Anxiety and Nervousness

What anxiety feels like

Anxiety is the body's alarm system. When the brain senses a threat, it triggers the fight-or-flight response, releasing adrenaline and cortisol. That response is useful when there is real danger, but in anxiety it fires too easily or does not switch off.

Mental and emotional symptoms

• persistent worry, often about many different things
• feeling on edge, restless or keyed up
• difficulty concentrating, or your mind going blank
• irritability
• a sense of dread or that something bad will happen
• trouble falling or staying asleep

Physical symptoms of anxiety

• heart palpitations, a pounding or racing heart
• fast breathing, or feeling you cannot get enough air
• muscle tension, headaches, jaw clenching
• sweating, trembling or shaking
• a churning stomach, nausea, diarrhea or "butterflies"
• dizziness, lightheadedness or tingling in the hands and lips (from overbreathing)
• chest tightness
• tiredness

Many people see a doctor first for these physical symptoms, without realizing they are caused by anxiety.

Common causes of anxiety and nervousness

Stress and life events

Work pressure, money worries, relationship problems, illness, bereavement and major changes are common triggers. Anxiety usually eases as the situation resolves or you adapt.

Anxiety disorders

When anxiety is persistent, excessive and disabling, it may be one of these disorders:

Anxiety often occurs together with depression.

Substances and medicines

• caffeine from coffee, energy drinks and some pain relievers
• nicotine, and withdrawal from it
• alcohol, especially the "hangxiety" of the next day, and alcohol withdrawal
• cannabis, stimulants and other recreational drugs
• withdrawal from benzodiazepines, sleeping pills or antidepressants
• medicines including steroids, some asthma inhalers, decongestants containing pseudoephedrine, thyroid hormone in excess, and some ADHD medicines

Medical conditions that cause anxiety

• hyperthyroidism: nervousness, tremor, weight loss, heat intolerance, fast pulse
• heart rhythm problems such as atrial fibrillation or supraventricular tachycardia
• low blood sugar, especially in people with diabetes
• asthma and COPD, where breathlessness provokes anxiety
• menopause and premenstrual changes
• rarely, pheochromocytoma, an adrenal tumor that causes attacks of high blood pressure, headache, sweating and palpitations

Anxiety vs a heart problem

Panic attacks can feel like a heart attack. Panic symptoms peak within about 10 minutes and usually settle within 20 to 30 minutes, often with tingling and a sense of dread. Chest pain that comes on with exertion, spreads to the arm, jaw or back, or occurs in someone with heart risk factors should be treated as a possible heart problem. If you are unsure, call 911.

How anxiety is assessed

A doctor will ask what you worry about, how long it has lasted, how it affects daily life, about sleep, mood, alcohol, caffeine, drugs and medicines, and whether you have thoughts of self-harm. Questionnaires such as the GAD-7 help measure severity. Physical examination and blood tests, commonly thyroid function, blood count and blood sugar, rule out medical causes. An ECG may be done if palpitations are prominent.

Treatment and self-help

Self-help that works

• Cut down caffeine and alcohol. Both worsen anxiety and sleep.
• Regular physical activity: about 150 minutes a week of moderate exercise reduces anxiety symptoms.
• Slow breathing: breathe in for 4 seconds and out for 6 seconds for a few minutes to calm the stress response.
• Regular sleep schedule.
• Guided self-help: CBT-based workbooks and apps.
• Talk to someone you trust, and keep up social contact rather than avoiding situations.

Talking therapies

Cognitive behavioral therapy (CBT) is the most effective therapy for anxiety disorders. It teaches you to recognize and challenge anxious thoughts and gradually face feared situations. Applied relaxation is another option.

Medicines

• SSRIs and SNRIs, such as sertraline, escitalopram or venlafaxine, are first-choice medicines for long-term anxiety. They take 2 to 6 weeks to work.
• Pregabalin and buspirone are alternatives for some people.
• Benzodiazepines relieve anxiety quickly but are used only short term because of dependence and withdrawal risks.
• Beta-blockers such as propranolol can reduce physical symptoms like tremor and palpitations in performance anxiety.

Frequently asked questions

Why do I feel nervous for no reason?

Anxiety can appear without an obvious trigger, especially in generalized anxiety disorder or panic disorder. Caffeine, poor sleep, alcohol, hormonal changes, thyroid problems and some medicines can also cause unexplained nervousness. A doctor can check for physical causes.

What are the physical symptoms of anxiety?

Common physical symptoms include a racing or pounding heart, fast breathing, muscle tension, sweating, trembling, nausea, an upset stomach, dizziness, tingling and tiredness. They are caused by stress hormones and can feel very real and frightening.

What is the difference between anxiety and nervousness?

Nervousness is a short-lived feeling, usually tied to a specific event, that passes once it is over. Anxiety is broader and can last for weeks or months, sometimes without a clear cause. When it is persistent and affects daily life, it may be an anxiety disorder.

Can anxiety be cured?

Many people recover fully, and most improve substantially with treatment. CBT teaches skills that keep working after therapy ends. Medicines help control symptoms. Anxiety can return during stressful times, but people usually know how to manage it.

When should I see a doctor about anxiety?

See a doctor if anxiety lasts more than a few weeks, interferes with work, school, relationships or sleep, causes panic attacks, or leads you to use alcohol or drugs to cope. If you have thoughts of suicide, call or text 988 in the US.