Anxiety
What is Anxiety and Panic Disorder?
Occasional anxiety is normal, however when it becomes a consistent part of daily life this is known as anxiety, or panic disorder. This is defined as a chronic condition of intense, excessive and persistent sense of apprehension or fear toward everyday situations. This feeling is difficult to control and begins to interfere with a person’s ability to navigate their normal daily activities, such as caring for themselves and their children, or preventing them from going to work. For people suffering from anxiety and panic disorders, their fears are entirely disproportionate to their circumstances.
How Common is Anxiety?
Estimates from the anxiety and depression association of America reveal approximately 40 million individuals over the age of 18 live with anxiety disorders. It is estimated that only 36.9% of those living with anxiety disorder actually pursue and receive treatment. Symptoms may start in childhood or during teenage years, continuing well into adulthood (1).
What Causes Anxiety?
The cause of anxiety and panic disorders is not fully understood and can be triggered by genetic factors, traumatic events, and life experiences (4). For some people, anxiety may be linked to underlying health conditions. Some medical issues associated with anxiety can include heart disease, diabetes, thyroid problems, chronic pain, and possible side effects from medications.
What are the Symptoms of Anxiety?
Physical symptoms can manifest with anxiety and panic disorder, such as sweating, heart palpitations, and feelings of stress. This can sometimes lead to being completely incapacitated and unable to perform typical activities of daily living. These symptoms can grow into what are often referred to as “panic attacks.” Panic attacks can cause a range of symptoms from pounding heart rate and inability to breathe or think, to feelings of numbness or detachment.
These feelings of fear appear at inappropriate times, often with no apparent cause. Although these panic attacks are not life threatening, they are frightening and often impact the quality of life for those experiencing them. Patients with a panic disorder are usually fatigued, feel weak, may experience troubles with concentrating, sleeping, and gastrointestinal function. Naturally, they have the urge to avoid things that trigger their anxiety and often struggle with controlling their worry or fears (1). There are different types of anxiety or panic disorders. They range from separation anxiety, social anxiety, and specific phobias to generalized anxiety disorder (1).
What are the Consequences of Anxiety?
While it appears that anxiety disorders are associated with a low proportion of healthcare costs on a population level, for the individual experiencing an anxiety disorder, their health care costs are significantly higher compared with people who do not have the condition (2). People with a panic disorder usually develop other mental or physical conditions that contribute to their issues, including (1):
Depression
Substance misuse or abuse
Difficulties sleeping (insomnia)
Digestive or bowel problems
Headaches
Chronic pain
Difficulties maintaining focus and attention on a certain task
Suicidal ideation
Decreased quality of life
What Happens in the Brain with Anxiety?
Key cortical and subcortical brain regions in anxiety are the amygdala, hippocampus, orbitofrontal cortex, anterior cingulate cortex and dorsolateral prefrontal cortex. When the DLPFC is overactivated, this leads to worry and perseveration, or persistent repetition of a thought, words or phrases. When it is not activated enough, the amygdala’s ability to perceive a legitimate threat becomes compromised and they become hypervigilant (3). What does this mean? It means that this loop is stimulated way more frequently than it should be, and over time, the hypothalamus starts to ignore cortisol’s instructions to stop producing CRH and the hippocampus cannot do its job to regulate the loop, either. We then get stuck in a state of chronic stress and the hippocampus begins to degenerate over time, which also leads to symptoms such as memory problems.
How is Anxiety Usually Treated?
Anxiety disorders are most often treated through the use of psychotherapy and/or the utilization of medications prescribed by a psychiatric provider, usually in a combination of the two. Cognitive behavioral therapy (CBT) is the most effective form of physiological counseling, as it focuses on improving your symptoms and gradually helps you return to the activities you have avoided. Medications can be helpful at times however they do not directly address the root cause of the dysfunction, that being problems with specific pathways.
CBT helps anxiety and panic sufferers learn new cognitive strategies to redirect their thoughts away from the catastrophic self-talk that occurs during anxiety and panic. CBT does not directly affect the pathways creating the problem, only the cognitive strategies one may employ to deal with the problem. We feel that CBT is necessary for anyone suffering from a significant anxiety or panic disorder, however many of our patients come to us after already completing a CBT program and still have symptoms. We find that CBT is more effective when performed after the problematic pathways have been rehabilitated.
TMS Treatment
Transcranial Magnetic Stimulation can be used as a repetitive inhibitory stimulus over the regions of the brain mentioned above like the dorsolateral prefrontal cortex. This inhibition can reduce overactivity within the loop mentioned above so the hippocampus can better regulate stress and anxiety.
Your Next Best Step:
Living with anxiety is extraordinarily challenging, but there is hope for recovery and freedom from this condition. To see if TMS is right for you, contact our front desk and schedule a free consultation with Shauna Hahn, PMHNP.
And remember, it’s never too late to start getting better.
References: