Anxiety disorders can ruin sleep and waking hours

August 22, 2005|by Dr. Matthew Wagner

It has been said that we live in an age of anxiety. Anxiety disorders are the most common psychiatric problem in the United States.

But what do we mean by the term anxiety?

Anxiety has emotional and physical components. People who suffer from persistent anxiety feel nervous, uneasy and tense. They worry excessively. They worry about their safety or their family's safety. They worry about job performance, finances or health. Sometimes they worry about minor things.

Now, everyone has worries about everyday life. However, people with anxiety disorders find their worries are often impossible to control or put off until later. Worrying often is accompanied by physical symptoms. People with clinical anxiety often feel restless or edgy, have trouble concentrating and notice irritability or muscle tension. Sleep problems are common.

This kind of anxiety - generalized anxiety - causes a lot of distress and impairs a person's ability to function.


Another kind of anxiety problem is panic attack. Panic attacks are unexpected. People suddenly feel intensely fearful, agitated or ill. Within minutes, they may feel shaky, sweaty or dizzy. Often the heart pounds or skips a beat. Persons may feel chest pain or a choking sensation, nausea, numbness or tingling. Often, persons feel like they are dying or going crazy.

We have been taught to recognize many of these signs as those of a heart attack. Therefore, many panic attack sufferers end up in a hospital emergency room for evaluation. Once other physical causes have been ruled out, a diagnosis of panic disorder can be made.

This diagnosis might be hard for some people to accept because the experience has so many physical symptoms. Although we do not know what triggers panic attacks, it appears that the "emergency response" trigger in the brain goes off at needless or inappropriate times. In other words, in a real, life-threatening situation, panic symptoms are perfectly normal. But persons with panic disorder experience attacks while driving, shopping, sleeping and at other times.

It is hard for those of us who have never had a panic attack to appreciate how awful the experience is. Sometimes persons with panic attacks start to avoid any situation where they think another attack may occur. They are afraid of embarrassing themselves or being somewhere where help is not available.

In severe cases, persons might feel unable to leave their homes. This condition is called agoraphobia, a common complication of panic disorder.

Generalized anxiety and panic attacks tend to first occur between the teenage years and the early 30s. The course and severity varies widely from person to person. For some people, the symptoms will subside over several years but might return later in life. Other persons struggle regularly with their symptoms. Some people never seek treatment or try to manage their difficulties with self-help books or tapes.

For those who do seek treatment, the good news is that it is often quite helpful. An explanation from a professional of what an anxiety disorder is and what can be done about it often provides relief. Treatment should always include some sort of counseling or psychotherapy. A therapist can help a person develop strategies to reduce anxiety, such as learning relaxation techniques.

Often persons with anxiety and panic unintentionally add fuel to the fire by thinking frightening thoughts. This tendency can be changed with therapy, producing a decrease in the symptoms.

Other simple interventions include limiting use of caffeine, increasing exercise and developing good sleep habits.

Medications are sometimes needed if these approaches are not successful. There are two categories of medications for panic and anxiety: fast-acting and slow-acting. Fast-acting drugs such as Valium, Xanax, Klonopin and Ativan work quickly to "turn the volume down" on anxiety symptoms. However, they wear off quickly and may need to be taken several times a day. Some people may develop tolerance to the good effects leading to a need to increase the dose. Addiction to these medications might result, but this is quite uncommon in persons with anxiety disorders who have no other history of addiction.

Slow-acting medications include drugs that act on the serotonin chemical system in the brain. There are now eight different drugs in this class, called selective serotonin reuptake inhibitors or SSRIs. Some of the more commonly prescribed ones include Zoloft, Prozac, Paxil, Effexor, and Lexapro.

These medicines are usually taken once daily. They take several weeks to get in the system and improvement is often gradual. When they work well they can block panic attacks altogether and significantly reduce the experience of crippling worry and anxiety.

Common side effects are sexual problems, nausea or weight gain, but these can usually be managed. The choice of what kind of medication to use depends on side-effect differences and a person's own preferences.

In another article I will talk about some other anxiety problems, including social phobia, post-traumatic stress, and obsessive-compulsive disorder.

Dr. Matthew Wagner is a staff psychiatrist with Behavioral Health Services of Washington County Health System.

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