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New Technique to Diagnose Anxiety Risk

doctor drawing blood from a female patient

The World Health Organization (WHO) indicates that anxiety is the most common mental health diagnosis in the world, and risk of developing anxiety had increased since the onset of the COVID-19 pandemic.

Over 300 million people report experiencing the symptoms of anxiety at least once during their lives, followed by roughly 280 million people who report experiencing the symptoms of depression at least once during their lives. In this context, we mean anxiety or depression that reaches a clinical threshold, as opposed to the typical worry or sadness everyone experiences during the course of their lives.

In addition, the COVID-19 pandemic increased rates of anxiety around the world. The WHO reports that between 2020 and 2022, rates of anxiety worldwide increased by 25 percent, with the largest increases seen in women and young adults.

That’s why a study published earlier this year caught our eye. The paper “Towards Precision Medicine for Anxiety Disorders: Objective Assessment, Risk Prediction, Pharmacogenomics, And Repurposed Drugs” presents a new, innovative way to screen for the risk of an anxiety condition that meets clinical criteria: a blood test.

But that’s not all.

Researchers believe clinicians – from primary care providers to mental health specialists – will be able to use this new blood test not only to assess risk of anxiety, but predict which anxiety medications or complementary treatments may be most effective for each individual.

You read that correctly: researchers assert they may have found a blood test that can screen for both anxiety risk and determine the best possible medication for the person being screened. If providers can implement this screening protocol on a large scale, it may create a significant change in the way we understand and approach anxiety diagnosis and treatment.

Based on the widespread prevalence of anxiety around the world – and the recent increases – we may need that change sooner rather than later.

About This Research: Diagnosing and Treating Anxiety

Interviewed in the online journal Science Daily, study author Dr. Alexander Niculescu describes this research effort:

“Many people suffer from anxiety, which can be very disabling and interfere with daily life. The current approach is to talk to people about how they feel to see if they could be on medications, but some medications can be addictive and create more problems. We wanted to see if our approach to identify blood biomarkers could help us match people to existing medications that will work better and could be a non-addictive choice.”

In his previous work, Dr. Niculescu developed blood tests for the following:

  • Depression
  • Bipolar disorder
  • Post-traumatic stress disorder
  • Chronic pain

These tests help clinicians arrive at an accurate diagnosis and help them formulate a treatment plan that’s tailored to individual factors identified by a blood screen. This is an important area of study for people with anxiety, because when anxiety goes untreated, the consequences can cause serious problems, including:

  • Low/decreasing self-esteem
  • Impaired work and school performance/achievement
  • Disrupted personal relationships
  • Increased frequency of chronic physical conditions
  • Alcohol or substance use
  • Increased risk of comorbid mental health conditions
  • Suicidal ideation/suicidal behavior/suicide attempts

That’s why it’s important to improve our diagnostic capabilities. If we can identify anxiety risk early, we can work proactively to prevent the escalation of untreated anxiety symptoms, and possibly prevent the onset of an anxiety diagnosis altogether.

What is Anxiety?

Here’s basic information everyone should know about anxiety. These facts are published by the helpful non-profit mental health advocacy organization the Anxiety and Depression Association of America (AADA):

  • Although anxiety can improve with therapy and medication, just over a third of people diagnosed with anxiety receive appropriate, effective, evidence-based treatment for anxiety
  • People diagnosed with anxiety are 4 times as likely to visit the doctor for mental health problems as people without an anxiety diagnosis
  • People diagnosed with anxiety are 6 times more likely to be admitted to a hospital for a psychiatric disorder than people without an anxiety diagnosis
  • Evidence shows that genetics, brain chemistry, personality factors, and life experiences all contribute to the development of anxiety and anxiety disorders

 Here’s how the Mayo Clinic discusses the phenomenon of clinical anxiety:

  1. It’s important to understand everyone experiences anxiety
  2. People with a clinical anxiety diagnosis worry about everyday situations much more intensively, excessively, and persistently than people without a clinical anxiety diagnosis
  3. Anxiety conditions often involve episodes of sudden, overwhelming fear, panic, or terror, which peak and fade within minutes, a.k.a. panic attacks
  4. Panic or worry may persist, and is often out of proportion, compared to the trigger
  5. Symptoms may partially or completely prevent an individual from participating in the basic activities of daily life

Anxiety diagnoses manifest in several ways, with the specific symptoms – and therefore diagnostic criteria – can vary for each diagnosis. However, the common thread among all anxiety disorders is this:

“A persistent, excessive fear or worry in situations that are not objectively or inherently dangerous.”

Next, let’s look at the prevalence of anxiety, by type, as published by the National Institute of Mental Health (NIMH).

Anxiety Among Adults 18+: Prevalence by Anxiety Type

  • Any anxiety diagnosis during lifetime: 32.9%
  • Among people with any anxiety diagnosis:
    • Severe impairment: 22.8%
    • Moderate impairment: 33.7%
    • Mild impairment: 43.5%
  • Generalized anxiety disorder (GAD) during lifetime: 5.7%
  • Among people with GAD diagnosis:
    • Past year diagnosis: 2.7%
    • Severe impairment: 32.3%
    • Moderate impairment: 44.6%
    • Mild impairment: 23.1%
  • Panic disorder (PD) diagnosis during lifetime: 4.9%
  • Among people with PD diagnosis:
    • Past year diagnosis: 2.7%
    • Severe impairment: 44.8&
    • Moderate impairment: 29.5%
    • Mild impairment: 25.7%
  • Social anxiety disorder (SAD) diagnosis during lifetime: 12.1%
  • Among people with SAD diagnosis:
    • Past year diagnosis: 7.1%
    • Severe impairment: 29.9%
    • Moderate impairment: 38.8%
    • Mild impairment: 31.3%
  • Obsessive-compulsive disorder (OCD) during lifetime: 2.5%
  • Among people with OCD diagnosis:
    • Past year diagnosis: 1.2%
    • Severe impairment: 50.6%
    • Moderate impairment: 34.8%
    • Mild impairment: 14.6%
  • Post-traumatic stress disorder (PTSD) during lifetime: 6.8%
  • Among people with PTSD diagnosis:
    • Past year diagnosis: 3.6%
    • Severe impairment: 36.6%
    • Moderate impairment: 33.1%
    • Mild impairment: 30.2%

That’s the prevalence data – and what it tells us is that millions of people in the country experience the symptoms of anxiety every day. People with mild or moderate anxiety may not experience significant disruption, but for people with severe anxiety, the presence and intensity of the symptoms can be completely debilitating.

Anxiety Risk: Signs and Symptoms to Know

Mental health experts identify symptoms for each of the anxiety diagnoses we list above. The following information on signs and symptoms is also available on web pages published by the National Institute of Mental Health (NIMH). We’ll review the symptoms of the most common types of anxiety, generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), beginning with GAD.

Anxiety Conditions: Symptoms By Anxiety Type

Generalized anxiety disorder (GAD)

  • Constant/persistent restlessness/agitation
  • Always feeling on edge
  • Persistent tiredness/fatigue
  • Difficultly with concentration
  • Persistent irritability
  • Unusual headaches, muscle aches, stomachaches
  • Constant worry
  • Sleep disturbance: too little or too much

Panic disorder (PD)

  • Racing pulse/elevated heartbeat
  • Unusual, excessive sweating or sweating with not apparent cause
  • Trembling in extremities
  • Tingling in hands
  • Chest pain
  • Feeling that something bad is about to happen, all the time
  • Feeling that emotions/fear is impossible/very hard to control

Social anxiety disorder (SAD)

  • Unusual sweating, trembling, blushing
  • Racing pulse/elevated heartbeat
  • Stomachaches/nausea
  • Physical rigidity/tension
  • Talking more softly or slowly than usual
  • Problems making eye contact during conversations, or at all
  • Problems spending time around strangers/initiating social contact
  • Extreme self-consciousness
  • Fear of being judged negatively by others

Obsessive-compulsive disorder (OCD)

  • Obsessions:
    • Fear of germs, dirt, or unclean things/surfaces
    • Severe difficulty managing uncertainty
    • Extreme need for order and symmetry in common objects/things
    • Distressing thoughts about losing control, or experiencing harm
    • Intrusive or unwanted thoughts
  • Compulsions:
    • Handwashing to the point of causing damage
    • Excessive checking of doors to ensure they’re locked
    • Excessive checking of appliances – like stoves – to ensure they’re off
    • Counting objects, thoughts, or behaviors
    • Continuous repetition of words or phrases
    • Persistent arranging/rearranging items to make them orderly

Post-traumatic stress disorder (PTSD)

  • Constant, reoccurring memories of trauma/initial traumatic event
  • Flashbacks: remembering trauma as if there/as if no time passed
  • Distressing dreams or nightmares
  • Extreme physical or emotional responses to trauma-related triggers
  • Recurring negative thoughts about self, people, and the world
  • Persistent sense hopelessness
  • Problems with memory or concentration
  • Difficult or rocky relationships
  • Difficulty forming relationships
  • Detachment from family
  • Lost interest in favorite activities
  • Feeling numb or emotionally distant
  • Getting startled easily
  • Sleep issues: too much or too little
  • Irritability
  • Unusual or uncharacteristic anger/aggression
  • Excess guilt or shame

That’s what anxiety looks like when a person has anxiety that goes beyond typical worry and meets the clinical criteria for a mental health diagnosis. As we mention above, the symptoms of clinical anxiety, and the experience of clinical anxiety, is far different than daily worries or concerns. The symptoms can completely prevent an individual from living a full and fulfilling life.

However, treatment for anxiety can be effective.

Anxiety: Evidence-Based, Effective Treatment

Evidence shows the most effective approach to symptom relief for anxiety diagnoses is a combination of psychotherapy, medication, community support, and complementary treatments. Here’s a review of the most effective available treatments for anxiety diagnoses.

Common Treatments for Anxiety

  • The three primary modes of psychotherapy for anxiety include:
    • Cognitive-Behavioral Therapy (CBT)
    • Dialectical Behavioral Therapy (DBT)
    • Exposure Response Prevention Therapy (ERPT)
  • Medications commonly used to treat anxiety include:
    • Anxiolytics
    • Anti-depressants
  • Community support for people with anxiety include:
    • Anxiety support groups (general)
    • OCD support groups
    • PTSD support groups
    • SAD support groups
  • Complementary treatments include:
    • Mindfulness-based stress reduction (MBSR)
    • Meditation
    • Yoga
    • Experiential therapies, such as exercise or outdoor/nature based activities
    • Expressive therapies, such as writing, music, or visual art

In addition, two new effective, evidence-based approaches to treating anxiety are becoming common for certain anxiety diagnoses:

  • Transcranial magnetic stimulation (TMS)
    • TMS is a non-invasive therapy that stimulates specific brain areas with magnetic pulses to relieve mental health symptoms
  • Psychedelic therapy with SPRAVATO® or IV ketamine infusions
    • Evidence shows psychedelic therapy can offer quick and long-lasting symptom relief from various mental health conditions

Those are the most common approaches to treating anxiety. We include TMS and psychedelic therapy because they’re new, and initial evidence and reports from clinicians indicate they may form part of a standard approach to anxiety treatment – as common as CBT or anxiolytic medication – in the years to come.

Here’s something important to understand: these approaches work, and can offer real symptom relief to people with anxiety. However, not every treatment works for everyone, and one type of anxiety medication – benzodiazepines – carries a risk of misuse, dependence, and disordered use.

A Biomarker Blood Test for Anxiety Risk: Results Indicate Clinical Potential

Let’s recap why researchers conducted this experiment. Dr. Niculescu elaborates on the reason a one-stop blood test might benefit people with anxiety, or people who may develop anxiety:

“This is something that could be a panel test as part of a patient’s regular wellness visits to evaluate their mental health over time and prevent any future distress. Prevention is better in the long run, so our goal is to be able to provide a comprehensive report for patients and their physicians using simply one tube of blood.”

Dr. Niculescu and his colleagues developed the test taking a 7-step approach:

1st Step:

Identified genes associated with low and high anxiety states, called biomarkers

2nd Step:

 Confirmed and condensed the relevant biomarkers for anxiety, integrating all previous available research on the genetics of anxiety

3rd Step:

Validated biomarkers in a group of people diagnosed with anxiety, and established a list of 95 potential biomarkers for a blood test for anxiety

4th Step:

Tested the candidate biomarkers for their predictive power for anxiety severity and predictive power for future clinical worsening

Fifth Step:

Analyzed biomarkers for correlation with other psychiatric diagnoses

Sixth Step:

Determined which biomarkers are already targets for existing medications

Seventh Step:

Determined which biomarkers are affected by various medications, natural compounds, or treatment approaches that may be adapted or repurposed to support/treat people with anxiety

Here’s something interesting about this study: researchers confirmed their primary hypothesis and all associated secondary hypotheses. If you’ve ever taken a lab science class, you know this only happens in rare circumstances in simple, introductory teaching experiments. If you’ve ever worked in research science in a lab in real-world conditions, you know this almost never happens.

In this case, it happened, and it’s an important step forward in mental health diagnostic practice. Here’s how the research team describes their finding:

“Current medication treatments for anxiety do not work well in everybody. Matching the right individuals to the right medications using their biomarker profile is a key actionable outcome of our work.”

How This Study Helps

One part of mental health treatment that can frustrate both patients and providers is the time it takes for psychotherapy and psychiatric medication to relieve symptoms. In some cases, it takes weeks. In other cases, it takes months. For some people, therapy and medication do not work at all, or show a very weak therapeutic effect.

That’s where the biomarker blood test for anxiety and anxiety risk can improve this process. If clinicians can use a simple blood test to identify anxiety risk, identify risk of anxiety worsening, an identify which medications might prevent the onset of anxiety, mitigate anxiety symptoms, and prevent escalation – i.e. worsening – then they can short-cut the trial-and-error component of mental health treatment, and begin with therapies that offer the best chance of quick, long-lasting symptom relief.

That would be a big step forward: we’ll watch for news on this potentially game-changing blood test, and report what we learn here immediately.

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