Areas › Worry and anxiety › Treatment and medication
Anxiety comes in two rough families. Fear is the sudden bodily kind that arrives in a rush, and worry is the slow kind that circles and will not settle.
The distinction earns its place because the two behave differently. Fear peaks and passes and shows up in the heart and the breath, while worry sits at low level for months and lives mostly in thought. Most people carry some of each, so the question is less which one you have and more which one is doing the damage this month.
This explains how treatments work. Never start, stop or change a medication because of something you read here.
Qur’an and Sunnah
Lord, increase me in knowledge (Quran 20:114). Learning to tell one kind of anxiety from another is part of what that asking is for.
فَتَعَٰلَى ٱللَّهُ ٱلۡمَلِكُ ٱلۡحَقُّۗ وَلَا تَعۡجَلۡ بِٱلۡقُرۡءَانِ مِن قَبۡلِ أَن يُقۡضَىٰٓ إِلَيۡكَ وَحۡيُهُۥۖ وَقُل رَّبِّ زِدۡنِي عِلۡمࣰ ا
exalted be God, the one who is truly in control. [Prophet], do not rush to recite before the revelation is fully complete but say, ‘Lord, increase me in knowledge!’
Qur’an 20:114read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
Long term treatment recommendations for generalised anxiety disorder describe it as affecting roughly four to seven people in a hundred over a lifetime, usually beginning in early adulthood and running a long course, which is why its treatment is discussed in months and years rather than weeks. That is the shape of the worry family in particular. These are expert recommendations rather than a single trial, so take the timescale as guidance about what to expect.
Christer Allgulander; Borwin Bandelow; Eric Hollander; Stuart Montgomery; David Nutt; Ahmed Okasha (2003). WCA Recommendations for the Long-Term Treatment of Generalized Anxiety Disorder. CNS Spectrums doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
Two things that feel alike from the outside can need quite different handling.
This one is still a draft. It is waiting on a scholar and a clinician to read it before it is published.
Near this one
If you have been given a drug from one category for a problem in another, it is fair to ask which part of it is doing the work. Often the useful effect is a side effect that has been borrowed.
One medicine can reach both the surging kind of anxiety and the circling kind, while another really only touches the surging kind. That is why the slower and broader option is usually the one people are started on.
Something that settles a surge of panic within minutes and something that changes how often the surges come are doing two different jobs. A person can need both, and it helps to say which is which.