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Anxiety

 

Everyone feels anxious now and then—it’s a normal emotion. For example, you may feel nervous when faced with a problem at work, before taking a test, or before making an important decision. Anxiety disorders are different, though. They are a group of mental illnesses, and the distress they cause can keep you from carrying on with your life normally. For people who have one, worry and fear are constant and overwhelming, and can be disabling. But with treatment, many people can manage those feelings and get back to a fulfilling life.

Types of Disorders

Anxiety disorder is an umbrella term that includes different conditions:

  • Panic disorder. You feel terror that strikes at random. During a panic attack, you may also sweat, have chest pain, and feel palpitations (unusually strong or irregular heartbeats). Sometimes you may feel like you’re choking or having a heart attack.
  • Social anxiety disorder. Also called social phobia, this is when you feel overwhelming worry and self-consciousness about everyday social situations. You fixate about others judging you or on being embarrassed or ridiculed.
  • Specific phobias. You feel intense fear of a specific object or situation, such as heights or flying. The fear goes beyond what’s appropriate and may cause you to avoid ordinary situations.
  • Generalized anxiety disorder. You feel excessive, unrealistic worry and tension with little or no reason.

 Symptoms

All anxiety disorders share some general symptoms:

  • Panic, fear, and uneasiness
  • Sleep problems
  • Not being able to stay calm and still
  • Cold, sweaty, numb or tingling hands or feet
  • Shortness of breath
  • Heart palpitations
  • Dry mouth
  • Nausea
  • Tense muscles
  • Dizziness

Causes

Researchers don’t know exactly what brings on anxiety disorders. Like other forms of mental illness, they stem from a combination of things, including changes in your brain and environmental stress, and even your genes. The disorders can run in families and could be linked to faulty circuits in the brain that control fear and other emotions.

Diagnosis

If you have symptoms, your doctor will examine you and ask for your medical history. She may run tests to rule out medical illnesses that might be causing your symptoms. No lab tests can specifically diagnose anxiety disorders.

Treatment (including treatment offered by the Prive-Swiss Professional Team)

Cognitive Behavioral Therapy (CBT)

Cognitive and behavioral therapies for generalized anxiety disorder (GAD) refer to a variety of techniques that can be provided individually or in combination. The basic premise underlying the therapy approaches is that thoughts, feelings and behaviors are inter-related, so altering one can help to alleviate problems in another (e.g., changing negative thinking will lead to less anxiety). The excessive, uncontrollable worry that is the hallmark of GAD is thought to be maintained through maladaptive thinking about the utility of worrying, a tendency to repeat worries instead of problem-solving, difficulties relaxing, and unhealthy behaviors, including attempted avoidance of negative thoughts and images, as well as situations that might provoke worry. The cognitive therapy techniques focus on modifying the catastrophic thinking patterns and beliefs that worrying is serving a useful function (termed cognitive restructuring). The behavioral techniques include relaxation training, scheduling specific ‘worry time’ as well as planning pleasurable activities, and controlled exposure to thoughts and situations that are being avoided. The purpose of these exposures is to help the person learn that their feared outcomes do not come true, and to experience a reduction in anxiety over time.

The research evidence suggests that both cognitive or behavior therapy on their own can be helpful for GAD (especially cognitive restructuring or applied relaxation). However, there may be some advantage to combining the approaches, with some studies finding that the treatment is more powerful when therapy involves cognitive work, exposures and relaxation. Cognitive Behavior Therapy (CBT) typically refers to a combination of the various cognitive and behavioral approaches, and ‘Anxiety Management Training’ usually refers to the particular combination of relaxation and cognitive restructuring. The therapies can be conducted individually or with a group, and CBT is helpful for older adults with GAD as well.

Dialectical Behavioral Therapy (DBT)

Integrating cognitive-behavioral techniques with concepts from Eastern meditation, dialectical behavioral therapy, or DBT, combines acceptance and change. DBT involves individual and group therapy to learn mindfulness, as well as skills for interpersonal effectiveness, tolerating distress, regulating emotions.

Eye Movement Desensitization and Reprocessing (EMDR)

Under certain conditions eye movements appear to reduce the intensity of disturbing thoughts. A treatment known as eye movement desensitization and reprocessing, or EMDR, seems to have a direct effect on the way that the brain processes information. Basically, it helps a person see disturbing material in a less distressing way.

EMDR appears to be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep. Scientific research has established EMDR as effective for posttraumatic stress disorder. And clinicians also have reported success using it to treat panic attacks and phobias.

Mindfulness Based Cognitive Therapy (MBCT)

Mindfulness based cognitive therapy (MBCT) is a type of therapy born from the union of cognitive therapy and meditative principles.

  • Cognitive therapy aims to help clients grow and find relief from symptoms of mental illness through the modification of dysfunctional thinking (Beck Institute, 2016).
  • Mindfulness can be summed up as the practice and state of being aware of our thoughts, feelings, and emotions on a continuous basis (Greater Good Science Center, 2017). Mindfulness also contributes to an acceptance of the self as it is, without attaching value judgments to our thoughts.

The marriage of these ideas is MBCT, a powerful therapeutic tool that can be successfully applied to depression, anxiety, bipolar disorder, and more.

Holistic/Complementary Interventions

There is growing scientific evidence about complementary and alternative treatments. Interest in complementary and alternative medicine, or CAM, is growing as consumers and health care professionals search for additional ways to treat anxiety, depression, and other mental health disorders.

Complementary medicine is used along with conventional medicine. An example is in-home treatment to help modify symptoms of panic attacks. Alternative medicine can include a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy recommended by a medical doctor.

Before beginning CAM or any type of treatment, talk to your mental health provider or primary care doctor. Visit: https://nccih.nih.gov/health/decisions/consideringcam.htm to learn more about CAM treatments.

The following complementary and alternative practices may be used to treat anxiety and depressive disorders. We advise that you speak with your primary physician and/or mental health provider before selecting any alternative/complimentary treatment:

  • Stress and Relaxation Techniques
    Relaxation techniques may produce modest short-term reduction of anxiety in people with ongoing health problems. These techniques have also been shown to be useful for older adults with anxiety.
  • Meditation
    Moderate evidence suggests that meditation is useful for symptoms of anxiety and depression in adults.
  • Yoga
    Yoga, which combines physical postures, breathing exercises, meditation, and a distinct philosophy, is one of the top ten practices of CAM (complementary and alternative medicine). It may also help alleviate anxiety and depression.
  • Acupuncture
    There are preliminary positive findings for acupuncture in the treatment of chronic anxiety associated with PTSD. A systematic review of acupuncture for PTSD found that the evidence of effectiveness is encouraging (Kim 2013): all four reviewed randomised controlled trials (RCTs) indicated that acupuncture was equal to or better than orthodox treatments, or that it added extra effect to them when used in combination. Three of the four are Chinese studies that used earthquake survivors and one similar RCT (Wang 2012) was too recent to be included in the review. It found that both electroacupuncture and paroxetine resulted in significantly improved scores for PTSD, but that the improvement was greater with electroacupuncture. There is also some evidence that the acupuncture effects may continue for at least a few months after the treatment course is finished (Hollifield 2007).A review that looked at the effects of combining brief psychological exposure with the manual stimulation of acupuncture points in the treatment of PTSD and other emotional conditions found evidence suggesting that tapping on selected points during imaginal exposure quickly and permanently reduces maladaptive fear responses to traumatic memories and related cues (Feinstein 2010).Kim’s review (Kim 2013) also included two uncontrolled trials (they too had positive outcomes). A more recent uncontrolled pilot study found that acupuncture appeared to be a therapeutic option in the treatment of sleep disturbance and other psycho-vegetative symptoms in traumatised soldiers (Eisenlohr 2012).Although more high quality trials are needed to substantiate these results, the overall evidence does lie promisingly in a positive direction, and, given the very low level of side effects and lack of demonstrably superior outcomes from other interventions, acupuncture could be considered as one possible therapeutic option alongside the existing repertoire. (See table overleaf)In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being.Research has shown that acupuncture treatment may specifically benefit anxiety disorders and symptoms of anxiety and stress by:

    • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010);
    • Regulating levels of neurotransmitters (or their modulators) and hormones such as serotonin, noradrenaline, dopamine, GABA, neuropeptide Y and ACTH; hence altering the brain’s mood chemistry to help to combat negative affective states (Lee 2009; Zhou 2008);
    • Stimulating production of endogenous opioids that affect the autonomic nervous system (Arranz 2007). Stress activates the sympathetic nervous system, while acupuncture can activate the opposing parasympathetic nervous system, which initiates the relaxation response;
    • Reversing pathological changes in levels of inflammatory cytokines that are associated with stress reactions (Arranz 2007);
  • Massage

Medication

Medication treatment of anxiety is generally safe and effective and is often used in conjunction with therapy. Medication may be a short-term or long-term treatment option, depending on severity of symptoms, other medical conditions, and other individual circumstances. However, it often takes time and patience to find the drug that works best for you.

Which medication your doctor prescribes for your anxiety, if any, will depend on your symptoms and type of anxiety disorder. And, each anxiety disorder has different symptoms. Medications often are used in conjunction with psychotherapy to treat anxiety disorders.

Two overall types of medications used to treat anxiety disorders include:

  • Anti-anxiety medications (sometimes called anxiolytics)
  • Antidepressants

Within each of these categories, there are subgroups of drugs that work differently and have their own benefits, risks, and possible side effects, however, it’s important to follow your doctor’s instructions when taking any prescription drug. Also, talk to your doctor if you’re concerned about the side effects of a medication, or if the drug you’re taking doesn’t seem to be helping with your symptoms.

Benzodiazepines

Benzodiazepines are the most common type of anti-anxiety medication. They help relieve anxiety by reducing abnormal electrical activity in the brain.

Commonly used benzodiazepines for anxiety disorders include:

  • Xanax or Niravam (alprazolam)
  • Klonopin (clonazepam)
  • Ativan (lorazepam)
  • Valium (diazepam)

Your doctor may prescribe benzodiazepines in combination with other medications, depending on your anxiety disorder. Benzodiazepines can be used along with an antidepressant and can work very quickly. The combination can be quite effective at relieving symptoms of anxiety in the short term.

In the long term, though, people can build up a tolerance to benzodiazepines. This means they need higher and higher amounts of the drug to get the same effect. Some people may even become dependent on their medication. When they stop taking them suddenly, unpleasant withdrawal symptoms occur. It’s important to follow your doctor’s instructions for tapering off your medication. This will help prevent withdrawal.

Other side effects of benzodiazepines may include:

  • Drowsiness
  • Dizziness
  • Nausea
  • Blurred vision
  • Headache
  • Confusion
  • Tiredness/fatigue
  • Nightmares

Buspirone

Buspirone (BuSpar or Vanspar) is an anti-anxiety medicine used to treat certain anxiety disorders and is taken by mouth. Buspirone is typically used to treat chronic anxiety. It’s not related to benzodiazepines. Unlike benzodiazepines, buspirone must be taken every day for a few weeks before it starts to relieve symptoms.

Side effects of buspirone may include:

  • Dizziness
  • Headaches
  • Nausea
  • Nervousness
  • Lightheadedness
  • Excitement
  • Trouble sleeping

Antidepressants

Antidepressants are drugs that help relieve the symptoms of depression by changing the balance of certain neurotransmitters (brain chemicals that help regulate mood). They may also be used as a first-line treatment for some anxiety disorders.

The two most commonly used types of antidepressants for treating anxiety disorders are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). SSRIs may be used to treat all anxiety disorders.

Examples of SSRIs include:

  • Prozac or Sarafem (fluoxetine)
  • Celexa (citalopram)
  • Zoloft (sertraline)
  • Paxil, Paxeva, or Brisdelle (paroxetine)
  • Lexapro (escitalopram)

SNRIs may also be used to treat all types of anxiety disorders. They are considered a first-line treatment for generalized anxiety disorder (GAD).

Examples of SNRIs include:

  • Effexor (venlaxafine)
  • Cymbalta (duloxetine)

Side effects of both SSRIs and SNRIs may include:

  • Nausea
  • Nervousness or restlessness
  • Dizziness
  • Reduced sexual desire
  • Drowsiness
  • Insomnia
  • Weight gain or loss
  • Headache
  • Dry mouth
  • Vomiting
  • Diarrhea

Some people respond better to some antidepressants than others. You may need to try a few different medications before finding one that works for you.

Other antidepressants that may be prescribed for anxiety include:

  • Wellbutrin, Zyban, Aplenzin, Budeprion, or Buproban (buproprion)
  • Tricyclic antidepressants, such as Amitid, Amitril, Elavil, or Endep (amitriptyline); Aventyl or Pamelor (nortriptyline); or Tofranil (imipramine).

Other Medications

Some people with phobias or panic disorder may be prescribed a heart medication known as a beta-blocker. This type of drug can help treat some of the physical symptoms of a panic attack, such as trembling and sweating.

Examples of beta-blockers include:

  • Sectral (acebutolol)
  • Tenormin (atenolol)
  • Kerlone (betaxolol)
  • Zebeta and Ziac (bisoprolol)
  • Coreg (carvedilol)
  • Normodyne and Trandate (labetalol)
  • Lopressor and Toprol XL (metoprolol)
  • Corgard (nadolol)
  • Bystolic (nebivolol)
  • Levatol (penbutolol)
  • Visken (pindolol)
  • Inderal and Inderal LA (propranolol)
  • Blocadren (timolol)

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