What an expert wants you to know about anxiety disorders

(CNN) — All adults under the age of 65 should be screened for anxiety, according to the influential US Preventive Services Task Force (USPSTF), which published new draft recommendations last month.

The recommendations, which help guide doctors’ decisions, are not final until the public comment period ends later this month.

However, this is the first time the national think tank has recommended screening for anxiety in such a large portion of the US population. What symptoms can people have? How often should an anxiety screening be done and what does it consist of? What treatments are there? And what do these recommendations mean?

To answer these questions, we spoke with Dr. Liana Wen, a CNN medical analyst, emergency room physician, and professor of health policy and management at the Milken Institute School of Public Health at George Washington University. She is also the author of Lifelines: A Doctor’s Journey in the Fight for Public Health.

CNN: How common are anxiety disorders?

Dr Liana Wen: According to draft recommendations from the US Preventive Services Task Force, the lifetime prevalence of anxiety disorders is 26% for men and 40% for women. This means that about 1 in 4 men and 4 in 10 women will develop an anxiety disorder at some point in their lives.

Obviously, this is a problem that needs to be addressed. Anxiety, like depression and other mental health problems, should be treated with the same attention we give to physical health problems. I am pleased that the task force has issued recommendations that will raise awareness of the need to diagnose anxiety.

CNN: How do you define anxiety?

Wen: This is an important clarification: it is extremely important to distinguish the feeling of anxiety from the medical diagnosis of an anxiety disorder. Anxiety is a normal response to stress. Everyone experiences some level of nervousness about situations in their lives.

Anxiety disorders are characterized by persistent and excessive fear or anxiety that affects a person’s ability to function. They can cause people to avoid situations, social engagements, professional functions, meetings or even everyday tasks, for example, and affect their work, education and personal relationships. Anxiety disorders include a number of diagnoses, such as generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias.

CNN: Are there population groups that may be at higher risk for anxiety?

Wen: Having any other mental health condition increases the likelihood that a person will develop anxiety disorders. For example, depression and anxiety often go hand in hand. A large study found that 67% of people with depression also had an anxiety disorder. There is also a link between anxiety disorders and tobacco and alcohol consumption. Stressful life events, such as job loss, bereavement, or pregnancy, can also increase the likelihood of anxiety disorders.

(The draft recommendations also acknowledge the need for further research on the prevalence of anxiety disorders in population groups defined by race and ethnicity, sexual orientation, and gender identity, among others.)

CNN: What are some of the symptoms of anxiety disorders?

Wen: People with anxiety disorders can experience a wide range of symptoms: being restless and restless, having feelings of panic or doom, having difficulty concentrating or sleeping, and experiencing panic attacks. Panic attacks are characterized by palpitations, shortness of breath, or cold, tingling hands.

It is important to note that many people with anxiety disorders may have other physical symptoms. For example, some develop headaches, stomach aches, nausea and fatigue. Because anxiety disorder symptoms are so varied, they are often not easily detected and diagnosed.

CNN: How often should doctors screen their patients for anxiety?

Wen: The working group’s draft recommendations do not specify this. This is because there is not yet enough research to say that the detection of anxiety must occur within a certain time interval. The National Task Force advocates a “pragmatic approach” that “could include assessment of all naïve adults and the use of clinical judgment to consider other factors, such as underlying health conditions and life events, for deciding whether further assessment is needed for people who are at high risk.

What that tells me, as a clinician, is that if we’ve never screened a patient for anxiety, it’s good practice to do so at least once. (This usually involves patients filling out a questionnaire and/or answering a series of questions during a medical exam.) Then, depending on what we find in the patient’s changing circumstances, we can reassess. For example, we can assess whether a patient has experienced a recent life change, has been diagnosed with depression or another mental illness, or has reported increased alcohol use.

Doctors should also be on the lookout for other symptoms that may indicate an underlying anxiety disorder.

CNN: What treatments are there for people who have been diagnosed with an anxiety disorder?

Wen: Like depression and some other mental health diagnoses, anxiety disorders can be treated with pharmacotherapy, psychotherapy, or both. Pharmacotherapy involves medication, while psychotherapy involves cognitive behavioral therapy, which is done by working with a psychologist or other mental health professional. Doctors also often recommend lifestyle changes, such as meditation, exercise, and reducing alcohol and tobacco use.

Some patients require long-term treatment. Many receive treatment for a period of time and are then followed up to see if they might need it again.

The bottom line is that treatments work. They reduce the symptoms of anxiety disorders and help people bring well-being back into their lives.

CNN: What should someone do if they think they might have an anxiety disorder?

Wen: There are online screening tools that people can use to see if they may have anxiety, including the Generalized Anxiety Disorder Scale. Anyone who thinks they may have an anxiety disorder should make an appointment with their primary care physician. If they are already seeing a mental health professional, they can go directly to that person.

It is important to tell your doctor about all your symptoms. Some that don’t seem directly related can actually point to an anxiety disorder. No need to waste time, the treatment exists and works.

If you’ve had a physical health problem, such as a headache due to a migraine or stomach pain due to an ulcer, you’d want it addressed. Mental health issues should be treated in the same way, with the same level of urgency.

CNN: Why do the guidelines say screenings should be for adults under 65? What about children or the elderly?

Wen: The task force specifies that the evidence is strongest to support routine assessment of anxiety in adults under 65 years of age.

This does not mean that children or older adults should not have an anxiety assessment. It is good practice for clinicians to be aware of anxiety symptoms or concerns in all their patients, regardless of age, and likewise for patients to raise the possibility of anxiety symptoms with their healthcare provider.

CNN: What’s the next step for the task force’s recommendations, when will they go into effect?

Wen: Those recommendations are currently at the draft stage, meaning the task force is seeking public comments until Oct. 17. I expect them to be finished by the end of this month.

Even then, it remains the responsibility of healthcare professionals to administer anxiety screening to their patients. I hope the recommendations achieve their crucial goal of raising awareness of anxiety disorders and getting more patients treated for this mental health problem.

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