Today a patient came in because she’s been feeling anxious because she’s had some heart palpitations. She’s seen a cardiologist (heart specialist) and learned that the abnormal heart rhythm is intermittent atrial fibrillation (a usually non-dangerous rhythm) that has likely been brought on by the increased stress and lack of sleep lately. When she gets the heart palpitations, she becomes more anxious, and the more anxiety that she experiences, the more heart palpitations she has. To her, it feels like an endless cycle that will never end.
This patient’s anxiety is understandable. We all experience stressful or potentially anxiety provoking details that occur in our lives. How we deal with these thoughts and events is critically important because it often determines how we function from day to day.
Feeling anxious can be a normal response to a stressful situation. The adrenaline rush after we learn that a bear is in our campsite might help us escape the dangerous situation. Feeling anxious for most of the day for long periods of time however is not normal.
Symptoms: Excessive worry or feelings of dread or being “on edge” may contribute to daily fatigue, and muscle tension. Other common symptoms may include headaches, hives, heart burn, constipation, diarrhea, abdominal pain, chest tightness, difficulty sleeping, memory problems and an increase or decrease in appetite. Sometimes a patient might have depression along with anxiety.
Often patients come in to talk with me about treatment for their anxiety with medications. I understand that feeling anxious is not particularly desirable, however in many circumstances, it’s normal. Treating the anxiety is often most effective by addressing the anxiety provoking situation rather than masking the symptoms with medication. Once the medications wear off, the anxiety returns and the cycle repeats itself.
I think it’s important to distinguish the difference between anxiety and an anxiety disorder. People who have “normal” anxiety may have worries from time to time, but these feelings do not interfere with daily life. An example might be a parent worried about their child who is late coming home from a date. I’m sure you can think of many other examples. People with an anxiety disorder are often worried or anxious about a number of events or activities and these worries are out of proportion to the situation. A parent might worry excessively about their child’s safety even when the child is at home with the family. An anxiety disorder can make routine activities difficult to complete. There are certain criteria that need to be met in order to make a diagnosis of an anxiety disorder and it’s my opinion that only a qualified health mental professional with training in anxiety disorders such a psychologist should make this diagnosis.
Treatment: Usually we tailor the treatment to the individual patient and what is causing the anxiety. If the anxiety is caused by a certain life event, then learning how to address the feelings and concerns related to the event is often the most helpful way to decrease the anxiety. Individuals who suffer from an anxiety disorder often require more treatment than those who have anxiety from stressful life events. Some possible treatments for anxiety might include:
1) Cognitive Behavioral Therapy (CBT): CBT focuses on the person’s behavior and patterns of thinking. The therapist helps teach you how your thoughts contribute to your anxiety and how to decrease these negative or unpleasant thoughts when they occur.
2) Eye Movement desensitization and reprocessing (EMDR): A particularly effective technique being used by psychologists who have had specialized training. One of the procedural elements is “dual stimulation” using either bilateral eye movements, tones or taps. During the reprocessing phases the patient attends momentarily to past memories, present triggers, or anticipated future experiences while simultaneously focusing on a set of external stimulus. During that time, clients generally experience the emergence of insight, changes in memories, or new associations. The clinician assists the client to focus on appropriate material before initiation of each subsequent set.
3) Medications: If medication is used to treat anxiety, you will need to see a primary care provider or psychiatrist. If a patient has an anxiety disorder however, my opinion is that the patient should also be treated by a mental health provider such as a psychologist and/or psychiatrist. Medications used to treat anxiety may include:
- Antidepressant medications such as SSRI or SNRI. Examples of these medications include Fluoxetine, Citalopram, Paroxetine, Fluvoxamine, Sertraline, Escitalopram, Venlafaxine, Duloxetine, Desvenlafaxine, and Milnacipran.
- Buspirone is an antianxiety medication used to treat anxiety disorders
- Herbal medications such as kava kava and valerian have been used. Kava Kava however has been linked to liver failure and is not recommended. There is not enough evidence to show whether herbal medications are effective or safe for treating anxiety disorders. Make sure to tell your medical provider if you are taking herbal medications
- Benzodiazepines such as Alprazolam, Chlordiazepoxide, Clonazepam, Clorazepate, Diazepam, Flurazepam, Halazepam, Lorazepam, Oxazepam or Prazepam are sometimes prescribed for short-term use only. Because of the addictive nature of these medications, and because of safety concerns, I generally do not prescribe these medications frequently
If you or someone you know is suffering from an anxiety disorder (in contrast to experiencing anxiety as part of a life event), I strongly recommend that you seek help from a qualified mental health professional. Sometimes it can be challenging to know whether the anxiety you experience is the result of a “life event” or an actual disorder. Most primary care providers can help you determine this or refer you to a mental health professional if further diagnosis is needed.
To find a Psychologist in your area, you may use the American Psychological Association Psychologist Locator website: http://locator.apa.org/
Helpful links for additional reliable anxiety related mental health information:
National Library of Medicine (www.nlm.nih.gov/medlineplus/anxiety.html)
National Institute of Mental Health (www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml)
National Mental Health Association (www.nmha.org)
Anxiety Disorders Association of America (www.adaa.org)
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO
Doctor Rennie's Blog 