Episode 64: September 21, 2010
by Rob Lamberts, MD
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The next two articles will cover an area that takes up a lot of my time in practice: anxiety and depression. These two problems are not just mental health issues; their presence can also greatly affect a person’s physical health. Today I’ll focus on anxiety, although I will start out with some general principles around both of these conditions.
How Can You Tell If You Have Anxiety?
When discussing anxiety and depression, we first have to define terms because both words represent emotions and medical conditions. Anxiety, the emotion, is a normal part of life. If you see flashing lights in your rear-view mirror, you get anxious. Simply feeling anxious is not cause for medical concern. The same is true for the emotion in depression--sadness--which happens as a normal part of life.
Clinical anxiety and depression are not the same as the emotions, although the emotions are present. These are real medical problems that have a big impact on your life. Two things separate emotional states and clinical conditions: duration and severity. In order to “officially” diagnose clinical anxiety and depression, symptoms have to last more than three months and have a significant impact on the daily function of life (although in reality, they are often diagnosed before 3 months).
I’m going to leave depression for next week and focus on anxiety now.
What Is Anxiety?
So what is anxiety? Anxiety, the emotion, is a feeling of powerlessness or helplessness. If you had a magic button in your car that made the police car behind you disappear, the presence of those lights wouldn’t be so traumatic. It’s the inability to control things we think may hurt us that makes us anxious. When clinical anxiety exists, it makes life feel out of control...which creates more anxiety. That is perhaps the hardest thing about clinical anxiety: you get anxious about being anxious.
How Is OCD Related to Anxiety?
But anxiety takes many forms, many of which don’t look like anxiety. When a person feels out of control, they often find ways to compensate. A good example of this is obsessive-compulsive disorder, or OCD. Many people with OCD have something in their life--past or present--that they want to control but can’t. Perhaps they were abused as a child, or perhaps they’ve lost spouse or child. Their reaction is to control something that is in their power--like keeping their house clean, washing their hands, or locking the door. That attempt to control things becomes a compulsion--something they can’t stop from doing.
What Is Generalized-Anxiety Disorder?
Big anxiety--anxiety that casts a long shadow in your life--usually needs professional help.
Sometimes anxiety is a non-specific feeling of worry or dread, such as with generalized anxiety disorder. Anxiety can be very specific to situations, such as with phobias including fear of bugs, snakes, public speaking, heights, or water. I am not talking about people who don’t like bugs or snakes, I am talking about people who won’t leave their house or can’t sleep because of these fears. Sometimes the anxiety revolves around relationships, as is the case with social anxiety disorder, and sometimes the symptoms come in episodic flares, like with panic disorder. Finally, some people escape their anxiety using alcohol, drugs, or other addictions. That list is by no means exhaustive; the bottom line with these behaviors is that they are a reaction to the person’s vulnerability or helplessness.
What Causes Anxiety?
Like most illnesses, anxiety disorders are a mix of heredity and environment. Having a family member with clinical anxiety doesn’t guarantee you will have it, but it will make you more prone to trauma that can trigger clinical anxiety. But please hear me on an important point: anxiety has a reason. It’s not moral weakness or a lack of faith that makes people struggle. Unfortunately, people around those with clinical anxiety don’t know that, and often chide them to “just don’t worry so much.” That adds the emotion of shame to the struggle with anxiety, and it is unnecessary. People with anxiety disorders don’t wake up and decide that they will be anxious. They would love to stop, but can’t.
How to Cope with Anxiety
So what can be done about anxiety? Here are my Quick and Dirty Tips for dealing with anxiety.
Tip #1: Don’t feel ashamed. I wouldn’t blame you for bleeding if I threw a brick at you, and most people dealing with anxiety have had emotional bricks thrown their way.
Tip #2: Look for root causes. Usually there is something from the past that hasn’t been dealt with that you are either trying to escape from or resolve. Understanding why you feel the way you do helps a lot in trying to overcome it.
Tip #3: Talk to someone. If the anxiety is not too big, talking to a friend, family member, or religious leader might help. But big anxiety--anxiety that casts a long shadow in your life--usually needs professional help. Find a counselor who has been trained to treat anxiety. You shouldn’t be ashamed for seeking help; it’s a much worse thing to run from your problems.
Tip#4: Take medications if needed. There are two main kinds of medications for anxiety: ones that last a short time, and ones that you take every day. The shorter-acting medications are usually medications like Valium or Xanax, which can be addictive if used too often. If you need one of these medications more that a few times a week, you should probably consider getting on a preventive daily medication, like Paxil or Zoloft. These medications don’t fix the root problems causing your anxiety, but they do steady your emotions enough that you can face those bigger anxieties that lurk in the shadows.
I’ll stop here for now. There is a whole lot more I could say, but I just wanted to give an overview. Next week I’ll cover anxiety’s cousin: depression.
Let me once again remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!