Mental Health
Performance Anxiety
Occasional feelings of anxiety and even panic attacks are common and, to a degree, a normal biological response to sudden changes and difficulties we face in our lives. Anxiety or panic can help you become more alert and focus on solving or escaping a situation. Once this is accomplished, the anxiety eases, nerves cool down, and you can carry on with your normal life. That’s the healthy sort of anxiety and something most people are very familiar with.
It’s only when anxiety becomes chronic or panic attacks excessively frequent that doctors may diagnose a clinical condition that requires some form of treatment. This typically is the case when the anxiety is negatively affecting your daily life, work and relationships. The five primary forms of anxiety disorder are:
Most people with anxiety disorder don’t exactly fit into one type but rather, combine two or three types. Panic attacks can accompany any of these five categories of anxiety. There also is a panic disorder (characterized by repeated sudden but short-lasting panic attacks), which is classified as an anxiety disorder in its own right. However, it often appears in conjunction with one or more other forms of anxiety disorder. For example, panic disorder is estimated to occur together with a general anxiety disorder in nearly 70% of cases.
Anxiety disorder is more common than you may think — one in every five U.S. adults will experience such clinical anxiety at least once during their life. Often, the disorder disappears on its own, as anxiety-triggering factors and situations go away or change. Anxiety disorder can however, become a long-term issue that needs treatment. The longer a person waits before seeking help, the more difficult it may be to treat the disorder.
Typically, the first line of treatment is therapy, where cognitive behavioural therapy (CBT) is the most commonly used method. It takes time but can be very effective, especially with mild and moderate cases of anxiety. A CBT therapist will teach you to replace anxious thoughts with constructive thinking and show you other coping strategies.
In more severe anxiety cases, therapy is often combined with medication. Your psychiatrist will determine what medication will be the most effective for you. Each case of anxiety disorder has unique circumstances and thus requires customized treatment. That said, doctors generally choose from the following lists of prescription medication options:
Selective serotonin reuptake inhibitors (SSRIs) such as Lexapro, Paxil, Prozac, and Zoloft are a common choice for treating generalized anxiety disorder, social anxiety and OCD. Over the course of 5-6 weeks, SSRIs gradually increase serotonin levels in the brain, which has a dampening effect on anxiety, mood swings, and the occurrence of panic attacks. In fact, SSRIs are the most commonly prescribed class of medications for treating panic disorders.
SSRIs are not only fairly effective, but also relatively well tolerated by the body and brain. As with any drug, there is of course the potential for side effects. Fortunately, most side effects are mild or moderate and many will resolve after the first few weeks of treatment. Patients most often complain about a reduced libido, dizziness and loss of appetite. More severe side effects are rare.
Benzos, whose best-known representatives are Xanax and Valium can alleviate anxiety disorder, muscle spasms, and panic attacks. They used to be a popular medication option for treating anxiety and panic in the past, but their relatively strong potential side effects — including addiction, withdrawal symptoms, fatigue and memory loss — have caused them to fall out of favour. Especially since several other options, like the above mentioned SSRIs, are available. If they are still prescribed, it’s typically for the medium-term, not exceeding 4 month, in order to reduce the chances of physical addiction.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) like Cymbalta and Effexor have also been found to effectively treat general anxiety disorder. Because SNRIs came on the market much later than SSRIs, there still aren’t as many distinctly branded medications. SNRIs are now on par with SSRIs in the treatment of depression. In the treatment of anxiety disorders they aren’t quite as common yet.
SNRIs function through raising serotonin levels just like SSRIs. Thus, they also require at least one month of treatment before their full effect on reducing anxiety becomes apparent. SNRI side effects are similar to SSRIs.
Propranolol is a beta-blocker originally developed as a blood pressure medication, which was later found to effectively treat a range of other conditions, including performance anxiety. It can be prescribed as an ad-hoc single-use medication that’s taken before an anxiety or panic-inducing event, such as public speaking, a job interview or test. Propranolol only needs half an hour for the effect to set in. As long as it’s only used occasionally, propranolol has relatively few side effects.
It’s very likely that your psychiatrist will choose one of the aformentioned four drug options as an initial treatment for your anxiety or panic attacks. Since every case is unique, there is no one medication that will deliver the best results for everybody. Your doctor may have you start out on one drug, and change to another at a later time if needed. Sometimes a combination of 2 drugs will work best.
Your medical history, family history, and other medications you may be taking, may all figure in to which medication is prescribed. As with every prescription, the ultimate aim is to find a medication that is effective while minimizing side effects.
It’s important to bear in mind that most anxiety medications take several weeks before you may notice improvement. During that time, as well as later on, anxiety therapy can be very helpful and effective.
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