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Post-traumatic stress disorder (PTSD) is a psychological and physical condition that is caused by very frightening or distressing events. It occurs in up to 30% of people who experience traumatic events.

Traumatic Events

PTSD can occur after experiencing or witnessing traumatic events such as:

military combat,

serious road accidents,

terrorist attacks,

natural or man-made disasters,

being held hostage,

violent deaths, and

violent personal assaults, such as sexual assault, mugging or robbery.

PTSD may also occur in any other situation where a person feels extreme fear, horror or helplessness. However, it does not usually develop after situations that are upsetting, such as divorces, job losses or failing exams.

Someone with PTSD often relives the traumatic event through nightmares and flashbacks. They may also have problems concentrating and sleeping, and feel isolated and detached. These symptoms are often persistent and severe enough to have a significant impact on a person’s day-to-day life.

PTSD is a Mental Health condition

PTSD first came to prominence during the First World War after soldiers suffered harrowing experiences in the trenches. Their condition became known as shell shock or battle fatigue syndrome. It has not been until fairly recently that it has been accepted that traumatic events outside of war situations have similar effects.

The term ‘post-traumatic stress disorder’ was first used after the Vietnam War. In 1980, PTSD officially became recognised as a mental health condition when it was included in the Diagnostic and Statistical Manual of Mental Disorders, which was developed by the American Psychiatric Association (APA).

How common is PTSD?

PTSD affects up to 30% of people who experience a traumatic event. It affects around 5% of men and 10% of women at some point during their life, and can occur at any age, including during childhood.

Approximately 40% of people with PTSD develop the condition after someone close to them suddenly dies.

Outlook

PTSD can be successfully treated even when it occurs many years after the traumatic event. Depending on the severity of your symptoms, and how soon they develop after the traumatic event, a number of different treatment strategies may be recommended. These include:

watchful waiting: waiting to see if the symptoms improve or get worse without treatment,

psychological treatment, such as trauma-focused cognitive behavioural therapy (CBT), or eye movement desensitisation and reprocessing (EDMR), and

medication, such as paroxetine or mirtazapine.

The symptoms of post-traumatic stress disorder (PTSD) usually develop immediately after the traumatic event. However, in some cases (less than 15%), the onset of symptoms may be delayed for weeks, months or years.

In PTSD, there are often periods of time when symptoms are reduced (symptom remission). These are followed by periods when symptoms increase. Some people with PTSD have symptoms that are severe and constant.

Most people who witness a traumatic event experience some of the symptoms of PTSD. The nature and severity of symptoms can vary widely between individuals. Some of the main symptoms associated with PTSD are described below.

Re-experiencing

If you have PTSD, you may frequently relive the traumatic event in the form of flashbacks, nightmares, or repetitive and distressing images or sensations. However, some aspects of the traumatic event may be forgotten in time.

Avoidance

Constantly reliving a traumatic experience can be very upsetting. If you have PTSD, you may try to avoid circumstances, situations or people that remind you of the traumatic event. You may also refuse to discuss your experience with others.

Hypervigilance 

If you have PTSD, you may find it very difficult to relax, and you may be anxious all the time. You may be hypervigilant (constantly aware) to threats, and be easily startled.

Irritability and angry outbursts are also common symptoms of PTSD. You may have sleeping problems, and find it difficult to concentrate.

Emotional Numbing

Sometimes, people with PTSD deal with their feelings by trying not to feel anything at all. This is known as ‘emotional numbing’.

If you have PTSD, you may feel detached or isolated from others. You may also experience feelings of guilt.

People with PTSD often seem deep in thought (introspective) and withdrawn. They may give up activities and pastimes that they used to enjoy.

Other Symptoms

Other common symptoms of PTSD include:

depression, anxiety and phobias,

drug or alcohol misuse, and

unexplained physical symptoms, such as sweating, shaking, headaches, dizziness, chest pains and stomach upsets.

As with many mental health conditions, PTSD sometimes leads to the breakdown of relationships, and causes problems at work.

PTSD in children

PTSD sometimes affects children who have witnessed a traumatic event, such as a road traffic accident. They may repeatedly re-enact the traumatic event through play, and they may have frightening and upsetting dreams.

Like adults, children with PTSD may lose interest in activities that they used to enjoy. They may also experience headaches and stomach aches.

Cause of Post-Traumatic Stress Disorder

It is not fully understood why some people develop post-traumatic stress disorder (PTSD) after experiencing a traumatic event, while others do not. However, there are a number of risk factors that seem to make certain people more likely to develop the condition.

Risk Factors

If you have had depression or anxiety in the past, or you do not receive much support from family or friends, you are more susceptible to PTSD.

There may also be a genetic factor involved in PTSD. For example, it is thought that having a parent with a mental health problem increases your chances of developing the condition.

Being abused during childhood is thought to be another risk factor for PTSD.

Abnormal Hormone response

Studies have shown that people with PTSD have abnormal levels of stress hormones.

When you are in danger, your body produces a number of natural chemicals, such as adrenalin. In very stressful situations, adrenalin triggers a reaction in the body, which is often referred to as the ‘fight or flight’ reaction. Adrenalin helps to deaden the senses and dulls pain.

People with PTSD have been found to continue to produce high amounts of ‘fight or flight’ hormones even when there is no danger. This may be responsible for their numbed emotions and feelings of detachment.

The Hippocampus

Diagnosing post-traumatic stress disorder (PTSD) can be difficult for two main reasons:

People who experience traumatic events often do not want to talk about their feelings.

people with PTSD may not seek treatment for many months or years after their symptoms appear.

When to seek Medical advice

If you have experienced a traumatic event, such as a serious road traffic accident, you may develop PTSD.

The Royal College of Psychiatrists (RCPSYCH) uses several criteria to help determine whether someone who has experienced or witnessed a traumatic event has PTSD. These include:

having vivid memories, flashbacks or nightmares,

trying to avoid things that remind you of the event,

sometimes feeling emotionally numb,

often feeling irritable and anxious for no apparent reason,

eating more than usual, drinking alcohol or using drugs more than usual,

being unable to control your mood,

finding it increasingly difficult to get on with others,

having to keep very busy to cope, and/or

feeling depressed or exhausted.

If it is less than six weeks since you experienced the traumatic event, and your symptoms are starting to improve, they may be part of the natural coping process.

However, discuss your feelings with your GP if your symptoms do not appear to be improving more than six weeks since the traumatic event.

Visiting your GP

As PTSD affects everyone differently, your GP will want to discuss your symptoms with you in as much detail as possible.

Your GP will ask you whether you have experienced a traumatic event, either in the recent or distant past, and whether you have re-experienced the event through flashbacks or nightmares. They may also ask you questions about your overall state of health, and whether you are having problems sleeping or you are having sleep disturbances.

If you have experienced a traumatic event, you may develop post-traumatic stress disorder (PTSD) in the days, weeks or months after the incident.

Although such events can be very difficult to come to terms with, confronting your feelings and seeking professional help is often the only way of effectively treating PTSD.

In treating PTSD, the National Institute for Clinical Excellence (NICE) recommends psychotherapy (talking treatments) as the first choice of treatment, before medication is used.

PTSD can be treated for many years after the traumatic event occurred, so it is never too late to seek help.

Treatment Plan

Treatment for PTSD usually begins with a detailed evaluation and a treatment plan tailored to your individual needs. Your GP may feel that you would benefit from seeing a mental health specialist, such as:

a counsellor, who is trained to listen sympathetically and can help you to deal with any negative thoughts and feelings,

a psychologist, who is an expert in the workings of the mind,

a community psychiatric nurse, who specialises in mental healthcare, or

a psychiatrist: a mental health specialist who diagnoses and treats mental health conditions.

The healthcare professionals you are referred to should always treat you with sensitivity and understanding. Your treatment plan should be discussed with you. Any decisions regarding your treatment will be clearly explained.

Watchful waiting

‘Watchful waiting’ involves carefully monitoring your symptoms to see whether they improve or get worse. It may be recommended in cases of PTSD where symptoms are:

mild, and

have been present for less than four weeks after the traumatic event.

If watchful waiting is recommended, you should have a follow-up appointment within one month.

Psychotherapy

Psychotherapy is a type of talking therapy that is often effective in treating emotional problems and mental health conditions, including:

depression,

anxiety,

obsessive compulsive disorder (OCD), and

post-traumatic stress disorder (PTSD).

A psychotherapist is a trained mental health professional who will listen to your problems and suggest strategies that may help you to resolve them. In cases of severe or persistent PTSD, a combination of psychotherapy and medication may be recommended.

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy (CBT) is a type of psychotherapy that teaches you skills that will help you to change any negative thought processes you may have.

Trauma-focused CBT uses mental imagery of the traumatic event to help you work through the trauma and gain control of your fear and distress.

You may be offered trauma-focused CBT if:

you have severe symptoms of PTSD, which develop within one month of a traumatic event, or

you still have PTSD symptoms within three months of a traumatic event.

Between 8-12 weekly sessions of trauma-focused CBT are usually recommended, although fewer (about five) may be needed if the treatment starts within a month of the traumatic event.

Eye movement desensitisation and reprocessing (EMDR)

Eye movement desensitisation and reprocessing (EMDR) involves making several sets of side-to-side eye movements while recalling the traumatic incident.

EMDR aims to help your brain process flashbacks so that you can come to terms with the traumatic experience and think more positively. EMDR has been found to help many people with PTSD reduce their distress.

Medication

NICE suggests that paroxetine, which belongs to a group of medicines known as selective serotonin reuptake inhibitors (SSRIs), or the antidepressant mirtazapine, should be considered for treating PTSD in adults.

However, these medications should only be used when:

the person chooses not to have trauma-focused psychological treatment,

the person cannot start psychological treatment due to a high risk of further trauma,

the person has gained little or no benefit from a course of trauma-focused psychological treatment, or

there is severe depression or hypersensitivity, which significantly affects the person’s ability to benefit from psychological treatment alone.

Amitriptyline or phenelzine may also be used under the supervision of a mental health specialist. The above criteria also apply.

SSRIs and antidepressants  are also prescribed to reduce associated symptoms of depression and anxiety, and help with sleeping problems. SSRIs are not usually prescribed to people who are under 18 years old, unless they are recommended by a specialist.

If medication is prescribed for PTSD and it proves to be effective, it is usually continued for a minimum period of 12 months before being gradually withdrawn (over the course of four weeks or longer).

If a medication is ineffective, your dosage may be increased.

Before you are prescribed medication for PTSD, you doctor should inform you about any potential side effects and symptoms when the medication is withdrawn.

Side effects of paroxetine

Common side effects of paroxetine include:

nerve problems that may cause symptoms such as orofacial dystonias (muscle spasms around the face and mouth),

withdrawal syndrome (dependence on the medication),

yawning, and

raised cholesterol.

Less common side effects of paroxetine include:

arrhythmias (irregular heart beats),

temporary changes in blood pressure,

confusion, and

urinary incontinence (the unintentional passing of urine).

Rarer side effects of paroxetine may include:

panic attacks, and

depersonalisation (you experience an unreal or altered state, or you feel that your mind is separate from your body.

In very rare cases, paroxetine may cause:

peripheral oedema (fluid around your legs and ankles),

acute glaucoma (a severe but short-lived eye condition that affects vision),

hepatic disorders, such as hepatitis (liver inflammation), or

priapism (in men): a long-lasting, often painful, erection of the penis.

Children and young people

NICE recommends that trauma-focused CBT is used to treat older children with severe symptoms of PTSD in the first month after a traumatic event.

Three months after the trauma, the treatment advice outlined below is recommended.

A course of trauma-focused CBT, which is adapted to suit the child’s age, circumstances and level of development.

A course of 8 to 12 trauma-focused sessions for children and young people who have chronic (long-term) PTSD following a traumatic event.

The psychological treatment should be regular and continuous (at least one session a week), and it should be delivered by the same person.

Where appropriate, the child and their family should be involved in the treatment plan.

Where appropriate, the child’s parents or guardians should be informed that trauma-focused psychological treatments have proved to be an effective method of treating PTSD. They should also be told that there is no evidence that other forms of therapy, such as play therapy, art therapy or family therapy, are effective.

Disaster Planning

Following disasters, healthcare and social services are responsible for arranging the appropriate social care and psychological support for everyone affected, including survivors and their relatives.

NICE recommends that there should be a planned psychological response to a disaster, which should contain:

provision for immediate practical help,

means to support the affected communities in caring for those involved in the disaster, and

the provision of specialist mental health, evidence-based assessment and treatment services.

Obsessive compulsive disorder (OCD) is a chronic (long-term) mental health condition that is usually associated with obsessive thoughts and compulsive behaviour.

Obsessions and Compulsions 

An obsession is an unwanted, unpleasant thought, image or urge that repeatedly enters a person’s mind and results in anxiety. A compulsion is a repetitive behaviour or mental act that a person feels compelled to perform to try to avert or undo the effect of the obsession.

Unlike the normal use of the word ‘obsession’, which may describe something that an individual enjoys, the obsession in OCD is unpleasant and frightening. The person feels the need to carry out their compulsion in order to prevent their obsession becoming true. For example, someone who is obsessively scared that they will catch a disease may feel compelled to have a shower every time they use a toilet.

How common is OCD?

OCD is one of the most common mental health conditions. It is estimated that up to 3 in 100 adults and up to 5 in 100 children and teenagers have OCD.

OCD usually starts in early adult life, with men tending to report earlier symptoms than women. However, OCD symptoms can begin at any time, including childhood.

The symptoms of OCD can range from mild to severe. For example, some people with OCD will spend about an hour a day engaged in obsessive compulsive thinking and behaviour. For others, the condition can completely take over their life.

The causes of OCD are unknown, although there are several theories.

Outlook

If you have OCD, seeking help is the most important thing you can do. Left untreated, the symptoms of OCD may not improve. In some cases they will get worse. Without treatment, nearly half of people with OCD still have symptoms 30 years later.

With treatment, the outlook for OCD is good. Some people will achieve a complete cure. Even if a complete cure is not achievable, treatment can reduce the severity of your symptoms and help you to achieve a good quality of life.

A form of psychotherapy, known as cognitive behavioural therapy, which includes graded exposure and response prevention, is a proven treatment with a high rate of success in OCD. This may also be combined with medication, such as antidepressants.

About 80% of people with OCD will respond to initial treatment.

Symptoms of Obsessive Compulsive Disorder

Most people with OCD generally fall into a set pattern or cycle of thought and behaviour. This pattern has four main steps:

Obsession – your mind is overwhelmed by a constant obsessive fear or concern, such as the fear that your house will be burgled.

Anxiety – this obsession provokes a feeling of intense anxiety and distress.

Compulsion – you then adopt a pattern of compulsive behaviour to reduce your anxiety and distress, such as checking that all your windows and doors are locked at least three times before leaving your house.

Temporary relief – the compulsive behaviour brings temporary relief from anxiety, but the obsession and anxiety soon return, causing the pattern or cycle to begin again.

Obsessive thoughts

Almost everyone has unwanted and unpleasant thoughts, such as a nagging worry that their job may not be secure, or a brief suspicion that a partner has been unfaithful. Most people can put these types of thoughts and concerns into context and are able to carry on with their day-to-day lives; they do not repeatedly think about worries that they realise have little substance.

However, if you have a persistent, unwanted and unpleasant thought that dominates your thinking to the extent that it interrupts your other thoughts, you may have developed an obsession.

Some common obsessions that affect people with OCD include:

fear of causing harm to yourself or to others through a deliberate action – for example, fear that you may attack someone else even though this type of behaviour disgusts you

fear of causing harm to yourself or to others through a mistake or accident – for example, fear that you may set the house on fire by accidently leaving the cooker on, which leads you to repeatedly check the kitchen appliances

fear of contamination by disease, infection or other unpleasant substance

a need for symmetry or orderliness – e.g. you may feel the need to ensure that all the labels on the tins in your cupboard face the same way

fear of committing an act that would seriously offend your religious beliefs

Compulsive Behaviour

Compulsions arise as a way of trying to reduce or prevent the harm of the obsessive thought. However, this behaviour is either excessive or not realistically connected at all. For example, a person with a fear of contamination by dirt and germs may wash their hands 50 times a day, or someone with a fear of causing harm to their family by thinking of disasters may have the urge to repeat an action multiple times to try and ‘neutralise’ the thought of harm. This latter type of ‘magical’, compulsive behaviour is particularly common in children with OCD.

Most people with OCD realise that such compulsive behaviour is irrational and makes no logical sense, but they cannot stop acting on their compulsion.

Some common types of compulsive behaviour that affect people with OCD include:

cleaning

handwashing

checking – such as checking that doors are locked, or that the gas or a tap is off 

counting

ordering and arranging

hoarding 

asking for reassurance

needing to confess

repeating words silently

prolonged thoughts about the same subject

‘neutralising’ thoughts (to counter the obsessional thoughts or images)

Causes of Obsessive Compulsive Disorder

The exact cause of obsessive compulsive disorder (OCD) is unknown, but a number of theories have been suggested. These are explained below.

Genetic Factors

There is evidence to suggest that OCD may be the result of certain inherited genes (units of genetic material) that affect the development of the brain.

No specific genes have been linked to OCD, but there is some evidence that the condition runs in families. For example, a person with OCD is four times more likely to have another family member with the condition compared with someone who does not have OCD.

Genetic and family studies have also shown that OCD may be related to other conditions, such as:

tics – rapid, repeated, involuntary contractions of a group of muscles

Tourette’s syndrome – a condition that causes a person to make repetitive movements or sounds

Some people with OCD may also have tics or Tourette’s syndrome.

Brain abnormalities

Brain imaging studies have shown that people with OCD have abnormalities in some parts of their brain, such as increased blood flow and activity.

The affected areas of the brain deal with strong emotions and the response to those emotions. In the studies, after successful treatment with cognitive behavioural therapy or selective serotonin reuptake inhibitors (SSRIs), the activity in the brain returned to normal.

Serotonin

The chemical serotonin also seems to play a part in OCD. Serotonin is a neurotransmitter, a chemical that the brain uses to transmit information from one brain cell to another.

Exactly how serotonin contributes to OCD is unknown, but medication that increases the serotonin levels in the brain, such as certain antidepressants, have successfully helped to treat the symptoms of OCD.

Infection

There have been reports of some children and young people developing OCD after an infection caused by streptococcal bacteria. It is possible that the antibodies (infection-fighting proteins) produced by the body react with part of the brain and cause OCD.

Life events

An adverse life event, such as a bereavement or family break-up, may trigger OCD in people who already have a tendency to the condition – for example, due to genetic factors.

This life event could also affect the course of your condition. For example, the death of a loved one may trigger a fear that someone in your family will be harmed. Stress, which can also be caused by life events, seems to make OCD symptoms worse. However, stress on its own is not a cause of the condition.

Family involvement

Your upbringing is not thought to cause OCD. However, some factors could make OCD more likely to develop. For example, having parents who are very overprotective. 

It is unhelpful if the family of someone with OCD becomes involved. For example, someone with OCD may ask a family member for constant reassurance about one of their fears, such as whether they have locked the door. If the family member continually reassures them that they did, in order to make them feel better, it may prevent them seeking necessary treatment

Diagnosing Obsessive Compulsive Disorder

Seeking Treatment

Many people with obsessive compulsive disorder (OCD) are reluctant to report their symptoms to a GP because they feel ashamed and embarrassed about their condition. People with OCD sometimes make a great effort to disguise their symptoms from their family and friends.

However, if you have OCD there is nothing to feel ashamed or embarrassed about. Like diabetes or asthma, OCD is a chronic (long-term) health condition. It is not your fault that you have it.

Getting help for others

Sometimes, the friends and relatives of a person with OCD ‘play along’ with their strange behaviour to avoid upsetting them. However, this is not recommended because it can reinforce the person’s obsessive compulsive behaviour.

It is better to confront them with the reality of their unusual behaviour, and suggest that they seek medical advice.

Initial Screening

When you visit your GP, they will probably ask you a series of questions.

The questions, which form the Fineberg-Zohar screening questionnaire, are a way of determining whether you are likely to have OCD. But, like all screening questionnaires, many people without OCD may score positively on the questionnaire.

The questions may include those listed below.

Do you wash or clean a lot?

Do you check things a lot?

Is there any thought that keeps bothering you that you would like to get rid of but cannot?

Do your daily activities take a long time to finish?

Are you concerned about putting things in a special order or are you very upset by mess?

Do these problems trouble you?

Assessment

If the results of the initial screening questions suggest that you have OCD, the severity of your symptoms will need to be assessed. Assessment may be carried out by your GP or you may be referred to a mental health professional.

There are several different methods of assessment. All of them involve asking a series of detailed questions to find out how much of your day-to-day life is affected by obsessive-compulsive thoughts and behaviour.

During the assessment process, it is important for you to be open and honest because accurate and truthful responses will ensure that you get the most appropriate treatment.

Types of OCD

The severity of OCD can be determined by how much your symptoms affect your ability to function normally on a day-to-day basis. Healthcare professionals refer to the disruption of daily function as functional impairment. OCD is classified into three levels of severity:

mild functional impairment – obsessive thinking and compulsive behaviour occupy less than one hour of your day

moderate functional impairment – obsessive thinking and compulsive behaviour occupy one to three hours of your day

severe functional impairment – obsessive thinking and compulsive behaviour occupy more than three hours of your day

Treating Obsessive Compulsive Disorder

If you have obsessive compulsive disorder (OCD), your recommended treatment plan will depend on how much your OCD is affecting your ability to function. Treatment is likely to involve:

behavioural therapy – to change the way you behave and reduce your anxiety 

medication – to control your symptoms

Treatment Plan

OCD that causes mild functional impairment is usually treated using a short course of cognitive behavioural therapy (CBT).

OCD that causes moderate functional impairment can be treated with a more intensive course of CBT, or antidepressants known as selective seretonin reuptake inhibitors (SSRIs). Such cases may also require referral to a specialist mental health service.

OCD that causes severe functional impairment will require referral to a specialist mental health service for a combination of intensive CBT and a course of SSRIs.

Children with OCD are usually referred to a healthcare professional who has experience of treating OCD in children.

Behavioural therapy

Cognitive behavioural therapy involving graded exposure and response prevention has repeatedly proved to be an effective treatment for OCD.

Exposure and response prevention

Exposure and response prevention (ERP) is a treatment that involves identifying a number of situations that cause you anxiety. These are then placed in order, depending on which situation causes the most anxiety.

You and your therapist will identify tasks that will expose you to the situation that cause anxiety, but at a level that you can cope with. You need to do the exposure tasks without carrying out your anxiety-relieving compulsions (the actions you usually take to help you cope with the situation).

Although this sounds frightening, people with OCD find that when they confront their anxiety without their compulsion, the anxiety disappears completely in one to two hours.

This same exposure task should be repeated two or three times a day. Each time, the anxiety is likely to be less, and last for a shorter period of time. Once one step has been conquered you can move onto a more difficult exposure task until you have overcome all of the situations that make you anxious. 

People with mild to moderate OCD usually need about 10 hours of therapist treatment combined with self-treatment exposure exercises between sessions. Those with moderate to severe OCD may need a more intensive course of CBT that lasts for more than 10 hours.

Medication

You may be prescribed medication if CBT fails to treat mild OCD or if you have moderate or severe OCD. The different types of medication that you may be prescribed are discussed below.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that boost levels of a substance called serotonin in the brain. Serotonin is a neurotransmitter, which is a chemical that the brain uses to transmit information from one brain cell to another. See the Health A-Z topic about SSRIs for more information about this type of medication.

Possible SSRIs that you may be prescribed include: 

fluoxetine

fluvoxamine

paroxetine

sertaline

citalopram

escitalopram

You normally need to take an SSRI for 12 weeks before you notice any benefit. Most people with moderate to severe OCD are required to take SSRIs for at least 12 months. After that time, your condition will be reviewed. If the condition is causing you very few or no troublesome symptoms, you may be able to stop taking SSRIs.

Side effects of SSRIs include:

headaches

feeling sick

These side effects should pass within a few weeks.

There is a small chance that SSRIs will increase your anxiety, which may cause you to have suicidal thoughts or a desire to self-harm.

Contact your GP immediately or go to your nearest hospital if you are taking an SSRI and you have suicidal thoughts or want to self-harm.

It may be helpful to tell a close friend or relative that you are taking SSRIs. Ask them to tell you if they notice changes in your behaviour or if they are worried about the way you are acting.

You may also have side effects when you stop taking SSRIs, so do not suddenly stop taking your medicine. If you no longer need the medicine, your GP will gradually reduce your dose. 

Some people respond better to one SSRI rather than another. If you have been taking full recommended doses of an SSRI for three months without benefit, you may be prescribed a different type of SSRI.

The doses of SSRI recommended for OCD are higher than those generally used for depression. There is evidence that low doses of SSRIs are ineffective.

Clomipramine

Clomipramine is a tricyclic antidepressant (TCA), which can be used as an alternative to SSRIs for treating OCD. TCAs are not as commonly used as SSRIs because they cause more side effects. However, they can be effective in treating people with OCD who cannot tolerate SSRIs.

Side effects of clomipramine include:

a dry mouth

constipation

diarrhoea

blurred vision

dizziness

fatigue (extreme tiredness)

Clomipramine is not suitable for people who have:

low blood pressure

arrhythmia (an irregular heartbeat)

recently had a heart attack

For adults at risk of cardiovascular disease (conditions that affect the heart or blood vessels), your GP may recommend a blood pressure test and an electrocardiogram (ECG) before starting your treatment. An electrocardiograph (ECG) measures the electrical activity of your heart.

As with SSRIs, a 12-month course of clomipramine is usually recommended, after which time your symptoms will be reviewed.

If SSRIs or clomipramine prove to be ineffective, you will be referred to a specialist mental health service.

Support Groups

Many people with OCD find support groups helpful. Support groups can:

reassure you 

reduce any feelings of isolation

give you a chance to socialise with others

Support groups can also provide information and advice for family members and friends who may be affected by your OCD.

OCD Action and OCD-UK are both national charities for OCD that can provide information about support groups in your area. You can find information on their websites at the links below.

Surgery

Surgery for OCD is the very last resort for treating severe OCD when all other forms of treatment have failed. It should not be considered at all until someone has:

received at least two full trials of different SSRIs or clomipramine, at recommended doses

had treatment for refractory OCD (OCD that does not respond to treatment) with the addition of antipsychotic medication or the recommended higher doses of SSRIs or mood stabilisers

received unsuccessful CBT treatments both in a clinic and at home, as well as having been treated by the National Service for OCD (see below)

Ablation neurosurgery

A very small number of people with OCD will need neurosurgery. During ablation neurosurgery, a neurosurgeon (a surgeon who specialises in surgery involving the brain and nervous system) will use an electric current or a pulse of radiation to burn away a small part of the limbic system. The limbic system is a structure in the brain that is responsible for some of the most important brain functions, such as the higher emotions, memory and behaviour.

Neurosurgery has never been subjected to controlled clinical trials. However, a survey conducted by the Royal College of Psychiatrists found that out of 478 people who had surgery for OCD, more than half felt that they had improved. But as many as 15% felt unchanged or worse.

In addition, surgery for OCD carries the risks of both short- and long-term side effects, such as memory loss and mental confusion, which can be serious and irreversible.

Deep brain stimulation

Deep brain stimulation is an alternative surgical technique that may be used more frequently to treat OCD in the future. Currently, it is only used as part of medical research.

Deep brain stimulation involves implanting an electrical generator into your chest and electrodes (small metal discs) into your brain. An electrical signal is sent from the device in your chest to the electrodes in your brain.

Some small studies looking at deep brain stimulation have reported an improvement in symptoms. But some possible serious side effects are associated with the technique, including:

infection 

bleeding inside the brain

Complications of Obsessive Compulsive Disorder

Depression

Some people who have obsessive compulsive disorder (OCD) also develop depression (feelings of extreme sadness that last a long time).

You should not ignore feelings of depression. If they are not treated they can become more severe. Untreated depression will also make it harder for you to cope with the symptoms of OCD.

If you have been feeling very down during the past month and you no longer take pleasure in the things that you used to enjoy, you may be experiencing depression. If this is the case, you should contact your GP.

People with OCD and severe depression may sometimes have suicidal feelings.

Quality Of Life

OCD can prevent you from doing normal day-do-day activities, which can then have an impact on your career or studies. This will affect your quality of life and could also affect your income if, for example, you are unable to work.

Depression is a serious illness. Health professionals use the words depression, depressive illness or clinical depression to refer to it. It is very different from the common experience of feeling unhappy, miserable or fed up for a short period of time.

When you are depressed, you may have feelings of extreme sadness that can last for a long time. These feelings are severe enough to interfere with your daily life, and can last for weeks or months, rather than days.

Depression is quite common and about one in ten people will experience depression at some point. However, the exact number of people with depression is hard to estimate because many people do not get help or are not formally diagnosed with the condition.

Women are more likely to have depression than men, and 1 in 4 women will require treatment for depression at some point, compared to 1 in 10 men. Men are far more likely than women to commit suicide, which may be because men are less likely to seek help for depression. Alternatively, it may be due to other factors including substance misuse, unemployment and social isolation.

Depression can affect people of any age, including children. Studies have shown that about 4% of children aged 5-16 in the UK are affected by depression.

People with a family history of depression are more likely to experience depression themselves. Depression affects people in many ways and can cause a wide variety of physical, psychological (mental) and social symptoms.

A few people still think that depression is not a real illness and that it is a form of weakness or admission of failure. This is simply not true. Depression is a real illness with real effects, and it is certainly not a sign of failure.

With the right treatment and support, most people can make a full recovery from depression. It is important to seek help from your GP if you think you may be depressed.

 Symptoms of Depression

The symptoms of depression can be complex. If you are depressed, you often lose interest in things you used to enjoy. Depression commonly interferes with your work, social life and family life. There are many other symptoms, which can be psychological, physical and social.

Psychological symptoms include:

continuous low mood or sadness

feelings of hopelessness and helplessness 

low self-esteem 

tearfulness

feelings of guilt

feeling irritable and intolerant of others 

lack of motivation and little interest in things

difficulty making decisions

lack of enjoyment

suicidal thoughts or thoughts of harming yourself

feeling anxious or worried 

reduced sex drive

Physical symptoms include:

slowed movement or speech

change in appetite or weight (usually decreased, but sometimes increased) 

constipation 

unexplained aches and pains

lack of energy or lack of interest in sex

changes to the menstrual cycle

disturbed sleep patterns (for example, problems going to sleep or waking in the early hours of the morning)

Social symptoms include:

not doing well at work

taking part in fewer social activities and avoiding contact with friends

reduced hobbies and interests

difficulties in home and family life

It can take some time to recognise that you may be depressed. Depression may come on gradually and some people continue to deal with the symptoms without recognising them. It can take a friend or family member to suggest that something is wrong.

Doctors describe depression by how serious it is

Mild depression has some impact on your daily life.

Moderate depression has a significant impact on your daily life.

Severe depression makes the activities of daily life nearly impossible. A small proportion of people with severe depression may have psychotic symptoms.

Grief and Depression

Even though grief and depression share many of the same characteristics, there are important differences between them. Grief is an entirely natural response to a loss, while depression is an illness. However, sometimes it can be hard to distinguish between feelings of grief and depression.

People who are grieving find that feelings of loss and sadness come and go, but they are still able to enjoy things and look forward to the future. However, people who are depressed have a constant feeling of sadness. They do not enjoy anything and have little sense of a positive future.

Other types of Depression

There are several different types of depression, and some conditions where depression may be a major symptom. These include:

Postnatal depression. Some women develop depression after having a baby. Postnatal depression is treated in similar ways to other forms of depression, with talking therapies and antidepressant medicines.

Bipolar disorder is also known as ‘manic depression’. It is where there are periods of depression and also periods of excessively high mood (mania). The depression symptoms are similar to clinical depression, but the periods of mania can include harmful behaviour where there are few or no inhibitions, such as gambling to a harmful extent, going on spending sprees and having unsafe sex. 

Seasonal affective disorder (SAD). Also known as ‘winter depression’, SAD is a type of depression that has a seasonal pattern usually related to winter.

Causes

There is no single cause of depression, and people develop depression for different reasons.

Depression has many different triggers. For some people, upsetting or stressful life events, such as bereavement, divorce, illness, redundancy and job or money worries, can be the cause. Usually, different causes combine to trigger depression. For example, you may feel low after an illness and then experience a stressful life event, such as bereavement, which leads to depression.

People often talk about a ‘downward spiral’ of events that leads to depression. For example, if a person’s relationship with their partner breaks down, they are likely to feel low, they may stop seeing friends and family, and they may start drinking more. All of this can make them feel even worse and trigger depression.

Some studies have suggested people are more likely to get depression as they get older and that it is more common among people who face difficult social and economic circumstances.

Depression is complex and a number of things can increase the risk of developing it.

Stressful Life Events

Most people take time to come to terms with stressful events, such as bereavement or a relationship breakdown. When these stressful events happen, you have a higher risk of becoming depressed if you stop seeing friends and family and try to deal with problems on your own

Illness

You may have a higher risk of depression if you are diagnosed with a chronic or life-threatening illness, such as coronary heart disease or cancer.

Head injuries are also an often under-recognised cause of depression. A severe head injury can trigger mood swings and emotional problems.

Even a minor head injury can damage the pituitary gland, which is a pea-sized gland at the base of the brain that produces thyroid-stimulating hormones (chemicals). This can cause a number of symptoms, such as fatigue (extreme tiredness) and a decreased interest in sex, which can lead to depression. 

Personality Traits

You may be vulnerable to depression due to certain personality traits, such as low self-esteem or being overly self-critical. This may be due to genes you have inherited from your parents, or your personality or early life experiences. These can all have a profound effect on the way you think about yourself in later life.

Family history of Depression

Research shows that some genes increase the risk of depression after a stressful life event.

Giving Birth

Some women are particularly vulnerable to depression after pregnancy. The hormonal and physical changes, as well as the added responsibility of a new life, can lead to postnatal depression.

Social Isolation

Becoming cut off from family and friends may increase your risk of depression, or it may be a response to feeling depressed as the downward spiral takes hold.

Alcohol and drugs

Substance abuse can be a cause of depression. Use of drugs, such as cannabis and cocaine, can also lead to feelings of depression. Some people try to cope by drinking too much alcohol or taking drugs. This can result in a spiral of depression. The isolation, alcohol or drugs make you feel worse about yourself, and in response you isolate yourself and drink or take drugs even more.

Diagnosing Depression

See your GP if you think you have depression. Your GP may give you a physical examination and do some blood or urine tests to rule out other conditions that have similar symptoms, such as underactive thyroid.

There are no physical tests for depression, so detailed interviews and questionnaires are usually used to make a diagnosis.

Many different questionnaires are used to measure depression. However, two classifications of mental illness are most widely used:

Diagnostic and Statistical Manual of Mental Disorders. This is a classification system based on all the known recorded symptoms associated with a particular mental condition. Your GP will ask you if you have certain symptoms and, depending on your answers, will be able to use the system to identify the condition.

International Classification of Diseases. This is a similar system of classifications, based on the known symptoms associated with particular diseases. Developed by the World Health Organization, it is a much wider system, covering all diseases (not just mental health). Your GP will ask you about your symptoms in order to classify your condition.

Using one of these two guidelines, your GP can usually diagnose depression, decide which type of depression you have, and rule out other mental health conditions.

Any discussion you have with your GP about your depression will be treated in the strictest of confidence. Your GP will only ever break this rule if there is a significant risk of harm to either yourself or to others, and if informing a family member or carer would reduce that risk.

Treating Depression

What is good Depression care? 

In most cases, your GP will help manage your depression. However, for some patients, particularly those with more severe depression or where treatment is not successful, more specialised care, including a stay in hospital, may be needed. The National Institute for Health and Clinical Excellence (NICE) recommends that:

Depression should be recognised in both GP practices and hospital, with particular attention given to high-risk groups, such as patients with a history of depression, long-term illness, head injury or disability, or other mental health problems such as dementia.

Patients’ preferences, and the experience and outcome of previous treatments, should be considered when deciding on a treatment.

Patients should have access to information about treatments and self-help and support groups.

Patients should give meaningful and properly informed consent to treatment, in particular if they have more severe depression or are subject to the Mental Health Act. 

There should be a clear agreement about all patient care, and this should be shared with the patient and their families and carers.

Living with Depression

There are many positive ways to lift your mood and recover from depression. With support and treatment from your GP, you can manage your symptoms yourself.

Self care

Self care is an integral part of daily life. It involves taking responsibility for your own health and wellbeing with support from the people involved in your care. Self care includes what you do every day to stay fit and maintain good physical and mental health, prevent illness or accidents and care more effectively for minor ailments and long-term conditions. People living with long-term conditions can benefit enormously from being supported to self care. They can live longer, have less pain, anxiety and fatigue, have a better quality of life and be more active and independent.

Take your medication

It is important to take your medication as prescribed, even if you start to feel better. Continuing with your medication can help prevent a relapse and, in some cases, it is needed in the long term. If you have any questions or concerns about the medication you are taking or side effects, talk to your healthcare team.

It may also be useful to read the information leaflet that comes with your medication to find out about possible interactions with other drugs or supplements. Check with your healthcare team if you plan to take any over-the-counter remedies, such as painkillers, or any nutritional supplements. These can sometimes interfere with your medication.

Regular reviews

You may be in regular contact with your healthcare team, and a good relationship with the team means you can easily discuss your symptoms or concerns. The more the team knows, the more they can help you.

Stay active and eat well

Research suggests that for some people, exercise can be as effective as antidepressants at reducing depressive symptoms, particularly in those with mild and moderate depression. Being physically active lifts your mood, reduces stress and anxiety, boosts the release of endorphins (your body’s feel-good chemicals) and improves self-esteem. The National Institute for Health and Clinical Excellence (NICE) recommends that exercise is used to treat depression in people of all ages.

What is Cylothmia?

Cyclothymia is a chronic form of bipolar disorder consisting of short periods of mild depression and hypomania separated by short periods of normal mood. Individuals with cyclothymia are never free of symptoms of either depression or hypomania for more than two months at a time. Although this disorder is not as severe as bipolar 1 and bipolar 2 disorders, it can completely disrupt the life of an individual and create personal chaos and pain. Cyclothymics never know from one day to the next what to expect.

Who can get it?

Cyclothymia is equally common in men and women and is believed to affect 0.5 to 1 percent of the population. Symptoms normally appear in the teens or early twenties, but have been known to begin at all ages. Approximately 30 percent of individuals with cyclothymia will eventually go on to experience a full-blown manic episode or major depression - at which time their diagnosis is changed to bipolar 1 or 2.

What are the causes?

The causes of cyclothymia are believed to be the same as those responsible for bipolar disorder. Although many people suffering from cyclothymia never seek treatment for their illness, help is available. Lithium and anticonvulsant medications have shown effective in treating a substantial number of people with cyclothymia.

DSM-IV Diagnostic Criteria for Cyclothymia:

For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode.

Note: In children and adolescents, the duration must be at least 1 year.

During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time. No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance.

Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in which case both Bipolar I Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed).

Symptoms

The symptoms in Criterion A are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise specified. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism). The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

The following represent common factors of symptoms:

Alternating episodes of hypomania and mild depression lasting for at least 2 years

Patients tend to be more irritable or dark, rather than euphoric or happy

Persistent symptoms (less than 2 symptom-free months in a row)

Treatment of Cyclothymia:

  Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe. Everyone experiences feelings of anxiety at some point in their life. For example, you may feel worried and anxious about sitting an exam or having a medical test or job interview.

Feeling anxious is sometimes perfectly normal. However, people with generalised anxiety disorder (GAD) find it hard to control their worries. Their feelings of anxiety are more constant and often affect their daily life.

There are several conditions for which anxiety is the main symptom. Panic disorder, phobias and post-traumatic stress disorder can all cause severe anxiety.

Generalised Anxiety Disorder (GAD)

GAD is a long-term condition which causes you to feel anxious about a wide range of situations and issues, rather than one specific event.

People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. GAD can cause both psychological (mental) and physical symptoms. These vary from person to person, but can include feeling irritable or worried and having trouble concentrating or sleeping.

How common is it?

GAD affects approximately 1 in 20 adults in Britain. Slightly more women are affected than men, and the disorder is most common in people in their 20s.

Outlook

GAD can significantly affect your daily life, making it difficult to perform everyday tasks. However, several different treatments are available to ease your psychological and physical symptoms.

Anxiety can affect you physically and psychologically (mentally).

 Psychological Symptoms

GAD can cause a change in your behaviour and the way you think and feel about things. Psychological symptoms of GAD include:

restlessness

a sense of dread

feeling constantly ‘on edge’

difficulty concentrating

irritability

impatience

being easily distracted

Your symptoms may cause you to withdraw from social contact (seeing your family and friends) to avoid feelings of worry and dread. You may also find it difficult and stressful going to work and may take time off sick. These actions can make you worry even more about yourself and increase your lack of self-esteem.

 Physical Symptoms

The physical symptoms of GAD can include:

dizziness

drowsiness and tiredness

pins and needles

irregular heartbeat (palpitations)

muscle aches and tension

dry mouth

excessive sweating

shortness of breath

stomach ache

nausea

diarrhoea

headache

excessive thirst

frequent urinating

painful or missed periods

difficulty falling or staying asleep (insomnia)

How can anxiety intensify?

If you are anxious as a result of a phobia or because of panic disorder, you will usually know what the cause is. For example, if you have claustrophobia (a fear of enclosed spaces), you know that being confined in a small space will trigger your anxiety.

However, if you have GAD, what you are feeling anxious about may not always be clear. Not knowing what triggers your anxiety can intensify your anxiety and you may start to worry that there will be no solution.

Causes of Anxiety

As with most conditions that affect mental health, the exact cause of generalised anxiety disorder (GAD) is not fully understood. Some people develop the condition for no apparent reason. Others may develop GAD after a major stressful incident.

Neurotransmitters

Research has suggested that GAD may be caused by an imbalance of certain chemicals that occur naturally in the brain. These chemicals are known as neurotransmitters.

Two neurotransmitters thought to affect anxiety are serotonin and noradrenaline. If the level of these chemicals in your brain becomes unbalanced, it can significantly affect your mood and increase your likelihood of developing anxiety-related conditions such as GAD.

However, GAD is most likely to have a complex combination of causes, rather than being triggered by just an imbalance of brain chemicals.

Combination of causes

Researchers believe that GAD is caused by a combination of factors, including:

your body’s biological processes

genetics (the genes you inherit from your parents)

your environment

your life experience

 Diagnosing Anxiety

You should visit your GP if anxiety is affecting your daily life or is causing you distress.

Generalised anxiety disorder (GAD) can be difficult to diagnose. In some cases, it can also be difficult to distinguish from other mental health conditions, such as depression.

Talking to your gp

Your GP may ask you questions about your worries, fears and emotions. They may also ask about your personal life. Tell your GP about all of your symptoms – physical and psychological – and explain how long you have had them.

You may find it difficult to talk about your feelings, emotions and personal life. However, it is important that your GP understands your symptoms and circumstances so that the correct diagnosis can be made.

You are most likely to be diagnosed with GAD if you have had the symptoms for six months or more. Finding it difficult to manage your feelings of anxiety is also an indication that you may have developed the condition.

To help with the diagnosis, your GP may carry out a physical examination to rule out any other conditions that may be causing your symptoms.

Treating Anxiety

There are two main forms of treatment for generalised anxiety disorder (GAD):

psychological therapy 

medication

Depending on your circumstances, you may benefit from one of these types of treatment or a combination of the two.

Studies of different treatments for GAD have found that the benefits of psychological treatment last the longest, but no single treatment is the best for everyone.

Before you begin any form of treatment, your GP should discuss all of your treatment options with you, outlining the pros and cons of each, while also making you aware of any possible risks or side effects. With your GP, you can make a decision on the treatment most suited to you, taking into account your personal preferences and circumstances.

Psychological Treatment

If you have been diagnosed with GAD, you will usually be advised to try psychological treatment before you are prescribed medication. The main type of psychological treatment for GAD is cognitive behavioural therapy (CBT).

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is one of the most effective types of treatment for GAD. Research suggests that around half of the people who have CBT recover from GAD and many others obtain some benefit.

CBT works by helping you to identify unhelpful and unrealistic beliefs and behavioural patterns. You and your therapist work together to help you change your behaviour and replace unhelpful beliefs with more realistic and balanced ones.

CBT mainly focuses on the problems that you are experiencing in the present, rather than events from the past. It teaches you new skills and helps you to understand how to react more positively to situations that would usually cause you anxiety.

The National Institute for Health and Clinical Excellence (NICE) recommends that you should have a total of 16 to 20 hours of CBT over a period of four months. Your treatment will usually involve a weekly one- to two-hour session.

See the Health A-Z topic about CBT for more information about this type of treatment.

Applied relaxation

Applied relaxation is an alternative type of psychological treatment. It was initially used to treat phobias, but it is now also being used to treat conditions such as GAD.

Applied relaxation focuses on relaxing your muscles in a particular way in situations that usually cause you anxiety. The technique will need to be taught to you by a trained therapist but involves: 

learning how to relax your muscles

learning how to relax your muscles quickly and in response to a trigger, such as the word ‘relax’

practicing relaxing your muscles in situations that make you anxious

You will need 12 to15 sessions to learn how to use applied relaxation correctly. It has been found to be as effective as CBT.

Medication

Your GP can prescribe a variety of different types of medication to treat GAD. Some medication is designed to be taken on a short-term basis, while other medicines are prescribed for longer periods. Depending on your symptoms, you may require medicine to treat your physical symptoms as well as your psychological ones.

If you are considering taking medication for GAD, your GP should discuss the different options with you in detail, including the different types of medication, length of treatment, side effects and possible interactions with other medicines before you start a course of treatment.

Long-term medication includes: 

selective serotonin reuptake inhibitors (SSRIs), such as sertraline or paroxetine 

venlafaxine 

pregabalin

Short-term medication includes: 

antihistamines 

benzodiazepines 

buspirone

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that increase the level of a chemical in your brain called serotonin. They can be taken on a long-term basis.

As with all antidepressants, SSRIs can take several weeks before they start working. You will usually be started on a low dose which will gradually be increased as your body adjusts to the medicine.

You may be offered an SSRI called sertraline. Sertraline is not specifically licensed to treat GAD, which means that the manufacturers of the medicine have not applied for a license for it to be used to treat the condition. However, it is used to treat similar conditions, such as panic disorderand obsessive compulsive disorder (OCD). 

Paroxetine is another SSRI that is often prescribed to treat GAD.

Common side effects of SSRIs include:

nausea (feeling sick)

low sex drive 

blurred vision 

diarrhoea or constipation 

dizziness 

dry mouth 

loss of appetite 

sweating 

feeling agitated 

insomnia (problems sleeping)

When you start taking an SSRI, you should visit your GP after two, four, six and 12 weeks to check your progress and to see if you are responding to the medicine. Not everyone responds well to antidepressant medicines, so it is important that your progress is carefully monitored.

If your GP feels it is necessary, you may require regular blood tests or blood pressure checks when taking antidepressant medication. If, after 12 weeks of taking the medication, you do not show any signs of improvement, your GP may prescribe an alternative SSRI to see if that has any effect.

When you and your GP decide that it is appropriate for you to stop taking your SSRI medication, you will gradually be weaned off the medication by slowly reducing your dose. Never stop taking your medication unless your GP specifically advises you to.

Venlafaxine

If SSRIs do not help ease your anxiety, you may be prescribed a different type of antidepressant known as venlafaxine.

Venlafaxine belongs to a group of medicines known as selective serotonin and noradrenaline reuptake inhibitors (SNRIs). This type of medicine increases the amount of serotonin and noradrenaline in your brain, helping restore the chemical imbalance that sometimes causes GAD.

You cannot be prescribed venlafaxine if you: 

have high blood pressure (hypertension) that is not being treated 

have recently had a heart attack 

are at risk of having irregular heartbeats (cardiac arrhythmias)

If you have any of the above conditions, you may be at risk of developing complications if you take venlafaxine.

Common side effects of venlafaxine may include: 

nausea 

headache 

drowsiness 

dizziness 

dry mouth 

constipation 

indigestion 

insomnia 

sweating

If you are prescribed this medicine, your blood pressure will be monitored regularly.

Pregabalin

If SSRIs and SNRIs are not suitable for you, you may be offered pregabalin. This is an anticonvulsant that is used to treat conditions such as epilepsy (a condition that causes repeated seizures). However, it has also been found to be beneficial in treating anxiety.

The most commonly reported side effects of pregabalin include:

drowsiness

dizziness

headaches

Pregabalin is less likely to cause nausea or a low sex drive than SSRIs or SNRIs.

Antihistamines

Antihistamines are usually prescribed to treat allergic reactions. However, some are also used to treat anxiety on a short-term basis.

Antihistamines have a calming effect on the brain, helping you to feel less anxious.

Antihistamines are only effective when used for a short period of time and will only be prescribed for a few weeks.

Hydroxyzine is the most commonly prescribed antihistamine for treating anxiety. This antihistamine can make you feel drowsy, so it is best not to drive or operate machinery when taking the medication. Other side effects of hydroxyzine include:

dizziness 

blurred vision 

headache 

dry mouth

Benzodiazepines

Benzodiazepines are a type of sedative that help ease the symptoms of anxiety within 30-90 minutes of taking the medication.

Although benzodiazepines are very effective in treating the symptoms of anxiety, they cannot be used for long periods of time. This is because they have the potential to become addictive if used for longer than four weeks. Benzodiazepines also start to lose their effectiveness after this time.

For these reasons, you will usually only be prescribed benzodiazepines to help you cope during a particularly severe period of anxiety. Benzodiazepines can cause side effects, including: 

confusion 

loss of balance 

memory loss 

drowsiness and light-headedness

Due to the above side effects, benzodiazepines can affect your ability to drive or operate machinery. Therefore, avoid these activities when taking the medication.

Speak to your GP if you experience any of the side effects listed above. They may be able to adjust your dose of medication or prescribe an alternative.

Buspirone

Buspirone is a medicine that can help ease the psychological symptoms of anxiety. It belongs to a group of medicines known as anxiolytics.

You will usually have to take buspirone for two weeks before you notice an improvement. It will be up to your GP how long you continue to take the medicine after this.

Buspirone works in a similar way to benzodiazepines, but does not become addictive. However, it is only recommended as a short-term form of medication.

Referral

If you have tried any two treatments (out of medication, CBT and self-help with guidance from your GP) and you still have significant symptoms of GAD, you may want to discuss with your GP whether you should be referred to a mental health specialist.

A referral will work differently in different areas of the UK, but you will usually be referred to your community mental health team. This includes a range of specialists including psychiatrists, psychiatric nurses, clinical psychologists, occupational therapists and social workers.

An appropriate mental health specialist from your local team will carry out an overall reassessment of your condition. They will ask you about your previous treatment and how effective you found it. They may also ask about things in your life that may be affecting your condition, or how much support you get from family and friends. Your specialist will then be able to devise a treatment plan for you, which will aim to effectively treat your symptoms. This may include any of the following:

psychological therapies such as CBT 

appropriate treatment of other diseases and conditions that may have an effect on your anxiety 

other medication

further referral to specialists

Self-help treatments for Anxiety

There are many ways that you can ease the symptoms of generalised anxiety disorder (GAD) yourself.

Exercise

Regular exercise, particularly aerobic exercise, will help you to combat stress and release tension. It also encourages your brain to release the chemical serotonin, which can improve your mood.

Aim to do a minimum of 30 minutes of moderate exercise, at least five days a week. Moderate exercise should make you feel slightly out of breath and tired. Going for a brisk walk is a good example.

Relaxation

As well as getting regular exercise, learning how to relax is important. You may find relaxation and breathing exercises helpful, or you may prefer activities such as yoga or Pilates to help you unwind.

Diet

Changing your diet may help ease your symptoms. Too much caffeine can make you more anxious than normal. This is because caffeine can disrupt your sleep and also speed up your heartbeat. If you are tired, you are less likely to be able to control your anxious feelings.

Smoking and drinking

 Smoking and alcohol have been shown to make feelings of anxiety worse. Drink alcohol in moderation and, if you smoke, try to give up.

The Department of Health recommends that men should not drink more than three to four units of alcohol a day and women no more than two to three units. 

Support groups

Support groups can give you useful advice about how to effectively manage your anxiety. They are also a good way to meet other people with similar experiences.

Support groups often involve face-to-face meetings where you can talk about your difficulties and problems with other people. Many support groups also provide support and guidance over the phone or in writing. Ask your GP about local support groups for anxiety in your area.

Understanding your Anxiety

Attention Deficit Hyperactivity Disorder, or ADHD, is the term used to describe three main kinds of behavioural problem in children:

overactive behaviour (hyperactivity)

impulsive behaviour  

difficulty in paying attention.

 What is ADHD?

All young children have lots of energy and like to be active. Young children also tend to have a short attention span - they soon get tired of an activity and want to move on to something new. So how can you know whether your child has ADHD or is just restless or bored?

Children with ADHD are not just very active; they also have a wide range of other problem behaviours that can make them very difficult to care for, manage and teach.    Because they are overactive and impulsive, children with ADHD often find it difficult to fit in at school. They may also have problems getting on with other children. These difficulties can continue as they grow up, particularly if children and families do not get the help they need.   Some children have significant problems with concentration and attention, but are not overactive or impulsive. These children are sometimes described as having Attention Deficit Disorder (ADD), rather than ADHD. ADD can easily be missed because the child may be quiet and dreamy rather than disruptive.

ADHD and ADD are not related to intelligence. Children with all levels of ability can have them.

What causes ADHD?

The causes of ADHD are still not fully known. It is believed to be caused by poor transmission of messages in the brain, and in particular by low levels of the neurotransmitters dopamine and norepinephrine, which carry messages from one neuron to another. These neurotransmitters are particularly associated with attention, organisation and managing emotions. 

Do children grow out of ADHD?

Some children grow out of ADHD; others have problems that continue into adolescence and beyond. Approximately two out of five children with ADHD continue to have difficulties at age 18. The main symptoms of ADHD, such as attention difficulties, may improve as children get older, but behavioural problems such as disobedience or aggression may become worse if a child does not receive help. In particular, boys who are hyperactive and aggressive tend to become unpopular with other children. It is therefore very important for children to receive help as early as possible, to prevent them from getting socially isolated and from developing other emotional and behaviour problems that can persist into adult life.

Does medication help?

ADHD is often treated with stimulant medication, which can produce short-term benefits for many children with ADHD. The theory is that medication can either reduce the uptake or increase the production of the neurotransmitters, so increasing the levels in the brain.

Medication does not cure ADHD – it can only reduce a child’s difficulties. The aim is to give children some relief from the symptoms, so they calm down, are better able to make friends and manage their emotions, learn more easily and are more responsive to other people. Children may become less aggressive as well as less hyperactive, and their performance at school may improve significantly. Once they are having fewer problems in their family, school and social lives, the hope is they can learn to manage their own behaviour better without the help of drugs.   However there are concerns that these drugs may be used too quickly to deal with behaviours that are not due to ADHD/ADD at all; the child may be simply over-boisterous or unruly or difficult to manage for other reasons to do with their family and environment. Also, they are very powerful drugs – some are classed as amphetamines – and can carry other health risks:

the long-term effects of stimulants on young, developing brains are still not fully known

children and adults with existing heart conditions are at risk of heart attacks if they take stimulant medications

stimulants can trigger or exacerbate hostility, aggression, anxiety, depression and paranoia – anyone with a personal or family history of suicide, depression or bi-polar disorder is at very high risk and should be closely monitored

stimulant abuse is an increasingly common problem among young people – young people use them to give them a boost when preparing for exams, and to help lose weight.

The reported side effects of stimulant medication for ADHD/ADD include some of the problems for which they are prescribed. They include: restlessness, difficulty sleeping, irritability and mood swings, depression, loss of appetite, headaches, upset stomach, dizziness, racing heartbeat and tics.

For these reasons, stimulant medication should only be prescribed to children who have been professionally assessed and diagnosed by an expert, and should be reviewed regularly.

Non-medical ways of managing ADHD include exercise, healthy diet, sleep management and behavioural therapies.

Parents

The first thing parents need to know is that ADHD is not your fault – you are not a ‘bad parent’. The second is that there are things you can do to help your child to manage their behaviour. There are now a number of behaviour management programmes run by professionals to help parents. You can learn ways of talking, playing and working with your child that can improve their attention and behaviour. These techniques can also be very helpful for other carers and friends, not just parents.

Teachers