Overcoming Anxiety For Dummies, 2nd Edtion

by Smith, Laura L.

  Upon seeing this category, you may have easily thought, "Hey, I'm anxious; I'm not crazy!" And, in fact, psychosis is a serious mental disorder that often involves disordered thinking, hallucinations, delusions, and other serious distortions of reality. So you may wonder why medications designed to treat psychosis have anything to do with treating anxiety. Those who merely suffer from anxiety rarely, if ever, experience the kind of substantially confused thinking that psychotics do.

  These medications are primarily prescribed for people who have severe, hard-to-treat anxiety or who suffer from other mental disorders along with anxiety. They're generally not prescribed unless other forms of treatment have been unsuccessful. They have some especially distressing side effects. Possibly the most feared are known as extrapyramidal side effects (EPS), which can include a wide range of problems, such as

  Abnormal, uncontrollable, irregular muscle movements in the face, mouth, and, sometimes, other body parts

  An intense feeling of restlessness

  Muscle stiffness

  Prolonged spasms or muscle contractions

  Shuffling gait

  These EPS effects appear to occur less often with the newer atypical antipsychotic medications as opposed to the older, traditional antipsychotic medications. Because the risk of EPS is relatively low, those with severe anxiety disorders for whom changes in behavior or thinking (see Chapters 5, 6, 7, and 8) or other medications haven't helped sufficiently may want to consider using these new anti-anxiety tools.

  However, because the risk exists, those with relatively milder anxiety problems would probably want to avoid them.

  Another disturbing side effect with many of these atypical antipsychotics is a change in metabolism that increases the risk of weight gain and can eventually lead to diabetes. As with most of the medications for anxiety, these should generally be avoided when pregnant or breast-feeding. Consult your physician for the best alternatives.

  Here are four antipsychotic medications, with their generic names in parentheses. Other medications are under development.

  Risperdal (risperidone)

  Abilify (aripiprazole)

  Zyprexa (olanzapine)

  Seroquel (quetiapine)

  Geodon (ziprasivone)

  Mood stabilizers

  Mood stabilizers are usually prescribed for other conditions. However, when standard treatments haven't worked, doctors sometimes find them useful for treating their patients' anxiety. People who suffer mood swings like those with bipolar disorder often benefit from this particular class of drugs. Medications in this category include Depakote (valporic acid), Eskalith (lithium), Lamictal (lamotrigine), Neurontin (gabapentin), Tegretol (carbamazepine), and Topamax (topiramate).

  A few intriguing medication options

  The search for anti-anxiety medication options leads to a few unexpected places. The following list describes a few of these.

  Catapres (clonidine) is a medication usually used to treat hypertension by relaxing the blood vessels. It seems to ease some symptoms of PTSD, especially in children. Serious side effects have been reported, however.

  D-cycloserine, an antibiotic used as a treatment for chronic tuberculosis, appears to also help people extinguish their fears more quickly and completely when they're doing exposure types of therapy (see Chapter 8). Taking this drug while facing fears may allow people to speed up the process of unlearning the original fear, and the patient only needs to take the drug during a few therapy sessions.

  Methylenedioxymethamphetamine (MDMA), also known as the street drug Ecstasy, has been found to facilitate exposure treatment for people with PTSD. The studies are promising but preliminary. Ecstasy appears to have a positive effect on mood and empathy.

  During therapy, it is administered under medical supervision — we don't encourage our readers to try this at home.

  Oxytocin is another interesting treatment for social phobia that is administered just before the client begins a session of cognitive behavioral therapy. Oxytocin, a naturally occurring hormone that is released by both men and women during orgasm, is given via nasal spray. Oxytocin won't give you an orgasm administered this way, but researchers at the University of Zurich in Switzerland have found that people with social phobia who are given a few sniffs of oxytocin feel more confident and open to therapy.

  Searching for Supplements

  Dietary supplements include vitamins, amino acids, minerals, enzymes, metabolites, or botanicals that reputedly enhance your health and/or your body's functions. Such supplements appear in many different forms — capsules, powders, tablets, teas, liquids, and granules. You can buy supplements from the Internet, your local drugstore, a grocery store, or a health food store. Claimed benefits of supplements include improved immune systems, enhanced sleep, stronger bones, revved-up sexual response, cancer cures, and overcoming anxiety.

  People seek supplements often because they assume that they're safer than prescription drugs. That's not necessarily true. Supplements are not considered drugs in the United States and therefore are not subjected to the same level of scrutiny as most medications. Before a prescription drug can come to market, the manufacturer must conduct clinical studies to establish the safety, effectiveness, dosage, and possible harmful interactions with other medications. The U.S. Food and Drug Administration (FDA) doesn't require clinical trials to establish the safety of herbs. Instead, after a supplement makes it to market, the only way it will be removed is if enough consumers suffer serious side effects and complain to the right agencies, which can trigger an FDA investigation and possible decision to withdraw the herb from store shelves.

  Another serious problem with supplements is that untrained salespeople often make recommendations for their use. Fortunately, healthcare professionals who are also interested and trained in the safe and effective use of supplements can help. By contrast, salesclerks vary widely in the usefulness of their advice. Dolores' story isn't all that unusual.

  A young, fit salesperson smiles at Dolores as she enters the health food store. Dolores tells him that she would like to find a natural remedy to help her calm down. She reports difficulty concentrating, poor sleep, and always feeling on edge. The young man nods and suggests a regimen of vitamins and supplements to build up her resistance to stress, improve her concentration, and ease her symptoms of anxiety.

  Pulling bottles off the shelves, he tells her, "Some B vitamins to build you up; C to fight infections. Here are some amino acids — L-lysine and tyrosine — and a compound, 5-HTP. Minerals: calcium, zinc, potassium, and magnesium. Kelp nourishes. Melatonin for sleep. Oh yes, maybe some SAM-e to improve your mood. Then the herbs: hops, passionflower, valerian, lemon balm, chamomile, and kava kava. Now, take these at least an hour before you eat. Eat carbohydrates with these, not protein. And this one needs to be taken just before bed."

  The bill comes to $214, and Dolores goes home feeling a bit overwhelmed. One day at work, after ingesting a dozen pills, she runs to the bathroom to throw up. A concerned friend asks her what's making her sick. Dolores tells her about all the supplements that she's taking. Her friend suggests that Dolores seek the advice of a naturopathic practitioner; she explains that these professionals attend a four-year, full-time training program and must pass a rigorous exam.

  Dolores visits a naturopathic practitioner who advises her to dump the majority of her purchases in favor of a multiple vitamin and one herbal supplement. He also discusses several relaxation strategies, exercise routines, and self-help books. Within a few weeks, Dolores feels like a new person.

  The example of Dolores may seem extreme. However, the supplement business is a highly profitable one. Well-intentioned salesclerks rarely have medical training.

  Dolores was actually lucky compared to Hector, whose story appears next. Hector not only tries herbal supplements, but mixes them with a prescription drug and alcohol, resulting in a very dangerous scenario.

  It's payday, and Hector's buddies invite him to hoist a few beers. "Sure,"
he says. "I can't stay too long, but I could use a couple of beers; it's been a tough week." Munching on spicy bar mix, Hector finishes off two beers over the course of an hour and a half. He stumbles a bit as he gets off the bar stool, and the bartender asks if he's okay. Hector reassures the bartender that he's sober. After all, he only had two beers.

  Driving home, Hector drifts into the left lane for a moment but swerves back into line. Just then, he hears a car behind him honking. A few moments later, he sees police lights flashing. Puzzled, he pulls over. Hector fails a field sobriety test, but a breathalyzer test registers Hector's blood alcohol level at .03, well below the legal limit. What's going on?

  Hector recently complained to his physician about feeling stressed at his job. His doctor prescribed a low dose of anti-anxiety medication and warned Hector not to take too much because it could be addictive if he wasn't careful. Hector found the medication useful, and it calmed him a bit, but the medication didn't quite do the trick. A friend recommended two herbs to try. Hector figured that would be a great, natural way to enhance the prescribed drug and that herbs certainly couldn't hurt him. To add up Hector's scorecard, he had combined two anxiety-alleviating herbs, a prescription drug, and alcohol — and was lucky that the police pulled him over. Hector could have ended up in a serious accident, harming himself or others.

  Don't forget that even moderate alcohol consumption, combined with anti-anxiety agents, can intensify sedative effects to the point of substantial impairment and even death. Be careful!

  Hunting for helpful herbs

  People have used herbal remedies for thousands of years. Some of them work. In fact, a significant number of prescription medications are derived from herbs. You may want to try out an herb or two for your anxiety. We recommend that you read the literature about each herb carefully to make an informed choice before purchasing them from a reputable dealer. And always let your doctor know what herbs or supplements you're taking.

  Saint John's Wort: This plant has been used since ancient times for medicinal purposes. Studies show that it's as effective as some antidepressants for mild depression. Research on St. John's Wort is insufficient to recommend this as a treatment for anxiety. Be careful: It can intensify the effects of sun and lead to sunburn.

  Kava kava: The islanders in the South Pacific have consumed kava kava for both pleasure and healing. They have typically used it to treat a host of ailments, including obesity, syphilis, and gonorrhea. The islanders have also used it for relaxation, insomnia, and anxiety reduction. Kava kava has been used extensively in Europe for anxiety, although usage varies from area to area. Studies suggest that it does have a positive effect on anxiety, although the effect is modest. However, a few countries have banned kava kava due to its reported, but apparently rare, potential for causing liver problems.

  Valerian: Valerian is an herb native to Europe and Asia. The word comes from the Latin term meaning well-being. Valerian has been suggested for digestive problems, insomnia, and anxiety. Like many herbs, it's used extensively in Europe but is gaining in popularity in the United States.

  Many other herbal remedies for anxiety are promoted as safe, effective methods. But beware; most of these herbs haven't been subjected to scrutiny for effectiveness or safety. We suggest that you avoid these because so many other anxiety-reducing agents and strategies work without dangerous side effects. On the other hand, we don't think that you need to be overly alarmed about drinking a little herbal tea from time to time. Most of these brews contain relatively small amounts of the active ingredients and likely pose little threat.

  Viva vitamins!

  Chronic stress taxes the body. The results of several studies link mood disorders to vitamin deficiencies, and especially severe deficiencies may make your anxiety worse. Therefore, some experts recommend a good multivitamin supplement.

  Can vitamins and minerals cure your anxiety? That's not likely. However, they may help to keep your body in better shape for handling the stresses that come your way. Just take care not to take huge quantities. Even vitamins can produce toxic effects at megadoses.

  Sifting through the slew of supplements

  If you search the Internet and your local health food stores, you can probably find over a hundred supplements advertised as antidotes for anxiety. But do they work? Only a few that we know of. The following have at least garnered a smidge of evidence in support of their value as possible anxiety axes:

  Melatonin: Reaching a peak around midnight, this hormone helps to regulate sleep rhythms in the body. In particular, it addresses the problem of falling asleep at the right time (known as sleep onset) as opposed to the problem of awakening in the early morning and being unable to go back to sleep. Synthetic melatonin taken in the early evening, a few hours before bedtime, may alleviate this particular type of insomnia, a common problem among those who have excessive anxiety.

  Side effects such as dizziness, irritability, fatigue, headache, and low-level depression are all possible, but the long-term side effects aren't really known at this time. Avoid driving or drinking alcohol when you take melatonin.

  If you have an autoimmune disease or if you're depressed, you should probably avoid melatonin.

  SAM-e: Claimed to relieve the pain and stiffness of osteoarthritis and fibromyalgia, this amino acid occurs naturally in the body. It may also help treat depression and anxiety. However, research on this supplement remains limited. SAM-e appears to increase levels of serotonin and dopamine in the brain, which could theoretically alleviate anxiety.

  Possible side effects such as gastrointestinal upset, nervousness, insomnia, headache, and agitation may result, but again, little is known about the possible long-term effects.

  Don't take SAM-e if you have bipolar disorder or severe depression. SAM-e may contribute to mania, which is a dangerous, euphoric state that often includes poor judgment and risky behaviors.

  5-HTP: This popular supplement is a compound that increases the levels of serotonin in the brain. Serotonin plays a critical role in regulating mood and anxiety. Some evidence also exists that 5-HTP may increase the brain's natural pain relievers, endorphins. Unfortunately, only limited research has been conducted on this supplement. These studies suggest that 5-HTP may reduce anxiety somewhat.

  Don't take 5-HTP if you're also taking another antidepressant. Also avoid it if you have tumors or cardiovascular disease.

  Omega-3 fatty acids: Found in flax seed, avocados, soybeans, and fish, these acids have been shown to improve mood for those with depression. Evidence of their usefulness for anxiety is less robust, but there is sufficient evidence that having enough omega 3 fatty acids in the body improves cardiovascular health. So, consider taking these supplements (make sure that they're purified to eliminate toxins like mercury).

  A number of alternative medicine practitioners also frequently recommend the supplement gamma-amino butyric acid (GABA). This supplement may have a mild tranquilizing effect, but little data is available to substantiate that claim.

  Stimulating the Brain

  People with severe cases of anxiety often try many different treatments. Unfortunately, a few cases neither resolve nor even improve with standard treatments such as psychotherapy or medication. For those people, new advances in science and technology may offer hope for improvement or even a cure to their suffering. However, you should be aware that the effectiveness of these new approaches has not yet been firmly established. They really should be considered as a last resort at this time.

  Vagus nerve stimulation (VNS)

  The vagus nerve sends information from the digestive system, the heart, and the lungs throughout the brain. Anxiety is usually experienced throughout these systems, with symptoms ranging from stomach upset to rapid breathing to feelings of fear to thinking that something bad might happen. VNS was developed as a treatment for people with epilepsy. A device is implanted in the chest that sends electric pulses to the vagus nerve.

  Later, this treatment was found to help those with
severe depression. Many of those who experienced relief from either epileptic seizures or depression also noted decreases in anxiety. Therefore, a few studies have been conducted using VNS with treatment-resistant cases of anxiety. Results are hopeful, but considerably more research is needed. For now, VNS remains an alternative only for those who have had multiple treatment failures for severe anxiety.

  Although serious side effects are rare, VNS can cause pain at the site of the incision, voice hoarseness, sore throat, and facial muscle weakness.