The usual symptoms of anxiety (and even depression) were listed in the previous article. Current medical science is able to physiologically explain only a few of those symptoms. Most remain a mystery as to why the body suffers such physical symptoms when its host (meaning “you”) is stressed out. Because those symptoms come in such a variety of shapes and sizes, and because they simply don’t make sense, it often becomes a challenge to put such symptoms together and come up with a diagnosis of “Anxiety.”
So, let’s say you read Part One and find that you are indeed suffering from anxiety and/or depression. Now, what can we do about? Unfortunately, the choices are somewhat limited in the CNMI. Classic stress reduction suggests exercise as the number one, non-medicinal treatment.
Exercising 40 minutes a day, 4-5 days a week, can cause certain positive improvements in body chemistry, which significantly reduces the negative impact of stress overload. The type of exercise found to be most beneficial is the strenuous, non-stop, sweat-producing, cardio-type exercise.
Many of us would probably need to start at a not-very-brisk walk for ten minutes, and gradually work ourselves up to eventually achieve our goal. If you’re not in shape, chat with your provider first to see what would be best for you. Unfortunately, the very folks who need the stress reduction the most, are the very ones least likely to find any free time for exercise.
Many of my patients are working long hours at one or two jobs just to put food on the table, come home to care for the kids, and are exhausted at the end of their day. Not an “excuse,” but the reality of the times. Exercise simply is not an option for many.
Another way suggested to reduce stress is to take a vacation. Yeah, right! Who has the money to take a couple of weeks’ vacation on Aruba or a trip to Europe to relieve your stress? Many of my patients cannot remember the last time they took a real vacation or even had some free time. Although it sounds great in theory, in practice “getting away” is also not a viable option for many.
For those who do have a bit of “free time,” taking a relaxing stroll on the beach at sunset, getting involved in a hobby or doing some kind of pleasing activity may be quite helpful. Donating your time to a worthwhile community service or getting involved in some group oriented activity (such as Beautify CNMI, the Red Cross, Hospital Volunteers, etc.) can take your mind off the stressors and give you a feeling of accomplishment.
Some of my patients who suffer from general anxiety disorder have symptoms such as tension headaches and stress-related chest pain. They become overly anxious that these are strokes or heart attacks and become even more anxious. With some reassurance, once they understand that these symptoms are not serious and that they are experiencing “normal” symptoms” to stress overload, they feel relieved enough that no further treatment is indicated.
We all have different backgrounds and genetic makeup; we are all unique in how we cope with our stressors, or handle the symptoms associated with anxiety. There are a number of suggested strategies each of us can employ to deal with stress; however, as I mentioned earlier, many of the usual strategies simply are not viable options to many of us who live in the CNMI.
And here lies the crux of the matter. The rest of this article will be devoted to the “pharmaceutical solutions.” If daily exercise, the occasional vacation, several sessions with one of the CNMI’s experienced and capable psychologists, or sending the kids away to summer camp for a couple of months were reasonable options, then using medication would be much farther down on the list of options.
My clinical experience suggests the very real benefits of medication for some people when other strategies don’t work for an individual or when those strategies are impractical. I do encourage trying various non pharmaceutical methods of stress reduction first.
Types of medications
There are basically 2 types of medications for people who are suffering from the symptoms of anxiety or depression. The first type includes all of the fast acting but short term meds. Clearly, there are both advantages and disadvantages to this group.
The short term meds are used best for people with “situational anxiety” (stress overload because, say, a family member died or you just got laid off work), people suffering from panic attacks, people who have occasional problems falling asleep (“I get into bed and I start thinking too much”), or for those who generally handle their stressors but occasionally are overwhelmed and need something to help relax them (say, before they get to the point of drowning the kids or shooting the husband).
The short term meds, from a group called “benzodiazepines” such as Valium, Xanax, or Ativan, work quickly, they are good for relaxation or sleep, and generally make a person feel much better, at least for a few hours.
The downside is: they work too well. These are narcotic drugs and can be highly addictive if used regularly.
Those of us who remember the medicine of the sixties and seventies (yes, there are some of us THAT old to recall when Valium was used for a host of emotional disorders) remember people being prescribed Valium for three to four times daily…for months or years.
The detox for those addicted to Valium or other similar medications is not unlike that of heroin. That is why the wiser providers use the short term drugs with much caution, write prescriptions for relatively small quantities, and advise the patient to use the medicine ONLY when needed. Different providers may have different ways of helping their patients cope with anxiety. There is not a black-and-white, wrong or right way to treat patients with anxiety disorders.
There are many acceptable strategies, depending upon situational variables. However, if you find that your provider writes you endless prescriptions for Valium or Xanax and is not trying other strategies, then I would strongly suggest walking away and finding a provider who has your best long term interests in mind.
So, we see that there are medically sound uses of the short term medications in a variety of situations. But these medications must be judiciously and cautiously prescribed.
What about those folks suffering from long term anxiety disorders with symptoms that plague them daily? These are the group of people who suffer from most of the symptoms we discussed in Part 1. That takes us to the long term medicines. These medications come from a general group with the tongue-tying name of “Selective Serotonin Reuptake Inhibitors” or SSRI. The typical ones are commonly referred to by their brand names such as: Paxil, Prosac, Zoloft, Celexa, and Lexapro. These work by increasing the availability of serotonin as a neuro-transmitter (or messenger) in your brain, transmitting nerve signals between brain cells. Huh?
There are a number of chemical transmitters that relay different things throughout your brain. Serotonin is really a hormone that works in different parts of the body. For our purposes, we’ll only discuss its very important function in the brain.
Briefly, changes in levels of serotonin in your brain can affect your mood. Some people seem to simply not have enough of that mood enhancing chemical working between the brain cells. For others, who knows?
There are undoubtedly a number of factors affecting the amount of serotonin circulating in your brain at any given time. But the bottom line is: serotonin tends to be a “feel good” chemical. The SSRIs help to keep serotonin in circulation resulting in feeling more normal, rather than anxious. This, of course, is a very simplistic description but it shall suffice for now.
Studies on serotonin first began in the late 1930’s. Medical science has improved its understanding of this chemical and some 40 years ago it was developed in Europe as an alternative to the anti-depressants of that time. The first widely used SSRI was Prosac. A subgroup of the SSRI’s is the Selective Serotonin and Norepinephrine Inhibitors.
This group of meds allows for increased circulation of both serotonin and norepinephrine. For those of you who are suffering from “fatigue” as a major symptom, norepinephrine is a naturally occurring chemical which tends to combat fatigue and depression, a good choice for certain folks.
Now, the bad news is although SSRIs work extremely well for those folks who need them, there are a number of potential problems when using these.
Much more complete information can be found online, starting with a Google search of “SSRI”.
Don’t miss the third and final part of this series where I will be sharing with you things to consider when starting an SSRI.
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