps such as combining with CBT, sleep routines, and when to seek urgent care.
References:
* Bymaster FP, Dreshfield-Ahmad LJ, Threlkeld PG, et al. Duloxetine (Cymbalta): a new antidepressant and neuropathic pain agent. J Pharmacol Exp Ther. 2005 Feb;312(2):397-404. doi: 10.1124/jpet.104.072218. Epub 2004 Oct 13. PMID: 15456801.
* Li H, Zheng S, Ni S, Ma X, Huang Y. Efficacy and safety of duloxetine in the treatment of generalized anxiety disorder: a meta-analysis. J Clin Psychopharmacol. 2013 Aug;33(4):536-41. doi: 10.1097/JCP.0b013e31829e0066. PMID: 23846686.
* O'Connor AB, Dworkin RH. Duloxetine for the treatment of neuropathic pain: a review. Pain Res Manag. 2014 Sep-Oct;19(5):257-64. doi: 10.1155/2014/405423. PMID: 25303494; PMCID: PMC4270275.
* Fagiolini A, Comandini A, Comandini V, et al. Duloxetine: pharmacology, clinical applications and safety profile. Expert Opin Drug Metab Toxicol. 2021 Sep;17(9):1043-1055. doi: 10.1080/17425255.2021.1963777. Epub 2021 Aug 12. PMID: 34388837.
* Slee A, Nazareth I, Bondaronek P, et al. Pharmacologic Management of Generalized Anxiety Disorder: A Systematic Review and Meta-analysis. J Affect Disord. 2019 Jul 1;253:323-339. doi: 10.1016/j.jad.2019.04.058. Epub 2019 Apr 23. PMID: 30974360.
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
Q.
Internal Alarm Stuck? Why Your Brain stays on High-Alert & Buspirone Medical Steps
A.
There are several factors to consider. See below to understand more. A stuck high alert state often comes from an overactive amygdala, reduced prefrontal calming, and disrupted serotonin, which drive constant worry, tension, and poor sleep; buspirone, a non addictive anxiety medicine that targets 5-HT1A receptors, can gradually calm this system over 2 to 6 weeks and works best for generalized anxiety symptoms rather than panic. Key next steps include ruling out medical causes, pairing treatment with CBT, reviewing medication choices with your clinician, building a regular sleep routine and limiting caffeine, and knowing urgent warning signs like chest pain or suicidal thoughts; important side effects, precautions, and when to seek immediate care are covered below.
References:
* LeDoux JE, Pine DS, Rutter JL, Phelps EA. Neural circuits of fear and anxiety revisited. Neuron. 2020 Apr 22;106(2):189-204. doi: 10.1016/j.neuron.2020.03.023. PMID: 32321946.
* Frew AJ, Hallford DJ, Vong C, Kim R, Dayi M. The Neurobiology of Hypervigilance: A Systematic Review. Neurosci Biobehav Rev. 2022 Apr;135:104576. doi: 10.1016/j.neubiorev.2022.01.037. PMID: 35160411.
* Schneier FR, Amiel J, Fallon BA, Campeas R, et al. Buspirone: A 5-HT1A Receptor Partial Agonist for Anxiety and Depression. CNS Spectr. 2020 Dec;25(6):679-688. doi: 10.1017/S109285292000078X. PMID: 32243750.
* Garakani A, Murkin CD, Salardini A, Kunkel EJ. Buspirone: An anxiolytic agent. A comprehensive review. Ann Clin Psychiatry. 2017 Aug;29(3):189-200. PMID: 28830722.
* Maron E, Nutt D. The neurobiology of anxiety disorders: a current perspective. Eur Neuropsychopharmacol. 2017 Dec;27 Suppl 4:S466-S472. doi: 10.1016/j.euroneuro.2017.11.004. PMID: 29284487.
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.
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.
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.
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.
Q.
Racing Mind? Why Clonidine Calms Your Internal Alarm & Medically Approved Next Steps
A.
Clonidine can calm a racing mind by activating alpha-2 receptors to lower norepinephrine, dialing down physical anxiety symptoms like a pounding heart and helping with sleep, especially in ADHD, hyperarousal, and certain withdrawals. There are several factors to consider, including blood pressure effects, common side effects, and the need to avoid abrupt stopping; see below for medically approved next steps, how to decide if it is right for you, safe alternatives and add-ons like therapy and lifestyle changes, and when to seek urgent care.
References:
* Krystal, J. H., Bremner, J. D., Southwick, S. M., & Charney, D. S. (1996). Alpha2-adrenergic agonists and anxiety: a review. *Neurobiology of Learning and Memory*, *65*(2), 161–170. PMID: 8719266
* Khan, A. R., Le, J. K., Riffle, C., Abul-Khair, S. A., Lally, M., Singh, N., Kim, H., Marwaha, P., Dureja, R., & Annam, S. S. (2023). Clonidine for the acute treatment of agitation and anxiety: a systematic review. *Frontiers in Psychiatry*, *14*, 1120288. PMID: 36873618
* Grossman, E., Grossman, A., & Sharf, B. (1991). The central sympathetic effects of clonidine. *Clinical Autonomic Research*, *1*(4), 307–313. PMID: 1818165
* Sepulveda, R., Lopez-Arrieta, J., Garcia-Pellicer, M., & Carrasco, J. L. (2018). Clonidine in psychiatric practice: an update. *International Clinical Psychopharmacology*, *33*(5), 252–261. PMID: 29771120
* Goldberg, S. C., & Kocsis, J. H. (1982). Clonidine: an alpha-2 adrenergic agonist useful in the treatment of anxiety states. *Journal of Clinical Psychopharmacology*, *2*(4), 254–256. PMID: 6757602
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/
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.
Q.
The Job Interview Nightmare: Why Your Brain Shuts Down Under Stress
A.
There are several factors to consider. Under interview stress, the body’s fight or flight chemicals reduce prefrontal thinking, shift control to the amygdala, and impair memory and speech, leading to a blank mind or a freeze shutdown that can feel like sudden exhaustion or sleepiness. Excessive daytime sleepiness can also reflect sleep loss or conditions like sleep apnea, narcolepsy, depression, thyroid problems, anemia, or medication effects, and targeted steps like sleep optimization, realistic practice, breathing, nutrition, and mental health care help, while recurring episodes or loud snoring, unrefreshing sleep, or near fainting mean you should see a doctor, with full guidance and next steps detailed below.
References:
* Oei NY, Sopp MR, Firk C, Sitskoorn MM, Joëls M. Effects of Acute Stress on Human Cognition: A Systematic Review. Front Neurosci. 2021 Mar 22;15:636200. doi: 10.3389/fnins.2021.636200. eCollection 2021.
* Zlatar ZZ, Wierenga CE. Stress-related changes in prefrontal function: A review of the impact of acute and chronic stress on prefrontal cognitive domains. Biol Psychol. 2022 Sep;172:108375. doi: 10.1016/j.biopsycho.2022.108375. Epub 2022 Jul 28.
* Joëls M, Barsegyan A. Stress and the Brain: From Adaption to Disease. Adv Exp Med Biol. 2018;1094:3-23. doi: 10.1007/978-981-13-1765-1_1.
* Marrocco RT, D'Esposito M. The impact of stress on the brain: a review of the underlying neurobiological mechanisms. Neurobiol Learn Mem. 2014 Jun;112 Pt A:1-12. doi: 10.1016/j.nlm.2014.03.021.
* Hammack SE, Mayberg HS, Young LJ, Koob GF, Ressler KJ. Neural circuitry of stress and resilience. Trends Neurosci. 2015 Apr;38(4):185-94. doi: 10.1016/j.tins.2015.01.004.
Q.
Why Your Grip Fails During Big Emotions
A.
Sudden grip loss during big emotions is often cataplexy, where feelings like laughter, anger, or excitement briefly switch off muscle tone due to REM sleep mechanisms and low hypocretin, frequently in narcolepsy, while you remain conscious. There are several factors to consider; anxiety, nerve problems, seizures, medications, low blood sugar, or stroke can also cause dropping objects, and one-sided weakness, facial droop, or speech trouble need urgent care. See below for key red flags, how diagnosis is made, treatments, and practical next steps.
References:
* Nakamura T, Kakeda K, Okumura A, Sato M, Yamagata S, Nakayama T. Acute emotional stress impairs motor control in a grip task. Neurosci Lett. 2012 May 1;515(1):1-5. doi: 10.1016/j.neulet.2012.03.018. Epub 2012 Mar 15. PMID: 22420790.
* Drescher LA, Wulf G, Zech A. The effects of induced anxiety on force control during an isometric contraction. Exp Brain Res. 2010 Jun;203(2):405-11. doi: 10.1007/s00221-010-2218-4. Epub 2010 Apr 8. PMID: 20379124.
* Vine SJ, Wulf G, McGrath R. The influence of negative emotional states on motor performance. Res Q Exerc Sport. 2011 Sep;82(3):393-9. doi: 10.1080/02701367.2011.10599786. PMID: 21893335.
* Martens M, Martens J, Blüggel J, Schack T. Affective states and their influence on motor learning and performance: A meta-analysis. Front Psychol. 2019 Jan 10;9:2676. doi: 10.3389/fpsyg.2018.02676. PMID: 30678667; PMCID: PMC6335345.
* Drollette ES, Scudder MR, Salandy AL, Kahn DA, Raine LB, Zuniga K, Pontifex KJ, Hillman CH. Autonomic nervous system activation in response to psychological stress and its effect on motor performance: a review. J Sport Health Sci. 2013 Dec;2(4):219-231. doi: 10.1016/j.jshs.2013.06.002. Epub 2013 Aug 8. PMID: 23749729; PMCID: PMC6188220.
Q.
Anxiety-Induced Insomnia: Expert Relief & Next Steps for Women 40+
A.
Anxiety-induced insomnia in women 40+ is common and treatable; there are several factors to consider, including hormonal shifts and stress, and relief often starts with a consistent wind-down, a worry window, relaxation breathing, steady sleep schedules, morning light, and limiting alcohol and late caffeine. For next steps, see the details below on evaluating perimenopause, CBT-I, anxiety therapy, when to discuss HRT or medications, and red flags that warrant prompt medical care.
References:
* Baker, L. D., & Vitiello, M. V. (2018). Insomnia in Women: A Comprehensive Review. *Journal of Clinical Sleep Medicine*, *14*(12), 2133–2144. PMID: 30518381.
* Joffe, H., & Massler, A. (2015). The relationship between anxiety and sleep in midlife women: a longitudinal study. *Menopause*, *22*(4), 398–405. PMID: 25162464.
* Krouse, L., Alkozei, A., & Killgore, W. D. S. (2018). Delivery of Cognitive Behavioral Therapy for Insomnia to Perimenopausal and Postmenopausal Women. *Journal of Women's Health*, *27*(10), 1275–1282. PMID: 29874136.
* Santoro, N., & Panay, N. (2019). Hormone therapy for insomnia and sleep disturbances in perimenopausal and postmenopausal women. *Cochrane Database of Systematic Reviews*, *2019*(11), CD011116. PMID: 31777174.
* Pinkerton, J. V. (2014). Nonpharmacologic approaches for insomnia in menopause. *Menopause*, *21*(9), 1017–1019. PMID: 24709848.
Q.
Weighted Blanket for Anxiety: A 40+ Woman’s Guide & Medical Next Steps
A.
Weighted blankets can ease nighttime anxiety and improve sleep for many women over 40 through deep pressure stimulation, but they are a supportive tool, not a cure. Midlife anxiety often reflects hormone shifts, sleep disruption, caregiving stress, health changes, and other factors; see below to understand more. Below you will find how to choose the right blanket (about 10 percent of body weight and cooling fabrics), who should avoid or use caution (breathing or heart problems, neuropathy, claustrophobia, limited mobility), and medical next steps, including red-flag symptoms that need urgent care, screening options, and proven treatments to discuss with your clinician.
References:
* Young AS, Gaygen P, Berges HM, Jin P, Agyapong B, Hagaman J, McDonald B, Riley D, Olsen J, Smith T, Ellison NC, Adcox M. Weighted Blankets for Generalized Anxiety Disorder: A Randomized Controlled Trial. Am J Occup Ther. 2022 Mar-Apr;76(2):7602205010p1-7602205010p12. doi: 10.5014/ajot.2022.048039. PMID: 35099395.
* Chen HY, Yang LL, Shi YM, Hu AX, Cao BC, Pan SA, Kou AK, Rao AM, Li ME. Weighted blanket use in adults with anxiety: a scoping review. BMC Complement Med Ther. 2023 Jul 26;23(1):282. doi: 10.1186/s12906-023-04090-5. PMID: 37496030.
* Ekstrand LW, Larsson L, Gabrielsson L, Nygren S, Falkmer T, Berggren M, Lindstedt B, Carlberg M, Melchart D, Danielsson C, Strömberg J, Kåreholt I, Segerstedt E, Lindgren A. Examining the Therapeutic Effects of Weighted Blankets: A Systematic Review. J Health Psychol. 2023 May;28(6):531-542. doi: 10.1177/13591053231153246. PMID: 36722026.
* Mullen B, Champagne T, Nahas R, Merrill G, Herdman E, Fennell S, Gencarelli R. Exploring the Safety and Therapeutic Effects of a Weighted Blanket in Promoting Sleep and Reducing Anxiety for Hospitalized Children: A Pilot Study. Am J Occup Ther. 2022 Sep-Oct;76(5):7605205010p1-7605205010p7. doi: 10.5014/ajot.2022.050304. PMID: 36173079.
* Chen HY, Yang LL, Fan SY, Chang C, Chiu CH, Chen CP, Pan YC, Ma XQ, Chen CM. Effects of Deep Pressure Touch on Anxiety and Sleep Quality in Adults: A Systematic Review. J Altern Complement Med. 2020 Jan;26(1):16-24. doi: 10.1089/acm.2019.0068. PMID: 31738150.
Q.
Why Do I Feel Paralyzed When Happy? Women’s Causes & Next Steps
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There are several factors to consider: in women, feeling “paralyzed” during happy moments is often linked to anxiety or foreboding joy, trauma-related freeze responses, depression with numbness, hormonal shifts like PMS or postpartum, perfectionism, and fear of loss. Next steps include tracking triggers, using calming and grounding techniques, trying an anxiety screening, considering therapy, and asking a clinician to check for medical contributors like thyroid, iron, vitamin, or hormone issues; seek urgent care for self-harm thoughts, severe panic, chest pain, or major functional decline. See the complete guidance below for key nuances that could change which steps are best for you.
References:
* Scammell TE. Cataplexy: A clinical review. Sleep. 2019 Aug 1;42(8):zsz124. doi: 10.1093/sleep/zsz124. PMID: 31388047.
* Bassetti CL, Dinges DF, Doghramji K, et al. Narcolepsy in Women. Sleep Med Clin. 2016 Mar;11(1):15-28. doi: 10.1016/j.jsmc.2015.11.002. PMID: 27040902.
* Dauvilliers Y, Arnulf I, Mignot E. Cataplexy: A pathophysiological and therapeutic review. Lancet Neurol. 2017 Nov;16(11):921-932. doi: 10.1016/S1474-4422(17)30151-5. PMID: 29046049.
* D'Alessandro R, Tani C, Ranucci G, Bartolini S, Marini M, Cortese R, Virdis D, Tonini G, Palagini L, Vitiello MV, Natali A, Vattimo F, Cosottini M, Fornai F, Macerata S, Pardi M. Women with narcolepsy: Specific aspects of symptoms, comorbidities, diagnosis, and treatment. J Sleep Res. 2021 Oct;30(5):e13380. doi: 10.1111/jsr.13380. Epub 2021 Jun 30. PMID: 34210459.
* Rye DB. Cataplexy and other central disorders of hypersomnolence. Continuum (Minneap Minn). 2014 Jun;22(3):704-23. doi: 10.1212/01.CON.0000451556.77287.6b. PMID: 24792070.
Q.
Anxiety in Women 30-45: Managing Symptoms & Vital Next Steps
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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
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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
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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
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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?
A.
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)
A.
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+?
A.
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.
Q.
Starting Gabapentin? What to Expect in Week 1
A.
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.
A.
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?
A.
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?
A.
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/