Anxiety - diagnosis and treatment

Anxiety is caused when the brain cannot resolve conflicts. It is a stress response. This results in circular thoughts so the same thing is thought over and over again.

Causes of anxiety

Some people are born highly strung and anxious. From an evolutionary point of view this could be very helpful. The anxious man would be a light sleeper and wake at the first sign of trouble, he would jump at any slight noise and react to any danger. These people will continue to be anxious even when they have nothing to be anxious about!

Some people are anxious because they find themselves in difficult situations (financial, social, emotional or whatever) from which they seem to have no escape. They must recognise that they have a problem, ask for help, make a plan and stick to it. Very often in my practice I find myself "making plans" for people who simply cannot see any way out of their situation. Nobody should be left without a "plan" for improvement, however modest that plan may be. Just having a plan, and therefore hope that things can improve, helps considerably.

There is a fine line between good stress and bad stress. Good stress causes excitement, bad stress causes anxiety - you can't define the stress by what it is, only by what effect it has on you. If you are feeling pessimistic or tired, what would have been a good stress becomes a bad stress. All stresses are different to all people. Everybody has to work out for themselves the sort of stresses they want in their life. Obviously personality has a large role to play here, but there are physical causes of anxiety which can be helped.

Physical causes of anxiety

Hyperventilation: this is often driven by allergies and low magnesium.
Hypoglycaemia: low blood sugar can certainly cause anxiety attacks
Excessive caffeine
Allergies to foods
Lack of sleep
Lack of exercise
Symptoms which cannot be explained: this is another good reason for the environmental approach to illness - it puts the patient back in control of his life.
Withdrawal symptoms or side effects of drugs: (prescribed or illicit), such as alcohol, tobacco, tranquillisers, cannabis etc. In the short term these drugs alleviate symptoms of anxiety, in the longer term they worsen them.

Effects of anxiety

Feeling anxious is unpleasant
Muscle tension and spasm. Muscles control all movements in the body, both conscious and unconscious. Muscle spasm in arteries can cause angina, cold hands and feet or high blood pressure. Muscle spasm in the gut can cause colic, diarrhoea or constipation. Muscle spasm in muscles causes pain and fatigue. A great many symptoms can be caused by muscle spasm.
Insomnia. This is a disaster and creates a vicious cycle of inability to sleep causing more anxiety. In order to sleep the brain has to be in the present. If you are thinking about the events of the previous day, or what is going to happen in the future, you will not be able to fall asleep. Often drugs are needed here to break this vicious cycle.

Treating anxiety

First of all identify and correct any physical causes of anxiety. The bare minimum should include taking nutritional supplements, avoiding sugar, caffeine and alcohol, getting the right balance between physical and mental exercise and making sure you always get a good night's sleep.

Try to work out what you are anxious about and do something positive to tackle this. Always have some plan of action. It may be a long term plan - something to look forward to in order to help the present situation.

There are some herbal and drug preparations which may be useful, but they should not be used regularly because they become addictive. However, it can be useful to have them to hand so if an unexpected situation comes up, they can be used with confidence. This gives the sufferer the comfort of knowing that he/she can at least survive that particular situation. The more effective the drug is at doing this, the more likely it is to become addictive. Most people turn to sugar, chocolate ("comfort eating") nicotine, alcohol or cannabis, doctors prescribe tranquillisers such as diazepam (Valium). I do not mind people using these things to help them through a stressful situation so long as they stop when the stress is gone. Usually they don't! Very often people switch from one tranquilliser to another.

I do prescribe the tranquillisers to help anxiety problems. I would rather a patient used diazepam than alcohol because alcohol is so damaging to the liver. However I am aware that many doctors will not prescribe simply because they know they will be "blamed" if problems of dependence subsequently arise. Some patients just need the knowledge that their tranquilliser is to hand and just that prop alone may allow them to cope with a difficult situation.

The key to using tranquillisers is to save them just for the stressful situations and not use them regularly. You should have at least 3 days in every week when you do not resort to any type of tranquilliser (sugar, chocolate, nicotine, alcohol etc) - more than that and you are on the road to dependency.

Exercise is very good for anxiety. There is a right balance between physical and mental - preferably both. In fact some people become hooked on exercise and look forward to their daily buzz to stay healthy. (See exercise) I know I do! The trouble is getting started - you actually need someone to drag you out for a walk initially, or take you swimming or whatever. The self discipline is the hardest part of getting well. You must find time every day to do something completely different and it must be something you enjoy. For me it is horses - any aspect of!

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