Anxiety Disorder

Anxiety disorders are the most common type of mental disorders that affect one in four individuals at some point in their lives. Effective treatments are available across both traditional and modern medicinal practices.

Anxiety disorder is a mental health condition and it is different from normal anxiety. Occasional anxiety is a normal feeling during stressful situations, it is how the brain alerts the body and mind when facing a threat or danger. However, Anxiety disorder is more severe and is typically characterized by:

  • Persistent, excessive worry or fear that can be mild or severe. 
  • Inability to control worries which gets worse over time. 
  • Inability to function normally.
 

Types
Generalized Anxiety Disorder (GAD)

Excessive, unrealistic worry and tension with little or no reason

Panic Disorder

Sudden, intense fear that brings on a panic/anxiety attack. One could break out in a sweat, have chest pain, have a pounding heartbeat (palpitations) or shortness of breath. Panic disorder is characterized by recurrent and frequent panic attacks

Social Anxiety Disorder/ Social Phobia

Overwhelming worry and self-consciousness with daily social situations. People with social anxiety disorder may avoid social situations entirely or endure it with great anxiety/discomfort.

Obsessive Compulsive Disorder (OCD)

Driven by recurring, unwanted thoughts (obsessions) and repetitive behaviors (compulsions). Compulsions can manifest as excessive cleaning, checking, counting, or arranging things in a specific way.

Hypochondria / Illness Anxiety  Disorder (IAD)

Excessive worry about having or developing a debilitating or life-threatening illness without underlying cause/symptoms or with mild symptoms. People with IAD will seek constant medical attention, do frequent medical tests and constantly talk about health to family and friends. 

Phobia-related Disorder

Intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object and one may avoid ordinary situations.

Separation Anxiety Disorder

Excessive fear or anxiety about separation from loved ones. The feeling is beyond what is appropriate for the person’s age, persists for long durations and causes problems functioning.

Selective Mutism (SM)

A rare disorder in which young kids, typically 5 years old, who talk normally with their family don’t speak in public, like at school.

Substance Induced Anxiety Disorder

Long term use of Tobacco, alcohol, illicit drugs(cocaine etc.) and abuse of some prescription drugs(Adderall, Ritalin, Opioids etc), can have a range of negative effects on the mind and body, including causing anxiety and panic attacks.

 

Symptoms

Symptoms of Anxiety Disorder

Anxiety disorders can manifest in various ways, and symptoms may differ from person to person. Here are some common symptoms associated with anxiety disorders:

Excessive Worry: Persistent and uncontrollable worry about everyday events, often accompanied by feelings of apprehension or dread.

Restlessness: Feeling on edge, agitated, or unable to relax. This may manifest as physical restlessness or an inability to sit still.

Fatigue: Feeling tired or fatigued despite adequate rest, possibly due to the physical and emotional toll of anxiety.

Muscle Tension: Persistent muscle tension which can lead to headaches, backaches, or other physical discomfort.

Irritability: Feeling easily irritable, impatient, or on edge, even in situations that wouldn’t typically bother you.

Difficulty Concentrating: Trouble focusing on tasks or remembering things due to intrusive thoughts or worry.

Sleep Disturbances: Difficulty falling asleep, staying asleep, or experiencing restful sleep. Nightmares or restless sleep can also be common.

Avoidance Behavior: Avoiding situations or places that trigger anxiety, which can interfere with daily activities and social interactions.

Social Withdrawal: Avoiding social situations or isolating oneself due to fear of judgment or experiencing anxiety in social settings.

Physical Symptoms: Physical symptoms, such as sweating, trembling, cold/sweaty hands, numbness in hands & feet, dry mouth, rapid heartbeat (palpitations), fast breathing(hyperventilation), shortness of breath, dizziness, feel like you are choking or gastrointestinal issues like nausea or diarrhea.

Cognitive Symptoms: Feeling of uneasiness, fear, panic, racing thoughts, overthinking, nightmares, catastrophizing (imagining the worst-case scenarios), or having difficulty controlling worry.

WHEN TO SEE A DOCTOR

  • When debilitating worry, fear or stress persists over 6 months 
  • When having three or more of the following symptoms consistently, affecting quality of day-to-day life
    • Rapid breathing, irritability, anger, difficulty sleeping, frequent stomach aches or headaches and fatigue
    • Children aged 10-18 may not openly express their worries, so it is essential that adults look out for these symptoms.
  • When children below 5 years show selective mutism at home/social setting
  • It is recommended that teenagers, pregnant & postpartum women, and adults over 65 years of age undergo Anxiety screening during periodic doctor visits.

WHOM TO SEE

  • Children should see their pediatricians or child psychiatrists for diagnosis and conventional medical treatment.
  • Adults can seek diagnosis and treatment from a primary care physician or psychiatrist. They may also consider consulting a psychologist for psychotherapy.
 

Risk Factors/Causes of Anxiety Disorder

Anxiety disorders can develop due to a combination of genetic, environmental, physiological and psychological factors.

Environmental Factors

Family Environment: Growing up in a family environment characterized by overprotection, excessive criticism, high levels of parental anxiety or pressure may increase the risk of developing anxiety disorders.

Trauma or Stressful Life Events: Experiencing traumatic events, such as physical or emotional abuse, neglect, accidents, or death of a loved one, can increase the risk of developing an anxiety disorder. Chronic stress or major life changes, like moving to a new city or starting a new job, can also trigger anxiety symptoms.

Substance Abuse: Substance abuse, including caffeine, alcohol, drugs, or prescription medications, can exacerbate or trigger anxiety symptoms.

High Pressured Academic/Work environment:  Lack of work-life balance, unrealistic academic expectations, the pursuit of perfection and fear of failure can cause anxiety in children and adults.

Increased digital & social media Addiction: Increased digital and social media usage has negative mental health outcomes, including anxiety, depression, and loneliness. Excessive screen time, cyberbullying, and exposure to unrealistic lifestyle have adverse effects on mental health. 

Genetics

Anxiety disorders can run in families, indicating a genetic predisposition. If you have a close family member with an anxiety disorder, you may be at a higher risk of developing one yourself.

Physiological Factors

Brain Chemistry: Imbalances in neurotransmitters that regulate mood and emotions, such as serotonin, dopamine, and gamma-aminobutyric acid (GABA), can play a role in the development of anxiety disorders.

Medical Conditions: Certain chronic medical conditions, such as thyroid disorders, heart disease, respiratory disorders, menopause  and some medications such as amphetamines and methylphenidate, corticosteroids, opioids & benzodiazepines can induce anxiety.

Neurobiological Factors: Structural or functional abnormalities in certain areas of the brain may contribute to anxiety disorders.

Psychological Factors

Personality Traits: Certain personality traits, such as being shy, perfectionistic, having low self esteem or thinking negatively may increase vulnerability to anxiety disorders.

Personality Disorders: Individuals with certain personality disorders, such as avoidant personality disorder, dependent personality disorder, panic disorder etc. may be more susceptible to developing anxiety disorders.


It’s important to note that not everyone with these risk factors will develop an anxiety disorder, and the presence of one or more risk factors does not necessarily mean that anxiety is inevitable.

Prevention of Anxiety Disorder

Simplifying life, managing stress effectively, and developing emotional regulation skills are crucial in preventing anxiety disorders. Community approaches to anxiety prevention include educating parents and implementing school programs that enhance social and emotional skills in young individuals to promote healthy coping strategies. Prioritizing physical well-being also plays a significant role in enhancing mental health.

Diagnosis of Anxiety Disorder

Anxiety disorder does not have any biological markers, so a doctor will conduct a physical examination and may order tests to rule out other physical health conditions that might be causing the symptoms.  If no physical cause is found, the patient may be referred to a mental health specialist like a psychiatrist, psychologist, or a therapist for further evaluation. 

A mental health specialist usually clinically evaluates patients in person. Clinical observation involves a comprehensive assessment of reported symptoms, mental status examination and an evaluation of how long and how severe the symptoms are. The classification of the mental disorder is done via well defined assessment tools. The mental health specialist usually asks questions and uses these tools to assess the type of anxiety disorder and treats patients accordingly. Both DSM and ICD provide tools that are used by doctors to compare and classify mental disorders.

DSM-5, The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

DSM-5 was developed by American Psychiatric Association (APA) and used predominantly by mental health professionals in the USA & Australia. While DSM-5 provides assessment tools for classification of mental health disorders,  it is important to note that these are not available for public use and are intended for experts and professionals in the field of mental health & healthcare insurance.

International Classification Of Diseases (ICD) 

ICD is an international classification system, published by the WHO, used to code and classify mortality and morbidity data. ICD is a comprehensive and technical resource intended for medical and mental health professionals, and it is not a substitute for seeing a trained, qualified medical or mental health provider.

 

Treatment of Anxiety Disorder

Anxiety Management: 

Acknowledging and understanding your anxiety disorder problem and learning to control unwanted fear is the first step in managing one’s anxiety. Doctors recommend ‘psycho education’, which is the process of “teaching clients with mental illness and their family members about the nature of the illness, including its etiology, progression, consequences, prognosis, treatment, and alternatives. This helps the patient and the family handle the patient’s symptoms better. The patient can also use the following to control the symptom.

Exercise

Exercise at least 30 minutes daily to reduce stress.

Mindfulness / Meditation

Practice techniques like Meditation, yoga, Taichi etc to clear the mind and focus on the present moment.

Support Groups

Joining a support group might allow people with anxiety to meet in comfort and safety, and give and receive support. Your psychiatrist might help you identify the right support group.

Self development

Improving self image can help patients manage anxiety symptoms since they often lack confidence and perceive themselves to be worthless. Some ways to improve this would be by.

  • Identify positives about yourself
  • Be kind to yourself – Dress up, treat yourself, go out for walks, listen to music.
  • Stop comparing yourself with others.
  • Disengage from social media
  • Being Assertive – Practise saying ‘NO’
  • Managing worries and unhelpful thoughts using structured problem solving methods or Cognitive Behavior Therapy.

Dietary adjustments 

A balanced diet, adequate water to stay hydrated and reduced alcohol,caffeine & tobacco intake help reduce anxiety. Some foods are known to reduce anxiety by increasing levels of neurotransmitters like Gamma-aminobutyric acid (GABA), glycine and serotonin. The following nutrient-rich foods are known to help with anxiety.

  • Magnesium rich foods like spinach, nuts etc.
  • Zinc rich foods like egg yolks, oysters etc. 
  • Omega 3 rich foods like mackerel, salmon, flax seeds, chia seeds etc.
  • Probiotic rich foods like yogurt, pickles etc.
  • Vitamin B rich foods like eggs, chicken, avocado, almonds etc.
  • Vitamin D rich foods like sardines, egg yolk, cod liver oil, dry fruits etc.
 

Allopathic Treatment

Anxiety disorders can usually be treated without staying in the hospital. However, if someone is feeling suicidal, not responding to regular treatments, or has other conditions like depression, personality disorders, or substance abuse, they may need to be hospitalized.

Cognitive Behavior Therapy (CBT)

CBT/ counseling is an evidence based psychotherapy that is provided by Psychiatrists and other mental health professionals to treat anxiety disorders and depression.The therapists control how you feel by examining your core beliefs, thoughts and actions. With CBT, you can learn to let go of negative thoughts and behaviors and develop better ways of thinking and habits. Typically, CBT consists of 6 to 20 weekly sessions, although the duration depends on the individual’s needs and circumstances

Allopathic Medications

Acute and chronic anxiety disorders need to be treated using medications depending on the type of anxiety disorder you have and whether you also have other mental or physical health issues. Most anxiety medications are prescription only drugs, and have many side effects. Please consult your doctor before and while on medication.

Benzodiazepines(Fast Action)

Mechanism

Prescription ONLY medications. These are tranquilizers which reduce symptoms of anxiety by increasing the action of a brain chemical called gamma-aminobutyric acid (GABA). GABA is a chemical that nerve cells use to communicate with each other and it reduces brain activity. It is believed that excessive activity in the brain may lead to anxiety or other psychiatric disorders.

Indication

Act as tranquilizers and are short-acting Benzodiazepines used for faster action like cases of panic disorders/ acute anxiety attacks/Seizures/severe cases of insomnia.

Side effects
  • Dependency
  • Risky when combined with other medications or alcohol, causing increase in toxicity/overdose
  • Short-term usage can cause drowsiness, fatigue, diarrhea,  withdrawal symptoms like headache, nausea, & tremors
  • Long-term usage can cause memory loss, insomnia, anxiety, depression and suicidal thoughts
Brands
  • Diazepam (Valium, Calmpose, Peptica, Zepose)
  • Alprazolam (Alprax, Trika, Anxit)
  • Chlordiazepoxide (Equilibrium, Anxibrium, Anxon)
  • Clobazam (Lobazam, Clozam, Solzam)
  • Lorazepam (Ativan, Lopez, Proline)
  • Oxazepam (Anxozap, Zaxpam, Oxiuse)

Antidepressants

Mechanism

Antidepressants alter the way your brain uses certain chemicals, called neurotransmitters, to help regulate your mood and behavior. They mainly affect the neurotransmitters serotonin and norepinephrine, and sometimes dopamine. 

There are at least seven types of antidepressant, but the commonly used ones are SSRIs

  • Monoamine oxidase inhibitors (MAOIs)
  • Norepinephrine and dopamine reuptake inhibitors (NDRIs)
  • Selective serotonin reuptake inhibitors (SSRIs) 
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Serotonin antagonist and reuptake inhibitors (SARIs)
  • Tricyclic antidepressants (TCAs) 
  • Tetracyclic antidepressants (TeCAs)
Indication

It takes time to reduce symptoms, used to treat long-term anxiety symptoms. Does not provide fast relief.

Side effects
  • Nausea, vomiting or diarrhea
  • Headache
  • Drowsiness
  • Dry mouth
  • Insomnia
  • Nervousness, agitation or restlessness
  • Dizziness
  • Sexual problems, such as reduced sexual desire,
  • Some have fatal suicidal thoughts and severe side effects when taken longer duration (particularly in children & young adults) 
  • SSRIs tend to have fewer symptoms than the other types of antidepressants
Brands
  • Sertraline (Serta, Zosert, Sertee)
  • Fluoxetine (Prodep, Barozac, Flumod)
  • Escitalopram Oxalate (Nexito, Stalopam, S-Celepra)
  • Duloxetine (Symbal, Duxet, Delok)
  • Citalopram (Lopram, Celica, Vocita)
  • Fluvoxamine (Fluvoxin, Voxidep, Uvox)
  • Paroxetine (Paxidep, Panex, Parocen)
  • Vilazodone (Vilano, Vilarest, Neuvilaz)

Buspirone

Mechanism

May reduce anxiety by stimulating serotonin and dopamine receptors on nerves, thereby altering the chemical messages that nerves receive. 

Indication

An antianxiolytic particularly used to treat generalized anxiety disorder(GAD).

Side effects
  • Restlessness
  • Nervousness
  • Nausea or vomiting
  • Drowsiness
  • Headache
  • Dizziness
  • Sleepiness
Brands
  • Buspine
  • Tamspar
  • Busiprox

Mirtazapine

Mechanism

Mirtazapine inhibits the central presynaptic alpha-2-adrenergic receptors, which causes an increased release of serotonin and norepinephrine in the brain that help maintain mental balance. 

Indication

Primarily used to treat anxiety, possesses multiple beneficial properties aside from its main purpose. These secondary effects include calming the nervous system (sedative), reducing nausea (antiemetic), decreasing anxiety (anxiolytic), and enhancing appetite (appetite stimulant). Hence used widely for anxiety and depression. 

Side effects
  • Drowsiness
  • Weight gain
  • Dry mouth
  • Dizziness
  • Sedation
  • Constipation
Brands
  • Mirtaz
  • Mtz
  • Mirtadep

BetaBlockers

Mechanism

It slows down the heart rate by blocking the effects of the hormone epinephrine, also known as adrenaline.

Indication

Usually used for reducing blood pressure, but can help mild cases of anxiety in social anxiety disorder. 

Side effects
  • Not much/mild side effects
  • Feeling tired
  • Lightheaded
  • Dizzy
  • Headache
  • Difficulty sleeping
  • Sexual side effects
Brands
  • Concor
  • Bisoheart
  • Besicor
 

Ayurvedic Treatment

Ayurveda approaches health as a balance of Soul (Atma), Mind (manas) and Body (Sharira) which are the tripods of life. An imbalance to this can cause mental disorders (Unmada roga), including anxiety disorders. In Ayurveda, anxiety (Chittodvega; ‘Chitta’ – mind & ‘Udvega’ – anxiety) is not an illness by itself, but is rather considered a cause of other physical and mental imbalances. Treatments target mental stability, cognition, stress reduction, and overall well-being.

Ayurveda has two broad treatment approaches for all mental conditions – Psychotherapy and Medications. 

Ayurvedic Psychotherapy – ‘Sattvavajaya Chikitsa’ 

As per ayurvedic principles, all beings are defined by 3 gunas / qualities of nature, each associated with specific characteristics:

  • ‘Sattva’ – goodness, purity, knowledge; generally described as enlightened qualities
  • ‘Rajas’ – impulsive, goal oriented, desire; generally described as passionate qualities
  • ‘Tamas’ – illusion, negative, dullness, darkness, destruction; generally described as ignorant or lazy qualities

Anxiety is caused when Rajas and Tamas qualities dominate Sattva qualities, leading to stress. Ayurveda emphasizes on restoring balance by withdrawing from these stressors through mind-control using a combination of intellect (Dhi), meditation (Dhriti) or remembrance (Smriti). 

Ayurveda offers a five-action (Panchakarma) treatment to restore this balance by clearing physical & mental toxins through a combination of diet, yoga, lifestyle modifications, massages and meditation. Many leading ayurveda treatment facilities offer multi-day panchakarma treatments that can reduce anxiety and greatly enhance physical and mental well being.

Ayurvedic Medications

The following Ayurveda medicines are used to treat anxiety and other related mental disorders.

Mandukaparni 
Biological Name – Centella asiatica Linn.
English – Indian pennywort
Hindi – Gotu kola
Tamil – Vallarai

It helps reduce anxiety and improve mental alertness or cognitive function. It has a protective effect on the central nervous system. 

Yastimadhu 
Biological Name – Glycirrhiza glabra Linn.
English –  Liquorice
Hindi – Mulaithi
Tamil – Athimadhuram

Liquorice root contains strong antioxidants and flavonoids that enhance memory, focus, calmness, and alertness. As a potent memory booster, it strengthens memory power, reasoning, problem-solving, and other cognitive skills. Its neuroprotective qualities shield against memory loss and combat stress and tension.

Guduchi
Biological Name – Tinospora cordifolia (Wild) Miers
English – Heart-leaved moonseed
Hindi – Gurcha
Tamil – Seendilkodi

An optimum dosage has anti-anxiety properties and helps in reducing anxiety disorder symptoms. However, consulting an ayurveda specialist is important before taking this medicine.

Shankhapushpi 
Biological Name – Convolvulus pleuricaulis Choisy
English – Butterfly Pea, Blue Pea
Hindi – Sankha puspa/Aparajit 
Tamil – Sanghu pu / Sanghu pushpam

It soothes nerves by reducing hormones such as cortisol and adrenaline produced during stressful times. It is used as a mental stimulant, anxiolytic and neuroprotective aid. It is used primarily to treat depression and to enhance memory and intellect in children with ADHD.

Aindri
Biological Name – Bacopa monniera
English – Water hyssop
Hindi – Brahmi
Tami – Neer Brahmi

It has anxiolytic and memory enhancing properties. It typically takes around 4-6 weeks to start showing noticeable benefits such as improved memory, cognition, reduced anxiety, and overall well-being.

Jyothishmati
Biological Name – Celastrus panniculata
English – Woody liana
Hindi – Malakangini
Tamil – Black oil plant/ Kuvarikuntal

The seed oil of Jyotishmati is used as brain tonic due to its beneficial effect on memory and intellect. The seed oil reversed the scopolamine induced deficits in navigational memory performance and reduced stress and anxiety.

Kushmanda
Biological Name – Benincasa hispida
English – Winter Melon/ White gourd/ Ash gourd
Hindi – Kushmand
Tamil – Neer Poosanikai

Kushmanda is a Medhya drug used to treat mental health issues. ‘Kushmanda Ghrita’ – A mix of Kushmanda, Liquorice & cow’s ghee is used to treat anxiety and other mental disorders widely in ayurveda

Ashwagandha
Biological Name – Withania Somnifera
English – Winter Cherry
Hindi – Asgand
Tamil – Amukkara Kizhangu

Ashwagandha roots and berries are used for treating stress and anxiety. It is commonly available as a powder (churna), and can be mixed with water, ghee or honey. It enhances the function of the brain and nervous system and improves memory. It should be avoided during pregnancy and while breastfeeding.

 

Homeopathy Treatment

Homeopathy uses the following medications to treat Anxiety.

Kali Phosphoricum

Indicated when anxiety is caused by exhaustion, chronic stress, insecurity, over sensitivity, emotional vulnerability and irritability. The potassium phosphate in the drug helps in treating fatigue, insomnia and inability to concentrate by providing a calming effect.

Aconitum Napellus

Used in treating acute/ sudden intense panic/anxiety attacks or post traumatic disorders. It helps in reducing the symptoms like palpitations, shortness of breath, and flushing of the face post anxiety attacks.

Argentum Nitricum

This is particularly used when anxiety causes stomach aches, churns, belching and slower digestion. It is indicated when having stage frights/ social anxieties. Anxiety causes sweating and craving for sweetness which are cyclic symptoms, both can be controlled using Argentum Nitricum – It calms the digestive effects of sugar and cools the body

Arsenicum Album

It can be used to treat both chronic and acute anxiety conditions. Specifically, used to treat obsessive/compulsive disorders(OCD) and a wide range of anxiety symptoms associated with it.

Calcarea Carbonica

It is indicated for all types of phobias and panic disorders accompanied by symptoms like excessive sweating and fatigue.

Yoga: 

According to Yoga, anxiety can be relieved by stimulating the parasympathetic nervous system or ‘rest and digest’ condition. This counters the sympathetic nervous system or the ‘fight or flight’ condition triggered by anxiety disorders.  Yoga involves practicing physical postures (asana), breathing exercises (pranayama), meditation, and relaxation techniques(yoga nidra).

Vrikshasana/ Tree Pose

Helps in mind-body control and balance.Body becomes more centered from inside, resulting in a sense of serenity and stability

Tadasana/Mountain Pose

Increases mental awareness, connects to deeper consciousness, and clears mental fog. Regular practice promotes calmness, positive choices, and improved mood, while also strengthening the nervous system.

Vajrasana/ Diamond pose

It helps to increase blood flow to upper parts of the body like the digestive system, lungs and brain by limiting blood circulation to the lower parts of the body. This helps in calming the mind and body. Aids the body to go in a meditative state.

Shashankasana/ Rabbit Pose

It enhances digestion and improves mental state by relaxing the mind and body.

Shavasana / Corpse Pose

The pose aims to relax the mind and body, reducing stress and grounding the body. It is a resting and restorative pose which is typically used at the end of a yoga session  to calm the body and mind.

Uttanpadasana/Raised leg Pose

Stimulates blood circulation, improves digestion and activates the nervous system.

Makarasana/ Crocodile Pose

It aids in stress management by relaxing the nervous system and muscles.

Pranayama/ Breath Regulation

Yogic breathing techniques (YBT) improves physical wellbeing & self awareness. Improves lung & Cognitive capacity, also reduces blood pressure & anxiety.

Meditation

Meditation is a technique where an individual concentrates on a specific object, thought, or activity to enhance attention, awareness, and achieve a calm and stable mental and emotional state.

References: 

https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/panic-attack
https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders
https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/overview/
https://www.nimh.nih.gov/health/topics/anxiety-disorders
https://www.hopkinsmedicine.org/health/conditions-and-diseases/phobias#:~:text=A%20phobia%20is%20an%20uncontrollable,that%20lasts%20for%20several%20minutes.
https://www.tandfonline.com/doi/pdf/10.31887/DCNS.2003.5.3/lvonmoltke
https://www.harmonyridgerecovery.com/substance-induced-anxiety-disorders-panic-attacks/#:~:text=Prescription%20medication&text=Stimulants%20like%20Adderall%20and%20Ritalin,panic%20attacks%2C%20especially%20during%20withdrawal.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683289/
https://www.indiatodayne.in/lifestyle/story/youth-struggle-soaring-anxiety-and-depression-rates-amidst-a-digital-age-669090-2023-08-28
https://www.cdc.gov/childrensmentalhealth/depression.html#:~:text=Anxiety%20may%20present%20as%20fear,the%20symptoms%20can%20be%20missed.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/obsessivecompulsive-disorder-ocd#:~:text=Obsessive%2Dcompulsive%20disorder%20(OCD)%20is%20a%20common%20anxiety%20disorder,or%20images%20are%20called%20obsessions.
https://pubmed.ncbi.nlm.nih.gov/10681894/#:~:text=Low%20SES%20is%20generally%20associated,are%20also%20related%20to%20stress.
https://www.who.int/standards/classifications/classification-of-diseases
https://www.cdc.gov/nchs/icd/index.htm
https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/anxiety-adults-screening
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573566/
https://www.health.harvard.edu/mind-and-mood/six-relaxation-techniques-to-reduce-stress
https://my.clevelandclinic.org/health/articles/22513-neurotransmitters
https://www.sciencedirect.com/topics/neuroscience/neural-basis-of-anxiety#:~:text=The%20other%20major%20neurotransmitter%20systems,associated%20with%20the%20benzodiazepine%20receptor.
https://my.clevelandclinic.org/health/treatments/24570-benzodiazepines-benzos
https://www.ncbi.nlm.nih.gov/books/NBK519059/#:~:text=Mirtazapine%20is%20an%20atypical%20antidepressant,release%20of%20serotonin%20and%20norepinephrine.
https://www.eurchembull.com/uploads/paper/1ebf7ae0c4631d4e4c1b99263ec1f8ac.pdf
https://www.hindawi.com/journals/ecam/2012/946259/#conclusion
https://www.sciencedirect.com/science/article/abs/pii/S0149763422002846
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296346/#:~:text=Kusmanda%20is%20described%20in%20Ayurveda,beneficial%20effects%20on%20mental%20health.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252722/#:~:text=Ashwagandha%20(Withania%20somnifera%2C%20fam.,its%20wide%20ranging%20health%20benefits.
https://storage.googleapis.com/journal-uploads/ejbps/article_issue/volume_8_july_issue_7/1625105828.pdf
https://www.peacehealth.org/medical-topics/id/hn-2195004#hn-2195004-dosage
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735501/