WHAT CAN HELP WITH WORRYING SO MUCH ABOUT THE WAY I LOOK?

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We live in a society that emphasizes appearance as the means to success and happiness. Given the media's bombardment of perfect-looking images, it is difficult not to compare yourself to television and film figures and magazine covers and come up short. Despite societal influences, however, the way a person looks doesn't produce worry or distress—rather, a person's thoughts about her appearance are the culprit. What are you saying to yourself about how you look? If you tell yourself that you look terrible, it's not surprising that you would feel anxious and depressed. But what's the evidence that you look terrible even if you don't resemble a magazine cover? Where is it getting you to think, “I look terrible”? Resisting unhelpful societal demands to look a certain way and learning to separate your appearance from your worth as a person are very important goals in improving emotional well-being. Growing up, perhaps you learned that self-value was based on having a particular body image. Now is an excellent time to question this old assumption. Inevitably, people get older, and physical changes will occur. If you awfulize these changes and condemn yourself for them, you will feel much worse than if you learn to tolerate the physical differences and accept yourself anyway. Again, using effective, forceful self-talk is key.

Anxiety-Generating Self-Talk

·       I must look perfect or I'm no good.

·       Everyone can see this flaw—how terrible!

·       I can't stand this flaw.

·       I can't be happy until I lose weight.

·       I hate my body!

Anxiety-Reducing Self-Talk

·       Nobody looks perfect all the time, and appearance is not the gauge of my worth.

·       People are far more focused on themselves than on anything about me. I look fine!

·       Even if I don't like this particular body part, I certainly can stand it. There's much more to me than this one feature.

·       If I'd like to lose weight, I can work on this goal, but it doesn't determine my level of happiness. Moreover, putting appearance-based demands on myself just makes me more anxious and interferes with reaching my goals.

·       My body can do an amazing number of activities! Why condemn it because it doesn't look like a movie star's body? I would never judge anyone else as harshly as I'm judging myself.

It is important to note that some people are so focused on perceived physical flaws that it becomes consuming. Body dysmorphic disorder is an increasingly recognized mental disorder in which a person is preoccupied with an imagined or slight deficit in appearance (e.g., “crooked” nose, facial lines, acne scars, thinning hair). Other people might not even notice what the individual is concerned about, but the BDD sufferer believes the flaw is repulsive. As a result, she may engage in compulsive mirror-checking or mirror-avoidance, over-grooming, skin-picking, cosmetic procedures, or reassurance-seeking. In addition to avoiding school, work, and social activities, people with body dysmorphic disorder tend to report high levels of distress and suicidal ideation and attempts. Other appearance-related, highly-distressing clinical conditions include eating disorders, which are prevalent in women and increasing in men. Both cognitive-behavioral therapy and medications (SSRIs) can be effective in treating eating disorders and body dysmorphic disorder. Early diagnosis and intervention are vital in offsetting the harmful effects of these conditions.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

A PART OF ME THINKS MY PARTNER IS CHEATING ON ME. I WORRY ABOUT IT ALL THE TIME. WHAT CAN I DO TO RESOLVE THIS ANXIETY?

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This is where you have to ask yourself if your worry is based on reason and fact or on imagination and fantasy. If you have a basis for your worry, you may allow the feelings to eat away at you rather than face the truth. The most direct way to discover the truth is to look your partner in the eyes and ask. To find out if you're imagining things, ask yourself the following questions, and be honest with yourself:

·       Do I have any evidence?

·       Is my evidence substantial?

·       If I ask my partner if he is having an affair, and he says “no”, will I believe him?

·       Is there any way he could convince me that he isn't having an affair?

·       If I hire a private detective to determine if there is an affair and the detective says “no,” would I believe her?

If your answers show that even though you don't have any evidence, your partner would deny it, and a detective would find no evidence, you would still worry—then your worry may be excessive. In this case, your worry is not based on fact or reason. Some people in this situation can be reassured but only temporarily. Treatment is often necessary because this kind of worry can easily take over your life and destroy your relationship.

If you get therapy, you may discover that there is indeed something you wish were different about your spouse or your relationship. It may be something you can speak with him about. He may or may not be willing to change, but you can have the satisfaction of knowing the truth about your own worries and knowing you took measures to address them.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

MY SON IS A POLICE OFFICER. EVERY DAY, I WORRY I WILL GET A CALL THAT HE IS HURT OR DEAD. HOW CAN I LIVE A HEALTHY LIFE WITH THIS CONSTANT WORRY?

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Anybody with a loved one working in dangerous conditions such as police work or the military would feel concern. The degree of concern, however, depends on how you think about this situation. Keep in mind that it is not really your loved one's work that causes your constant worry. Rather, it is what you tell yourself about his work. If you are saying to yourself, “Today will be the day I get the call that he's been killed,” here's what might be going on in your head:

You are telling yourself something is going to happen at a certain point in time. This type of thinking (self-talk) is called fortune-telling.

You are also jumping to the worst conclusion about what could happen. This is called catastrophizing.

At the same time that you are overestimating the danger and threat of the situation, you are underestimating your own or a loved one's ability to cope.

One of the best ways to deal with constant worrying is to learn to challenge negative predictions and develop more realistic views of situations and coping resources. For example, you might remind yourself that your loved one is doing the job she wants to do, that she is skilled, that she works with competent colleagues, and that she has handled difficult situations well in the past. Also note that there is a difference between possibilities (it could happen) and probabilities (it's likely to happen). You could get a call that your loved one has been hurt or killed, but that's not the most likely outcome. We're better off when we resist turning small negative possibilities into probabilities. Life has no guarantees, but learning and practicing more realistic self-talk can help you better tolerate uncertainties.

Further, it's important to realize that we can't see into the future—you are not God, and no one has a crystal ball. The truest statement we can make about the future is that we don't know what it holds. Therefore, it is best to try to live in the moment. Sometimes our focus on someone else's well-being can be a way of avoiding attending to our own lives. Start focusing on spending your time in ways that feel meaningful and productive—maybe through becoming more engaged in your own work, getting together with friends, or starting something new, like a hobby or volunteering.

Finally, we sometimes worry because we believe that our worry magically protects others. Or, we believe the person we're concerned about not only wants us to be concerned about them, but to worry about them. We think that he will feel better in a dangerous situation if he knows we are constantly worrying about him. These ideas overestimate the effects of worry for any benefit. In fact, these beliefs are akin to believing in magic. We have no evidence that worry benefits anyone, but we do know that it causes the worrier harm. If you want to help your loved one, focus on what you can control. Send a care package, help out, express your love. It's generally better to control those aspects of your life you can actually control than those aspects of your life where the only control is through magic.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

EVERY ONCE IN A WHILE, I HAVE A THOUGHT ABOUT DOING SOMETHING "OUT THERE" LIKE THROWING SOMETHING AT MY NEIGHBOR OR TELLING OFF MY BOSS. DOES THIS MEAN I'M CRAZY?

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Studies have shown that 85-90% of ordinary people experience intrusive thoughts or mental images that they consider distressing or disruptive. Just because negative thoughts come into your mind, that does not make you crazy or abnormal. What distinguishes normal intrusive thoughts from psychotic or delusional thoughts is that the latter involve a break with reality. For example, a psychotic person may believe that the thought originates from a higher authority, such as Jesus Christ, and may even hear the thought as an actual voice (auditory hallucination). The person may then feel that he has no choice but to obey.

It is normal to have thoughts about things you would not actually do. You will become needlessly anxious if you attach great significance to the negative thoughts. If you have a negative and impulsive thought like “I'm going to embarrass my boss in front of everybody,” and then you say to yourself, “Because I have this thought, I'm a horrible person” or “That was terrible of me,” you are going to be a lot more bothered than if you can say to yourself, “It's just a thought, and I know I wouldn't act on it.”

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

IS IT NORMAL TO WORRY ABOUT WHAT PEOPLE WILL THINK OF ME?

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In the way that the outdoor temperature is reflected in degrees on a thermometer, it's helpful to think of worry as occurring at different levels instead of as an all-or-nothing emotion. It is completely normal to be concerned about what people think of us. We live in a social world, and interaction with other people is vital. Naturally, we want others to think well of us. Getting along well with others feels good and often helps us reach our social and professional goals.

Yet, focusing on the views of others can make us overly cautious and anxious. Here are some signs that your focus is excessive or unhealthy:

You don't feel good about yourself, and are projecting your negative feelings. For example, you imagine your boss is unhappy with your work rather than admitting that you aren't happy with your performance.

You may be engaging in a thinking mistake known as mind-reading —assuming that you know what a person is thinking about you when you actually have no evidence for your conclusion.

You tell yourself that it's terrible if someone doesn't like you, when maybe it's just inconvenient. Another person's view of you is not a measure of your worth unless you allow it to be.

To shift these tendencies, give yourself credit for your strengths and practice learning to accept your mistakes—we all make them! And keep in mind that most people are more focused on their own priorities and interests than on thinking about you. To illustrate this point, try writing down all the topics that others could be considering or discussing, besides you! You'll find that this list is endless!

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

MY MOTHER WORRIED ALL THE TIME, AND I TEND TO WORRY A LOT TOO. DOES THAT MEAN THAT I'M GOING TO BE A WORRIER FOR THE REST OF MY LIFE LIKE SHE IS?

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Worry is based on self-talk. Often when people worry excessively, they overestimate danger in the world and underestimate their ability to cope. Just because your mother worried a lot does not automatically mean you are going to be a worrier for the rest of your life. Worrying can become a habit, but all habits can be changed with hard work. When you start to worry, instead of letting your mind toss around “what if this and what if that?” it is a good idea to flesh out what is most likely to happen. Focus on probabilities (likelihoods) rather than remote possibities. Also, ask yourself, “What's the worst- case scenario and how would I deal with it?”

Perhaps your mother was afraid to drive and never drove her car. This is a behavior that can change if a person is willing to question some of her negative assumptions. Your mother might have said to herself, “I can't drive—I'll crash…What if I totaled the car?…What if I hurt somebody else?…What if I became paralyzed?” If that is what she believed, it makes sense she would feel anxious about driving and probably avoid it. However, it might have been good for her to question, “Why can't I learn to drive a car?” and “Even though car accidents happen, what makes it certain I'm going to have a car accident if I try to drive?” Worrisome thoughts can be identified, evaluated and disputed, but it takes consistent effort. Remember also that life contains hassles, problems, and nuisances, so an absence of any distressing emotion is not going to be realistic. However, if you notice yourself worrying excessively, you might decide you prefer appropriate concern to excessive worry. The difference between worries and concerns depends on your thinking!

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

I ALWAYS WORRY ABOUT MY HEALTH. PEOPLE TELL ME I AM A HYPOCHONDRIAC. WHAT CAN I DO ABOUT THIS?

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Hypochondriasis is a disorder where someone fears developing, or believes she already has, a dreaded disease and repeatedly seeks medical attention. She is preoccupied with her health and commonly misinterprets harmless bodily sensations as indicative of serious illness. In her mind, something is really wrong with her, and the doctors keep missing the problem. She continues to pursue appointments with physicians to increase the chance of “getting to the bottom of the matter,” and she hates to be called a hypochondriac. Despite the accumulated evidence suggesting no dangerous illness, the hypochondriac doesn't consider her beliefs to be irrational or unreasonable. Most individuals with hypochondriasis are so focused on the idea of having a severe medical problem that the other matters in their life take a back seat. The vocational, romantic, family, and recreational aspects of their lives are often in shambles, and they don't recognize it.

Whereas patients frequently visit their doctors to feel better, hypochondriasis actually persists because of repeated medical examination and reassurance. People seek temporary relief strategies that ultimately keep them from disconfirming their incorrect, unhelpful, exaggerated illness beliefs. Getting better means learning alternative explanations for bodily sensations and practicing believing more accurate, realistic explanations related to one's health. Additionally, it is essential to decrease the “safety behaviors” (e.g., looking on the internet, reading medical texts, taking blood pressure and temperature) and reassurance-seeking (e.g., visiting a doctor, calling the doctor's nurse) that actually maintain the excessive worry over time.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

AS LONG AS I CAN GET REASSURANCE FROM ONE OF MY FAMILY MEMBERS ABOUT MY WORRIES, I FEEL BETTER. DO I STILL NEED TO SEEK TREATMENT FOR MY WORRYING?

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This depends on the extent and severity of your worrying. If the following statements are true for you, then it might be a good idea to seek professional treatment:

1.My worry feels out of control.

2.I feel like I can't stop worrying.

3.My worry causes me a great deal of distress.

4.My worry causes problems with my family, social, work, and recreational activities.

Reassurance from a family member or even a close friend can be helpful in the moment, but over time your problems with worry are likely to persist. Reassurance-seeking is recognized by professionals as a “safety behavior,” or a short-term coping mechanism. Let's say I worry that my husband has been in a car accident, even though there is no evidence for that. I ask my sister, “Is he okay? Did anything happen to him?” and she tells me, “He's fine…everything is fine.” I might feel better at the time, but I haven't learned anything as far as how to look at my negative thinking in a more realistic manner. What I've learned is that every time I worry about my husband, I can ask my sister about it to feel better. To really begin to make a dent in your worrying, you don't want to have to depend on anyone's reassurance. You want to learn to be your own rational coach or reassure.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

WHY DO I WORRY?

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Many factors contribute to worrying, including your biology, past experiences, the current environment, and your thought processes. To understand worry, it can be very helpful to explore self-talk (what a person is saying to himself moment-to-moment and deeper beliefs that may be creating or fueling anxiety). Worrying is usually associated with “what if?” thinking in which a person consistently overestimates threats or danger and underestimates his ability to cope. Many individuals also have superstitious or magical beliefs about worrying. For example, some people hold the false assumption that worry protects them or loved ones. Here are some of the thoughts individuals may use to justify worry:

If I stay worried about Joe, he will feel better knowing that I am thinking about him. People like to know you have them in your thoughts and prayers. It's the proper thing to do.

Worrying about others shows I'm a caring and unselfish person.

Others may be harmed if I don't keep them in my thoughts. I have to worry to protect them and me.

God will see what I sacrifice to make others happy and reward me.

As indicated above, some people view worry as a way of producing results in the world, when in reality, action is required to produce results. Repeated reassurance-seeking as well as avoidance behaviors may also maintain excessive worrying. These strategies offer short-term gain at the cost of long-term pain. When a person constantly relies on others to make her feel better, the worrisome thoughts might subside temporarily, but they tend to be strengthened over the long-run. This also happens with the use of avoidance behaviors. Repeatedly calling your daughter at college to make sure she is safe or not going to work because you are afraid you made a mistake on a report are examples of behaviors that actually give worry more power over you. Resisting making the call to your daughter and going into work despite the mistake are ways that you show yourself “It wasn't as bad as I thought” and “I can handle this even if it is uncomfortable.” These thinking and behavior changes are essential for chipping away at your worry!

There is no simple answer to the question “Why do I worry?” but do keep in mind that worry is a habitual way of negative thinking that can be improved.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

ARE THERE ANY MEDICATIONS THAT ARE OKAY FOR SOMEONE OVER 70 TO TAKE FOR ANXIETY?

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The SSRI antidepressants are effective for treating many anxiety disorders and are generally safe for older adults. However, they can have some uncomfortable side effects. For example, taking Paxil, which has more anticholinergic properties, may result in mild interference with memory. In general, the main drawbacks of SSRIs are that they can induce more anxiety at first, and they take a fairly long time to work (anywhere from 2 to 10 weeks). Doses for older individuals may also need to be lower than usual starting amounts.

The benzodiazepines are commonly used to treat anxiety, but they can create problems for older individuals. These medications may interfere with memory when memory may already be failing. If taken before bedtime, they may make it difficult to wake up and use the bathroom at night. Benzodiazepines may increase the risk of stumbling and falling. If there are any breathing problems, these medications may over-sedate the breathing muscles and cause problems with more shortness of breath. Increased anxiety may follow when people feel like they can't breathe adequately.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

TO CONTROL MY ANXIETY, WILL I HAVE TO TAKE MEDICATIONS ALL MY LIFE?

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How long you need to take medication depends on many factors including the type of anxiety disorder, the presence of other disorders or illness, and whether you've gone through a course of psychotherapy. It also seems that the earlier the disorder started (e.g., age 10 or 11), the more chronic and tenacious the illness may be, and the more likely medications might be needed long-term. Another factor that may suggest a more persistent illness requiring medication is the presence of serious psychiatric disorders among many close relatives.

Fortunately, as a result of comprehensive research studies, physicians have guidelines that recommend the length of medication usage for particular problems with anxiety. The good news is that you do not need to make this call on your own. Let your prescribing doctor and your therapist, if you have one, help you determine if and when you are ready to discontinue your medications. Gradually decreasing the dosage often makes it easier to wean off a medication, and sometimes, this is the only safe way to go.

Further, there are psychotherapies that have been shown to treat anxiety disorders effectively. In fact, certain types of therapy have proven superior to medication in the long-term treatment of some anxiety disorders (e.g., cognitive-behavioral therapy for panic disorder). This may be because the skills learned in cognitive-behavioral therapy help an individual cope with panic on his own. Moreover, these skills are with him for the long-term and not discontinued like medications.

In pursuing psychotherapy for the treatment of anxiety, the individual should be prepared to assume responsibility for tackling the problem. Neither a prescribing physician nor a psychotherapist offers a magic remedy to remove anxiety. Ultimately, the patient must face her fears and demonstrate to herself that she will survive in spite of them.

It is not unusual to stop medicines and go many years without a return of anxiety symptoms, only to have them appear again. Do not despair. This often stems from severe stress or the development of another mental or physical disorder. With proper evaluation and treatment—a course of medications and/or psychotherapy—it is common to see anxiety symptoms diminish again.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD 

IF I STOP TAKING AN ANTIANXIETY MEDICINE, WILL I GET ANXIOUS AGAIN?

telegraph.co.uk

If nothing else has changed, you may become anxious again. The reason is that most anxiety disorders are chronic and wax and wane over time. You may feel better with the anxiety medication, and then assume you are ready to stop your treatment, only to find that the anxiety returns. Here are some important exceptions:

Sometimes, our anxiety is associated with a life crisis—e.g., disaster, loss of a loved one—and will resolve on its own whether or not we use medication to aid our adjustment. In these cases, stopping the medications after a few months may not lead to increased anxiety.

If you have completed a successful course of psychotherapy while on medication, you may not experience a return of symptoms when you stop the medicine. Many factors contribute to the production of anxiety symptoms, including past experiences, your defenses, avoidance behaviors, and the way you think. These factors can often be identified in psychotherapy and remedied accordingly.

If you decide to stop your medications, talk to your physician about how to do so. As noted earlier, some anxiety medications are dangerous to stop abruptly.

 Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD 

WHAT SHOULD I BE AWARE OF IF I DECIDE TO TAKE MEDICATION OF MY ANXIETY?

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When considering medication for the treatment of anxiety, here are some suggestions.

1.When you tell your doctor about medications you are already using, make sure to include any over-the-counter drugs or alternative medicines, such as herbal supplements. Although we may think of these medicines as harmless, some can cause serious problems when combined with prescription medication.

2.If the prescribing doctor is new to you, make sure he or she is aware of any medical conditions—such as cardiac problems, high blood pressure, low blood pressure, pregnancy, nursing, and addictions—that could complicate your treatment.

3.Ask your doctor how the medication works and what to expect when you take the drug. What are the intended effects, and what are the side effects?

4.Find out what side effects signal the need for medical attention.

5.As much as we like to think of doctors as magicians, they rely on you to let them know what works and doesn't work. Sometimes, the initial prescription and dosage are just right for you. Other times, you need to work with your doctor to figure out the right dosage of the right medication. The process can sometimes feel discouraging, but stick with it. The rewards are worth it.

6.Ask your doctor up front how you would go about stopping the medication if it would need to be discontinued. It can be dangerous to stop certain medicines abruptly, and these need to be tapered off slowly under your doctor's supervision.

7.Follow your doctor's directions for when and how to take your medications, and expect the best.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD 

WHAT ARE THE LONG TERM SIDE EFFECTS OF MEDICATIONS ADVERTISED ON TELEVISION LIKE ZOLOFT AND PAXIL?

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The long-term side effects of the SSRIs, like Zoloft and Paxil, are fairly benign for adults. In general, they may cause weight gain or interference with sexual function. In some cases, sleep disturbance may be a long-term effect. A few people also complain of losing their normal range of emotions and may describe their feelings as numb.

When SSRIs are combined with a number of other drugs, other concerns may arise, such as the increased risk of liver toxicity. This risk is most likely in a small subset of the population (about 5 to 10%) who has a genetic predisposition to poor metabolism of medications.

Women who want to become pregnant or breast-feed should consult with their physicians or pharmacists regarding taking any of these medications. There can be adverse consequencess on the developing fetus or the nursing child. The long-term effects of these drugs on children and adolescents are less well-known.

Of course, if a person develops other illnesses and/or takes other kinds of medicines, the side effect profile might change considerably. Again, it is wise to consult with your physician.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

WHAT NEW DRUGS ARE BEING STUDIED FOR ANXIETY? HOW ARE RESEARCHERS HOPING TO IMPROVE ON CURRENT MEDICATION?

theage.com.au

Researchers are trying to develop new drugs that combine the benefits of benzodiazepines (the fast action) with the benefits of the SSRIs (effectiveness with fewer side effects). Parallel to new brain research, drug studies are focusing on the receptor for the body's natural tranquilizer, GABA. While GABA's anxiety-inhibiting effect was the basis for the development of the benzodiazepines, new research is zooming in on the receiving center for GABA and identifying specialized subunits—sort of like different lines coming into a phone center. Whereas benzodiazepines, like Valium, work across all the subunits at once, new drugs aim to specify which combinations of subunits to activate. Several pharmaceutical research labs are currently trying to produce fast-acting anxiety medications that don't include the addictive potential, sedation, memory impairment, or lack of coordination associated with existing benzodiazepines.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

MY DOCTOR MENTIONED THAT DRUGS LIKE NEURONTIN AND INDERAL ARE BEING USED TO TREAT ANXIETY? ARE THEY SAFE? WHAT ARE THE SIDE EFFECTS?

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Neurontin (gabapentin), an anticonvulsant, is a relatively safe medication, and is popular with psychiatrists and patients because it doesn't require monitoring of blood levels, as do other anticonvulsants. The side effects of Neurontin include dizziness, blurred vision (diplopia), lack of balance (ataxia), sleepiness (somnolence), and fatigue. Patients are advised not to drive or operate complex machinery until they have enough experience with the drug to know that it will not affect their performance. Another warning with Neurontin is that very rarely, the sudden discontinuation of the medication could result in a seizure.

Inderal (propranolol), a beta-blocker, is usually safe to use, but requires medical supervision. As with any prescription drug, don't be tempted to use a pill offered by a friend or family member. Inderal is not safe for individuals with asthma or severe breathing problems, as it can worsen these conditions. Side effects of Inderal include slowing of heart rate (bradycardia), lowered blood pressure (hypotension), cardiac arrhythmia, congestive heart failure for those at risk, depression, fatigue, lightheadedness, nausea, vomiting, diarrhea, and cramping.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

WHAT ARE THE SIDE-EFFECTS OF THE SSRI AND SSRI-LIKE ANTIDEPRESSANTS?

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Initial side effects of SSRIs often include mild nausea, loose bowel movements, anxiety, headache, and sweating. They usually disappear after a few weeks. Individuals taking SSRIs for an extended period of time may complain of weight gain. With some of the SSRIs, it is not uncommon to have sexual dysfunction. This is a later side effect and may remain until the medication is discontinued. For men, it may mean low desire, difficulty achieving an erection, trouble ejaculating, or delayed ejaculation (which is why this class of drugs is used in treating premature ejaculation). For women, it may mean low desire, trouble lubricating, or difficulty having an orgasm. Some people complain of sedation with these medications. It is usually helpful to have them taken before bedtime if that occurs. An additional side effect of the SSRIs is that patients occasionally report very vivid dreams.

The most harmful side effect, though rare, is serotonin syndrome. It is most likely to occur if two or more serotonergic medications are used simultaneously. Although there are isolated examples of this syndrome with one SSRI, the most important combination of drugs to avoid is that of an SSRI and an MAOI. Serotonin syndrome starts out with lethargy, restlessness, confusion, flushing, sweating, tremor, and sudden jerking of the feet. It can progress to increased temperature, generalized muscle rigidity, kidney failure, and even death.

In general, however, the side effects of the SSRIs are easier to tolerate than those of the tricyclics or the MAOIs. SSRIs are also much safer to use and are less dangerous if someone overdoses on them.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

WHAT ARE THE SIDE EFFECTS OF THE TRICYCLIC AND MAOI ANTIDEPRESSANTS?

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The side effects of the tricyclics are many, and some can be dangerous. Initially, patients can experience dry mouth, constipation, urinary retention, orthostatic hypotension (sudden lowering of blood pressure upon standing up), blurred vision, tachycardia (increased heart rate), and rarely, cardiac arrhythmias (with high doses). In the long-run, it is common to see weight gain and sexual dysfunction. If one overdoses on these medicines, the result can be fatal.

Common side effects of the MAOIs include orthostatic hypotension, headache, insomnia, weight gain, sexual dysfunction, peripheral edema (swelling), and afternoon sleepiness. If taken with certain forbidden foods or beverages (ones that contain tyramine—including aged cheeses, smoked meats, and certain wines), blood pressure can escalate and lead to a hypertensive crisis and possible stroke. Individuals taking these medications must be on a restricted diet.

Sedation is common in these medications, and some of them help individuals sleep better. Unfortunately, anxiety symptoms may worsen on initiation of these medicines—and any other antidepressants. The initial doses are best started low and slowly increased to therapeutic doses to keep this side effect to a minimum. Some doctors will start patients on a combination of an antidepressant and a benzodiazepine. It takes several weeks for the antidepressant to have an antianxiety or antidepressant effect. The benzodiazepines work quickly and can help the patient until the antidepressant kicks in.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

OF THE MEDICATIONS CURRENTLY AVAILABLE FOR ANXIETY, WHICH ARE HAVING THE MOST SUCCESS?

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The most popular medications for the treatment of anxiety are the newest class of antidepressants, the SSRIs—Prozac, Zoloft, Paxil, Lexapro, and Celexa. Some of the non-SSRI antidepressants (for instance, Effexor) are also promising.

Since the 1960s, the stand-by medicines for anxiety have been the benzodiazepines, known by names such as Valium, Librium, Ativan, Xanax, and Klonopin. They are quite effective and work quickly. They can also be sedating and are often used to help with insomnia. The biggest disadvantage of these drugs is that some people can become psychologically and/or physiologically dependent on them. Sometimes, a person may get a “buzz” from one of these drugs and subsequently abuse it like alcohol or other intoxicating substances. If a person becomes physiologically addicted, sudden withdrawal has been known to lead to seizures and even death. A subtler side effect of these drugs is a very slight loss of memory.

Unlike the benzodiazepines, the SSRIs were designed to treat depression. However, abundant research and clinical practice have shown that they are also effective in combating many forms of anxiety. Today, SSRIs are considered the first-line medication treatment for anxiety. Whereas SSRIs take longer to work—sometimes several weeks—they don't lead to marked physiological dependence. Sudden discontinuation of some SSRIs is associated with uncomfortable withdrawal-like symptoms, although rarely associated with seizures or death. Additionally, SSRIs do not produce an intoxicated feeling, and they generally do not impair memory. Unfortunately, SSRIs are usually more expensive because most of the patents on these drugs have not expired. Older antidepressants, such as tricyclics and monoamine oxidase inhibitors, can be effective in treating anxiety and are often less expensive. The downside is that they are loaded with side effects and are less safe than the SSRIs.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

I'VE HEARD THAT BENZODIAZEPINES HAVE MANY SIDE EFFECTS. WHAT ARE THEY? IS BusPAR A GOOD ALTERNATIVE?

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Benzodiazepines can promote calmness by increasing the level of GABA in your brain. However, they can also produce sedation and grogginess, lack of balance, and impaired memory. Other risks of use include:

1.    Excess muscle relaxation that can compromise breathing in people who have lung disease (respiratory suppression)

2.    Accident proneness, especially if combined with alcohol

3.    Psychological and/or physiological dependence for some individuals

4.    Recovering alcoholics who use benzodiazepines may lose control of their abstinence behavior.

Lowering the dose of the medicine can reduce some of these side effects.

Whereas benzodiazepines work on GABA, Buspirone, or BuSpar, is known as a partial 5HT agonist—this means it helps to increase the level of serotonin in your brain. It can be a good alternative for those concerned about the addictive potential of the benzodiazepines. BuSpar has the following advantages: it does not interact with alcohol to promote intoxication, lead to dependency, or cause impairment of mechanical performance like driving a car. In contrast to the quick action of the benzodiazepines, however, BuSpar can take several weeks to work, gradually reducing anxiety over time. BuSpar's side effects include nausea, headache, nervousness, insomnia, dizziness, and lightheadedness.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

WHAT ARE THE ADVANTAGES AND DISADVANTAGES OF USING THESE DRUGS?

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Let's look at each type of medication and their advantages and disadvantages:

I. Antidepressants

Examples: Tricyclics: Elavil, Tofranil, Norpramin, Pertofrane, Pamelor, Sinequan

MAOIs: Nardil, Parnate

SSRIs: Prozac, Paxil, Zoloft, Celexa, Luvox, Lexapro

Other: Effexor, Remeron, Cymbalta

Good News:

Generally effective

Not addictive like benzodiazepines

Tricyclics are particularly inexpensive

Bad News:

Can take weeks to months to work (usually two to six weeks)

Anxiety can become worse before it gets better

Temporary side effects: headache, sweating, dizziness, insomnia

Temporary and sometimes ongoing sexual side effects, e.g., loss of sex drive or inability to have erection or climax

Tricyclics and MAOIs can be unsafe, if not lethal, due to numerous side effects

II: Benzodiazepines

Examples: Valium, Librium, Xanax, Ativan, Klonopin

Good news:

They offer immediate relief, usually within hours

Excellent sleep aides, especially if used to initiate sleep

Bad news:

Can have sedative effect; if the dose is too high, intoxication can result

They are more likely to produce a psychological dependence and sometimes a physiological dependence—especially if you have a history of alcohol dependence

Certain types of benzodiazepines (those with a short half-life) can produce withdrawal and possibly seizure if stopped abruptly after several months; although this is a rare event, it can be life-threatening

III. BuSpar

Good News:

Doesn't lead to dependency

Sometimes used successfully to restore sexual functioning impaired by antidepressants

Bad News:

Effective with fewer individuals than the benzodiazepines

Takes three to four weeks to work

IV. Anticonvulsants

Example: Neurontin

Good News:

Seems to be effective at calming anxiety

Improves sleep

Bad News:

Side effects include sleepiness, dizziness, and “brainfog”

V. Beta-Blockers

Example: Inderal

Good News:

Reduces physical “fight-or-flight” symptoms, such as increased heart rate, sweating, shaking, and shortness of breath

Helpful in calming performance anxiety before public speaking or test-taking

 Bad News:

Very short-term effect

Physical effects, such as slowed heart rate, can be problematic

VI. Antihistamines

Examples: Benadryl, Vistaril

Good News:

Calming, sedating effect

Non-addictive, so there is less concern about potential for dependence

Bad News:

Not as effective as other medications for anxiety

Side effects include drowsiness, dry mouth, constipation, and urinary retention.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

CAN MEDICATION TREAT ANXIETY?

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Yes, several medications can treat anxiety, and each has its own benefits and drawbacks. The type of medication used is often determined by the kind of anxiety disorder a person has.

There are two categories of effective medicines along with a few medications that are in a class by themselves. Antidepressants and benzodiazepines are the two major categories. Antidepressants, now considered a first-line medication treatment for anxiety, are divided into four categories, including: (a) the original and rarely used tricyclics ; (b) the monoamine oxidase inhibitors (MAOIs); (c) the newer and more commonly used selective serotonin reuptake inhibitors (SSRIs); and (d) drugs similar to the SSRIs, such as Effexor.

In addition to these categories of drugs, an antianxiety medicine called BuSpar is available, and certain medications used to treat other conditions have been applied to the treatment of anxiety. Anticonvulsants, like Neurontin, are gaining popularity in their use by psychiatrists, although these medications are not well-studied as antianxiety agents. Beta-blockers, like Inderal, are another class of medications commonly utilized. Finally, antihistamines, such as Benadryl and Vistaril, are used in some cases to treat anxiety.

If you are considering medications, it is important to consult with a physician or psychiatrist who is experienced in prescribing medications for the treatment of anxiety. Treatment of an anxiety disorder may require a different dosage of a medication than indicated for other disorders. For example, a higher dosage of an SSRI may be needed for the treatment of obsessive-compulsive disorder than for the treatment of depression.

 Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

IF I SUFFER FROM ANXIETY, IS MY BRAIN DIFFERENT THAN OTHER PEOPLE'S?

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Over the years, researchers have attempted to identify brain chemicals and structures that may be involved in anxiety. Below are some of their findings.

A chemical in the brain called serotonin has been linked to several human functions, such as mood, sleep, memory, and appetite. Serotonin is active in a number of areas of the brain, including the amygdala , a structure that controls fear and anxiety responses. Research has suggested that people with anxiety disorders may suffer from a deficiency of serotonin. This may be why a class of antidepressants called SSRIs (selective serotonin reuptake inhibitors), which increase the level of serotonin in the brain, have been successful in the treatment of anxiety disorders. The amygdala itself is currently the focus of much research on anxiety disorders, and findings suggest that emotional memories stored in this portion of the brain may contribute to phobias.

Another promising area of continued investigation involves the brain amino acid GABA , short for gamma-aminobutyric acid. Evidence suggests that GABA may be deficient in people who suffer from anxiety. Research has shown that decreases in GABA can promote anxiety, restlessness, racing thoughts, and difficulty sleeping. By offsetting the effects of an excitement-producing brain chemical known as glutamate, GABA works to tone down brain activity and keep you calm. Benzodiazepines help boost the effect of the GABA in your brain. New research is focusing on the specific sites where GABA is received, and working to identify the functions of each of these sites. This opens up the possibility of developing medications that activate the good aspects of GABA without promoting addictive side effects.

Modern brain technology allows us to look at differences in how brains function. Through imaging technology, we can observe blood flow to certain areas of the brain, and notice differences in the size of structures within the brain. In addition to the amygdala, researchers have focused on the hippocampus , a part of the brain that helps to encode information into memories. Studies have shown that the hippocampus can be up to 25% smaller in people who have undergone severe stress because of child abuse or military combat. This may explain why these individuals experience flashbacks, fragmented memories, and difficulty recalling details of the events.

It is encouraging that the more we learn about brain structure and function in people with anxiety disorders, the more we may be able to treat these concerns with better medications and therapies.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

WHEN DO ANXIOUS PEOPLE USUALLY COME IN FOR TREATMENT?

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The point at which an anxious person seeks help often depends on the specific anxiety disorder, the person's personality, and what's going on in the environment. Here are some general observations:

1.    A person having a panic attack often seeks treatment in response to the attack, thinking she is either losing her mind or having a heart attack. She will typically rush to the emergency room to have it checked out and treated, without recognizing the problem as an anxiety disorder until it is diagnosed. People with panic attacks don't go long without seeking help.

2.    By contrast, people with obsessive-compulsive disorder may go years without seeking help, feeling ashamed of the problem and keeping it a secret.

3.    People with generalized anxiety disorder often accept their worrying as normal. Sometimes they develop somatic symptoms—body symptoms that are manifestations of anxiety. They might feel tension headaches, upset stomachs or bowels, muscle aches, tightness in their chests, and shallow breathing, all of which may be signs of anxiety. Many people who wouldn't see a doctor for worry will see one for somatic symptoms. Often, when a worrier has a particularly difficult life challenge or dilemma, the somatic symptoms are triggered.

4.    People with specific phobias may not seek treatment until the phobia clearly interferes with functioning in a more profound way. For example, someone with a fear of flying may not come in for help until he knows he must fly somewhere for his job.

5.    People with social phobias can have a very troublesome time getting help, as they are fearful of doing things in front of others that will cause them humiliation.

6.    Whether people seek help for acute stress disorder or posttraumatic stress disorder depends on how disruptive the symptoms are to their functioning. Just the thought of talking or thinking about the trauma again can be extremely unsettling, so people avoid seeking help. Often, PTSD sufferers initially attend treatment at the urging of loved ones—more to satisfy someone else than themselves.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD