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Constant anxiety isn't something people just imagine they have. When anxiety is constant, or at least seems that way, generally the more specific diagnosis would be panic disorder. Unlike a phobia, which is a specific fear, or social anxiety, which isn't as keenly felt when you are alone, panic disorders can cause distress essentially every waking moment.

Panic disorders occur as a combination of life experience and genetic predisposition that affects the "wiring" and chemistry of the brain. In general, people who are prone to panic disorder are unusually sensitive to their own heart beat. When something happens to cause the heart to beat more slowly (going on a beta-blocker for high blood pressure, for instance), they tend to get depressed. When something happens to cause the heart to beat more quickly, they tend to panic, even if it is a medication or an athletic event or going from a lower elevation to a higher elevation with its lower oxygen levels.

The most common triggers for panic are:

  • Certain settings, such as stores and public transportation (especially in patients with agoraphobia). Activating a phobia can set off a panic disorder.
  • Illness. General fatigue and inflammation increase the likelihood of panic attacks.
  • Injury (eg, accidents, surgery), especially when the outcome is uncertain.
  • Interpersonal conflict or loss, especially affecting a spouse, child, or parent.
  • Starting antidepressant therapy with Zoloft (sertraline) can induce panic in previously asymptomatic patients.
  • Use of cannabis can trigger panic attacks in people who are phobic of suffocation, due to holding in breath.
  • Use of stimulants, such as caffeine, decongestants, cocaine, and sympathomimetic drugs, such as methamphetamine and/or MDMA (also known as Ecstasy).

In people who experience constant anxiety, the chemistry and wiring of the brain or some other physical characteristic perpetuate anxiety once it sets in. There can be a variety of causes.

  • Some people have adrenal glands that keep producing the stress hormone cortisol in response to a scary or anxiety-provoking incident long after the incident has passed.
  • Some people have unusual sensitivity to carbon dioxide, so that their bodies act as if oxygen levels were falling, they breathe more rapidly, their hearts race, and they feel panic.
  • Some people experience panic that is really a partial epileptic seizure, and then the fact that seizure has occurred generates its own anxiety.
  • Some people lack receptors for chemicals that calm brain activity.
  • Some people have unusual imbalances in the production, promotion, or transport of the brain chemicals serotonin, dopamine, and norepinephrine.

Constant panic can also be influenced by culture. In Japan, for instance, a panic attack can lead to a condition known as taijin kyofusho, a fear of offending others, which becomes more of a problem than the panic attack from which it originates.

Panic attacks and/or constant anxiety usually first appear in early adulthood, between the ages of 20 and 25. They are 2 to 2.5 times more common in women than in men. Different phobias that can trigger panic attacks appear at different ages; panic at the site of blood usually starts in childhood, while fear of enclosed spaces (claustrophobia) or the outdoors (agoraphobia) usually does not start until early adulthood. About 95 percent of people who have agoraphobia suffer panic attacks; other phobias are not as closely linked to constant anxiety.

If you're feeling anxious all the time, what can you do? First of all, see a doctor to make sure that the real problem isn't something that has more to do with your cardiovascular system or lungs. It is easier to address these issues than it is to treat generalized anxiety disorders. 

Then, if you know you have a specific phobia, it may be more useful to seek psychological treatment for that single issue than to pursue a complex program of treatment for free-floating anxiety. 

If you have a problem with anxiety, then you need to avoid stimulants. Avoid or eliminate tea, coffee, and colas.

Pursue medication, including self-medication (notably alcohol and marijuana) as last resort. Prescription medications for anxiety such as Prozac and Lexopro can actually increase anxiety at first. Different people can have very different reactions to Zoloft, because it has to be processed in the liver with an enzyme that also activates pain relievers and sleep aids.

Alcohol may dull anxiety, but drunkenness can result in getting into situations that give you tangible reasons for long-term anxiety. Certain strains of marijuana that emphasize the chemical CBD over THC may be relaxing, but a street dealer will not be able to provide them reliably, and there are no strains of marijuana that do not also contain chemicals that can cause some degree of anxiety.

It's best to deal with the fears you know before you try to tackle a condition that not even doctors understand very well. Tame your anxiety without drugs as much as you can, and use drugs only as a last resort and under a doctor's supervision.

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