I could not help but create this post. I am pretty much fed up with the entire medical field and its doctors who completely mislead people who suffer anxiety or depression. One of the most critical reasons for my anger is that most doctors and psychiatrists do not practice what they learned in school. They prescribe the same medications for both anxiety and depression! Yet the two conditions are very different, as I already described it in a previous post; here I go a little deeper to drive the point home.

On MedLine, anxiety is defined as follows:

… for millions of people in the United States, the anxiety does not go away, and gets worse over time. They may have chest pains or nightmares. They may even be afraid to leave home. These people have anxiety disorders. Types include

• Panic disorder
• Obsessive-compulsive disorder
• Post-traumatic stress disorder
• Phobias
• Generalized anxiety disorder

If you click on some of the links on the bottom of MedLine link, you get to the American Psychiatric Association‘s definition of anxiety:

Anxiety disorders are the most common of emotional disorders and affect more than 25 million Americans. Many forms and symptoms may include:

• Overwhelming feelings of panic and fear
• Uncontrollable obsessive thoughts
• Painful, intrusive memories
• Recurring nightmares
• Physical symptoms such as feeling sick to your stomach, “butterflies” in your stomach, heart pounding, startling easily, and muscle tension

Anxiety disorders differ from normal feelings of nervousness. Untreated anxiety disorders can push people into avoiding situations that trigger or worsen their symptoms. Job performance, school work, and personal relationships can also suffer. (emphasis added)

Types of Anxiety Disorders

Panic Disorder
The core symptom of panic disorder is the panic attack, an overwhelming combination of physical and psychological distress. During an attack several of these symptoms occur in combination:

• Pounding heart or chest pain
• Sweating, trembling, shaking
• Shortness of breath, sensation of choking
• Nausea or abdominal pain
• Dizziness or lightheadedness
• Feeling unreal or disconnected
• Fear of losing control, “going crazy,” or dying
• Numbness
• Chills or hot flashes

Because symptoms are so severe, many people with panic disorder believe they are having a heart attack or other life-threatening illness.

As you can see from the examples above, anxiety has nothing to do with being nervous about something specific at the moment anxiety appears; I have yet to meet a person of anxiety who is “clinically depressed” at the same time! Depression, also by the American Psychiatric Association is as follows:

Depression is a serious medical illness that negatively affects how you feel, the way you think and how you act. Depression has a variety of symptoms, but the most common are a deep feeling of sadness or a marked loss of interest or pleasure in activities. Other symptoms include:

• Changes in appetite that result in weight losses or gains unrelated to dieting
• Insomnia or oversleeping
• Loss of energy or increased fatigue
• Restlessness or irritability
• Feelings of worthlessness or inappropriate guilt
• Difficulty thinking, concentrating, or making decisions
• Thoughts of death or suicide or attempts at suicide

Clinical depression is well defined into subgroups by a UC Berkeley post:

Common Symptoms
of Clinical Depression
There are different forms of clinical depression with different combinations of the following symptoms:

Physical:

• Sleep disturbances-insomnia, oversleeping, waking much earlier than usual
• Changes in appetite or eating: much more or much less
• Decreased energy, fatigue
• Headaches, stomachaches, digestive problems or other physical symptoms that are not explained by other physical conditions or do not respond to treatment

Behavioral/Attitude:

• Loss of interest or pleasure in activities that were once enjoyed, such as going out with friends, hobbies, sports, sex, etc.
• Difficulty concentrating, remembering, or making decisions
• Neglecting responsibilities or personal appearance

Emotional:

Persistent sad or “empty” mood, lasting two or more weeks

• Crying “for no reason”
• Feeling hopeless, helpless, guilty or worthless
• Feeling irritable, agitated or anxious
• Thoughts of death or suicide

As you can see, anxiety is a syndrome (a condition of unknown causes) whereas depression is an illness (a specific ill structure of the brain). Not only are the two completely different in symptoms, they are driven by different mechanisms. Anxiety is an internal stress response, called a “stressor,” whereas depression is a response to either a physical change of the body or as a consequence of an event.

Yet the very first sentence after a lengthy discussion of all trophies earned by the lecturing doctor in an educational video (there are several but this was the one that got me fed up) says that anxiety is fearing the feature, being nervous about something, etc.

This video I brought up as an example because it is an educational video that is supposed to advance the understanding of someone… be it the consumer or future doctors but it is completely wrong. How can we change this? The answer is not clear since the treatment of all anxiety and depression by medication today is the same: SSRIs, SNRIs, and alike, all stimulating more serotonin and similar hormones that have absolutely nothing to do with anxiety–they may with depression but definitely not with anxiety.

Anxiety! The Truth!

As a person who has suffered anxiety all of my life, knocking me on my shoulders out of the blue on a perfect day, without any trauma or cause, I can tell you precisely what anxiety is. I have no clue what depression is since I have never ever been depressed for a moment in my life. Here is how it started:

I was 19 and was riding the subway in Europe, seated comfortably, reading a fun book. I rode this subway every day of  my life up to that point so I was familiar with every turn, every stop and bump. The subway had to stop to wait until the previous car left the station–a rather common occurrence in rush-hour. That day, in that instant, I felt a hot rod-like electricity shooting from the top of my head to the bottom of my tailbone–that is all through my CNS–central nervous system.  Was I nervous? No; I was reading an interesting romance novel. Was I scared? No, I was sitting pretty in a train; not even crowded. Did I have anything to make me nervous? Perhaps my lipstick may not have been perfect… NO! For crying out loud! I was 19 with a perfect life ahead of me and no worries!

When about 1 month later my then boyfriend–now husband–and I went to the movies and I had to leave as a result of the same hot-rod sensation in my back and the urge to vomit up my dinner, with shaking and sweating, and pounding heart, I knew something was up but as I was only 19, I had no idea what that was, nor did my boyfriend.

About a week later, from a perfectly content deep sleep, I awoke in the middle of the night for the same hot-rod, sick to my stomach, pounding heart, shaking, hot and cold, ready to run nowhere fast. I jumped into the shower taking hot and cold to “snap out of this whatever this things is” but it did not work. So in the middle of the night, my boyfriend–by then fiance–walked me to the nearest hospital–less than a mile away–where I received Valium and I was fine within an hour or so. But we discovered that I lost nearly 30 lbs in the process of my anxiety–I was thin to start with–so this was something serious to be taken care of immediately. After a full examination, the doctors discovered that I had no B-12 in my body, so they gave me intravenous B-12 for 3 months I believe twice or perhaps once a week. I recovered to some degree, regained my lost weight, but not fully recovered in my “hot rod” so a low dose of benzodiazepine (like Valium, Klonopin, etc.) stayed with me for life.

40+ years later I am still taking the same low dose drug for the same reason once a day–I still have a perfect life, husband who I had when I was 19 as a boyfriend, 2 wonderful and successful sons, 2 daughter-in-laws who can knock everyone’s shoes off, one awesome smart granddaughter and another on her way; no financial troubles, taking early retirement to do what I love: science, research, painting, photograph, gardening, and travel. So why do I have anxiety? I am not nervous, never had a better and more comfortable life. Yet I still am on a low dose of benzo. It perfectly controls my anxiety.

Psychiatrists tell me that “oh but it affects your memory“… really? I got my PhD in 3 years in a very mathematical field (almost got my PhD in math actually!) graduating at age 53. Whatever  memory it many have affected was obviously not important. They also say that it does not affect short-term memory but only long-term. But it seems to me that I surprise my family how I recall little details of long time ago events, including colors, scents, etc. I am not one of those special persons who can recall the day of the month and year but getting pretty darn close! And I seem to remember more as I get older! So no, after 40+ years of benzo use, neither my long-term nor my short-term memory suffered.

On the other hand, I know people on serotonin drugs whose memory goes into decline on the spot even after a single pill but that is ignored–financial motive?

As a result of the perceived (or so motivated by ulterior motives of big pharma) bad effects of benzodiazepines on the brain, doctors prescribe serotonin drugs, as listed above, for anxiety. Serotonin not only has nothing to do with anxiety, it can also be deadly by causing serotonin syndrome and definitely can make your brain-cells shrink! It can also make one suicidal and jump out the window. I suppose calling serotonin enhancing drugs “safe alternative to benzo” is premature at best and down right incorrect at worst–oh but yes all benzos are generic whereas SSRIs and SNRIs do still go by brand name… sorry; I cannot stop being cynical!

Anxiety is a Darwinian evolutionary process of alertness that was necessary in the caveman’s life. The fact that we are not living in a cave and the anxiety stress response is still with some of us is a genetic oops that may in time be resolved by genetic modification. In fact, those who are predisposed to migraines suffer from anxiety. The connection of anxiety and the ensuing insufficient nutritional sources in the brain causing migraine is very well described and explained by several articles and a book. Anxiety causes trouble in one’s life but I do not know a single person with anxiety who is also clinically depressed and I certainly know that only a small percentage of clinical depression sufferers benefit from depression medications; only about 30% of depression sufferers are helped by serotonin enhanced medications.

If you have anxiety, please show this post to your doctor! Serotonin will hurt you and not help you! A low dose benzodiazepine that is long acting, meaning it starts up slow and leaves the body slow, does not give you severe highs and lows and will not make you crazy or jump out the window–the right low dose will not even make you sleepy. It will make you feel well-enough to do whatever you wish.

Is it addictive? You bet. Exactly the same way as sugar or caffeine is addictive… which soft drink do you prefer? And latte or black?

Comments are welcome, as always! (I don’t bite; I am not on serotonin!)

Angela