Anxiety

Anxiety served a biological purpose for our ancient ancestors. It ensured that early humans were safe and had enough food, water, and shelter to provide for their large families.

 

Fast forward to the mid-20th century where an increase in technological advances has decreased human movement. As of 2013, the average American sits for 13 hours a day. Our bodies and minds were not designed to be sedentary for such long periods of time. It is not surprising that cases of anxiety, substance abuse, ADHD, and suicide rates have largely increased as we as a society converted to sitting for 6-16 hrs a day.

 

While anxiety serves a different purpose today than it did for our ancestors, it is a normal part of life to occasionally experience, especially around stressful situations. However, constantly living in a stressed and anxious state is exhausting. If anxiety is affecting your day-to-day activities, you may have an anxiety disorder.

 

Thankfully there are ways to manage everyday anxieties and anxiety disorders. I work directly with you to tailor a plan that is specific to you and your needs.

 

Understanding where you find meaning in life, learning how you socialize (regardless of being introverted or extroverted), and maintaining a balanced exercise routine will all be part of your holistic treatment plan to bring more happiness and less anxiety into your life.

 

In some cases, medication may be part of your treatment plan. When it comes to medication, there truly is no pill to solve all of our problems. Previously, opioid prescriptions were seen as the fastest way to “heal” depression, anxiety, and physical pain. To date, over 45,000 lives have been taken by the opioid crisis (Source: National Institute on Drug Abuse). Unfortunately, many doctors are turning to another class of addictive, immediately effective drugs called benzodiazepines, or better known as “America's Other Prescription Drug Problem”. These drugs are physically and psychologically addictive and over time will require higher doses to achieve the same effect.  

 

If medication is part of your treatment plan you can rest assured I would never prescribe something I wouldn’t prescribe to a friend or family member in a similar situation.  The gold standards for treating anxiety are two classes of medications called SSRI's and SNRI's such as Zoloft, Prozac, or Cymbalta. Watch the video below to learn how SSRI's function in the brain. After the video there is a little more information about the specific types of medications.

Two medications commonly prescribed for anxiety and depression that have little effect on weight, appetite, or sleeping patterns are Zoloft, Lexapro, and Prozac. Zoloft is in my clinical opinion the best for anxiety. In it's own class of medication is Wellbutrin, which tends to be prescribed more for depression, as it helps with energy levels throughout the day. Because of this, it should be taken in the morning. It also cannot be taken by people who have a history of seizures, because it lowers the seizure threshold. While this medication has been known to have almost zero sexual side effects, it can reduce a person’s appetite.

Another medication commonly prescribed for both anxiety and depression is Remeron. Typically, patients take this medication before bed time, as it increases sleepiness, which is great for people who have trouble sleeping. It also increases appetite, which can be good for people who have little appetite (but frustrating for those who tend to overeat). Additionally, it’s known to give people vivid dreams, which is tolerable, unless you are prone to nightmares.

Most antidepressants take anywhere from 3-6 weeks to see results. Common side effects include headaches and stomach aches, and in the first few days, these, as well as sleeplessness and appetite change can occur. Serotonin is the neurotransmitter that these medications are influencing, and they are present in the brain as well as the stomach. Some believe this is the reason people get both stomachaches and headaches. Because it can take several weeks for these medicines to work, I really emphasize the use of lifestyle changes, such as increasing exercise to help reduce symptoms even faster. An added benefit here is exercise doesn’t cause any undesirable side effects the way medication does.

Another important warning about medications for depression is what I like to call the “black box warning.” This is basically that for all people under the age of 24, there is a potential of increased suicidal thoughts and/or behaviors. Specifically, SNRI’s (such as Cymbalta or Effexor) can cause this increase in the risk of suicide, so I don’t write prescriptions for those medications to children. There are various beliefs about why this happens. One theory is that many young people feel depressed and lack motivation and energy, and when they are given these types of medication, it simply increases their motivation to the point where they move forward with and act on these thoughts.

This is why I am very cautious with prescribing these medications, and also why I tend to spend time talking to you and explaining all the potential side effects.

 

Contrary to the standard practice in the field of mental health, I don’t just push medication on patients and add more when things aren’t working. Medication is only one piece of a larger, more complex puzzle. I want to educate my clients on all of the facts, so they can make a better, more educated decision.

Helpful Tip for Reducing Anxiety in the Moment:
Breathing Exercises

When people get really anxious or upset, they can recruit the help of breathing techniques, which many patients enjoy and benefit from. This technique (explained below) is especially nice because it is free and easy to do. These are the steps required:

  • Sit up and straighten the spine.

  • Close your eyes.

  • Breathe in through your nose for 6 long seconds, slowly expanding the lungs as much as possible.

  • Breathe out through your mouth for the same 6 seconds.

  • Repeat several times.

 

The reason this works is because of something called the vagus nerve. This is a nerve that runs down through the brain, past the heart and lungs. When you get really excited, upset, or sad, your heart starts to beat faster, blood pressure increases, and breathing speed increases and becomes shallower. When you breathe in very deeply, it stimulates this nerve, which has an opposite calming and relaxing effect. This deep breathing can be observed when you’re sleeping and is consequently one of the most relaxed states our bodies experience throughout the day.

 

In fact, a very effective treatment for un-treatable depression is a device called a vagus nerve stimulator. This is a device that is implanted into the chest, which connects to the vagus nerve and delivers a small shock every several seconds. While this treatment is only used in severe cases, it works because of the anti-depressant effect stimulation of the nerve has on the body and mind.  When you breathe deeply, it simulates this sensation, leading to a feeling of relaxation. 

 

While this is a very effective tool to use in the moment when you are feeling anxious or upset, being able to identify your triggers for feeling this way is even more effective. Recognizing when you are beginning to feel upset, anxious, or angry is particularly important because once you’re in full-blown rage or panic, it is very hard to think rationally enough to calm yourself down.

When someone gets very angry or upset, all the blood in our brain tends to flow to the more reptilian, primitive part of the brain. This part of the brain is far away from the higher functioning, frontal lobe that guides logical thinking, which would aid you in relaxing. When something repeatedly makes you really sad or angry, you can assume that this is a trigger, and when you encounter it in the future, prepare yourself to deal with it by practicing the breathing exercise discussed above.

 

Another good thing about this exercise is that you can do it anywhere. If you’re trapped at work, you can do it there, but if you can get out of the situation, perhaps go for a walk and get some exercise first, it will be even more effective. Being able to find something that works in the moment, before things get super-hot is crucial. So next time your wife, husband, child, or boss is saying mean things to you, try some breathing before things escalate.

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Dr. JOHN GANZ
HARBORSIDE PSYCHIATRY LLC

Call (or text) 843 929-0880 to make an appointment

Harborside Psychiatry LLC

1671 Belle Isle Avenue. Suite 110 Mt. Pleasant, SC 29464

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Dr. JOHN GANZ
HARBORSIDE PSYCHIATRY LLC