May is Mental Health Awareness Month! If you feel stressed, you are not alone! Forty million Americans (about 18 percent) have an anxiety disorder. Federally Qualified Health Centers are known for having integrated services that include behavioral health providers who work closely with primary care providers. This month I have asked our behavioral health nurse practitioner Julie McGuire, APRN, and our social worker Monica Kaufman, LCSW for an update on anxiety.
Anxiety disorders are the most common types of mental health disorders in developed countries, according to the Centers for Disease Control and Prevention. Anxiety disorders include panic disorder, obsessive compulsive disorder, generalized anxiety disorder, and post-traumatic stress disorder (PTSD) along with several others.
Anxiety and panic attacks can be both debilitating and terrifying for the individual experiencing them. People often become desperate to alleviate the sensations associated with anxiety and panic and turn to alcohol or illegal drugs. However, the most effective treatment for sustained relief from anxiety and panic is behavioral therapy.
Many people mistake panic attacks with heart attacks and often make frequent visits to the ER. Common physical sensations during a panic attack include heart palpitations, chest pain, dizziness, feeling disoriented, sweating, blurred vision, shortness of breath, nausea and shaking.
Anxiety disorders are the result of negative thoughts and excessive worry. For example, an individual with panic disorder may begin to fear having panic attacks in front of others. They may fear that having a panic attack will lead others to believe that they are “crazy,” and fear rejection. Because of this belief, the individual will stop going out in public, and may start to avoid going to the grocery store during busy times. Individuals with anxiety and panic often live in a world of fear that eventually becomes smaller and smaller if their anxiety is untreated.
It is easy for an anxious person to get caught up in the “worry cycle.” The worry cycle begins with a concern or fear. The individual often gets caught in a continuous loop of worried thoughts that begin with “what if…”. The “what if” thinking often leads to physical symptoms such as nausea, shaking, heart palpitations and shortness of breath. These sensations intensify the anxiety the individual is experiencing, and they are less able to think rationally.
In behavioral modification therapy, therapists help individuals with anxiety change the way they think about situations and analyze the probability of the feared event happening. Anxious individuals realize that they do in fact have control over their thoughts and actions. Therapy helps people learn how to relax and to decrease the physical symptoms that come with anxiety. Learning to practice progressive muscle relaxation, meditation and deep breathing can be useful skills in decreasing and managing anxiety.
The most complete relief from anxiety disorders is often achieved with a combination of behavioral therapy and medication. Anti-depressants are actually the first line and best medication for anxiety disorders. Many people feel confused by the name — “But I am not depressed!” Anti-depressants assist in providing 24-hour relief from the distressing symptoms of anxiety, such as restlessness, being keyed up and on edge, irritability and sleep disturbances. Some common names of anti-depressants used to treat anxiety and panic are Paxil, Prozac, Celexa, and Effexor.
Benzodiazepines are also used to help with panic attacks. The benzodiazepine class of medications includes Xanax, Valium, Ativan, and Klonopin. They can be considered rescue medications for severe panic attacks, and are usually indicated for short-term crises and to provide fast acting relief until longer-term solutions are in place. Benzodiazepines are typically not used without an anti-depressant for long-term medication therapy. These medications carry risks of tolerance, dependence, and addiction. They can also cause treatment-induced anxiety and can be difficult to manage long term.
Depending on the reasons for the anxiety, situational vs. more chronic conditions, medications may be used for a short time, or many years for chronic anxiety. Anti-depressants are quite safe overall for long-term use, but the risks and benefits of medication management should always be discussed at length with your primary care provider to determine if medications are right for you or your loved one.
If you notice that you feel like you’re “going crazy” and have begun to avoid more and more things that make you uncomfortable or nervous, you could have anxiety. The first step toward recovery is to discuss your situation with a mental health professional. Your primary care provider (PCP) can help you get plugged into the appropriate therapy for your individual situation. Don’t fret unnecessarily — don’t be embarrassed to seek help!
Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (which is closely affiliated with Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com