Arm Yourself to Fight Anxiety….
You have lots of options, but you need to start somewhere
There it is again. That sense of dread. You have no idea why it is here again. Your heart rate is climbing, you feel sweaty and you have a nest of butterflies in your gut, making you more queasy by the minute. You feel like you drank a gallon of Cuban coffee and you can’t escape the effects. You start to feel lightheaded. I have to get out of here, but I can’t run away from my mind!
What I have described is a full-blown panic attack. Hopefully that has not happened to you, but if it has you have my sympathy. It’s a very uncomfortable feeling and can occur from out of nowhere.
The national Institute of Mental Health website states that approximately 20% of adults in the US suffer from anxiety, and at least 30% of adults will experience at least one episode during their lifetime. Certainly with the pandemic and all that we’ve been through over the last several years, these numbers might even be higher and are perhaps under reported.
About 1 in 5 Americans suffers from anxiety
I know that in my own practice over the last two years I have seen a tremendous spike in the number of patients that we are treating for anxiety. Much of this is fueled by the same thing that all anxiety is fed by- fear of the unknown, fear of what has not happened yet and may never come to be.
Before you look at treatment options the first thing you should look at is to see whether or not you actually have anxiety and how bad is it. One of the easiest ways to do that is to use a clinical tool called the GAD 7, or Generalized Anxiety Disorder questionnaire. Here is a link GAD 7
A word of caution on answering the questions. Don’t get hung up on the answers. The questionnaire wants you to give your overall sense of how much you’ve been affected by the questions that are presented in the last two weeks. So don’t get into the nitty-gritty and start saying stuff like “well Tuesday wasn’t bad but Wednesday was better”. Just give the overall gestalt of how you’ve been feeling in the last two weeks for each question.
The GAD 7 questionnaire can help determine your anxiety level
OK, so now that you’ve gotten a quantitative assessment, let’s talk about what your options are when it comes to treatment.
If there’s one thing I’ve learned in my 30+ years of practice, it’s that anxious people don’t like to take medications. Although I’ve never read this anywhere my assumption is that the thought of taking a medication that could potentially cause side effects is an anxiety provoking activity in and of itself. Anxious patients want to be in control at all times, and they realize that taking a pill means they’re giving up control and it makes them uncomfortable. So therefore sometimes the hardest thing to do is to convince them to take a low-dose of the medication, and slowly titrate the dose while having frequent visits with them to guide them through the process.
There are a variety of medication available for anxiety. Some of the most commonly used are medicines in the SSRI family. That stands for selective serotonin reuptake inhibitors. These drugs are not addictive and not habit forming however they don’t work right away and they take as long as six weeks before you see a substantial improvement. I usually tell patients they’ll begin to feel better in two weeks but maximum effect is at six. Medication’s in this group include things like Celexa (Citalopram), Zoloft (sertraline), and Lexapro (escitalopram) to name but a few.
A drug in a different family is called BuSpar (buspirone) and is also useful for anxiety but requires usually more than once a day dosing. This too is not habit forming nor is it a controlled substance.
SSRI meds and buspirone can be helpful to treat anxiety
Some patients have anxiety that is so debilitating that they require medications that will work almost immediately. That almost always brings us to the class of medicines known as benzodiazepines. You know these medicines by their brand names such as Valium, Xanax, and Klonopin.
As a rule I try to stay away from these medications and never offer them as an “upfront treatment” for someone with anxiety. Why? Because they are highly addictive and trying to come off them can be quite difficult and requires a long weaning process. Secondly, in the state where I practice providing these medication’s is severely limited by law. Therefore if I think your anxiety is this severe, I will refer you to a psychiatrist to manage your medications in this regard. Do benzodiazepines have their place? Certainly they do. However I think that’s better left for the specialist to help manage.
Medicines are not for everybody for a variety of reasons. And as I’ve mentioned on previous posts, you should not be using my advice to diagnose or treat yourself or make decisions about what treatment you need. You should be discussing that with your physician.
But if you’re not interested in taking medication there are some self-help things that you can consider doing. If you have access to mental health benefits, one of the most important therapies you can consider is what is called Cognitive Behavioral Therapy (CBT- not CBD!)
CBT may help you conquer your anxiety
CBT must be administered from a psychologist who has expertise in this. They teach you a variety of techniques to help you to learn how to quiet your mind and redirect the perseverating thoughts that occur. That’s really an inadequate description of the process and I can’t get into the details here, but it is highly effective. I read articles that say that these techniques work about 75 to 80% of the time as long as the patient puts the time and effort in with a therapist to do the work. Good news — no side effects!
If you don’t have access to healthcare benefits perhaps you want to help yourself. Recently I listened to the audiobook “ Unwinding Anxiety”, by Judson Brewer, MD. He is a practicing psychiatrist and also a researcher. I thought that his book was life-changing. He gives a very detailed plan on how to conquer your anxiety in a step-by-step fashion. You can get it from your library for free like I did. And if you like what he has to say he has an app available. Pricey but worth it. On the app you can take no more than one class a day on his techniques and do a step-by-step guided unwinding of your anxiety. Since having read the book and completed the app, I’ve been recommending this to every one of my patients who comes to see me with anxiety.
“Unwinding Anxiety” by Judson Brewer, MD
While his book does go on to explain his research and the proof that he has that his techniques work, you can skip over that if it’s not of interest to you and just stick to the parts that are the mapped out plan for improving your anxiety. Unlike a lot of other self-help books that I’ve read, what appealed to me about this one was that it has a plan that actually works and is spelled out in detail. The fact that it’s backed by research makes it all the more appealing to me as a physician.
Two other titles that might be of interest are “The Feeling Good Handbook” by David Burns, and the “New Guide to Rational Living” by Albert Ellis. Those titles were given to me by a colleague who is a psychologist. Years ago I asked him what do I do when I have patients that either don’t want to go for counseling or just need some slight help on their own and he recommended these books. Caveat about these two — not every section of the book will apply to you. Read the parts that seem specific to the way that you think and focus on those. These are not meant to be books that you read through in a week and are cured. They are workbooks and that means you have to work! It’s a marathon not a sprint.
As I said in the title of the article, you need to make a choice and get started if you want to get better. Please reach out to your physician to see what is the best path for you. It might be some combination of the things I discussed.
I want you to live your best life possible and that won’t happen unless you take the steps necessary to make that happen.
Good luck on your journey. I hope you found this information helpful. And if you did, please share it with someone.
Disclaimer: the information contained in this article is not meant to diagnose or treat any medical condition for informational purposes. Likewise, the words and opinions expressed are the author’s and his alone and are not those of his employer.
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Originally published at https://medupdate.substack.com on August 27, 2022.
