ANXIETY

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The best care

What is anxiety?

“Anxiety is a normal emotional and physiological response to a perceived threat”,
“Anxiety is the commonly used word to describe the feeling of fear, worry, uncomfortable and uneasiness”.
 
Let’s face it, we all face anxiety at some time in our life. Most of us face anxiety when we face some amount of competition such as in exam or playing an important game or prior to the interview or any situation when there is certain unpredictability. We also face this in day to day life when we are interacting with higher ups or when we are challenged to do certain role and it’s been judged. However this anxiety wares off when we the anxiety provoking situation ends or when the task is finished.

Anxiety per se is not bad it helps us to react to the certain situation in a controlled way or helps us to finish our task in time etc. Human’s brains are wired to take certain amount of stress and anxiety. Certain individual can take a lot amount of stress and can perform well in their normal function. However, when the load of stress is too much or there is a mismatch in what the person can take then we may see a problem developing.  Thus when there is too much stress we may become anxious even for day to day things or in other words, we get anxious to situations which we normally do not, then perhaps we may be having unhealthy anxiety or may be an Anxiety Disorder.

What happens when we have anxiety?

As stated before anxiety is a normal psycho-physiological response to the perceived threat and it’s an evolutionary “fight or flight” reaction to survival. This reaction works well in a situation when there is a real threat to life like for example when we see a snake etc. However in the modern society this reaction may become maladaptive for situations such as in office or during a meeting or social situation etc.

When we perceive the threat we secrete “fight or flight” hormone and one  of them is Adrenaline which leads to increased heart rate, feeling jittery, tremors, increased respiration, light headedness, etc. For some when they are anxious to certain degree this can help them to perform better, but for others it may lead to poor performance and poor concentration and these are the one who may develop anxiety disorder. For some anxiety may remain constant and then may lead to poor functioning, sleep disturbances, weakness etc. and this is the time you may have to consult a Doctor.

These are some of the anxiety symptoms you may notice when you are anxious


Are there different types of anxiety disorder?

Yes, Anxiety disorders are a group of disorders with core features of fear and worry.
There are around more than 6 types of Anxiety Disorder and some of them are
1)     Generalized anxiety Disorder
2)     Panic Disorder
3)     OCD ( obsessive Compulsive Disorder)
4)     Phobias
5)     Social Anxiety disorder
6)     Post-Traumatic Stress Disorder


Let us understand the type of anxiety disorder?

Generalized Anxiety Disorder

If you are anxious for long time and feel fearful for small day to day things, nothing specific, but too much worry and wants to know detail of every bit, finding difficulty to take a decision and it is affecting your work or at home then perhaps you may be having generalized anxiety. Some people might call you a nervous person or nervous wreck and they might find you as a person who doesn’t want to take any risk and indecisive. Many of them who suffer from anxiety may take up jobs which are less anxiety provoking and restrict themselves when there are challenges ahead due to their anxiety.
Case vignettes:
 
“Mr. Vinod* was working in a Call center but left his work 2 months back and currently unemployed, He studied Diploma in Computer science, and due to his anxiety and fear that he may not cope well in his studies, opted not to pursue his higher studies and started working in different job before joining the call center. He left his last job as he could not cope with his anxiety. He was worried he may do some mistake or might not able to give his full 100% to his clients. Even though the employer was happy with his works  and also encouraged him to stay, he felt he is taking too much risk and with constant thoughts of worries. He noted his emotions were irrational but could not help it. He sometimes felt he is not like others and noticed he could not enjoy his life like others. He felt unable to relax and also worried that he might not take proper decision also . He knew he is worrying too much, but could not find any help to overcome his worries. He used many self-help book, yoga to reduce his anxiety but in vain”
 
Panic Disorder
 
What is panic disorder?

This is an exaggerated anxiety response to the perceived threat. Sometimes this can be unpredictable and you may not identify the triggers for this attack.
 
 
 
During panic attack following symptoms you may notice
·      Increased heart rate  
·        sweating
·        feeling nausea
·        chest pain, feeling unable to breathe or chest tightness
·        tremulousness or tremors of whole body
·        feeling that you're going to die
·        sometimes fainting sometimes or you may pass out or                 becoming unconscious
·        mind going blank or light headed
·        feeling you are getting heart attack
·        feeling that something bad is going to happen and you do not have control over it

usually panic attacks lasts 30 mins to an hour and subsides by itself. During this time you may have lost control and may have visited Emergency hospital as you may feel you may be dying. You become more anxious henceforth and constantly may be worried about future panic attacks or feel when the next attack may occur. You constantly go from one hospital to other or one doctor after another to get reassurance or to find everything is alright but still not convinced.

Case Vignettes

“ Shalini* aged 24 works in a multinational company came to Emergency Department with a history of sudden onset of increased heart rate, chest pain and chest tightness. She reported it was sudden in onset and had visited the  ER twice in last 2 days. She could not recall what started this attacks but felt it was sudden without any reason. She felt like she is going to have an heart attack and so made a quick visit to ER to get herself treated. All her reports were within normal limits but was not convinced and was asking the doctor ‘have you checked it properly?’. She was constantly worried since couple of days about this attacks and worried when it will return back
 

PTSD:


This is an anxiety state, a  person develops soon after experiencing shocking life events or a scary events.
These persons might have experienced such a life event that are shocking which they might find hard to comprehend and digest. PTSD develops commonly in army personals who have been in war torn area and more commonly in person who have experienced events such as deadly road traffic accidents, rape survivors, Tsunamis survivors etc.
 
These people develop symptoms of anxiety which are prolong and can be dated back to the event. They regularly experience the anxiety when they see similar situations in Television or they might reexperience the event regularly at least daily and worry about the situation happening over again. So they tend to avoid situations which can provoke their reexperience and thus anxiety. They get startled easily and can get easily annoyed. They become more isolated and avoid talking about the event which they feel can provoke their intense anxiety.
 
Why anxiety disorder needs to be treated?

If not treated people with anxiety may go in for long term chronic anxiety state. This can increase medical comorbidity, including Myocardial Infarction ( heart attack), type 2 diabetes, Hypertension and may be stroke on a long term. Sometimes when the brain is chronically stressed, it may get atrophied especially in the Amygdala area of the brain also called emotional regulating centre. This may render resistant to the common psychiatric medications due to atrophied amygdala and very hard to treat. They may become resistant to common drugs and will have propensity to get addicted to substance or drugs.
 

 

Treatment of anxiety Disorder

 

Self Help


Some of the anxiety disorder mentioned above can be treated through self-help.


These are things you may do to help yourself


1)     Reduce your caffeine intake by reducing tea, coffee, Beverages, cola etc.


2)     Check whether you are taking over the counter medications, like herbal preparations, sometimes these can worsen your anxiety.


3)     Stop taking alcohol and also stop cigarettes, if you are a smoker. Sometimes people take alcohol to reduce the anxiety but these measures are counterproductive and this applies to cigarettes as well.


4)     Maintain regular exercise and if you have not been exercising then start some exercise like good walk or yoga can help to some extent.


5)     Eat healthy food and stay away from junk foods.


6)     Learn some relaxation technique such as Meditation, Mindfulness meditation, progressive muscle relaxation etc.


7)     Learn some stress management technique and understand the trigger factors and learn how to cope or reduce your stress.


8)     Develop a good supportive network especially with families and close friends who can help in time of distress.


Understanding the anxiety and its psycho-biological mechanism is very important and this understanding in turn may help you in reducing the anxiety state. So don’t panic these are easily treatable conditions in doubt please seek help from professionals as soon as possible.
 


Treatment:

Medications:

Mainstay of treatment are medications. Usually your Doctor may prescribe antidepressants such as newer antidepressants like SSRI, SNRI etc. They might also prescribe benzodiazepines which may give you quick relief, but are advised to taper it after a while. Usually medications are given for a course which may last up to 6 months even though you may have improved symptomatically after a fortnight of using medications. For more information please do not hesitate to contact your doctor.

Counselling:


Also your doctor may advise to go for counselling also called psychotherapy. Here a specific type of psychotherapy is advised such as Cognitive behavioral therapy. Sometime doctors will do short CBT during sessions or may advise long term CBT with a Psychologist.


Other treatments such as


TDCS:
Sometimes tdcs ( transcranial direct current stimulation ) is advised where ever it is present.


Biofeedback is also advised for relaxation and as adjuvant treatment.

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