...
So tell me, Doctor, what is the problem?
Well, what you've actually got is a problem with anxiety.
Anxiety?
...
Anxiety.
What exactly is anxiety?
Well, it's a common condition, it's pretty common, well, it's dead common.
Associated with affective and cognitive symptomatology, including somatic manifestations,
tachycardia, dysrhythmias, episodic hyperhidrosis, sweaty armpits,
frequency of micturition, enhanced gastric peristalsis, and sometimes, interestingly, diarrhea.
Neuro-transmitters, such as gaminoaminobutyric acid, 5-hydroxy-triptamine, are probably involved,
and treatment may require tablets, such as benzodiazepines, azerpyrones, or selective serotonin reuptake inhibitors.
So I'm going to start you on some tablets.
White one, probably.
Well, I'll just see how the family takes it.
And I'll see you again in six weeks.
Are there any questions?
No.
You sure?
Ah...
Yes.
Oh, fine. Well, then, I'll see you in six weeks.
Okay. Bye-bye, then.
Well, as it happens, I don't have any medical problems related to anxiety.
And, of course, doctors don't really talk like that, although sometimes it can feel a bit as though they do.
Because if a doctor tells me there's something wrong with me, well, maybe it makes me a bit anxious
that by the time I get home, I always realize that I haven't understood everything that the doctor said
and that there are always some questions that I should have asked but for some reason didn't.
In fact, I always feel I'd like an instant replay of what the doctors told me
so that I could really take it in and then have some time to think about it
so that I could then ask the right questions.
And that's exactly why we've made this video.
So that you can hear the key facts from Rob Bachman over there, who's a proper doctor, a hospital specialist,
and who really understands what most people want to be told and need to know.
So, when you're listening to what Rob's got to say, if there's anything at all that you don't understand first time,
you can replay it. And, if necessary, replay it again and again and again, until you really feel that you've got it.
Then you can think about it for a bit.
And next, you can start to jot down on a piece of paper the questions that you want to ask your own doctor next time you see them.
So, let's get started. Over to you, Rob.
Right. Well, let's start with what I'm going to be telling you about problems with anxiety.
First, what is anxiety all about?
Then, how common is it?
Then, what are the main symptoms?
Next, the main patterns of anxiety,
followed by what causes it?
Then, how is the diagnosis made?
Then, how anxiety problems are treated?
That's divided into treatment without medications and medications that help.
And finally, where can I get more information and help?
Okay. So now, let's go back to the beginning and start with what is anxiety all about?
Anxiety is simply those feelings that we all have from time to time of being tense and nervous and wound up, anxious, in other words.
And those feelings, of course, are not in themselves a medical condition. They're part of daily life.
But in some people, those feelings of being tense and wound up are there for most of the time.
And, this is important, they happen for no particular reason.
Or if they happen when there is a reason, a life event that triggers the anxiety, the anxiety is out of all proportion.
It's excessive or inappropriate compared to the significance of the event.
In other words, the anxiety gets out of hand.
And when that happens, the anxiety causes responses within certain parts of the nervous system of the body.
Those parts are called the autonomic nervous system.
That's the bit that controls the automatic functions such as pulse rate and breathing and actions of the stomach and so on.
As well as that, certain glands, the adrenal glands, also contribute by releasing hormones.
They also increase the pulse rate and they affect other functions of the body.
So those feelings of anxiety are always accompanied by physical symptoms such as the fast pulse, the dry mouth, butterflies in the stomach and so on.
And that combination of feelings and physical symptoms is what we mean when we talk about the state of anxiety.
Now, as I've said, we all get these feelings and symptoms if something very alarming or stressful happens.
That's just part of the occasional crises of normal life.
If you find that you have these anxiety feelings and symptoms for a lot of the time, and if they arise without a good reason,
and if they interfere with your ability to live your life normally and fully, then that's not part of normal daily life.
That's a medical condition.
Or rather, it's a group of medical conditions because it so happens that there are several different patterns of anxiety.
For instance, the feelings might be there all the time or they might be triggered by something you see or have to do.
And depending on the pattern that the anxiety takes in your particular case, the treatment that your doctor recommends may be different.
And that's important because with the right sort of treatment or combination of treatments,
there's a high chance that your symptoms will improve or even in many cases go away completely.
You can lead a normal or a near normal life.
So as we are going to discuss, this is a medical condition that can be treated and often relieved to a considerable extent, sometimes relieved completely.
So I think you'll find the information on this video very useful to you and encouraging as well.
So do keep watching.
Anxiety, the medical condition, not the normal everyday feelings is actually very common indeed.
Actually, it's a bit difficult to be very accurate about how common it is because some studies have used slightly different definitions from other studies.
But probably at any one time, just under 20% of the general population,
about actually one in six people probably have a medical problem with anxiety at any one time.
And about one in four have had problems with anxiety in the previous six months.
So it is a very widespread and a very common problem.
Let's listen as Betty describes her symptoms, some of which may be all too familiar to you.
Well, it started off in a post office queue or a supermarket queue where I was standing,
maybe having to wait quite some time to be served.
And it was like my throat closing up, my heart palpitating, just that I couldn't get any air into my lungs.
And I just felt like I was going to die and I had never experienced anything like it in my life before.
I thought I was the only one in the world that this had happened to, and I was absolutely terrified.
Well, as you've just heard from Betty, there are quite a few symptoms of anxiety.
It's probably easiest to think of those symptoms in three main groups.
The feelings that you have, in other words, the psychological symptoms.
The symptoms that come from your muscles and your motor system, that is the trembling, tension feeling and so on.
And a group of symptoms that start, as I mentioned, from the reflexes from your adrenal glands and from your autonomic nervous system,
that is the automatic functioning of your nervous system, which is not under voluntary control.
That's the symptoms like the dry mouth, the fast heartbeat, the palpitations, as Betty described it, butterflies in the stomach and so on.
So now let's look at those three groups in a bit more detail.
First of all, the psychological symptoms.
Probably you recognize all of those already, but they are that feeling of being on edge,
the feeling that something bad might happen. Betty said she felt like she was going to die.
You find that you startle easily. You might be irritable.
And that while you have the feelings, you have great difficulty in concentration.
During the anxiety, you cannot get to sleep easily when you want to.
Another common feeling is the sensation that you're somehow sort of cut off from everything, as if everything is unreal or perhaps far away.
Then the second group, symptoms in the muscles.
The most common problems here are feelings of tension and aching in the muscles.
Often there's a sort of feeling of trembling or shakiness in the muscle and also a general feeling of restlessness, of being restless.
Furthermore, during periods of anxiety, you might also find that you tire very easily.
Now the third group, the actions of the automatic part of your nervous system, the autonomic nervous system as it's called.
Those may give you a rapid pulse rate, sometimes with feelings of palpitations when you become aware of your heart tapping or pounding in your chest.
You may have a dry mouth, as Betty said, but your skin actually is likely to be sweaty or clammy or even wet.
You may also feel a bit short of breath, as Betty said, you can't get enough air in.
You may also feel lightheaded or dizzy or sometimes you may feel a churning feeling in your stomach, you may actually feel nauseous.
You may also notice that you go to pass urine very often.
So those are the variety of symptoms that may occur with anxiety.
As I said, these are symptoms that we all feel from time to time in very stressful situations.
But these symptoms mean that you have an anxiety state if you get these feelings very often, perhaps many times a day.
Or if they're there for a lot of the time or even all of the time and if there is no reason for them to be there.
In other words, if they are not appropriate for what is going on.
Now of course the precise details of each person's anxiety are truly unique.
But in general terms, you can think of anxiety problems in three main types.
And these are often called firstly the generalized anxiety disorders,
meaning that the anxiety is there for most of the time and does not seem to be linked to any particular problem.
It does not seem to be linked to any particular event or stimulus in your life.
Then the panic disorders or panic attacks in which the anxiety comes in attacks with little or no anxiety between the attacks.
However, on that subject it has to be said that some people become afraid of having a panic attack.
Some people become afraid of making an exhibition of themselves and so because of that they feel anxious in anticipation.
Even when they are not actually having an attack.
So they may become afraid of let's say having a panic attack in a supermarket or a post office.
And because of that anxiety they become afraid of leaving the house.
That is called anticipatory anxiety.
Then the third main group is the phobic disorders or phobias.
Here the anxiety is triggered by something specific, an event or a stimulus.
For example, fears of spiders or of snakes or of being in a public place.
Or actually a lot of people, actually about one in twelve, have some fear of picking up infections
or of being contaminated in some way in public places like restaurants for example.
Now all of those may be what we call simple phobias.
If you feel the fear but it doesn't interfere with your life in any way.
Or if the fear is so bad that it does affect your life, dictating to you as it were where you can and cannot go and what you can and cannot do.
Then it is called a complex phobia.
And that's the kind of situation that warrants and benefits from treatment as I'm going to tell you later.
Now in addition to those three main types of anxiety, general anxiety states, panic attacks and phobias.
There is one as it were special case and that is where the anxiety is related to a particular incident.
Something that was very traumatic, an accident or an assault or an emergency of some description.
Anxiety that follows and is related to memories of an incident like that is called post-traumatic stress disorder.
Actually post-traumatic stress disorder is not all that rare.
In many cases there is depression, meaning low mood associated with it.
So that's a special case where the trigger is a single traumatic event in the past.
So one of the first things your doctor will want to know from you is how your anxiety problem causes its problems for you.
Is it there all the time with a sort of steady chronic state or does the anxiety come in sudden attacks for no particular reason that you can see?
Do you have panic attacks without or perhaps with some type of event or situation triggering attack?
Or do you have a phobia meaning that every time you go into the situation, a shop or having to give a talk or fly in an aeroplane or seeing a spider,
every time do you get the attack then, basically every time the triggering situation happens?
Now there's just one other point. I've been describing these three main types as if they were quite distinct from each other and separate.
But in practice there may be some overlap between these patterns.
So the way in which your particular anxiety occurs may have some features of two of these.
But in general terms anxiety problems can usually be assigned to one of these three main types.
As we'll see the focus and the method of treatment may vary accordingly.
What is the reason for anxiety?
We don't know exactly why. Some people get severe problems with anxiety and others do not.
The generally accepted theory is that something goes wrong with the brain's usual response to emergencies.
That response, which is usually called the fight or flight response, is a reflex.
It's automatic and it's a mechanism for getting the whole body into a state of alertness in the event of a sudden emergency.
And of course that's very useful if you're suddenly being chased by a lion or something like that.
In anxiety states we believe that the particular individual has an emergency fight or flight response
that keeps on getting triggered when there is no emergency, when there is no lion chasing you in other words.
Now we don't know exactly why some people's systems get triggered like that while other people's do not.
But there is some evidence that it does run in families.
There's also some evidence that people with anxiety problems don't have the right amount of certain chemicals in the brain.
These are chemicals called neurotransmitters. One of them called GABA seems to be involved.
But we don't know precisely how the problem arises.
So at the moment the exact cause is unknown.
But we do know that people with severe anxiety attacks or similar problems are not just being silly and need to pull themselves together.
This is a medical condition just like diabetes and high blood pressure are medical conditions even if we don't know the cause.
Now the actual diagnosis of anxiety problems is based on what you tell your doctor and your doctor's examination of you.
In particular your doctor may want to know the exact details of things like how much coffee you drink,
how much alcohol you take, whether you're taking any medications.
Please do try and answer these questions as fully and honestly as you can because there may be something going on that makes the symptoms much worse.
For example if you happen to be drinking lots of coffee your anxiety symptoms may disappear altogether when you cut down or stop.
Now it does happen that there are a few medical problems which can look like anxiety attacks.
For example problems with the thyroid or problems with rhythms of the heart, disorders of certain glands and some other problems as well.
So your doctor may want to do some blood tests or some other tests to make sure that these problems are not what's going on
and that your symptoms are genuinely caused by anxiety and not by something else.
Forgive me for interrupting but I do want to remind you that if you're not completely clear about what you've just heard,
rewind the tape and go over it again, again and again if necessary.
After all this is quite difficult stuff and it may be all the more difficult for being new and for being about you which can make you feel anxious.
So don't feel shy about replaying the tape as often as you need.
So far then we've been talking about what kind of a problem anxiety is, the main patterns of anxiety and how the diagnosis is made.
And in a sense that sort of brought us up to where you are now.
What I'd like to do next is talk about the future, in particular how anxiety is treated.
So let's go on to that next.
Now as regards to the treatment of anxiety problems there are basically two main approaches.
There's counselling and therapy, there are several different ways this can be done,
there are several different types of medications that help.
In many cases the best approach may be to use both types of treatment.
But the precise details of the best approach for your particular problem is something that your doctor will recommend.
And tailoring the types of treatment to fit your situation is a major part of the successful treatment of anxiety problems.
So do be prepared for your doctor to recommend a type of counselling or psychotherapy or a medication or a combination of both.
So now let's start by talking about the types of psychotherapy and counselling.
Now there are several different approaches to helping you cope with your anxiety problem by support, counselling and therapy.
Now though you might have been thinking, I mean surely all this talk therapy is the same, actually it isn't.
Some people's problems may need a lot less than others.
To begin with many people with anxiety problems will improve simply by being reassured by their doctor
that there is nothing wrong with the heart or the thyroid or the lungs or whatever.
So being listened to, having your symptoms understood and then getting a full explanation from your own doctor
or a member of her or his team is very important in all cases and it may be all that is needed in some cases.
Now if that type of listening and explanation isn't enough, your doctor may suggest for you a course of counselling sessions
given by your doctor or by trained counsellors or psychotherapists.
Psychotherapy might be with just you and the therapist one on one or it might be with a group
if you happen to be comfortable with a group which may help a lot actually by allowing sharing of other people's experiences
or it may be with you and your spouse. So that is psychotherapy.
Now as well as the more simple reassurance and explanation and the more detailed psychotherapy
there are several methods of helping you deal very specifically with the anxiety and its triggers.
These methods may be very important in your case. For example you might be helped by stress management
helping to sort out the factors in your life that provoke anxiety and seeing which ones among them you can avoid or reduce
and which ones you can't avoid that can cope with more effectively.
Now in addition there is a type of therapy called cognitive therapy and cognitive therapy helps you
through detailed discussions alter the way you think of and assess certain factors in your life
including for example the triggers that start off your anxiety and the symptoms that you then experience.
So cognitive therapy can be of help in some cases. Now when the trigger is very specific like public places
or spiders or something like that your doctor may suggest behavioral therapy.
Behavioral therapy will give you techniques that can help you change the way you react to the situation
and the way you behave and that can have a very dramatic effect on your symptoms too.
These types of therapy are a very important part of the treatment of phobias
and in cases where the trigger for the anxiety is very obvious.
In that type of case the therapy may include what is called graduated exposure.
Graduated exposure means helping you to deal with the phobia inducing situation
and with your therapist staying in the situation at first imaginary or then in reality
until you are able to cope with or control your anxiety feelings.
So to summarize the non-medication types of treatment as I've said there are several different types of talk therapy
which can help anxiety problems. Depending on what your situation is your doctor will make specific recommendations
and will discuss the details with you. What the therapy is like, how long it might be expected to continue for,
what the benefits are likely to be and so on.
So now let's turn to the medications that are used in anxiety problems.
Now before I start talking about the different medications used in the treatment of anxiety
I need to tell you something about the names of individual drugs because most medications have got more than one name
and that can confuse you at first. When I do mention a drug or medication I'm always going to use the drug's chemical name
or generic name. Quite often the same drug is produced by several different manufacturers
who each give it their own trade name or brand name.
That means that the largest name printed on the label may be different even though the drug in the liquid
or the tablet or whatever it is is identical. Usually the generic name will be printed in small print
somewhere on the label or the package. So please don't be put off if the big name on the package
isn't the name your doctor or pharmacist uses. The same medication often appears under different brand names.
Also as I talk about these drugs I'm going to mention one or two of the side effects if they are important or common.
Just so that if you happen to get any of these symptoms you'll know what they're due to and you'll mention them to your doctor
if they're a problem for you. So with all that in mind let's start off with the medications commonly used in anxiety.
Basically there are four groups of these. First the family of tranquilizer medications called the benzodiazepines.
These are commonly used medications such as diazepam, one trade name is Valium, others like lorazepam, oxazepam and related compounds.
Then there's another newer compound which is called buspirone which is an entirely different type of medication.
Then there are medications called beta blockers which decrease the effects of the autonomic nervous system
and of the adrenal glands on your body and they reduce symptoms that way.
And finally there are some other medications which may be used. Let's talk about all these four groups in a little more detail.
Well first of all the types of tranquilizers known as the benzodiazepines.
There are several members of this particular group which can be used in the treatment of anxiety problems.
They include medications such as oxazepam, lorazepate, alprezolam which is actually sometimes used for panic disorders,
clonazepam, chlorodiazepoxide, diazepam usually called as I said Valium, all of which are commonly used.
Now the point about using these types of medications is that quite often they are recommended for short periods only,
even two weeks or so or less. That's done firstly because the effects wear off after a short time
and secondly so that you don't get habituated to them.
If that happened then you might have difficulty stopping the medication later on.
Unfortunately in many cases these drugs produce their effects, reducing the symptoms, in a few days or a week or so.
So often you'll have experienced the benefit early on.
Now as regards possible side effects these medications might make you drowsy.
So you shouldn't drive or operate machinery that could harm you or others if you feel drowsy while you're taking the medication.
Also these drugs increase the effects of alcohol.
So the effect of even a drink or two might well be more marked than usual if you're on the medication.
So be very aware of that as well.
But used with those cautions and provided you and your doctor have had a discussion about what is expected from the medication,
these can be very effective.
I should just also mention that in a very few cases, a very few, you may need to stay on these medications for a longer time.
Now the second medication I mentioned is called BuzzPiron and there may be other similar medications on the way in the future.
In most cases the improvement in symptoms may begin a little later, perhaps two or three weeks or so.
So don't be impatient if nothing much is happening in that first week.
Unlike the benzodiazepine group, BuzzPiron doesn't cause the side effect of drowsiness.
In fact, you might even feel a little bit over excited or light headed.
So as with all these medications, very important for you to discuss the likely benefits and the possible side effects with your doctor.
Just one other very important and actually very encouraging piece of news.
BuzzPiron doesn't create habituation.
In other words, you will not get hooked on it in any way.
The third group of the medications called beta blockers.
These don't really affect your feelings, but they do stop the autonomic nervous system and the adrenaline system from producing those bodily effects.
There are two situations in which the beta blockers are most commonly used.
First, they may help when the physical symptoms associated with your anxiety are very prominent and those symptoms are very disturbing in themselves.
And secondly, they're often used when there is a specific phobia.
The classic case is, say, a musician who gets severe anxiety when getting ready for a concert.
And then the shakes or the tremor may actually affect the person's performance.
Beta blockers taken before the event are very often very helpful.
By contrast, beta blockers are not likely to be very helpful in those generalized anxiety states when there isn't a specific trigger.
As regards side effects, beta blockers will not make you drowsy, but they can interfere if you have other medical conditions such as asthma.
So once again, make sure you've got the details from your doctor and that he or she knows about any other medical problems that you have.
Finally, there are some other medications that are used in certain cases.
For example, certain antihistamines may help.
Of course, if you happen to have depression, then you may be recommended to take antidepressants as well.
In certain cases, antidepressants may have special effects in improving the anxiety symptoms.
I need to make this clear. This is quite different from the use of antidepressants in depression.
It just happens that these drugs also turn out to be very effective in anxiety disorders, whether there is depression present or not.
We assume that they work on anxiety in a completely different way from their action in depression.
But if your doctor prescribes one of them, it doesn't mean that he or she believes you're depressed.
It means you've got the kind of anxiety where these drugs may help.
Just one word of warning. Sometimes the panic attacks get a little bit worse in the first few days.
Strangely enough, that's not a bad sign at all and may be followed by marked improvement.
So if that happens, persevere. There is definite light at the end of the tunnel.
Now, as regards which antidepressants are used, medications often used include clomipramine,
and there is also a newer one, peroxetine, which belongs to the family of antidepressants,
called the SSRIs, the serotonin selective reuptake inhibitors, which is particularly effective for the treatment of panic attacks.
In addition, there are other antidepressants which can be used.
Some of these drugs have a gradual effect, actually sometimes over several months.
So in some cases you may still be improving even after six months.
So don't be discouraged. Don't give up early.
Again, make sure you understand the medication that your doctor is recommending
and that you ask the kind of questions you want about it.
But to summarize this whole area of treatment, your understanding of what is going on
and of what the treatment is, what it's for, those are all important factors in achieving success.
Once you understand what the problem is, and I do hope this video has helped you with that,
the treatments like what can be expected from it and for how long you might need it,
once you understand those things, the chance of success is much higher,
and you will find that the symptoms are much less troublesome or have even vanished altogether,
and that you can cope with and deal with any problems much more easily.
As it happens, there are some organizations especially set up to help patients with problems,
with anxiety attacks or with phobias, and we've made a list of those.
And if you look at the package that this video came in,
you will find a list of the important organizations with addresses and phone numbers
on the insert that comes inside that package.
So if one of the questions you're asking yourself is, what can I do for myself right now?
One of the answers is make contact with one or more of those organizations
and do get the up-to-date information that they make available. It is really worth it.
Sure it is, Robert. You know, when you were talking just now, one or two things surprised me.
I mean, first of all, you're saying that problems with anxiety are so common
that one in eight people are going to be affected by them at some point in their lives.
It is absolutely astounding, isn't it? I must say, I didn't think until I read the stuff
that it could be that common, but it genuinely is.
Okay, now, something that puzzles me even more.
You're saying that anxiety states can be treated with antidepressants,
although the person isn't depressed.
Well, you're puzzled, everybody is puzzled, and it is a real mystery.
Perhaps the way antidepressants work with anxiety is different
to the way in which they work in depression.
And actually, they may work even better in anxiety than they do in depression.
And that has to be good news for anxiety sufferers.
And they're not addictive, right?
Absolutely right. Actually, a recent survey showed that nine out of ten people
think that antidepressants are addictive, but they are not. Absolutely not.
Great news. Well, I hope you've got some useful information from this video.
And forgive me repeating myself, but if there's anything that isn't clear,
do please play that part of the tape again and again till you've really understood it.
And one more suggestion. As I said right at the beginning of this tape,
none of us can remember what we hear or what we want to ask when we're at the doctor's.
It's a fact of life. So why not jot down the important questions
that you want to ask on a bit of paper, and then make sure that you go through that list
when you're actually there with the doctor.
Finally, we both hope that you'll also write or phone the organisations
that we've told you about for more information,
because understanding what's going on always, always makes things better.
Bye bye. Bye bye.
Thank you.