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Anxiety

AnxietyAnxiety is an exaggeration of the normal mental and physical sensations of fear. It is the feeling one would get if there was a tiger in your living room when there is no tiger there. Anxiety is a terrible feeling and people will go to great lengths to avoid feeling it.

Actually, anxiety is a general term for several disorders that produce fear, apprehension, or worry. This includes Social Anxiety Disorder, Panic Disorder, Obsessive Compulsive Disorder (see OCD page), Separation Anxiety Disorder, Post-Traumatic Stress Disorder, and Generalized Anxiety Disorder. Approximately 27% of Americans suffer from one form of anxiety or another. But everyone experiences anxiety at some point. How can you tell if you are experiencing everyday anxiety (e.g., getting nervous before public speaking) or an anxiety disorder?

The key is probably to determine if the anxiety one experiences is out of proportion to the stressor. For example, most everyone would be distraught if a swarm of bees came at them, but what if you react the same way to the sight of a single bug? Most everyone worries at one time or another about the future, but what if you are unable to sleep every night because of worries about what will happen tomorrow?

Anxiety can manifest as fears, nervousness, restlessness, worries, uncertainty, irritability, and trouble concentrating. In children, anxiety can be confused with ADHD, because of restlessness and trouble focusing. Anxiety also can produce physical symptoms, such as trembling, upset stomach, nausea, diarrhea, headache, chest pain, trouble breathing, irregular heartbeats, muscle tension, and sleep disturbance. These physical symptoms are particularly likely during severe anxiety or panic attacks.

Generalized Anxiety Disorder is a chronic anxiety disorder which is best characterized by excessive anxiety and worries about multiple aspects of life. The fears are often unrealistic or an exaggeration of likely events.
Asian Girl Shows Timid Expression

Panic Disorder is an anxiety disorder characterized by episodes or “attacks” of extreme anxiety with a number of physical symptoms.

Social Anxiety Disorder is a chronic excessive fear of public embarrassment or being harshly judged in social situations. This can lead to reluctance to go to school, go to work, or engage in any activity that requires interacting with people outside the immediate family.

A Phobia is a specific fear of a specific object or situation. Examples include fear of spiders, water, snakes, or dogs. Agoraphobia is perhaps the most common phobia and, practically speaking, is a fear of being trapped in a situation. People with agoraphobia will always try to position themselves so they can quickly leave a room or situation if they feel excessive anxiety.

Obsessive-Compulsive Disorder

Trichotillomania and skin-picking are symptoms of anxiety. Trichotillomania is the repetitive pulling of one’s own hair and often can become engrained into a highly complex behavior. Patients with trichotillomania often feel a great deal of shame and attempt to hide the behavior or its resulting hair loss. A number of websites and references conclude that trichotillomania is very difficult to treat. However, I have found that trichotillomania and skin-picking are very responsive to treatments I utilize.

Treating Anxiety Disorders

Research has shown that abnormal levels of certain neurotransmitters are present in the brain of people with anxiety disorders. Special imaging techniques are required to detect and measure neurotransmitters levels in the brain. No other techniques can accurately measure these levels, although a variety of techniques are purported to do so. Medications help to correct these abnormal levels or modulate the abnormal anxiety circuits in the parts of the brain called the amygdale, caudate nucleus, putamen, and other areas. Medical conditions that affect the entire body can also produce the symptoms of anxiety. These need to be treated specifically.

Treatments for anxiety disorders include medications, a variety of therapy techniques, physical exercise, and even certain supplements. It is important to realize that all remedies and medications have a certain degree of risk or side effects. For example, valerian root is a natural remedy often purported to help anxiety, but with daily use it can lead to bleeding disorders. Some medications for anxiety, such as the benzodiazepines, are addictive and interfere with learning and memory function. Other medications which are often prescribed for anxiety, the SSRI’s, can actually worsen anxiety in some patients. No single medication seems to be effective for all patients with anxiety disorders.

Neuroimaging studies have shown that there are different portions of the brain involved in different anxiety disorders. For example, most patients with OCD have overactive anterior cingulate gyri and caudate nuclei. Studies have shown that inositol and SSRI’s reduce abnormal activities in these areas1-4. A recent imaging study showed therapy also could improve the brain dysfunction associated with anxiety5.

Numerous therapeutic studies have shown that the combination of medications and therapy is more effective than either alone6,7. Different therapeutic modalities work better for different types of anxiety. Cognitive-behavioral therapy is particularly effective for OCD. PTSD responds well to Eye Movement Desensitization and Reintegration (EMDR), along with other techniques.

Dr. Henderson utilizes a thorough understanding of brain function, pharmacology, and therapeutic modalities to help his patients live free of anxiety symptoms.

References

1)       Saxena et al., Differential cerebral metabolic changes with paroxetine treatment of obsessive-compulsive disorder vs major depression. Arch Gen Psychiatry. 2002 Mar;59(3):250-61.

2)       Diler et al., Pharmacotherapy and regional cerebral blood flow in children with obsessive compulsive disorder. Yonsei Med J. 2004 Feb 29;45(1):90-9.

3)       Carey et al.. Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram. BMC Psychiatry. 2004 Oct 14;4:30.

4)       Carey et al., Single photon emission computed tomography (SPECT) in obsessive-compulsive disorder before and after treatment with inositol. Metab Brain Dis. 2004 Jun;19(1-2):125-34).

5)       Saxena et al., Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder. Mol Psychiatry 2009 Feb;14(2):197-205.

6)       Simpson et al., A randomized, controlled trial of cognitive-behavioral therapy for augmenting pharmacotherapy in obsessive-compulsive disorder. Am J Psychiatry 2008 May;165(5):621-30.

7)       Franklin et al., Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: the Pediatric OCD Treatment Study II (POTS II) randomized controlled trial. 2011, JAMA. 306(11):1224-32.