Ask Dr. Richards About Anxiety Disorders

Ask Dr. Richards About Anxiety Disorders
Thomas A. Richards, Ph.D., Psychologist
Anxiety Questions and Answers
The volume of e-mail we receive at The Anxiety Network and our related sites is becoming so great that we can no longer answer each and every question we receive. We have posted some relatively common questions on this page and will be posting more in the future, but can no longer answer e-mails personally like we have done in the past. Please accept our apologies for this, but the volume of correspondence is so great that we cannot possibly continue to meet it. The Anxiety Network Store contains the audio files people have requested for panic disorder and generalized anxiety disorder, and also has books listed that can be informative concerning the anxiety disorders.

1. What kind of anxiety do I have?
I was told I have anxiety disorder about two years ago. Back then I would have to run out of places. I used to feel as if something bad was going to happen. I was always on edge. But now my symptoms are different. I can go in places and do the stuff I couldn't do before. I just always feel like I'm going crazy, like my mind is on overdrive. Everyday feels like it might be the day I have to go to the mental hospital. It comes and goes. Does this mean I'm going crazy and that I have something worse than anxiety? I hope I can get some answers. Thank you.

A: You are talking about panic disorder and the symptoms you describe are all typical symptoms of this anxiety disorder. People with panic many times feel entrapped, closed in, and claustrophobic ("I just need to get out of there!"). No, people with panic disorder do not go "crazy". It is impossible for this to happen. Check out the panic disorder pages on The Anxiety Network for symptoms, diagnosis, treatment, and prevention.

Please read our Panic pages on The Anxiety Network, particularly the article dealing with these very real fears: What You Fear The Most Cannot Happen. Everyone with panic has felt this way at one time or another. You need to get into an anxiety treatment program where they will use cognitive-behavioral therapy to help you get over these symptoms. The symptoms, as you know, are very real and terrifying, but all of them can be overcome, and you can do it.
2. Can't Shake Social Anxiety
It seems that my life is full of pain and I just can't seem to shake it. I get into relationships and they somehow for whatever reason do not last more than one to eight years...at the end of each relationship, I go into hiding because of my social phobia.

I used to use alcohol to mask the social anxiety and now that I don't drink, I am definitely afraid. I have no female friends because I find it very difficult to get close to anyone for fear they won't like me anyway. I am on Zoloft but still need help.

A: It is all too common for people with social anxiety to mask the pain of anxiety with alcohol, but, of course, this only causes greater problems for you as the years go by. Relationships are very difficult for people with social anxiety because there is always another person involved. That may sound strange, but a person with social anxiety is anxious around other people -- in many cases, even their own partners. I always recommend that people overcome their social anxiety before trying to enter into a new emotional relationship.

The first priority for people with social anxiety is to find an social anxiety specialist who can help you get over the "vicious cycle" of social anxiety, so that your anxiety is reduced, you feel calmer, and you can relate to other people on an easier basis. Until your social anxiety is on the path to being overcome, it will be hard to maintain emotional relationships.

Please read over all our pages on social anxiety disorder and check out the thorough information found on The Social Anxiety Institute (link is external) website.
3. What kind of anxiety makes me want to "get out of here"?
I wake up (4:30 a.m.) with a sense of smothering (feeling like I can't get enough air), hot, with my heart "pounding out of my chest", and an over-whelming urge that I need to GET OUT OF HERE.

A: These are symptoms of panic disorder. They are very real and very terrifying, and it will help if you become as educated as possible about this anxiety disorder. Basic Facts on Panic Attacks is a good first start, but all of the articles on the Panic/Agoraphobia Home Page should be helpful. You will find that panic is successfully treated with cognitive-behavioral therapy and that most people go on to live happy, calm, peaceful lives.

Basic Facts About Panic Attacks is a article that describes a panic attack.
4. Social Anxiety Not Diagnosed - They See It as Depression
Dear Dr. Richards,

My psychiatrist dismissed my social anxiety as a minor diagnosis and went with depression as my primary diagnosis. I didn't really see it his way and I have only seen him twice, so I was wondering if this is an appropiate diagnosis. Thanks for the pages on anxiety, they are very helpful. I can't figure out what I would have done in the past when this knowledge of social anxiety wasn't present. It seemed I would have been doomed to a life of despair.

A: Without seeing you, I can't make a definitive diagnosis. However, it is likely that if you know you have social anxiety that the depression (or more technically "dysthymia") is caused by the anxiety disorder. The majority of people with social anxiety disorder also have depression. It is the anxiety that causes the depression, however, and not the other way around. When you live with the depth of anxiety and fear that social anxiety causes every day of your life, it is only natural that you would also be depressed. An active, structured cognitive-behavioral program can help you overcome social anxiety for good.

Some of this information can be found on our Social Anxiety and Misdiagnosis page.
5. Medications for Social Anxiety
My psychiatrist recently prescribed me Paxil. Now I read paxil is good medication for treating social anxiety. Your pages seem to prefer the anti-anxiety medications and MAOI if needed. Could you tell me the benefits that anti-anxiety medications would provide over Paxil.

A: This is a complicated issue and it is discussed more thoroughly on our Social Anxiety and Medications Page. Clinically, we have yet to see significant amounts of people with social anxiety helped through the use of the SSRIs. In conjunction with cognitive-behavioral therapy, we have found clonazepam or lorazepam, anti-anxiety agents, when diagnosed appropriately, to be a good starting point for people with social anxiety disorder, as defined by the DSM-IV. These are safe medications if given to people who have NOT gone through alcoholic or drug addictions. Every person is different, however, and you must see a psychiatrist who understands the anxiety disorders, and understands that the anti-anxiety agents are not addicitive, in the low amounts prescribed, to people with a diagnosable case of social anxiety disorder.
6. Anxiety Audios
The three audio files you now have available appear to be for all anxiety sufferers. These are not the social anxiety therapy series tapes are they?

A: No. You are correct: The audio files that are now available are helpful adjuncts to cognitive-behavioral therapy for anxiety in general. We use them here at the clinic to reinforce and keep the anti-anxiety momentum going. Most often, people with panic disorder and generalized anxiety disorder find them helpful.

The social anxiety therapy sessions are in digital format, and you can find a complete description of this audio therapy series here (link is external).
7. Is Generalized Anxiety Disorder (GAD) Sometimes Seen as ADHD?
My 9 year old daughter was recently diagnosed with GAD. We took her to have testing done for ADHD and learning disabilities, but none were found. Thankfully, we learned that GAD is something that is treatable. But we are having trouble finding information on GAD and especially how it relates to younger children. Is ADHD often misdiagnosed? Could children and adults who have been diagnosed with ADHD actually have GAD?

A: It is good that you had your daughter tested to rule out attention deficit hyperactive disorder (ADHD) and specific learning disabilities. Yes, some symptoms of generalized anxiety disorder appear the same as ADHD and learning disability symptoms. Generalized anxiety makes it difficult for people to concentrate and pay attention. Symptoms include racy and worrying thinking and an inability to relax and slow down. See our article on What is Generalized Anxiety Disorder? Treatment for GAD must be cognitive and multifaceted. That is, the emphasis must be placed on the "slowing down" methods and strategies and the feelings of acceptance that must be engendered. Even a half dozen methods is not adequate for people with GAD. Your therapist should have several dozen practical strategies to chip away at the generalized anxiety.

Because generalized anxiety disorder makes it difficult for the child to concentrate in the classroom, it is suspected that many children have been diagnosed with ADHD when they really have generalized anxiety.
8. Help for Obsessive-Compulsive Disorder
You were very helpful when you answered my previous questions about my 19 year old son. He has been diagnosed with OCD, which is not as serious as some other cases we hear about, but is serious enough to make him lose his ability to concentrate on other things and generally speaking, he cannot be happy or live normally while obsessing. Even while doing something else, his obsession is hovering in the back of his mind and he takes time off constantly to indulge it. In view of his misery, he just agreed to see a psychiatrist for a medication evaluation, which up to now he was totally against. The psychiatrist prescribed Luvox, 1/2 a pill of 50 mg twice a day, for a week, followed by 1 pill twice a day, for another week, then back to see him. Since I read all the comments about SSRIs in your website, I am aware that the laboratories "push" the medicines they want to sell, and of course they make up brochures that will tell you how good it is for you. I read the brochure on Luvox that the doctor gave us, and it says "specially indicated for OCD". Can I believe that, after having read your pages and your concerns? I looked up Luvox in the Internet, and to my amazement I got a lot of articles back, most of them on Prozac. All of them spoke horribly of these medications. One of them was an article explaining that one teenager that recently committed a mass murder was taking Luvox, and that this medication can cause "mania", explained as the tendency to commit mass murders. I don't have to tell to you how sick and worried I am after having read all that. Luckily, 1/2 a tablet is only 25 mg. and God knows what amount of medication these people in the articles were taking, or what did they mix it with, like drugs and even other medication. Since you always stress in your articles that some medications are indicated for anxiety and some others are not, I imagine that the same may be the case for OCD. In your experience, is Luvox indicated for OCD? So, I wonder, just how serious this is, just how much does he need medication, would it go away only with the Cognitive Behavioral Therapy? Mostly, I am worried about the side effects of Luvox, and about how long will he be on this medication. I know you are very busy and I appreciate whatever efforts you can make to answer me.

A: We do not specialize in obsessive-compulsive disorder (OCD), but we do have a page that links to other reliable sites: The Obsessive-Compulsive Disorder Links Page. The internet sites that claim these horrible results (i.e., mass murder, mania, etc.) for the SSRIs are inaccurate. The SSRIs are typically good medications for clinical depression, and prescribed appropriately by a psychiatrist, can be life-saving medications. Luvox and other SSRIs are helpful in the treatment of OCD and considered to be among the first-choice medications.

A psychiatrist will need to monitor the medication's effects on a consistent basis to make sure the drug is working and is not causing too much fatigue. Sometimes, older drugs (TCAs) are also used for this condition, as are the MAOIs.

Cognitive-behavioral therapy has been shown to be effective long-term for OCD and there is a good book on the subject, which can be accessed through the OCD links page called "Brain Lock".

Medication alone is usually not enough to help the person with OCD. Don't worry about the medication, under the care you have described.