Anne Hubbard has not lost her job, house or savings, and she and her husband have always been conservative with money.
But a few months ago, Ms. Hubbard, a graphic designer in Cambridge, Mass., began having panic attacks over the economy, struggling to breathe and seeing vivid visions of "losing everything," she said.
She "could not stop reading every single economic report," was so "sick to my stomach I lost 12 pounds" and "was unable to function," said Ms. Hubbard, 52, who began, for the first time, taking psychiatric medication and getting therapy.
In Miami, Victoria Villalba, 44, routinely slept eight hours a night until stories of desperate clients flooding the employment service she runs began jolting her awake at 2 a.m. No longer sleepy, she first began to respond to e-mail, but that caused sleeping colleagues' BlackBerrys to wake them, so now she studies business books and meticulously organizes her closets.
"I'm embarrassed," she said. "Normal people aren't doing this."
With economic damage expected to last months or years, such reactions are becoming common, experts say. Anxiety, depression and stress are troubling people everywhere, many not suffering significant economic losses, but worrying they will or simply reacting to pervasive uncertainty.
Some are seeking counseling or medication for the first time. Others are resuming or increasing treatment, or redirecting therapy for other issues onto economic anxiety.
"The economy and fear of what's going to happen is having a huge effect," said Sarah Bullard Steck, a Washington therapist who also directs the employee assistance program at the Commerce Department. "People are coming in more" with "severe anxiety" or "more marital strife, some domestic violence, some substance abuse."
Alan A. Axelson, a Pittsburgh psychiatrist, said he was seeing first-time patients and infrequent ones experiencing "relapse and needing more therapy and medication" even though, he said, "Pittsburgh's actually doing pretty good economically."
It is early to measure the recession's consequences, but surveys suggest a growing impact. In an American Psychological Association poll in September, 80 percent reported the economy's causing significant stress, up from 66 percent last April. The National Sleep Foundation said 27 percent of people surveyed last fall had sleeplessness because of economic anxiety.
National Suicide Prevention Lifeline calls jumped to 50,158 in January 2009 from 39,465 a month in January 2008, and economic stress more frequently "played a central role," said Richard McKeon, the group's federal project officer.
The Treasury, Labor and other departments started a Web site for people experiencing stress. The Substance Abuse and Mental Health Services Administration is training counselors who usually assist people devastated by tornadoes and floods to now help people with what they "are going through with the economy," said Dr. McKeon, an agency adviser.
And while a New York Times/CBS News poll found fewer people saying the economy had worsened, most did not think it was improving. People overwhelmingly thought the recession would last another year or more, and 70 percent were concerned that a household member would be jobless.
Anxiety is not just troubling those with much to lose, like older people and homeowners. Elizabeth Dewey-Vogt, 25, a paralegal whose bills and shrinking overtime made her move in with her parents in Alexandria, Va., said she began "constantly worrying about finances," and having panic attacks, "rapid heart beat, choking sensation, chills or sweating, numbness and tingling in my fingers," and feeling "almost removed from my body."
Ms. Dewey-Vogt said that she now took anxiety medication, and that a therapist advised her to pull over or "concentrate on the license plate ahead" if she began panicking while driving and to grip on the handles of her chair when panicking at work.
Even children show signs.
Daniel A. Cohen, a Manhattan psychiatrist, said he saw "more families in crisis," with children experiencing "increased signs of anxiety and depression" and more nightmares and acting out.
Joshua Batista, 16, of Queens, who was treated for depression and post-traumatic stress after a taxi accident, said he had "gotten more depressed and stressed" since "the recession and that stuff started." In school, he said he experienced "a nervous breakdown where I was pulling out my hair, hitting my head." Joshua, a singer-guitarist, said the economy limited his music purchases and earnings. Therapy and medication have increased. Asked to leave school, he will be taught at home. "He noticed it was happening at the same time as the economy," said his mother, Elissa Levine.
Even for insured people, the economy both causes anxiety and makes help less affordable.
Susan Bandrowsky, 30, a photographer in Wilmington, Del., with bipolar disorder, said she felt strain because her husband, having lost a long-term consulting contract, worked short-term jobs requiring travel, unsettling their 4-year-old autistic son. Fearing the loss of insurance, Ms. Bandrowsky would like more therapy, but to save co-payments she spaces appointments, which, she said, "ups the anxiety."
Many seeking help are fearful, not actually incurring economic difficulty, said Joseph Ojile, founder of Clayton Sleep Institute in St. Louis, where patients increased 25 percent since October.
Steven Craig, a psychologist in Birmingham, Mich., said "people of less means" were handling some of this better because "their identity is not as caught up in how much money they have."
Many ask primary physicians for medication, not therapy referrals, because they fear that employers will consider them unstable or resent counseling during work hours, said Allen J. Dietrich, a family doctor in Lebanon, N.H. He said he broached the subject of emotional stress gently because many had come in with physical complaints like arthritis or headaches.
Still, a survey of employee assistance programs found a jump in stress-related requests. "The stress level has increased a lot," said Suzanne Greenlee, human resources benefits director at Sodexo Inc., a food services company.
Even for Ms. Greenlee, who said she "realized how tense I was" after trying Sodexo's stress-management coach. She e-mailed the coach, "Today I'm feeling totally overwhelmed."
During therapy recently, Marcy Krust, 39, told Dr. Craig, "People say it's going to be better, but I don't feel that way yet." A divorced mother and on-and-off patient, Ms. Krust said she had not needed therapy for months until, with layoffs affecting her technology firm's clients and fellow hockey moms, she felt "out of control" and "started to forget things." Now twice-monthly sessions focus on the economy. Dr. Craig advises writing down worries, and making decisions about controllable things, like vacations.
Scott Schuck, 43, a Minneapolis business owner who had consulted Dr. Craig only for career coaching, began twice-weekly phone sessions after stress started waking him and creating "a lot of anxiety" in his relationship with his girlfriend.
Ms. Villalba, wary of medication, started meditation classes, even meditating in her car outside her office.
Ms. Hubbard, knowing "financially we were fine," said she believed "I shouldn't feel like this, I'm lucky." She cried visiting her primary doctor, who recommended therapy and medication, hard to accept, she said, because her Depression-era parents believed "you pull yourself up."
"I felt like a neurotic middle-class, middle-aged woman too weak to deal with life on my own," she said. "I should be stronger, it was simply money, and why do I have to take pills to not worry about money."
But treatment and further organizing family finances helped. She said the weakening economy made her "fear that even if you do everything right, something bad can happen to you."