When is Stress Too Stressful? - Part 2
Are You Worried Sick?
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by Sarita Uhr, MD
Dr. Sarita Uhr shows us how to tell
the difference between normal worry and the anxiety disorders.
Part 2 of 2 (Read
Part 1 Here) Question: What parts of the
brain are responsible for anxiety? Answer: Reseach has shown that the amgydala and
hippocampus are the structures in the brain that produce anxiety.
The amgydala is a structure deep in the brain that alerts the brain
if there is a threat. It is thought to be the part of the brain that
stores emotional memory. The hippocampus is thought to encode
traumatic events to memory. Question: Are men and women equally affected by
anxiety? Answer: No. Anxiety Disorders aretwo to three
times more common in women than men. Gender differences occur as
early as age 6. Women are at higher risk to develop Panic Disorder
and Post Traumatic Stress Disorder. Research is being done to
determine if hormones are responsible for some of these differences.
Environmental and genetic factors are being studied as well.
Question: What are the treatments for anxiety?
Answer: The combination of therapy and psychopharmacology is usually the most effective treatment. Certain therapies are particularly effective for anxiety as well as certain types of medications.
Question: What types of therapy are effective for anxiety?
Cognitive Behavioral Therapy (CBT) is a very important part of treating anxiety disorders. It changes the way one thinks about anxiety. The therapist helps change thought patterns associated with these "anxiety- triggers". For example, when some one is having a panic attack, it is a common misperception to think one is having a heart attack. The person learns to calm down with "self talk". Instead of thinking, "I am dying. I am having a heart attack! I have to call an ambulance to take me to the hospital ", he or she learns to think, "I am having a panic attack. I am going to be okay in a few minutes. The symptoms are going to pass".
Exposure therapy is important for the treatment of Panic Disorder or specific phobias. The premise of exposure therapy is that one must face his or her fear in order to eliminate it. For example, if a person with Social Phobia gives frequent presentations that go smoothly, their anxiety about giving talks diminishes over time. In other words, one takes small steps to face his or her fears and gradually becomes desensitized to the fearful situation.
Psychotherapy can be beneficial in a variety of ways. First, a psychotherapist can teach a person breathing techniques and progressive muscle relaxation which may help reduce anxiety. A therapist may encourage exercise, yoga, or meditation which helps relax the body and mind.
Second, a therapist can help identify one's triggers for anxiety. If conflict with coworkers is a stress, the therapist will help the individual face and resolve conflict so he or she can get along better with others. If an individual has a tendency to take on too many projects in an effort to please others, a therapist will help that person learn to set better boundaries and thus take better care of him or herself. Third, psychotherapy helps a person explore the psychological roots of his or her anxiety. For example, an individual who is a perfectionist is often trying to win the approval and love of a critical parent. A therapist can help free one from the need for parental approval. Fourth, a therapist can encourage and guide one in having balance and having time to de-stress. Working too hard to the exclusion of spending time with one's family can cause stress.
Learning to give the family a higher priority can reduce stress by bringing back those feelings of connection. In addition, a therapist will emphasize the importance of time to oneself. "What activities nurture the soul?" To a woman, it may be having coffee with a girlfriend, taking a bubble bath, or having uninterrupted quiet time to read. For a man, exercise and watching sports are common stress relieving activities. Achieving balance between work, family, and friends is key to a happy life. Fifth, psychotherapy can help one learn to express feelings, be more flexible, and become less critical of oneself. Bottom line, psychotherapy teaches coping skills for stress.
Question: Are medications effective for anxiety?
Answer: Although the foregoing psychotherapy techniques are effective for anxiety, medications are the main treatment for the Anxiety Disorders. Medications reduce symptoms of anxiety. They do not cure anxiety.
Question: Which medications are effective for anxiety?
Answer: The most common medications prescribed for anxiety are the antidepressants. All the newer antidepressants are effective for anxiety as well as depression. The Selective Serotonin Reuptake Inhibitors known as the SSRI's are the mainstay of treatment. The SSRI's change the levels of serotonin in one's brain. Nerve cells communicate by electricity and chemicals. Serotonin is one of these chemicals. Examples of the SSRI's include Zoloft, Paxil, Lexapro, and Celexa. Another class of drugs are the SNRI's which work on serotonin and norepinephrine. Examples of SNRI's include Effexor and Cymbalta. Effexor has been approved for the treatment of Generalized Anxiety Disorder. These medications are usually well tolerated. They take about a month to "kick In' and are not addicting.
Another class of drugs are the antianxiety drugs. The most common are the benzodiazepines. Examples include Xanax, Klonopin, and Ativan. The benzodiazepines work on a chemical in the brain called GABA. They work very quickly unlike the SSRI's and are very calming. The down side of these drugs is that they require higher doses to get the same effect over time. This phenomena is called tolerance. On stopping them, there are withdrawal symptoms such as increased anxiety. These medicines have a high potential for abuse. They tend to be "addicting". Psychiatrists tend to shy away from them because of better alternatives mentioned above.
Question: What are the risks of untreated anxiety?
Answer: There are both physical and mental consequences. Individuals with untreated anxiety are at significantly higher risk for having a heart attack, high blood pressure, and stroke. Constant stress suppresses the immune system and may lead to an increased incidence and severity of infections. Untreated anxiety leads to depression. There is a significantly higher suicide rate in individuals with an Anxiety Disorder. It puts one at risk for substance abuse. Often, drugs and alcohol are used by people with anxiety to self medicate. Another risk of untreated anxiety is that certain parts of the brain have been shown to atrophy or shrink. Neurogenesis, which means the growth of new nerve cells, is one of the hottest topics in neuroscience today.
Researchers at Yale, Princeton, and Columbia University have done animal studies showing that stress causes nerve cells to die and stops the growth of new nerve cells in the part of the brain called the hippocampus. They have demonstrated that antidepressants, such as the SSRI's stimulate the growth of new brain cells. The SSRI's have been shown to stimulate the production of proteins called trophic factors. Trophic factors promote the growth of nerve cells. It is like giving plant food to a withering plant to bring it back to life. The delay in the effect of the antidepressants may be due to new nerve cells being born and establishing connections with other cells. This process can take several weeks.
Question: Why do professionals have such a hard time getting treatment for anxiety?
Answer: A common attitude of professionals I see who experience anxiety is, "I am smart. I should be able to fix this myself". Most people with anxiety like to be in control and it is difficult for them to give control over to a pill. If this applies to you, ask yourself, "Can I really combat my genetics, my serotonin imbalance, and my shrunken hippocampus by myself? Is that how I would tackle a problem at work or would I gather all the resources at my disposal to overcome this problem?". If one has high cholesterol the doctor tells you to try diet and exercise first to try and lower it. If it is still high, one takes cholesterol medicine because the former ways were not effective enough to overcome one's genetics. Anxiety treatment follows the same pathway. First, try relaxation techniques.
Second, learn better coping skills in therapy. Third, make some positive life style choices. If these steps are not effective enough, then medication is required to reduce anxiety.
Conclusion:
Many people think they are being noble or brave to put up with stress. That's nonsense! Stress is damaging to your brain and to your physical health. If you feel stressed, get treatment. The combination of therapy and medication is very effective for anxiety. A psychiatrist will evaluate your symptoms and determine a treatment plan based on the diagnosis and any past experience with medications and/or psychotherapy.
If you are worried about stress, quit worrying about your worry and get help.
Dr. Sarita Uhr is a board certified psychiatrist in private practice in North Dallas. She specializes in the treatment of anxiety, depression, substance abuse, and women’s issues. She did a fellowship in psychopharmacology at Stanford University School of Medicine and was an Assistant Professor of Psychiatry at the University of Texas Health Science Center at San Antonio before private practice. Her skills include medication management as well as psychotherapy.