Anxiety Disorders

The Overview of Anxiety Disorders:

Occasional anxiety  is a normal part of life. You might feel anxious when faced with a problem at work, before taking a test, or 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, school work, and relationships.
An anxiety disorder may make you feel anxious most of the time, without any apparent reason. Or the anxious feelings may be so uncomfortable that to avoid them you may stop some everyday activities.

Epidemiology:

Causes

Anxiety is a normal response to stress or a dangerous situation and it’s often referred to as the “fight or flight” response. It’s also the most prevalent mental health condition. Anxiety becomes problematic when it is constant or in reaction to inappropriate circumstances, which over time can negatively affect your day-to-day life.

Causes of anxiety include:

• stress
• traumatic life experiences
• thyroid problems
• dysfunctional serotonin
• excessive alcohol
• Either caffeine or sugar intake
• hormone imbalance

Risk Factors

Research shows that risk factors for anxiety disorders include

• being female,
• experiencing stressful life events in childhood and adulthood,
• having a family history of mental health disorders,
• having limited economic resources and
• being shy in childhood.

There are several different types of anxiety disorders i.e.

1. Generalized Anxiety disorder
2. Panic disorder
3. Specific Phobias
4. Social anxiety disorder
5. Obsessive compulsive disorder
6. Post traumatic stress disorder ( in other words, PTSD)
7. Acute stress disorder
8. Agoraphobia
9. Separative  Anxiety disorder
10. Selective Mutism

1. Generalized Anxiety Disorder:

Generalized anxiety disorder (in other words, GAD) is much more than the normal anxiety people experience day to day. It’s chronic and exaggerated worry and tension, even though nothing seems to provoke it. Furthermore, having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. They tend to feel tired, have trouble concentrating, and sometimes suffer depression too. People with GAD also seem unable to relax. They often have trouble either falling or staying asleep. It’s more common in women than in men and often occurs in relatives of affected persons.  At last, It’s diagnosed when someone spends at least 6 months worrying excessively about a number of everyday problems. [1]

Symptoms i.e.:

• Restlessness or feeling wound-up or on edge
• Being easily fatigued
• Difficulty concentrating or having their minds go blank
• Irritability
• Muscle tension
• Difficulty controlling the worry
• Sleep problems ( especially difficulty falling or staying asleep or restless, unsatisfying sleep) [1]

2. Panic Disorder:

This is characterised by discrete episodes of acute anxiety. Firstly, The onset is usually in early third decade with often a chronic course. After that, The panic attacks occur recurrently every few days. Basically, The episode is usually sudden in onset, lasts for a few minutes also is characterised by very severe anxiety. Panic disorder is usually seen about 2-3 times more often in females. Panic disorder can present either alone or with agoraphobia. Generally, People with panic disorder have feelings of terror that strike suddenly  and repeatedly with no warning. You may genuinely believe you’re having a heart attack or stroke, losing  your mind, or on the verge of death. Additionally, Attacks can occur any time, even during non-dream sleep. While most attacks average a couple of minutes, occasionally they can go on for up to 10 minutes. Occasionally, they may last an hour or more. [1]

Symptoms i.e.:

• Palpitations
• Either Pounding heart or accelerated heart rate
• Sweating
• Either Trembling or shaking
• Sensations of shortness of breath
• Both Smothering, and choking
• Feeling of impending doom
• Feelings of being out of control during a panic attack
• Intense worries about when the next attack will happen. [1]

3. Phobias:

Generally, Phobias occur in several forms. A specific phobia is a fear of a particular object or situation. Social phobia is a fear of being painfully embarrassed in a social setting. Additionally, agoraphobia, which often accompanies panic disorder, is a fear of being in any situation that might provoke a panic attack, or from which escape might be difficult if one occurred. Phobias aren’t just extreme fear; they are irrational fear.
You may be able to ski the world’s tallest mountains with ease but feel panic going above the 10th floor of an office building. [1]

4. Social Anxiety Disorder:

"Social phobia is an intense fear of becoming humiliated in social situations, specifically of embarrassing yourself in front of other people. It often runs in families and may be accompanied by depression or alcoholism. Social phobia often begins around early adolescence or even younger." Blushing it may seem painfully embarrassing, also you feel as though all eyes are focused on you.  You may feeling anxious about giving a speech, talking to either a boss or other authority figure, or dating.  Occasionally, it may involve a "fear of using a public restroom, eating out, talking on the phone, or writing in the presence of other people, such as when signing a check.  [1]

Symptoms i.e. :

• Being very afraid that other people will judge them
• 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 also  keeping friends
• Blushing, sweating, or trembling around other people
• Feeling nauseous or sick to your stomach when other people are around [1]

5. Obsessive Compulsive Disorder:

The disturbing thoughts or images are called obsessions, and the rituals performed to try to prevent or dispel them are called compulsions. Furthermore, Obsessive-compulsive disorder is characterized by anxious thoughts or rituals you feel you can’t control. If you have OCD, you may have  persistent, unwelcome thoughts or images. Besides this, OCD strikes people of all genders in approximately equal numbers and afflicts roughly 1 in 50 people. It can appear in childhood, adolescence, or adulthood, but on the average it first shows up in the teens or early adulthood. [1]

Symptoms e.g.:

• You may be obsessed with germs or dirt, so you wash your hands over and over.
• The person may be filled with doubt and feel the need to check things repeatedly.
• He might be preoccupied by thoughts of violence also fear that you will harm people close to you.
• People may spend long periods of time either ‘touching things or counting.
• Occasionally, You  may be troubled by thoughts that are against your religious beliefs.
• A lot of healthy people can identify with having some of the symptoms of OCD, such as checking the stove several times before leaving the house. [1]

6. Post-Traumatic Stress Disorder:

In general, Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images. Anniversaries of the event are often very difficult. Post-Traumatic Stress Disorder (in other words, PTSD) is a debilitating condition that follows a terrifying event. Often, people with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to.  These include kidnapping, serious accidents such as car or train wrecks, natural disasters such as floods or earthquakes, violent attacks such as a mugging, rape, or torture, or being held captive. Or it could be something witnessed, such as mass destruction after a plane crash. PTSD can occur at any age, including childhood.
Patients may also experience sleep problems, depression, feeling detached or numb, or being easily startled. People may lose interest in things they used to enjoy and have trouble feeling affectionate. They may feel irritable, more aggressive than before, or even violent.
A person having a flashback, which can come in the form of images, sounds, smells, or feelings, usually believes that the traumatic event is happening all over again.

Pathogenesis:

Pathophysiology

The significant mediators of anxiety in the central nervous system are thought to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). The autonomic nervous system, especially the sympathetic nervous system, mediates most of the symptoms.

The amygdala plays an important role in tempering fear and anxiety. Patients with anxiety disorders have been found to show heightened amygdala response to anxiety cues. The amygdala and limbic system structures are connected to prefrontal cortex regions, and prefrontal-limbic activation abnormalities may be reversed with psychological or pharmacologic interventions.[4]

Clinical Features:

Sign and Symptoms

• muscle tension
• chest tightness
• heart palpitations
• high blood pressure
• insomnia
• digestive problems
• panic attacks
• irritability
• difficulty concentrating
• restlessness
• sweating
• anxiousness
• inability to socialize

Physical examination

• The following are the some of the physical examination findings associated with anxiety disorders i.e.:

Appearance of the patient i.e.

• The patient appears panicky, restless, anxious

HEENT i.e.

• Dry mouth

Extremities i.e.

• Cold, sweaty, tingling of hands and feet

Respiratory i.e.

• Shortness of breath

Cardiovascular i.e.

• Tachycardia, palpitations

Musculoskeletal i.e.

• Tense muscles

Central nervous system i.e.

• Dizziness

Mental status examination i.e.

Complete mental status examination should be obtained for each patient with anxiety symptoms, assessing appearance, behavior, ability to cooperate with the exam, level of activity, speech, mood and affect, thought processes also content, insight, and judgment. Patients are generally oriented times 3 and cooperative. Mood may be normal or depressed.

Affect is often preserved. Psychotic symptoms are not typical of uncomplicated anxiety disorders. Suicidal ideation should be assessed by asking about passive thoughts of death, desires to be dead, thoughts of harming self, or plans or acts to harm self. Homicidal ideation is uncommon. Cognition is typically intact with no impairment in memory, language, or speech. Insight also judgment are typically intact.[5]

Diagnosis

Generally, Anxiety is not a simple diagnosis. It’s not caused by a germ that can be detected in a blood test. It takes many forms and can also accompany other medical conditions.

To diagnose anxiety, a complete physical examination is essential. Additionally, This helps your doctor discover or rule out other illnesses that may be causing your symptoms or that may be masked by the symptoms. A complete personal history is also necessary for your doctor to make an accurate diagnosis.

Diagnostic criteria

An anxiety diagnosis depends a lot on your description of the symptoms you’re experiencing. Mental health professionals use the “Diagnostic and Statistical Manual of Mental Disorders” (often called the DSM) to diagnose anxiety and other mental disorders based on symptoms. The criteria differ for each anxiety disorder.

The DSM lists the following criteria for generalized anxiety disorder (GAD) i.e.:

• excessive anxiety and worry most days about many things for at least six months
• difficulty controlling your worry
• appearance of three of the following six symptoms: restlessness, fatigue, irritability, muscle tension, sleep disturbance, and difficulty concentrating
• symptoms significantly interfering with your life
• symptoms not being caused by direct psychological effects of medications or medical conditions
• symptoms aren’t due to another mental disorder (e.g. anxiety about oncoming panic attacks with panic disorder, anxiety due to a social disorder, etc.)[6]

Differential Diagnosis

• Pheochromocytoma
• Asthma
• Atrial fibrillation
• Hyperthyroidism
• Alcoholism
• Delirium
• Diabetic ketoacidosis
• Substance abuse[4]

Complications:

Investigation

• complete blood cell count (CBC) chemistry profile,
• thyroid function tests,
• urinalysis, also
• urine drug screen.

If the anxiety symptoms are atypical or there are some abnormalities noted in the physical examination more detailed evaluations may be indicated to identify or exclude underlying medical conditions.

This would include the following i.e.:

• electroencephalography,
• brain computed tomography (in other words, CT) scan,
• electrocardiography,
• tests for infection,
• arterial blood gas analysis,
• chest radiography, also
• thyroid function tests.[4]

Treatment

Anxiety disorders are generally treated with psychotherapy, medication, or both.

Psychotherapy i.e.:

• Psychotherapy or “talk therapy” can help people with anxiety disorders.
• To be effective, psychotherapy must be directed at the person’s specific anxieties and tailored to his or her needs.
• A typical “side effect” of psychotherapy is temporary discomfort involved with thinking about confronting feared situations.

Cognitive Behavioral Therapy (in other words CBT):

• CBT is a type of psychotherapy that can help people with anxiety disorders. Similarly, It teaches a person different ways of thinking, behaving, also reacting to anxiety-producing and fearful situations.
• CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.
• Two specific stand-alone components of CBT used to treat social anxiety disorder are cognitive therapy and exposure therapy.
• Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful thoughts underlying anxiety disorders.

Exposure therapy:

• This therapy focuses on confronting the fears underlying an anxiety disorder in order to help people engage in activities they have been avoiding.
• It is especially, used along with relaxation exercises and/or imagery. One study, called a meta-analysis because it pulls together all of the previous studies and calculates the statistical magnitude of the combined effects, found that cognitive therapy was superior to exposure therapy for treating social anxiety disorder.
• CBT may be conducted individually or with a group of people who have similar problems. Besides this, Group therapy is particularly effective for social anxiety disorder. Often “homework” is assigned for participants to complete between sessions.

Self-Help or Support Groups:

• Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others.
• Internet chat rooms might also be useful, but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each other and false identities are common.
• Talking with a trusted friend or member of the clergy can also provide support, but it is not necessarily a sufficient alternative to care from an expert clinician.

Stress-Management Techniques:

• Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy.
• While there is evidence that aerobic exercise has a calming effect, the quality of the studies is not strong enough to support its use as treatment.
• Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, please avoiding them should be considered.

Drug treatment:

The drugs of choice for generalised anxiety disorder have traditionally been  benzodiazepines, and for panic disorder, antidepressants. It is useful to begin the treatment of panic disorders with small doses of antidepressants, usually SSRIs (e.g. fluoxetine).

• Benzodiazepines (such as alprazolam and clonazepam): are useful in short-term treatment of both generalised anxiety and panic disorders.
• Several antidepressants (such as sertraline): are now licensed for treatment of anxiety and panic disorders.
• β-blockers such as propranolol and atenolol: are particularly useful in the management of  anticipatory anxiety (e.g. anxiety occurring before going on stage or before examinations). However, due care must be exercised in the use of propranolol in the patients with history of asthma, bradycardia or heart block.

Atenolol

• does not cross the blood brain barrier and takes care of only the peripheral symptoms of anxiety. It also has less likelihood of causing bronchial constriction than propranolol.

Buspirone:

• is an anti-anxiety drug which does not have any dependence potential, unlike It takes about 2-3 weeks before its action is apparent. It may be preferable to benzodiazepines for the long–term management of anxiety disorder. It, however, has not much role in the management of panic disorder. [2]

Prevention

Coping mechanisms may help you handle anxiety that comes from life’s stressors. Here are some things you can try i.e.:

• Exercise
• Meditation
• Relaxation exercises, including deep breathing
• Visualization
• Good sleep habits
• Healthy diet
• Learn interpersonal skills for dealing with difficult people also situations or get parenting skills training for help dealing with your children[7]

Homeopathic Treatment of Anxiety  Disorders

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines of Anxiety disorders:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

The following remedies may be useful to you in treating symptoms of anxiety.

Aconite:

A panic attack that comes on suddenly with very strong fear (even· fear of death) may indicate this remedy. Strong palpitations may accompany a state of immense anxiety, shortness of breath, also flushing of the face.

Symptoms i.e.:

1. Sudden, intense ailments from fright.
2. Anxiety also restlessness with complaints.
3. Fears that do not subside.
4. Either Faintness or dizziness upon waking up.
5. Sudden fever with one cheek red, the other pale.
6. Intolerance of pain.
7. Painful urination with anxiety.
8. Pains· followed by numbness also tingling.
9. Eye pain also injuries.
10. Throbbing headache.
11. Unquenchable thirst.

Argentum nitricum:

This remedy is indicated when anxiety develops before a big event. (for instance, an interview for job, an exam, a public speech, social engagement, marriage, etc.)

Symptoms i.e.:

1. Emotional upset.
2. Fear.
3. Anxiety.
4. Extended period of either unusual or continued mental exertion.
5. Dizziness.
6. Diarrhoea.
7. Craving for sweets and salt. Additionally, Craving for strong flavours.
8. Enthusiastic and suggestible, with a tendency towards peculiar thoughts also impulses.

Arsenicum album:

This remedy is recommended for people who are deeply anxious about their health, also extremely concerned with order and security. Panic attacks often occur around midnight or the very early hours of the morning. Generally, The person may feel exhausted and still be restless fidgeting, pacing, and anxiously moving from place to place. These people may also have digestive problems or asthma attacks accompanied by anxiety. Moreover, They are typically obsessive about small details and very neat. Lastly, they may feel a desperate need to be in control of everything.

Symptoms i.e.:

1. Anxious.
2. Anxiety associated with later stages of head cold, also with sneezing.
3. Asthma worse after midnight, fears, suffocation while lying down.
4. Fearful.
5. Irritable.
6. Restless.
7. Sleepiness but insomnia.
8. Thirsty for frequent small drinks.
9. Weak and exhausted.
10. Desires Air but is sensitive to cold.
11. Vomiting, with or without diarrhoea, after eating also drinking.

Calcarea carbonica:

People who benefit most from this remedy have a chilly constitution. The slightest cold "goes right through them." They have trouble keeping them- selves warm. Calcarea patient have especially a craving for sweets, and are easily fatigued. They are dependable, solid people who become overwhelmed either from physical illness or too much work and start to fear a breakdown. Furthermore, Their thoughts can be muddled and confused when tired, which adds to the anxiety. Worry also bad news may agitate them, and a nagging dread of disaster ( either to themselves or others) may develop. Fear of heights and claustrophobia are also common.

Symptoms i.e.:

1. Increased perspiration.
2. Night sweats.
3. Cold hands also feet.
4. Dizziness.
5. Nausea.
6. Ravenous hunger.
7. Aversion to fats .
8. Craving especially for eggs.
9. Eyes specifically sensitive to light.
10. Pale face.
11. Large appetite especially with slow digestion.

Gelsemium:

This remedy is specifically indicated when you have feelings of weakness, trembling, and mental dullness (in other words being "paralyzed by fear"). It is also useful when a person experiences anxiety about an upcoming event such as stage-fright about a public performance or interview, or anxiety before a test, impending visit to the dentist, or other stressful events. Chills, perspiration, diarrhea, and headaches will often occur with nervousness. Besides this, Fear of crowds, a fear of falling, and even a fear that. the heart might stop are other indications for Gelsemium.

Symptoms i.e.:

1.Nervousness.
2. Apprehension.
3. Anxiety either prior to an examination or public performance.
4. Fatigue also aching of whole body.
5. Limbs, head, eyelids heavy.
6. Headache.
7. Scalp sore to touch.
8. Sore throat.
9. Lack of thirst.
10. Dizziness, trembling, fatigue, also dullness.

Ignatia amara:

A sensitive person who is anxious because of grief, loss, disappointment, criticism, loneliness ( or in other words any stressful emotional experience) may benefit from this remedy. Additionally, The primary factor for this remedy is emotional stress, especially disappointment or grief. Other indications are a defensive attitude, frequent sighing, and mood swings. Surprisingly, The person may burst unexpectedly into either tears or laughter.

Symptoms i.e.:

1.Vomiting.
2. Sensation of a lump in the throat.
3. Chills with fever.
4. Thirst during chills.
5. Chills relieved by warmth.
6. Cramping pains either in the abdomen or back.
7. Headaches that feel like a nail driven into the side of the head.
8. Skin very sensitive to drafts.
9. Introspective.
10. Sad. Likewise Brooding.
12. Tearful.
13. Rejects company.
14. Disappointed.
15. Grieving.
16. Insomnia specifically from emotional distress.
17. Nausea relieved by eating.
18. Eating intensifies hunger.

Kali phosphoricum:

Indicated when a person has been exhausted by overwork or illness. Feels a deep anxiety and inability to cope. Jumpy and oversensitive. May be startled by ordinary sounds. Hearing unpleasant news or thinking of world events can aggravate the problems. Insomnia and an inability to concentrate may develop, increasing the sense of nervous dread. Eating, warmth, also rest often bring relief.

Symptoms i.e.:

1. Exhaustion.
2. Deep anxiety also inability to cope.
3. Headaches.
4. Jumpy also oversensitive.
5. Startled by ordinary sounds.
6. Backaches.
7. Nervous digestive upsets.

Lycopodium:

Lycopodium patients attempt to cover an inner sense of inadequacy by putting up fronts, by pretending to be something they are not. They feel anxiety from mental stress and suffer from a lack of confidence. He can be self-conscious so that he feel intimidated by people they perceive as powerful. Additionally, Person can feel a deep anxiety and fear of failure, when they take on responsibility and usually do well, once started on a task.

Symptoms i.e.:

1. Shakes head without any apparent cause.
2. Facial contortions.
3. Gassy, either constipation or diarrhoea.
4. Sour belching.
5. Claustrophobia.
6. Irritability.
7. Digestive upsets with gas also bloating.
8. Craves sweets, warm food also drink.
9. Night cough.
10. Wants to be alone.
11. Cranky on waking.
12. Bullying tendency.
13. Fear of failure.
14. Breaking down under stress.

Natrum muriaticum:

The primary candidates for this remedy are personally aloof but have a social conscience and a desire to help others. Deep emotions and a self- protective shyness can make these people seem reserved, aloof, and private. Even when feeling lonely, they tend to stay away from social situations, not knowing what t? say or do. Easily hurt also offended, they can brood, bear grudges, dwell on unhappy feelings, and isolate themselves. Additionally, They refuse consolation even when they want it. They are often sympathetic listeners to other people’s problems. Claustrophobia, anxiety at night (either with fears of robbers or intruders), migraines, and insomnia are often seen when this remedy is needed.

Symptoms i.e.:

1.Tongue feels dry.
2. Mucous membranes dry.
3. Nausea.
4. Insomnia.
5. Claustrophobia.
6. Migraine headache.
7. Vomiting.
8. Pain around eyes.
9. Craves salt and dry food.
10. Weepy but won’t let others see it.
11. Consolation aggravates them.
12. Angry from isolation.
13. Fright, grief, also anger.
14. Nervous, discouraged, broken down.
15. Depressed.

Phosphorus:

Indicated when the victims are openhearted, imaginative, excitable, easily startled, and full of intense and vivid fears. Just thinking of almost anything can easily trigger strung anxiety. Always nervous and sensitive to others. They can overextend themselves with sympathy to the point of feeling exhausted and "spaced out" or even getting ill. Also need a lot of company and reassurance. A person often feel better from conversation or a back-rub. Easy flushing of the face, palpitations, thirst, also a strong desire for cold, refreshing food are other indications for Phosphorus.

Symptoms i.e.:

1. Anxious.
2. Fearful.
3.Weak .
4. Associated with hoarseness.
5. Tight heavy chest.
6. Dry rasping cough.
7. Burning pains specifically, in stomach, abdomen, between shoulder blades.
8. Thirst for cold drinks that are vomited.
9. Nausea.
10. Night sweats.

Pulsatilla (Puls):

People who need this remedy often express anxiety as insecurity and clinginess, with a need for constant support also  comforting. They fear being alone. Additionally, They are easily discouraged, moody, tearful, whiny, even emotionally childish. Besides this Getting too warm or being in a stuffy room often increases anxiety. Anxiety around the time of hormonal changes (for example puberty, menstrual periods, or menopause) often is helped with Pulsatilla.

Symptoms i.e.:

1. Sensitive
2.Weepy.
3. Wants attention also sympathy.
4. Changeable symptoms also moods.
5. Craves open air.
6. Sensitive to heat.
7. Dry mouth with lack of thirst.
8. Rich food upsets stomach.
9. Insomnia from recurring thought.
10. Head colds.
11. Loose cough, especially worse at night.
12. Delayed menstrual period with scanty flow.

Silicea (Silica):

Indicated for those who are capable and serious, yet are also nervous, shy, and subject to bouts of temporary loss of confidence. Anxiety can be extreme when they are faced with a public appearance, interview, examination, or any new job or task. Worry and overwork can bring on headaches, difficulty concentrating, also states of exhaustion, over sensitivity, also dread.

Symptoms i.e.:

1. Worry.
2. Overwork.
3. Headaches.
4. Difficulty concentrating.
5. Exhaustion.
6. Over sensitivity.
7. Overreact and devote attention to tiny details.
8. Low stamina.
9. Frequently catch colds, sore throats, occasionally, other illnesses.

The Diet & Regimen

Diet e.g.:

1. Eat a Clean also Well-Balanced Diet
2. Avoid Sugary also Processed Foods
3. Limit Caffeine also Alcohol

Supplements e.g.:

4. Ashwagandha
5. Kava Root
6. Vitamin B Complex

Essential Oils e.g.:

7. Lavender Oil
8. Roman chamomile essential oil

Lifestyle e.g.: 

9. Physical Activity also Exercise
10. Get Enough Rest
11. Meditation

The Do’s & Don’ts

Do’s:

• Practice relaxation techniques like deep breathing and progressive muscle relaxation.
• Challenge negative thoughts and replace them with more realistic ones.
• Gradually face your fears in a controlled and safe environment.
• Maintain a healthy lifestyle with regular exercise, balanced nutrition, and adequate sleep. [18]
• Seek professional help from a therapist specializing in anxiety disorders.
• Engage in cognitive-behavioral therapy (CBT), which has been shown to be effective for anxiety.
• Learn and practice coping skills to manage anxiety triggers.
• Build a strong support network of friends, family, or support groups. [19]
• Practice mindfulness to increase awareness of your thoughts and feelings without judgment.
• Accept your anxiety as a natural human experience rather than trying to fight it.
• Identify your values and set goals that align with them.
• Take action towards your goals, even when feeling anxious.[20]

Don’ts:

• Avoid situations that trigger your anxiety.
• Self-medicate with alcohol or drugs.
• Isolate yourself from supportive friends and family.
• Engage in excessive worry or rumination. [18]
• Rely solely on medication for anxiety management.
• Give up on treatment if you experience setbacks.
• Compare your progress to others.[19]
• Get caught up in trying to control your anxiety or eliminate it completely.
• Avoid situations that trigger your anxiety.
• Let your anxiety dictate your choices and behaviors. [20]

References

1. Homeopathy in treatment of Psychological Disorders by Shilpa Harwani / ch 7.
2. A Short Textbook of PSYCHIATRY 7th edition by Niraj Ahuja / ch 8.
3. Psychiatry, Fourth Edition – Oxford Medical Publications -SRG-by John Geddes, Jonathan Price, Rebecca McKnight / ch 24.
4. https://www.ncbi.nlm.nih.gov/books/NBK470361/
5. https://www.wikidoc.org/index.php/ Anxiety_physical_examination
6. https://www.healthline.com/health/anxiety-diagnosis
7. https://www.webmd.com/ anxiety-panic/guide/causes-anxiety

8. Lancet Study (2017)

9. Lancet Study (2021)

10. World Health Organization (WHO) Data (2020)

11. National Mental Health Survey (NMHS) of India (2016)

12. Epidemiology of anxiety disorders: global burden and sociodemographic associations (2023)

13. Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (11th Edition)
14. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (4th Edition)
15. The Neurobiology of Anxiety Disorders: Brain Imaging, Genetics, and Psychoneuroendocrinology (1st Edition)
16. Anxiety Disorders: A Comprehensive Review of Assessment and Treatment (1st Edition)
17. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)
18. The Anxiety and Phobia Workbook (7th Edition)
19. Mastery of Your Anxiety and Panic (MAP-4): Therapist Guide (Treatments That Work)
20. The Mindfulness and Acceptance Workbook for Anxiety: A Guide to Breaking Free from Anxiety, Phobias, and Worry Using Acceptance and Commitment Therapy (ACT)