When Does Anxiety Become a Problem?

The New York Times

By Christina Caron

June 23, 2023

The president of the American Psychiatric Association answers questions about a new recommendation to screen all adults under 65 for anxiety.

How much anxiety is too much?

On Tuesday, a panel of influential medical experts recommended for the first time that doctors screen all adult patients under 65 for symptoms of anxiety.

The new guidelines were issued by the U.S. Preventive Services Task Force after a draft version was released last September. Earlier in 2022, the experts had made similar recommendations for children ages 8 to 18.

There are millions of Americans who struggle with anxiety: About 1 in 5 adults in the United States has an anxiety disorder, according to the National Alliance on Mental Illness. Having some anxiety isn’t necessarily a problem: Experts say an internal alarm system benefits us in different ways, helping to improve our performance or recognition of danger and encouraging us to be more conscientious. In addition, it’s common to feel more anxious when we’re faced with stressful life events like starting a new job, experiencing the death of a loved one or moving to a new city.

At times, however, anxiety can become more pervasive and overwhelming.

How do you distinguish the protective anxiety from the more problematic anxiety? And, given that the panel did not recommend screenings for older adults, what do you do if you’re 65 or older and have been feeling anxious?

I asked Dr. Petros Levounis, the president of the American Psychiatric Association, to answer these questions and more.

Questions and answers have been edited and condensed for clarity.

How do you know if your anxiety is in need of evaluation?

Anxiety can cause people to try to avoid situations that trigger or worsen their symptoms. Some signs to be on the lookout for include a sense of dread or worry that just won’t go away or having trouble sleeping or eating.

Other symptoms may include restlessness, a sense of fear or doom, increased heart rate, sweating, trembling and trouble concentrating.

If you feel like the worry is too much, and it starts affecting your work, your relationships or other parts of your life — or you feel depressed by these feelings — it might be time to speak with someone. That could be a primary care provider or a mental health professional. The anxiety may not go away on its own and may get worse if you don’t ask for help.

What are “normal” levels of anxiety? How much is too much?

We all feel anxious from time to time. If you have a big test coming up, family worries or concerns about paying your bills, you can start feeling nervous. Your heart may beat faster, you’ll notice you are sweating more, you feel on edge. Sometimes that feeling disappears as quickly as it arrives.

But if you start to notice that worry and fear are there constantly, that is a signal that you need some help. The good news is treatment is available, and it works.

What is treatment like?

The first step is to see your doctor to make sure there is no physical problem causing your symptoms. If an anxiety disorder is diagnosed, a mental health professional can work with you on finding the best treatment. Most people living with anxiety respond well to two types of treatment: psychotherapy, or “talk therapy,” and medications. These treatments can be given alone, but a combination of both has been found to be the most effective.

Cognitive behavioral therapy, or C.B.T., a type of talk therapy, can help a person learn a different way of thinking, reacting and behaving to help feel less anxious. Medications will not cure anxiety disorders, but can provide significant relief from symptoms. The most commonly used medications are anti-anxiety medications (generally prescribed only for a short period of time) and antidepressants.

The new recommendation does not include patients 65 and older. If a doctor doesn’t offer to screen older adults, what should they do?

Ask! You may know that anxiety often comes with an overwhelming feeling of nervousness, fear and worry for long periods of time. But anxiety can also have physical symptoms like shortness of breath, fatigue, chest pain or gastrointestinal issues. Older adults may think this is just a sign of aging. But it’s important to share all of your symptoms — including your emotional concerns — with your doctor.

Does a positive screening mean that you will need treatment?

Clinicians should follow up positive screens with a few questions, such as the duration of symptoms, degree of distress and impairment, and current or previous treatment history.

Screening for any mental disorder without appropriate follow-up is potentially harmful. Steps like screening and brief interventions for those with depression and anxiety can go a long way toward increasing early detection of mental health disorders as well as the prevention of lost life to suicide.