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Anxiety Disorder: When is it too much?

Anxiety Disorder: When Is It Too Much?

What is anxiety? Clinicians may define it somewhat differently than most people usually do. “I am anxious to get better” means that someone is eagerly expecting a good thing to happen. In a clinical sense, “I am anxious” means something else: being worried, nervous, or apprehensive. Healthy dose of anxiety is useful. We are hard-wired to be apprehensive and alert in the face of adversities. Without it, our ancestors would not survive in their harsh environment. When you run into a saber-toothed tiger, you better be scared and prepare to fight or flee – or else, you will be eaten. So, only those of our ancestors that had this mechanism in place, survived and gave offspring. Those that did not, died out early enough to be childless. Therefore, we all are blessed (or sometimes cursed) having this fear and anxiety machinery pre-installed.

Now, what happens when there is no saber-toothed tiger around and we still get nervous, fearful and anxious? That can be a problem. Distinguishing normal negative expectations and concerns from clinically significant nervousness and anxiety can be difficult. The issue is not black and white. Is it normal to be concerned about starting a new job, thinking about how you will fit it, whether you will succeed? Is it normal to be upset if your husband is in the hospital? Is it natural to commiserate with your daughter who is going through divorce? Of course it is. The problem then is not being concerned and upset. The problem is the degree to which it affects a person, and whether it is accompanied by other problems.

Abnormal (clinical) anxiety would present with worries that are hard to control. They are all-consuming. Then do not allow focusing on anything else. They are present day and night, occupy one’s mind to the point that it is hard to function and concentrate, make it hard to sleep. Worries and nervousness would often lead to the feelings of tension, not being able to relax, irritability, snappiness, feeling exhausted and tired. Frequently this would be accompanied by muscular tension, headaches, stomach discomfort, breathing difficulties. Sometimes anxiety may reach the point of panic attacks that would present with intense fear, shortness of breath, tightness in the chest, dizziness, numbness or tingling. Panic attacks may lead a person to be afraid to go out and to stick to a safe place like home (agoraphobia). Specific phobia is another example of anxiety disorders (fear of heights, planes, closed spaces). Anxiety may present as a fear of social situations. In mild cases, it may be restricted to discomfort when speaking if front of others. In more severe cases, someone may be feeling tense and nervous whenever encountering strangers, feeling under the scrutiny of others, being self-conscious to the point of sweating, blushing, and trembling. (This is not the same as paranoia when people are convinced that they are being watched and followed.)

How do to treat anxiety? The first step is to recognize that this is a problem. Sometimes, many years of chronic worries still do not allow a person to understand that this is not just a character flaw but a treatable condition. In my practice, I have heard it many times that only after someone started treatment, they would look back at years of emotional distress realizing how bad it was, often regretting that they have not started treatment way earlier.

Anxiety can be treated with medications, psychotherapy, alternative modalities such as herbs, meditation, relaxation techniques. In my practice, I would use medications like SSRI’s or SNRI’s (selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors respectively), such as Zoloft, Paxil, Effexor, Cymbalta, buspirone (Buspar), mirtazapine (Remeron), nefazodone (Serzone), other classes of medications. Tranquilizers like Xanax or Ativan or Klonopin have their place in treating acute severe anxiety on a temporary basis; in my opinion, their long-term use should be generally avoided. I would often recommend my patients self-help books on anxiety management, relaxation tapes, herbal remedies such as Valerian root. Psychotherapy can be an excellent tool for treating anxiety and panic. In the process of therapy a person can gain a better insight into what triggers negative emotions, identify dysfunctional thoughts that produce anxious feelings and correct them, learn how to handle stress that triggers anxiety, and channel it differently. Oftentimes, the combination of biological treatments and psychological interventions leads to the best results, just like in many other (if not most) psychiatric conditions. Physical exercises are excellent means of reducing stress in general and helping anxiety specifically. After all, we are hard-wired to act on our fears, not to brood on them.