Tuesday, January 5, 2010

Anxiety

This topic is inspired by a request. Whenever a reader, a friend or my family asks me to look into something, I take it very seriously. It helps when I am reading the medical or research journals to keep that person in mind. It makes it real.

Readers of this blog should know this about me by now, but I will explain again that I am almost always anti medication. You should know as well, that I make exceptions! The bottom line for me and medicine has always been this: The smallest dose that is effective - when their is more benefit than risk - to treat a condition that is life threatening or chronically disabling which cannot be ameliorated through other measures.

Anxiety is a chronically disabling condition which is most often triggered by stress. This is not fear, which is related to specific threats or conditions that usually have a clear start and end to them, but a physiological response to uncontrollable and unavoidable stresses that recur day after day. Uncontrollable response and Uncontrollable stimulus. That is important. The response is multifaceted and includes stomach upset, sweating, heart racing, being unable to focus, or being unable to think about anything but one's symptoms, feeling tired, having difficulty sleeping - and more. There is no medical test that can diagnose anxiety disorder, but tests are done to rule out other conditions that might cause similar symptoms.

Many times anxiety is treated with short or long acting psychotropics (drugs that act on the chemicals or neurotransmitters in the brain and central nervous system - mind altering drugs). These are medications with some of the worst side effect profiles and least effective research data available. Other than these top drugs the usual fare for treatment includes cognitive behavioral therapy- or talk therapy.

klonopin, xanax, ativan and valium are more short acting as needed drugs and
effexor, lexapro, zoloft, paxil and more are used long term and take longer to start working

I offer other suggestions tonight based on a Medscape article that was released last spring. The article I read references over 117 sources, most are peer reviewed research studies. I feel that the information I am sharing with you is appropriate and worth considering.

There were some things in the article that did not appeal to me, and this includes use of some supplements and vitamins, but I will tell you that there is clear evidence that some vitamin deficiencies and some food sensitives can cause stressful reactions in the body. A full panel blood assay should be conducted if one has these persistent physical and mental symptoms and a food elimination trial can be conducted to see if a specific food is causing problems. Without a doubt, alcohol, tobacco and other drugs can exacerbate this issue significantly.

All of the options for treatment are for reducing the stress or the response to the stress. I must iterate, anxiety disorder is an uncontrollable phenomena, but limiting and managing stressors IS possible.

Let us begin then with nutrition. Persons with this disease can ease their symptoms through a healthful diet that limits starchy and sugary foods, or foods with a high glycemic index. A diet that is high in vegetables, fiber, lean protein, fish and fruits is said to be best. It is important to avoid high and low blood sugars, so frequent small meals are suggested. This is also a way to make sure that adequate vitamin, mineral and nutrient intake is occurring. Exercise is also a known stress reducer and should be done consistently and near daily.

Also helpful, meditation, which involves either concentrating on something (word, phrase,action, object, etc) or being mindful about ones self (feelings, thoughts, sensation - from moment to moment over time). A technique you may be familiar with can also help. It is called relaxation training, and it is when you clench a muscle group real tight and then release, until you've worked your way down or up the body. Another helpful strategy which I have used with my clients is guided imagery, but here are three new-to-me ideas that I really liked.

Safe Place - the person imagines being in a certain place, either alone, or with others, in which they feel one hundred percent secure and reassured that nothing is wrong and nothing bad will happen.
Wise Guide- has the person tap into their own inner sense of wisdom and guidance, and
Caring Circle- is having an image of being surrounded by people who truly care for the individual and what only the best for them.
(all of these can be taught to the patient by clinicians who have had special training)

Others ideas that did not resonate with me include self hypnosis or autogenic training, and biofeedback (uses machines) mostly because I think there are better things. Many people do benefit from prayer and being a part of a religious community.

Another method for managing the stress is through journaling. I myself use a journal to write out both things that are concerning me and things that I have accomplished. Some clinicians debate the use of journals in regards to whether they should be used to capture negative or positive emotions, but I think they could be used to express both. A very helpful tool in this same theme is creative writing or what I have come to call staging. Here the person writes about a situation that is concerning them and creates a happy or positive ending to their scenario.

A few more: EMDR also known as eye movement desensitization and reprocessing (more for PTSD), Cranial Electrotherapy Stimulation (yes, just like it sounds), which requires equipment that insurance doesn't usually cover, massage and separately therapeutic touch, acupuncture, and environment (control what you can and try to avoid stressful people or media).

To summarize, anxiety disorder is a condition that is both biological and psychological but not imagined and not controllable. Medicines may be taken to ease some of the symptoms but other techniques which are far safer, can reduce the stress and or manage it. Today I have mentioned quite a few, but they ONLY work if YOU WORK THEM. If you don't like the concept you really won't be fair about it, so try a different one. The nutrition and exercise piece however, is pretty much a must do.

Now I realized that though one person asked me about this, several of my friends have talked to me about their conditions and the medications they do and do not take. I should not be surprised of my friends distress in that 10% of our children and nearly 34% of our adults experience this condition. I hope the information in today's blog is helpful to this group of people.

2 comments:

Emily said...

Thanks Deirdre! I appreciate the useful info.

Anonymous said...

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