Anxiety in These Uncertain Times -- Patricia Farrell, PhD -- 04/10/03
By Patricia Farrell
From Iraq to the stock market, terror alerts to the stalling economy, you have plenty of reasons to feel anxious on a daily basis. How do you cope during these worry-filled days? Should you seek professional help? We asked these questions and more when WebMD's mental health expert, Patricia Farrell, PhD, was our guest.
The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Hello Dr. Farrell. Welcome back to WebMD Live. Let's get to our questions.
Member: I am a very well controlled (by medication) manic-depressive. However, my son is active duty U.S. Army -- Special Forces. He has not as yet been deployed but that does not prevent me from having anxiety about the future. I wonder how to best handle and prepare myself especially if he is deployed? I have learned many lessons about helping myself in certain situations but this is a whole new deal!
Farrell: I agree. This is something that generally people don't want to have to deal with. Unfortunately it's a fact of life for many of us right now. One thing I find very helpful is to become part of a support group or to become involved in an activity that will do something for the troops. We've seen people getting together to send emails, to send various supplies and it might be something that would be good for you, even if your son hasn't been deployed. Activity generally will help with anxiety.
Member: I was very much against the invasion of Iraq for many reasons, and now that the U.S. has swept in and taken over like taking candy from a baby, I feel twice as angry and upset because now the pro-war folks will be crowing and saying "told you so." I'm afraid I might pop someone if they do that in person to me. How do I calm down and be more objective about what I feel so strongly?
Farrell: One of the things we always tell people in those kinds of situations is to stop, walk away, and talk to somebody about it. I don't think you will be that impulsive that you will hit someone, but I can understand your anger and would ask that you try to come up with a way that you will find comfortable to handle this if it happens.
Moderator: Can you please give us some advice on how to help our children who are being affected by the anxieties from the war?
Farrell: One thing we need to remember is that as adults, we have a great deal of power over what happens to us in our lives, but our children have very little power over it. When it comes to the war environment in which we find ourselves, children are frightened because they don't know what might happen to themselves, their families, and their friends. We need to help them. Some suggestions:
You can expect that your children may go through some changes in their behavior right now, and they will need reassurance from you that all of you are going to be safe.
Member: My friend was recently diagnosed with an anxiety disorder and was prescribed an antidepressant. Are these medications effective in treating anxiety disorders?
Farrell: Yes. Although the FDA had originally approved these medications only for depression, it was found through clinical experience that they were equally effective for anxiety disorders.
So it is a general rule now that if an SSRI antidepressant can be used for anxiety, then it will be used.
Member: I sometimes have slightly panicky feelings while eating in a restaurant, like everyone is watching me eat. I also am uncomfortable in party environments where I must mingle with strangers. This has seemed exaggerated during the wartime. Does this sound like an anxiety problem to you? I take Celexa for mild depression; does it also help with anxiety?
Farrell: Yes. That medication can help with anxiety, and what you're describing is more like social anxiety. I don't like to call it social phobia, because I really don't believe it's a phobia. It's not unusual for someone who may have a tendency to be shy to experience what you are right now. You might take a look at some suggestions regarding social anxiety in terms of changing your way of thinking about the situation. My book, How to be Your Own Therapist, does have many recommendations.
Member: Another question about the Celexa. I've heard one side effect is having nightmares. I have recently been having very bad dreams almost every night, but I've been on the Celexa for nearly a year. Is there a connection and if so, why now and not when I first started taking it. The dose is the same.
Farrell: Sometimes after a period of time a medication may produce a side effect that wasn't seen initially. I don't know that Celexa is necessarily one that causes nightmares, however, it's possible. I would suggest that you discuss this with your prescribing doctor.
Member: I take Klonopin for anxiety and have for more than five years. Is there any risk in taking it for so long, and is there another medication you think I should try in its place? I have tried a number of the SSRIs without much success.
Farrell: Klonopin is a very effective medication for anxiety and panic, and I have not heard of any long-term studies that have either indicated that it was dangerous or totally safe to take for many years. I would ask that you discuss this with your prescribing physician.
Member: Is Nurontin -- the anti-seizure drug -- also used as an anti-anxiety medication?
Farrell: Nurontin is used for a variety of problems. It is an anti-seizure medication, but it is also used for anxiety and pain relief.
Member: Can you just stop taking Paxil or do you have to wean yourself?
Farrell: It is not a good idea to discontinue Paxil. You do have to wean yourself off it and do this with the assistance of your prescribing physician.
Member: Is there anything that I can take over the counter? I have been taking Paxil. It isn't working for me at all. I am taking 30 mg. I am always uptight, nervous all the time, can't focus on anything, not even TV.
Farrell: There's nothing that is sold over the counter that would be as effective or safe as a prescription medication. If your current medication isn't working, perhaps you want to discuss this with your doctor, because you may need a higher dose, or you may need something else added to your medications.
Member: What is the best way to wean off an SSRI? I'll certainly ask my doctor about it first, but is it generally best to go to every other day on the same dose level as a first step of to cut the dose in half and keep taking it every day?
Farrell: When weaning off medication, your body is going to tell you which is the best way to do it. Some people do, with the advice of their physician, take it every other day. Some people half the dose; some people take the dose every two days. There are really many ways to do it.
Moderator: Can you discuss some of the cognitive techniques you use to calm a person who is feeling anxious?
Farrell: We generally would use three methods:
Much of cognitive therapy depends on changing the way you see things. In other words, is the glass half full or half empty?
Member: My husband and I had been trying to have our second child. After a miscarriage, we decided to hold off a bit, but now it turns out that I am pregnant. I can't help but feel very worried about this. I don't know if I am wrong in thinking this way. But the way I think is, "Why bring a child into this world in such a terrible time?" I am a true believer in the word of God and I know that worse things are heading our way. So, my question is, how do I cope with feeling this way? I don't think that I don't want to have this child; it's just that I do not want to suffer. My husband has no idea how I feel. Please give me some suggestions on how to cope with this.
Farrell: Remember one thing: No matter what time we live in, there will always be difficulties. They are not going to last forever. They will be things that we can pull through. Bringing a child into the world, as you know, is a wonderful thing, and you and your husband will have the opportunity to share numerous joys with this new baby. Your attitude is understandable given the current situation in Iraq, but don't let that situation stop you from experiencing the joy of parenthood.
Member: What are your suggestions for not taking problems to bed; actually just cutting them off at the time of bedtime?
Farrell: Many years ago I worked in a hospital where I learned a very important lesson from a nurse. She said to me, "When I leave the job, as soon as I walk out the door I leave everything behind me." I think that's what you need to practice when you are ready to go to bed at night. I know it's not that simple, but perhaps you can begin to tell yourself that now is the time for you to take care of yourself and that means getting a good night's sleep. You might also practice relaxation breathing just before you try to go to sleep.
Member: I'm 16 years old and my problem is that these days sometimes my heartbeat is fast and after a few seconds or minutes it comes back to normal and sometimes I feel that I'm going die and stuff. And sometimes I feel that my breathing is not up to normal. My grandma died a few months ago and two weeks before that my aunt also died. Could this be depression or a disease? Please tell me what has happened to me!
Farrell: I'm sorry to hear about your losses, and I'm sure they have been upsetting for you. What you are describing sounds to me like a normal reaction to loss. We call it more an adjustment problem than anything else, and I would suggest that you talk to your mom or maybe a counselor at school. This doesn't mean you have an illness or that you have a disorder, it just means you have a natural need to talk about something upsetting.
Member: Why do I worry about something over which I have no control? I always wake up in the middle of the night and cannot sleep.
Farrell: It sounds like what you're describing is possibly a generalized anxiety disorder, and I would wonder if you've considered a professional evaluation to help you cope with this and to have a better understanding of it.
Member: The economy is hurting my company and I'm scared to lose my job. I don't want to start looking for another job; that's so exhausting, especially when you have to keep it a secret, but I can't stop worrying about it. Any tips for lightening my mental load?
Farrell: I always believe that the best thing to do in any situation, whether you feel you have an extremely secure job or not, is to always be aware of job possibilities at all times. If you keep yourself knowledgeable, you may be able to deal with your anxiety, because you will have begun to formulate a plan if you have to look for new employment.
Member: I feel so stressed I ignore things, like responsibilities in my life. Am I depressed? I suffer from anxiety. What should I do?
Farrell: I'm wondering if you give yourself some breaks from the stress in your life and what you do to just have fun. That may sound frivolous, but it's not. Fun and joy and laughter are absolutely essential. It's the best way to handle stress.
Member: I'm 45, good health, never had anxiety problems. I recently had bronchitis and I have never had it before. It's taking me a long time to get over it. I'm now having some anxiety and some fear. Where is this coming from? I've never had it before? How do I get over it?
Farrell: I think what you've experienced is something that is quite common, and that is an anxiety that is based on something physical that you recently experienced. So if you've never had bronchitis before, and you've just had it now and we are currently very concerned about respiratory illnesses such as SARS right now, it would be normal to be a bit anxious. Do some self-talk and tell yourself, "I'm OK, it's just bronchitis, the doctor will take care of it. The best thing I can do is relax."
Member: What makes a healthy person without any fears other than normal fears become a person full of anxiety fears, even being afraid to travel any distance in a car with someone they trust? I really don't like what I have become.
Farrell: Anxiety disorders can come from many sources. For instance, you may have been under a great deal of stress and you've been denying it and it's building up. The second thing is you may have reached a point in your life where your biology is working against you. We know that anxiety can be related to hormones, diet, lack of exercise, not enough sleep, and some physical conditions. I would think the first thing to do would be to see about a complete physical to rule out any medical causes. After that you might look at the stress in your life and see how you can manage it a bit differently or decrease it, if you can, and please remember, adequate sleep is very important.
Member: I have a fear of death. I always think I am going to die. Even though I am only 27 and in good health, every time I have heartburn I have a hard time controlling thoughts of having a heart attack or something like that. I have gone to the ER many times and they always tell me that nothing is wrong. I have trouble controlling my breathing and my vision gets blurry. I feel dizzy. I was on Xanax and Paxil for a about a year. I am off it now, but still have these feelings at least once to twice a week. I have tried all the local mental health clinics and I don't feel I am getting anywhere. It's not that I am scared of dying; it's just that I don't want to be separated from my loved ones. I just want to be here and enjoy life. I love to live and don't want it to be over. Please help me!
Farrell: I think what you're saying is that the help you're looking for should be more directed to change your way of thinking about things. For instance if you are concerned about being away from your loved ones, is it related to feelings of helplessness, or do you feel you can't cope adequately? When you went to the mental health centers, I would hope they were treating you with cognitive techniques, which would give you better coping skills. Most of the time a fear of death and separation from loved ones can be handled very effectively this way.
The fact that you were on medication indicates to me that the problem had been serious enough to seek medical help, and you might want to consider that again.
Member: What's the difference between agoraphobia and social anxiety?
Farrell: Agoraphobia generally comes with panic attacks. It's interesting that the panic attacks are what cause the agoraphobia. In other words, first you have a panic attack, some place, at the mall, in your office, or in a car, and you associate that place with the panic attack. In order to avoid having another panic attack, you stop going to the mall, going to the office, or using your car. Agoraphobia actually comes from a Greek word that means open place.
Member: My anxiety level always seems to be at its worst shortly after awakening. I have always tried to lower the level by exercising most mornings. Lately exercise seems to have an entirely opposite effect and I feel even more anxious after I exercise. Any Ideas why this is?
Farrell: It's an interesting biological fact that when you awaken in the morning, you have higher levels of a stress hormone in your blood. I would suggest that for the first few minutes after awakening you give yourself a few positive messages and that you allow yourself to walk a little slower and just take a little bit of time. I find that for some people, the body gives cues that actually bring on anxiety; in your case, the exercise does it. To counteract these cues that are being misinterpreted I suggest slowing down physically, just for the first 15 minutes or so. This may do the trick for you.
Member: How much has prescription and other drug stimulants become a contributor of anxiety? From over-the-counter Sudafed to prescribed amphetamines to the prevalence of illegal marijuana in years past, I can't help but wonder what kind of toll these foreign substances have taken on people's bodies and affected the mind and emotions. What has this done to hinder the healthy, realistic coping mechanisms that so many of our adults seem to be lacking?
Farrell: There's no question in my mind, and that of most professionals in the mental health field, that prior substance abuse of marijuana or cocaine or some of the over-the-counter diet products can have long-lasting negative effects on the ability to handle anxiety. In fact, recent research shows that marijuana use can have long-lasting serious effects and sometimes medication is only minimally effective for these individuals. So there is no safe recreational substance. Even alcohol can cause serious problems in the long haul.
Moderator: Dr. Farrell, we are almost out of time. Before we wrap up for today, do you have any final comments for us?
Farrell: Just remember: We've been through things like this before, we've come through it, and we're going to do it again. Go out there and watch a funny movie. It's the best thing you can do right now.
Moderator: Our thanks to Patricia Farrell, PhD, and thank you members for joining us today.
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