What is Generalized Anxiety Disorder?

Generalized Anxiety Disorder (GAD) is overwhelming anxiety involving excessive worrying that is difficult to control.  The ruminations usually are over multiple every-day events and issues, and often interferes with solving the very problems being worried about.   Generalized anxiety is usually associated with irritability, muscle tension, a sense of restlessness or being on-edge, and difficulties sleeping.  Understandably, generalized anxiety disorder also often includes symptoms of excessive fatigue and difficulties focusing.  At least 6 months of symptoms that lead to decreased functioning need to be present to fulfill a formal diagnosis.  Generalized anxiety disorder is quite common, with an estimated lifetime prevalence of 5.7%- 14.8% in the United States (Arch Gen Psychiatry 2005 Jun; 62(6):593; Arch Fam Med 2000 Sep-Oct;9(9):876).

Around 60% of people suffering from generalized anxiety disorder also suffer from clinical depression (Am J Psychiatry 1999 Dec;156(12):1915).

GAD is associated with a much higher risk of suicide in young adults aged 16-25 years (Psychol Med 2007 Mar;37(3):431).  Substance abuse is also increased in people suffering from GAD.

Traditional Treatments for Generalized Anxiety Disorder

Cognitive behavioral therapy (CBT) can be very helpful in the treatment of generalized anxiety disorder.  CBT trains patients to use techniques to reduce their physical anxiety, such as progressive muscle relaxation, breathing retraining, and mindfulness meditation.  Patients are asked to log their worries throughout the day and are trained to reassess/question their thought patterns.  Sometimes, patients are asked to write down narratives of their worries and to review them repetitively until their anxiety dissipates; this is called exposure and habituation.

While hypnotic medications and antidepressants are often effective in treating generalized anxiety disorder,  medications such as Valium (diazepam) and Xanax (alprazolam) can sometimes result in abuse and dependence, and antidepressants can be insufficient.  For example, a 2003 Cochrane review suggested that 5 patients with anxiety need to be treated with an antidepressant in order for one to demonstrate significantly diminished symptoms (Cochrane Database Syst Rev. 2003;(2):CD003592).

Transcranial Magnetic Stimulation:  A Potential Future Treatment for Generalized Anxiety Disorder

Bystritsky and colleagues recently conducted a  study that showed promising preliminary results for the treatment of generalized anxiety with low frequency transcranial magnetic stimulation on the right side of the head overlying the frontal lobe (J Clin Psychiatry. 2008 Jul;69(7):1092-8).  After 3 weeks of treatment there were significant reductions in anxiety symptoms.  Six months later, follow-up interviews of the same patients demonstrated persistent benefits from the initial TMS treatment J Clin Psychiatry. 2009 Mar;70(3):431-2.  This is very exciting news, but because this study is preliminary with only 10 participants, more research is needed to completely clarify the effects of TMS on generalized anxiety.

Depression and generalized anxiety disorder commonly co-occur.  If you or a loved one are suffering from clinical depression as well as anxiety,  Transcranial magnetic stimulation (TMS) is an FDA-approved treatment for depression that can help not only the depression symptoms, but also the anxiety symptoms.

If you found this post on generalized anxiety disorder informative, take a look a our post on ECT and TMS.

The Pros and Cons of Social Anxiety Medication

Social anxiety disorder (SAD), or social phobia, is one specific type of anxiety disorder characterized by intense fear in social situations. SAD goes beyond normal “shyness” and often leads to excessive social avoidance, which can cause significant issues in social or occupational environments.

People with social anxiety disorder are typically afraid that they will make a mistake and be embarrassed or humiliated in front of others. A lack of social skills or experience in social situations can make this fear worse. Sometimes, the anxiety can escalate into a panic attack. To help with these problems, some people turn to social anxiety medication.

Before undertaking a treatment plan that includes social anxiety medication, however, it would be useful to consider the positives and negatives of this route.

The pros of social anxiety medication

The are a number of positive aspects of taking social anxiety medication, including the following:

• Convenient: Once a social anxiety medication has been prescribed, it is relatively easy to follow through on the treatment plan. One only needs to remember to take a pill, and there is very little time or effort involved.

• Often effective: Once a satisfactory dose has been achieved, social anxiety medication can make a big difference in terms of “taking the edge off” your anxiety or panic attacks. One common group of social anxiety medication prescribed is the benzodiazepines, which smooth out muscle tension and shakiness caused by anxiety.

• Variety of choices: Several different classes of drugs exist, with slight differences in both mechanism of action and resulting effectiveness. Because of this, it is possible that if a particular line of social anxiety medication treatment is not effective, a different one may produce better results. For example, a beta-blocker medication, such as propranolol, can also help relieve the physical and emotional symptoms of SAD, especially performance anxiety.  Beta blockers are commonly used to lower blood pressure, so it is important that you have a doctor monitor your treatment while taking this drug.

• Availability: Because many anxiety medications are also used to treat depression, most pharmacies in the U.S. keep a supply on hand.

The cons of social anxiety medication

As with any drug treatment, taking social anxiety medication can also have a number of down sides. These include the following:

• Tolerance to some medications can build up over time: If benzodiazepines are being used as social anxiety medication, they are usually only meant to be a temporary solution, and taking them on a regular basis may build up one’s tolerance. This may lead to the need for doctors to prescribe higher dosages to get the same original beneficial effect.  The good news is that there are other medications which do not cause tolerance to develop, that can also be used to treat social anxiety disorder, such as serotonin-reuptake inhibitors (SSRI’s).

• Associated with a variety of side effects and potential complications: Stomach issues, weight fluctuations, sexual side effects and shakes or tremors can sometimes be associated with social anxiety medications.

• May have adverse effects if mixed with other drugs: You should avoid consuming alcohol or street drugs while taking social anxiety medication.  Social anxiety medication can sometimes interact with other prescription drugs, so it is important to tell your doctors all of the medications you are taking at each visit.

• A possible, blunted, state: Described at times as a passionless mood, patients say that in addition to limiting their ability to feel anxiety, sometimes social anxiety medication also limits their ability to experience the natural joys of life. In effect, they feel numb to all strong emotions.

It is important to note that there are very common treatment options for SAD that do not involve any form of medication for social anxiety. Cognitive Behavioral Therapy (CBT), particularly group CBT for social anxiety, can be extremely effective

SAD significantly increases the risk of developing a mood disorder, such as clinical depression, and having both SAD and depression simultaneously can make it much harder, though certainly not impossible, to effectively treat either illness.

If depression persists despite psychotherapy like CBT and social anxiety medication, consider TMS, or transcranial magnetic stimulation, a new non-drug FDA approved treatment for depression that is effective, non-invasive, and safe.

If you found this post on social anxiety medication interesting and want to learn more about other behavioral health issues, please check out our next post on mood disorder.

WHAT IS PTSD?

Posttraumatic stress disorder (PTSD) is a potentially disabling anxiety disorder.  People who have PTSD have experienced intense fear, terror or hopelessness in response to a traumatic event that was life-threatening or that threatened their physical integrity (eg, war trauma, accidents, victimization from a crime, torture, rape, sexual molestation, severe emotional cruelty).  If you suffer from PTSD, you are not alone.  PTSD affects millions of people annually, with the lifetime prevalence of PTSD being 7.8% in the United States (Kessler et al 1995).

PTSD involves at least 1 month of symptoms characterized by (American Psychiatric Association, DSM-IV-TR, 2000):

• Emotional re-experiencing of the traumatic event, which triggers significant feelings of fear and anxiety.  This can include intrusive, recurrent thoughts, images, and/or nightmares of the trauma.  Sometimes, patients with PTSD experience flashbacks, which are periods of time when they relive the trauma while dissociating from reality, and can include hallucinations. These symptoms are usually triggered by traumatic reminders, which can be as obvious as encountering the assaulter or visiting the site of the trauma; sometimes, however, re-experiencing can be activated by more elusive associations with the trauma, such as smells, sounds, textures, subtle images, etc.
• Avoidant Behaviors.  Due to the extreme anxiety traumatic reminders can spark, instead of processing the trauma, often PTSD sufferers end up detaching from their friends and family, and avoid potential triggers.  All too often, this results in a very limited existence; especially if traumatic reminders include motor vehicles, crowded places, specific people, work, and even sleep.  Often family and friends see victims as being œchecked out and emotionally numb.
• Ongoing Symptoms of Hyper-Arousal.  This can include symptoms of:  Insomnia – Difficulties falling or staying asleep, either due to a fear of having a recurrent nightmare, or to being roused by a nightmare, is common in PTSD.  Insomnia can be a problem in PTSD even in the absence of nightmares.  Irritability, depression, anger or rage – Difficulties focusing, and impaired or fragmented memory.  Hypervigilance – PTSD sufferers commonly are on alert for another traumatic event and frequently expect to have a shortened lifespan.  Exaggerated Startle – Patients are often very œjumpy, especially if surprised by an unexpected pat on the back or approach from behind.

While most trauma sufferers develop PTSD soon after the trauma, it is possible to develop PTSD decades after the insult (Andrews et al; Smid et al 2009).  Interestingly, most people who experience a trauma do not develop PTSD. Only between 10-20% of trauma victims develop PTSD (Breslau N et al, 1998; Breslau N, 2009).

What makes someone more at risk for developing PTSD after a traumatic event? (Brewin, et al 2000)

• Female gender
• Limited emotional support
• Exposure particularly to violent trauma
• Witnessing the death of a family member or loved one
• History of a psychiatric diagnosis
• Family history of psychiatric illness, and
• History of early adversity (eg, death of a parent during childhood)

What makes people less vulnerable to PTSD after experiencing a trauma?

People who experience trauma and do not develop PTSD often reach out to a reliable support system of friends and family, and access trauma support groups, where they use the opportunity talk about — and process — their traumatic experiences. When reflecting on their actions during the trauma, they tend to be able to acknowledge their resilience in the face of trauma; this may  reaffirm their sense of being competent in an unpredictable world, rather than helpless.

There are many treatments for PTSD, including support groups, exposure therapy, EMDR, and medications.  Studies indicate that Transcranial magnetic stimulation, or TMS, a non-invasive outpatient treatment involving magnetic waves, is another promising non-drug approach to PTSD treatment.

If you found this post on PTSD interesting, check out our other posts on behavioral health, including one on protected time.

Anxiety Treatment Can Help

Anxiety is a normal part of life;  We all need a little anxiety to motivate us to move from one task to another, such as getting out of bed on time to get ourselves to work, organize a holiday party, or plan a trip.  We need healthy levels of anxiety to force us out of complacency and propel us into action.  Even the “flight-or-flight” response we experience when in true danger, such as when being chased by a lion, is essential to our adapting to situations in a ways that increases our chances of success or survival.

Anxiety is pathological, however, when it is experienced in situations that do not warrant impulsive action or a stress response.  Excessive anxiety not only leads to discomfort or fear when one should feel at ease or safe, but it often leads to unnecessary avoidances of many life experiences.  Pathological anxiety, in its many forms, can be a tough condition to cope with on a day-to-day basis due to its combination of emotional and physical symptoms. In most cases, anxiety begins with some type of mental trigger, and then symptoms begin to spread, creating physiological reactions throughout the body. It is important to recognize, however, that while anxiety disorder symptoms can be serious and uncomfortable, relief is possible with appropriate treatment. There are many different types of anxiety treatments available, and these approaches can be tailored to specific symptoms and needs.

The most important step an individual with chronic anxiety can make is to actively seek anxiety treatment. There are a variety of management options available:

Types of anxiety treatment

The different anxiety treatment approaches usually fall into one of three categories medication, psychotherapy, and alternative/complementary therapies.

Medication is frequently used as an anxiety treatment in order to alter chemicals in the brain involved in stress. Benzodiazepines, for instance, effect brain cell receptors in a way that reduced brain excitation and results in muscle relaxation, reduced worrying, and — at higher doses — increased sleep.  Benzodiazepines are anxiety treatments that are potentially habit-forming, so it is important to avoid changing your doses without guidance from your physician.  Serotonin-reuptake inhibitors, such as Paxil (paroxetine) and Prozac (fluoxetine), are also utilized extensively in anxiety treatment, as well as antidepressants.

As far as non-medication anxiety treatment, cognitive behavioral therapy (CBT) is frequently effective. Anxiety sufferers are taught, through CBT, to recognize the particular thoughts and behaviors that lead to feelings of anxiety and tension. The goal is to teach the person to manage triggers of anxiety in a step-wise fashion, slowly developing confidence in their ability to cope, as well as increased habituation to situational triggers of their anxiety.

Further, there are a few alternative and complementary options to anxiety treatment. Some of these are herbal remedies and the use of mind-body connections.  Acupuncture is also a very effective approach to excessive anxiety management.

Another non-medication option that is increasing in popularity is Transcranial Magnetic Stimulation (TMS). TMS is an FDA-approved treatment for clinical depression that uses noninvasive MRI-strength magnetic pulses generated from outside of the head to improve the function of very specific parts of the brain. This happens without direct physical contact with the brain or circulatory system. One of the primary advantages of TMS is its lower side effect profile, especially when compared to prescription drug therapies.  While the FDA-approved protocol for the treatment of depression currently involves left-sided high-frequency TMS, the application of low frequency TMS to the right side has been shown to help reduce anxiety and depression symptoms.

Combining Different Approaches to Anxiety Treatment

It is a good idea to take a œteam approach to anxiety treatment. Many successful courses of anxiety treatment combine several different options. This can be particularly effective if healthcare providers — including therapists, psychiatrists, and internists — stay in contact with one another.  A successful integration of one or more of these anxiety treatment options will maximize the chances for a life free of excessive levels of anxiety.

If you are at the point of seeking anxiety treatment, it is likely that you have endured symptoms for an extended period. Try to keep in mind what life was like before the anxiety disorder, as this can motivate you to undertake and maintain an anxiety treatment plan. Anxiety treatment can be successful, but it is up to you to take the first step.

If you feel that you may be experiencing depression related to anxiety and would like to seek  anxiety treatment, West Coast TMS Institute in Sherman Oaks, California is available. Feel free to contact us if you feel you may be experiencing some symptoms of anxiety or mood disorder and would like to set up a consultation for possible depression and  anxiety treatment.

If you found this post on anxiety treatment interesting and want to learn more, please check out our next post on social anxiety medication.

The Most Common Symptoms of Anxiety

The Most Common Symptoms of Anxiety 

Some degree of anxiousness is a regular part of our day-to-day lives. Any time a new challenge is faced, such as a first date or a job interview, a bit of nervousness and apprehension is to be expected. When symptoms of anxiety are detached from specific events and become pervasive a challenge to be faced on daily basis anxiety can become a very disruptive presence in a person’s life, especially when it comes to social anxiety disorder symptoms.

Clinically diagnosed anxiety, referred to as General Anxiety Disorder (GAD), is characterized by long-lasting symptoms of anxiety that are not focused on any one object or situation. A diagnosis of GAD is made when a person has been excessively worried about an everyday problem for six months or more.

About four million adult Americans suffer from GAD during the course of a year. It most often begins in childhood or adolescence, but can also start in adulthood. Symptoms of anxiety are more common in women than in men.

Psychological or emotional symptoms of anxiety

Many of the psychological or emotional symptoms of anxiety are experienced regularly in an average person’s daily life. When these symptoms are experienced without provocation, or when the symptoms lead to a response that is out of proportion with what might be normally expected in a situation, GAD is often the cause.

Some of these symptoms of anxiety are:

• Irrational or excessive fear or worry
• Anticipating the worst outcome of any given situation
• Trouble concentrating and holding a thought
• Constantly looking for signs of danger or stress
• Feeling tense or irritable

Physical symptoms of anxiety

Anxiety is a product of the body’s “fight-or-flight” response, and induces many physical symptoms. Sometimes these physical symptoms of anxiety lead sufferers to mistake their disorder for a medical illness. They may visit many doctors and make numerous trips to the hospital before their anxiety disorder is discovered.

Some of these symptoms of anxiety are:

• Heart pounding and shortness of breath
• Sweating
• Muscle tension and tremors
• Headaches
• Nausea and/or dizziness
• Frequent urination or diarrhea
• Fatigue

The presence of some or all of these symptoms is what lead sufferers to seek medical assistance. Once at a doctor’s office, their doctor will work to establish a medical/family history while also performing a physical examination. There is no specific medical test to determine if a patient does have anxiety disorder, but this exam may discover other medical conditions that may be contributing to how the patient is feeling.

Treating symptoms of anxiety

Anxiety disorder is often accompanied by feelings of depression. Many of the symptoms of anxiety are nearly the same as the symptoms of depression. It is believed that both conditions are the result of similar physiological causes. Because of this, treatment for symptoms of anxiety is very similar to that of depression and comes in two primary forms medication and cognitive behavioral therapy (CBT).

Drugs are prescribed for anxiety typically when symptoms are inhibiting one’s ability to function on a daily basis. The family of drugs often prescribed is the benzodiazepine family. These medications do have the potential for dependence; therefore, it is important to work closely with your doctor when taking them. These are also called tranquilizers, as they smooth out the muscle tension and restlessness caused by anxiety. More straightforward antidepressants, such as Paxil and Prozac, have also been used in treating symptoms of anxiety.

As part of CBT, people displaying symptoms of anxiety are taught to recognize the types of thoughts and behaviors that lead to feelings of anxiety and tension. The goal is to teach the person to identify symptoms of anxiety while they are mild in order to avert a full-blown anxiety-induced event.

If you feel that you may be experiencing depression related to symptoms of anxiety, West Coast TMS Institute, located in Sherman Oaks, Los Angeles, is available to help you.  Our medical director has expertise in both the medication and a new non-medication treatments for depression and can provide you with a comprehensive psychiatric evaluation. Contact us if you feel you may be experiencing some symptoms of anxiety and would like to set up a consultation for possible anxiety treatment.