Anxiety is a universal phenomenon. We all worry at times about what the future has in store. We get butterflies in our stomach when our fight-or-flight response is activated. We may feel concerned about how we will be perceived by others.

These are normal human experiences. But when do they become anxiety disorders? In short, when they inhibit our ability to function or when they distress us to a significant degree.

There are three anxiety disorders I would like to discuss: generalized anxiety disorder (GAD), panic disorder (PD), and social anxiety disorder (SAD).

GAD revolves around worry, not just everyday worry but excessive worry about a multitude of topics, e.g., work, school, family, health, etc. Folks with GAD will constantly ask “what-if” questions and have difficulty controlling the worry. They have associated symptoms, including restlessness, fatigue, irritability, difficulty sleeping and concentrating due to the worry, and even tension in their muscles.

The hallmark of PD is panic attacks, which are acute and sometimes unprovoked triggers of the fight-or-flight response characterized by heart palpitations, sweating, shaking, shortness of breath, lightheadedness, and a feeling of impending doom, just to name a few symptoms. Imagine the feeling of being chased by a bear, but there is no bear in sight. Panic attacks can be so severe that people will report to the emergency department concerned that they are having a heart attack. PD is often associated with agoraphobia, a fear of being in public alone, or even with a companion if a panic attack occurs and an easy escape may not be possible.

The key to SAD is a marked fear and avoidance of social situations due to concern about being embarrassed, humiliated or scrutinized by others. Social situations that trigger SAD can range from small social situations to parties to large public speaking engagements. They are often associated with panic attacks.

GAD, PD and SAD are all common disorders, and fortunately they are also readily treatable with medications, psychotherapy or a combination of both. There are multiple medications that are used for anxiety, either to prevent anxiety from happening in the first place or to reduce anxiety that is impending or ongoing.

Antidepressants such as fluoxetine (Prozac), sertraline, (Zoloft) or escitalopram (Lexapro) are very effective at preventing anxiety. Other medications, some of which are potentially habit-forming, can serve to treat acute anxiety when it is happening or about to happen. These include benzodiazepines, such as alprazolam (Xanax) or clonazepam (Klonopin), and certain antihistamines, among others.

Habit-forming medications like benzodiazepines should be avoided if possible or used for the shortest reasonable period of time, e.g., until a preventive medication has time to take effect, so as to avoid dependence or addiction.

Psychotherapy can be extraordinarily effective for anxiety disorders and without the side effects associated with medications. One psychotherapy option is cognitive-behavioral therapy (CBT), which focuses on how we can modify our anxiety-provoking thoughts to change our resultant feelings and behaviors, as well as how we can modify our anxiety-provoking behaviors to change our resultant thoughts and feelings.

Although anxiety disorders can be debilitating for some, there are treatment options available that are summarized above. If you or a loved one is experiencing symptoms consistent with an anxiety disorder, please seek professional help. The Cruz Clinic in Livonia and Ann Arbor has a team of trained mental health professionals who are well-equipped to treat these common conditions with a combination of medications and psychotherapy. We can be reached at (734) 462-3210 or via the web at www.cruzclinic.com.


Dr. Wedes is a board-certified Psychiatrist who specializes in General Adult Psychiatry. Conditions he commonly sees include depression, bipolar disorder, anxiety, ADHD, and schizophrenia, among others. He strives to create a safe environment free from judgment. Dr. Wedes graduated from the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and completed residency at University of Pittsburgh Medical Center. He has over 10 years of experience.