Anxiety Disorders: Psychiatry and Psychopharmacology - Dr Neil S. Kaye

Anxiety Disorders: Psychiatry and Psychopharmacology – Dr Neil S. Kaye



opinions options answers voice America health and wellness welcome to psychiatry ask the experts posted by dr. Neil k all comments views and opinions expressed are solely those of the host guests and callers dr. K will not diagnose or treat callers the information provided is informational in nature in the next hour dr. K explores the inner workings of the brain and mind grab a pen and paper and sit back here's your host dr. Neil k good evening i'm dr. neal k and i want to welcome you all to our show today we want to say a special hello to friends and family all over the world we know are listening today's topic is anxiety disorders will be talking about things like panic disorder or agoraphobia generalized anxiety disorder social anxiety phobias and post-traumatic stress disorder as I said I'm me okay I'm a psychiatrist with expertise in pharmacology meaning medication treatment neuropsychiatry the brain and how it's involved in thinking behavior and emotions geriatric psychiatry the mental health issues in people over age 65 and forensic psychiatry legal issues in the criminal civil family domestic and regulatory area the purpose of all our show is to increase education and awareness of mental health issues we will not be diagnosing or giving specific treatment recommendations some things that can only properly be done in the context of a doctor-patient relationship each week on psychiatry ask the expert we focus on a specific topic in psychiatry we talk about the disease or illness itself the common symptoms and presentations of each illness and of course treatment options with a focus on psychopharmacology medication treatment we talk about potential risks and benefits side effects dosing and when and how to use the best medications we're broadcasting from Wilmington Delaware my partner on the show is a longtime friend and co-host Jay birch good evening meal and hello to all of you out there in the internet while tonight's topic you've very accurately described as anxiety disorders we'd like to remind our listeners that they have any question related to mental illness we're here to try and answer those questions that we do indeed know the answers to and for those we don't know the answers to will be glad to give a passage Kitty guess so you'll take it away great to get today's topic is anxiety disorders and later on in the call we're going to invite listeners to call in with questions so I'll please plant the call we call a number eight six six three six nine 3742 tonight we're focusing on anxiety but as Jason will take hold on any topic in mental health the take-home points for today's topic first everyone experiences anxiety second anxiety will kill you third medications can help treat anxiety especially with other treatments involved and forth you need to feel power and control in order to beat your anxiety I'll try to get these take-home points and some other helpful tips for anxiety up on my website later this week so if listeners go to www court psychiatrist calm look for the link to psychiatry ask the expert we'll try to get those up as quickly as we can now let's go to our own mark hunter Rick on our radar segment what's been on your screen this week anything sure all as a relates anxiety there's just an awful lot I think that I pick up on my radar this week I think everything going on in our world today is provoking anxiety Jay these are difficult parts we have constant change people believe that they are seeing threats continuously whether it's terrorism or economic downturn here in Wilmington you know our largest employer has recently been purchased and we're anticipating somewhere between 3,000 and 6,000 people losing their jobs obviously something that would provoke tremendous anxiety in anyone we have issues of how to pay for heating oil wits winter and natural gas with prices up as high as they are and we're still only partway into the twin sir the list goes on so almost any of the news stories on the front page today in some way relate to anxiety and so mental health just a big part people slides the other store that piqued my interest this week was one on liver failure and what's interesting to me about the story is that the number one cause of liver failure at the present time is tylenol acetaminophen I bring this up because I think there's a perception out there amongst the general public that over-the-counter medications must be safe because they're over the counter and that somehow prescription medications are more dangerous and this is a good example where that's just not the case something that anybody can buy over the counter and is used and added into a lot of different cold remedies and all sorts of things actually is a very toxic substance it's much more little an overdose than almost anything else that we use and yet this is over the counter and really unregulated and those two stories together we're big part of my radar screen this week what have you run across Jay when the oh I don't know is the warm weather for january or the full moon or just what it was but my radar screen was constantly being hit and I've got several things that I think warrant discussion the first actually ties into a topic for tonight you mentioned PTSD or post-traumatic stress disorder I was taking the papers out one of the wall street journal's that I had at home was from November 28 and there was a lead article right on the front page entitled in Iraq war zones therapist a consult the soldiers trauma without going through the entire article the key points that I took from the article were these first of all that in the Vietnam era the draft really supplied enough troops though it was rare for someone to do more than one year of combat duty but in today's army many soldiers have to do several tours of combat duty so in the Iraq situation we're running into people going back for a second and third tour of duty and the problem is that the initial symptoms of combat stress or post-traumatic stress disorder get worse with repeat exposures now the second point that's important to the Army's credit they recognize this as the problem that they have to deal with and they've actually deployed an increased number of mental health workers to Iraq the third point is that the purpose of these combat stress detachments is to help those affected troops cope with the situation until they finish their tours if possible how does that strike Union well it's a huge huge issue hob the artist Surgeon General Kevin Kylie aw has reported that thirty percent of soldiers coming home from Afghanistan and or Iraq have stress-related mental health issues now that's a tremendously high number thirty to forty percent of our troops are actually National Guard reservist well we just call the weekend warriors they may be serving their first tour of active combat and as you know that a lot of these men and women are being redeployed multiple ponds which is much different than what we've seen in the past we actually believe we're seeing much higher rates of combat stress than we've ever seen before and treatment is needed interesting the people who are most in need are those least likely to seek help because they're worried about the stigma of this PTSD traumatic stress disorder is an anxiety disorder it's actually worthy of an entire show itself and so sometime in February or march will actually do they show just on PTSD but this is absolutely a big issue we're all using some of the techniques that the Israeli army developed for getting people back onto the front lines faster as you noted and we're having success with that that is we're able to get our troops back to battle faster but it's not it's not inexpensive in terms of the emotional cost and when they come home again we're just seeing real high rates of this what else have you come up with well on my radar screen is the new issue of vanity fair magazine the februari issue which is quite a contrast to the post traumatic stress issue and the non-traumatic photograph of a very lovely Lindsay Lohan but here's the key quote on the cover I had a problem and I couldn't admit it allegedly in the article in the interview miss Lohan the same teenage actress admits to dealing with bulimia which is an eating disorder the key point about this is that the whole subject of eating disorders bulimia and anorexia becomes topical and then area of interest again so as you know eating disorders are fairly common with up to four percent of women perhaps suffering from bulimia and it's not just a disease of teenage girls perhaps as many as one in five bulimic patients exactly a male eating disorders happen to have one of the highest mortality rates of any mental illness what are your thoughts on this Neal okay I know you were reading Vanity Fair you always surprise me so glad to hear your browser learning adjust cover your broadening your horizons there uh but yeah bulimia an eating disorder and probably something will have to do a whole show on involves a distorted body image the Tyne here to anxiety is that Western society is where you see this disorder and that there is a huge pressure on people particularly young women to be thin and to be attractive in to look like I'll Lindsay they're on the cover of Vanity Fair and that produces a great anxiety which ends up meaning to be treated in some way we've got just a minute or so it will break anything else that you want to touch on before we go to break alright well while I'm on things that are a topical of interest to tonight's subject anxiety here's a news story out of Florida from last week that ties right into tonight's toppled we have a record of six middle school students taken to the hospital after having taken some xanax given to them by a classmate you know we think of experimenting with drugs and we don't normally include prescription drugs as a rule at least I don't but obviously psychotropic medications those used to treat mental illnesses we have some experimental value or potential the drug in this case denix is frequently used to treat anxiety we're going to talk more about denix later on yeah what we talk more about xanax later on we get into treatment quickly what I'd like to say is that in this story these kids actually brought xanax to school that was prescribed for their parents other children now actually ingested the xanax what's important is toss back to why they said about tunnel that ZeniMax is actually a very safe medication overall these kids that nosek well I know bad outcome as a result of taking this prescription potent medication or against something over the counter could be much more dangerous let's go to break and have to break we'll all talk about the diagnosis of anxiety callers get your questions in order real life solutions voice America health and wellness to perform at your maximum potential you need to have all aspects of your life working properly online brain and body dr. michael john kell will bring you honest open discussions concerning your physical mental and financial health if you're ready to find purpose and meaning in your life tune in to mind brain and body every friday at eight a.m. pacific mind brain and body on voice america health and wellness radio dedicated to your health wealth wisdom and purpose today host a aprendizaje grace maxima caridad notice cucharas a alguien 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K welcome back to psychiatry ask the expert i'm dr. neal k and tonight we're discussing anxiety disorders and their treatment the phone lines are open for our callers and let's get right into talking about anxiety right knee high anxiety seems like something shouldn't need a definition but i'm sure you're the expert you're going to give us an expert's definition sure I think we ought to talk about how experts use this word that's such a common word let's talk about what the experts really mean anxiety is a continuum there's a spectrum or range obviously we all get anxious once in a while we're supposed to I like to tell patients that anxiety is a built-in defense so God programs us to be able to experience anxiety because anxiety acts to keep us safe an ID is your body's warning system it's supposed to go off and alert you that things in your immediate environment might be dangerous when we're anxious our eyes dilate the hair on our next stands up basically we're ready for that fight or flight that you always hear about so anxiety acts to protect us sometimes it can even motivate us I mean imagine if you had no anxiety well you probably would never study for the test and you wouldn't do as well but anxiety can be a motivator you had no anxiety about things well you might be more prone to break the law because well you wouldn't worry about being arrested or jailed and you also wouldn't avoid truly dangerous situations well how about a meme you I'm I'm sitting here with you quite honestly I'm a little anxious probably even a little nervous we're just having a conversation but you know it's going down over the Internet airwaves is this normal anxiety should I be concerned when when does anxiety get to be a disorder well I think that you're talking about sort of what we'll call normal performance anxiety and we all should have again a little bit of anxiety and that don't think there's anything abnormal and then it becomes a disorder when the alarms go off at the wrong time essentially they're false alarms we're getting signal from our body from our mind that things are dangerous and we go into that fight-or-flight kind of response but actually there's no danger of in the environment now anxiety can be they it can be diffused it can be unpleasant and it's a sense of apprehension it's also accompanied by what we as position is called autonomic symptoms and that's basically physical symptoms things like headaches sweating palpitations shortness of breath chest tightness stomach flutters and butterflies trouble staying still and those are common symptoms of anxiety in fact they also lead to people going to doctors or emergency rooms to be evaluated for medical situations which are really the physical symptoms of anxiety now of course when an expert uses that word anxiety we mean that the individual is experiencing a specific pattern of symptoms that worthy that writes a level of a diagnosis so anxiety well it might be a symptom but it also could be a diagnosis or a disorder in a simple way I like to think of anxiety is fear when that fear response is out of control that's when I talk about it as a disorder last night thing I'd say that again to be disorder they have to feel like you have lost control over it that the anxiety is now running you instead of you being able to control it your experience districts it bothers you you'll want it to go away and actually people with anxiety especially panic truly want it to go away the suicide attempt rate in panic disorder is the same as in major depression it can make people feel so badly that they would rather be dead and continue to experience it anxiety is impairing it gets in the way of social or occupational or personal relationships and functioning the symptoms have to be present for a certain period of time generally a few weeks and again we can't have a lot of these physical systems associated with it all right let me take the quiz then I understand that there's anxiety it seems to be sort of a natural response directly related to rational cause of circumstance but anxiety becomes a disorder when that sort of direct connection to the rational causes is lost is that Zarek that's a good way of summarizing it so we're getting a on the quiz here basically anxiety is not just a stress reaction each of us as individuals had a different level at which we perceive or experience something as being threatening so some people are higher risk takers and others and a lot of that has to do with our life experiences what happened was early on that the template programs us for future fear reactions the other thing is that people will manifest their fear differently some people will recognize fear they can talk about it they can solicit support many people experience it in physical ways they get the palpitations the sweating the false heart attack syndrome choking sensations lumps in their throat and a lot of people feel anxious and ashamed that they feel so anxious the shame actually then makes their anxiety worse that distorts their perceptions of the actual danger that worsens the anxiety and you can see we get into this very unhealthy cycle of anxiety and with the anxiety we have to be able to break that unhealthy cycle people feel anxious when they don't feel enough control so that what we do as humans is we look for anything that will help us to re-establish a sense of control a lot of times this involves us looking for or making up a reason to explain the anxiety so let's say somebody has a panic attack that's something that can happen without any trigger whatsoever but it happens when they're on i-95 driving that's pretty common around here we have a lot of people out i 95 phobia they can't tolerate the high-speed traffic and all of that and what happens is they decide that I 95 is the cause of the panic and anxiety and so the response would be to stop driving on i-95 then they might have another panic attack driving just on a local Road and so they decide well all roads are dangerous and cause anxiety so you have to stay off of the roads and then they get locked in our house may develop agoraphobia point is that the panic attack was really not related to 95 but people make an association because that gives them a sense of control they feel that if they can explain it if they can identify a trigger and that's something external that that allows them to have control and the more control or less anxious they feel you've already gone into the subject or the exact disorder panic panic attacks I'm sure there are other anxiety disorders what are the most common types of anxiety disorders well the three types of anxiety that we hear about the most would be panic disorder GID or generalized anxiety disorder and sa being social anxiety let me try to define each of these for listeners so panic that's the big one anak is recurrent attacks of acute anxiety now panic attacks are actually not triggered by anything they are just like seizures they just are electrical discharges that can happen they are associated with extreme fear they start abruptly they reach full intensity within minutes I can't the last a few minutes maybe longer but generally not more than 15 or they frequently have palpitations shortness of breath sweating trembling shaking dry mouth a choking sensation chest pain nausea dizziness fake feeling a fear of losing control or going crazy a fear of dying hot or cold flashes numbness or tingling it core weekly at a minimum in order to be considered a disorder now when you say panic is the big one does that mean that panic attacks are the worst anxiety disorder is that are they the most commonly seen anxiety disorder out of Portus panic fall into that kind of category panic and generalized thank God are probably our two most common and certainly the two most common that we see in terms of getting treatment generalized anxiety chronic free-floating anxiety we're going to define that as six months of prominence tension worry feelings of apprehension about everyday events and problems often accompanied by again the physical symptoms palpitations shortness of breath sweating trembling shaking dry mouth choking chest pain nausea muscle tension feeling Twp an exaggerated response to minor surprises startling easy maybe some sleep problems the last one we'll talk about is social anxiety marked persistent fear of social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others basically the person fears that he or she will act in some way that will make him or her feel embarrassed or shame the person recognizes this fear is out of proportion that is unrealistic but nonetheless they act to avoid such situations the one other thing to mention would be substance induced anxiety this would include the overuse of things like taffy alcohol withdrawal cocaine decongestants and other stimulant induced anxiety situations let's go to break and when we come 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welcome back to psychiatry ask the expert if you have a question or comment dial toll-free at 1 866 369 3742 now back to the show here's dr. k hi dr. y ok welcome back to psychiatry at the expert and remember the lines are open at eight six six three six nine 3742 can you let me summarize because their topic tonight is anxiety disorders and so far you've kind of talked us through normal anxiety how anxiety becomes a disorder we just finished discussing the three major types of anxiety disorders that being panic attacks generalized anxiety disorder socializing social anxiety disorder so anything else you want to say about those before you go on well Jay anxiety is the most common sentiment psychiatry it's probably the most common symptom and diagnosis frankly in all of medicine so fifty percent or more of what actually comes into a family practitioners off his ends up being anxiety and not actually something else in the physical realm about twenty percent of people that's one out of every five people you need will meet the criteria for an anxiety disorder thirty percent of women twenty percent of men will experience anxiety at a level of severity sufficient infeed diagnosed with a psychiatric anxiety disorder at some point in their life it is a little bit more common in lower socioeconomic populations where there are more stressors so that's to be expected the impact is huge 30 to 50 billion dollars a year is a reasonable estimate common phenomena somebody has chest pains shortness of breath some dizziness and lightheadedness the first thing they do is it go to the emergency room and they end up getting the million-dollar cardiac workup only to be told that everything is normal and it's probably anxiety and they treat it with something like that acts alprazolam as we talked about contact the beginning of the show and so we end up doing an awful lot of unnecessary expensive and sometimes interventional medicine in people who really don't need it because people both doctors and page often are unwilling to consider anxiety on that differential diagnosis list until they rolled out everything else physical and that's not really a good approach the anxiety disorders should be considered part of the differential diagnosis particularly in younger people where we know that physically they're very unlikely to be sick and that has significant cardiac disease and pulmonary disease and things like that let me make sure that once that one thing is clear that I'm not certain up right now in perhaps the audience's neither if I have normal anxiety an anxiety disorder starts to develop you talked about Panik and might be driving on i-95 and then I stop driving on on 85 and then I stopped driving on another road and another Road in another Road is there some kind of a hierarchy of these anxiety disorders am I likely to say for example have social anxiety disorder and that develops into generalized anxiety disorder meant to panic attacks or do these disorders to just develop individually and kind of separately from one another actually there's about 13 different anxiety disorders in our diagnostic manual but the symptom overlap between the various anxiety disorders is huge and in fact most people will have more than one it's not necessarily that one evolved into the other it's more that they tend to just present simultaneously so people with generalized anxiety disorder chronic free-floating anxiety will have panic attacks episodic alee it becomes panic disorder if the frequency and intensity gets to be severe and off or frequent enough people with social anxiety well there's anxious in social situations but they're very likely to have a panic attack when they are forced to perform to do that presentation at work that they dread doing to stand up in front of the group that they're worried about being embarrassed in front of them things like that so there's a lot of overlap with them also a lot of overlap with the depressive disorders we talked about last week about three-quarters of people with depression had anxiety as a presenting symptom and if you're anxious long enough and it's untreated the pretty good champions are going to end up developing depression as well one of the problems has been in the past that a lot of patients were treated by primary care doctors and they were simply giving nerve pills minor tranquilizers things like xanax and valium for their anxiety and they weren't really getting treatment for some of those developing depressive symptoms that were coming on at the same time okay what are their theories about how anxiety disorders evolved or what the cause of them are we going to talk about neurotransmitters some more like we did last week relative to depression well I think there's a variety of theories out there and we want to cover the primary theories the ones that make the most and today so there's an older work on analytic theories that that people are anxious because of repressed conflicts from childhood and frankly all this Freudian stuff that really just doesn't turn out to be helpful and so we largely have discarded that now the behavioral theories especially something that I call learning theory is well accepted it certainly as part of the picture and here again using that I 95 example this is a learned response people have something bad happened they make a cause-effect relationship even if it's not correct it gives them a sense of control and so they learn and practice their avoidance response which is excessive in an appropriate and that clearly is part of developing anxiety associated with that is a cognitive distortion that is people either misperceive or miss process the cues in their environment they see things and being more dangerous than they are they perceive that danger where it doesn't relieve this this is less than the treatment that we call cognitive behavioral therapy we're not going to talk a lot about that tonight but I do think is very important and that it's almost impossible to treat some on fri anxiety with just medication cognitive behavioral therapy very helpful should absolutely be a first-line intervention in any of the anxiety disorders to help people in reprocessing and unlearning and improperly learning the responses biological theories of course led to medications for anxiety we've spent a lot of time both in human and in animal models trying to understand this because it getting these are so disabling and impairing if you look at the autonomic responses that we talked about before it creates a heartrate diarrhea headaches increased respiration although that fight and flight kind of response mobile is all linked to epinephrine and norepinephrine transmitters chemical messengers put out by our adrenal gland designs that let us do that fight-or-flight that we need to preserve ourselves now occasionally we can have too much of this norepinephrine secreted and this goes to a particular area in the brain known as the locus coeruleus and that has connections to something that we call the limbic system the limbic system is the area in the brain that houses emotional response and it can produce a tremendous fear response as a result of that drugs that can block norepinephrine that can help in those pathways and these would be things like beta blockers alpha agonist some of the antidepressants can actually be effective in panic and in these fear response anxiety disorders by helping to block norepinephrine Neil could you explain to our audience fairly common beta blockers they know as blood pressure medications what about alpha agonist trout magnets are also used for blood pressure they have another more spots that helps to reduce that tone hi strong tension in our nervous system that produces the anxiety drives up your blood pressure again blood pressure elevation is helpful if you suddenly need to sprint and avoid that saber-toothed tiger that's chasing you across the open plain but of course in today's world it's not what you want now we've got serotonin of course that's our old friend we've talked about that last week in depression and we talked about the relationship of anxiety and depression maybe two sides of the same coin so meds that enhance serotonin that would be the serotonin reuptake inhibitors some of the older try cyclic antidepressants and a medication known as buspar buspirone work on serotonin and again serotonin is a big transmitter in that limbic system and emotional system in our brain with the fear Center specifically the amygdala less chemical that we end up talking about here is something called GABA gapa now GABA is a transmitter in the brain that overall decreases activity in the brain it's kind of the blanket on the brain overall just turns down tone it's a really big gain switch in our system and this is where the benzodiazepine class of drugs work the benzodiazepines or the valium class and we know them as things like valium and xanax ativan klonopin by their trade names and the benzodiazepines actually elevate gaba so as they drive up GABA that puts more of a blanket on the brain which ends up reducing anxiety they were very rapidly they're very well tolerated but the problem with them as a class is that blanket is very nonspecific it tends to reduce activity throughout the brain and not just in the fear centers where we wanted to and that can be problematic in some ways we're using a shotgun when we want to use a rifle we want to use something more specific more targeted to one area of the brain that way sometimes people on benzodiazepines have kind of that can I say spaced out appearance where they don't really seem to be responding to anything really specifically it is again overall the benzos can just turn down your total tone so they'll throw down your level of alertness they turn down your ability to have fast motor responses and that's why we're always cautious about people driving operating machinery and things like that when they're on a benzo doesn't mean you can't do it but overall they have is blanketing quieting effect the other thing that obviously comes into play is an attempt by people with anxiety to self-medicate here we're talking primarily about alcohol alcohol is very much like those benzos your brain seed alcohol and the benzodiazepine Valium Xanax type jobs is being very similar and so alcohol will reduce the overall activity in the brain it puts parts of the brain to sleep and this results of course some people either misusing it or self-medicating with alcohol which is not the right thing to do in fact people with panic attacks are about four times more likely to have alcohol abuse than the general population it's not that they want to be addicts and in fact if you think about it people with anxiety want to have control and so surrendering control to a medication or alcohol it's kind of the opposite of what you would expect in someone with a real anxiety disorder but again anxiety can be so impairing so painful psychically emotionally to a person that they will do whatever whether it's alcohol or pot or as I said even I they kill themselves sometimes simply to make things go away I think we're going to go to break and when we come back and break we're going to talk some more about the medication helping you make informed decisions for your life this is voice America health and wellness they are you doing educational videos top quality right here you'll never hear anyone selling education on the street but with free family learning programs you can get the education you need call 1 877 Hamlet one for information on free learning programs 1 877 fa m li t 1 check it out check it out with your GED right here Danity ma come on check it out free family learning programs from the National Center for Family Literacy brought to you by the National Center for Family Literacy in the F Council when you combine energy secrets from ancient China and the latest breakthroughs in 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King welcome back to psychiatry ask the expert I'm and dr. K with j-bert and we're well Jake well Neil you've covered quite a bit so far I mean 13 different anxiety disorders and you talked about four or five different theories about the causes of bees anxiety so I'm going to guess that the treatment options are pretty complicated you want to just kind of highlight some of the most successful ones if there are any successful ones sure actually I anxiety disorders great outcome treatment is highly effective and that's one of the main reasons I want listeners to walk away believing that they absolutely can be helped with their symptoms with their disorder the best thing I can recommend for anyone is a combination of medications and cognitive behavioral therapy the medications that we usually start out with our the serotonin specific reuptake inhibitors and I'll come back to them in just a minute i also want to put in a couple plugs for some other things relaxation therapy breathing techniques biofeedback exercise yoga these all have benefits benefits have been well documented in good studies and certainly comprise part of the treatment program for someone with anxiety the first class of medications we're going to talk about the benzodiazepines we're going to start with the benzos because they are the fastest acting there are the oldest drugs we've had them for years they can be tremendously helpful particularly in something like panic disorder so we're talking about xanax or alprazolam add a van which is lorazepam in the generic form quantity and clonazepam valium diazepam there are a few others but those are the big foreign use in the United States these drugs are all sister drugs so they all share the same basic properties some are a little faster acting summer little longer-acting some a little more sedating some a little less dating but by and large the bends over the class are very similar fast-acting well tolerated but they have the potential for being abused for people becoming dependent on them or addicted to them they have the potential for abuse because of that so we like to use them in acute situations as rescue medication but we try not to use them for the long-term management of anxiety because of that risk of abuse so we'll certainly use them up front and we may even prescribe them along with something like a serotonin reuptake inhibitor to allow the benzo to work wall it's taking time for the SSRI to come up to speed in a person system timeout me on hold on hold on you mentioned acute treatment rescue therapy by benzos not ideal for the long term give give me some timelines a to therapy with what the heck is rescue therapy sure a cute treatment were looking at getting somebody calm down for the first few weeks maybe a month at the most but we ought to be able to get them up to all up to speed pretty quickly the other types of medications again the SSRIs the serotonin enhancing compounds well they're going to take anywhere from two to six weeks to come on board in a patient system and so we're going to need to move those along pretty quickly so will tend to start with a SSRI along with a benzo the older antidepressants tricyclics nao inhibitors some of the new or other types of antidepressants also have some efficacy in these areas but for most of our patients will start a drug like a prozac or zoloft or paxil and and and and work that we might begin need to use a benzo initially but we're going to want to get rid of that been so in the long term of presentation of the person we also want to get rid of caffeine street drugs water patients to exercise to get normal sleep and to get out and face their fears well that sounds pretty simple and so if I follow a regimen like that you talked about the high degree of success in treating anxiety disorders about what percentage of people really come out the other side actually if you look at patients about eight weeks after initiating treatment probably sixty to seventy percent of people have good control of their symptoms in about eight weeks that they'll follow the treatment plan do the therapy take their medications properly now anxiety patients a lot of times want to readjust their meds and again control things themselves and you need to be cautious about that because this is one area where the doctor might actually know best you need to work with your doctor in concerts in order to get the best outcome medications will be part of it as we come into the home stretch here I want to say thank you to everyone and go over some important points as well as give you some referrals anxiety too common treatable disorder it has an excellent prognosis everybody experiences anxiety and remember it will never kill you medications psychotherapy are important and they help you to gain control on power over what's going on anybody you know it's experiencing anxiety help it to get professional help they can't just pull themselves up by their bootstraps anxiety is real we know where in the brain it resides we can take pictures of it with certain imaging studies and so that's important some of the reef alls some of the websites I like to recommend ad aor d anxiety disorder association healthy minds dot org social phobia org and an H a dot org en a mi org and ni n H org these are reputable organizational websites where you're going to get good advice I'll tell you to stay out of the chat rooms in places where the material isn't properly screened and you hear a lot of people's own experience but not necessarily what's backed up by good research and studies you know about this site a lot of the pharmaceutical manufacturers happen how you score the pharmaceutical sites are generally good the FDA monitors these sites for accuracy and content and so again they're betting sites might think they're they're certainly worth looking at so I would certainly add those to the list I want to thank everyone for listening and participating remember to needs of psychiatry ask the expert next week we're going to be talking about neonate aside and infanticide these are mothers who kill their children now that order provoked anxiety it's been a great week for me I look forward to talking with everybody next week bye bye thank you for listening to psychiatry ask the expert to learn more about dr. K visit court psychiatrist calm tune in next Tuesday for another hour of psychiatry ask the expert dr. Neil k

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