Methodist Healthcare - December 02, 2020

It's normal to feel anxiety from time to time. Maybe you're feeling nervous about the pandemic, going out to public places, anxious about a work project, worried about a health issue or concerned about your finances. As troubling as it can be, occasional angst is not harmful. In fact, it can actually be helpful, serving as the motivation you need to tackle new challenges.

However, too much anxiety is not healthy. It could also be a warning sign of an anxiety disorder or another medical condition that needs treatment, according to Dr. Mikael Jacobson, psychiatrist and medical director of Behavioral Health Services at Methodist Hospital | Specialty and Transplant. Dr. Jacobson discussed anxiety, and he offered some insight on what's normal, what's excessive and when it may be a red flag for a serious health issue.

Q: Is it normal to experience bouts of anxiety?

A: Yes, anxiety is a normal response that everyone experiences. It's actually part of what drives people. If we didn't have anxiety, you wouldn't be as motivated to do things. It makes you take that extra step, to dress up a bit nicer to make a good first impression. It's a normal response to stressful events and change. I would actually be more concerned if someone did not have anxiety when coping with change.

Q: At what point does anxiety start to become a problem?

A: Anxiety becomes a problem when it is debilitating to the point that it takes over your life. It is a problem when it shifts from being something that motivates you to take an extra step in life to something that keeps you from moving forward. Anxiety becomes a problem when it interferes with your life and no longer helps you prepare for it.

Q: Are there different types of anxiety disorders?

A: Yes, there are many different anxiety disorders.

  • Generalized anxiety is probably the most common. People with generalized anxiety get overly anxious about a wide variety of everyday things. The worry is traditionally out of proportion to the circumstance.
  • Social anxiety occurs when people have a high-level of anxiety, fear and avoidance of social or performance-based situations. I see social anxiety a lot in high performers, CEOs and other professionals.
  • Panic disorders cause people to have panic attacks, a sudden period of intense fear that comes on quickly and reaches a peak within minutes. Sometimes these intense episodes of fear have certain triggers and sometimes they do not.
  • Phobia disorders occur when very specific things cause anxiety or fear resulting in a desire to avoid those things, such as a fear of heights or spiders. You can always have anxiety about a medical condition you're facing. For example, if you've had a heart attack, your fear of having another heart attack may be so intense that it disrupts your life.
  • Separation anxiety has traditionally been associated with children however adults can experience this too. Separation anxiety is characterized as fear of being separated from people you are attached to.

Q: Do anxiety disorders also cause physical symptoms?

A: If you have normal anxiety, your heart rate may pick up. You could get a little sweaty and have a bit of an upset stomach. When it starts crossing over into pathological anxiety, you might start having more headaches, challenges breathing, chronic pain or develop symptoms that resemble irritable bowel syndrome (IBS), such as diarrhea, nausea and vomiting.

Q: Could symptoms of anxiety signal an underlying medical condition – not a mental health issue?

A: Absolutely. If your blood sugar drops too low, it can cause you to sweat and feel shaky, which may be confused with anxiety. If your thyroid gland is overactive, you can sweat excessively and feel restless and nervous. These symptoms could be mistaken for anxiety.

Irregular heartbeats and tachycardia, which is increased heart rate, can also present as an anxiety disorder. Dehydration often looks like anxiety because it increases heart rate and can make you feel lightheaded or dizzy. For women, hormonal imbalances can trigger anxiety as well as mood swings, insomnia and depression.

If you're having symptoms of anxiety, please speak with your healthcare provider because it could be an actual physical condition that needs treatment. Don't just assume it's anxiety - seek the medical cause first.

Q: Are anxiety disorders often dismissed as "just part of life"?

A: Anxiety disorders are very treatable, yet many people are not receiving treatment. Our society and culture are really behind the times. We don't talk about it a lot or seek help. That mentality has to change. We have to begin to think of anxiety and depression as actual health problems, like diabetes, heart attacks and strokes, and start treating them as such.

Q: How are anxiety disorders treated?

A: Treatment involves therapy, which can help you identify what's causing your anxiety and learn how to work through it, or a combination of therapy and medication. Together, medication and therapy have often been proven to have the best and most effective response in serious anxiety-based disorders.

As a treating psychiatrist, my preference is to try the least invasive means as possible first, just as we would with any disorder. Let's figure out what's going on, what's causing the anxiety and see if we can fix that. In addition to therapy, we could ensure you're getting enough rest and consider lifestyle and dietary changes, like exercise, reducing caffeine intake and eating a healthy diet to avoid major swings in your blood sugar. If these strategies fail, then yes, let's try medication.

An anxiety disorder is a health problem and we approach it the same way that we do many other health problems. People with diabetes may try changing their diet or exercising before starting a medication. It's the same philosophy. Medication does help but it's not the only solution.

Q: Many medical problems worsen if left unchecked. Is the same true for anxiety?

A: Some anxiety – a more normal course of anxiety, like going off to college, getting married, having kids – will improve over time. These are normal, expected anxieties that everyone experiences. Some people are not able to transition through normal anxiety and it begins to change the way they interact with the world. This is when it's important to have early conversations with a healthcare provider, family member or seek out a therapist.

Q: Are there ways to ease anxiety before it becomes debilitating?

A: Find someone close to you that you trust and try to identify what's causing your stress. Is it financial? Is it work? Is it family? Is it not feeling organized? Talk about it and try to figure out how to mitigate that stress. Maybe that person is in a similar situation, such as a co-worker who has the same boss. Find out how they are handling it. Exercise is also a wonderful way to boost endorphins and release tension and stress.

Q: When is it time to seek medical help?

A: If you feel like your anxiety is causing you to pull away from friends and family and you're not doing the things you used to enjoy, you really need to start looking for help. If you're not able to find time to relax because you can't shut off your stress, you need to find a healthcare provider that can intervene and help you.

Q: What is the first step?

A: Anyone struggling with anxiety should first talk to their primary care doctor and ask, "Am I worrying too much or is this normal?" At that time, they could have a physical, which would help rule out medical conditions that can present as anxiety. It's a good, safe place to begin. Just start the conversation. That's the biggest thing.

If you or someone you know is experiencing challenges with anxiety, talk to your healthcare provider. If you need help finding a provider or call (210) 575-0355.

COVID-19 has challenged us with additional responsibilities, including social distancing which can make us feel isolated resulting in increased stress or anxiety. If you or someone you know is experiencing increased fear and anxiety that becomes a safety concern, please call 911 or head to the ER.

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