Anxiety Symptoms & Treatments
Anxiety is a normal response to a threat or to psychological stress and is experienced occasionally by everyone. When someone is faced with a dangerous situation, anxiety triggers the “fight or flight” response. However, when anxiety occurs at inappropriate times, occurs frequently or is so intense and long lasting that it interferes with a person’s normal activities, it is considered a disorder.
Mood and anxiety disorders are among the most common type of mental disorders in Canada. In 2013, approximately 3 million Canadians (11.6%) aged 18 years or older reported that they had a mood and/or anxiety disorder. Basic activities of daily living and the ability to work are challenging for many people dealing with an anxiety disorder. In fact, more than a quarter reported that their disorder affected their life “quite a bit” or “extremely” in the previous 12 months.
Anxiety disorder is a generic blanket term outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) that includes generalized anxiety disorder (GAD), social anxiety disorder, panic attacks and panic disorders with or without agoraphobia, specific phobic disorders, obsessive compulsive disorder, acute stress disorder, substance-induced anxiety disorder and anxiety secondary to a medical condition.
There are many potential causes or risk factors that increase a person’s likelihood of experiencing anxiety. These include alcohol intake, use of prescription medications, genetic and environmental factors such as trauma, life stress and toxicities. It may be a combination of these factors or may be related to brain chemistry including abnormal neurotransmitter and stress hormone levels.
Long periods of chronic stress gradually reduce the body’s ability to calm itself resulting in elevated excitatory activity. This increased activity eventually results in depletion of neurotransmitters and adrenal hormones and ultimately in exhaustion, and/or anxiety. Circadian rhythms also become altered with cortisol levels spiking in the evening.
Recent studies show the importance of the gut microbiome to the function of the nervous system. Pathways of communication between the brain and gut include the enteric nervous, neuroendocrine and immune system. Alterations in any of these systems can cause alterations in gastrointestinal barrier function, increased anxiety and depressive-like behaviours. Most of the serotonin in our body is made in our digestive system. Certain bacteria and yeast can trigger symptoms of anxiety. In short, a healthy gut equals a healthy brain and a healthy mood.
Anxiety can arise suddenly as seen in panic attacks or gradually over minutes, hours or even days. It can last from a few seconds to years and ranges in intensity. Anxiety is basically your sympathetic nervous system in overdrive so for a full blown panic attack, symptoms may include shortness of breath, dizziness, an increased heart rate and tremor or trembling. Anxiety disorders can be so distressing that people often suffer from depression as well. In fact, people with an anxiety disorder are twice as likely to develop depression.
For the diagnosis of GAD, according to the (DSM-IV) diagnostic criteria, in addition to uncontrollable worrying, there must also be at least 3 out of 6 somatic symptoms including: restlessness, fatigue, concentration problems, irritability, tension or sleep disturbance occurring for a period of at least 6 months. For the diagnosis of GAD, significant distress or impaired functioning from the condition must be present.
Anxiety sensitivity refers to the fear of behaviours or sensations associated with the experience of anxiety. The concept of anxiety sensitivity implied that the “fear of fear” could precede panic experiences and predict panic attacks and other anxiety conditions. In 1984, Steven Reiss wrote 16 items on the brief questionnaire called the Anxiety Sensitivity Index (ASI) to be used as an indicator of who is more likely to have panic attacks, post traumatic stress and ordinary fears and phobias. As of July 2013, the ASI has been used in more than 1600 research studies.
Generalized Anxiety Disorder 7 (GAD-7) is a self-reported questionnaire for screening and severity of GAD. It has 7 items which measures the severity of various signs of GAD. A copy of the GAD-7 can be found here.
Testing that is important for anxiety disorders include:
- Adrenal hormone (cortisol) testing
- CDSA testing for gut function
- Multivitamin & mineral (spectracell) testing
Conventional treatment focuses on pharmaceutical and psychological interventions. Pharmacotherapies include synthetic anxiolytics (eg benzodiazepines, buspirone) and antidepressants (eg tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors (SSRI/SNRIs)). Most often, anti-depressant medications such as SSRIs are prescribed first for anxiety disorders. Buspirone is considered a first line anxiolytic for GAD. Common side effects with benzodiazepines include sedation, motor disturbances and cognitive interferences while long term treatment can cause dependence and withdrawal issues. Abrupt cessation may cause rebound symptoms such as insomnia, agitation and digestive disturbance as well as anxiety may return to an even higher level than before treatment.
Non-pharmacological treatment include psychoeducation, supportive counselling, relaxation and breathing techniques and cognitive behavioural therapy (CBT). CBT show improved outcomes if used with pharmacotherapy.
NATUROPATHIC MEDICAL TREATMENT
Naturopathic treatment goals are aimed at reducing anxiety, worrying and somatic symptoms, supporting and normalizing adrenal function, encouraging stress management through lifestyle changes.
- Diet: avoid caffeine, sugar and processed foods. Incorporate organic foods including lots of green leafy vegetables.
- Supplements: treatment typically consists of replacing low neurotransmitters with precursors and vitamins and minerals involved in serotonin metabolism. These include vitamin B6, Magnesium and Zinc. 5-hydroxytryptophan (5HTP) is a precursor to serotonin and supplementation leads to increased levels which calms the mind and body.
- GABA –providing natural GABA to calm the mind.
- Botanicals: Valeriana officinalis (Valerian), Withania somnifera (Ashwaganda), Matricaria recutita (Chamomille), Piper methysticum (Kava-kava) and Passiflora incarnata (Passionflower) are examples of nervines used to reduce tension, anxiety and overexcitable states.
- Piper methysticum (Kava-kava) -at doses greater than 9 grams/day, liver enzymes can elevate and should be monitored.
- Acupuncture, massage, aromatherapy and meditation can all be helpful as relaxation therapies.
If you, a friend or family member has been diagnosed with anxiety disorder or you have symptoms that may reflect a diagnosis of anxiety disorder, schedule an appointment today with one of our highly trained naturopathic doctors.
1. 2015 June 3. Mood and anxiety disorders in Canada. Government of Canada. Retrieved from: http://healthycanadians.gc.ca/publications/diseases-conditions-maladies-affections/mental-mood-anxiety-anxieux-humeur/index-eng.php
2. Sarris J & Wardle J. Clinical Naturopathy: an evidence-based guide to practice. 2010. Churchill Livingstone. p.238-256
3. 2013 March 19. Natural approaches to anxiety: less stress when you don’t guess. Naturopathic Doctors News & Reviews. Retrieved from: http://ndnr.com/anxietydepressionmental-health/natural-approaches-to-anxiety/
4. Greist J. (2016). Overview of Anxiety Disorders. Merck Manual. Retrieved from: http://www.merckmanuals.com/home/mental-health-disorders/anxiety-and-stress-related-disorders/overview-of-anxiety-disorders
5. Marciano, M. Piper methysticum. The Naturopathic Herbalist. Retrieved from: https://thenaturopathicherbalist.com/herbs/p-q/piper-methysticum-kava-kava/
6. Foster JA, McVey Neufeld KA. 2013 May. Gut-brain axis: how the microbiome influences anxiety and depression. Trends in Neuroscience. 36(5). Retrieved from: http://neuroscienceresearch.wustl.edu/userfiles/file/Gut_brain%20axis%20How%20the%20microbiome%20influences%20 anxiety%20and%20depression_Tran%20%20%20.pdf