Monday, May 20, 2019

More Than Anxious


This blog is not intended to diagnose, treat, cure, or prevent any disease.  It does not replace the medical advice of a physician.  The readers should regularly consult with their primary care practitioner in matters relating to health, disease, any symptoms, medications, and supplements. The information on this site is for educational purposes only. It is recommended you speak with your primary care provider before making any changes regarding your health. 

MORE THAN ANXIOUS

I had a request to write a post on anxiety.  I thought it was a great idea since chances are either you or someone you have interacted with today suffers from anxiety.  May is actually Mental Health Awareness Month, so there is no time like now to discuss this.

Anxiety is one of those illnesses that is difficult to understand unless you have been there.  Some anxiety sufferers have been told, "It's all in your head!"  Well, if what they mean by that statement is that there is a malfunction in the nervous system (especially the brain), then I guess they are correct since the brain resides in our heads!  However, usually that statement is suggesting that you just need to change your thinking and get over it.  This post is not only for those who are dealing with anxiety but also for the lucky ones who are not.  Chances are if you do not have an anxiety disorder, then you know someone who does.  

Anxiety101

Approximately 40 million adults suffer from anxiety in the United States, making it the most common mental illness.  That means nearly one in five of us have this common disorder.  The interesting thing though is that less than 40% receive treatment.

You may have felt anxious a time or two (or more!) for various reasons.  As you may be aware anxiety symptoms include: feeling tense, restless, nervous, having a sense of impending doom or panic, increased heart rate, trembling, sleep problems, gastrointestinal symptoms, and avoiding things that trigger anxiety.  If you feel some of these symptoms before a test or a performance that may be normal.  However, when it is interfering with your work, relationships, or every day activities, that may be a sign that it is time to see your doctor. 

Is it possible that the reason for less than half of those with anxiety not seeking treatment is due to the stigma attached to mental illness?  They may think that they should be able to think or pray their way through it.  Some are told if they ignore it, it will go away.  The fact that anxiety can be caused by genetics, trauma, and biological factors (just like other illnesses), can make it difficult for it to just go away if ignored.   It may even be a sign of other conditions such as hyperthyroidism. Therefore, it is important to see your doctor if you suspect you may be suffering from anxiety.  It can often times be diagnosed by your primary care practitioner (PCP) based on your symptoms and ruling out other conditions according to DSM-5 criteria.  Sometimes you may be referred to a psychiatrist for diagnosis. 

It's Just In Your Head - well, sort of!

The pathophysiology behind anxiety is quite vast.   The brain is a complex organ to say the least! Here are a few things that may be disrupted causing anxiety disorders.

1.      Neurotransmitters (serotonin, dopamine, GABA, and others) may not be at healthy levels, affecting our mood.  That is how some anxiety medications work – by altering the levels of these neurotransmitters. More on that later. 
2.      The way we process amino acids (proteins) can affect our levels of neurotransmitters. One may have a genetic predisposition that disrupts this process leading to certain conditions like anxiety and depression.
3.      There are also structures in the brain that may not be working properly and trigger anxiety, such as the amygdala.  This set of almond size neurons deep in the brain processes emotions and is responsible for how the body reacts to fear. Experts believe many types of anxiety disorders are due to its malfunctioning.  Sometimes a mental stressor (such as abuse) or a physical stressor (such as an infection) is enough to cause the amygdala to not work properly.
4.      The hippocampus is another part of the brain that is important in processing emotions.  In addition, it processes long-term memories.  It is often found to be smaller in those who suffered abuse as a child and in some people with depression. There is a link between stress and a smaller hippocampus which is tied to anxiety disorders.

      The point is that there are physical causes for a mental illness!

Types of Anxiety Disorders

There are many kinds of anxiety disorders:  Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Panic Disorder, Post Traumatic Stress Disorder (PTSD), and specific phobias.  You may recognize some of them.  I’m not going to go into details about each one, but more information can be found at the Health and Human Services website.

Treating Anxiety

So what can be done about anxiety?  There are a variety of medications, natural remedies, and lifestyle adjustments that can help manage this illness.

Let’s look at some conventional methods first.
·        Antidepressants (mostly SSRIs– selective serotonin re-uptake inhibitors) are used commonly to treat anxiety.  They work by stopping the re-uptake of serotonin therefore increasing serotonin which is one of our feel good neurotransmitters.  They are usually taken once a day and usually a difference is seen in a few weeks.  Many people are on these long term. There are side effects such as (but not limited to) insomnia, drowsiness, nausea, decreased libido, headache, blurry vision.  Not everyone has side effects and some may go away after a few weeks.  An interesting fact about serotonin is that there are more serotonin receptors in our gut than there are in our brain.  That is why many people with irritable bowel syndrome may also have depression/anxiety.  There is a lot of interesting research out there now about the gut-brain connection.


·          Besides SSRIs, there are also benzodiazepines, sedative type medications that help increase GABA.  These may be prescribed short term.  They are addicting and are not meant to treat anxiety long term.

·        Cognitive Behavioral Therapy (CBT):  This involves working with a qualified counselor to help identify faulty thoughts and come up with solutions. 

There are some herbal and other supplement remedies as well.  Keep in mind that these can also have side effects and interfere with certain medications, so you need to do your research and inform your doctor if you are thinking of going this route.
 According to the Mayo Clinic, the following are a few herbal remedies that have shown some effectiveness for anxiety in clinical studies.

·        Kava:  appears to be promising, but there is controversy over reported cases of serious liver damage.  Use caution.

·        Passion Flower: often combined with other herbs; generally considered safe

·        Valerian: generally considered safe; not recommended for longer than a few weeks since long term safety studies are lacking

·        Chamomile: generally considered safe; can increase the risk of bleeding; caution with blood-thinning medications; possible allergic reactions of you are allergic to other plants in chamomile family such as ragweed, chrysanthemums, marigolds, daisies

·        Lavender: may cause constipation, low blood pressure, and increase sedative effect of other medications or supplements; may reduce anxiety when used as aromatherapy
·        Lemon Balm: generally well-tolerated; may cause nausea, abdominal pain

Here are a couple of other supplements used for anxiety.

·        L Theanine: This is one of my favorites for calming all of that “mind chatter.”  Some of you might be laughing because you know what I’m talking about.  Sometimes my brain does not stop.  Even if I’m resting, I’m still thinking!  L theanine is an amino acid and is needed for the body to make GABA (the calming neurotransmitter).  It is found in green tea and can be taken as a supplement on an empty stomach.  One of the benefits is that it is not sedating.

·        CBD Oil: The endocannabinoid system is found in many parts throughout the body—one of which is the amygdala (mentioned above).  CBD oil is discussed extensively in my April 2019 post.

A few simple lifestyle changes may ease anxiety.  Here are a few helpful tips.

·        Physical activity can be beneficial.  Of course do something you will enjoy.  You don’t have to join a gym if that’s not for you.  A simple walk can do wonders.  Walk and vent with a friend who will listen and then follow that with a cup of green tea (preferably decaf). J

·        Deep breathing exercises:  This is something you can do anytime, anywhere and no one even has to know.  You may be sitting at your desk at work or driving down the highway.

·        Sleep: Sleep is important for restoring our bodies and filling up our stress tanks.  When we cut ourselves on sleep we can deplete ourselves of important chemicals necessary to help balance our mood.  Here guidelines on good sleep hygiene from the CDC.

·        Meditation:  Some think of monks or chanting when they hear the word meditation.  That doesn’t have to be the case though. There are all kinds of ways to meditate.  Some types of meditation include guided imagery and mindfulness. Or you can focus on a specific word or scripture. Sometimes I just like to sit on the porch, close my eyes, and focus on all the different sounds of birds chirping. Yes, meditating can be overwhelming for those that are constantly active physically or mentally, but you will be surprised at the benefits after just a few short weeks of practice.  Checkout some meditation apps such as Calm and Insight Timer.

·        Yoga or gentle stretching.  If you are not sure where to start check out some videos online.

·        Journaling:  Writing down thoughts and struggles can be calming.  Keep a journal at your bedside and if thoughts are keeping you from going to sleep, write them down to get it off your chest.  Others benefit from focusing on the positive by keeping gratitude journals.


Final Thought

Thinking good, positive thoughts can do wonders for the body, but sometimes it may not be enough when it comes to anxiety disorders. If you are battling an anxiety disorder and someone tells you just to think differently, you may want to respond by telling them to just think differently when their appendix is ready to burst! Would you be ashamed if your appendix burst and you needed treatment?  Of course not, so it goes with a mental disorder.   



Remember: It's your body, your health, your life.  YOU are your best advocate!


Best in Wellness,




"Be joyful in hope, patient in affliction, and faithful in prayer." (Romans 12:12)






Disclaimer:  This blog is not intended to diagnose, treat, cure, or prevent any disease.  It does not replace the medical advice of a physician.  The readers should regularly consult with their primary care practitioner in matters relating to health, disease, any symptoms, medications, and supplements. The information on this site is for educational purposes only. It is recommended you speak with your primary care provider before making any changes regarding your health.