Mental Health

Anxiety

Anxiety is a feeling of unease, worry or fear. Everyone feels anxious at some point in their life, but for some people it can be an ongoing problem.
 
A little bit of anxiety can be helpful; for example, feeling anxious before an exam might make you more alert and improve your performance. But too much anxiety could make you tired and unable to concentrate.

Symptoms of anxiety

Anxiety can have both psychological and physical symptoms. Psychological symptoms can include:
 
  • feeling worried or uneasy a lot of the time
  • having difficulty sleeping, which makes you feel tired
  • not being able to concentrate
  • being irritable
  • being extra alert
  • feeling on edge or not being able to relax
  • needing frequent reassurance from other people
  • feeling tearful
 
When you’re feeling anxious or stressed, your body releases stress hormones, such as adrenaline and cortisol. These cause the physical symptoms of anxiety, such as an increased heart rate and increased sweating.
 
Physical symptoms can include:
 
  • a pounding heartbeat
  • breathing faster
  • palpitations (an irregular heartbeat)
  • feeling sick
  • chest pains
  • headaches
  • sweating
  • loss of appetite
  • feeling faint
  • needing the toilet more frequently
  • “butterflies” in your tummy
 
Anxiety can also be a symptom of another condition, such as panic disorder (when you have panic attacks) or post-traumatic stress disorder, which is caused by frightening or distressing events.

Is anxiety bad for you?

A little anxiety is fine, but long-term anxiety may cause more serious health problems, such as high blood pressure (hypertension). You may also be more likely to develop infections. If you’re feeling anxious all the time, or it’s affecting your day-to-day life, you may have an anxiety disorder or a panic disorder.

Help for anxiety and panic

There are effective treatments available for anxiety and panic disorders, so do talk to your GP if you think you may benefit from them.
 
You could also consider using an online mental health service, ask your GP or mental health professional, or contact the service directly to find out.

Panic disorder

Panic disorder is where you have recurring and regular panic attacks, often for no apparent reason.
 
Everyone experiences feelings of anxiety and panic at certain times during their lifetime. It’s a natural response to stressful or dangerous situations.
 
However, for someone with panic disorder, feelings of anxiety, stress and panic occur regularly and at any time. 
 
There are several conditions that can cause severe anxiety including
 
  • phobias – an extreme or irrational fear of an object, place, situation, feeling or animal
  • generalised anxiety disorder (GAD) – a long-term condition that causes excessive anxiety and worry relating to a variety of situations
  • post-traumatic stress disorder – a condition with psychological and physical symptoms caused by distressing or frightening events

Panic attacks

A panic attack occurs when your body experiences a rush of intense psychological (mental) and physical symptoms.
 
You may experience an overwhelming sense of fear, apprehension and anxiety. As well as these feelings, you may also have physical symptoms such as:
 
  • nausea
  • sweating
  • trembling
  • a sensation that your heart is beating irregularly (palpitations)
 
The number of panic attacks you have will depend on how severe your condition is. Some people may have one or two attacks each month, while others may have several attacks a week.
 
Panic attacks can be very frightening and intense, but they’re not dangerous. An attack won’t cause you any physical harm, and it’s unlikely that you’ll be admitted to hospital if you’ve had a panic attack.

What causes panic disorder?

As with many mental health conditions, the exact cause of panic disorder isn’t fully understood.
 
However, it’s thought the condition is probably linked to a combination of physical and psychological factors.
 
It’s important to be aware that some physical conditions and disorders can have similar symptoms to those of anxiety. For example:
 
  • mitral valve prolapse
  • postural orthostatic tachycardic syndrome (POTS)
  • anaemia
  • paroxysmal atrial tachycardia – episodes of rapid and regular heartbeats that begin and end abruptly
  • thyrotoxicosis – where large amounts of thyroid hormones are released into the bloodstream, causing rapid heartbeat, sweating,tremor and anxiety
  • poorly controlled diabetes
  • adrenal tumours – growths that develop on the adrenal glands (two triangular-shaped glands that form part of the kidneys)
  • carcinoid syndrome – a set of symptoms caused by some carcinoid tumours that can develop in the cells of the endocrine system (glands that produce and secrete hormones)
  • Zollinger-Ellison syndrome – causes overproduction of insulin and low blood sugar (hypoglycaemia)

Diagnosing panic disorder

See your GP if you have symptoms of anxiety or panic disorder (see above).
 
You may be diagnosed with panic disorder if you experience recurrent and unexpected panic attacks followed by at least one month of continuous worry or concern about having further attacks.

Treating panic disorder

The aim of treating panic disorder is to reduce the number of panic attacks you have and ease the severity of your symptoms.
 
Psychological therapy and medication are the two main types of treatment for panic disorder.
Complications of panic disorder,Panic disorder is treatable, but to make a full recovery it’s important that you seek medical help as soon as possible. Treatment for panic disorder is much more effective if it’s given at an early stage.
 
Left untreated, panic disorder can become a very debilitating and isolating illness. It can also increase your risk of developing other mental health conditions, such as agoraphobia or other phobias.
 
Agoraphobia is a fear of being in situations where escape might be difficult, or help wouldn’t be available if things go wrong.

Depression and Low Mood 

Most people experience ups and downs in their life, and can feel unhappy, depressed, stressed or anxious during difficult times. This is a normal part of life.
 
Many difficult events and experiences can leave us in low spirits or cause depression: relationship problems,bereavement, sleep problems, stress at work, bullying, illness, and pain being just a few.
 
Changes to hormones, such as during puberty, after childbirth and during the menopause, can also have an effect on your emotional and mental health.
 
But sometimes it’s possible to feel down without there being an obvious reason.

What is the difference between low mood and depression?

A general low mood can include:
 
  • sadness
  • an anxious feeling
  • worry
  • tiredness
  • low self-esteem
  • frustration
  • anger
 
However, a low mood will tend to improve after a short time. Making some small changes in your life, such as resolving a difficult situation or talking about your problems and getting more sleep, can improve your mood. 
 
A low mood that doesn’t go away can be a sign of depression. Symptoms of depression can include the following:
 
  • continuous low mood or sadness
  • feeling hopeless and helpless
  • having low self-esteem 
  • feeling tearful
  • feeling guilt-ridden
  • feeling irritable and intolerant of others 
  • having no motivation or interest in things
  • finding it difficult to make decisions
  • not getting any enjoyment out of life
  • having suicidal thoughts or thoughts of harming yourself
  • feeling anxious or worried
 
Depression can also come on at specific points in your life, such as the winter months (SAD) and after the birth of a child (postnatal depression).

Getting help

Whatever the cause, if negative feelings don’t go away, are too much for you to cope with, or are stopping you from carrying on with your normal life, you may need to make some changes and get some extra support.
 
“We all know what it feels like to be down,” says Professor David Richards, professor of mental health services research at the University of Exeter. “Most people who feel low will start to feel better after a few days or weeks. But if these feelings persist or get in the way of everyday life, it’s time to seek help.”
 
If you’re still feeling down or anxious after a couple of weeks, talk to your GP or call NHS 111. A GP will be able to discuss your symptoms with you and make a diagnosis.

Seek help immediately

If you start to feel like your life isn’t worth living, get help straight away. see your GP. If you’ve had depression or anxiety in the past, even if they weren’t formally diagnosed, get help immediately. You’re more likely to have an episode of depression if you’ve had one before.

What type of help is available?

Self-help

 
Whether you have depression or just find yourself feeling down for a while, it could be worth trying some self-help techniques. However, if your GP has diagnosed depression, it is important that you also continue with your prescribed treatment.
 
Life changes, such as getting a regular good night’s sleep, keeping to ahealthy diet, reducing your alcohol intake and getting regular exercise, can be effective in helping you feel healthier and more relaxed. This can often help people feel more in control and more able to cope.
 
Self-help techniques can include activities such as meditation,breathing exercises and learning ways to think about problems differently. Tools such as self-help books and online counselling can be very effective.
 
If you are diagnosed with depression, your GP will discuss all of the available treatment options with you, including antidepressants and talking therapies.
 

Talking therapies

 
There are many types of talking therapies available. Different types of talking therapies suit certain problems, conditions and people better than others. To help you decide which one would be most suitable for you, talk to your GP about the types of talking therapy on offer, and let them know if you prefer a particular one.
 

Antidepressants

 
Antidepressants are a type of medication commonly used to treat depression and other conditions. There are several types available, including SSRIs (selective serotonin reuptake inhibitors), TCAs (tricyclic antidepressants) and MAOIs (monoamine oxidase inhibitors). If your GP prescribes you antidepressants, they will explain the type they have chosen and why it suits you.

What is stress?

Stress is the feeling of being under too much mental or emotional pressure.
 
Pressure turns into stress when you feel unable to cope. People have different ways of reacting to stress, so a situation that feels stressful to one person may be motivating to someone else.
 
Many of life’s demands can cause stress, particularlywork, relationships and money problems. And, when you feel stressed, it can get in the way of sorting out these demands, or can even affect everything you do.
Stress can affect how you feel, think, behave and how your body works. In fact, common signs of stress include sleeping problems, sweating, loss of appetite and difficulty concentrating.
 
You may feel anxious, irritable or low in self esteem, and you may have racing thoughts, worry constantly or go over things in your head. You may notice that you lose your temper more easily, drink more or act unreasonably.
 
You may also experience headaches, muscle tension or pain, or dizziness.
 
Stress causes a surge of hormones in your body. These stress hormones are released to enable you to deal with pressures or threats – the so-called “fight or flight” response. 
 
Once the pressure or threat has passed, your stress hormone levels will usually return to normal. However, if you’re constantly under stress, these hormones will remain in your body, leading to the symptoms of stress.

Managing stress in daily life

Stress is not an illness itself, but it can cause serious illness if it isn’t addressed. It’s important to recognise the symptoms of stress early. Recognising the signs and symptoms of stress will help you figure out ways of coping and save you from adopting unhealthy coping methods, such as drinking or smoking.
 
Spotting the early signs of stress will also help prevent it getting worse and potentially causing serious complications, such as high blood pressure.
 
There is little you can do to prevent stress, but there are many things you can do to manage stress more effectively, such as learning how to relax, taking regular exercise and adopting good time-management techniques.
 
Studies have found that mindfulness courses, where participants are taught simple meditations across a series of weeks, can also help to reduce stress and improve mood.

Recognising your stress triggers

If you’re not sure what’s causing your stress, keep a diary and make a note of stressful episodes for two-to-four weeks. Then review it to spot the triggers.
 
Things you might want to write down include:
 
  • the date, time and place of a stressful episode
  • what you were doing 
  • who you were with
  • how you felt emotionally 
  • what you were thinking 
  • what you started doing 
  • how you felt physically 
  • a stress rating (0-10 where 10 is the most stressed you could ever feel)
 
You can use the diary to:
 
  • work out what triggers your stress 
  • work out how you operate under pressure 
  • develop better coping mechanisms
 
Doctors sometimes recommend keeping a stress diary to help them diagnose stress.

Take action to tackle stress

There’s no quick-fix cure for stress, and no single method will work for everyone. However, there are simple things you can do to change the common life problems that can cause stress or make stress a problem.
 
These include relaxation techniques, exercise and talking the issues through.

Get stress support

Because talking through the issues is one of the key ways to tackle stress, you may find it useful to attend a stress management group or class. These are sometimes run in doctors’ surgeries or community centres. The classes help people identify the cause of their stress and develop effective coping techniques.
 
Ask your GP for more information if you’re interested in attending a stress support group. You can also use the search directory to find emotional support services in your area.

Post-traumatic stress disorder (PTSD) 

Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events.
 
Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt.
 
They may also have problems sleeping, such as insomnia, and find concentrating difficult. These symptoms are often severe and persistent enough to have a significant impact on the person’s day-to-day life.

Causes of PTSD

The type of events that can cause PTSD include:
 
  • serious road accidents
  • violent personal assaults, such as sexual assault, mugging or robbery
  • prolonged sexual abuse, violence or severe neglect
  • witnessing violent deaths
  • military combat
  • being held hostage
  • terrorist attacks
  • natural disasters, such as severe floods, earthquakes or tsunamis
 
PTSD can develop immediately after someone experiences a disturbing event or it can occur weeks, months or even years later.
 
PTSD is estimated to affect about 1 in every 3 people who have a traumatic experience, but it’s not clear exactly why some people develop the condition and others don’t.

Complex PTSD

People who repeatedly experience traumatic situations such as severe neglect, abuse or violence may be diagnosed with complex PTSD.
Complex PTSD can cause similar symptoms to PTSD and may not develop until years after the event. It’s often more severe if the trauma was experienced early in life as this can affect a child’s development.

When to seek medical advice

It’s normal to experience upsetting and confusing thoughts after a traumatic event, but most people improve naturally over a few weeks.
 
You should visit your GP if you or your child are still having problems about four weeks after the traumatic experience, or if the symptoms are particularly troublesome.
 
If necessary, your GP can refer you to mental health specialists for further assessment and treatment.

How PTSD is treated

PTSD can be successfully treated, even when it develops many years after a traumatic event.
 
Any treatment depends on the severity of symptoms and how soon they occur after the traumatic event. Any of the following treatment options may be recommended:
 
  • watchful waiting – monitoring your symptoms to see whether they improve or get worse without treatment
  • psychotherapy – such as trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR)
  • antidepressants – such as paroxetine or mirtazapine

Anger

Anger is a feeling that affects us all. Things that can make us feel angry include a threat to us or people close to us, a blow to our self-esteem or social standing in a group, being interrupted when we’re pursuing a goal, being treated unfairly and feeling unable to change this, being verbally or physically assaulted, or someone going against a principle we feel is important.

Physical signs of anger

Everyone has a physical response to anger. Our body releases the hormone adrenalin, making our heart beat faster and making us breathe quicker and sweat more.
 
This allows us to focus on the threat and react quickly, but it can also mean we don’t think straight, and maybe react in ways we might regret later on. 
 
“One person in five has ended a relationship because of the way the other person dealt with anger,” says Celia.
 
“Reports show that anger problems are as common as depression and anxiety, but people don’t often see it as a problem, or don’t realise there are ways to tackle it.

Individual reactions to being angry

How people react to feeling angry depends on many things including the situation, their family history, cultural background, gender and general stress levels.
 
People can express anger verbally, by shouting. Sometimes this can be aggressive, involving swearing, threats or name-calling. Some people react violently and lash out physically, hitting other people, pushing them or breaking things.
 
Other people might hide their anger or turn it against themselves. They can be very angry on the inside but feel unable to let it out.
 
It’s important to deal with anger in a healthy way that doesn’t harm you or anyone else. Intense and unresolved anger is linked to health conditions such as high blood pressure, depression, anxiety and heart disease. It can also affect your relationships and your work, and get you into trouble with the law.
 
Dealing with anger in a healthy way includes:
 
  • recognising when you get angry
  • taking time to cool down
  • reducing the amount of stress in your life
 
You can also look at what makes you angry and how you deal with those feelings. 

Learning to control your anger

Anger management courses involve group discussions and counselling. If you feel you need help controlling your anger, see your GP.
 
If uncontrolled anger leads to domestic violence or abuse (violence or threatening behaviour within the home), there are places that offer help and support. Talk to your GP, or contact domestic violence organisations.