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Treating Anxiety
40 million American adults suffer from anxiety disorders and many are taking a class of drugs known as benzodiazepines which include Xanax, Klonopin, Valium, and Ativan. These drugs are addictive and dangerous. There is a risk of respiratory depression that can cause overdose, especially when taken with opioids or alcohol. Discontinuing their use can cause severe withdrawal symptoms, such as seizures. Their usage can also lead to falls and cognitive decline. Most importantly, these drugs do not work in the long term. Studies have shown that after just 8 weeks, those on Xanax had worse anxiety than those who took a placebo. (Occasionally benzodiazepines are prescribed to treat depression, however research has shown that people with a predisposition to depression are likely to have increased levels of depression after using benzodiazepines.)
Besides benzodiazepines, certain SSRI anti-depressants such as Prozac, Zoloft, Paxil, Celexa, Lexapro, and others are used to treat anxiety but provide little benefit in relieving anxiety symptoms and come with their own side effects such as headache, nausea, agitation, weight gain and sexual problems.
The poor efficacy and terrible side effects of these commonly prescribed drugs have not gone unnoticed by the medical professionals themselves. I attended the 2019 Integrative Mental Health Conference in San Francisco last week. There I sat with 900 frustrated psychiatrists and other mental health workers, all of whom feel that conventional medicine has let them and their patients down. This conference focused mainly on alternative methods on dealing with things such as anxiety, depression, epilepsy, Alzheimer's and more. Today I will share what I learned about anxiety. More to come on the others in future blog posts.
What is Anxiety?
Anxiety disorders are characterized by fear, excessive nervousness, apprehension, and worry that is out of proportion to the actual danger. OCD (obsessive-compulsive disorder), PTSD (post-traumatic stress disorder), panic disorder, and phobias are examples of anxiety disorders. Symptoms include:
* Nervousness
* Tension
* Panic
* A sense of doom
* Increased heart rate
* Fatique
* Sweating
* Trouble concentrating
Victoria Maizes
Dr. Maizes is a Professor of Medicine, Family Medicine and Public Health at the University of Arizona Center for Integrative Medicine. Here are some things she said about anxiety.
Many anxiety symptoms actually can be a result of something else and must first be ruled out. For example, anxiety can actually be hypo-thyroid or hyperthyroidism. Or various heart ailments such as congestive heart failure, cardiac arrhythmias, or chronic obstructive pulmonary disease. These symptoms can also be a result from lead toxicity or pesticide exposure, or even vitamin B12 deficiency.
Unexpected side effects from many medications also can cause anxiety symptoms like beta agonists, corticosteroids, thyroid hormones, oral contraceptives, ADHD drugs, or OTC medications that contain lots of caffeine.
Many beverages like coffee, tea, soda, energy drinks, and other highly caffeinated drinks can cause symptoms that also mimic anxiety.
So it's important the these other things are ruled out before getting treated for anxiety. Unfortunately, many doctors will just quickly write out a prescription for their favorite benzodiazepine before ruling out the plethora of things that can cause similar symptoms.
What to do Besides Take Drugs?
Cognitive Behavioral Therapy (CBT)
People with anxiety tend to castrostrophize negative events and have a low tolerance for uncertainty. With CBT, a person is taught to use skills that encourage evidence-based thinking. For example, ask yourself, "how likely is the thing that I am worried about will actually happen?" For example, I have great anxiety about driving. I've been in 4 car accidents, even though I wasn't even driving in any of them. I visualize cars coming at me and hear crashing sounds. But I should ask myself how likely is it that this is really going to happen each time I get into a car?
Lin-Manuel Miranda had wonderful advice when he said:
"Your mind is yours alone. Do what it takes to make yourself comfy.
Draw the blinds, kick out unwelcome guests. Make it your home."
Physical Activity
One of the best ways to deal with anxiety is through exercise as it increases the availability of neurotransmitters such as serotonin and dopamine. Exercise also positively effects the body's main central stress response system called the hypothalamic pituitary adrenal axis (HPA.)
Studies have shown reduction of stress from:
* Aerobic exercise (Zumba is my favorite)
* Yoga
* Tai Chi
Shinrin-Yoku (Forest Bathing)
Walking in nature is a proven way to reduce anxiety. Walking in nature reduces cortisol levels and lowers heart rate. What is remarkable is that as little as 5 minutes a day effectively reduces anxiety!
Getting in touch with nature, in any way, is soothing. My daughter-in-law, Karina Aldredge, created the popular Instagram, Sacredelements which, through pictures and videos, reminds her 87,000+ followers to connect daily with the beauty that surrounds them.
Mindfulness
Meditation can help reduce anxiety. Basically, it is just paying attention, non-judgmentally, to the present moment. There are many types of meditations including Guided Imagery. There are many free guided imagery meditations available on the web and countless books, utube videos, DVDs and other sources of information on various meditative practices. You need to find one that works well for you.
Zen Proverb:
"You should sit in meditation for 20 minutes every day
- unless you are too busy; then you should sit for an hour."
Relaxing Breath
Everyone should do this!! It's a simple breathing exercise that Dr. Weil taught me years ago and it's very effective for anxiety. This exercise tones your parasympathetic nervous system (which can slow your heart rate and lower your blood pressure after the sympathetic nervous system has activated the fight or flight response.)
This only takes 45 seconds and should be done twice a day.
* Place the tip of your tongue against the ridge on the roof of your mouth
* Exhale completely through your mouth
1. Inhale deeply through your nose to a count of 4
2. Hold your breath for a count of 7
3. Exhale through your mouth to a count of 8
4. Repeat 1, 2, 3, for a total of 4 breaths
Diet
Although Dr. Maizes didn't spend a lot of time on diet, here are some recommendations from her as well as other sources like the Mayo Clinic.
* It's important to keep your blood sugar stable so make sure your meals, especially breakfast, contain some protein.
* Eat complex carbohydrates like oatmeal, quinoa, whole-grain breads and cereals. Carbohydrates increase the amount of serotonin in your brain which can calm you. But stay away from simple carbs like sugary foods and drinks.
* Stay hydrated and drink lots of water. Dehydration can affect your mood.
* Limit alcohol. Although it can have an immediate calming effect, it can later make you edgy and interfere with your sleep.
* Limit or avoid caffeine. It can make you jittery and nervous and interfere with sleep.
* Check for food sensitivities. Certain foods or food additives can cause irritability or anxiety.
* Eat healthy, balanced meals that include fresh fruits, vegetables, high omega-3 foods such as salmon, and fermented foods for a healthy microbiome.
Sleep
Sleep is critical to our mental health. Dr. Maizes says, "No one can GO to sleep. One must LET GO to sleep."
Of course she recommended the usual suspects:
* Limit caffeine
* Reduce light exposure
Supplements and Herbs
Certain supplements show promise in helping anxiety, especially high dose vitamin B. Whereas omega-3 and inositol also show promise, the dosages in the study seem prohibitive to me.
Kava Kava studies showed supplements of this herb helped with anxiety associated with menopause and with benzodiazepine withdrawal. It is available in tea for but do not pour water over the tea bag as it will deactivate the kava kava.
Chamomile is another herb that can be enjoyed as a tea or capsule that helps with mild to moderate anxiety.
Vaporized lavender when used in aromatherapy generates the terpene linalool which can trigger a relaxing effect by directly stimulating olfactory sensory neurons.
Adaptogens are herbs used to help the body adapt to stress and make it more resilient. There were several mentioned that helped reduce anxiety:
* Rhodiola is widely used to alleviate anxiety, depression, and insomnia.
* Ashwaganda
* Holy Basil
* Asian and American Ginseng
* Siberian Ginseng
Acupuncture
I am a big fan of acupuncture but it's important to find a skilled practitioner. Studies have shown acupuncture can have a substantial positive effect in reducing anxiety.
