Anxiety Induced by Drugs or Medical Problems
Anxiety can be caused by a medical disorder or the use or discontinuation of a drug. Examples of medical disorders that may cause anxiety include neurologic disorders, such as a head injury, brain infection, or inner ear disorder; cardiovascular disorders, such as heart failure and abnormal heart rhythms (arrhythmias); endocrine disorders, such as an overactive adrenal or thyroid gland; and respiratory disorders, such as asthma and chronic obstructive pulmonary disease. Even fever can cause anxiety.
Drugs that can induce anxiety include alcohol, stimulants, caffeine, cocaine, and many prescription drugs, such as ephedrine (used, for example, in decongestants) and theophylline (used, for example, to treat asthma). Some over-the-counter weight-loss products contain both ephedrine and caffeine. Drugs that can induce anxiety when discontinued include benzodiazepines.
Anxiety may occur in dying people as a result of fear of death, pain, and difficulty breathing (see Section 1, Chapter 8).
Treatment
A doctor aims to treat the primary causes rather than the secondary anxiety symptoms. Anxiety should subside after the medical disorder is treated or the drug has been discontinued long enough for any withdrawal symptoms to abate. A doctor can treat any remaining anxiety with appropriate antianxiety drugs or psychotherapy (such as behavior therapy). For people who are dying, strong analgesics with potent antianxiety effects, such as morphine, are often appropriate. No dying person should have to experience intense anxiety.
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