Clinical Views on Treating Anxiety, GAD, and Possible Causes of GAD
Clinical experience and observations in dealing with anxiety and treating anxiety. Having practiced psychiatry in Scottsdale since 2002 I have found that there can be a plethora of causes of anxiety in someone’s life. Anxiety can manifest in numerous ways. With this said, anxiety treatment will be different in each case as well. Psychiatry is as much a healing art as it is a science and requires years of experience to properly diagnose an illness properly, especially when there is a comorbid illness accompanying the primary illness. Is anxiety genetic? Stress in one’s life seems to increase increase one’s vulnerability to having an anxiety disorder and some studies have shown that the environment can change or turn certain genes in the fetus on or off and create a predisposition for an anxiety disorder. Other medical illnesses can share the symptoms of either anxiety or depressive disorders. Diabetes and Thyroid disorders are just a few which can cause depression or anxiety. Once the underlying medical illness is diagnosed and treated, the anxiety symptoms generally resolve. We know that substances such as Amphetamine, Caffeine and Cocaine can elicit anxiety symptoms as well. Once the substances are out of one’s system, the anxiety symptoms dissipate (assuming they have not damaged the areas of the brain that are responsible for pleasure).
The Symptoms of Generalized Anxiety Disorder will Depend on the Person, and Different in Each Case
- Accelerated heart rate
- Sweating or trembling
- Feeling of choking or shortness of breath
- Feeling of dizziness or a feeling of faintness
- Chest pain or pressure
- Nausea or diarrhea
- Fear of losing control or a fear of dying
- Numbness or tingling in one’s extremities
- Chills or hot flashes
- Acid Reflux
If these symptoms should manifest, and are intense and last for about 10 minutes, we call it a panic attack. If these symptoms are more mild but longer lasting for hours of the day for about six months, we call it GAD Generalized Anxiety Disorder, especially when accompanied by excessive or unrealistic multiple worries.
Other symptoms of anxiety tend to be associated with phobias triggered by different objects or situations (e.g. animals, natural environment, blood-injection-injuries, situational or in social performance situations). People can also become anxious from obsessional thoughts that make them perform certain behaviors, such as, the fear of germs and illnesses, causing a person to wash his or her hands excessively. Those who witness or are involved in traumatic incidents can also have triggers of conversations or places where the event occurred causing them to relive and experience severe anxiety symptoms.
These symptoms of anxiety can be debilitating. We know that anxiety disorders and depression account for much lost time from work as well as disability. These symptoms interrupt some one’s ability to concentrate and remember things due to the consolation of physical symptoms (i.e. upset stomach, dizziness, chest pressure). Sometimes in the case of panic attacks it can be very unnerving to the point one needs to get to the emergency room for fear that one is having a heart attack or will die. If this is the result of anxiety, an anti-anxiety (benzodiazepine) medication such as Xanax or Ativan is given. This usually is given in intramuscular form so that it takes effect more quickly. This usually takes the symptoms of anxiety away quickly. The side effects of anxiety can also cause physical harm to the body, especially with acid reflux and Barrett’s Esophagus.
Treatment for Anxiety is Very Effective
The usual treatment of these anxiety disorders is to treat the with an antidepressant medication such as an SSRI or SNRI and psychotherapy. We know that the cause of these illnesses are similar to depression. As far as we know at the present there is a chemical imbalance in the neurotransmitters Serotonin, Norepinephrine, and Dopamine. There seems to be a deficiency of these neurotransmitters. This deficiency is corrected while one is taking the antidepressant medication. It can take up to four to six weeks for the antidepressant medication to reveal it’s true efficacy. Within the first few weeks many people see improvement in their amount of worry, decreasing along with their physical anxiety symptoms. Sometimes, it is necessary to give an anti-anxiety medication such as Klonopin, Ativan, or Xanax for the first four weeks if the anxiety symptoms are very intense. This is prescribed for a short amount of time because these medications, unlike antidepressant medications are addictive. We give them along with the antidepressant for the first four weeks to give the antidepressant time to reach the therapeutic levels. After this time a taper off is usually tried.
Side effects that may occur with the antidepressants include: upset stomach, headache, diarrhea or constipation, decreased libido, weight gain or weight loss. The side effects are a little different depending on the one you are started on to initiate treatment. Many side effects get better and go away after the first week of treatment and often are preferable to the symptoms of anxiety.
Some of the side effects of the benzodiazepines (i.e. Klonopin, Ativan, Xanax), are psychomotor slowing and sedation. Therefore you have to know how you are functioning after you take this especially before you get behind the wheel of a car.
The success rate of anxiety treatment and being treated with these agents is high. These antidepressant are 75% effective with the first antidepressant or anti-anxiety tried. Sometimes though people have untoward side effects that would be too bothersome to continue on the particular antidepressant. At that time, the medication is switched.
It may be necessary for one to be treated for anxiety with the antidepressants long-term. These illnesses are usually chronic in nature lasting many years and the research is showing us that these illnesses left untreated can be very detrimental to the brain and have a deleterious effect on the neurons. Those who aren’t treated for depression actually have lower brain volumes than those who are due to their high number of circulating stress hormones(glucocorticoids). These substances cause cell damage and death, whereas, the antidepressant medications have a neuro-protectant effect preventing this cell death and damage and will replace the dead cells by forming new brain cells from stem cells in the brain. Since depression and anxiety are so closely linked, one can extrapolate the findings that there would be cell damage also with anxiety disorders that are left untreated. Additionally one of the best ways to avoid a relapse in cases of generalized anxiety is to remain on the medication(s) for at least a full 12 months. Recent studies have also revealed that PTSD or lingering anxiety might be attributed to not enough dynorphin in the system. This discovery may lead to new medications for regulating the levels of dynorphin similar to how serotonin or norepinephrine is regulated for depression. Read about PTSD and dynorphin.
The good news is that we have many very effective medications to treat the anxiety disorders. Many times, symptoms resolve and patients get back to their usual state of functioning. I have been very fortunate to see many of my patients return to healthy functioning and productive lives through medication management.
Other Ways of Treating Anxiety Disorders With an Holistic Approach
The other treatment of anxiety disorders is with Psychotherapy. The research has proven that the combination of medication and psychotherapy is the most effective way to treat both anxiety and depression. For this reason, I usually work in close association to therapists that are simultaneously treating patients. So with holistic approach we can often treat the symptoms and defeat anxiety. If you live in Metro Phoenix and are looking for an experienced Scottsdale psychiatrist, an initial evaluation, or anxiety treatment; please contact me; I would find it a joy to bring your life back to one of wellness and fulfillment. Read more on anxiety.