“My nerves are shot!”

For the uninitiated, “My nerves are shot!” is a phrase very commonly heard by this wandering pilgrim in his days seeking to help those suffering from seemingly insurmountable anxiety and stress.  It basically means, “I can’t take all this anxiety anymore!!  I’m completely beaten down by all of it!  Please help!!!!”

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After hunting around, I managed to find some pictures that illustrate the following fact:

Even though I myself might not have the courage to trust in rickety, rusty, rotting stairs to climb to the top of tall belfries, and then to lean out over the top to look down at the tiny buildings, cars, and people below, some folks DO possess this bravery, and I tip my hat to them!

For example, these young ladies certainly had a lot of intestinal fortitude while mounting up to this belfry at the top of the Basilica in Quito, Ecuador:


But, once they reach the top, what a view they received as their reward!!

Amazing!

And then here is another young man who overcame, undoubtedly, tremendous fear to climb out onto the precipice of imminent disaster to capture great photos:

I’ve got to hand it to him … he’s got a ton of courage!  Courage which I do not possess.  And likely never will.  Which, taken with the long range view in mind, is perfectly ok by me.

I do very much appreciate the photographs he has given the rest of us, though!

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As we decided in our last installment (well, at least I decided!) anxiety is the degree to which our bodies are activated, in any given situation, moreso than is needed to deal with that situation.   And as we also talked about, anxiety disorders are extremely common, with as many as 40% of American adults having a diagnosable anxiety disorder at some point in their lives (in many cases, for their ENTIRE lives!).  That means 2 of every 5 of us will be impaired by anxiety in some way, shape, or form during our journey!  This outnumbers almost any other illness we might ever face.  And as such, anxiety disorders ought to be taken very seriously.

Now, we also discussed the fact that there is a very big difference between having an “anxiety disorder”, and having an “anxious” or “fearful” state of mind.  This is a huge distinction, and we’ll talk more about that later on, down the road.

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Currently, the most common form of treatment for anxiety disorders is medical, i.e., medication.  Whether it ought to be or not is a debate for another venue and time.

There are 3 primary classes of medicine used to help people with anxiety disorders:

1)  Tricyclic Antidepressants:  The word “tricyclic” refers to their chemical molecular structure.  The word “antidepressant” means that all of these medicines were originally marketedas antidepressants.  It has very little to do with how they actually work within the nervous system.  And they are used to treat far more than just depression.  Anxiety, chronic pain, insomnia, migraine prevention, etc. are all within their purview these days.   The class includes:  Amitriptyline (Elavil), Nortriptyline (Pamelor), Desipramine, Imipramine, Clomipramine (Anafranil), Doxepin, and Trazodone, among others.

2)  SSRIs (aka, Selective Serotonin-Reuptake Inhibitors):  This class also is primarily considered to be “antidepressants”, but once again, we find them being used to treat other problems, most especially anxiety.  The list includes:  Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), Citalopram (Celexa), Fluvoxamine (Luvox), and Escitalopram (Lexapro).  All of these medicines can lessen anxiety, though they typically take longer to achieve this dampening effect.

3)  Benzodiazepines.  This is by far the most effective class of medicine if you simply want to lessen anxiety in its global context.  It includes:  Diazepam (Valium), Alprazolam (Xanax), Clonazepam (Klonopin), Lorazepam (Ativan), Chlordiazepoxide (Librium), Clorazepate (Tranxene), etc.

The problem with “Benzos” is that they have developed a negative connotation and reputation for many people, both inside and outside of the mental health profession.  ‘Tis true, some people do abuse benzodiazepines.  A slender few become addicted to them.  Not even close to a majority, but that fact seems to matter little to many people.  In my experience, VERY few people who truly do struggle with a real anxiety disorder will ever abuse their medicine.  They simply want relief!  NOT to get high.  But, as with so many things, a few people with selfish or unhealthy intentions can often ruin things for many others, and this has been the case with these medicines.  However, it is also true that many prescribers have too often written scripts for these medicines without really finding out whether and to what degree their patient actually has a crippling anxiety problem.  I have been guilty of this at times.  Most of the time, though, when I prescribe such a medicine for someone, I have been careful in the diagnosis, but I do often choose to trust people until such time that they might prove to be not trustworthy.  The vast majority of the time my trust in them has been well-founded, and they end up very grateful for the help with this hugely disabling condition!

There are other medicines commonly used to help with anxiety, but they are usually fairly unique-type meds, not a part of a larger class.  Examples include Buspirone (BuSpar), Hydroxyzine (Vistaril or Atarax), Gabapentin (Neurontin), and a couple of other more obscure medicines not used much in a number of years.

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However, there are other ways beside medicine to treat anxiety disorders.

There is what is called, “Cognitive Therapy”.  This is a form of treatment in which you work with your therapist to identify some of the “automatic thoughts” that go through your head in certain situations.  In this case, these would be situations in which you ordinarily begin to feel symptoms of anxiety arise within your body.  Then, while you are in a safe and calm place, you begin to REALLY examine these thoughts, as well as the beliefs that underlie them, and see just how true and accurate these beliefs and thoughts actually are.  For any of us who do this sort of exercise, we quickly realize that there is an incredible amount of pure junk (I wanted to use a word that includes a large case ‘B’ next to a large case ‘S’ here, but as this is a “family” forum, I’ll stick with ‘junk’!) percolating around in our minds, and it has a huge impact on our lives.  But, again, that’s a discussion for another day.

As you identify the falsehoods and silly thinking or logic that permeates your belief systems, you begin to try to change those automatic thoughts with other self-talk which you, yourself, script out.  Some people will actually write down a few “true” statements on a 3×5 index card and carry it around with them, to pull out whenever they start to feel anxious.  You could also write a few such lines on your cell phone.  As you begin to practice responding with more accurate statements about yourself, the situation, the worst case scenario, and other “outside-the-box” choices you can make for yourself in that instant, and as they become more habitual for you, the less your anxiety and worry become.

Almost all forms of therapy are really exactly like this, though other forms don’t have the specific “homework” assignments that cognitive therapy does.  They are all about looking at what we do (and feel and think), why we do it, and how unsound our thinking is that undergirded the reasons why we did so.  Then we look deeper to find truths about ourselves and others around us, and try to build our future upon more truthful and sound foundations.  Some therapies will have us delve back into our childhoods, or walk through traumatic experiences over again, or examine the relationships we had with our parents, or siblings, or various authority figures, etc.  But the goals are still pretty much as I’ve laid out above, when you distill them all down.

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Other forms of treatment are not exactly “therapy” in the common lingo, but they are still ‘therapy’ in the purest sense of the word!  These other forms I categorize as “Mind over Matter”!  Or, in this case, “Mind over Body”!  These forms include such things as Biofeedback, Deep (Abdominal) Breathing Techniques, Progressive Muscle Relaxation, and Visual Imagery.  In addition, while they are not specifically treatments for anxiety problems as the things listed above are, Yoga, T’ai Chi, Pilates, and other forms of exercise which emphasize breathing, flexibility, and mindfulness, are excellent tools for people to explore who deal with anxiety disorders.

In all of these endeavours, the goal is for the person practicing these things to maximize one’s control over one’s body.  To slow things down to at least a manageable level.  When we again think about how the body automatically begins spitting out huge amounts of adrenaline (epinephrine) and norepinephrine in response to, say, standing on the parapet of a 500-foot tall belfry, and how this leads to dramatic increases in heart rate, breathing rate, cold sweats, dizziness, churning guts, shaky hands, weak knees, and a strong feeling that we may very well die, the one thing we would most wish for is the ability to control some of this, so we could make it go away!  If by deepening and slowing our breathing, or by closing our eyes and imagining ourselves in a “safe place” (for me, it’s always been sitting on the sand at Holden Beach, North Carolina, on a warm, breezy summer day, with the constant and soothing sound of the surf driving all fear from my mind!), we can actually direct our bodies to shunt some of that adrenaline away and feel quickly less tense and panicky, so much the better.  The best thing about these techniques, if practiced repeatedly, is that they can be called upon at any time in any place, and no external chemical is needed!

Actually, one of the best non-specific treatments for anxiety is to simply exercise.  Walking or running, or any of the numerous forms of dance-type exercises now popular … really, any kind of what is called “aerobic” exercise … will help build resistance in your cardiovascular and respiratory systems to the over-stimulating effects of adrenaline.  I often tell my patients of the stories I saw a number of years ago during a summer olympics broadcast of a couple of marathon runners who first started out running, in response to their doctor’s recommendation that they start exercising as a way to prevent or lessen panic attacks.  Lo, and behold!  They became world-class long-distance runners, and had no more panic attacks to boot!  Now, of course, one does not need to run 26.2 miles in 3 hours or so in order to overcome panic disorder … but you get the idea.   🙂

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I’ve very superficially described only a few of the many treatments available for anxiety disorders.  Some of these disorders, such as Obsessive-Compulsive Disorder, require very intensive treatments that have to be tailored to that person’s specific patterns and O-C drives.  Social phobia or specific phobias (such as fear of heights!) will often require a form of therapy known as exposure, or progressive desensitization, to help someone go from the panic caused by even the mere thinking about the thing they dread, to actually being able to be in that situation for several minutes, and to see that you CAN live through it and do okay.

The one thing I have hoped above all in these last two posts is to convey the truth that if you or someone you care about is dealing with some kind of anxiety disorder, there is hope.  In many cases the hope is that it can be managed better, feel better, and NOT be an obstacle to living a normal and happy life, or to achieving your goals and dreams.  In some other cases, there is good hope for a complete cure … learning and finding a way to live free of whatever anxiety has haunted you for so long.  Either way, I urge you to seek help, as it is out there.

I wish you calmness and peace.

Craig Meek, M.D.

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One comment on ““My nerves are shot!”

  1. Shelly says:

    calmness and peace…my mantra every day! The more I read your blog, the more I love it! I have to wait until I get the last assignments done for this semester before I can really dig into it but THANKS!! My goal is to be a therapist helping others traverse the mine field of mental illness in healthy, productive ways. There’s nothing like a great therapist; I think I have the ‘best’! She is for me anyway 🙂 I can tell you are a great doc too. I’ll be an LICSW in about three years.

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