Lifeline Anxiety Disorder Newsletter |
A quarterly newsletter for people - and families of people - who suffer from the panic brought about by fears, anxieties and phobias. Disclaimer.
ISSN 1499-6375 (Print)
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If you’re depressed, it could be that anxious worry just may help you to cope betterResearchers looking at depression and anxiety, have, in the past, been apt to class all types of anxiety together. Many, however, argue that the anxiety of the chronic worrying variety is distinct from the fearful, vigilant type of anxiety which causes panic attacks. A published study from the University of Illinois provides evidence of differences in brain activity in people with depression and/or anxiety in both forms. In a previous study, the researchers used functional magnetic resonance imaging to show that the two types produce very different patterns of brain activity – fearful anxiety lights up in the right inferior temporal lobe, which is just behind the right ear, while worry activates the left frontal lobe area, the region linked to producing speech. Activity in the right frontal lobe is known to be normally seen in depression without anxiety. In this new study, they used functional magnetic resonance imaging to see brain activity in several distinct groups of participants – depressed people who are not anxious, anxious people who are not depressed and people with varying degrees of depression and one or both types of anxiety. Scanning their brains while participants applied colours to words that had negative, positive or neutral meanings, enabled the researchers to see the regions in the brain which respond to emotional words. The participants with depression and worry proved to be better at the task than those with depression and fearful anxiety. They were able to focus on applying the colour rather than on the meaning of negative words. This may be because worry itself helps us to plan more efficiently and to focus better on the job at hand. While engaged in the emotional word task, brain activity in worried and depressed participants was very different to that of the fearfully anxious depressed participants. The scans showed right frontal lobe neural activity in the participants with depression when fearful anxiety was elevated, but worry was low. In the case of depression in the participants with worried but not fearful anxiety, major activity was in the left frontal lobe. Fearful anxiety, therefore, appears to heighten the brain activity normally associated with depression, while worried anxiety seems, to some extent to counter it, reducing some of the negative effects of depression and fear. In other words, a particular type of anxiety helps processing in one part of the brain, at the same time hindering neural processing in another part of the brain. Treatment response is better when CALM is availableAnxiety disorder patients would possibly have higher rates of relief from symptoms as well as better rates of recovery if primary care physicians were to offer flexibility in treatment. This is especially applicable in cases where treatment must address more than just one mental health disorder. 1,004 patients ages 18 to 75 with one or more of four anxiety disorders – post-traumatic stress disorder, generalized anxiety disorder, panic disorder and social anxiety disorder – were randomly treated, in seventeen primary care clinics in four U.S. cities, with either CALM (the Coordinated Anxiety Learning and Management program, developed by University of Washington researchers, which provides choice in treatment) or usual care – i.e. the treatment selected by the physician. More than half of the participants had two or more anxiety disorders and two or more chronic medical conditions. Two-thirds also had major depression. Treatment in the CALM group included an average of 7.0 visits for cognitive behavioural therapy and 2.24 medication or other care management visits, with 57% choosing to use both, 34% choosing only cognitive behavioural therapy and 9% choosing only pharmacotherapy and other care management. Using the 12 item Brief Symptom Inventory, the researchers found that anxiety symptoms were significantly lower for the CALM recipients at 6 months, 12 months and 18 months. The remission rate for them was 51.49% at one year compared with 33.28% in the usual care group. The researchers also found symptom relief to be superior. |
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TOP Growing older; getting anxious – there are solutions that don’t ‘age’ you prematurelyThe recession of the last couple of years has impacted on the lifestyles of most demographic groups, but something that has not had much media attention is the hit seniors, and those close to being seniors, have taken. Older seniors – those whose childhood and youth took place during the Great Depression – remember the food lines, the lack of jobs and the severe poverty of the 1930s and may feel panic. Pre-boomers and older boomers who learned that it was no longer possible to work for a company for forty years and retire with a pension and, accordingly, socked every spare penny away into RRSPs – are feeling anxious and worried at the loss of value of the funds they invested in – losses they are not going to be able to recoup before that money becomes the (now dwindling) income intended for retirement living. The huge increase in economy-related anxiety is, in fact, affecting millions of the generation of people who were the first to consciously plan for their retirement. It is these older adults who – when economic stability returns– don’t have the time left to make up the investment values they have lost. These are older adults who have known how life was in less affluent times than those that their children and grandchildren have always known. Is it any wonder that there is growing statistical evidence that the incidence of mental illness is increasing in older adults? Feeling powerless naturally causes anxiety – in those genetically predisposed to anxiety disorders, it’s more than enough to trigger an ongoing problem. While anxiety disorders are the most common mental health problem in women and, among men, second only to substance disorders, historically, they are known to decline with age. Today, in contrast, the incidence of mental illness generally is increasing in older adults, anxiety disorders included. Health providers and seniors themselves tend to dismiss anxiety symptoms as “worrying too much” and in the current economic climate that makes sense, but studies are showing that almost 20 per cent of people over age 65 have met the criteria for an anxiety disorder during the past six months. There is reluctance for people, whether the older person experiencing anxiety and panic, or friends and family members, to discuss the problem or find help. The primary reasons for this are the perception that this is part of normal aging and social stigma about ageism. Education specific to seniors is needed to decrease stigma, both in society and personally, and to recognize the differences between normal aging and signs of mental health problems. But it’s not just seniors themselves who need educational support. It is also needed for service providers, both those involved in mental health and those engaged in other social services. Family members, inadvertently shrugging off the anxiety being presented as just a part of getting older and ignoring what is actually a treatable condition, also need education. In other words, the public and, especially health professionals need to know that symptoms occurring in later in life and traditionally viewed as part of the aging process, are, quite simply, NOT. In most cases they are both treatable and preventable, just as they are with other age groups. By far the most common anxiety disorder – and the most trivialized in terms of being perceived as part of the aging process – is generalized anxiety disorder (GAD). In older adults it is associated with physical disability, memory difficulties, decreased quality of life, increased use of services, mortality and depression. Ageism, stigma, busy doctors’ offices and the patient’s concurrent complaints of sleeplessness result in the most often prescribed treatment being benzodiazepines. Nearly half of all long-term prescriptions for these drugs are given to people over the age of 65, two thirds of them are women, many are widows and most are in the lower income brackets. There are studies showing that as many as 20% of older adults are using benzodiazepines. Many primary physicians and a large percentage of seniors literally have no idea that there are other options. The result is cognitive and psychomotor impairment and drug dependency as anxious seniors grow older. Studies show drug dependency developing at age 60 years or older in 35% of participants, and the substances most commonly abused being benzodiazepines. Selective serotonin reuptake inhibitors (SSRIs) are thought to be safer but little research has been done on their effectiveness for anxiety disorders in older age groups. This is, in fact, the primary reason that so many seniors are still being prescribed benzodiazepines. GAD, since it is the most predominant anxiety disorder among seniors, is the most studied and SSRIs are found to be helpful but take longer to have an effect on the disorder. Short term use of a benzodiazepine is usually advocated until the SSRI becomes effective. Since SSRIs are primarily antidepressants and GAD, in older age groups, is usually accompanied by depression, such a treatment plan can be effective. There is also less research on the effectiveness of other treatments in older adults, but some recent studies show cognitive behavioural therapy (CBT) to be helpful. It appears to be more effective for GAD than for panic disorder and social phobia and other anxiety disorders. Research is finding cognitive therapy, relaxation training and other supportive therapies effective for older age groups. A program of education and awareness, relaxation training, cognitive therapy, problem-solving skills training and behavioural sleep management is the ideal solution. The education and awareness component, then, should be seen as the key to solving the growing problem of anxiety disorders in the people on whose lives economic instability is having the most impact. TOP FROM ONE READER TO ANOTHER...Never too late These people were old. Maybe it’s not politically correct to refer to them as ‘old’ but that’s the word that came to my mind. I stood to welcome them to our anxiety support group, half wondering if they were in the right place. It turned out that they were definitely in the right place. It was just where she, the wife, needed to be to get some help. The husband, I'll call him Michael, had seen a small listing of our group in a local magazine’s calendar of events. Until he mentioned it, I didn’t even know the magazine included us. Michael had convinced her that it was worth a try. He had done everything he could think of to get her some help and nothing had worked. The wife, who I’ll call Rose, was dressed in a pretty outfit, wearing her white hair up in a fancy twist. Rose had come at a great cost. She was literally shaking, her head tilted down towards our large oval table. I could already tell that her shaking was from anxiety and not from age. At first, Michael was her spokesman. It was only after I gave a brief history of my panic disorder with agoraphobia that Rose could meet my eyes and begin to speak. Her blood pressure was high, dangerously high. She had learned it was high during a free blood pressure screening at church. The nurse had taken immediate action by phoning for an ambulance Rose, with Michael at her side, had been raced into the emergency room. Tests were given. It wasn’t a heart attack. There should have been relief and rejoicing, but that's not what happened. Michael was placed in a waiting room. Rose was left alone on a bed in a dark room after being told to ‘relax or you’ll have a stroke’. I gasped. I couldn’t help it. I wondered what was wrong with these doctors, these nurses... I couldn't understand why they had no idea of the nature of anxiety, of kindness, of simple common sense. I could feel hot anger but tried to convey only compassion to Rose. All the group members started talking at once. Her story had certainly struck a nerve. One person wanted to know whether this blood pressure reading was an isolated event. Michael answered that her blood pressure had been high for years but never this elevated. After the emergency room experience, Rose saw her family physician and a cardiologist. Her heart was found to be healthy. The various combinations of blood pressure medications were not effective. In a soft voice, Rose told us that she worried constantly about her high readings and did not know what to do. Always a poor sleeper, now she slept little and was losing her appetite. Michael said the family doctor had suggested an antidepressant but Rose was afraid of that type of medicine. Michael repeated that it was his idea to come to our group. He proudly told us that they had been married sixty-seven years. Rose gave us a hint of a smile. The room had become silent. I carefully explained how anxiety can, not only, affect our mental well being but also cause dramatic physical changes. Rose was surprised when I told her the numbers my blood pressure reached during medical procedures or even routine office visits. So I kept adding other ways anxiety had impacted my life. Rose shook her head and said, ‘I thought I was the only one.’ She said her children knew she had high blood pressure, but she had never told them she suffered from anxiety. Except for doctors and her husband, she had never told anyone. Rose and Michael attended our meetings faithfully for several months. She remained reluctant to give us any details of her life saying only that she had always been fearful. She was a very private person. During a follow-up visit with her doctor, he repeated his desire to put Rose on an antidepressant. When he mentioned the name of the medication, she immediately said, ‘That's the one Barb is on.’ She remembered how much it helped one of our group members and how few side effects it had caused. She agreed to try it. The change in Rose was impressive. She smiled as she told us that this would be her last meeting. Her blood pressure readings were normal and she was sleeping better. The medicine made her drowsy, but she thought that would pass in time and that it was worth feeling sleepy. She was very grateful to all of us for sharing our knowledge and support. Saying goodbye was bittersweet. I was thrilled to see the joy in Rose's face and equally in Michael’s as I shook his hand. I would miss seeing them. Rose had shown tremendous courage to come to a group of strangers and admit her fears. It would have been easy for her to say she was too old to try something new. It would have been understandable if Michael had grown tired and frustrated with not getting any results. Rose showed us that we can make progress no matter how many years we have been anxious. Because of her, we know it’s never too late. Colette Carner. 'From one reader to another...' contributors may be contacted using our contact form. Your message will be forwarded. TOP LIFELINE REVIEWS |
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Overcoming Anxiety For Dummies, The first edition of this book was published in 2001 and it was followed by a number of Anxiety for Dummies books by Drs. Elliott and Smith. It quickly became recognized as a comprehensive book on anxiety around the world and advocated by many therapists as a supplement to their treatment. When their publisher approached them about updating the original book, the authors evaluated the changes the world has gone through in the nine years since they wrote it. With so many new triggers to anxiety – terrorism, the recession, escalating environmental worries, pandemics and more – they decided that it was definitely time for a second edition. The three goals of the book are for readers to understand just what anxiety is and the different forms it comes in, to learn what’s good about anxiety and what’s bad and to be informed on the latest techniques for overcoming it. Overcoming Anxiety For Dummies is divided into the following six parts:
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Reducing brain acidity can normalize the fear responseUniversity of Iowa studies show that a basic factor of metabolism acidity has a role in fear response. The acidity level or pH of our brains is well regulated, a large increase or decrease in brain acidity being seriously disrupting. One study, however, indicates that pH can sometimes rise and fall in the synapses (the communication points between the neurons) and some of these have proteins – acid-sensing ion channels (ASIC) – which stimulate the neurons when increased acid is detected. The capacity to show fear in genetically modified mice lacking the proteins was reduced and normalized when the researchers restored the ASIC gene in the amygdala only, suggesting that normal fear behaviour requires the ability to detect changes in synaptic pH in the amygdala. The same research also showed that inhalation of elevated concentrations of carbon dioxide triggered strong fear reactions in normal mice which required the presence of the acid-sensing protein in the amygdala. People with panic disorder are unusually sensitive to carbon dioxide inhalation and other laboratory procedures that increase brain acidity, experiencing a panic attack when they inhale air containing 35% carbon dioxide. Most healthy people will not. People with panic disorder tend to generate excess lactic acid in their brains. Scientists have long hypothesized that an abnormality affecting basic cellular metabolism or pH lies at the heart of the genetic vulnerability to panic disorder. The University of Iowa studies also suggest that, since people with panic disorder build up excess lactate in their brains, lactic acid (lactate) accumulating in acid-sensitive fear circuits may trigger panic attacks. Glucose metabolism produces lactate which is normally consumed during brain activity. An accumulation in the brain, however, will make the brain more acidic. The studies support the possibility of developing means to modify the metabolic or neurochemical pathways involved in brain acidity and anxiety response. Aerobic exercise training, for example, may reduce anxiety by improving the brain's ability to prevent excess acid accumulation in the acid-sensitive brain regions involved. Anxiety – high blood pressure riskNew Canadian research links chronic anxiety to a fourfold increased risk for high blood pressure. The study involved 185 patients, average age 58, with no previous history of high blood pressure. Sixteen per cent had an anxiety disorder. After one year, 14 per cent of them had developed high blood pressure compared to four per cent of the anxiety free. The Montreal researchers think that anxiety disorders possibly cause changes in the function of blood vessels and the heart's pumping chamber. Since elevated blood pressure is a leading risk factor for heart disease and stroke, it is important that anxiety disorders should be diagnosed and treated. |
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2nd Edition by Dr. Charles Elliott and Dr. Laura Smith. Wiley Publishing Inc. April 2010.
Summer 2010 issue for download.