Anxiety Disorders: Symptoms & Treatment
Anxiety disorders: GAD, panic attacks, social anxiety and agoraphobia. A neurobiological approach, pharmacogenomics and rTMS by psychiatrist Paschalis Gkikas.
Anxiety Disorders: Symptoms & Treatment
Anxiety disorders: GAD, panic attacks, social anxiety and agoraphobia. A neurobiological approach, pharmacogenomics and rTMS by psychiatrist Paschalis Gkikas.
What are anxiety disorders?
Anxiety is a normal biological response to danger. The fight-or-flight system has helped humans survive for thousands of years. The problem begins when this system remains activated without a real threat, or when it is triggered disproportionately by everyday stimuli.
DSM-5 and ICD-10 (F40–F41) describe several distinct clinical entities that fall within anxiety disorders:
- Generalized Anxiety Disorder (GAD / F41.1): Chronic, uncontrollable worry about multiple areas of life, lasting at least six months.
- Panic Disorder (F41.0): Recurrent, unexpected panic attacks with intense physical symptoms.
- Social Anxiety Disorder (F40.1): Persistent fear of social evaluation and exposure.
- Specific Phobias (F40.2): Disproportionate fear of specific objects or situations.
- Agoraphobia (F40.0): Fear of situations from which escape may be difficult — often following panic disorder.
Clinical presentation & symptoms
Anxiety disorders can “disguise” themselves as physical problems, making diagnosis challenging.
Psychological symptoms
- Persistent, exhausting worry
- Difficulty concentrating and a sense of the mind going blank
- Sense of impending catastrophe
- Irritability
Physical symptoms
- Palpitations, shortness of breath
- Muscle tension, headaches
- Sweating, trembling
- Gastrointestinal discomfort
- Sleep disturbances
Panic attack — what it is and when it appears
A panic attack is an intense anxiety response that develops suddenly, peaks in less than 10 minutes and includes at least four of the following: tachycardia, shortness of breath, choking sensation, dizziness, numbness, fear of dying or “going crazy”, depersonalization.
Neurobiological basis
Anxiety disorders are not “weakness of character” or “excessive sensitivity”. They have a measurable neurobiological basis:
- Amygdala hyperactivity: The brain’s fear-processing center misclassifies neutral stimuli as threats.
- Prefrontal cortex (PFC) dysfunction: Reduced top-down regulation of the amygdala — the rational brain loses control over the emotional brain.
- HPA axis dysregulation: Chronic hypersecretion of cortisol with downstream neurotoxic effects.
- GABA & serotonin: Deficiency of the main inhibitory neurotransmitter (GABA) and dysfunction of serotonergic transmission.
- Noradrenaline: Hyperactivity of the locus coeruleus — the brain’s “alarm system” remains switched on.
Treatment approach
First-line treatments
- Genome-guided pharmacotherapy (PGx): SSRIs and SNRIs are the pharmacological cornerstone. In the clinic, medication selection is not based on trial and error — it is guided by pharmacogenomic analysis to identify the most appropriate medication from the first session.
- Cognitive Behavioral Therapy (CBT): Proven effectiveness in GAD, social anxiety disorder and panic disorder.
Second-line & treatment-resistant cases
For patients who do not respond adequately to pharmacotherapy:
- rTMS (repetitive transcranial magnetic stimulation): rTMS neuromodulation has shown significant effects in anxiety disorders, targeting the right dorsolateral prefrontal cortex (rDLPFC) to reduce hyperactivity. It is an approved treatment that is often used in patients for whom traditional methods have not produced the desired results.
- tDCS (transcranial direct current stimulation): Adjunctive neuromodulation for chronic anxiety.
- Medication regimen review based on updated PGx analysis.
Every clinical case is treated as unique. There is no “routine” protocol — there is your individual history, your genome and the treatment plan that emerges specifically for you.
Frequently asked questions (FAQ)
What is the difference between normal anxiety and an anxiety disorder?
Normal anxiety is adaptive — it appears in response to real threats and subsides. An anxiety disorder is characterized by anxiety that is disproportionate or lacks an objective trigger, persists over time, impairs functioning and is accompanied by physical symptoms.
Can anxiety disorders mimic heart problems?
Yes. Palpitations, shortness of breath and chest pain during a panic attack are often confused with cardiological events. This is why the patient should receive a full assessment, including psychiatric evaluation.
How long does treatment last?
It depends on the type and severity. Usually, pharmacotherapy continues for at least 12 months after remission, while CBT may be completed in a limited number of sessions.
Is rTMS effective for anxiety?
Clinical data show a significant reduction in anxiety symptoms with rTMS, particularly as part of combined treatment in resistant cases. The physician assesses case by case whether it is an indicated option.
