However, there are forms of persistent or unusual anxiety, and these can be concerning to parents. A child may refuse to leave a parent, miss school, or constantly cry. They may refuse to talk to people. They may also feel shortness of breath, clammy hands, or have an increased heart rate. These symptoms are typical of various types of anxiety disorders:

Generalized Anxiety Disorder is an anxiety disorder with persistent worrying of six months or more, even without a significant stressor. A child with a generalized anxiety disorder may constantly worry about lunchtime, getting hurt, war, safety, or illness. They may worry about the future, of losing loved ones, or the weather. Constantly worrying can decrease a child’s focus in school, interaction with their classmates, ability have fun, or sleep quality.¹

Panic Disorder involves recurrent and unexpected panic attacks that do not have any known trigger. It was previously thought to occur only in adults, but current research has found that children also experience panic disorder. Girls have a higher risk of panic disorder than boys.²

Separation Anxiety Disorder is an overwhelming fear of separation from home or any figure that a child may be attached to, lasting for at least four weeks. While any child would feel anxious to leave a person or home behind, this is normal until four. Older children should be able to leave the house and their parents or guardians. Some signs of separation disorder may include attempts to avoid school by pretending to be sick.¹

Social Anxiety Disorder (Social Phobia) is a fear of embarrassment in social situations, like public speaking, parties, or public restrooms. Some children may freeze when speaking in front of a class. An extreme form of social phobia is called selective mutism. Children with selective mutism can become so fearful that they would not talk, except at home or with their closest friends. ¹

Specific phobias are extreme and constant anxiety or fear caused by the presence or the expectation of a particular object or situation. While a parent may generally calm a child’s fears, a persistent fear lasting for at least six months may indicate a specific phobia. Some examples are fear of animals, insects, going to the doctor, people in costumes, tunnels, needles, or vomiting.¹ Agoraphobia is a specific phobia that involves a fear of being unable to escape a difficult situation and may be manifested by a fear of public transport, visiting a shopping center, or leaving the house.³

What Causes Anxiety Disorders in Children?

Genetics can play a role in anxiety, as children who have family members with anxiety have a higher chance of having anxiety. Brain chemicals (called neurotransmitters) in each person may also lead to anxiety, especially those within the amygdala, hippocampus, prefrontal cortex.⁴ Social and environmental factors also play a crucial role in forming anxiety in children, like scary encounters (such as with dogs)⁵ and anxious, overprotective, or critical parenting behaviors.⁶

In knowing the signs of anxiety and its possible causes, a parent or guardian can seek help for their child through a psychiatrist who may provide the appropriate therapy.

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It is essential to consider that medications that cross the blood-brain barrier can cross the placenta, hence reaching the baby. It can also enter breast milk (to a less extent)

Unfortunately, the answer is not always clear-cut, so it is reasonable to consider various sources of clinical knowledge, like clinical guidelines of psychiatric and obstetric medical societies, systematic reviews, meta-analyses, and randomized clinical trials. 

Currently, here is the knowledge available for drug classes commonly used for anxiety:

Benzodiazepines

Benzodiazepines are drugs like triazolam, oxazepam, midazolam, alprazolam, lorazepam, temazepam, diazepam, chlordiazepoxide, flurazepam. Benzodiazepines are used for acute episodes of anxiety and panic attacks by reducing the stimulation of nerves. However, benzodiazepine use during pregnancy has led to some reports of orofacial clefts, apnea, hypotonia, and feeding difficulties in infants.¹

Some doctors may still prescribe benzodiazepines in pregnancy when the benefit exceeds the risks. ¹

Non-benzodiazepine anxiolytics and hypnotics

Buspirone and Zolpidem are the two drugs under this drug class that are relatively safe for pregnancy. On the other hand, drugs such as Eszopiclone and Zaleplon have more risks during pregnancy.²

Selective Serotonin Reuptake Inhibitors (SSRIs)

There is a lack of evidence of the ill effects of SSRIs on fetuses and breastfeeding. There have been short-term complications of SSRIs like maternal weight changes and premature delivery³. However, it should be weighed versus the risk of relapse if the medications are discontinued. The approach to modifying SSRIs should be individualized for each patient and discussed with a physician. 

Paroxetine, however, should be avoided by pregnant women and women who plan on conceiving because of heart defects in infants.²

Selective Norepinephrine Reuptake Inhibitors (SNRIs)

Another option during pregnancy would be SNRIs, like duloxetine and venlafaxine. These drugs are considered relatively low-risk. However, there is a small risk of postpartum hemorrhage (bleeding after giving birth) and congenital heart defects.⁴

Tricyclic Antidepressants (TCAs)

TCAs can help both anxiety and depression, most commonly when other medications have not helped. A TCA like clomipramine may lead to heart defects. However, an alternative TCA, like maprotiline, has no documented effects on fetuses and is considered safer during pregnancy.²

Takeaways

Women who are planning on conceiving and whose symptoms of anxiety are mild may be able to taper off their medications. However, if there is any history of severe anxiety, depression, bipolar disorder, or suicide attempts, it may be better to maintain medications than risk a relapse. It may be better for the baby overall. 

A consult with your psychiatrist and obstetrician can help reduce your risk as well as improve the health of your child by tapering, modifying, or discontinuing your medications while pregnant. Other than medications, it is also important to do other non-medical ways to help reduce your stress. 

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1. Deep breathing exercises. Remember to take slow, deep breaths whenever you recognize that your breathing becomes quick and shallow. It increases the oxygen in your body and helps induce calm and a sense of control. Try breathing in for about four seconds, holding your breath, then slowly breathing out for another four seconds. This exercise can help remind you to take things slow.
2. Close your eyes. Sometimes, an overwhelming number of stimuli can help start a panic attack. Reducing the triggers by ceasing to look around the environment can help you center yourself in the present.
3. Get enough sleep. Sleep deprivation can lead to worse anxiety and depression than what a person would usually feel. Getting some good quality sleep for at least seven to nine hours a night can help reduce panic attacks. If you are having trouble sleeping, make sure to practice good sleep hygiene, that is, turning off all the lights before you sleep, sleeping in a designated bed, changing to your bedclothes, and making yourself comfortable.
4. Be mindful of where you are. A panic attack can change your view of reality and give you an impending sense of doom. Remind yourself that you are present wherever you are, on the ground beneath your feet.
5. Reduce the caffeine, alcohol, and nicotine. Excess caffeine increases anxiety, as it causes you to palpitate and be more awake.1 While alcohol can help reduce tension in the short run, it can worsen anxiety in periods of sobriety.2 Smoking cigarettes can seem calming, but it can lead to long-term higher levels of anxiety.3
6. Do some exercise. When you exert a certain amount of physical effort, it helps increase the amount of endorphins in your blood. Endorphins are a natural form of feel-good hormones that help to reduce pain and anxiety in the brain. Light cardiovascular exercise can help reduce stress, like a light jog or swimming. Regular exercise can help reduce the total amount of anxiety you may have. Aim to at least have 30 minutes of aerobic exercise three times a week. However, if you are having difficulty breathing, do catch your breath first.
7. Learn to let go. Learning to be more comfortable with uncertainty is challenging. However, a level of acceptance of the unknown is something that we can all strive to attain. After all, there are things that we cannot control, and all we can work on are the things that we can change today – not tomorrow, the next month, or the next year.
8. Understand that many people also have anxiety. Finding a support system of people in your network or outside your network can help you cope with these symptoms together. Anxiety disorder and panic attacks are now more prevalent than ever, and it is okay not to be perfectly fine.
9. Consult with a psychiatrist. Sometimes, a thyroid problem, medications, or recreational drugs can increase anxiety levels, and it may be worth seeking a consult with a psychiatrist. Therapy can help reduce negative thinking patterns and help you cope with uncertainties and fears. Prescription medications such as benzodiazepines (like clonazepam and alprazolam) can help acutely reduce symptoms of anxiety. Remember, these medications can be highly addictive, so decreasing your dose may benefit your body. Long-term anxiety medications, like escitalopram, sertraline, and fluoxetine, may also benefit you as first-line therapy. Many psychiatrists are available through teleconsultation, allowing you to reach them during a panic or anxiety attack, and help keep attacks under your control.

The post What do I do if I am having a panic attack or anxiety attack? appeared first on NowServing Health.

Anxiety is often a key response to stressors in the environment. It is a response that can lead to self-preservation. However, when one has persistent worry and fear that is out of proportion to the situation at hand, or for a prolonged period, then one may consider a possible diagnosis of anxiety disorder.

What are the symptoms and types of anxiety disorder?

Anxiety disorder includes symptoms of restlessness, inability to sleep well, irritability, fatigue, muscle tension, and difficulty concentrating.

There are many types of anxiety disorders, depending on how long the symptoms have been happening and their causes. When symptoms of anxiety, such as a constant fear of something terrible happening without an apparent reason, persist for more than six months, then one may consider the possibility of having generalized anxiety disorder.

There may be obvious triggers for some types of anxiety disorders. For example, social anxiety disorder is triggered by speaking in public or interacting with strangers. Separation anxiety disorder causes symptoms when a person is away from home or loved ones. Some may have specific phobias, like closed spaces, crowds, or public transport. However, there are times that these symptoms simply come without warning.

Symptoms of panic attacks:

When anxiety disorder symptoms escalate in intensity out of proportion to the stressors, it may become a panic attack. Strictly speaking, the DSM-5 does not recognize the term “anxiety attack,” but this may be interpreted as increased intensity of symptoms of worry, distress, or fear. The onset of intense anxiety can result in a panic attack. Still, a panic attack can also come out of the blue without a particular trigger. Repeated panic attacks are known as panic disorder.

• The symptoms of a panic attack can last as long as ten minutes with at least four of the following:
• An uncomfortable awareness of one’s heartbeat (palpitations)
•  Coldness, pins-and-needles sensation, or numbness of the hands and feet (paresthesias)
• A feeling that you are not in touch with reality (depersonalization or derealization)
• Upset stomach (in the form of diarrhea, difficulty swallowing, nausea, or constipation)
• Intense fear of dying
• Fear of losing control
• Light-headedness
• Chest pain or tightness
• Chills
• Choking
• Profuse sweating
• Shaking
• Shortness of breath
• Shaking or trembling

Anxiety and panic symptoms can overlap with other diseases

As one may notice, many of these symptoms may appear to be very somatic or physical. Chest tightness can often be confused with a heart attack but could also be a symptom of anxiety. An upset stomach, gastrointestinal reflux, difficulty swallowing food or water, diarrhea, or constipation can be anxiety symptoms. Other symptoms, like insomnia or uncontrollable crying, can also be symptoms of depression and may coexist with anxiety disorders. Tics, which can be likened to shaking, can also be a symptom of Tourette’s syndrome. Shaking or trembling can be related to hyperthyroidism. To get a clear picture of the causes of one’s symptoms, it is always essential to have a medical workup with a physician.

Why do anxiety disorder or panic disorder cause these symptoms?

The symptoms of anxiety and anxiety attacks are caused by increased activation of the sympathetic nervous system – a physiologic mechanism so that our body can engage in “fight or flight.” The heart rate increases to raise the amount of circulating blood. The gastric system ceases to digest food so that energy is directed towards activities that need urgent movement. Muscles tense and twitch in preparation for an attack.

How do I know if I have an anxiety disorder?

A standardized questionnaire can help screen whether a person is experiencing emotional distress enough to warrant a consult with a physician. One example is the GAD-7 screening tool that allows one to score mild, moderate, moderately severe, or severe anxiety. A score of 10 or higher may warrant a call to a psychiatrist to help assess the possible lifestyle improvements and, if necessary, medications to help one cope with anxiety better. Telemedicine consults have been a great tool to initiate a conversation with a physician to manage anxiety better.

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