by Roberto Pino
PhD in Pharmacology and Toxicology University of Florence

What is anxiety and how does it manifest itself?

Ask a handful of people with an anxiety disorder to describe it and they will likely paint different pictures . One is afraid of speaking in public, while another is filled with intense fear at the very thought of getting on a plane. A third worry about all things chronically. A fourth suffers from unpredictable episodes of panic, with lack of air, sweating and chest pains. Many others would undoubtedly say they suffer from insomnia.

Why the wide range of symptoms? Because anxiety disorders are not a single condition, but rather a spectrum of related disorders.

Table 1 – Anxiety and Stress Disorders at a Glance

TIPI	SINTOMI PRINCIPALI
Fobie	Paura irrazionale , intensa e persistente collegata ad un particolare oggetto o situazione
Disturbo d'ansia sociale (fobia sociale)	Ansia causata da determinate situazioni sociali come parlare in pubblico o più semplicemente compiere un’azione davanti a qualcuno
Disturbo post-traumatico da stress (PTSD)	Ansia conseguente ad evento gravemente traumatico o pericolo di vita. SI manifesta con pensieri intrusivi e angoscianti, problemi di sonno, ipervigilanza, astinenza sociale, rabbia e altri sintomi di ansia.
Disturbo d'ansia generalizzata	Ansia e preoccupazione eccessiva che si manifesta per una varietà di cose e nella maggior parte dei giorni. Sintomi fisici frequentemente associati sono : tensione muscolare, aumento della frequenza cardiaca e vertigini.
Attacchi di panico e disturbi di panico (DAP)	Un attacco di panico è un'ondata improvvisa di intensa ansia, apprensione, paura o terrore, con sintomi fisici come mancanza di respiro, palpitazioni, sudorazione e dolori al petto. Il disturbo di panico comporta ricorrenti attacchi di panico che si verificano all'improvviso e senza preavviso, causando preoccupazioni persistenti e interferendo con il funzionamento sociale. A volte questo porta le persone a evitare di uscire di casa.
Disturbo ossessivo-compulsivo (DOC)	Pensieri angoscianti ricorrenti (ossessioni) e comportamenti ripetitivi incontrollabili (rituali o compulsioni) intesi a ridurre l'ansia provocata da tali pensieri. I sintomi durano più di un'ora al giorno e causano disagio significativo o interferiscono con il normale funzionamento.
Disturbo acuto da stress	Sintomi di ansia che durano fino a un mese dopo un'esperienza traumatica o durante sollecitazioni ambientali stressogene continuative.
Condizioni mediche che producono o imitano i sintomi dell'ansia	Ansia pronunciata, attacchi di panico, ossessioni o compulsioni causate da una condizione medica come una malattia della tiroide o una malattia che causa difficoltà respiratorie.
Disturbo d'ansia indotto da sostanze	Ansia pronunciata, attacchi di panico, ossessioni, compulsioni o eventualmente paranoia causata da farmaci, abuso di sostanze o esposizione a una tossina.

What are the causes?

There is no single cause but a plurality of factors such as the predisposition of each subject, life experiences and the surrounding environment. The interplay of factors helps explain why traumatic or emotionally important life experiences, such as the Covid-19 situation we are all facing, can trigger anxiety in some people but not others.

High levels of anxiety can also be associated with a hectic lifestyle that makes us feel overwhelmed by countless family, work and social commitments. Our body is thus exposed to numerous daily stresses and is not always able to adapt and find its natural balance.

How to recognize it?

Importantly, stress and anxiety disorders can coexist. In fact, they share many common functions. The underlying biological mechanisms are similar and involve part of the same biochemical pathway in the brain. Most importantly, both can unleash a state of distress for situations that may not be as scary. The key difference is that the stress disorder is caused by one or more real causes or traumatic experiences.
At an optimal level, anxiety can be an emotion that pushes us to find solutions to problems, increasing our self-esteem and helping us to grow. The same emotion, when excessively intense and lasting, can become an impediment to living life and makes us slaves to the fears that most terrify us.
Anxiety is therefore considered pathological when it turns into a disproportionate reaction to the anticipation or misinterpretation of a potential danger that affects the person’s individual and collective relationship life.
Emotions such as anguish, fear, agitation, anger, which can also manifest themselves on a somatic level with dizziness, muscle tension, joint pain, abdominal cramps, gastrointestinal disorders, palpitations, breathlessness, etc., are the characteristic symptoms of an anxiety disorder.

What happens to the brain?

The Hypothalamic-Pituitary-Adrenal Axis
The body has an “alert” system that allows us to react immediately to a dangerous situation. Its activation increases some biochemical mediators such as adrenaline and cortisol with the consequent increase in heart and respiratory rate and the level of energy necessary to face the imminent threat through a “fight or flight” response (fight-or -flight response).

The crucial part of this system is the Hypothalamic-Pituitary-Adrenal Axis (HPA or Hypothalamic-Pituitary-Adrenal Axis,) described in the figure above.
This physiological system has evolved to protect us in the face of a situation that we perceive as dangerous for our survival. When the danger ceases, the system returns to its natural equilibrium. However, in some people with anxiety disorders, this system has been seen to remain continuously activated. It is as if the dangerous situation (real or imaginary) were always present.

What can we do in these cases?

It is very important and necessary to have recourse to the appropriate health specialists , in order to correctly identify the disadvantage in progress and choose the correct therapy.
Psychotherapy, particularly Cognitive Behavioral Therapy ( CBT ), has been shown to be effective for the treatment of anxiety disorders.
Meditation practices like Yoga and Mindfulness can also be an antidote to our busy lives. They allow us to raise awareness of what is happening in the present and accept them without judgment.
Another valid help for managing the effects of anxiety states can be provided by phytotherapy either alone in cases of mild or moderate entity or in association with psychotherapy.

What is herbal medicine and how does it work?

Phytotherapy is the medical discipline that uses medicinal plants and their preparations for therapeutic purposes (Biagi et al., 2016). Each medicinal plant has more pharmacological effects than the single action of the synthetic drug, interacting with different organs and systems of our body. Furthermore, phytotherapeutic preparations have been developed to be well tolerated and used in more fragile patients such as children and the elderly.

What therapeutic solutions does phytotherapy suggest for the state of anxiety?

Many plants can be used in the state of anxiety, by virtue of the different manifestation of this in terms of expression of the symptoms that characterize it. Let’s see some of the most important.

Exerens, has formulated a herbal product called Ansirens ®, developed specifically for anxiety symptoms with or without somatic manifestations . Its drop formulation allows greater handling and action of its components. It includes the presence of three natural ingredients which, if taken regularly for a period of at least 4 weeks, help to overcome periods of strong stress and anxiety.

• Rhodiola Rosea is used as a tonic-adaptogen in case of physical and mental fatigue and to promote normal mood. Thanks to its adaptogenic properties it increases the body’s resistance to external stimuli and stress.
• Linden has sedative and anxiolytic properties and promotes relaxation in case of stress.
• Passiflora incarnata promotes mental well-being. Traditional use of Passionflower for the relief of symptoms of mental stress and to aid sleep.

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References

• Anxiety and Stress Disorders – Harvard Health Publishing, Harvard Institutes of Medicine (2019)
• Gelfuso, EA; et al. Anxiety: A Systematic Review of Neurobiology, Traditional Pharmaceuticals and Novel Alternatives from Medicinal Plants. CNS & Neurological Disorders – Drug Targets, Vol. 12, No. 8 (2013)