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Recognizing Anxiety Attack Symptoms

By the National Institute of Mental Health

What are the different kinds of anxiety attack symptoms?

Panic Attack - Disorder

• Repeated episodes of intense fear that strike often and without warning.
• Chest pain
• Heart palpitations
• Shortness of breath
• Dizziness
• Abdominal distress
• Feelings of unreality, and fear of dying

Generalized Anxiety Disorder

Constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months. Almost always anticipating the worst even though there is little reason to expect it; accompanied by physical symptoms, such as:

• Fatigue
• Trembling
• Muscle tension
• Headache
• Nausea

Obsessive-Compulsive Disorder

Repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control.

Post-Traumatic Stress Disorder

Persistent symptoms that occur after experiencing or witnessing a traumatic event such as rape or other criminal assault, war, child abuse, natural or human-caused disasters, or crashes. Symptoms Include:

• Nightmares
• Flashbacks
• Numbing of emotions
• Depression
• Feeling angry
• Irritable or distracted
• Easily startled
• Family members of victims can also develop this disorder.

Phobias - Social Phobia and
Specific Phobias

People with social phobia have an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in social situations, which leads to avoidance of many potentially pleasurable and meaningful activities. People with specific phobia experience extreme, disabling, and irrational fear of something that poses little or no actual danger; the fear leads to avoidance of objects or situations and can cause people to limit their lives unnecessarily.

How common are anxiety attack symptoms?
Panic attack symptoms
Agoraphobia symptoms
Specific phobia symptoms
Social phobia symptoms
Generalized anxiety disorder
Obsessive-Compulsive symptoms
Acute and Post Traumatic Stress
Do anxiety attack symptoms coexist with other disorders?
Treatments for anxiety attack symptoms?

How Common Are Anxiety Attack Disorders?

Anxiety disorders, as a group, are the most common mental illness in America. More than 19 million American adults are affected by these debilitating illnesses each year. Children and adolescents can also develop anxiety disorders.

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Panic Attack Symptoms and Panic Disorder

A panic attack is a discrete period of intense fear or discomfort that is associated with numerous somatic and cognitive symptoms . These symptoms include palpitations, sweating, trembling, shortness of breath, sensations of choking or smothering, chest pain, nausea or gastrointestinal distress, dizziness or lightheadedness, tingling sensations, and chills or blushing and “hot flashes.” The attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes. Most people report a fear of dying, “going crazy,” or losing control of emotions or behavior. The experiences generally provoke a strong urge to escape or flee the place where the attack begins and, when associated with chest pain or shortness of breath, frequently results in seeking aid from a hospital emergency room or other type of urgent assistance. Yet an attack rarely lasts longer than 30 minutes. Current diagnostic practice specifies that a panic attack must be characterized by at least four of the associated somatic and cognitive symptoms described above. The panic attack is distinguished from other forms of anxiety by its intensity and its sudden, episodic nature. Panic attacks may be further characterized by the relationship between the onset of the attack and the presence or absence of situational factors. For example, a panic attack may be described as unexpected, situationally bound, or situationally predisposed (usually, but not invariably occurring in a particular situation). There are also attenuated or “limited symptom” forms of panic attacks.

Panic attacks are not always indicative of a mental disorder, and up to 10 percent of otherwise healthy people experience an isolated panic attack per year (Barlow, 1988; Klerman et al., 1991). Panic attacks also are not limited to panic disorder. They commonly occur in the course of social phobia, generalized anxiety disorder, and major depressive disorder .

Panic disorder is diagnosed when a person has experienced at least two unexpected panic attacks and develops persistent concern or worry about having further attacks or changes his or her behavior to avoid or minimize such attacks. Whereas the number and severity of the attacks varies widely, the concern and avoidance behavior are essential features. The diagnosis is inapplicable when the attacks are presumed to be caused by a drug or medication or a general medical disorder, such as hyperthyroidism.

Lifetime rates of panic disorder of 2 to 4 percent and 1-year rates of about 2 percent are documented consistently in epidemiological studies (Kessler et al., 1994; Weissman et al., 1997) (Table 4-1). Panic disorder is frequently complicated by major depressive disorder (50 to 65 percent lifetime comorbidity rates) and alcoholism and substance abuse disorders (20 to 30 percent comorbidity) (Keller & Hanks, 1994; Magee et al., 1996; Liebowitz, 1997). Panic disorder is also concomitantly diagnosed, or co-occurs, with other specific anxiety disorders, including social phobia (up to 30 percent), generalized anxiety disorder (up to 25 percent), specific phobia (up to 20 percent), and obsessive-compulsive disorder (up to 10 percent) . As discussed subsequently, approximately one-half of people with panic disorder at some point develop such severe avoidance as to warrant a separate description, panic disorder with agoraphobia.

Panic disorder is about twice as common among women as men (American Psychiatric Association, 1998). Age of onset is most common between late adolescence and midadult life, with onset relatively uncommon past age 50. There is developmental continuity between the anxiety syndromes of youth, such as separation anxiety disorder. Typically, an early age of onset of panic disorder carries greater risks of comorbidity, chronicity, and impairment. Panic disorder is a familial condition and can be distinguished from depressive disorders by family studies (Rush et al., 1998).

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Agoraphobia Symptoms

The ancient term agoraphobia is translated from Greek as fear of an open marketplace. Agoraphobia today describes severe and pervasive anxiety about being in situations from which escape might be difficult or avoidance of situations such as being alone outside of the home, traveling in a car, bus, or airplane, or being in a crowded area .

Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder (American Psychiatric Association, 1998). Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and the subsequent worry, preoccupation, and avoidance (Barlow, 1988). Thus, the formal diagnosis of panic disorder with agoraphobia was established. However, for those people in communities or clinical settings who do not meet full criteria for panic disorder, the formal diagnosis of agoraphobia without history of panic disorder is used .
The 1-year prevalence of agoraphobia is about 5 percent (Table 4-1). Agoraphobia occurs about two times more commonly among women than men (Magee et al., 1996). The gender difference may be attributable to social-cultural factors that encourage, or permit, the greater expression of avoidant coping strategies by women , although other explanations are possible.

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Specific Phobia Symptoms

These common conditions are characterized by marked fear of specific objects or situations . Exposure to the object of the phobia, either in real life or via imagination or video, invariably elicits intense anxiety, which may include a (situationally bound) panic attack. Adults generally recognize that this intense fear is irrational. Nevertheless, they typically avoid the phobic stimulus or endure exposure with great difficulty. The most common specific phobias include the following feared stimuli or situations: animals (especially snakes, rodents, birds, and dogs); insects (especially spiders and bees or hornets); heights; elevators; flying; automobile driving; water; storms; and blood or injections.

Approximately 8 percent of the adult population suffers from one or more specific phobias in 1 year (Table 4-1). Much higher rates would be recorded if less rigorous diagnostic requirements for avoidance or functional impairment were employed. Typically, the specific phobias begin in childhood, although there is a second “peak” of onset in the middle 20s of adulthood . Most phobias persist for years or even decades, and relatively few remit spontaneously or without treatment.

The specific phobias generally do not result from exposure to a single traumatic event (i.e., being bitten by a dog or nearly drowning) (Marks, 1969). Rather, there is evidence of phobia in other family members and social or vicarious learning of phobias (Cook & Mineka, 1989). Spontaneous, unexpected panic attacks also appear to play a role in the development of specific phobia, although the particular pattern of avoidance is much more focal and circumscribed.

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Social Phobia Symptoms

Social phobia, also known as social anxiety disorder, describes people with marked and persistent anxiety in social situations, including performances and public speaking (Ballenger et al., 1998). The critical element of the fearfulness is the possibility of embarrassment or ridicule. Like specific phobias, the fear is recognized by adults as excessive or unreasonable, but the dreaded social situation is avoided or is tolerated with great discomfort. Many people with social phobia are preoccupied with concerns that others will see their anxiety symptoms (i.e., trembling, sweating, or blushing); or notice their halting or rapid speech; or judge them to be weak, stupid, or “crazy.” Fears of fainting, losing control of bowel or bladder function, or having one’s mind going blank are also not uncommon. Social phobias generally are associated with significant anticipatory anxiety for days or weeks before the dreaded event, which in turn may further handicap performance and heighten embarrassment.

The 1-year prevalence of social phobia ranges from 2 to 7 percent (Table 4-1), although the lower figure probably better captures the number of people who experience significant impairment and distress. Social phobia is more common in women (Wells et al., 1994). Social phobia typically begins in childhood or adolescence and, for many, it is associated with the traits of shyness and social inhibition (Kagan et al., 1988). A public humiliation, severe embarrassment, or other stressful experience may provoke an intensification of difficulties (Barlow, 1988). Once the disorder is established, complete remissions are uncommon without treatment. More commonly, the severity of symptoms and impairments tends to fluctuate in relation to vocational demands and the stability of social relationships. Preliminary data suggest social phobia to be familial (Rush et al., 1998).

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Generalized Anxiety Disorder Symptoms

Generalized anxiety disorder is defined by a protracted (> 6 months’ duration) period of anxiety and worry, accompanied by multiple associated symptoms . These symptoms include muscle tension, easy fatiguability, poor concentration, insomnia, and irritability. In youth, the condition is known as overanxious disorder of childhood. In DSM-IV, an essential feature of generalized anxiety disorder is that the anxiety and worry cannot be attributable to the more focal distress of panic disorder, social phobia, obsessive-compulsive disorder, or other conditions. Rather, as implied by the name, the excessive worries often pertain to many areas, including work, relationships, finances, the well-being of one’s family, potential misfortunes, and impending deadlines. Somatic anxiety symptoms are common, as are sporadic panic attacks.

Generalized anxiety disorder occurs more often in women, with a sex ratio of about 2 women to 1 man (Brawman-Mintzer & Lydiard, 1996). The 1-year population prevalence is about 3 percent (Table 4-1). Approximately 50 percent of cases begin in childhood or adolescence. The disorder typically runs a fluctuating course, with periods of increased symptoms usually associated with life stress or impending difficulties. There does not appear to be a specific familial association for general anxiety disorder. Rather, rates of other mood and anxiety disorders typically are greater among first-degree relatives of people with generalized anxiety disorder (Kendler et al., 1987).

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Obsessive-Compulsive Disorder Symptoms

Obsessions are recurrent, intrusive thoughts, impulses, or images that are perceived as inappropriate, grotesque, or forbidden . The obsessions, which elicit anxiety and marked distress, are termed “ego-alien” or “ego-dystonic” because their content is quite unlike the thoughts that the person usually has. Obsessions are perceived as uncontrollable, and the sufferer often fears that he or she will lose control and act upon such thoughts or impulses. Common themes include contamination with germs or body fluids, doubts (i.e., the worry that something important has been overlooked or that the sufferer has unknowingly inflicted harm on someone), order or symmetry, or loss of control of violent or sexual impulses.

Compulsions are repetitive behaviors or mental acts that reduce the anxiety that accompanies an obsession or “prevent” some dreaded event from happening . Compulsions include both overt behaviors, such as hand washing or checking, and mental acts including counting or praying. Not uncommonly, compulsive rituals take up long periods of time, even hours, to complete. For example, repeated hand washing, intended to remedy anxiety about contamination, is a common cause of contact dermatitis.

Although once thought to be rare, obsessive-compulsive disorder has now been documented to have a 1-year prevalence of 2.4 percent (Table 4-1). Obsessive-compulsive disorder is equally common among men and women.

Obsessive-compulsive disorder typically begins in adolescence to young adult life (males) or in young adult life (females) (Burke et al., 1990; DSM-IV). For most, the course is fluctuating and, like generalized anxiety disorder, symptom exacerbations are usually associated with life stress. Common comorbidities include major depressive disorder and other anxiety disorders. Approximately 20 to 30 percent of people in clinical samples with obsessive-compulsive disorder report a past history of tics, and about one-quarter of these people meet the full criteria for Tourette’s disorder . Conversely, up to 50 percent of people with Tourette’s disorder develop obsessive-compulsive disorder (Pitman et al., 1987).

Obsessive-compulsive disorder has a clear familial pattern and somewhat greater familial specificity than most other anxiety disorders. Furthermore, there is an increased risk of obsessive-compulsive disorder among first-degree relatives with Tourette’s disorder. Other mental disorders that may fall within the spectrum of obsessive-compulsive disorder include trichotillomania (compulsive hair pulling), compulsive shoplifting, gambling, and sexual behavior disorders (Hollander, 1996). The latter conditions are somewhat discrepant because the compulsive behaviors are less ritualistic and yield some outcomes that are pleasurable or gratifying. Body dysmorphic disorder is a more circumscribed condition in which the compulsive and obsessive behavior centers around a preoccupation with one’s appearance (i.e., the syndrome of imagined ugliness) (Phillips, 1991).

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Acute and Post Traumatic Stress Disorders - Symptoms

Acute stress disorder refers to the anxiety and behavioral disturbances that develop within the first month after exposure to an extreme trauma. Generally, the symptoms of an acute stress disorder begin during or shortly following the trauma. Such extreme traumatic events include rape or other severe physical assault, near-death experiences in accidents, witnessing a murder, and combat. The symptom of dissociation, which reflects a perceived detachment of the mind from the emotional state or even the body, is a critical feature. Dissociation also is characterized by a sense of the world as a dreamlike or unreal place and may be accompanied by poor memory of the specific events, which in severe form is known as dissociative amnesia. Other features of an acute stress disorder include symptoms of generalized anxiety and hyperarousal, avoidance of situations or stimuli that elicit memories of the trauma, and persistent, intrusive recollections of the event via flashbacks, dreams, or recurrent thoughts or visual images.

If the symptoms and behavioral disturbances of the acute stress disorder persist for more than 1 month, and if these features are associated with functional impairment or significant distress to the sufferer, the diagnosis is changed to post-traumatic stress disorder. Post-traumatic stress disorder is further defined in DSM-IV as having three subforms: acute1 (< 3 months’ duration), chronic (> 3 months’ duration), and delayed onset (symptoms began at least 6 months after exposure to the trauma).

By virtue of the more sustained nature of post-traumatic stress disorder (relative to acute stress disorder), a number of changes, including decreased self-esteem, loss of sustained beliefs about people or society, hopelessness, a sense of being permanently damaged, and difficulties in previously established relationships, are typically observed. Substance abuse often develops, especially involving alcohol, marijuana, and sedative-hypnotic drugs.

About 50 percent of cases of post-traumatic stress disorder remit within 6 months. For the remainder, the disorder typically persists for years and can dominate the sufferer’s life. A longitudinal study of Vietnam veterans, for example, found 15 percent of veterans to be suffering from post-traumatic stress disorder 19 years after combat exposure (cited in McFarlane & Yehuda, 1996). In the general population, the 1-year prevalence is about 3.6 percent, with women having almost twice the prevalence of men (Kessler et al., 1995) (Table 4-1). The highest rates of post-traumatic stress disorder are found among women who are victims of crime, especially rape, as well as among torture and concentration camp survivors (Yehuda, 1999). Overall, among those exposed to extreme trauma, about 9 percent develop post-traumatic stress disorder (Breslau et al., 1998).

1. The acute subform of post-traumatic stress disorder is distinct from acute stress disorder because the latter resolves by the end of the first month, whereas the former persists until 3 months. If the condition persists after 3 months duration, the diagnosis is again changed to the chronic post-traumatic stress disorder subform.

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Do Anxiety Attack Symptoms Coexist with Other Physical or Mental Disorders?

It is common for an anxiety disorder to accompany depression, eating disorders, substance abuse, or another anxiety disorder. Anxiety disorders can also coexist with illnesses such as cancer or heart disease. In such instances, the accompanying disorders will also need to be treated. Before beginning any treatment, however, it is important to have a thorough medical examination to rule out other possible causes of symptoms

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What Are the Treatments for Anxiety Attack Symptoms?

Treatments have been largely developed through research conducted by NIMH and other research institutions. They are extremely effective and often combine medication and specific types of psychotherapy. More medications are available than ever before to effectively treat anxiety disorders. These include antidepressants and benzodiazepines. If one medication is not effective, others can be tried. New medications are currently being tested or are under development to treat anxiety symptoms. The two most effective forms of psychotherapy used to treat anxiety disorders are behavioral therapy and cognitive-behavioral therapy. Behavioral therapy tries to change actions through techniques such as diaphragmatic breathing or through gradual exposure to what is frightening. In addition to these techniques, cognitive-behavioral therapy teaches patients to understand their thinking patterns so they can react differently to the situations that cause them anxiety.

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National Institute of Mental Health
Office of Communications
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513
Fax: 301-443-4279
TTY: 301-443-8431
E-mail: nimhinfo@nih.gov
NIMH Web site:
http://www.nimh.nih.gov

L-Theanine for Relaxation and Stress

By Dr. Marcus Laux, ND

Levels of stress and anxiety have reached epidemic proportions. For an increasing number of people, it is literally ruining their lives. Whatever the cause—a hard day at the office, screaming kids, the commute home, the never ending list of things to do—stress causes both emotional and physical problems as well as impairs our ability to enjoy life to the fullest. As companies downsize and corporate competition intensifies, everyone is working longer hours. Technology may have eliminated many tedious, mind-numbing tasks, but it has extended work hours, and the pressure for instant response. Job insecurity and the threat of unemployment haunts many people. Add events such as divorce, the birth of a child, the death of a loved one, plus the daily pressures of balancing home and work, and its little wonder the figures for stress are so high. For most of us, stress and anxiety have become an inescapable part of modern day living. It's estimated that up to 50 million Americans suffer from the effects of stress.1 For some, anxiety and stress are persistent and overwhelming, and can interfere with daily life. A disorder called generalized anxiety disorder can cause its sufferers to worry constantly, always expect the worst to happen, and feel tense all of the time.2 Sufferers can’t just “snap out of it,” because this disorder is caused by an imbalance of chemicals in the brain.2 But there’s help out there to relieve stress and anxiety. We will talk about a dietary supplement that helps people relax and cope with stress, anxiety, tension, and occasional sleep difficulties. But first, we need to discuss some background about stress, anxiety, and the side effects associated with antidepression and anti-anxiety medications.

What is stress?

Stress is a psychological and physical response to the demands of daily life that exceed a person's ability to cope successfully. Stress is often characterized by fatigue, sleep disorders, irritability, and constant worrying. Depression often accompanies stress. The accumulated effects of stress may lead to more serious medical problems. Stress may be work related or may stem from personal problems, such as divorce, family conflicts, or financial concerns. Often stress results from a combination of events.3

Why is stress bad for me? What does it do to my body?

Too much stress can actually damage your health. There is ample evidence that living a highly stressful lifestyle damages the heart, raises blood pressure, and can contribute to digestive problems. Not surprisingly, stress can also be damaging to the brain, even leading to premature brain cell aging.4-6

Most people are familiar with the body’s dramatic response to an emergency. The heart pounds, the muscles contract, and the lungs expand; and while this is happening, we are capable of greater than normal strength and speed. This response is the body's way of rescuing itself when faced with an emergency. We don't have to think about it to make it happen. It's automatic.

The same can be said of a chronic stress response. Whether we're stuck in traffic, about to give a speech in front of a group, or sitting in the waiting room at a doctor's office, the human stress response happens automatically. The difference between the two is that the body’s response in an emergency starts and resolves itself quickly. The response to being stuck in traffic may not.

In an emergency situation, the adrenal glands, located above the kidneys, secrete the hormone, cortisol, until the emergency passes. Then the body returns to its normal function.

However, chronic stress is more complex and can last longer. When our body is subjected to high levels of cortisol for an extended time, our health can be damaged. Studies have shown that increased cortisol production caused by long-term, chronic stress may damage the entire nervous system and suppress the immune system. 4-6

The good news is that alterations in the central nervous system and the immune system can return to normal when stress is removed. The key is to learn how to deal with daily stress to allow the body to return to its normal state. 4-6

Why do I have difficulty sleeping when I feel stressed out?

Most commonly, sleeplessness is the result of stress in our lives. In fact, sleep disturbances are one of the most serious symptoms of stress and can be difficult to control. We live in a fast-paced world. Sometimes the responsibilities in our lives cause so much stress that we are unable to relax enough to fall asleep or stay asleep.7,8

Serious medical conditions can also disrupt sleep. Sleep disturbances are often associated with depression. In fact, 90% of people with depression and anxiety also experience sleeping difficulties.7,8

What are some conventional treatments for anxiety and stress?

Antidepressants and anti-anxiety medications are frequently used in combination with behavioral therapy to ease anxiety and stress. Antidepressants are among the most widely prescribed medications in the United States. 9-12

The two major classes of antidepressants are selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants (TCAs). These medications work by inhibiting the re-uptake of neurotransmitters, such as serotonin, resulting in the accumulation of these neurotransmitters. Brain chemicals such as serotonin are thought to be low in conditions such as anxiety and depression. Preventing their reuptake by the nerve cells essentially increases the amount of available chemical. 9-12

Anti-anxiety medications include the benzodiazepines, which include the drug, alprazolam (Xanax®). Benzodiazepines can relieve symptoms within a short time. These medications belong to the group of medicines called central nervous system (CNS) depressants (medicines that slow down the nervous system).13,14

What are some of the common side effects of antidepressants and anti-anxiety medications?

Antidepressant medication, such as the SSRIs and the TCAs, can help regulate the brain’s neurotransmitters to help relieve the symptoms of depression and stress. However, these medications can cause a number of side effects, such as nausea, sedation, weight gain and sexual side effects (decreased libido, delayed orgasm, or erectile dysfuction). 9-12

The side effects of anti-anxiety medication, such as benzodiazepines, include drowsiness, loss of coordination, fatigue, and mental confusion. These effects make it dangerous for people taking benzodiazepines to drive or operate some machinery. In addition, many anti-anxiety medications may be habit-forming, causing mental or physical dependence, especially when taken for a long time or in high doses. Benzodiazepines can cause seizures, if abruptly discontinued.13,14

Are there any natural alternatives to antidepressants and anti-anxiety medications that could help promote relaxation?

Since ancient times, it has been said that drinking green tea brings relaxation. The substance that is responsible for this sense of relaxation is L-theanine.15

L-theanine has shown the ability to promote deep muscle relaxation and improve good quality sleep. Even though L-theanine is found in green tea, it does not contain caffeine. L-theanine is simply one of the amino acids in green tea.15,16 L-theanine supplements are a natural alternative to promote relaxation. Since it does not cause sedation, it can be taken during the day to alleviate stress and anxiety.15,16

How does L-theanine work to help you relax during stressful times?

Although L-theanine’s mechanism of action has not been fully elucidated, current research has focused on L-theanine’s effect on brain transmitters and brain waves. Scientists believe that L-theanine supports the balance of various neurotransmitters in the brain.16 In a laboratory study, researchers found that L-theanine is able to cross the blood-brain barrier to support the activity of certain neurotransmitters in the brain.15,16

In a recent study, the brain activity of 50 volunteers was measured after the oral administration of 50-200 mg of L-theanine. L-theanine promoted the generation of alpha-brain waves, considered to be an index of relaxation, in the volunteers. This study concluded that one way in which L-theanine promotes relaxation in humans is by increasing alpha brain waves.15

Does L-theanine have any other benefits for our bodies besides promoting relaxation?

Yes, L-theanine has been shown to help the regulation of blood pressure. The same neurotransmitters that help us relax also regulate blood pressure in our bodies. When L-theanine is absorbed in our bodies, it results in slightly lowered blood pressure.15

Laboratory studies have demonstrated that L-theanine affects both the nervous system and the cardiovascular system. Thus, L-theanine’s calming effect on our mental state is augmented by lowering blood pressure as well.15 However, the blood pressure was never lowered to abnormally low levels.

Conclusion

In today’s fast-paced world, we need to manage stress in our lives. Stress management is a matter of mental and physical survival—stress cripples lives, causes illness, and even kills.

Of course, there are other things you can do to reduce anxiety and stress as well. Setting priorities, concentrating on activities that give joy, taking care of our health and relationships, and simplifying our lives are other ways to improve emotional well-being.

L-theanine as a natural support in your busy life is an important tool to overcoming stress and anxiety. It can be used daily or just when you need a little extra help to relax. By being able to relax, leaving your stress and anxiety behind, you will be able to face each day’s challenges with renewed vigor and confidence!

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References

1. Stress and Anxiety. American
Psychological Association Website. Available at: http://okpsych.org/doc uments/DisasterEffects.doc. Accessed on August 5, 2002.

2. Generalized Anxiety Disorder. National Women’s Health Information Center. The Office on Women’s Health- US Department of Health and Human Services Website. Available at: http://www.4woman.gov
/faq/gad.htm. Accessed on August 14, 2002.

3. Porth C. Concepts of Altered Health. In: Pathophysiology: Concepts of Altered Health States. 5th ed. New York, NY: Lippincott; 1998: 1327-28.

4. Sapolsky R. Stress, Glucocorticoids, and Damage to the Nervous System: The Current State of Confusion. Stress. 1996 ;1:1-19.

5. McIntosh L, Sapolsky R. Glucocortoids may enhance oxygen mediated neurotoxicity. Neurotoxicity. 1996; 17:873-82.

6. Lombroso P, Sapolsky R. Development of the cerebral cortex: Stress and brain development. J Am Acad Child Adolesc Psychiatry. 1998;37:1337-9.

7. Sleep and Depression. National Sleep Foundation Website. Available at: http://sleepfoundation.org/ask/ sleepanddepression.html. Accessed on July 30, 2002.

8. Depression and Insomnia. Self-Help Insomnia Website. Available at: www.sleepbetter.com.au/ sb_depres.htm. Accessed on July 30, 2002.

9. Selective Serotonin Reuptake Inhibitors. American Medical Association Website. Available at: http://archfami.ama–assn.org/ issues/v8n3/ffull
/fqa0599-2.html. Accessed on August 5, 2002.

10. Selective Serotonin Reuptake Inhibitors. Virtual Hospital—Unversity Iowa Healthcare Website. Available at: http://www.vh.org/ Providers/Conferences/
CPS/13.html. Accessed on August 5, 2002.

11. Tricyclic Antidepressants. Medline Plus Medical Encyclopedia Website. Available at: http://www.nlm.nih.gov/ medlineplus/druginfo/ antidepressants
tricyclicsystem202055.html.
Accessed on August 5, 2002.

12. MAO Inhibitor. Medline Plus Medical Encyclopedia Website. Available at:
http://www.nlm.nih.gov
/medlineplus/
druginfo/uspdi/202052.html. Accessed
on August 5, 2002.

13. Anxiety Disorders. Anxiety Disorder Association of America Website. Available at: http://adaa.org/
Public/index.cfm.
Accessed on August 14, 2002.

14. Benzodiazepines. MEDLINEplus Drug Information Website. Available at: http://nlm.nih.gov/medlineplus/ druginfo/benzodiazepinessystemic 202084.html. Accessed on August 14, 2002.

15. Juneja L, Chu D, Okubo T, Nagato Yokogoshi H. L-theanine: a unique amino acid of green tea and its relaxation effect in humans. Trends in Food Science & Technology. 1999; 10: 199-204.

16. Yofogoshi H, Kobayashi M, Mochizuki M, Terahima T. Effect on theanine, r-glutamylethylamide, on brain monoamines and striatal dopamine release in conscious rats. Neurochemical Research. 1998;23: 667-73.

17. L-Theanine: A Safe and Effective Dietary Ingredient. NutriScience Innovations, LLC. Vender Literature. Updated November 1, 2000.

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Lifestyle tips for managing stress and anxiety attack symptoms

Does L-theanine have the same type of side effects as prescription antidepressants and anti-anxiety medications?

L-theanine has been extensively consumed in tea without any side effects.17 Using an L-theanine supplement is a safe alternative because it will relieve anxiety and promote relaxation without causing the daytime sedation and grogginess that is associated with prescription medications on the market today.17

However, individuals with chronically high stress levels and poor sleep patterns may feel slightly sleepy when first using an L-theanine supplement. This effect occurs, not because the L-theanine makes them sleepy, but because they are finally relaxed and able to listen to their bodies’ demands for rest. After catching up on a few nights’ sleep, they should be able to use L-theanine without feeling sleepy.

Where can I find a reliable source for L-Theanine?

L-Theanine promotes mental and physical relaxation without inducing drowsiness. L-Theanine is an amino acid found in green tea that produces relaxing effects in the brain.

VitaCost L-Theanine 100 mg 60 Caps

VitaminShoppe L-Theanine 200 mg 60 Caps

Shopping with us is safe. Guaranteed

Relaxation Resources

Learn to relax, ease tension and handle stress. www.relaxationexpert.co.uk

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How to keep chronic stress from undermining your health

By Karen Pallarito - HealthDay Reporter

Whether you're caring for a loved one who's ill, coping with the loss of a job, or recovering from an abusive relationship, it's a good bet that you're experiencing some level of stress.

Even crawling through bumper-to-bumper traffic each morning is enough to cause some people to lose their cool.

Being exposed to these stressful situations day-after-day, year-after-year can be mentally and emotionally draining -- sometimes to the point of breakdown. And the physical toll is huge. Stress can put you at risk for high blood pressure and heart disease, trigger headaches and asthma attacks, and exacerbate other medical conditions.

Some psychologists say stressed-out Americans are an increasingly common breed.

With the war in Iraq, the threat of terrorism, uncertain economic times, broken marriages and wayward children to worry about, "I'd say that we have a whole series of events coming together now that are more profound than any other time in history," said Don R. Powell, a licensed psychologist and president of the American Institute for Preventive Medicine, which provides stress management training to corporate employees.

Learning to cope with stress becomes all that more important, he asserted.

Now might be the time to do something about it. February is Wise Health Consumer Month, a time when Americans will be urged to empower themselves to make better health decisions. That includes learning new ways to manage stress.

"Stress is the body's non-specific response to any increased demand that's placed upon it," Powell said. Even positive changes -- getting married, changing careers -- can be stress-provoking. "You can be under a lot of stress from winning the lottery, just as you could be from losing your job," he said.

Studies show a little bit of stress actually can be a good thing. Short-term stress, the type that produces a fight-or-flight response, boosts the immune system, preparing it for possible infection or injury, according to a major review of stress-and-immunity studies in the July 2004 issue of Psychological Bulletin, published by the American Psychological Association (APA).

But when stress becomes chronic or prolonged, it can wear you down.

"In general, we think that anything that lasts longer than a fight or a flight -- a few minutes to maybe a few hours -- marks the transition from a beneficial to a harmful stress response," said Suzanne C. Segerstrom, an associate professor of psychology at the University of Kentucky in Lexington and a co-author of the review.

Older people and those who already have compromised immune systems seem to be particularly vulnerable, the analysis revealed.

What's not known is whether the relationship between stress and disease is due to changes in the immune system. It seems plausible for some conditions, such as viral cancers and heart disease, Segerstrom allowed, "but it hasn't been tested."

Just how stressed-out are we? According to the APAs online Help Center:

• Forty-three percent of all adults suffer adverse health effects from stress.
• Seventy-five percent to 90 percent of all physician office visits are for stress-related ailments and complaints.
• Stress is linked to the six leading causes of death -- heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide.

There's even evidence linking stress with premature aging. Researchers at the University of California, San Francisco found that prolonged psychological stress affects molecules that are believed to play a role in cellular aging and, possibly, the onset of disease. In the study, the immune cells of women who care for chronically ill children aged faster than those of women with healthy kids.

So what can people do to lessen the effects of stress on the body? Powell teaches a technique to help victims of stress revamp how they think about things. A traffic snarl needn't set your teeth clenching. Just turn on some soothing music.

"Perception is everything," Powell said.

For the person who's weary of running late or missing deadlines, a course in time management may be just the ticket.

Traditional relaxation techniques, including meditation, deep muscle relaxation and hypnosis, also can help a person de-stress. So can a good night's sleep -- a minimum of seven hours each night. And don't forget proper nutrition and exercise: these things can keep you healthy and better able to cope with stress.

More Stress information

The American Psychological Association has more on how stress affects us.

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Does your immune system need a boost? This test by Dr. Linda Page is quick and easy.

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