Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18% of the population.[1]

Anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment.

Anxiety disorders cost the U.S. more than $42 billion a year, almost one-third of the country’s $148 billion total mental health bill, according to “The Economic Burden of Anxiety Disorders,” a study commissioned by ADAA.[2]

From that study:

More than $22.84 billion of those costs are associated with the repeated use of health care services; people with anxiety disorders seek relief for symptoms that mimic physical illnesses.

People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders.

Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality and life events.[3]

There are different types of anxiety as listed below:

Generalized Anxiety Disorder (GAD)

GAD affects 6.8 million adults, or 3.1% of the U.S. population.
Women are twice as likely to be affected as men.

Panic Disorder

6 million, 2.7%
Women are twice as likely to be affected as men.
Very high comorbidity rate with major depression.

Social Anxiety Disorder

15 million, 6.8%
Equally common among men and women, typically beginning around age 13.
According to a 2007 ADAA survey, 36% of people with social anxiety disorder report experiencing symptoms for 10 or more years before seeking help.

Specific Phobias

19 million, 8.7%
Women are twice as likely to be affected as men.
Typically begins in childhood; the median age of onset is 7.

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are closely related to anxiety disorders, which some may experience at the same time, along with depression.

Obsessive-Compulsive Disorder (OCD)

2.2 million, 1.0%
Equally common among men and women.
The median age of onset is 19, with 25% of cases occurring by age 14. One-third of affected adults first experienced symptoms in childhood.

Posttraumatic Stress Disorder (PTSD)

7.7 million, 3.5%
Women are more likely to be affected than men.
Rape is the most likely trigger of PTSD: 65% of men and 45.9% of women who are raped will develop the disorder.
Childhood sexual abuse is a strong predictor of lifetime likelihood for developing PTSD.[4]

Occasional anxiety is a normal part of life. You might feel anxious when faced with a problem at work, before taking a test or when making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The feelings can interfere with daily activities such as job performance, schoolwork and relationships.[5]

Common anxiety signs and symptoms include[6]:

• Feeling nervous, restless or tense
• Having a sense of impending danger, panic or doom
• Having an increased heart rate
• Breathing rapidly (hyperventilation)
• Sweating
• Trembling
• Feeling weak or tired
• Trouble concentrating or thinking about anything other than the present worry
• Having trouble sleeping
• Experiencing gastrointestinal (GI) problems
• Having difficulty controlling worry
• Having the urge to avoid things that trigger anxiety
• Generalized Anxiety Disorder

People with generalized anxiety disorder display excessive anxiety or worry for months and face several anxiety-related symptoms.

Generalized anxiety disorder symptoms include:

• Restlessness or feeling wound-up or on edge
• Being easily fatigued
• Difficulty concentrating or having your mind go blank
• Irritability
• Muscle tension
• Difficulty controlling the worry
• Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)
• Panic Disorder

People with panic disorder have recurrent unexpected panic attacks, which are sudden periods of intense fear that may include palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath, smothering, or choking; and feeling of impending doom.

Panic disorder symptoms include:

• Sudden and repeated attacks of intense fear
• Feelings of being out of control during a panic attack
• Intense worries about when the next attack will happen
• Fear or avoidance of places where panic attacks have occurred in the past

Social Anxiety Disorder

People with social anxiety disorder (sometimes called “social phobia”) have a marked fear of social or performance situations in which they expect to feel embarrassed, judged, rejected or fearful of offending others.

Social anxiety disorder symptoms include:

• Feeling highly anxious about being with other people and having a hard time talking to them
• Feeling very self-conscious in front of other people and worried about feeling humiliated, embarrassed or rejected, or fearful of offending others
• Being very afraid that other people will judge you
• Worrying for days or weeks before an event where other people will be
• Staying away from places where there are other people
• Having a hard time making friends and keeping friends
• Blushing, sweating or trembling around other people
• Feeling nauseous or sick to your stomach when other people are around

What causes anxiety disorders?

The cause of anxiety disorders is unknown, but it’s becoming clear that many of them are caused by a combination of factors, including systemic diseases, such as hypothyroidism, insulin resistance, hypoglycemia, leaky gut, or celiac disease, diet, abnormal intestinal bacteria, nutritional deficiencies, genetic mutations, previous life experiences, neurotransmitter imbalances, situational stress, and environmental stress.

Anxiety is not caused by a Prozac deficiency

All the potential causes described above must be evaluated in someone complaining of anxiety. See thyroid disorders, insulin resistance, gastrointestinal health and micronutrients for discussion of those conditions.

A very common mutation that may cause anxiety is the MTHFR (methyltetrahydrofolate reductase) mutation. Look at Figure 1.

At the top of the diagram is folic acid. That is a synthetic not found in nature. Dietary folate is in uncooked green leafy vegetables. Both of these have to be metabolized to 5-MTHF (5-methyltetrahydrofolate) for the body to use them effectively.

When someone has the MTHFR mutation, the last step (where you see the X) is inefficient. The most common genes involved in this process are the C677T and the A1298C. If there are mutations in either of these genes, people are unable to produce adequate amounts of 5 MTHF for optimal metabolism. If they are given 5MTHF (a vitamin) combined with B2, B6, and B12, the frequencies of the conditions listed in Figure 2 are decreased.

The following neurotransmitters imbalances have been associated with anxiety:

Low Serotonin

Low GABA

High Norepinephrine

High Epinephrine

Medications may also cause anxiety such as the one listed below [7]:

Prescription medicines that may cause anxiety include:

• Asthma medicines, such as albuterol, salmeterol and theophylline
• Blood pressure medicines, such as methyldopa
• Hormones, such as oral contraceptives
• Medicines that contain amphetamines, such as Benzedrine, Dexedrine and Ritalin
• Steroids, such as cortisone, dexamethasone and prednisone
• Thyroid medicines
• Other medicines, such as phenytoin, levodopa, quinidine and some antidepressants.

Nonprescription medicines that may cause anxiety include:

• Medicines that contain caffeine, such as Anacin, Empirin, Excedrin, No-Doz and cough medicines
• Decongestants, such as phenylephrine, including Sudafed PE
• Illegal drugs, such as cocaine, crack or speed (amphetamines)

Deficiencies of the following nutrients have also been associated with anxiety. (See Figure 3 as well.)

Carnitine: Studies show that carnitine can reduce anxiety and improve feelings of well-being.[8]

Chromium: Its effect on serotonin transmission may explain its anxiolytic (anxiety- relieving) effect in animal studies.[9]

Folate: Aids in production of neurotransmitters such as dopamine and serotonin, which have a calming effect on mood.[10]

Inositol: A neurochemical messenger in the brain, inositol (vitamin B8) affects dopamine and serotonin receptors. Trials confirm it is very effective in reducing panic attacks.[11]

Choline: Precursor to the neurotransmitter acetylcholine, which affects focus and mood, low levels of choline have been linked to anxiety.[12]

Serine: Exerts a calming effect by buffering the adrenal response to physical or emotional stress. Lowered anxiety scores of patients with post-traumatic stress disorder.[13]

Copper: An integral part of certain chemicals in the brain (such as endorphins) that calm anxious feelings, copper deficiency may exacerbate anxiety-like behavior.[14]

Magnesium: Regulates the HPA (hypothalamic-pituitary adrenal) axis, which controls physical and psychological reactions to stress; deficiency can induce anxiety and emotional hyper-reactivity.[15]

Selenium: Repletion of selenium to normal levels reduced anxiety scores in clinical trials; some suggest the mechanism of action is due to its role in key regulatory proteins (selenoproteins).[16]

Zinc: Reduces anxiety in clinical trials, possibly due to its interaction with NMDA (N-methyl-D- aspartate) receptors in the brain, which regulate mood.[17]

Vitamin B6: Cofactor in synthesis of calming neurotransmitters such as GABA (gamma-aminobutyric acid), serotonin and dopamine.[18]

Vitamin B3: One of the symptoms of severe B3 deficiency (pellagra) is anxiety. Pharmacological doses of B3 may enhance the calming effects of GABA in the brain, as it converts tryptophan to serotonin.[19]

Vitamins D and E: Low vitamin D status is linked to anxiety; animal studies confirm the role of vitamins D and E in reducing anxiety-related behavior.[20]

An evaluation of someone complaining of anxiety should include an extensive past medical and surgical history, medication history, family history, and history of any past traumatic events.

Bloodwork should include a CBC, CMP, complete thyroid profile with TSH, Free T4, Free T3, reverse T3, ferritin, TPO and Thyroglobulin antibodies. Other tests include fasting insulin; Hgb A1c; salivary hormone testing; food allergy panel; neurotransmitter testing; stool test if indicated to evaluate for abnormal bacteria, yeast, parasites, absorption and digestion; micronutrient analysis through SpectraCell, and neurotransmitter test through Sanesco. (See link for advanced testing-Put in Doug’s website)

Therapy

The type of therapy will depend on the results of the individual testing.

Possible therapies: Correcting metabolic dysfunctions (thyroid, insulin), balancing hormones, replacing deficient micronutrients and minerals, repairing abnormal bowel findings, and returning neurotransmitters to balance.

Psychotherapy

Cognitive Behavioral Therapy (CBT)

Self-Help or Support Groups

Stress-Management Techniques

Medication

Anti-Anxiety Medications

Recommended Supplements to Address Anxiety:

Resources

1. National Institute of Mental Health
2. The Journal of Clinical Psychiatry, 60(7), July 1999
3. https://www.adaa.org/about-adaa/press-room/facts-statistics
4. https://www.adaa.org/about-adaa/press-room/facts-statistics
5. http://www.nimh.nih.gov/health/topics/anxiety disorders/index.shtml#part_145333
6. http://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/dxc-20168124
7. http://www.webmd.com/anxiety-panic/medications-that-can-cause-anxiety
8. Int J Neuropsychopharmacol 2005;8:65-74. Scand J Gastroenterology 2011;46:750-759
9. Clin Pharmacol 2007;21:531-534 Basic Clin Pharmacol Toxicol 2006;98:155-159.
10. Altern Med Rev 2009;14:114-140  Altern Med Rev 1998;3:208-220. http://www.spectracell.com/online-library-mnt-anxiety-abstract/
11. Am J Psychiatry 1995;152:1084-1086 JClin Psychopharmacol 2001;21:335-339.
12. Am J Clin Nutr 2009;90:1056-1060. Biol Pyschiatry 2012;71:75-83
13. Int J Neuropsychopharmacol 2009;12:1279-1282. Curr Opin Neurol 2004;17:197-204. Stress 2004;7:119-126.
14. J Trace Elem Med Biol 2003;17 Suppl 1:3-9. Neurobiol Dis 2010;37:130-140. Physiol Behav 2010;100:95-100
15. Neuropharmacology 2012;62:304-312. J Am Coll Nutr 2004;23:529S-533S. Pharmacol Biochem Behav 2004;78:7-12.
16. Int J Psychiatry Med 2003;33:55-69. Biol Psychiatry 1991;29:1092-1098.
17. Hum Exp Toxicol 2012’;Epub ahead of print. Curr Opin Clin Nutr Metab Care 2010;13:685-689. Pharmacol Re. 2011;63:1050-5.
18. Altern Med Rev 2009;14:114-140 Med Hypotheses 2000;54:803-807. Psychosom Med 1998;60:297-308.
19. Altern Med Rev 2009;14:114-140. J Orthomolec Med 2004;19:104-110. Gen Hosp Psychiatry 2008;30:581-584.
20. Neuroreport 2004;15:1271-1274. Clin Rheumatol 2007;26:551-554. Biosci Biotechnol Biochem 2011;75:1894-1899 Biofactors 2009;35:273-278.