Anxiety is something we all feel from time to time. It’s normal to feel anxiety symptoms like apprehension or nervousness when faced with a difficult situation at work, school or home.
An anxiety disorder, however, is quite different. A true anxiety disorder is a brain disease – more precisely a dysregulation of the brain’s inhibitory chemical messengers. Anxiety disorders can paralyze the sufferer with constant fear and worry. There are actually a number of anxiety disorders, including: panic attacks, social anxiety disorder, phobias, post-traumatic stress disorder and obsessive-compulsive disorder. These conditions are characterized by feelings of fear, apprehension and panic; obsessive, ruminative thoughts; distressing intrusive thoughts and/or nightmares related to a past traumatic experience, difficulty sleeping, and counting or checking rituals.
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Clinical studies suggest a correlation between anxiety disorders and dysfunction in the amygdala, a part of the brain involved in attaching emotional resonance to events occurring in a person’s environment. Also, a low level of gamma aminobutyric acid (GABA) a neurotransmitter that inhibits energy in the brain seems to contribute to heightened anxiety. The use of alcohol has also been shown to reduce GABA in the brain, making it harder for alcohol users to naturally calm their anxiety.
A common drug for the treatment of social anxiety disorder is “selective serotonin reuptake inhibitors”, or SSRIs. This class of drugs increases levels of serotonin in the brain, and is commonly prescribed to treat depression. Examples of these drugs are Fluvoxamine, Sertraline, Paroxetine, Fluoxetine, and Escitalopram. There is currently some controversy about how well these drugs work. For example, a 2010 study about their use for treating mild to moderate depression showed little, if any, benefit over the use of placebos. However, the same study also showed a significant improvement for severe cases.
Another class of psychoactive drugs is Benzodiazepines, such as Librium and Valium. These work by enhancing the effect of an inhibitory neurotransmitter known as gamma-Aminobutyric acid, resulting in sedative, anti-anxiety properties. These drugs are often used as treatment for panic disorder and generalized anxiety disorder. As with SSRIs, there is some debate over the use of Benzodiazepines. In particular, long-term use can lead to negative side effects and addiction. The UK NICE guidelines recommend against taking Benzodiazepines for anxiety disorders for longer than 2 to 4 weeks.
There are also drugs that can be used specifically to treat the physical symptoms of social anxiety. For example, beta-blockers block the action of adrenaline, which is responsible for the “fight of flight” response. This can help minimize some physiological symptoms, such as sweating, shaking, blushing and elevated heart rate.
In general, there are risks and downsides associated with all medications:
- Drugs can help relieve the symptoms of anxiety disorders, but generally do not target the underlying problems. Therefore, any benefits gained from taking medications tend to reverse after stopping the drug treatment.
- All drugs have potentially harmful side effects. Depending on the particular drug, side effects can include weight gain, troubles concentrating, acne, agitation, etc. Furthermore, one can develop a dependency or addiction.
- In some cases, drugs can actually prevent true progress. For example, short-term progress from medication may lead someone to think they are “cured” of their social anxiety, and they may stop seeing their therapist. However, it is likely that theirsymptomsreturn as soon as they stop taking the medication. Furthermore, there is some evidence that Benzodiazepines can actually interfere with making therapeutic progress.
In general, it is recommended that medication is only used for severe and debilitating cases of social anxiety disorder, with therapy preferred for mild to moderate cases. Even when medication is used, it should be used in combination with therapy. Studies show that the best long-term benefits are gained through the use of “cognitive behavioral therapy”.
As with other mood disorders that we treat in our dual diagnosis treatment program, we know that the proper diet and regular exercise can have a powerful effect on reducing anxiety and the frequency of panic attacks or anxiety attacks by influencing the biological component of anxiety disorders. Exercise puts a healthy amount of stress on the nervous system. For anxious people, this is a good thing, since stressing brain circuitry results in increased growth and durability.