ANXIETY, PANIC, OCD, AND OTHER ANXIETY DISORDERS
"An anxiety disorder is not a mental illness," Dr. Cohen says. "Most anxiety sufferers live normal lives and have normal thinking processes except where anxiety intrudes. High anxiety is mental pain. It is almost always treatable."
Dr. Cohen has been treating anxiety disorders successfully for 38 years. He was one of the first doctors in America to employ modern methods of therapy and medication treatment. He is one of the very few doctors who uses a safer, low-dose approach with medications. "Anxiety disorders are very treatable when the right approach is used," he says. "Even people with long histories of severe anxiety, avoidance or withdrawal, or agoraphobia can be helped.
Yet, people with anxiety disorders often have difficulty obtaining good treatment. Many doctors do not recognize the signs of anxiety disorders and instead ignore the patients' problems or minimize their importance. Other doctors simply prescribe tranquilizers that can cause dependency. Some doctors consider anxiety patients to be hypochondriacs. Some therapists take anxiety patients on long journeys through their past, while not addressing the anxiety-related issues and challenges today. Dr. Cohen understands that anxiety disorders cause great discomfort, substantially reduce people's quality of life and often impair their ability to function normally. His methods have been proven over many years, and his rate of success with anxiety disorders is very high.
Medication treatment with other doctors is often rocky for anxiety sufferers, who are frequently highly sensitive to medications. Standard doses of antidepressant and/or anti-anxiety medications often overmedicate anxiety sufferers, causing many to quit treatment. Dr. Cohen's methods have always included a start-low go-slow approach. For example, Prozac (fluoxetine) is usually started at 20 mg/day, just as the manufacturer recommends. Yet a study published in 1988 showed that 54% of patients respond to just 5 mg, which caused far fewer side effects or patients quitting treatment (Wernicke JF et al. Psychopharmacology Bulletin 1988). Few doctors know this because the information was never disseminated. Lower doses cause fewer side effects, a basic scientific fact. The same problem of overtreatment exists with many medications prescribed for anxiety.
Dr. Cohen is nationally recognized as a leader in safer methods with medications because of in-depth research, medical journal articles and lectures at the FDA, Scripps Clinic and major medical conferences. He enjoys taking the time to discuss causes and strategies for treating anxiety and to adjust medications carefully for each person's needs and sensitivities.
The bottom line is that with effective therapy methods and, when necessary, careful medication treatment, anxiety disorders are highly treatable.
Types of Anxiety Disorders
If you have high anxiety, panic attacks, social or other phobias, or OCD, you are not alone. Anxiety disorders affect 40 million Americans. Almost everyone experiences anxiety now and then, but people with anxiety disorders experience very high levels of anxiety for months or years, to a degree that interferes with normal activity and enjoyment. There are 7 major types of anxiety disorders:
- Generalized Anxiety Disorder (GAD). People with GAD worry excessively about everyday problems. Their days are filled with anxiety and tension. They recognize that their constant worry is unnecessary, but they cannot stop. These people have difficulty falling asleep and/or awaken early and cannot go back to sleep. They often have physical symptoms such as rapid heart rate, tightness in the chest, headaches, trembling, lightheadedness, sweating, difficulty breathing. GAD affects 7 million Americans, two-thirds women.
- Obsessive-Compulsive Disorder. People with OCD find it difficult to get through a day without repetitive thoughts (obsessions) or repetitive behaviors (compulsions). OCD sufferers have very active minds and have trouble turning them off. They may have trouble focusing on tasks and completing them. Some OCD sufferers have a compulsion to repeat behaviors such as washing their hands (for fear of germs) or repeatedly counting their steps (to focus their mind and to bind their anxiety). More than 2 million Americans have OCD. Sleep disorders are common in this group.
- Panic Disorder. Panic attacks are awful. Panic sufferers believe they are dying. Symptoms may be physical (pounding heart, difficulty breathing) or mental (intense fear). Panic disorders affect 6 million Americans and occur more frequently in women.
- Agoraphobia. Often occurs in conjunction with a panic disorder, people with agoraphobia avoid situations in which they experienced high anxiety or panic. Over time, they become fearful of many situations, finally reaching an end-point in which they are fearful of leaving home.
- Social Phobia. Also known as "social anxiety disorder." People with social phobia experience intense anxiety in interpersonal situations. Such situations may include work situations, school, conferences or parties. Symptoms may also include difficulty concentrating, self-consciousness, fatigue, difficulty speaking, sweaty palms, pounding heart, feelings of being overwhelmed. 15 million Americans are affected by social phobias.
- Specific Phobias. Phobias generate intense fears in situations that pose little or no actual danger. Specific phobias include elevators, escalators, tunnels, heights, highway driving, water, flying, dogs, insects, and blood. Facing the feared object or situation is difficult because it elicits panic feelings. Specific phobias affect more than 19 million Americans, more often in women.
- Post-Traumatic Stress Disorder. PTSD often results when a person experiences a terrifying ordeal. PTSD is best known among war veterans, but it can occur with many types of psychological trauma such as child abuse, mugging, rape, automobile accidents, plane crashes, earthquakes, and bombings. Symptoms of PTSD include irritability, emotional withdrawal, reduced interest in activities, aggressiveness, avoidant behavior, nightmares, flashbacks. PTSD affects more than 7 million Americans.
Dr. Cohen's Broad Experience in Treating Anxiety Disorders
Dr. Cohen's treatment of anxiety disorders involves psychotherapy or medication treatment, often both. Psychotherapy initially focuses on defining your anxiety and/or panicky feelings and their origins. Is there a personal history of anxiety, a family history, early traumas? What events or changes may have been involved? Psychotherapy also focuses on creating strategies for handling emotions in difficult situations. The difficult situation may be flying in an airplane, entering a supermarket, going to a party, or it may involve a relationship with a family member or friend. Subsequent sessions focus on each individual's inner feelings, strengths, self-esteem issues, communication skills, problem solving, and identification of life goals.
Medication can be very useful in reducing anxiety, panic attacks, insomnia, or other symptoms. Many people with anxiety disorders are highly sensitive to medications, and Dr. Cohen always uses medication cautiously in anxiety patients. Many people respond well to low medication doses. Unfortunately, some doctors simply place anxiety patients on high doses of tranquilizers (Xanax, Ativan, etc.), causing people to become dependent on these drugs, while their anxiety disorders remain unimproved. Dr. Cohen uses better and more effective methods without causing dependency. Dr. Cohen is also uniquely knowledgeable about natural, non-drug therapies for anxiety disorders.
- Annals of Pharmacotherapy. Antidepressants: An avoidable and solvable controversy. 2004;38:1743.
View all of Dr. Cohen's medical articles, consumer publications, and presentations.
NOTE TO READERS: The purpose of this E-Letter is solely informational and educational. The information herein should not be considered to be a substitute for the direct medical advice of your doctor, nor is it meant to encourage the diagnosis or treatment of any illness, disease, or other medical problem by laypersons. If you are under a physician's care for any condition, he or she can advise you whether the information in this E-Letter is suitable for you. Readers should not make any changes in drugs, doses, or any other aspects of their medical treatment unless specifically directed to do so by their own doctors.
If you have questions about your medications or medical care, Dr. Cohen is available for consultation at his office or by telephone.
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