Part II (see previous blog entry for Part I of this interview, conducted by David DiSalvo)

Tell us what “anxiety” really is in a clinical sense, and how it’s different than “a case of nerves” that everyone occasionally feels.

You’re correct that everyone feels stress and gets a case of nerves from time to time. You couldn’t live a meaningful life without them. Normal anxiety occurs when you’re faced with real challenges and hassles. Normal anxiety can even prepare you to deal with such challenges more effectively. Some experts call this type of anxiety facilitative anxiety. Normal anxiety dissipates when the problem is solved or diminishes.

Think of preparing for an examination. If you have no anxiety or worry at all, you’re likely to feel little motivation to prepare. If you’re moderately anxious, you’ll spend a lot more time studying. If your anxiety goes over the top, you may study a lot, but be unable to concentrate or you may deal with the anxiety by procrastination or avoidance of the task. In other words, complete absence of anxiety isn’t always such a good thing, moderate amounts can help and excessive anxiety interferes with performance.

Clinical anxiety debilitates rather than facilitates. By definition, most anxiety disorders persist for months. They involve reactions that exceed the objective nature of whatever seems to trigger them and in some cases; no trigger is even easily identifiable. Clinical anxiety comes with strong physical symptoms such as fatigue, restlessness, interrupted sleep, poor concentration, muscle tension, and irritability. Clinical anxiety reduces quality of life.

When it comes to prescribing meds for anxiety, the voices of dissent are many. Tell us something about the controversy surrounding benzodiazepines and other anxiety meds.

Evidence suggests that many anxiety disorders are treated especially effectively with certain psychotherapies most of which are based on cognitive behavior therapy. Thus, we would rarely suggest medications as the first line strategy. Benzodiazepines, although frequently prescribed for anxiety by general practitioners, are especially problematic for a variety of reasons including:

• Benzodiazepines have a significant addictive potential which may be heightened among those with anxiety disorders.
• Some data suggests that these drugs may actually increase the risk of relapse when combined with cognitive behavior therapies for anxiety.
• Benzodiazepines increase the risk of falling among the elderly and one study showed they may double the risk of automobile accidents. Of course, combined with alcohol, these risks escalate considerably.
• One study suggested that taking benzodiazepines on a prolonged basis shortly following a trauma actually increased the risk of developing Post Traumatic Stress Disorder later.

This is not to say that medications have no role to play in the amelioration of anxiety disorders. However, we generally recommend that any use of benzodiazepines be strictly limited to short-term acute stress. Other medications such as the Selective Serotonin Reuptake Inhibiters (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) sometimes appear useful as adjuncts to psychotherapy especially when appropriate therapies have failed to result in sufficient improvement.

Diagnosed cases of depression are also rising, and some believe that it’s an increasingly over-diagnosed illness. What do you believe is behind the surge in depression cases?

Of course doctors and mental health workers are more aware of the symptoms of depression than ever before. In fact, increasing numbers of primary care offices provide screening instruments for depression and anxiety. The public has also become more aware of the symptoms of depression due to a bombardment of advertizing, largely paid for by the pharmaceutical industry. For the most part, this increased awareness is a good thing and it has steered many people into earlier treatment of their distress.

At the same time, we have concerns about that the fact that antidepressant medications are today the most prescribed drug for any condition whether mental or physical. We worry that doctors may be prescribing medications for what used to be considered subclinical conditions. People receive prescriptions after breaking up with a boyfriend, being fired from a job and failing to be accepted into a college. Life transitions such as moving to a new city or coping with grief or loss sometimes trigger a trip to the doctor’s office for relief. When emotional reactions to such events are unusually profound or prolonged, medication may be warranted in some cases. However, there’s value in struggling with sadness, worry, and loss. From times such as these, humans develop new philosophies, literature, and creative solutions. We’d hate to see medications used to stifle struggles. Happiness is better appreciated when one has experienced sadness.

One of the continuous controversies surrounding psychiatric disorders is the influence of drug companies on the prescription-perhaps the over-prescription-of certain meds. How large a concern do you think this really is?

The heat has turned up on this controversy in the past few years as increasing numbers of articles have appeared which indicate that pharmaceutical companies have frequently engaged in questionable practices such as holding back negative results from publication. In addition, many authors of medication studies have failed to disclose their substantial financial ties to the pharmaceutical industry. Finally, it appears that many of the authors of clinical practice guidelines have had significant financial arrangements with the pharmaceutical industry.

If you could choose any topic, which would it be for your next Dummies book?

We’d really like to answer this question. However, we’re currently discussing the next project or two with the For Dummies publisher (Wiley). We can say that one of these projects excites us more than any of the others we’ve done to date as we see a huge need for an accessible book on this topic.

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From Psych Central's website:
PsychCentral (June 30, 2009)

From Psych Central's Drs. Laura L. Smith & Charles H. Elliott:
A Recent Interview of Us by David DiSalvo | Anxiety and OCD Exposed (July 1, 2009)

PTSD in the News: Weekly Roundup | PTSD in the News | Heal My PTSD, LLC (July 4, 2009)

    Last reviewed: 30 Jun 2009