From the Guidelines
The sensation of sinking, also known as a feeling of impending doom or anxiety, can be caused by anxiety disorders, as suggested by the most recent and highest quality study 1.
Possible Causes
- Anxiety disorders, such as generalized anxiety disorder (GAD) 1
- Panic attacks
- Low blood pressure
- Medication side effects
- Vestibular disorders affecting the inner ear balance system ### Importance of Screening
- Screening for anxiety is crucial, as it can help identify individuals with anxiety disorders, including GAD, which is the most prevalent anxiety disorder 1
- The GAD-7 scale is a recommended tool for screening for GAD 1 ### Management
- Cognitive behavioral therapy (CBT) and other forms of psychotherapy are initial treatments for most patients with anxiety disorders 2
- Medications, such as selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs), may be used as secondary treatments 2 ### Key Points
- Anxiety disorders can present with excessive worry or fear that is disproportionate to the actual risk 1
- A thorough history, physical examination, and diagnostic assessment are necessary to diagnose anxiety disorders and rule out other causes of symptoms 1
- Referral to a psychiatrist, psychologist, or equivalently trained professional may be necessary for further evaluation and treatment 1
From the Research
Causes of Anxiety
The sensation of sinking, also known as a feeling of impending doom or anxiety, can be caused by various factors, including:
- Disturbances in serotonergic neurotransmission, which is widely accepted as a contributing factor to anxiety disorders 3
- Noradrenergic neurotransmission disturbances, which may also contribute to the symptoms of anxiety, as noradrenaline modulates the activity of brain regions associated with anxiety, such as the amygdala 3
- Autonomic dysfunction, inflammation, endothelial dysfunction, and changes in platelet aggregation, which may help explain the relationships between anxiety disorders and cardiovascular disease 4
- Threatening or stressful situations, which can trigger a normal response of fear, but can also lead to anxiety disorders if the feeling persists or is overwhelming 5
Neurotransmitters Involved
The following neurotransmitters are involved in the pathophysiology of anxiety disorders:
- Serotonin, which has been shown to have decreased function in anxiety disorders, as well as in depression 3
- Noradrenaline, which plays a critical role in the control of anxiety, and disturbances in its neurotransmission may contribute to the symptoms of anxiety 3, 6
- Gabaergic systems, which also play a critical role in the pathophysiology of anxiety disorders, as abnormalities in these systems are related to structural and functional alterations in specific brain areas 6
Brain Regions Involved
The following brain regions are associated with anxiety disorders:
- Amygdala, which is modulated by noradrenaline and is involved in the processing of emotional information 3, 6
- Prefrontal cortex, locus coeruleus, and hippocampus, which are also involved in the pathophysiology of anxiety disorders, as abnormalities in these regions are related to structural and functional alterations 6