Anxiety Causes and Management: Underlying Medical and Neurological Conditions

Many situations create anxiety. Below is a brief overview of some problems people may encounter. Other common challenges, like stress-related anxiety, panic, and social anxiety, are explored in greater detail elsewhere on this site.

Medical Problems as a Cause of Anxiety

There are several medical conditions that can interrupt normal neurologic pathways in the brain and cause generalized anxiety. For example, people with heart disease, kidney disease, and chronic pain often experience some anxiety. Those with breathing problems (i.e., asthma, COPD) often have some serious anxiety when they are unable to breathe efficiently, which is understandable. Hormone imbalances (adrenal dysfunction, sex hormones, diabetes, thyroid hormones - especially hyperthyroidism, diabetes, caffeine, gastrointestinal problems (esp. irritable bowel syndrome), electrolyte imbalances, and sleep disturbances (especially insomnia and sleep apnea). And, it is not surprising that many kinds of neurological conditions that cause brain damage and disrupt neurotransmission, like strokes, multiple sclerosis, traumatic brain injuries, epilepsy, and dementia, can create anxiety. It often becomes a vicious cycle: The condition makes the anxiety worse, and the anxiety makes the condition worse. In many of these cases, anxiety due to neurological dysfunction, concern about the condition itself, and self-esteem issues all intermingle, worsening the anxiety. 

It is essential to treat concurrent medical problems and anxiety concurrently: That is, work with the underlying medical condition and, if necessary, the anxiety issue as well. Anxiety often contributes to worsening illness because stress weakens the immune system, among other things. It is difficult to expect success when you treat one without treating the other.

If you are having trouble with anxiety related to a medical problem, you may want to speak to your primary care provider or a counselor. Otherwise, consider some of the approaches below.

Underlying Mental Health and Neurological Conditions that May Cause Anxiety

​Many co-occurring mental health problems also go hand in hand with anxiety. I find that nearly all the people I have met with depression also mention an element of anxiety (and vice versa). The physiologic/neurologic mechanisms underlying anxiety are very much like those of depression. Someone may be depressed because of their bothersome - sometimes incapacitating - anxiety (and vice versa). Anxiety can be extremely distressing. Many of the prescriptive medications and other measures (below) are quite effective in helping to treat both anxiety and depression.

Functional Neurological conditions can contribute to anxiety because there is a change in brain structure from some type of damage. For example, Parkinson's disease, Alzheimer's and other types of dementia, traumatic brain injuries, and conditions like stroke, MS (multiple sclerosis), and others. It is conceivable - and possible - that some of the treatments below can help with anxiety (and depression) related to these medical problems.

Aging as a Factor in Anxiety

Aging can give rise to anxiety. The fear of getting old, familial situations, socioeconomic changes, physical decline, pain and even having your car keys taken away (i.e. freedom) as well as many other aspects of aging, can cause anxiety in older people. (The section about aspects of aging, is discussed on another section of this site).

Feeling Anxiety

Understanding the Underlying Medical and Neurological Conditions that Cause Anxiety Helps in the Management of Anxiety

In addition to diagnosing and treating specific medical causes of anxiety, various other approaches can help in the management of anxiety linked to underlying medical and neurological conditions. Since individuals respond differently, having a range of options ensures personalized care. For severe cases, combining medication with therapy is often the most effective strategy, but personal preferences vary—some may favor one approach over another.

General Approaches to Anxiety

First of all, you want to try to attack this early, especially if it is escalating. Consider these approaches;

• Acknowledging your feelings

• Staying present in the moment

• Relaxation and meditation exercises play a big role in reducing feelings of stress and anxiety:  

           --Deep breathing exercises - These help release endorphins in your brain, which are "feel good" hormones. This technique is practiced by taking a deep breath through your nose, using your diaphragm muscle located just beneath your lower ribs (instead of using neck, shoulder, and upper chest muscles), pausing and then releasing the breath, through your mouth. Repeat this several times.

           -Progressive muscle relaxation techniques: This is done by tightening muscle groups for eight seconds then relaxing them for several seconds: Begin with facial muscles, with the face, moving to the scalp - tighten muscles eight seconds, then relax; then the neck, doing with each muscle group of the chest, back, pelvis, extremities and so on. This releases some tension and stress. If you do not have time to move through all of your muscle groups, do this with those muscles you believe have the most tension.

-Guided Imagery -  Relax your body. Think of a relaxing place you have been and focus on only that - focusing on texture, smells and visuals.

-Use Mindfulness - This is when a person focuses on the present moment, feeling and experiencing the moment with awareness and acceptance, not judgment. This reportedly helps the fronto-limbic area of the brain, an area of the brain responsible for emotional regulation and processing, as evidenced by MRIs.

-Analytical Meditation - This meditation involves focusing on an object or a concept and attending only to that.

-Body Scanning-Focus on a part of your body and feel relaxation, warmth, release of tension

• Yoga (there are several free online yoga classes - just be sure they are reputable sites )

• Read self-help books

• Social support - Engage with Family, friends, or groups. This is very important.

      (even online)

• A healthy diet and exercise may be involved in

       developing greater neuroplastic patterns so that you can "re-form" your anxious thoughts

• Journaling

• Make yourself do things you enjoy

• Avoid alcohol and drugs (these are often a means of self-medication that are used by those who do not want to deal with therapy or other medications for mental health, but they eventually have harmful physical and neurological effects)

• Get enough sleep

• Biofeedback (you will need training in this)

• Get Counseling. Sometimes we get into a rut, and our brain keeps circulating the same anxious messages. Counseling helps you "retrain" your brain to learn other patterns and to see things from a different perspective. Some of these approaches include

            CBT  - Cognitive behavioral therapy                                                                                  DBT - Dialectical Behavioral Therapy

            ERT - Emotion Regulatory Therapy

• EMDR (this is a unique treatment that patients often find helpful. It is reported to decrease the activity of the brain's amygdala, considered the "emotion center" (especially for trauma).

• For some, spirituality can contribute to a deeper sense of control, purpose, and connection, personal control, offering social support, and potentially improving overall health and well-being

• Massage therapy

Over-the-Counter Treatment of Anxiety

There are no over-the-counter commercial treatments for anxiety except possibly an antihistamine, which will help make a person possibly more relaxed and tired.

• Benadryl/diphenhydramine as directed over the counter

Considered Alternative and Herbal Approaches to Anxiety

• L-Theanine

• Ashwagandha

• ​Lemon balm

• ​Valerian

• Magnesium

• Kava kava

• CBD or medical marijuana

• Vitamins -  Band D and Omega 3s

• Aromatherapy (especially lavender, chamomile, and others)

Prescriptive Treatments for Anxiety

• SSRIs - Selective serotonin reuptake inhibitors.  (common: Celexa/citalopram, Lexapro/escitalopram, Prozac/fluoxetine, Luvox/fluvoxamine, Paxil/paroxetine, Zoloft/sertraline, Trintellix/vortioxetine)These increase the availability of serotonin neurotransmitters for use in the brain. These work by enhancing cortical (thinking) processes (assists well with therapies) and possibly by decreasing excitation in the amygdala (emotion center).

• SNRIs - Serotonin-norepinephrine reuptake inhibitors - (common: Effexor /venlafaxine, Cymbalta/duloxetine, and Pristiq/desvenlafaxine. These medications help decrease activity in the amygdala.

• Barbiturates and benzodiazepines increase GABA (these work very well for episodic moments of great anxiety but both are potentially very addictive and should not be used on an ongoing basis)

• Other Antianxiety Medications-Remeron/mirtazapine is used off-label for anxiety (not FDA approved for this problem). This medication actually causes greater production of serotonin in the brain. Buspar/buspirone increases serotonin and decreases dopamine (an excitatory neurotransmitter in the amygdala).

There are many medications and many approaches that can help with anxiety. If your anxiety is making your life uncomfortable, if it is causing unhappiness or making it hard to function, talk to someone to see if there might be something you can do to help yourself out of that rut.

Problem with medications?

• Are you having side effects? Many can cause side effects, especially stomach symptoms in the beginning. Typically, these settle down. However, if your side effects are too bad, especially if you start feeling more anxiety or depression, talk to the person who prescribed them (ideally) or another healthcare provider.

• The medications don't seem to be helping? It typically takes these medications about two to three weeks to start working well. Don't give up and be sure not to skip any doses (you might end up on an emotional roller coaster ride!). If it continues to be ineffective, you may need an increased dose, an add-on medication, or a switch.

• Do you feel blunted? "I don't want to take these medicines. I don't don't seem to feel any emotion". This is a fairly common complaint about antianxiety (and antidepressant) medications. If this is occurring, and you think the loss of feelings is worse than your anxiety, you can have your prescriber change your medication to one that works in a different way or you can try some therapy instead.

• "I feel great, I think I will come off my medications." Not a good idea if you've been on them for a while. Don't just drop off your medication - it's probably helping. Speak to your prescriber about decreasing it slowly so you don't end up in "shock" (too much of an anxiety rebound). I have met a lot of people who just drop off their medications and they realize how bad they feel without them.