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Anxiety

Anxiety is characterized by excessive tension and worry. Unlike fear, it is persistent and future oriented. There are many types of anxiety disorders, including generalized anxiety, social anxiety, phobias, and panic disorder.

Our evidence-based analysis on anxiety features 61 unique references to scientific papers.

Research analysis led by and reviewed by the Examine team.
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Summary of Anxiety

Overview | Causes | Symptoms | Diagnosis | Treatments

Overview

Anxiety, defined by the American Psychological Association (APA), is:

“an emotion characterized by apprehension and somatic symptoms of tension in which an individual anticipates impending danger, catastrophe, or misfortune”.


Those “somatic symptoms” they’re referring to differ from what you feel when you temporarily fear something in the present moment.[1]

The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) says anxiety is associated with muscle tension and increased mental vigilance to keep an eye out for future threats. In anxiety disorders, the feelings of fear, dread, and uneasiness are not temporary and can be overwhelming. Not only do these feelings persist, but they can also worsen over time and interfere with normal daily activities — grocery shopping, work, sleep, to name a few.

Causes

The causes of anxiety disorders are complex, and risk factors can differ by type of anxiety (i.e., separation anxiety, generalized anxiety, panic). Your genetics, environment, and brain biology can all play a role. General risk factors across anxiety disorders include:

  • Exposure to traumatic, highly negative or stressful events

  • A family history of anxiety disorders

  • Physical health conditions that may contribute to or aggravate anxiety, such as thyroid dysfunction, and heart arrhythmias

  • Personality traits, such as excessive shyness or becoming withdrawn in social situations

Anxiety is, to some extent, an overactive and poorly regulated fear response with roots in dysfunctional brain and endocrine activity, so it may be influenced by therapy, drugs, supplements, exercise, or food. Foods and supplements that affect anxiety may do so by affecting the production of neurotransmitters and hormones involved in the fear response.

Symptoms

Different anxiety disorders can have different symptoms. Below, we’ve detailed some of the common ones.

Symptoms of common anxiety disorders
GENERALIZED ANXIETY DISORDERPANIC DISORDER
(at least 4 symptoms)
SOCIAL ANXIETY DISORDERSPHOBIA-RELATED DISORDERS

Persistent feelings of worry or tension for at least 6 months, with no clear cause

Chest pain or discomfort

Blushing

Intense anxiety when faced with a feared situation or object

Difficulty breathing

Chills

Difficulty talking

Irrational or excessive worry

Difficulty concentrating

Difficulty breathing

Fear of social occasions or situations (e.g., parties, dinners, public speaking, public restrooms)

Persistent intense anxiety when a feared situation or object is unavoidable

Easily fatigued

Dizziness

Nausea

Taking intrusive steps to avoid a fear (situation or object)

Emotional outbursts

Feeling detached

Sweating

Headaches

Feeling out of control

Trembling

Irritability

Heart palpitations

Muscle tension

Hot flashes

Restlessness

Numbness or tingling of hands, feet, or face

Sleep problems

Persistent feeling of impending doom or death

Stomach upset

Stomach upset

Sweating

Sweating

Under- or overeating

Trembling/shaking

Diagnosis

Diagnosing anxiety disorders is a complicated process, so don’t self-diagnose. If you suspect you’re overstressed or anxious, see a mental-health clinician or your primary care doctor.

During your appointment, they’ll ask you about your symptoms and may take a full medical history. If deemed necessary, you may undergo a physical exam or additional lab tests to further pinpoint a proper diagnosis. The doctor may also order a psychological evaluation.

Anxiety is largely measured through a variety of questionnaires or behavioral observations designed to assess the severity of symptoms as well as neuroimaging tests, but the latter are less common in research.

The DSM-5 lays out specific criteria for when fear and anxiety cross the line into anxiety disorders.

  • They’re persistent

  • They’re out of proportion to the actual threat

The types of anxiety disorders DSM-5 recognizes are summarized in the table below. You’ll notice one recurring criterion: to rank as a disorder, the fear, anxiety, or avoidance behavior should interfere with living a normal life.

Anxiety disorders as classified by the DSM-5
DISORDERDEFINITION

Agoraphobia

Strong fear in situations where escape feels difficult, such as wide-open spaces or crowded, enclosed places. Often accompanied by dysfunctional avoidance of those situations

Generalized anxiety disorder (GAD)

Excessive, disruptive fear or worry about a wide range of subjects

Other/unspecified disorders

Life-disrupting, troubling anxiety that doesn’t fall into any of the categories above

Panic disorder

Frequent panic attacks and a fear of future attacks. Avoidance behavior

Selective mutism

Failure to speak in specific social situations where speaking is expected. Usually develops in childhood. Often accompanied by social anxiety disorder

Separation anxiety

High levels of fear and anxiety caused by separation from home or a particular person. Usually develops in childhood

Social anxiety disorder

Life-disrupting fear, anxiety, or avoidance behavior caused by social situations

Specific phobia

Life-disrupting fear, anxiety, or avoidance behavior caused by a specific situation or object

Substance-, medication-, and disease-related disorders

Anxiety that can be traced to another disease, a medicine, or substance withdrawal

Reference: Diagnostic and Statistical Manual of Mental Disorders, fifth edition. American Psychiatric Association. 2013.[2]

Treatments

Supplements

Supplements such as magnesium and lavender have good evidence for dampening anxiety severity to a moderate extent. On the flip side, nicotine and yohimbine may worsen anxiety.

The table below displays an analysis of human studies and indicates how supplements may affect anxiety. While there is no cure-all, some supplements may aid in anxiety control or symptom relief.

Therapy

Cognitive behavioral therapy (CBT) works well for many anxiety disorders,[3][4] especially in combination with drugs.[5] Other therapies, such as relaxation therapy,[6] also work quite well and may bring results on par with CBT.

Meditation

The quality of research on meditation’s effects has been questioned.[7][8][9] Keeping that in mind, there is some evidence that meditation can reduce symptoms of anxiety,[10] especially among people for whom anxiety is a secondary concern.[11] It may also reduce physical signs[12] and mental symptoms[13] of stress.

Exercise

Aerobic exercise (i.e., running, jogging) reduces anxiety in people who have clinical anxiety, with higher-intensity exercise tending to be more effective.[14] Resistance training (i.e., weight lifting, bodyweight exercise) has less evidence, but that evidence suggests it can also benefit people with anxiety disorders.[15]

Exercise benefits are roughly on par with therapy but lower than with drug treatment.[5] 

Diet

It is difficult to say if specific diets can lessen anxiety, but tasty foods can benefit your mood in the short term, and healthy food can help in the long run. The evidence for improved mood is especially strong in favor of Mediterranean-style diets,[16][17] but that may be because no other type of healthy diet has been seriously studied for its effects on mood or anxiety, specifically.

Even studies can’t prove how much of the improvement in mood was due to the Mediterranean diet itself versus the placebo effect — switching to a healthier diet and expecting to feel better — or even regression to the mean, where people feel better as time passes. But we can say that healthy eating patterns won’t hurt, at the very least.

Drugs

When it comes to anxiety disorders, drugs work better, on average, than exercise and therapy. Medication also boosts the effectiveness of therapy.[5] Antianxiety medications, beta-blockers, and antidepressants are commonly used to help relieve symptoms, but some drugs work better than others, depending on the anxiety disorder.

For instance, duloxetine (Cymbalta), a selective serotonin-norepinephrine reuptake inhibitor (SNRI), works really well for generalized anxiety disorder[18] but is no better than a placebo for panic disorder, for which tricyclic antidepressants seem to work best.[19]

The first step is to discuss a specific treatment plan with your physician or healthcare provider.

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The Human Effect Matrix looks at human studies to tell you what supplements affect Anxiety.

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Grade Level of Evidence
Robust research conducted with repeated double-blind clinical trials
Multiple studies where at least two are double-blind and placebo controlled
Single double-blind study or multiple cohort studies
Uncontrolled or observational studies only
Level of Evidence
? The amount of high quality evidence. The more evidence, the more we can trust the results.
Supplement Magnitude of effect
? The direction and size of the supplement's impact on each outcome. Some supplements can have an increasing effect, others have a decreasing effect, and others have no effect.
Consistency of research results
? Scientific research does not always agree. HIGH or VERY HIGH means that most of the scientific research agrees.
Notes
grade-a Notable Very High See all 8 studies
Appears to be quite reliable and effective in treating non-psychotic anxiety, with less reliability on the topic of generalized anxiety (which lavender shows some promise for). It is possible that long-term usage of kava may have similar side-effects as long term usage of benzodiazepines (not demonstrated, but wholly logical) and most studies on kava are of a few weeks in duration without any problems.
grade-b Notable Very High See all 9 studies
Evidence suggests potent anxiolytic effects in the context of chronic stress and anxiety disorder, with lesser potency in standard forms of anxiety not related to stress. There may be more benefit to social anxiety as well with ashwagandha relative to other anxiolytics. More high-quality studies are needed to get an accurate assessment of how effective it is and the optimal dose.
grade-b Notable Very High See all 4 studies
There appears to be a decrease in anxiety symptoms associated with high dose inositol, and it has been noted to be comparable to fluvoxamine in potency.

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Frequently Asked Questions and Articles on Anxiety

How eating better can make you happier
Food and supplements that can help fight stress, fatigue, anxiety, depression, and help you sleep better.
Does chewing gum offer any health benefits?
Chewing gum can provide health benefits ranging from improved oral health to reduced hunger and stress levels, but for some people these are balanced out by possible downsides such as increased headaches.
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