Patient information · Mental health
Anxiety
why it produces physical symptoms, and what helps
Anxiety is the body's threat response firing when there is no threat, or firing far harder than the situation warrants. The physical symptoms are genuine, not imagined, and they are one of the commonest reasons people are investigated for a heart or gut problem and told nothing is wrong.
Please get help today if
- you are having thoughts of harming yourself or ending your life
- you feel unable to keep yourself safe
- you are unable to eat, drink or sleep because of anxiety
- you are hearing or seeing things others do not, or feel detached from reality
- someone close to you is seriously worried about you
If you are having thoughts of harming yourself or ending your life, help is available now and these feelings can be treated. Call 999 or go to an emergency department if you have already harmed yourself or feel unable to stay safe. Otherwise call Samaritans free on 116 123, any time of day or night, text SHOUT to 85258, or call NHS 111 and select the mental health option. Please also tell someone you trust, and tell us — we would far rather you did.
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.
Have the physical causes checked once, properly, then stop checking. An overactive thyroid, anaemia, certain medicines, excessive caffeine and alcohol withdrawal all mimic anxiety and are worth excluding with a single set of blood tests and an examination. Repeated investigation after that tends to feed the anxiety rather than settle it.
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
Helps
- Slow breathing out longer than in — four in, six out — for a few minutes
- Regular sleep and meals, which stabilise the whole system
- Cutting caffeine substantially; it directly produces anxiety symptoms
- Scheduling a fixed 'worry time' rather than resisting worry all day
- Facing avoided situations gradually rather than all at once
Keeps it going
- Avoidance — every avoided situation teaches the brain it was dangerous
- Reassurance-seeking, checking symptoms and searching online
- Alcohol, which reduces anxiety for two hours and increases it for twelve
- Cannabis, which worsens anxiety in most regular users
- Fighting the feeling, rather than letting it rise and pass
Panic attacks
If your anxiety comes in sudden intense surges peaking within ten minutes, with a feeling of impending death or loss of control, that is a panic attack and it responds to a specific approach. See our separate leaflet on panic attacks.
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
Book an appointment if anxiety is affecting your life. We offer unhurried consultations, physical assessment and blood tests to exclude other causes, prescribing where appropriate, and referral to talking therapy without a long wait. You do not have to be at crisis point to be seen.
Unhurried appointments, no long wait
Seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.