Attacking anxiety

September 22, 1999
Web posted at: 2:37 p.m. EDT (1837 GMT)

In this story: What is anxiety? Types of anxiety Treatments RELATEDS

By Ronald Pies, M.D.

(WebMD) -- We are living in "the age of anxiety," W.H. Auden commented in the 1920s. Life hasn't gotten any calmer since then, and anxiety attacks are all too common.

Most people have had some brush with irrational fears and lived to tell the tale. But serious, long-term anxiety can interfere with the business of daily living. Fortunately, both psychotherapy and medications may help a person overcome the problem.

Mental-health professionals try to distinguish between fear and anxiety. Fear is what you experience when someone is pointing a loaded gun at you. Anxiety is what you feel when you step onto the elevator and, for no apparent reason, break out in a cold sweat.

Thus, fear is a realistic response to a real threat. Anxiety is an unrealistic response to an imaginary threat.

Of course, some anxiety is normal -- anyone who has gone out on a first date or had to make a speech knows this. But for many people, anxiety reaches the proportions of a true clinical disorder, over the course of a lifetime.

Types of anxiety

Psychiatrists recognize five main types of anxiety disorders, all of which cause significant impairment in social, vocational or other important areas of functioning:

Anxiety can also be due to a depressive disorder; psychotic disorder, such as schizophrenia; or medical disorder, such as an overactive thyroid.

Treatments

Anxiety disorders may be treated with psychotherapy alone, medication alone, or a combination of psychotherapy and medication. For most patients with severe anxiety disorders, combined treatment appears to be most effective.

Psychotherapy can involve traditional psychoanalytic techniques, popularly associated with Freud. However, most research studies have focused on cognitive-behavioral therapy (CBT). CBT aims at altering the self-destructive or irrational thoughts that often underlie anxiety, such as the notion that "I'm a total flop as a human being if I blow this speech."

CBT also helps the anxious individual change his or her avoidance through gradual exposure to the feared situation. For example, Joe had terrible nightmares stemming from a motor-vehicle accident in which he accidentally struck a pedestrian.

He refused to drive at all and needed several hours to get to work each day. Joe's therapist helped him by gradually exposing him to the feared situation. First he showed Joe photographs of a car. Then, he suggested that Joe ride as a passenger while his wife drove. Finally, the therapist suggested that Joe drive in a secluded parking lot.

Several new medications are proving to be helpful for anxiety. While Valium, Xanax and similar sedatives are still used, antidepressants are playing an increasing role in the treatment of anxiety disorders.

Panic disorder, obsessive-compulsive disorder, PTSD and various phobic disorders are now known to respond to antidepressants that boost levels of the brain chemical serotonin. Prozac, Zoloft, Paxil and similar agents fall into this category. Side effects can include upset stomach, headaches or insomnia.

A different kind of antidepressant called venlafaxine is now used to treat generalized anxiety disorder. In some people, it has the side effect of nausea.

There is a good deal of interest in herbal remedies for anxiety, such as the plant extract kava kava. One German study found kava kava more effective than a placebo (sugar pill) in a mixed population of nonpsychotic anxious patients.

However, kava kava may worsen depression in some patients, cause skin reactions and interact with prescribed medications for anxiety. Thus, people suffering from severe or persistent anxiety should consult a physician, rather than choosing medicines on their own.

RELATEDS AT :

Anxiety disorders

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RELATED SITE:

Anxiety Disorders Association of America

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