Private anxiety clinic in London, same-day mental health.

What anxiety does to the body

Adrenaline prepares you to fight or run. That is useful facing genuine danger and deeply unpleasant sitting at a desk. It produces a racing or thumping heart, breathlessness, chest tightness, dizziness, nausea, churning stomach, sweating, trembling, tingling in the hands and around the mouth, and a feeling of unreality.

These symptoms are harmless but frightening, and the fear of them commonly becomes the main problem — you begin scanning your body, notice every skipped beat, and the scanning itself generates more adrenaline. Being told the tests are normal rarely breaks that loop on its own.

What actually works

• Cognitive behavioural therapy has the strongest evidence of anything, including medication. It is practical and time-limited rather than open-ended, and is available in person, online and through guided self-help.
• Medication — usually an SSRI — is effective for moderate to severe anxiety. It takes two to four weeks to begin working and often makes anxiety slightly worse in the first fortnight, which is the commonest reason people stop. Starting low and going slowly avoids most of that.
• The two together work better than either alone for many people.
• Exercise has a genuine, measurable effect — not a consolation prize. Aerobic exercise three times a week is comparable to some medication in trials.
• Avoid benzodiazepines for more than a very short period. They work immediately, then stop working, and cause dependence and rebound anxiety.

Self-help with evidence

When to be seen

• anxiety most days for more than a few weeks, or affecting work, sleep, relationships or eating
• you are avoiding things you used to manage
• you are using alcohol or drugs to cope
• physical symptoms you would like properly excluded, once
• you want to start, change or stop medication — particularly stopping, which should be gradual