GINNY SUGIMOTO | Chronic anxiety is a treatable disease
A few months ago, I walked into my exam room and found my new patient, a woman in her mid-30s, pacing around the room. As I examined her, I noticed she looked unusually tired, and her hands were shaky. While her vital signs such as heart rate and blood pressure were within normal ranges, she told me that she wasn’t sleeping well.
As we talked about her health, I learned that she was worrying a lot about everything in her life, though there were no specific recent problems with her marriage, children or job. She described, and exhibited, a jumpy nervous energy and inability to relax that was becoming debilitating. After I gathered more of her history to rule out an alcohol, drug or physical problem, I felt fairly confident that she had a significant anxiety disorder that needed treatment. I was glad she had made the appointment to get help.
Everyone has anxiety or feels nervous at least once in awhile. It’s a normal response to anything from an upcoming test to concern for a loved one. This kind of anxiety can usually be improved with distraction, such as exercise, books, movies or sometimes just a conversation with a good friend. It eases with time, when the source of the anxiety goes away.
Anxiety that is severe enough to cause physical symptoms, like shaking or fainting, or ongoing anxiety that interrupts your life — like my patient’s — may be a bigger issue and should be discussed with a doctor.
There are many different anxiety disorders and their onset can be gradual or sudden. Women are twice as likely as men to have anxiety disorders, but men can suffer from them, too. All of them can be improved, and many cured completely. Without treatment, however, anxiety disorders are unlikely to get better and can negatively impact your life and the lives of those around you. They can make it hard to think, communicate, sleep, eat and sometimes even sit still.
The two disorders I see most frequently are generalized anxiety disorder (GAD) and panic disorder. Some people have both conditions. People with GAD are anxious even when there’s no obvious reason to feel that way, and they are often unable to go about their daily lives. They can be tired and have other physical symptoms such as non-specific pain, fatigue, lightheadedness and shakiness. People with panic disorder will have short-term, intense episodes of panic and fearful anxiety, such as chest pain with shortness of breath and lightheadedness that may last 10-30 minutes.
Other anxiety disorders include obsessive-compulsive disorder, social anxiety and specific phobias.
To determine if you have an anxiety disorder, your doctor will ask questions and likely offer you a standard questionnaire that asks about your anxious feelings, overall mood and physical symptoms.
Most anxiety disorders are under-diagnosed and undertreated. Many patients think their disorder is just a part of their personality they need to live with, so they don’t mention their symptoms. I think they also wait because they don’t know that there are effective treatments. They will often self-medicate with alcohol or another addictive drug to try to calm jitters and nerves.
For many years, doctors lacked effective medications and a clear understanding of how to treat the problem. But in recent decades we have learned that the disorders can be reduced or eliminated with non-addictive medications and counseling. For instance, people with panic attacks can learn techniques to calm their mind, help them recognize they are not in danger and prevent attacks, or come out of the attack. Treatment for ongoing anxiety disorders can include a daily medication, individual or group therapy at a weekly counseling session or both.
Anxiety and depression sometimes go hand-in-hand. Significant anxiety disorders are mostly treated with medications that help with anxiety and depression. Another class of drugs, called benzodiazepines —f or example Valium and Ativan — can be very effective for short-term treatment of acute anxiety. They are addictive so should not be used long-term.
Anxiety can be associated with specific life events but often the cause of the anxiety disorder is unknown. Sometimes it’s multifactorial, which means it’s both part of a person’s make-up and influenced by lifestyle and environment. Researchers are trying to find out more about what causes anxiety disorders. A healthy lifestyle, including regular exercise, limiting caffeine and alcohol, getting adequate sleep and a healthy diet can help all of us to cope with stress and lessen anxiety, and it’s especially true for people with anxiety disorders.
When I gave my new patient the GAD screening test, I learned that she was indeed suffering from generalized anxiety disorder, and that she was finding it hard to cope with her life because of it. Together we determined that a low dose of medication, coupled with some counseling, would be the best course of action to help her recover her health. Months later, she has been getting good sleep and feeling more settled and happy, and is coping more easily with the smaller anxious moments of regular life. If you think you might be suffering an anxiety disorder, please make an appointment with your doctor. There is help available for these conditions.
National Institute of Mental Health: www.nimh.nih.gov
Questionnaire for Generalized Anxiety Disorder: http://www.adaa.org/screening-generalized-anxiety-disorder-gad
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