Do you suffer high anxiety? research reveals more about how stress affects body and mind. Here is the rundown on causes and therapies

VFW Magazine, Jan, 2003 by Norman Brown

Physicians are seeing an unprecedented number of patients with anxiety disorders. So many, in fact, that tranquilizers have become the fifth most commonly prescribed drug, far ahead of any antibiotic or birth control pill.

Are we entering the "Age of Anxiety" (after depression in the Nineties and schizophrenia in the Eighties)?

It's not certain whether more of us suffer from anxiety, or that "we may just be less tolerant of feeling uneasy," says Dr. Brian Doyle, psychiatrist at Georgetown University. That makes it important to know about therapies for anxiety attacks as well as the side effects (sexual and otherwise) of drugs like Prozac.

If you've ever felt overwhelmed by worry that made you sick, you're not alone. The National Institute of Mental Health (1-800-647-2642) estimates about 19 million Americans suffer from anxiety disorders of some type. But sufferers seek treatment less often than people with other mental disorders, except for panic attacks. "When a person feels he's going to die, that sends him to a doctor," Doyle says.

What Causes Anxiety?

In these stress-filled and unpredictable times, anxiety has become a common problem. Angry motorists, harried salespersons and surly neighbors all lead to nonstop stress. Separation from family or tensions at home also can contribute to a case of high anxiety. But isn't it a bad idea to turn away from tough situations? Not necessarily.

"Taking some time off can help distance you from problems so that you can think more effectively," notes Jerilyn Ross, therapist and president of the Anxiety Disorders Association of America (www.adaa.org). She suggests taking the time to list your fears and map out possible solutions to relieve anxiety.

But because of the stigma associated with mental illness, and poor training that prevents many physicians from making accurate diagnoses, only a third of those suffering from anxiety disorders get treatment, Ross says. "Anxiety disorders are misunderstood, miscdiagnosed or trivialized."

What causes anxiety? When there is no obvious emotional reason, you should suspect a physical problem, says Dr. Edward Hallowell, psychiatrist and author of Worry: Hope and Help for a Common Condition (Ballantine, 1998), In these cases, a complete medical workup can help your doctor diagnose the problem.

Some medical causes of anxiety:

* Endocrine disorders, including an overactive or underactive thyroid, mood swings caused by changes in blood sugar, or hormone imbalances that affect the body's secretion of insulin and adrenaline.

* Cardiovascular or respiratory conditions, particularly low blood pressure, irregular heart rhythm and acute attacks of asthma, emphysema, bacterial pneumonia and pulmonary embolism--a blood clot in the lung that travels from the leg or pelvis.

* Medications and stimulants. Side effects of decongestants, diabetic preparations, bronchodilators, anti-hypertensives and antidepressants can mimic anxiety symptoms. The same is true of nicotine, caffeine, diet pills and nasal sprays because of their sympathomimetic effects.

"A certain amount of anxiety is normal and can lead to constructive action," Hallowell says. "Like having a doctor look at that mole on your back." It becomes a symptom when it starts to inhibit thought and disrupt normal activities. For some, it can be incapacitating.

Nearly everyone has experienced mild or general forms of anxiety, such as when having to give a speech or meeting strangers. Except for phobias and panic attacks, anxiety disorders occur equally in men and women, and heredity is often a contributing factor.

Doctors often see anxiety symptoms disguised as acute chest or stomach problems. And a third of these patients may actually undergo costly and unnecessary medical procedures. Others may prescribe powerful antianxiety drugs or, worse, dismiss the complaint as trivial.

Therapy Options

Brief therapy or medications will help most people with general anxiety disorders, at far less cost than long-term treatment. As many as 70% can get substantial relief through counseling, says Dr. John Saksa, research scientist at Yale University School of Medicine. In one Swedish study, a simple exercise program was nearly as effective in reducing panic attacks as any antidepressant.

When anxiety symptoms are severe and cannot be controlled through behavioral techniques alone, doctors may be able to prescribe effective medications. The options will depend on the type and cause of the anxiety:

* General anxiety or excessive worry can frequently be relieved with benzodiazepine tranquilizers (Xanax, Valium).

* Social phobias and performance anxiety often can be controlled with betablockers such as Inderal (propranolol).

* Panic attacks or recurrent bouts of anxiety-related symptoms that have no identifiable cause may respond to monoamine oxidase inhibitors, tranquilizers or antidepressants.

Conventional psychotherapy has come under increasing attack in recent years as being too costly--and ineffective. But it was Freud who coined the term "anxiety neurosis" as a symptom of thoughts and feelings repressed in the subconscious.