Emotional Health

Anxiety In America’s New Political Climate

You ask specifically whether your anxiety might be related to menopause. Given higher rates of anxiety in women, there has long been a proposal that hormones may be playing a significant role. Some studies in fact have shown that, while pre-menopausal women develop anxiety disorders at higher rates than men, this actually equalizes after menopause. During the menopausal transition, the jury is out as to whether rates of anxiety are higher.  Some studies have shown that those with lower levels of anxiety may experience a slight uptick in symptoms, with those with higher levels noting no change.  In contrast, other researchers have found no such connection between anxiety and the menopausal transition, or even lower than average levels.  The bottom line? Individual results may vary. Given what you describe, being anxious for much of your life, menopause may be a piece of the puzzle, but is less likely to be the primary cause of your current experience.

There are a number of treatment options for anxiety. I commend you for wanting to try something other than medication to start with. The non-pharmacological treatment with the most evidence is cognitive behavioral therapy (CBT).  CBT for GAD focuses on the anxious person’s tendency to focus on the negative and catastrophize. If you’re an anxious person, when your boss walks by your office without saying hello you immediately jump to, “I did something terrible and will be fired and not be able to pay rent and end up homeless on the streets,” rather than the more likely, “Maybe she is having a bad day or maybe she is busy/preoccupied/etc.”  Life throws you turbulence and, while part of you recognizes it’s just a bit of turbulence, another part of you knows for sure the plane will crash.  With catastrophizing, even very benign things take on a threatening hue when viewed through the lens of anxiety.  Further, these beliefs tend to be perpetuated by avoidance and procrastination — you mention you’ve been avoiding going out with your work peers because it makes you more anxious. This is a very common phenomenon. The problem is, by not going out, you don’t get the opportunity to prove to yourself that going out is fine; in fact, you may begin to enjoy their company again.   CBT works on these various cognitive distortions, helping you to acquire tools to address your anxiety and begin to change the self-perpetuating thought process around these issues.  On average, over half of those who try CBT notice significant improvement that persists even a year later.  There are many books available to help guide you through CBT for anxiety and worry, which is a great way to start. If you are able to, working with a therapist experienced in CBT is the most likely to bring success.

Other treatment options that have shown success in some studies include yoga, tai chi, and regular physical exercise.  Mindfulness, with its focus on attending to the present in a nonjudgmental way, has also been shown to be moderately effective against anxiety. Similarly transcendental and qigong meditation have been shown to reduce anxiety. All of these approaches require regular practice for them to have their anxiety reducing effect, so it is important to find a method that works well with your own preferences. Further, you are more likely to be successful if you find someone experienced to help you get started and guide you along the way.

Medications can be very helpful in the treatment of anxiety, particularly if other interventions don’t bring sufficient relief.  Also, sometimes people are too anxious to really focus on therapy, and medication can help tone down the worry until they learn skills to help manage anxiety, at which point they may be able to taper down or off medications. While we often think of benzodiazepines (lorazepam, clonazepam, alprazolam) for the treatment of anxiety, the best first-line medications are actually antidepressants called selective serotonin reuptake inhibitors (SSRIs), including paroxetine, citalopram, and escitalopram, and serotonin and norepinephrine inhibitors (SNRIs), including venlafaxine and duloxetine.  About two thirds of people taking SSRIs experience a significant reduction in anxiety. While anxiety and depression often coexist, SSRIs are helpful in treating anxiety even in those not suffering from depression. However, it takes an average of four weeks for SSRIs to begin to be helpful and, paradoxically, some people feel slightly more anxious when they start using the medication.  During this initial period, it may be helpful for some to add a benzodiazepine. While benzodiazepines (like the drug suggested by your GP) can be very effective in the short term, they do not work as well for chronic anxiety and, as you mention, can be addictive. Thus the goal is often, but not always, to be eventually tapered off the benzodiazepine.

It will be important for you to work closely with your primary care doctor or a psychiatrist to find the right combination of medications and therapy to help manage your anxiety.  There are many ways to help decrease anxiety and, with persistence, you can find the right mix that works for you. You clearly have been successful in many areas of your life and are motivated to deal with this problem so that you can look forward to a more joyful life.

 

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  • Sally Bahner August 30, 2018 at 11:21 am

    I’ve thought a lot about this article after I read it the other day. So many of us feel the same way — anxious, sleepless, depressed — and it goes to show you just how toxic this presidency is, not only for its policies, but for its affect on our daily lives. It can’t be medicated away. I have visions of many [male] doctors chuckling behind their desks about women being upset about who is running the country. I’m 68 and cannot remember a time when people were so emotionally affected by the political climate.

    Reply
  • Karen Cox August 27, 2018 at 9:29 am

    Thank you for the letter and answers to the letter about anxiety since the election. I have felt almost exactly like the writer and your answers have given me
    great guidance. I’m calling my doctor this morning and hopefully will start on a path where I will be more able to cope.

    Reply