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?

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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