Anxiety disorders affect 40 million adults in the United States, making it the most common mental health condition in the country. Untreated anxiety can affect every facet of life, making it difficult to relax, to achieve success in a work environment, to have fulfilling hobbies, and to maintain close relationships with family and friends. While there is no cure for anxiety, there are ways to manage it. While there are many prescription anxiolytics, today I want to talk about some behaviors, supplements, vitamins and homeopathic remedies that you can use to help deal with anxiety and release the hold it may have on your life.
Let’s start with some simple stuff. Some behaviors that you should stop and some you can start to help quell anxiety.
Behaviors to stop
Alcohol: If you think consuming alcohol would help ease anxiety, you would be wrong. While alcohol relaxes the body, it clouds the mind, and a clouded mind actually increases anxiety. And though you might feel relaxed for an hour or two, once you stop drinking, your mind and body are affected as the alcohol leaves your system, so the other 22 hours of your day will only be filled with more anxiety. Not only that, if you have chronic anxiety and drink in a misguided attempt to help it, you’re going to be consuming alcohol in quantities that can end up in your developing alcoholism.
Smoking tobacco: Again, you may think that cigarettes might help anxiety. When a smoker gets stressed, they often say they want to smoke to chill out. So why does smoking seem to help smokers relax? Smoking cigarettes interferes with certain chemicals in the brain. When smokers haven’t had a cigarette for a while, the craving for another one makes them feel irritable and anxious. These feelings can be temporarily relieved when they light up a cigarette, so smokers associate the improved mood with smoking. In fact, it’s the effects of smoking that are likely to have caused the anxiety in the first place, as nicotine raises blood pressure. Additionally, many studies have shown that cutting out the cancer sticks improves mood and thereby reduces anxiety.
Caffeine: This one is a no-brainer. Caffeine is actually a psychoactive drug, and like many of its kind, it is a stimulant. When you consume it, caffeine stimulates your “fight or flight” response, and studies show that this not only increases anxiety, it can even trigger an anxiety attack. If you’re anxious, consuming caffeine is pretty much the worst idea ever in the history of ideas.
Poor diet: Like it or not, what you eat can make a difference in how you feel, physically and mentally. You should not be on a first name basis with the Dominos delivery dude and the Mickey D’s drive-thru girl. Fact, Jack! Cut out the high carbs, the high fats, the processed foods and sugars. Remember: garbage in, garbage out.
Electronics: Surfing the net, watching YouTube vids, online shopping, and anything done on a screen can lead to an increase in anxiety by affecting your sleep. How? Exposure to the blue light of a screen anytime within four hours of sleep disrupts the natural circadian rhythm, and may even disrupt the natural production of melatonin, resulting in poor sleep. Functioning normally while tired can increase anxiety.
No news is good news: If you are anxious or prone to anxiety, stop watching the news. Stop reading the news. Stop listening to the news. Why? The press is categorically tailor-made to incense, aggrevate, enrage, and incite. All of these roads lead to Anxiety City. So think again before feeling guilty for not keeping up with current events. A national survey conducted by (oddly enough) NPR and a bunch of other eggheads found that watching, reading, or listening to the news caused people greater stress and anxiety. It’s like the old saying goes…what you don’t know can’t hurt you. And clearly, what you do know can.
Anti-Social media: The advent of social media has completely changed the way humans interact on a global scale. Just stop and think about that. It literally changed the entire planet. Now you can interact with anyone on the face of the earth that has a cellphone on a 24/7 basis. It sounds like the greatest thing ever, but it can cause an incredible amount of anxiety in a number of ways. Trust me, I see it day in and day out. So, how does social media cause anxiety? It has brought the concept of keeping up with the Jonses to a whole new level. Used to be the Jonses just lived down the street. Now they’ve moved. To everywhere! There are billions of electronic Jonses to emulate, be jealous of, to love, to hate, and to outdo. From posting the perfect picture that took 2 hours to take on Fakebook to likes and hearts and wow! faces, everyone gets to weigh in and hate on. All of these things are so anxiety producing. But social media can also be addicting. It’s a like-seeking quest, and every like reward is a dopamine hit. Dopamine is a happy chemical. A hit gives a little high, akin to any drug high. And just like with drugs, there can be an actual withdrawl if you separate that person from their source, their cellphone. Some people check social media 20 times or more in a day. They must check for likes, they must see what all their “friends” are doing, what all those electronic Joneses are up to. Keeping up with them and always being on the hunt, all are naturally anxiety producing. If you find that social media becomes stressful, makes you feel jealous, or mad or sad as a result of trolls or the presence or absence of positive comments, silence the alerts, put the damn phone down, and do something more positive with your time. If you feel anxious when you do this, go visit your parents or a friend in real life. You’ll get through the anxiety and be better for it. Then do whatever you have to do to set and stick to limits on your social media use. Be electronically anti-social and personally social.
There are also tons of behaviors that you can add to your life to help with anxiety.
Behaviors to start
Exercise: You don’t have to turn into a gym rat, just spend at least 15 minutes a day doing something that moves your body.
Meditation: Spend 5 minutes a day centering yourself. Clear your mind and the rest will follow.
Breathing: Dr. Andrew Weil deveoped a breathing exercise called 4-7-8. It goes like this: exhale completely through your mouth, making a whoosh sound. Close your mouth and inhale quietly through your nose to a mental count of 4. Hold your breath for a count of 7. Exhale completely through your mouth, making a whoosh sound to a count of 8. You’ll likely find this is very helpful in reducing anxiety.
Reading: This is great for distracting yourself from stressors occupying your mind and causing anxiety. Open a book and immerse yourself in someone else’s story.
Routine: Establishing and following a routine forces behavior modification and can be stress reducing.
Positive affirmations: Practice saying all the good things about yourself to yourself.
Connect with nature: Take a walk in the woods or get some sand between your toes. Try to lose your worries and yourself in a place that’s bigger than you.
Eat healthy: Eat lots of fresh fruit and veggies and eat only lean meats. There are some natural food components that can help with anxiety. Omega-3 fatty acids make up the basic building blocks of the brain and nervous system. They are essential for cognitive functioning and have also been shown to improve symptoms of depression, which is often closely linked with anxiety disorders. These brain-boosting amino acids are found in a wide variety of fish species, including salmon, tuna, mackerel, herring, sardines and anchovies. They are also found in supplement form. Probiotics are also helpful. Probiotics are microorganisms known for their digestive health benefits. But recent research has revealed that probiotics can also have a profound impact on mental health. A healthy balance of bacteria in the body can boost the body’s ability to cope with stress, improve overall mental health, and bolster cognitive functioning. Probiotics can be found in direct supplement form but are also found in a wide variety of foods and drinks. Some of the most common sources include sauerkraut, yogurt, kimchi, kombucha, miso, and pickles. Put good stuff in, get good stuff out.
Talk: Whether to a therapist, friend, family member or clergy, find someone to talk to and share worries and anxiety with. The support of others can do wonders.
Be grateful: Count your blessings; think about the good things in your life: a home, support of family and friends, a place to sleep, food to eat, a vehicle, whatever the positives may be, be happy that you have them.
Take action: If you have something you need to do that’s weighing on your mind, do it. If you have a bunch of things to do, make a priority list and start doing them. As you finish the items, literally cross them off the list. This way the list isn’t overwhelming and it will feel really good to mark things off.
Sauna: Heat is amazingly relaxing and wonderful in combating anxiety. Relax the body to relax the mind.
Massage: A great massage is fabulous in reducing tension and anxiety.
Accupuncture: The Chinese haven’t been wrong for thousands of years. Accupuncture is one of the most relaxing, stress and anxiety reducing activities. Don’t be scared of the needles. Almost a must if you have anxiety.
Spirituality: If you have it, use it. Prayer can be centering, almost meditative.
Supplements and vitamins: If you live with anxiety, one measure you can take to reduce your symptoms is to include supplements and vitamins for anxiety in your diet. These can be taken directly in an oral pill form and in the consumption of various foods and drinks. Before taking any of these, check with your physician first, especially if you already take any prescription medications.
Some of the best supplements and vitamins for anxiety include:
B Vitamins: B vitamins are vital to healthy nervous system functioning, so they play an important role in various aspects of mental health. They also have a significant impact on stress management and mood. Because of these benefits, many people with anxiety take B-complex vitamins and/or incorporate B vitamins into their diet through a variety of foods, including wild salmon, shrimp, tuna, halibut, yogurt, eggs, cheese, lamb, venison, turkey, grass-fed beef, carrots and green, leafy vegetables.
L-Theanine: L-theanine is an amino acid that can improve focus, reduce stress and promote relaxation. You pretty much have to take this as an oral supplement because it’s not commonly found in many foods or drinks. You can take 400mg of the supplement three times a day.
Chamomile: Chamomile has been used as a traditional medicine for thousands of years to calm anxiety and settle stomachs. Chamomile is best known as an ingredient in herbal tea, but is also available as capsules, liquid extracts, tinctures, and topical creams. Adults can take it in capsule form, 400 to 1600 mg in divided doses daily; as a liquid extract, 1 to 4 ml three times daily; in a tincture, 15 ml three to four times daily; or as a tea, 1 to 4 cups per day.
Lavender: Lavender is an herb that has been proven effective by leading researchers as a natural remedy for treating signs of anxiety. In one published study, lavender oil was shown to be just as effective as the pharmaceutical drug lorazepam, but without sedative effects or potential for drug abuse or dependence. Other studies have confirmed the anti-anxiety properties of lavender as well as many other medicinal benefits. Lavender oil capsules can be taken by mouth, 800mg three times a day. Tea can also be made by using 1 to 2 tablespoons of whole, dried flowers for each cup of boiling water. Steep for 10 to 15 minutes using a tea infuser or strain before drinking. You can also add six drops of lavender oil extract and 1/2 cup of dried lavender flowers to bath water for a great anxiety relieving soak.
GABA: Gamma-aminobutyric acid is a neurotransmitter located in the brain that is crucial to serotonin production. Serotonin is one of the nervous system’s most “feel-good” neurotransmitters, so GABA plays a significant role in reducing anxiety, regulating mood and in relaxation, aka “feeling good.” I’m told this is very effective. When I tried it, I noticed that my skin tingled. An unual and somewhat unpleasant side effect.
Passionflower: This is a calming herb commonly used as a household treatment for anxiety. It has been shown to alleviate nervousness, promote positive moods, and improve sleep quality. Passionflower can be consumed as an extract and tablet, or can be added into teas and tinctures.
Valerian Root: This has been used for a variety of medicinal purposes since the time of ancient Greece. While most commonly known as a sleep aid, this herb can also be helpful for reducing anxiety. Valeric acids found within the herb convert to calming, “feel-good” neurotransmitters in the body, regulating stress and relaxing the mind and body. Valerian root extract is available in both capsule and liquid form, as well as a tea.
Licorice Root: This herb carries many health benefits for people with anxiety because of the effects it has on the adrenal glands, which produce the stress hormones adrenaline and cortisol. Licorice helps regulate the production of these hormones, relieving stress and reducing anxiety symptoms. Licorice root can also soothe gastrointestinal upset, which is common in many people with anxiety. Be aware that most drinks and candies that claim to contain licorice only contain flavoring, which has no benefits. It’s best to consume licorice in an extracted, purified form. Deglycyrrhizinated licorice (DGL) is the safest and most effective variety of medicinal licorice root available. DGL is sold in capsule, powder, tea and chewable tablet forms.
Ashwagandha: Ashwagandha is a plant native to India and North Africa that has been used for centuries to reduce anxiety, combat the effects of aging, and improve energy. In natural medicine, the root is considered to be an “adaptogen,” or a compound that helps regulate the body’s natural processes and promote overall wellness and health. Today, many people use Ashwagandha to improve mood and reduce anxiety symptoms. While the benefits of Ashwagandha are gained by eating the fruit, seeds and shoots of the plant it is derived from, Ashwagandha is most commonly consumed in capsule form, 600mg a day.
CBD products: Cannabidiol (CBD) is a type of cannabinoid, a chemical found naturally in marijuana and hemp plants. Unlike THC, tetrahydrocannabinol, another type of cannabinoid, CBD doesn’t cause any feelings of intoxication or the “high” associated with cannabis. Several studies point to the potential benefits of CBD for anxiety. It can be found in many forms: oil, gummies, teas, tinctures, vape pens, and more. As for where to begin, consider trying a sublingual (under the tongue) CBD tincture first. They have high bioavailability, meaning the body easily absorbs them. If you’ve never used CBD before, be sure to do some research and get it from a reputable place…not from the gas station around the corner. Start by taking the dropper and placing the liquid under your tongue and allow it to sit for about 2 minutes so it absorbs into your bloodstream before you swallow it. Figuring your ideal dose is tricky. Most packaging will have guidelines, but dosing is still a guessing game, as CBD affects everyone differently. You can try one dropper full and go from there. You’ll have to see how you feel to determine how much works best for you.
Rhodiola: Also referred to as “golden root,” Rhodiola has a long history of medicinal use in traditional Chinese and Siberian medicine. Like Ashwagandha, Rhodiola is considered to be an adaptogen, meaning that it promotes physical and mental health while improving mood and resilience to stress. It is typically taken in capsule form, but it is also available in extracts and teas.
While the above homeopathics, supplements, and vitamins can be beneficial for anxiety, it’s important to check with your doctor before adding them to your diet. Taking this precaution can help prevent any potentially dangerous side effects or drug interactions. Keep in mind that while vitamins for anxiety can be helpful, they are not a substitute for prescription medications or doctor-approved therapies. It is especially important to speak to a medical professional if your anxiety co-occurs with another mental health condition.
The supplements, vitamins and homeopathics discussed above can be found on Amazon. I discuss anxiety and other mental health issues in my book Tales from the Couch, also available on Amazon.Learn More
Couples and Conflict
One of my foremost jobs as a psychotherapist is to be a listener. All day, every day people come to me to talk about their problems. As you can imagine, many times patients want to talk about their spouses, specifically how they fight with them. So I want to talk a little bit about couples and fighting. Whether it’s about money, children, career, housework, all couples fight. Nobody gets along 100% of the time without some conflict. It’s all a matter of how you resolve that conflict. I had a patient named Roxanne come in for her session yesterday, and she told me that she and her husband Bill fight all the time. One yells at the other and the other yells back louder until it reaches a terrible crescendo and both storm off in opposite directions. She said she had no choice in this, he just made her so angry and they just didn’t get along. I told her that the first thing that had to happen for the relationship to move forward was to decide that it wasn’t his fault and wasn’t her fault, it was both of them. She immediately recoiled and told me I was dead wrong. That it was all Bill’s fault. He was never home, he didn’t want to be a part of the family, he this, he that, ad nauseum. I asked her about how they fight, her yelling and screaming…was it working? Was it resolving anything? She launched in again, saying it wasn’t her fault, it was his fault because he made her yell. He antagonized her. I told her that she didn’t have to go to every fight he invited her to, she had the choice. This is a point that I think a lot of couples miss. Just because your spouse may be baiting you, looking for a fight, it doesn’t mean you have to give them what they’re looking for. You don’t have to respond at all. You have a choice in how you behave.
I explained to Roxanne that the only way to start to resolve an issue is to not yell and scream, not raise a voice. Once you express anger, you’ve made the situation worse. I suggested to her that the only way to make the situation better when Bill is yelling and screaming is to fall silent. Until the yelling stops, nothing productive can be accomplished. A conflict cannot be resolved through warfare. Once people raise their voice, no interaction happens. For instance, if you raise your voice at a child, they shut down. They will hear nothing you say. The same happens in couples. If one raises their voice at the other, from that moment forward, nothing constructive happens. So, if you’re married or in a relationship and you find you are having problems or there is fighting, and yelling, you are responsible for your response, and your response should be to not yell back, fall back. All yelling does is put fuel on the fire. If you fall silent, eventually they will stop yelling, and once the yelling stops, resolution can start. You can begin a conversation by discussing what the problem is, why you keep arguing, and what you can each do to make things better. That’s the only way these things will really be resolved. But you have to be willing to change how you respond to conflict and how you fight. Learn to fall back if baited. Talk should replace screaming matches.
I hear so often in my office “it’s not me, it’s him, it’s her, they’ll never change, we tried that” blah, blah, blah, blah. If you really want to effect change in your relationship, change your own behavior and then the reaction you get back from your spouse or partner will change. Stop yelling and start conversing. Focus on what you can each do to make the relationship better. To resolve conflict, cooler heads should always prevail over heated emotions.Learn More
January 6, 2018 THE RIGHT APPROACH TO THE OPIOD CRISIS
As a practicing doctor with certification in psychiatry and having worked in Palm Beach County for the past 25 years, my views on the current opioid epidemic are the result of my daily contact with addicts, their families, the medical community, law enforcement and the judicial system. My work has taken me from the E.R. to the inpatient treatment centers and rehabs to the courts to our psychiatric hospitals and to our coroners offices. I have watched this epidemic from its earliest stages to its current existential threat status. As a result I have come to the following conclusions about this tragic situation our community and communities across the country find themselves faced with. WE MUST CHANGE THE WAY WE THINK ABOUT THIS AND TREAT THIS PLAGUE.
1.) Move away from the concept of a war on drugs. Move towards providing an aid package for these vulnerable and impaired individuals.
2.) Move away from concepts of criminalization, imprisonment, and that they are deserving of severe punishment. Move towards treatment and therapeutic interventions. View individuals with OUD as impaired and of need of help.
3.) The concept of opiate-dependent individuals as merely addicts that are weak, self-indulgent, hedonistic, and who are scorned by all is not helpful in resolving this national issue. There certainly is a volitional component to this illness. While personal responsibility and accountability is the only path to a healthy life, opiate-dependent individuals need a support system and tools to help get them on that path. Individuals suffering from OUD hate themselves, the behaviors in which they engage, and the resulting consequences. People with OUD are reckless with their lives because they feel their lives have little or no value. The mind-set of the opiate-dependent individual is one in which it doesn’t matter if they live or die. These vulnerable individuals are also prone to abuse and exploitation.
4.) Society must track these individuals and intervene when necessary.
5.) Society as a whole must be educated about opiates and all aspects of drug dependency, starting in grade school. Opiates come in pill form, patches, lollipops, and can be snorted and inhaled. Drug dependency can begin after one dose. Five days of continued use of opiates can result in drug dependency. Individuals who are genetically predisposed to dependency are more affected.
Like many drugs, over time the same amount of opiates has less and less affect which results in individuals increasing the drug dose and decreasing time between doses. This is the concept of drug tolerance. People spend more time getting the drug and doing the drug, and it becomes a vicious cycle. OUD individuals start to live a life of lies to cover their drug use. They spend a majority of their time planning to get money and make time to use drugs. They become psychologically consumed by thoughts of procuring opiates, using opiates, and disregarding everything else, including family, friends, job, health, and finances. All that matters to them now is getting high. When in withdrawal, these individuals can become very desperate and dangerous. They will go to great lengths to get high.
What can we do in terms of how society should deal with the problem? When treating an OUD patient, both incentives and consequences need to be geared towards keeping them off the drug of abuse. These five areas are conceptual changes needed towards resolving the national opiate use crisis and treating patients with Opiate Use Disorder:
1.) There needs to be a massive education campaign similar to the education campaign against tobacco including the danger of opiates and treatment options for OUD individuals. Explain the dangers of opiates, what opiates are, how they affect our brains, and, importantly, how easily it is to become dependent. The potential of overdose and death needs to be underscored. For example, the opiate called fentanyl, in amounts barely visible to the human eye, can cause individuals to stop breathing. Fentanyl is measured in micrograms. There are 100 milligrams in a gram. There are 1000 micrograms in a milligram. There are 100,000 micrograms in a gram. Two hundred micrograms or maybe less is lethal, which hardly covers the tip of a needle.
2.) The streets must be flooded with Narcan inhalers. One to three sprays in a nostril can revive an opiate overdose.
3.) The streets must be flooded with test kits to determine what is in the drugs and how much is in them. People make better decisions when they know what is in the drug they are taking. For example, if someone makes a street purchase of a drug with fentanyl or methadone in it, they need to be extra careful because those drugs can easily kill you. Methadone is dangerous not only because it is so potent but because it lasts so long. There is an even more dangerous drug on the street called carfentanyl which is 100 times more potent than fentanyl! Note: methadone has been useful in the treatment of OUD, however, it is so dangerous that the dose must be given out on a daily basis. While methadone blocks cravings, it provides a high so can still be abused and lead to an overdose. Buprenorphine is another drug used in treating OUD, and it has been found to be safe enough to prescribe on a monthly basis. The negatives and stigma associated with methadone should not be associated with buprenorphine.
4.) Laws need to be changed. Instead of charging people with accessory to murder when a friend overdoses and dies, give them immunity. Give complete immunity to people in the presence of someone who overdoses if they call 911 during the overdose. Encourage people to call 911 and save lives, not run and hide fearing prosecution.
5.) The court system for individuals with OUD must change. Once in the system, these individuals must be tracked with drug testing and given treatment when needed. Criminal records for possession or use can be wiped away if the individual stays sober. Incarceration should be a last resort. Charging people with felonies for drug possession scars people for life. Once labeled a felon, re-entering society becomes very difficult. OUD individuals are not sociopaths or criminals, they are ill with a disease. Treat the illness and there are no criminal problems.
This perspective demands basic changes in our societal and individual thinking about opioid dependency. Equally as important is the way the established medical community regards and treats this diagnosis and it is just that….a medical condition.
I have many thoughts for my peers and given the opportunity, I would welcome the chance to share them.
No matter what our circumstances in life, we are all touched by this epidemic in some way. We all have skin in this game. Time is precious, costly and limited. Soon may become later and it is already too late to wait.
More comprehensive explanations about how to deal with addictions in my book Tales From The Couch on amazon.com
Mark Agresti, M.D.Learn More