Anxiety

There are numerous types of anxiety: Generalized Anxiety, Panic Disorder, Social Anxiety Disorder, Obsessive-Compulsive Disorder (OCD), Claustrophobia and  dozens of other phobias. Conditions as common as stage-fright or fear of flying are types of anxiety. EVERYONE has some degree of anxiety about certain situations; this is normal. Anxiety becomes a medical condition when it gets out of control and takes over your life.


Impact

A medical diagnosis of anxiety – that is, a type of anxiety that’s bad enough to cause significant effect on a person’s ability to lead a normal life, is very common. At any given time, about 18% of the population is suffering from some type of anxiety, and over a lifetime, 30% of people will develop an anxiety. The severity can vary greatly, from a bad case of stage-fright (which, if you’re an entertainer, can impact your career) to an Obsessive-Compulsive Disorder or some type of phobia so severe that a person can’t leave their home, can’t go to work or can’t go shopping. Anxiety is less frequent a cause of suicide than Depression, but statistics show that suicide is about 3 times more common among those with an anxiety diagnosis than those without.


Causes

Everyone has some degree of anxiety. We think anxiety developed very early in the history of mammals (probably millions of years ago) as a means of keeping us safe in a dangerous world. When faced with a potentially harmful situation, our alertness increases, our pulse increases, we pay close attention to everything around us. In a world full of constant threats, this helped keep us alive. However, in the modern world, where such threats are much less common, sometimes this “fight or flight response” can be triggered by a situation that is NOT truly dangerous, yet for some reason, our subconscious has decided that it is, and reacts accordingly. Everyone who has anxiety knows that it does NOT make sense. The person who has fear of flying KNOWS that flying is far safer than driving a car, KNOWS that the reaction he/she gets is completely irrational, yet once the fear response kicks in, there is almost no way of controlling it; no way of “talking yourself down.”


Treatment

Managing anxiety can be difficult, but with perseverance and determination, it CAN be conquered. Various psychotherapy techniques can be used. For example, the person who has an irrational fear of snakes can force him- or herself to be exposed to snakes frequently, maybe even buying a pet snake, and eventually training the brain that there IS no threat. There are also medications for many types of anxiety. The SSRI’s (Selective Serotonin Re-uptake Inhibitors) are a very useful class of medications. They work by adjusting the amount of serotonin and other transmitters in the brain (epinephrine, norepinephrine, dopamine, etc.). Examples include Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), Lexapro (escitalopram) and many others. They affect mostly serotonin; serotonin gives a general sense of well-being and calmness. By increasing its level, many types of anxiety can be suppressed. The Benzodiazepines comprise another class of medications; examples include Xanax (alprazolam), Valium (diazepam), Ativan (lorazepam), Klonopin (clonazepam) and several others. This group is a double-edged sword, however – they typically work very quickly, and for certain conditions (especially Panic Disorder) they work very well, however they have two problems. One, with repeated frequent use of one of these medications, the body develops a tolerance, meaning the body adjusts to the medications, and fights back. The medication then loses its effect. Two, these medications have more significant side effects – they can cause confusion and drowsiness, they can be addictive and are frequently abused, and in high doses they can suppress the breathing and even cause death if not managed properly. A psychiatrist or psychiatric nurse practitioner is essential to weigh the pros and cons of the various medications and decide which one (or which combination) is best for you.