Anxiety & panic

What is anxiety?

Everyone feels anxious sometimes: before an exam, a job interview or a difficult conversation at home. This kind of worry is normal. It passes, and it can even help us prepare.

An anxiety disorder is different. The fear or worry is much stronger than the situation deserves, it lasts for weeks or months, and it starts to affect sleep, work, studies or relationships. Many people describe it as constant “tension” or ghabrahat that simply won’t switch off.

Anxiety disorders are health conditions, not a sign of weakness, poor upbringing or lack of willpower. They are the most common mental health conditions in the world. In India, the National Mental Health Survey 2015–16 found that about 3.5% of adults were living with an anxiety or stress-related disorder, and women were affected more often than men. Worldwide, only about one in four people with an anxiety disorder receives any treatment. That is a pity, because treatment works well.

Types of anxiety disorders

Anxiety shows up in different ways, and a person can have more than one type.

• Generalised anxiety disorder (GAD): worrying most days, for months, about many everyday things such as health, money, children or work. It often comes with restlessness, muscle tension and poor sleep. The worry feels hard to control, even when you know it is excessive.
• Panic attacks: sudden surges of intense fear with strong body symptoms, such as a pounding heart, breathlessness, chest discomfort, trembling, sweating, dizziness or tingling in the hands. An attack builds up within minutes.
• Panic disorder: repeated, unexpected panic attacks, along with constant fear of the next one. People often start avoiding places where an attack happened, such as the metro, crowded markets, driving or being alone at home. When avoidance spreads widely, it is called agoraphobia.
• Social anxiety disorder: intense fear of being judged, embarrassed or watched, when speaking in class or meetings, eating in front of others or meeting new people. It is much more than shyness and can quietly hold back studies and careers.
• Specific phobias: strong fear of one thing, such as heights, lifts, flying, dogs, injections or the sight of blood, leading to avoidance.
• Health anxiety: persistent fear of having a serious illness, with repeated checking of the body, searching symptoms online, or seeking tests and reassurance that calm the fear only briefly.

Signs to look out for

Anxiety affects the mind, the body and behaviour. Many people first see a physician for body symptoms, and anxiety is recognised only after several normal test results.

In the mind

• Constant worry, or a feeling that something bad is about to happen
• Difficulty concentrating, or the mind “going blank”
• Irritability, restlessness or feeling on edge
• Fear of losing control, collapsing or dying during an attack

In the body

• Palpitations or a racing heart
• Breathlessness, a choking feeling or chest tightness
• Stomach upset, “gas”, acidity, nausea or loose motions
• Headaches, muscle aches, trembling or sweating
• Dizziness, or tingling and numbness in the hands, feet or around the mouth
• Poor sleep and constant tiredness

In behaviour

• Avoiding places, situations or people that trigger fear
• Repeatedly seeking reassurance or medical tests
• Needing someone with you to travel or go out
• Using alcohol, cigarettes, cannabis or pills to calm down

Panic attack or heart attack?

A panic attack can feel exactly like a heart attack. The heart pounds, the chest feels tight, breathing is hard and there may be an overwhelming sense of dying. Many people with panic disorder first arrive at an emergency department convinced something is wrong with their heart.

Panic attacks are frightening, but they are not dangerous in themselves. The body’s alarm system, the “fight or flight” response, fires when there is no real danger. Symptoms usually peak within minutes and then settle, although a person may feel shaken and tired afterwards.

However, chest pain should never simply be assumed to be panic, especially:

• The first time it happens
• If the pain is heavy or crushing, or spreads to the arm, jaw or back
• If you have diabetes, high blood pressure, high cholesterol, a smoking habit or a family history of heart disease
• If you faint, or the breathlessness does not settle

In these situations, call 112 or go to the nearest emergency. Once a doctor has checked your heart and ruled out a physical cause, a psychiatrist can help you understand and treat the panic. Repeating heart tests after every attack tends to increase fear rather than reduce it, so a clear plan agreed with your doctors helps.

Why does it happen?

There is rarely a single cause. Several factors usually combine:

• Genes and temperament. Anxiety often runs in families, and some people are naturally more sensitive to stress.
• Pressure and stress. Board exams, competitive entrance tests, job insecurity, long working hours, money worries, marriage pressure and conflict at home can all build up.
• Difficult experiences. Loss, illness in the family, accidents, bullying or abuse can leave the alarm system on high alert.
• Physical factors. Thyroid problems, anaemia, some medicines, and too much tea, coffee or energy drinks can cause or worsen anxiety symptoms.
• Substances. Alcohol, cannabis and nicotine may seem to calm nerves briefly, but coming off them makes anxiety worse.
• Other conditions. Anxiety often occurs alongside depression, OCD, sleep problems and ADHD.

Anxiety often begins in childhood, the teenage years or early adulthood, but it can start at any age.

Coping with alcohol or sleeping pills: a hidden risk

Many people with anxiety find that a drink in the evening, a cigarette or a “sleeping tablet” brings quick relief. That is understandable, but the relief comes at a cost.

• Alcohol calms nerves for a few hours, then leaves anxiety and sleep worse the next day, which leads to drinking again. Over time this can turn into dependence.
• Sleeping pills and calming tablets (benzodiazepines and similar medicines) work quickly, but the body gets used to them. Some people need more to get the same effect and feel more anxious when they miss a dose. The World Health Organization advises that they are generally not recommended for anxiety disorders because of their high potential for dependence and limited long-term benefit.
• Cannabis can trigger or worsen panic in some people.

In India, these pills are sometimes obtained without a proper prescription and taken for years. If you have been taking them regularly, do not stop suddenly. Stopping abruptly after long use can cause severe anxiety, sleeplessness and, in some cases, fits. A psychiatrist can plan a slow, safe reduction. With his special focus on addiction, Dr. Tarwani regularly helps people who are coming off alcohol or habit-forming pills while treating the anxiety underneath.

When to see a psychiatrist

Consider speaking to a psychiatrist if:

• Worry or fear is affecting your sleep, work, studies or relationships
• You have repeated panic attacks, or live in fear of the next one
• You avoid places, travel or people because of anxiety
• You have had many normal tests for body symptoms, but the symptoms continue
• You use alcohol, sleeping pills or other substances to cope
• You also feel low, hopeless or have lost interest in things

Anxiety is easier to treat early, before avoidance and coping habits set in.

How anxiety is diagnosed

A first consultation is a conversation, not a judgement. The psychiatrist will ask what you feel, when it started, what triggers it and how it affects daily life. You will also be asked about sleep, mood, alcohol, tobacco, pills, caffeine, medical conditions and family history. With your permission, a family member can share what they have noticed.

Because anxiety symptoms overlap with physical illness, you may be advised simple tests, such as a thyroid test, blood count or blood sugar, or an ECG where relevant. Short questionnaires may be used to measure severity. The diagnosis follows international criteria (ICD-11), and the plan is built around your goals.

Treatment

Anxiety disorders respond well to treatment. Most plans combine the following.

1. Cognitive behavioural therapy (CBT)

CBT is a structured talking therapy with strong evidence for anxiety and panic. It helps you:

• Notice anxious thoughts (“My heart is racing, so I must be dying”) and test them against the facts
• Understand the cycle in which fear of body sensations creates more symptoms
• Face feared situations gradually through exposure, step by step and at your own pace, so the brain learns they are safe. Someone who avoids the metro after a panic attack might first stand on the platform, then travel one stop, then take longer journeys.
• Drop “safety behaviours” such as constant checking, reassurance-seeking or never going out alone

CBT usually involves regular sessions over a few months, with practice between sessions. It can be done in person or online.

2. Breathing and grounding skills

Simple skills calm the body’s alarm response and make attacks less frightening:

• Slow breathing: breathe in gently through the nose, then breathe out more slowly than you breathed in, for a few minutes
• Grounding: name five things you can see, four you can hear and three you can touch, to bring attention back to the present
• Relaxation: progressive muscle relaxation, shavasana, pranayama or mindfulness, practised regularly and not only when anxious

These skills are tools to ride out anxiety, not ways to avoid it. They help most when practised daily.

3. Lifestyle changes

• Regular sleep and wake times
• Physical activity most days, such as a brisk walk, yoga or sport
• Less tea, coffee and energy drinks, and stopping smoking
• Not using alcohol or cannabis to cope
• Regular meals, and breaks from screens and news, especially late at night
• Time for people and activities you enjoy

4. Medicines

For moderate or long-lasting anxiety, or when therapy alone is not enough, antidepressant medicines are the main longer-term treatment. Despite the name, they treat anxiety as well as depression, and they are not habit-forming. They take a few weeks to work, and some people feel slightly more restless in the first days. When they help, they are usually continued for 6 to 12 months after you feel better, to prevent relapse.

Calming or sleeping medicines may occasionally be used for a short period, for example while an antidepressant starts working. Because they can be habit-forming, they are prescribed only short-term and under close supervision.

Medicines must only be started, changed or stopped with your doctor. Never share them or take someone else’s.

5. Treating other conditions together

Depression, OCD, sleep problems and dependence on alcohol or pills often occur alongside anxiety. Treating them together lowers the chance of relapse and improves overall well-being.

Outpatient or online care?

Most people with anxiety are treated as outpatients while continuing work or studies. Online consultations suit CBT, follow-up and people living outside Delhi NCR. Dr. Tarwani sees patients at Sukoon Health in Gurugram and South Delhi, and online.

Recovery and setbacks

Most people improve a great deal with treatment and go back to doing the things anxiety had taken away. Anxiety can flare again during stressful periods, such as exams, a new job or illness in the family. This is not failure. The skills learned in therapy can be used again, and an early review with your psychiatrist helps you get back on track quickly.

For families

Watching someone you love struggle with fear can be confusing, especially when medical tests are normal. A few things help:

• Take the symptoms seriously; avoid saying “it’s all in your mind” or “just stop thinking so much”
• Don’t force someone into feared situations, but gently encourage small steps instead of helping them avoid everything
• Avoid giving the same reassurance again and again; instead, remind them of the skills they are learning
• Notice if alcohol or pills are becoming a way of coping
• In children and teenagers, watch for stomach aches before school, school refusal or intense exam fear. Under-18s are seen with a parent or guardian
• Look after your own health and rest too

You are welcome to consult Dr. Tarwani first, on your own, to plan the next steps.

Common myths

• “It’s just tension, everyone has it.” Everyday worry passes. An anxiety disorder lasts, causes real suffering and needs treatment.
• “Panic attacks mean a weak heart.” New chest pain should be checked, but panic attacks themselves do not damage the heart.
• “All anxiety medicines are addictive.” Antidepressants used for anxiety are not habit-forming. Certain calming and sleeping pills can be, which is why they are used only short-term.
• “A drink helps you relax.” Alcohol eases anxiety for a few hours, then makes it worse and can lead to dependence.
• “Talking won’t change anything.” CBT has strong evidence for anxiety and panic, and its benefits often last after therapy ends.