Stress is not a disease and is a normal part of everyone's life. Stress in small quantities is good: it makes us more productive. For example, the fear of a bad grade can make the a student study more attentively.

However, too much stress is unhealthy and counterproductive. The same student, if he was recently mugged and or is getting over the sudden death of a friend will not be able to study as well.

Persistent and unrelenting stress is called anxiety.

Anxiety is an emotion often accompanied by various physical symptoms. These can include twitching or trembling, muscle tension, headaches, sweating, dry mouth, or difficulty swallowing. Some people also report dizziness, a rapid or irregular heart rate, increased rate of respiration, diarrhea, or frequent need to urinate when they are anxious. Fatigue, irritable mood, sleeping difficulties, decreased concentration, sexual problems, and nightmares are also common.

Sometimes a medical illness may masquerade as anxiety.

Some people are more sensitive to stress and are more likely to develop anxiety disorders. This can be caused either by genetic predispositions or by previous (particularly early childhood) exposure to certain stresses. Other times it is simply a question of how stressful the current environment is.

• actual danger: very often stress is an appropriate reaction
• emotional stress such as grief and depression often lead to anxiety
• physical stress such as a medical illness
• medication side effects
• drugs including caffeine, cold remedies (Cough/Cold Combinations - oral), sympathomimetics, decongestants (Antihistamines and Decongestants - oral), bronchodilators, tricyclic antidepressants, and thyroid supplements
• withdrawal from drugs (including caffeine and nicotine)
• substance abuse or withdrawal (including alcohol)
• poor diet (deficiency of Vitamin B12)
• hyperventilation syndrome
• thyroid problems (hyperthyroid disease mostly)
• low blood sugar
• cardiac problems
• in extremely rare cases, a tumor of the adrenal gland (pheochromocytoma)

Finding what is causing the anxiety and addressing it is the preferred and most effective solution. Unfortunately, this is not always possible.

A first step is to take an inventory of what you think might be making you "stresses out." What do you worry about most? Is there something constantly on your mind? Does anything in particular make you sad or depressed?

Then, find someone you trust who will listen to you. Very often, talking can help relieve anxiety. Most communities have resources like self-help groups and hotlines which can help with problems of anxiety. Ministers, social workers, friends, neighbors, and family can all play a therapeutic role.

Also, take a look at your lifestyle. Do you eat well? Do you sleep enough? Are you exercising? How much caffeine do you take in a single day?

Learn techniques, including biofeedback and relaxation therapy, to reduce muscle tension. Biofeedback is a process of monitoring body functions (such as the tightness of certain muscle groups) and altering these functions through relaxation. Follow a regular energetic exercise routine using aerobic exercise if possible.

Avoid using "mood-altering" drugs when overwhelmed by life's problems. These drugs will not provide a solution and can often cause additional difficulties.

• you are unable to work because of anxiety, self-treatment has failed, or the cause of the anxiety is unknown.
• there is a sudden feeling of panic.
• problems cannot be resolved without outside, professional help.

Your primary health care provider is a valuable resource. He or she can determine with you if your anxiety would be best evaluated and possibly treated by a mental health care professional.

• When did the anxiety begin?
• What physical symptoms develop that make you feel anxious?
• What physical symptoms do you have that you are worried about?
• What makes the anxiety better?
• What makes it worse?
• What other symptoms are also present?

A general physical examination will be performed. Close attention will be paid to your pulse, respiratory rate and blood pressure.

Diagnostic tests may include blood tests (CBC or blood differential, thyroid function tests) as well as an electrocardiogram (EKG).

If the anxiety is not accompanied by any worrisome physical signs and symptoms, a referral to a mental health care professional may be recommended for appropriate treatment.

Psychotherapy such as cognitive-behavioral therapy (CBT) has been shown to significantly decrease anxiety. In some cases, medications such as benzodiazepines or antidepressants may be appropriate.

After seeing your health care provider:
You may want to add a diagnosis related to anxiety to your personal medical record.