Anxiety disorders
Also called: anxiety, generalised anxiety disorder (GAD), panic disorder, social anxiety disorder, phobias, ghabrahat (anxiety, nervousness)
Anxiety disorders cause fear or worry that is stronger than the situation, lasts for months and gets in the way of daily life. They are the most common mental health conditions in the world. Talking therapy, self-help and some medicines work well.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Everyone feels worried or nervous at times, for example before an exam or a job interview. In an anxiety disorder, the fear or worry is much stronger than the situation calls for, it is hard to control, and it keeps coming back for months. It can affect sleep, work, study, family life and physical health. It is a real health condition, not a weakness of character, and it can be treated.
There are several types. In generalised anxiety disorder (GAD) a person worries about many everyday things most of the time. Panic disorder brings sudden attacks of intense fear with a pounding heart and a feeling that something terrible is about to happen. Social anxiety disorder is a strong fear of being judged or embarrassed in front of others. Phobias are intense fears of a particular thing or situation. Some people have more than one type, and anxiety often occurs together with depression.
The World Health Organization says anxiety disorders are the most common mental disorders worldwide and that more women than men are affected. They often begin in childhood or the teenage years. Only about one in four people who need care receive it, partly because of stigma and too few services. Talking therapy, especially cognitive behavioural therapy (CBT, a structured therapy that helps you change unhelpful thoughts and habits), and certain medicines help most people feel much better.
In Pakistan
A review of community studies in Pakistan found that around one in three adults had anxiety or depression, with higher rates in women, and linked it to social stresses such as money problems and family or relationship difficulties; these studies are older and mostly from Punjab and Sindh.
Symptoms
- Constant or excessive worry or fear that is hard to control
- Feeling restless, tense, on edge or unable to sit still
- Being irritable and finding it hard to concentrate or make decisions
- Trouble sleeping and getting tired easily
- A fast or pounding heartbeat (palpitations), sweating, trembling or shaking
- Feeling dizzy or light-headed, or short of breath
- Stomach upset, nausea (feeling sick) or headaches
- Sudden attacks of intense fear (panic attacks) with a sense that something terrible will happen
- Avoiding places, people or situations that bring on the fear
Causes and risk factors
Causes
- A mix of biological, psychological and social factors; often there is no single clear cause
- Genes and family history, which can make some people more vulnerable
- Stressful or traumatic life events such as abuse, violence, bullying or a serious loss
- Changes in brain chemical messengers (such as serotonin) and an over-active stress response
- Some medicines, alcohol, illegal drugs, or a medical condition such as an over-active thyroid
What makes it more likely
- Being female
- A parent, brother or sister with anxiety, depression or another mental health condition
- Difficult or traumatic experiences in childhood or adult life
- A long-term or painful physical illness
- Past or current misuse of alcohol or drugs
- Already having another anxiety disorder or depression
- Money problems, low education and relationship or family difficulties (shown in studies from Pakistan)
Complications
Without help, anxiety can last for years and make it harder to study, work, keep friendships and enjoy life. It raises the risk of depression and of misusing alcohol or other substances to cope. Long-lasting anxiety has also been linked with a higher risk of heart problems. Severe anxiety, especially together with depression, increases the risk of thoughts of self-harm and suicide. Anxiety can return after treatment, so regular follow-up with a doctor is useful. The good news is that with the right treatment most people improve a great deal.
When to see a doctor
- Thoughts of harming yourself or ending your life: get urgent help now by going to the nearest hospital emergency department or telling someone you trust
- Chest pain, an irregular heartbeat or breathlessness that is new or different from your usual anxiety: see a doctor urgently to rule out a heart or lung problem
- Anxiety so severe that you cannot look after yourself, eat, or leave the house
- Feeling much more agitated or having new suicidal thoughts after starting an antidepressant, especially if you are under 30
- Using alcohol, drugs or more sedative tablets than prescribed to cope with anxiety
Diagnosis
A doctor diagnoses an anxiety disorder by talking with you about your worries, physical symptoms and how they affect your daily life, and by asking about your health, medicines, alcohol and drug use, and family history. Being open helps the doctor reach the right answer. Generalised anxiety disorder is usually diagnosed when worry about many things has been present most of the time for at least 6 months, is hard to control and affects daily life. The doctor will also ask about low mood, because depression often occurs at the same time.
There is no single blood test for anxiety. A physical examination and some tests may be done to rule out other causes that can feel like anxiety, such as an over-active thyroid, heart rhythm problems, asthma, diabetes problems or the effects of drugs or alcohol. Tests may include a blood count, thyroid tests, a urine test and sometimes an ECG (heart tracing).
Treatment
- Learn about the condition: understanding anxiety and how treatment works is the first step, and your doctor will keep an eye on how you are doing
- Start with self-help: guided self-help books, online courses, group sessions, relaxation and breathing exercises, regular exercise and good sleep
- If symptoms continue or are severe, try a talking therapy such as cognitive behavioural therapy (CBT) or applied relaxation, or start a medicine; both work, so your preference matters
- If a medicine is chosen, it is usually an SSRI antidepressant first; if it does not help or is not tolerated, your doctor may try another SSRI, an SNRI or pregabalin. Your doctor decides the dose
- Give treatment time: medicines usually take a few weeks to work, and your doctor will review you regularly, more often in the first weeks
- Keep taking a medicine that works for as long as your doctor advises (often at least a year), and never stop it suddenly; it should be reduced slowly with your doctor
- If anxiety is severe, complex, not improving, or there is a risk of self-harm, your doctor will refer you to a psychiatrist or specialist mental health team
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| SSRI antidepressants | first choice of medicine for most anxiety disorders, including generalised anxiety disorder and panic disorder; they can cause short-lived extra anxiety or poor sleep at the start | Sertraline (14 brands), Escitalopram (47 brands), Citalopram (7 brands), Paroxetine (21 brands), Fluoxetine (87 brands) |
| SNRI antidepressants | an alternative when an SSRI has not worked or is not suitable | Duloxetine (4 brands) |
| Pregabalin | an option for generalised anxiety disorder when SSRIs and SNRIs are not tolerated; it can be misused, so doctors use it with care | Pregabalin (13 brands) |
| Tricyclic antidepressants | sometimes used for panic disorder when an SSRI is unsuitable or has not helped; more side effects than SSRIs | Clomipramine (9 brands) |
| Beta blockers | sometimes used to calm physical symptoms such as a racing heart and shaking, mainly in social or performance anxiety; they do not treat the worry itself | Propranolol (17 brands) |
| Benzodiazepines | only for short-term use in a crisis, prescribed and watched by a doctor, because they can cause dependence (addiction) and do not help in the long term; not recommended for panic disorder | Diazepam (68 brands), Lorazepam (17 brands) |
Also used (not yet in our price list): venlafaxine (an SNRI), imipramine (a tricyclic antidepressant), buspirone
Self-care and prevention
Self-care
- Talk to someone you trust, or a health professional, about how you feel
- Practise slow breathing, muscle relaxation or a few minutes of mindfulness every day
- Be active: regular exercise, even a short daily walk, can ease anxiety
- Keep regular times for sleeping and meals, and eat a healthy diet
- Cut down on tea, coffee, cola and energy drinks, as caffeine can make anxiety and sleep worse
- Avoid alcohol, smoking and drugs; they may seem to help at first but make anxiety worse over time
- Face feared situations step by step instead of avoiding them, ideally with guidance from a therapist
- Use good-quality self-help books or courses recommended by your doctor or psychologist
Prevention
- Build coping skills early: school and parenting programmes that teach children to handle emotions help prevent anxiety
- Stay physically active, as exercise can help protect adults against anxiety
- Keep close, supportive relationships; having someone to confide in lowers the risk
- Limit alcohol, avoid drugs and keep caffeine low
- Seek help early when worry starts to affect daily life, before it becomes severe
Common questions
Is anxiety a real illness or just weakness?
Anxiety disorders are real and common health conditions. They are caused by a mix of genes, life events and brain chemistry, not by weak character. Anyone can develop one, and they can be treated.
Can anxiety be cured?
Most people get much better with treatment, and many become free of symptoms. Talking therapy such as CBT teaches skills that keep helping after treatment ends. Anxiety can come back, so it helps to keep using your skills and see your doctor if symptoms return.
Are anxiety medicines addictive?
SSRI and SNRI antidepressants are not addictive, but stopping them suddenly can cause unpleasant withdrawal symptoms, so they should be reduced slowly with your doctor. Benzodiazepines (sleeping or calming tablets) can cause dependence, so they should only be used for a short time under a doctor's care. Pregabalin can also be misused.
How long do anxiety medicines take to work?
Antidepressants used for anxiety usually take a few weeks to start working. Some people feel a little more anxious in the first days, which usually settles. Your doctor will review you regularly and, if the medicine helps, will usually advise continuing it for at least a year.
Can a panic attack harm me?
A panic attack feels frightening, with a racing heart and breathlessness, but it passes, usually within minutes. If you have chest pain or breathlessness for the first time, or it feels different from usual, see a doctor urgently to rule out a heart or lung problem.
Sources
- NICE. Generalised anxiety disorder and panic disorder in adults: management (NICE clinical guideline CG113) (2020).
- WHO. Anxiety disorders (2026).
- StatPearls (NCBI Bookshelf). Anxiety - StatPearls - NCBI Bookshelf (2023).
- NHS. Generalised anxiety disorder (GAD) - NHS (2024).
- National Institute of Mental Health (NIMH). Anxiety Disorders (2024).
- MedlinePlus. ANXIETY: What you need to know (NIH MedlinePlus Magazine) (2023).
- BMJ (Mirza and Jenkins). Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review (2004).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.