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Tuesday, May 29, 2012

Stressed out?


Yesterday while out with friends, I was asked what was the most common disorder that I treat. Without thinking twice I answered anxiety disorders. Yes, most people suffer with anxiety (including myself) that for the most part, is normal. Anxieties that interfere with your day to day activities or impair your ability to function should be evaluated. I find that if these conditions continue, patients often end up self medicating with either prescription drugs or illicit drugs to get relief. The problem with self medicating is that it always worsens the condition in the end.


  

Anxiety Disorders include the following conditions:


During my evaluations I am careful to rule out any other causes for anxiety symptoms such as endocrine, vascular or acute drug withdrawal syndromes. I also have to rule out other psychiatric diseases such as depression, somatoform disorders and personality disorders. This is no small task but is very doable after the first or second session. Often I have to obtain labs and clarify health history from a primary care physician. Actually, a lot of my referrals come from primary care physicians who have already ruled out the medical causes for presenting anxious symptoms.

Medications used for the treatment of anxiety disorders usually includes antidepressants. Let me repeat, THE TREATMENT FOR ANXIETY IS AN ANTIDEPRESSANT. Benzodiazepines are helpful but they are not the first line drugs of choice. I usually use these for a short period of time (less than a month) or until I have an antidepressant working. Because these drugs rapidly calm anxiety, they often psychologically reinforce and cause more anxiety in the long run. I prefer using SNRI antidepressants but also routinely use SSRI's. Often alpha or beta blockers can be helpful, especially for acutely anxious situations.

After I have obtained control and resolution of most anxious symptoms, I then focus on coping skills. My preference is CBT (cognitive behavioral therapy). Addressing irrational fears and developing strategies to reduce fear in real time is curative. Once successful strategies are developed and can be automatically used, I can taper most of my patients off medications. Conflict resolution of past traumas rather than dwelling on them or being victimized by them is my treatment goal orientation.

Patients are then given assignments to be social and practice their skill set. Social phobia? Anonymous meetings present great opportunities here. OCD? Talking out loud your anxiety with a confidant is better than hiding it in some ritualistic behavior. Panic Disorder? No, I don't push you out of a plane parachuted but you can gradually be challenged with a progressive set of social exercises.

Addressing the biopsychosocial aspect really works with anxiety disorders. If you are suffering personally or professionally, treatment is easy and provides a tremendous amount of relief in a few weeks. There really is no need to keep worrying after all, don't you think?