Dr. M.J. Bazos, MD
Patient Handout
ANXIETY
About Your
Diagnosis
Generalized anxiety disorder (GAD), one
of many different anxiety disorders, is characterized by excessive anxiety and
worry about a number of events and activities, such as work or school
performance. In GAD, anxiety and worry occur on most days and have been present
for at least 6 months. In addition to the anxiety, individuals find it very
difficult to control their worrying even when reassured by others. In GAD,
anxiety and worry are associated with specific symptoms, including restlessness
or feeling keyed up, uptight, or on edge; being easily fatigued or feeling
“drained”: having difficulty concentrating or feeling that
one’s mind has gone blank; irritability out of proportion to whatever may
have caused it; and feeling angry for no apparent reason. Muscle tension or
tightness occurs, as well as sleep disturbances, especially difficulty falling
or staying asleep or having a very restless, unsatisfying sleep. For GAD to be
diagnosed, the intensity of anxiety has to cause some impairment in the
individual’s ability to function either on the job or in social
relationships. The anxiety may also cause physical symptoms including shortness
of breath, chest tightness, rapid and pounding heartbeat, sweating, a sensation
of choking, and abdominal distress. Some forms of anxiety besides GAD include
panic attacks, in which the physical symptoms just mentioned occur
“out of the blue” for no apparent reason, last for a very brief
period, and then resolve. The individual with panic attacks may not, in fact, be
anxious most of the day and may be relatively calm between the episodes of
panic. Agoraphobia, another form of anxiety, is a fear of being out in
open spaces alone, where one might feel trapped and unable to get home.
Agoraphobia often occurs in conjunction with panic and sometimes leads
individuals to become virtual prisoners in their own homes. Phobias are a
type of anxiety involving fears of
specific
objects, places, or behaviors. Examples of phobias include fear of urinating in
public restrooms, fear of using public transportation, or specific fears such as
fear of heights (acrophobia), fear of foreigners (xenophobia), and fear of
closedin places (claustrophobia). Other forms of anxiety include the
obsessivecompulsive disorder, the posttraumatic stress disorder, and the acute
stress disorder, as well as the anxiety caused by legal drugs such as caffeine,
the anxiety caused by drugs of abuse such as amphetamines or cocaine, and the
anxiety caused by medical conditions and medications, such as those used to
treat asthma (steroids, aminophylline). In general, anxiety is a state of fear
or worry that (1) may or may not have a cause, (2) the individual cannot
control, and (3) that significantly compromises the individual’s ability
to function normally. It should be pointed out that worry and anxiety are normal
feelings; however, it is all a matter of degree. Sometimes anxiety can allow us
to make plans and provisions for the future and can, in fact, be beneficial.
Such beneficial anxiety is called
anticipation.
Living With Your
Diagnosis
Generalized anxiety disorder
is fairly common, affecting up to 10% of individuals at any particular point in
time. Its childhood equivalent, the so-called overanxious anxiety disorder of
children is also fairly common. Studies of families suggest that anxiety can be
transmitted to children genetically, especially in conditions such as panic
disorder. The matters about which anxious patients can worry are endless. They
are likely to report worry over minor matters, and they are often anxious for at
least half the day during an average day. In children and adolescents, the
worries will center around the quality of their school performance or some
aspect of their social functioning in school. They may also be concerned with
their own physical or mental imperfections as they see them, and such anxious
adolescents will require constant reassurance. There are some medical conditions
that have a high correlation with anxiety. These include such conditions as
ulcerative colitis, Crohn’s disease, asthma, hypertension, heart disease,
ulcer disease, reflux esophagitis, and headaches. During evaluation, anxious
patients often have rapid or pressured speech and often shift from one subject
to another without any apparent connection. These patients may be extremely
restless, shifting about in their chair or tapping their fingers or toes,
ringing their hands, putting their head in their hands, and often even getting
up and walking across the room. Patients will use such phrases as “I feel
like I’m going to jump out of my skin,” “My whole body’s
on fire,” “I think
I’m going to have a heart attack,”
or similar comments. In the treatment of anxiety, it is very important to
determine whether some medical condition or substance abuse is causing the
anxiety. Common drugs that can produce anxiety include theophylline, any
medications with caffeine, steroids, many antihypertensives including Aldomet,
stimulating antidepressants such as Prozac, inhalers used for breathing problems
such as Breathine and Vanceril, thyroid medication, and diet pills. Many
over-the counter medications such as some antihistamines, some cough and cold
preparations, and diet pills that contain caffeine can also cause anxiety,
and
dietary intake of excessive amounts of
caffeine and sugar can make any anxiety syndrome worse. Once a medication or a
medical condition has been eliminated as a cause of anxiety, then an adequate
history should be obtained for substance abuse to eliminate the possibility that
the individual may be using some kind of psychostimulant that might be producing
anxiety. Attention should also be directed toward uncovering any precipitants in
the individual’s home environment or any major stressors that might be
contributing to the
anxiety.
Treatment
The
treatment of anxiety involves both behavioral techniques and medication. One
behavioral technique used is biofeedback, wherein patients are hooked to a
machine and learn to decrease their muscle tone or control their brain waves by
regulating their breathing. Other behavioral techniques include progressive
muscle relaxation, which is often done to a prerecorded tape; imagery, where
individuals imagine that they are in some pleasant setting; meditation; and
hypnosis. Behavioral techniques have been very effective in treating anxiety and
are the commonly used methods in those patients who prefer not to take
medication. If you have been prescribed a medication for anxiety, it is most
likely one of the minor tranquilizers of the benzodiazepine class. This would
include such drugs as alprazolam (Xanax), lorazepam (Ativan), or diazepam
(Valium). Although these drugs are very effective for the rapid relief of
anxiety, they do have side effects. They typically slow down breathing and
therefore may not be the best drugs to use in someone who has asthma,
bronchitis, or emphysema. They also are broken down by the liver, so they may be
bad choices in someone who has severe liver disease, such as cirrhosis or
hepatitis. Finally, these drugs can be habit forming; that is, they cannot be
discontinued without being tapered for fear of withdrawal signs and symptoms.
Those individuals who have a history of substance abuse, particularly abuse of
depressant drugs, such as alcohol, barbiturates, or benzodiazepines should not
be prescribed these drugs. Because the duration of action of some of the
benzodiazepines, such as Xanax and Ativan, is fairly short, they may have to be
given three or four times a day. Also, the benzodiazepines may produce a
significant degree of sedation, which can impair driving and the ability to
operate certain machinery. Another group of drugs that are used to treat anxiety
are the antidepressants. The tricyclic antidepressant drugs, such as imipramine,
have been very effective for years in treating anxiety disorders. The major
drawback of these medications is that they are not effective as quickly as the
benzodiazepines. It may take 10 days to 2 weeks before the beneficial effects of
imipramine and other tricyclic antidepressants are seen. They also may initially
increase anxiety before relieving it, and they have side effects such as weight
gain, sexual dysfunction, dry mouth, constipation, and blurry vision. The
advantages of the tricyclic antidepressants are twofold: (1) they can be given
once daily, and (2) they may be more effective than the benzodiazepines when
depression is associated with the anxiety, as it often is. Other antidepressants
used to treat anxiety are the selective serotonin reuptake inhibitors (SSRIs).
In particular, paroxetine (Paxil) seems to have significant antianxiety effects.
It can be given once daily, usually in the evening, and may improve sleep. It
has few side effects, except for diarrhea, constipation, and some sexual side
effects. Paxil is similar to imipramine in that its therapeutic onset is
delayed; it may take 2–3 weeks before the beneficial effects are seen. In
addition, you may have to avoid using Paxil if you are taking certain other
medications because of its interaction with them. Buspirone (BuSpar) is also
used for anxiety. It is the only drug approved for anxiety that is not
potentially physically addicting, so it is often substituted for the
benzodiazepines. The advantages of using BuSpar are that it is less likely to
cause sedation and that there is no withdrawal on discontinuing it. Side effects
of Buspar may include gastrointestinal distress and headaches.
Finally, the beta-blocker, propranolol
(Inderal) is often used for treating some of the effects of anxiety and is
particularly effective for treating the runaway heartbeat and sense of heart
pounding that many anxious patients feel. Because Inderal is also used to treat
high blood pressure, individuals with low blood pressure should not take it. It
can also sometimes make individuals feel very tired, and should not be used in
patients who have severe lung disease. Anxiety disorders can cause significant
suffering and worry for patients. However, these are treatable
conditions.
The Dos If you
have an anxiety disorder diagnosed, it is very important to minimize your level
of stress; to have some activity that you enjoy doing such as reading, writing,
or knitting; to participate in a regular exercise program; and to watch your
diet. If you are taking antianxiety medications, you should be very careful when
driving or operating dangerous
machinery.
The DON’Ts
Do not use products containing caffeine, and decrease your sugar intake as
much as possible. In addition, remember that most prescribed medications for
anxiety have some sedating effects; therefore you should avoid drinking alcohol.
When to Call Your Doctor
You should call your doctor if the nature of your anxiety changes, if you
notice any side effects from your medications, or if your anxieties are
accompanied by depression and suicidal ideation or thoughts. Web sites:
http://www.soven.net/~schwcof
http://www.cts.com/~health
http://spiderweb.com/npadnews