What are anxiety and panic disorders?

Anxiety and panic disorders are severe mental health conditions that affect millions of people worldwide. According to the World Health Organization (WHO), anxiety disorders are among the most prevalent mental health issues, affecting an estimated 264 million people globally.

These afflictions can manifest as excessive fear, worry, or nervousness, often interfering with daily activities. Panic disorders, a subset of anxiety, are characterised by sudden, intense episodes of fear, known as panic attacks. Those attacks can be physically and emotionally overwhelming. Physical symptoms of panic attacks might include:

• Racing or Pounding Heart (Palpitations): A rapid, irregular heartbeat is a hallmark sign of a panic attack.
• Shortness of Breath: Many people feel they can’t catch their breath or are suffocating.
• Chest Pain or Discomfort: Chest tightness or sharp pains, which can be mistaken for a heart attack, often accompany panic attacks.
• Dizziness or Light-headedness: Feeling faint or unsteady is a common symptom.
• Sweating: Excessive sweating, often accompanied by cold or clammy skin, may occur during an attack.
• Trembling or Shaking: Some individuals may experience trembling or notice their hands shaking.
• Nausea or Upset Stomach: Gastrointestinal discomfort or the sensation of wanting to vomit can arise.
• Chills or Hot Flashes: Sudden feelings of heat or cold may sweep over the body.
• Numbness or Tingling: A sensation of numbness or tingling (often in the hands, feet, or face) is expected and is commonly referred to as paraesthesia.
• Choking Sensation: Some people may experience a tightness in their throat or feel as though they are choking.
• Muscle Tension: Tightness or soreness in the muscles, often from the body’s fight-or-flight response.

The WHO recognises these conditions as significant contributors to the global disease burden, as they can severely impact quality of life, productivity, and overall well-being. Proper management, early intervention, and access to care are essential for improving outcomes for individuals affected by anxiety and panic disorders.

What is the conventional treatment for anxiety and panic disorders?

In Western medicine, anxiety and panic disorders are treated using a combination of approaches, including medications, psychotherapy, and lifestyle changes. The treatment plan is often individualised based on the disorder’s severity and the patient’s specific needs.

Common biomedical treatments include:

1. Medications:

• Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs, such as sertraline and fluoxetine, are commonly prescribed for anxiety and panic disorders. They work by increasing the levels of serotonin in the brain, which helps regulate mood and anxiety.
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): These medications (venlafaxine and duloxetine) are also used to treat anxiety disorders, affecting both serotonin and norepinephrine.
• Benzodiazepines: These are fast-acting medications (e.g., lorazepam, diazepam) that help relieve acute anxiety and panic symptoms but are usually prescribed for short-term use due to the risk of dependence.
• Beta-Blockers: These medications, such as propranolol, are sometimes used to manage the physical symptoms of anxiety, like a racing heart or trembling. They are also used to regulate blood pressure.
• Tricyclic Antidepressants (TCAs): These older medications are less commonly used but may be effective for some individuals when SSRIs or SNRIs are not suitable.

2. Psychotherapy:

• Cognitive Behavioural Therapy (CBT): CBT is one of the most effective forms of therapy for anxiety and panic disorders. It helps patients recognise and challenge irrational thoughts and behaviours, teaching them coping strategies to manage anxiety and panic attacks.
• Exposure Therapy: This therapy gradually exposes patients to the triggers of their anxiety or panic in a controlled manner, helping them reduce their fear response over time.
• Mindfulness-Based Therapies: These therapies, which incorporate mindfulness (such as meditation) and relaxation techniques, help individuals manage stress and anxiety by focusing on the present moment.

3. Mind-body therapies:

• Mind-body modalities are holistic approaches that emphasise the connection between mental and physical well-being, utilising meditation, yoga, mindfulness, and biofeedback to promote relaxation and emotional balance.
• Acupuncture and TCM are also considered mind-body therapies.

These therapies are beneficial for anxiety and panic disorders because they help individuals cultivate awareness of their thoughts and bodily sensations, reduce stress, and improve emotional regulation. By fostering a sense of calm and enhancing coping skills, mind-body therapies can effectively alleviate symptoms of anxiety and empower individuals to manage their reactions to stressful situations.

4. Lifestyle modifications:

• Regular Exercise: Physical activity reduces anxiety symptoms and improves mood by releasing endorphins and improving overall health.
• Stress Management Techniques: Practices like yoga, meditation, and deep breathing can help manage anxiety symptoms.
• Healthy Diet and Sleep: Proper nutrition and good sleep hygiene are essential in maintaining mental health and reducing anxiety.

Combining a range of treatments often results in the most effective management of anxiety and panic disorders.

Why are anxiety and panic disorders so prevalent?

Anxiety and panic disorders are increasingly prevalent; here are several interconnected factors that might contribute to their rise:

1. Modern lifestyles and stress: The fast-paced, high-pressure nature of contemporary life has significantly increased stress levels. Many people face constant demands from work, financial pressures, and social obligations. This chronic stress can trigger or exacerbate anxiety and panic disorders as the body and mind struggle to cope with continuous overstimulation.

2. Digital overload and Social Media: The rise of technology, particularly social media, plays a significant role. Constant exposure to curated images of success, beauty, and happiness can create unrealistic expectations, leading to feelings of inadequacy, comparison, and anxiety. Furthermore, the 24/7 connectivity and information overload from smartphones and other devices can disrupt sleep, increase stress, and reduce the ability to relax and disconnect.

3. Isolation and loneliness: Despite more excellent connectivity through digital means, many people feel more isolated than ever. Changes in social structures, urbanisation, and decreased face-to-face interaction can foster feelings of loneliness, which is closely linked to anxiety. The COVID-19 pandemic further exacerbated this, as lockdowns and social distancing measures left many isolated for extended periods [1].

4. Economic uncertainty: Financial pressures, job insecurity, and the rising cost of living are significant stressors that can contribute to anxiety and panic disorders. Economic uncertainty, particularly among younger generations, has created a sense of instability and fear about the future, fuelling mental health struggles. Geographic regions currently affected by war generate additional worries and contribute to economic uncertainty.

5. Increased awareness and diagnosis: As mental health awareness has grown, more people are seeking help for anxiety and panic disorders, leading to higher rates of diagnosis. This increased awareness is positive, but it also highlights the widespread nature of these conditions, which may have been underreported or misdiagnosed in the past.

6. Environmental factors: Pollution, climate change, and urbanisation can all contribute to rising anxiety levels. Environmental stressors, such as noise pollution, crowded living conditions, and concerns about global climate events, add to the daily stress burden many individuals face.

7. Biological and genetic factors: Research suggests that anxiety and panic disorders can have genetic components, making some people more predisposed to developing them. Additionally, modern research on the microbiome has shown that poor diet and gut health may influence mental health, potentially increasing anxiety levels in populations consuming more processed and less nutritious food.

8. Post-pandemic effects: The COVID-19 pandemic has impacted mental health globally. Many people experienced increased anxiety due to health concerns, isolation, job losses, and the uncertainty of the pandemic. Even as the world recovers, lingering effects, such as health anxieties, grief, and economic instability, continue to affect mental health [2].

9. Pharmaceutical and substance use: Over-reliance on medications, stimulants like caffeine, and recreational drugs can also contribute to anxiety. Some medications or substances can create or exacerbate symptoms of anxiety and panic, especially when used long-term.

In combination, these factors create a climate in which anxiety and panic disorders are more likely to develop and persist, contributing to their rising prevalence. Effective management requires recognising the factors that cause and raise anxiety levels and addressing both individual and societal contributors. We are also responsible for promoting our mental well-being and reducing stressors.

Anxiety and panic disorders in TCM

In Traditional Chinese Medicine (TCM), anxiety and panic disorders (like all disorders) are seen as imbalances in the body’s vital energies, particularly related to the organs responsible for emotional regulation. TCM takes a holistic approach, viewing mental health as deeply connected to the individual’s physical body and our spiritual connection and well-being. Anxiety and panic disorders are commonly associated with disharmony in the heart (Fire), liver (Wood), and kidney (Water) systems. Often, there are imbalances in Qi (energy), blood, and Shen (spiritual, mental, and intellectual association).

1. Heart (Xin): The heart is considered the seat of the mind and spirit (Shen). Emotional disturbances are often linked to a disturbance in the heart’s ability to regulate Shen properly. When the heart Qi is deficient, or there is excess heat in the heart, symptoms like insomnia, palpitations, restlessness, and panic attacks may occur. This is closely related to the nourishing properties of blood, as in TCM, the heart governs the blood.

2. Liver (Gan): The liver is responsible for the smooth flow of Qi throughout the body. When liver Qi stagnates—often due to stress, frustration, or emotional suppression—it can cause anxiety, irritability, and a sense of internal tension. In extreme cases, the liver’s failure to regulate Qi can lead to a build-up of internal heat and phlegm, worsening anxiety symptoms and disturbing the mind.

3. Kidney (Shen): The kidneys are associated with fear and are considered the foundation of vitality and essence (Jing). Panic disorders may be connected to a deficiency in kidney Yin or Yang, leading to a state of instability and deep-seated fear. Kidney deficiency is often implicated when symptoms like fearfulness, exhaustion, or weakness accompany anxiety.

4. Qi and blood Imbalances: Anxiety can also arise from Qi deficiency, leading to fatigue, shortness of breath, and overwhelming. Similarly, blood deficiency (especially heart blood deficiency) can lead to the mind being unsettled, resulting in anxiety, poor concentration, and feelings of unease.

5. Phlegm and dampness: In TCM, excessive moisture and phlegm can obstruct Qi’s flow and create mental confusion or heaviness, contributing to anxiety. Phlegm misting the mind can also cause emotional instability and even panic attacks in severe cases.

The treatment of anxiety and panic disorders in TCM

Acupuncture aims to restore the flow of Qi, calm the Shen, and balance the organ systems, particularly the heart, liver, and kidneys. In addition to treating the disharmony pattern, specific acupuncture points might be selected to calm anxiety, panic or fear.

TCM practitioners may prescribe Chinese herbal medicine (CHM) formulas based on the specific imbalance. Such formulas include Suan Zao Ren Tang, Chai Hu Jia Long Gu Mu Li Tang, Gui Zhi Jia Long Gu Mu Li Tang, Tian Wan Bu Xin Dan, etc. It depends on the practitioners’ framework and the formula systems they might opt for. Additionally, each formula might be modified to suit an individual presentation.

In TCM, emotional health is supported through balanced living, which includes proper diet, moderate exercise, stress reduction, and emotional expression. Meditation and Qi Gong are often recommended to cultivate inner peace and balance. In summary, anxiety and panic disorders in TCM are viewed because of an energetic disharmony, with treatment aimed at restoring balance to the organ systems, promoting the free flow of Qi, nourishing the blood, calming the mind and spirit and addressing the person’s disharmony pattern. It doesn’t matter if an individual takes prescription medication; the TCM approach will incorporate it into its overall treatment.

If you are considering acupuncture or Chinese herbal medicine for anxiety or panic disorders, here are some details about your local AHPRA-registered practitioner.

Book your appointment today or reach out with any questions that you might have.

[1] https://www.psychologytoday.com/us/blog/live-long-and-prosper/202210/technology-use-loneliness-and-isolation

[2] https://www.healthdata.org/news-events/insights-blog/acting-data/new-global-burden-disease-analyses-show-depression-and