By Eric Milbrandt, MD, MPH
Occasional anxiety is part of life. Many feel anxious when faced with a new project at work, before taking a test, or when making important decisions. I felt anxiety as the deadline approached to write this article. This type of anxiety can be unpleasant, but it may motivate you to work harder and to do a better job. Anxiety disorders, however, involve more than temporary worry, stress, or fear. For those with an anxiety disorder, the anxiety does not go away and often gets worse over time. The presence of an anxiety disorder is a risk factor for the development of other anxiety and mood disorders, substance abuse, and risk of suicide. The symptoms can interfere with daily activities such as job performance, school work, and relationships.
Anxiety disorders are some of the most common psychiatric conditions in the western world. In the United States, as many as one in five persons are affected. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and various phobia-related disorders. People with generalized anxiety disorder (GAD) display excessive anxiety or worry most days of the week about a variety of things, such as health, work, social interactions, and life circumstances. Symptoms include:
• Feeling restless, wound-up, or on-edge
• Being irritable
• Having difficulty concentrating
• Difficulty controlling feelings of worry
• Sleep problems
• Being easily fatigued
• Muscle tension
Panic disorder is the presence of recurrent unexpected panic attacks. Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation. People with panic disorder often worry about when the next attack will happen and try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. Symptoms of a panic attack include:
• Rapid, pounding heartbeat
• Trembling or shaking
• Feelings of shortness of breath, smothering, or choking
• A sense of impending doom
• Dry mouth
• Feeling out of control
A phobia is an intense fear of specific objects or situations. While is may be appropriate to be fearful in certain circumstances, the fear felt with a phobia is out of proportion to the actual danger posed by the object or situation. Common phobia are fear of flying, heights, snakes, needles, and blood. Social anxiety disorder involves an intense fear of social or performance situations. Those affected fear being negatively judged by or embarrassed in front of others. People with agoraphobia have an intense fear of public transportation, open spaces, enclosed spaces, crowds, or being alone outside the home.
What to do about anxiety?
There are a variety of treatment options for anxiety disorders. For some, medical treatment isn’t necessary at all. Non-drug lifestyle changes can be an effective way to relieve stress and anxiety. These primarily involve self-care, such as:
• Getting enough sleep
• Avoiding caffeine, alcohol, and tobacco
• Eating a healthy diet
When lifestyle changes alone are not enough, treatment then falls into two additional categories, psychotherapy (“talk therapy”) and medication. Working with therapist, psychologist, or psychiatrist, people can learn tools and strategies to deal with anxiety as it occurs. One such example is cognitive behavioral therapy (CBT), which teaches people different ways of thinking, behaving, and reacting to anxiety-producing events.
Medications used to treat anxiety include antidepressants, benzodiazepines, and beta-blockers. Antidepressants take time to work, so it is important to give the medication a chance before deciding whether it works. In some people, antidepressants initially make anxiety worse before the brain gets used to their long-term calming effects. Benzodiazepines, such as Xanax or Klonopin, work quickly to control anxiety. However, benzodiazepine tolerance is common, and people often need ever increasing doses or become dependent on them. Beta-blockers are medications that reduce the physical feeling of anxiety by blocking the effects of adrenaline, thereby reducing heart rate, sweating, and tremor associated with anxiety-provoking events. Beta-blockers are particularly helpful in performance situations, such as public speaking.
Recently, two additional treatments for anxiety disorders are becoming popular, especially for those that fail to improve with lifestyle changes, counseling, and medication. Cranial Electrotherapy Stimulation (CES) uses a small handheld device, such as Alpha-Stim, that delivers low-level electrical current via electrode clips that are applied to the earlobes. It can be effective for a variety of acute and chronic stress conditions.
Low-dose ketamine infusions, such as those provided by The Infusion Clinic of Ocala, can be valuable and highly effective for treating resistant cases of anxiety, depression, and PTSD. Ketamine is a medicine developed more than 50 years ago for anesthesia during surgery and other painful procedures. High-dose ketamine has been used safely for that purpose in children, adults, and animals for decades. About 15 years ago, medical researchers began studying low-dose ketamine infusions for treatment-resistant mood disorders, including anxiety disorders. Since then, studies have proven conclusively that the drug not only works but works quickly, with significant and lasting relief within hours of the first infusion.
Dr. Eric Milbrandt is owner of The Infusion Clinic of Ocala, located at 40 SW 1st Ave, Ocala, FL 34471. Dr. Milbrandt is a critical care medicine specialist with over 15 years of experience providing care to the sickest of hospitalized patients, including those with severe depression, anxiety, and PTSD. He is board certified in Critical Care Medicine, completed a fellowship in Quality Improvement and a Master of Public Health at Vanderbilt University. He is a graduate of The Ketamine Academy, a leading provider of comprehensive online training for all major aspects of ketamine therapy. The Infusion Clinic of Ocala provides both Alpha-Stim and low-cost ketamine infusions for the rapid treatment of anxiety, depression, PTSD, and chronic pain.
You can find out more about ketamine in the January issue of Health & Wellness Magazine (https://tinyurl.com/y7sursfq), online at https://www.InfusionClinicOcala.com, or by calling The Infusion Clinic of Ocala at (352) 325-5755.