Anxiety Disorders: More Than Just Butterflies

**VivaLasViejas**, ASN, RN

Almost everyone has experienced it: the sensation of butterflies in your stomach as you prepare for a presentation or an appearance in traffic court. The dry mouth that makes you feel like you're spitting cotton. The rapid heart rate and slight shortness of breath that characterize a normal response to stressful stimuli. In other words, you're feeling anxious.

Now imagine those sensations writ large. Instead of butterflies, you feel nausea and may even vomit or experience diarrhea. Your hands tremble visibly and your voice shakes whenever you try to speak. Your heart pounds; you break out in a cold sweat; your throat closes up. And worst of all, you have the horrid suspicion that if you don't run away from the situation, you just might have a heart attack and die.

Anxiety disorders are among the most common mental illnesses in early 21st century America. Tens of millions of men, women, and children suffer from one or more of these maladies, which include---but are not limited to---obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and the phobias. What's more, anxiety goes hand-in-glove with many of the major psychiatric illnesses, particularly the affective disorders.

Almost any event that occurs in the course of one's life can contribute to the development of anxiety that rises to the level of impairment. Childhood trauma, such as physical or sexual abuse, is thought to be a common cause; so are the adult experiences of war and natural disaster. But sometimes, anxiety or panic can arise from comparatively insignificant occurrences, such as being laid off or enduring a minor surgical procedure, and the intensity can be so severe that it renders the sufferer incapable of completing even normal daily activities.

To say the least, the cost to society in lost productivity and health care utilization is staggering. A severely anxious person is paralyzed, in effect; he or she may not be able to focus on work or school, attend to everyday business such as paying bills, or even perform basic laundry or meal preparation. Substance abuse is common among this population, as victims will often try to self-medicate their anxiety by consuming large amounts of alcohol or turning to marijuana and illegally obtained prescription drugs. And tragically, unrelieved anxiety---like its companion, major depression---can even lead to suicide.

What can be done to help the anxious patient? For one thing, medication in the form of antidepressants like paroxetine (Paxil) and fluoxetine (Prozac) have mild anxiolytic properties, and this may be all some people need to calm the storm. However, those with more complex and severe anxiety may require stronger agents called benzodiazepines, which unfortunately carry a high risk of dependency, but are often the only effective pharmaceuticals for this condition.

These include short-acting medications like lorazepam (Ativan, or "Vitamin A" as health professionals often call it) and drugs with moderate duration like alprazolam (Xanax), as well as the long-acting clonazepam (Klonopin). All are controlled substances which must be prescribed by a doctor---preferably a psychiatrist---and carefully monitored for abuse, as tolerance tends to develop with the passage of time. Ideally, benzos should be used only for a brief period to bring a crisis under control, but since anxiety disorders are often chronic, the meds may be taken for months and even years. (Note: a patient should NEVER attempt to stop a benzo on his/her own; withdrawal may cause seizures, along with a rapid increase in symptoms.)

Psychotherapy can also be helpful in managing anxiety and panic. Mindfulness and cognitive behavioral therapy are popular forms of treatment in which patients learn how to be aware of their thoughts during periods of stress, and to replace negative thinking patterns with healthier ones. Another therapeutic intervention is one in which the patient is gradually re-introduced to situation(s) that contribute to his/her anxiety, and taught more constructive methods of handling them. The latter remains controversial, but can be extremely effective for some patients.

But above all, people with anxiety disorders need to know that the condition is not their fault. They are NOT being 'weak' or 'silly'. Research has shown that the brain goes through changes during exacerbations, thus the need for medication and treatment of episodes. The good news is, anxiety---like almost all mental illnesses---can be managed if not cured, and sufferers can regain their ability to live happy, productive lives.

Anxiety Disorders: More Than Just Butterflies

About VivaLasViejas, ASN, RN

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