Anxiety becomes a disorder when it stops being proportionate — when it arrives without a threat, persists after the threat has passed, or produces physical symptoms severe enough that the person believes they are having a heart attack. A great many people in Islamabad first present to a cardiology department rather than a psychiatric one.
Islamic Medical Centre assesses and treats anxiety disorders and panic in Islamabad. Treatment is deliberately cautious with sedative medication, because the most commonly prescribed remedy for anxiety in Pakistan is also the one most likely to create a dependence of its own.
The forms anxiety takes
Anxiety is not a single condition, and the distinction matters because the treatments differ. Assessment establishes which pattern is present rather than treating anxiety as one undifferentiated complaint.
- Generalised anxiety: continuous worry across many areas, with tension, poor sleep and exhaustion
- Panic disorder: sudden intense episodes with palpitations, breathlessness, chest tightness, and a conviction of dying
- Social anxiety: intense fear of judgement, leading to avoidance of gatherings, presentations and interviews
- Specific phobias: focused and intense fear of a particular object or situation
- Health anxiety: persistent fear of serious illness, sustained despite normal investigations
- Obsessive compulsive presentations, which are assessed separately as they respond to different treatment
Panic attacks and the emergency department
A panic attack produces genuine physical symptoms — racing heart, chest tightness, breathlessness, sweating, tingling in the hands and face, dizziness and a powerful sense that something catastrophic is happening. It is not imagined, and telling someone in the middle of one to relax achieves nothing.
Because the symptoms resemble a cardiac event, most people attend an emergency department at least once, and being told that nothing is wrong is rarely reassuring for long. The important clinical point is that a first episode does warrant physical assessment — cardiac and thyroid causes need excluding — but repeated normal investigations in a recognisable pattern should redirect attention rather than prompt a further round of tests.
Why the usual prescription is a problem
Alprazolam, bromazepam and similar medicines work quickly and well for acute anxiety, which is exactly why they are prescribed so widely here. The difficulty is what happens after several weeks: tolerance develops, the dose rises, and stopping produces rebound anxiety worse than the original complaint, which the patient reasonably interprets as proof the medicine is necessary.
This is the single most common route into sedative dependence seen at this centre, and it usually began with an appropriate prescription for a genuine problem. These medicines have a legitimate short-term role. As an ongoing treatment for an anxiety disorder they are the wrong tool, and where dependence has already formed the withdrawal requires a supervised taper because abrupt cessation can cause seizures.
What treatment actually involves
Anxiety disorders respond well to psychotherapy, and cognitive behavioural work has the strongest evidence. The core of it is straightforward in principle and difficult in practice: identifying the thoughts driving the anxiety, and reducing the avoidance and safety behaviours that maintain it. Avoidance is what keeps an anxiety disorder alive, because it prevents the person ever learning that the feared outcome does not occur.
- Assessment establishing which anxiety disorder is present, and excluding physical causes
- Cognitive behavioural therapy, with graded exposure where avoidance is prominent
- Breathing and physiological control techniques for panic
- Antidepressant medication where indicated, which is effective for anxiety and does not create dependence
- Short-term sedative use only where genuinely necessary, with a defined end point agreed in advance
- Treatment of co-occurring depression, which accompanies anxiety more often than not
- Review of caffeine, nicotine, sleep and, where relevant, alcohol
Anxiety alongside substance use
Alcohol and sedatives both relieve anxiety in the moment and worsen it substantially between doses, which produces a cycle that tightens over time. Many people with an established anxiety disorder are managing it with something, and assessment asks about this directly rather than waiting for it to be volunteered.
Caffeine deserves specific mention because it is so rarely considered. Heavy consumption of tea, coffee and energy drinks produces palpitations, tremor and disturbed sleep that are frequently indistinguishable from an anxiety disorder, and reducing it is occasionally most of the treatment.
How long treatment takes
Panic disorder often responds within weeks once exposure work begins, and it responds well. Generalised anxiety and social anxiety usually take longer, because the patterns are older and more embedded. Where medication is used it is typically continued for a period after improvement rather than stopped immediately, since early discontinuation is associated with relapse.
Improvement is rarely linear. Setbacks during exposure work are expected and are part of the process rather than evidence that it is not working.
Frequently Asked Questions
- Is a panic attack dangerous?
- The attack itself is not physically dangerous, though it is intensely unpleasant and the symptoms are real. A first episode should be assessed physically to exclude cardiac and thyroid causes; repeated normal investigations in a clear pattern point to panic rather than to a need for further tests.
- I was prescribed Xanax for anxiety. Is that a problem?
- For short-term use it has a legitimate role. Beyond several weeks tolerance develops, the dose tends to rise, and stopping produces rebound anxiety worse than the original problem. This is the most common route into sedative dependence we see. If you have been taking it for months, do not stop abruptly — it requires a supervised taper.
- Are antidepressants used for anxiety?
- Yes, and they are among the more effective treatments for anxiety disorders. Unlike sedatives they do not produce tolerance or dependence, though they take several weeks to work and should be reduced gradually rather than stopped abruptly.
- Can anxiety be treated without medication?
- Frequently, yes. Cognitive behavioural therapy is effective for anxiety disorders on its own, particularly for panic and phobias. Medication is added where symptoms are severe, where depression is also present, or where therapy alone has not been sufficient.
- Why does avoiding the situation make it worse?
- Avoidance provides immediate relief and prevents the person from ever learning that the feared outcome does not happen, so the fear is preserved intact. Graded exposure reverses this, which is why it is central to treatment even though it is uncomfortable.
- Could my anxiety be caused by something physical?
- Thyroid disorder, cardiac arrhythmia and certain medicines can all produce anxiety symptoms, and assessment checks for them. Heavy caffeine intake is a frequent and easily missed contributor.
- Does anxiety happen alongside depression?
- Very often. The two occur together more commonly than either occurs alone, and treatment addresses both rather than choosing between them.
- How soon will I feel better?
- Panic often improves within weeks of beginning exposure work. Generalised and social anxiety usually take longer because the patterns are older. Improvement is normally uneven, with setbacks that are part of the process.