According to the Anxiety & Depression Association of America (ADAA) “Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States”
Causes of anxiety may include
- Lifestyle and Personality Factors
- Family factors: parenting practices
- Hormonal factors
- Environmental factors
- Drugs and medication
- Underlying health condition
- Gut–Brain Axis
Lifestyle and Personality Factors
Lifestyle Factors
- Stressful life events
- Chronic stress or major life events increases the risk for developing anxiety.
- Common triggers include
- Work stress
- School stress
- Build-up of stress
- Change in living arrangements
- Past or childhood experiences
- Pregnancy
- Unemployment
- Relationship problems
- Grief
- Neglect
- Feeling lonely or isolated
- Financial insecurity
- Traumatic events
- Physical, sexual, verbal or emotional abuse, divorce, losing a loved one, child parent separation, injury, serious medical illness, etc.
Personality Traits
- Specific personality traits increase the risk of anxiety which includes
- Irritability
- Being introverted
- Having low self-esteem
- Overthinking
- Perfectionism
- People-pleaser
- Procrastination
- Resistance to change
- Timid (easily frightened)
- Type A personalities (aggressive, anxious, impatient, ambitious, organized, proactive, goal-oriented, time urgent, competitive, etc.)
- Trying to control things, etc.
Family factors: parenting practices
Parenting practices
- Parenting style may contribute to the development of anxiety in children
- Family environment contributing to anxiety
- Avoidance
- High family conflict
- Maternal anxious attachment
- Maladaptive parenting practices
- Parental modeling of anxiety
Hormonal factors
Hormonal fluctuations
- Adrenal insufficiency (Addison’s disease)
- Diabetes
- Hormonal therapy
- Overactive thyroid
- Pregnancy
- PCOS
- Medications
- Menstrual cycle
- Menopause
- Stress
Environmental factors
- Difficulties at work
- Relationship problems
- Family issues
- Childhood experiences
- Experiencing trauma
- Anticipation (event)
- Perceived threat
Drugs and medication
Anxiety can be a side effect of certain medications
- ACE inhibitors
- Antidepressants
- Antimigraine agents
- Antipsychotic agents
- Antiviral agents
- Corticosteroids
- Hypnotics
- Nonsteroidal anti-inflammatory drug (NSAIDs)
- Opiates
- Sedatives
- Sympathomimetic
- Synthetic hormones
Substance use
- Alcohol (effects levels of GABA, dopamine, and serotonin in the brain)
- Caffeine (stimulant increases cognitive function, attention, alertness, may cause or worsen anxiety)
- Tobacco (neurotransmitter systems, inflammation, oxidative stress, mitochondrial dysfunction, neurogenesis, and epigenetic effects lead to anxiety)
- Other recreational drugs
Underlying health condition causing anxiety
Medical conditions can mimic the symptoms of anxiety and it is important to investigate and rule out general medical causes
- Angina
- Arrythmias
- Cardiac tamponade
- Congestive heart failure (left-sided)
- Myocardial infarction
- Valvular disease
- Adrenal dysfunction
- Carcinoid syndrome
- Cushing disease
- Diabetes Mellitus
- Parathyroid disease (hyperparathyroidism, pseudo-hyperparathyroidism)
- Pancreatic tumors
- Pheochromocytoma
- Pituitary disease
- Thyroid disease (hyperthyroidism, hypothyroidism, thyroiditis)
- Dysbiosis
- Gastroesophageal reflux disease
- Irritable bowel syndrome
- Peptic ulcer disease
- Polyarteritis nodosa
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Temporal arteritis
- Hyperkalemia
- Hyperthermia
- Hypoglycemia
- Hyponatremia
- Hypoxia
- Porphyria
- Substance ingestion/overdose
- Cerebral trauma and/or post-concussive syndrome
- Cerebrovascular disease
- Cerebral syphilis
- Encephalopathy
- Huntington disease
- Mass lesions
- Migraines
- Multiple sclerosis
- Seizure disorders
- Subarachnoid hemorrhage
- Vertigo
- Asthma
- Chronic obstructive pulmonary disease (COPD)
- Pneumothorax
- Pulmonary edema
- Pulmonary embolism
- Sleep apnea, obstructive/nonobstructive
Gut–Brain Axis and Anxiety
- The human microbiome consists of over 100 trillion bacteria, 10 times the number of human body cells that share symbiotic properties with humans
- 60% of anxiety and depression patients experience intestinal function disturbance (including dysbiosis and inflammation of the gut)
- Increased antibiotics prescriptions are correlated with mood disorders (changed the microbiota)
Microbiome Functions
- Microbiota supports host metabolism (produces short-chain fatty acids, choline, and bile acids)
- Complex carbohydrates such as dietary fiber absorbed and fermented by gut microbiome into short-chain fatty acids such as butyrate, acetate, propionate enters the circulation and plays a role in the brain via the gut-brain axis
- Modulates intestinal motility
- Provides protection against pathogens and toxins
- Regulate immune system, cytokines secretion from adipose tissue and insulin signaling
- Neurotransmitter synthesis
- Produces close to 20 neuropeptides that serves as second messengers in the brain, thus regulating mood and cognition
- Bidirectional link between the central nervous system (CNS) and the enteric nervous system (ENS)
- ENS aka the second brain operates independently of the central nervous system (CNS) (brain and spinal cord)
- Regulates gastrointestinal function (intestinal digestive and absorption)
- Composed of 200–600 million neurons
- Fight or flight response of the central nervous system leads to slowing down or stopping digestion by the ENS
- Controls vagal and sacral parasympathetic nerve fibers and visceral sympathetic nerve fiber
- The vagus nerve is the primary connection between the brain and intestinal tract and parasympathetic nerves (brain-gut communication)
Dysbiosis and intestinal permeability
- Leads to the production of proinflammatory endotoxin—lipopolysaccharide (LPS)
- LPS is a component of the outer membrane of Gram-negative bacteria, there is about 1 g of LPS in the human intestinal tract
- Enter the blood system
- Increased LPS migration could increase the immune response
- Activate the inflammatory system
- Increases norepinephrine in plasma, linked to mood disorder
Stress
- Changed gut microbiome (decreased Bifidobacterium, and Lactobacillus)
- Produced proinflammatory reaction
- Effected mood through the HPA axis (hypothalamic–pituitary–adrenal axis)
- Changed intestinal permeability (intestinal barrier function)
- Enabling different molecules to enter the bloodstream
- Lead to hypersensitivity
Gut microbiome secretes neurotransmitters
- Serotonin (aka 5-hydroxytryptamine (5-HT))
- Gut microbiome manufacture about 95 percent of the body’s supply of serotonin
- Serotonin stabilizes mood, feelings of well-being, and happiness
- Also involved in sleep, and digestion
- Acetylcholine (regulates memory, attention, learning and mood)
- Dopamine, gamma-aminobutyric acid [GABA], glycine (regulates sleep, appetite, mood and cognition
When to see a doctor
Seek a healthcare provider when experiencing disproportionate and persistent anxiety to address your root cause
DISCLAIMER
This information is intended for educational purposes only and it is not intended to take the place of consultation with your physician.
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