Anxiety Disorders: Recent Global Approach to Neuro-pathogenesis, Drug Treatment, Cognitive Behavioral Therapy, and Their Implications

Anxiety is a group of mental disorders characterized by the sudden feeling of intense fear, panic, shortness of breath, chest pain, restlessness, GIT problems, insomnia, fatigue, muscle tension, sweating, loss of memory, blurred vision, and impaired learning. It occurs typically in response to a stressful situation that may become pathological when it is no longer controlled or occurs in the absence of real threat. This review aimed to appraise the literature on the prevalence, classification, neuro-pathogenesis, diagnoses, and treatment of anxiety disorders (AD). The search was made using PubMed, Embase, MEDLINE, and PsycINFO databases. Anxiety disorders arc the most common mental disorders affecting humans, especially among developing nations. In general, the lifetime prevalence of AD is about 14%, with an annual prevalence of 31%. Unfortunately, AD, in general, is underdiagnosed and undertreated globally. Anxiety disorders are classified based on the Diagnostic and Statistical Manual for Mental Health Disorder V (DSM-V). Examples of AD include generalized anxiety disorder, panic attack, agoraphobia, specific phobia, social anxiety disorder, separation anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, selective mutism, medication anxiety disorder, and medical condition anxiety disorder. Generally, anxiety is caused by biological, genetic, autonomic, biochemical, and environmental changes. Gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the CNS. It is known for the induction of sleep, relaxation, and prevention of excitation; therefore, depletion of GABA in the occipital cortex is implicated in anxiety pathogenesis. Besides, hormones such as serotonin, dopamine, noradrenaline, and glutamate are involved in anxiety etiology. Treatments of anxiety disorders involve the use of drugs and cognitive behavioral therapy (CBT). Classes of drugs used in the management of anxiety include selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, a tricyclic antidepressant, benzodiazepines, antihistamines, monoamine oxidase inhibitors, atypical antipsychotics, azapirones, and reversible inhibitors of monoamine oxidase.