Coping in an age of anxiety

Dear Reader,

These are not only the best of times and the worst of times. They also are nerve-wracking, nail-biting times for tens of millions of Americans: Slightly less than a quarter of adults and a rising number of young people suffer from anxiety disorders, which have become the nation’s most common and pervasive mental woes.

They’re as real to those who suffer from them as any physical complaint. The deep apprehension that sufferers feel exceeds the worry or jitters that are part of everyday life. Rather, it becomes a dread that patients and experts describe as “deep, persistent, seemingly uncontrollable, overwhelming, excessive, irrational, and disabling.” It’s often accompanied by crushing depression.

Some experts trace the pervasive anxiety problems to Americans’ hectic, demanding, over-pressurized modern life, especially with its 24/7, electronics device-driven, social media-laden existence. This year, arguably, also has been annus horribilis—still incomplete and already marred by horrible storms, floods, wildfires, and relentless acts of public violence, including mass shootings and clashes over police (mis)conduct. Angry, divisive politics—and the angst and the uncertainty they foment—certainly don’t help. Neither will the frenzied rush of the year’s end and the impending holiday season.

But are there ways we can unhook ourselves from feeling so stressed that too many of us self-medicate with alcohol or gulp down powerful, risky, and expensive anti-anxiety medications? Can we get the kids calmer so they’re not jittery with hair twisting, nail biting, and upset stomachs—all while glued to screens and manic with their social media activity?

Yes. Breathe deeply, and read on.

Anxiety disorders: pervasive but treatable

Make no mistake, modern life is full of stress: You may be grappling with a consuming project at work. You may be juggling several jobs and struggling to make ends meet. Your kids face a barrage of homework assignments, relentless testing, and ever-shifting peer demands and pressures.

Most of this can be considered a new normal. But experts say that our responses to it aren’t. An estimated 40 million Americans now suffer from anxiety disorders—fear, nervousness, restlessness, irritability, and fatigue that doesn’t fade and can cripple them in their daily lives.

Mental health experts say there are some common types of this syndrome, including a generalized anxiousness, panic, and social anxiety. The trouble may worsen when you also must cope with phobias, or when you encounter specific situations, such as separation from loved ones or comforting settings or objects.

Clinicians say patients with generalized anxiety complain of restlessness, feeling wound-up or on edge. They fatigue easily, can’t concentrate, are irritable, and experience tension, especially in their muscles. They can’t control their worries and their sleep is disrupted and unsatisfying. They also may exhibit dizziness, nausea, diarrhea and frequent urination. Their symptoms may be vague enough so doctors less inclined to consider anxiety disorders subject them to a battery of tests that may not detect a disease or physical condition.

Those with the panic form, experts at the National Institutes of Mental Health say, may experience “sudden periods of intense fear that may include palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath, smothering, or choking; and feeling of impending doom.”

Those with social anxiety have a “marked fear of social or performance situations in which they expect to feel embarrassed, judged, rejected, or fearful of offending others,” the NIMH experts say. They add that these individuals may experience symptoms such as difficulty being with others and talking with them, as well as extreme self-consciousness. They can become fretful about encountering others and stay by themselves. They struggle to make and keep friends. They may blush, sweat, or tremble around other people, as well as feel nauseous or ill around others.

Although all of us may exhibit some of these strong reactions at times, depending on the circumstance, patients most often head to their doctors or mental health professionals when they realize their anxiety is constant and can’t be kept in check.

Those susceptible to anxiety disorders, it should be noted, often don’t have as much control of their lives as many of us do, experts say. That’s because they may be shy or inhibited. They’re often poorer and less privileged. They’re more likely to be women than men. They may have been divorced or widowed. They may have experienced traumas, and many have family histories of mental health issues.

To be sure, the nation isn’t involved in a Depression or a great war. But Americans have much to be anxious about these days. Social analysts and commentators have pointed out that recent times have become glum, full of conflict, and punctuated with brutish events, including natural calamities and terrorist attacks. The Great Recession, the globe’s most profound economic shock since the Great Depression, has receded for many. But now a giant gulf yawns between America’s haves and have-nots. Income inequality, combined with social inequities, have played a part not only in creating great anxiety in the country but also downright despair, experts say, pointing to real and perceived grievances’ super-charging the tragic opioid drug abuse epidemic. Too many baby boomers have been poor stewards of their personal finances, and with 10,000 of this huge demographic cohort retiring each day with too little saved, no wonder that there are high anxieties for many Americans about the future.

Our partisan divide also is as deep as it has been in the post-war period, studies find, and the issues that politicians choose to play on are disturbing, often personal, and as wounding as possible. We can’t change our skin color, gender, or sexual orientation, and when these and other aspects of our already fixed backgrounds become topics of bitter political dispute, it can be make us anxious and angry. The Trump Administration has pursued a politics of conflict and unpredictability that has led to uncertainty—and even, many Americans say, chaos. This can be distressing to witness, especially when it stirs hints of war and even nuclear conflict. An annual, national survey about our deepest fears has found Americans anxious and afraid about health care and high medical bills. It also surfaced some newer and big worries about government corruption, possible involvement in global conflict—especially a nuclear exchange with North Korea—and environmental woes, including global warming and water and air pollution. Young people also are clearly stressed about their lives (see below), fueling their problems with anxiety and depression.

Mental health issues don’t get their due, and individuals may be wary of seeking help, fearing they will be stigmatized. But anxiety problems should not be ignored, doctors say, because they also may signal other health concerns: Experts recently published a study showing a “partial list” of at least “47 … illnesses, ranging from cardiac arrhythmias to pancreatic cancer, that may first present as anxiety.” Patients with respiratory conditions like asthma, sleep apnea, or pulmonary embolism could exhibit symptoms of anxiety, or those with cardiac symptoms like chest pain or rapid heartbeat could have an anxiety disorder. Further, because clinicians may be too quick to treat anxiety with drugs, the experts noted that another “partial listing” of 30 categories of medications that may cause this woe, including antidepressants such as selective serotonin reuptake inhibitors, or SSRIs.

Kids’ high anxiety gives grownups cause to wring their hands

Anxiety disorders are hitting young people especially hard.

The National Institute of Mental Health says that 38 percent of girls ages 13 through 17, and 26 percent of boys in that same age group, have an anxiety disorder.

The New York Times recently reported:

“Over the last decade, anxiety has overtaken depression as the most common reason college students seek counseling services. In its annual survey of students, the American College Health Association found a significant increase — to 62 percent in 2016 from 50 percent in 2011 — of undergraduates reporting ‘overwhelming anxiety’ in the previous year. Surveys that look at symptoms related to anxiety are also telling. In 1985, the Higher Education Research Institute at UCLA began asking incoming college freshmen if they ‘felt overwhelmed by all I had to do’ during the previous year. In 1985, 18 percent said they did. By 2010, that number had increased to 29 percent. Last year, it surged to 41 percent. Those numbers — combined with a doubling of hospital admissions for suicidal teenagers over the last 10 years, with the highest rates occurring soon after they return to school each fall — come as little surprise to high school administrators across the country, who increasingly report a glut of anxious, overwhelmed students.”

Experts are uncertain what’s causing the rising tide of anxiety issues in the young, who made a mad fad this summer of “fidget spinners.” But they say that youthful brains, in a critical period of development, crave stimuli—and contemporary society provides it in excess, especially with a relentless avalanche of information and activity thundering down on youngsters from media, social media, games, and entertainments and through electronic devices and an array of screens.

This all comes atop lives that, while well intentioned, seem driven by parents’ insistence that kids participate in and excel at an array of not only academic but also extracurricular activities. Youngsters are not only supposed to plow through school and school work—including standardized tests and loads of homework, both of which hallmarks of even elementary classrooms these days—they also must march through an array of lessons (music, dance, arts and crafts) and after-school programs (soccer, gymnastics, and football and baseball).

As Time Magazine described it:

       “[B]eing a teenager today is a draining full-time job that includes doing schoolwork, managing a social-media identity, and fretting about career, climate change, sexism, racism–you name it. Every fight or slight is documented online for hours or days after the incident. It’s exhausting.”

It’s also sending many kids over the edge, not only with disorders involving anxiety, depression, and suicide but also with other problems including “cutting” (scarring and disfiguring oneself), obesity, and eating disorders.

High schools across the country are reporting they can’t cope with teen-agers’ needs for mental health support, and colleges and universities have conceded they are overwhelmed with student demand for psychiatric services. Collegians with suicidal tendencies or other crises may be getting the emergency help they need. But for young people with problems with stress, anxiety, and depression, appointments at student health programs with counselors, psychologists, or psychiatrists may take weeks—and both patients and professionals agree this is unacceptable.

Easing anxiety is both for individuals and societies

What should we do about our anxiety issues?

The paths forward are small and person

If your struggles with your fears and apprehensions intrude on the way you live your daily life, you should see your medical professionals—your doctor, or perhaps a counselor, psychologist, or psychiatrist. Yes, you may need to overcome your fears that even seeking such care may subject you to unfair, unwarranted, and unjustified stigma. But you shouldn’t let others’ prejudices add to your suffering. Sadly, too many people do: experts estimate that only 37 percent or so of those with anxiety disorders seek treatment.

Your doctor, as discussed, will need to rule out physical causes for your anxiety. You then may be given medications to treat your disorder, and you may be encouraged to participate in therapies. If recommended, you should follow both courses.

The temptation these days may be, as always, to think that magical pills will resolve any health challenges. Doctors, especially to start, may prescribe antidepressants, anti-anxiety drugs, and beta-blockers for patients with anxiety disorders. These drugs aren’t candy, and they carry significant risks. Ignore the popular characterization that America has “shifted from being the Prozac to the Xanax nation” due to the prevalence of anxiety woes.

It is true that the class of drugs known as benzodiazepines—dispensed in such brands as Xanax, Librium, Valium, and Rohypnol—may be prescribed to “help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry.” But as the opioid drug abuse epidemic has blazed across the country, public health officials have issued major cautions about benzodiazepines, which now carry regulators sternest “black box” warning: Experts underscore that they should not be taken in overlapping fashion with potent painkillers. The results can be lethal.

There also are major prescribing warnings about antidepressants, which also are given for and often show good results in treating anxiety. As the National Institutes of Mental Health reports about these drugs—sold in a range of brands including Prozac, Paxil, Zoloft, Celexa, Cymbalta, Wellbutrin, Olpetro, and Tofranil, to name a few:

“They may be risky for children, teens, and young adults. A ‘black box’ warning—the most serious type of warning that a prescription can carry—has been added to the labels of antidepressants. The labels now warn that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. For this reason, anyone taking an antidepressant should be monitored closely, especially when they first start taking the medication.”

In my practice, I see the major harms that patients can suffer while seeking medical services and the wreckage that can be inflicted on them by dangerous drugs. It’s simply unacceptable that doctors keep giving patients powerful psychiatric medications so readily, including prescribing them off-label to tots.

As for beta blockers and anxiety disorders, some doctors may prescribe these medications “such as propranolol and atenolol … in the treatment of the physical symptoms of anxiety, especially social anxiety.” The drugs, first developed to treat heart woes, can help “to control rapid heartbeat, shaking, trembling, and blushing in anxious situations.” The medical literature indicates that these drugs may have mixed, at best, results, and that they address symptoms more than causes of anxiety disorders. But read media accounts and it is clear that popular hype is starting to overtake beta blockers, pushing them, especially to the young and high-achievers, as a “smart” or mind-enhancing drug.

For the anxiety ridden, a key component of treatment also rests not just with drugs but also with therapies of the cognitive and exposure varieties. Both try to help patients identify, discuss, challenge, and better deal with “unhelpful” thoughts that make them excessively anxious. Patients may do this in individual or group settings.

They also may benefit from a newer form of treatment in “positive psychology,” which, in brief, emphasizes the aspects of “what makes life worth living.” Its therapeutic approach aims to build on patients’ strengths and to help them better balance their negatives and fears, including, in some other forms, to help us all find lives in which we experience an optimal “flow” in which things click and work exceedingly well.

Indeed, as with all negatives, anxiety disorders may be pointing us at some broad, deep challenges we need to take on and resolve in our contemporary society. We may need to be less extreme and more moderate in many things: We can ease off our material striving so we have greater community and connection with each other. We could be less about me, more about us. We can stress less about earning and achieving and maybe spend a little more energy on appreciating and enjoying. We can step back from our brutal partisan politics, so we try to work together to fix our common problems. We can turn off our devices and social media, make time for relaxing and less competitive exercise, and get more sleep (see below) so we’re not frazzled and exhausted. It won’t matter, really, in the days ahead, if the turkey’s a little dry or if the kids are sitting on folding chairs, just so long as the loved ones at the table are together, healthy, and happy, right? In the upcoming season of giving thanks and appreciating higher purposes and meaning, here’s hoping you and yours are healthy—and that we recalibrate all our lives, so they are less anxious and more filled with joy.

Sleep and exercise: key ways to keep anxiety in check

It’s more than common sense: Research and experts say that exercise and sound sleep can play important roles in helping those with anxiety disorders.

Disturbances in sleep often accompany and worsen the health of those who are anxious. It can be something of a chicken-and-egg challenge.

But besides the essential benefits that sound sleep can confer—such as allowing the brain to process complex materials and to restore itself—the lack of it, especially when complicated by anxiety, can be harmful to mental and physical health. In the young, it can complicate key developmental activities. Just consider: When you’re groggy or weary, your attentiveness dips, your moodiness rises, and you can feel more stressed. Some researchers are tying sleeplessness to attention disorders in the young, and this distraction, especially in the face of the myriad stimuli that teenagers are subjected to, can add to their anxiety.

Getting a good night’s sleep should be a priority for those with anxiety disorders. They can follow best practices that really can be applied to us all: Hit the sack according to a routine—at the same time each night and winding down slowly into peace and quiet, without food, noise, light, and other disturbances around. Ban electronic devices from the bedroom, especially smartphones, tablets, electronic games, and, yes, videos and broadcast programming, especially if it is scary, violent, action-packed, intense, or arousing.

Appropriate exercise can help us all sleep better, too, and it can benefit the anxious. It helps to relieve stress and to get the mind off the day’s business. But don’t exercise just before you try to go to sleep. Don’t overdo it. For many people, a gentle 10-minute walk a few times during the day can be as beneficial as a longer, tough workout. If possible, recruit a friend or loved one in your regimen, and do exercise that you find fun and relaxing. Keep at your program. And see if it helps to do at least part of it outdoors and in the sunshine, taking proper care of yourself during the various seasons.

Are media, social media and e-devices making us fret too much?

They’ve become a critical part of Americans’ lives. But it’s inarguable that media, social media, and electronic devices (smart phones, tablets, and all manner of screens) add immeasurably to our collective anxiety. And we all need to think about better ways to use and draw boundaries for them—especially for the young.

No one’s talking about any First Amendment limits. But even for savvy and engaged citizens, the 24/7 cable broadcast news cycle often tips over the line of excess, creating significant individual and societal stress. This has been especially true since the election of President Trump.

Without diminishing anyone’s democratic participation, would it be sensible to suggest that we all, periodically, might just put ourselves on a news diet—setting time limits on what media we consume and being highly selective of which outlets we choose? If news reports make us anxious, particularly as we must determine the veracity and credibility of the huge flows of information that inundate us, might we step back and think about what’s in them that triggers strong responses and how we might better deal with these semi-automatic reactions?

Grown-ups may make themselves about as popular as a bottle of catsup in a five-star French restaurant. But educators, pediatricians, and other experts say we’re long past due in helping kids learn more about best practices and boundaries for media, social media, and burgeoning e-devices. This effort may need to start earlier and earlier, even with tots. The support and discipline becomes even more crucial and may need to be greater and deeper with older youths, especially since some expert observers fear that an entire generation may be succumbing to real harm from over-exposure to the negatives of e-devices and the content that they bombard audiences with.

Try some experiments during the upcoming holiday season, a period that’s supposedly legend for quality family time. Don’t ban your kids from e-devices, media, or social media. But try seeing if everyone can quit them for spans—say just during meals, and especially for an hour before bed time(and of course during lights-out time—see above). Be sure the adults participate, too. Figure out some small rewards for good performance. And try having a New Year’s family chat to see if these are practices that one and all—surprise, surprise—may want to extend and expand?

HERE’S TO A HEALTHY REST OF 2017!

Sincerely,

Patrick Malone
Patrick Malone & Associates