Anxiety

In this episode, Wendy takes a look at the different types of anxiety in relation to bipolar disorder, and some options for coping.

Wendy's novel on psychiatric hospitalizations is out on Amazon! It's called "Involuntary Hold." Check it out~ There is a plot twist you won't see coming!



International Helpline Info

 For those living outside the United States, I finally found some helpful information. The International Association for Suicide Prevention has a directory of crisis centers and helplines for over 50 countries! 

Just got to the internet and type in:

      findahelpline.com/i/iasp

And it will bring you to a drop-down menu where you can input your country and region, and it will give you the information for your location. Granted, it doesn’t cover everywhere, but it’s a start!

** Remember if you, or a loved one, is in emotional crisis... Help is just a phone call away. Simply dial 9-8-8 for the Suicide and Crisis Hotline, or text "HOME" to 741741 to chat with someone via text 24/7 across the United States. **

Please contact us at bipolarforlife@myyahoo.com with any questions, suggestions, or comments.

Transcript

Bipolar for Life
 Episode 5-ANXIETY 

According to the National Institute of Mental Health, approximately 19.1% of adults in the U.S. have some type of anxiety disorder. (That’s about 40 million people). Most people with bipolar disorder have a coexisting mental health condition of some sort, and according to recent research, anxiety disorder is the most prevalent.

A 2018 study found that anxiety disorder rates among people with bipolar disorder are 3 to 7 times higher than that of the general population.

42% of people who have bipolar disorder will experience some kind of anxiety disorder in their lifetime.

Welcome to Bipolar for Life, a show dedicated to survival. This podcast examines the day-to-day struggles with this life-threatening mental illness.

 I’m your host, Wendy Foard, and I have lived with bipolar disorder for 43 years now; it hasn’t always been pretty…  I’ve survived several suicide attempts, four psychiatric hospitalizations, and one disastrous trip to rehab. Yet, I’m still here!

Let me say at the outset, that I am NOT a medical doctor. I am simply a seasoned manic depressive, trying to help others survive this deadly condition through information and shared experiences. 

 Tonight, I’d like to talk about a common experience for us all, Anxiety. Anxiety is a normal emotion. It’s our brain’s way of reacting to stress and alerting us to danger. It’s the “fight or flight” response, and everyone feels anxious now and then. 

 Occasional anxiety is a part of everyday life; we have a problem at work, or an important decision to make, and we may worry about these things. 

But anxiety disorders are different. They are a group of mental illnesses that can cause constant, overwhelming anxiety and fear which can get worse over time. These feelings become excessive, all-consuming and interfere with daily life. 

When anxiety disorder and bipolar disorder co-occur, symptoms may worsen.  According to experts, the impact of having both disorders may include: 

-An increase in number and severity of mood episodes

-An increased rate of mixed states (symptoms of both mania & depression simultaneously)

-An increased rate of rapid cycling

-An increase in suicidal thoughts and plans

-An increased risk of substance use disorder.

There are other impacts as well, but most significantly, there is a decrease in functioning and quality of life. 

There are several types of anxiety disorders, but tonight we’ll talk about the 6 types that are most closely associated with bipolar disorder.

They are Panic Disorder, Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), Specific Phobias,  Post-Traumatic Stress Disorder (PTSD), and Obsessive-Compulsive Disorder (OCD). 

 Panic Disorder – People with panic disorder have panic attacks. These are sudden, repeated periods of seriously intense fear when there is no actual danger. The attacks come on quickly and can last several minutes or more. Panic disorder occurs in about 1 in 5 people who have bipolar disorder: most commonly in those in depressive or mixed states. Some physical symptoms include:

chest pain, heart palpitations, shortness of breath, dizziness, and stomach aches. Bipolar disorder can increase the likelihood of panic attacks, although people who experience occasional panic attacks may not develop panic disorder. 

 Generalized Anxiety Disorder (GAD) – After Panic Disorder, GAD is the most common anxiety disorder for bipolar disorder. People with GAD experience a constant state of excessive worry over everyday issues, such as personal health, money, work, and social interactions. This overwhelming worry occurs every day for at least 6 months. The main symptoms include:

Iritability, muscle tension, difficulty concentrating, sleep disturbances, being easily fatigued, and feeling restless or on edge.

 Social Anxiety Disorder (SAD)- People with SAD, also referred to as social phobia, experience overwhelming and extreme self-consciousness in social situations. For example, you obsessively worry about others judging you, or being embarrassed or ridiculed. When in front of others, symptoms of SAD include rapid heart rate, nausea, panic, or a feeling of your mind “going blank.” Some research has shown that people with both bipolar disorder and SAD have higher rates of atypical depression, as well as traits of other anxiety disorders—PTSD and OCD, in particular.

 Specific Phobias- People with phobias have such an extreme fear or an aversion to something that it becomes physically or psychologically disabling. Their fear may be about spiders, flying, going to crowded places, or being in social situations.  More than 1 in 10 people with bipolar disorder also have a specific phobia, and it’s more common in women than in men. In many cases, phobias start in childhood, and some research suggests that familial factors play a role in instances of coexistence with bipolar disorder. 

Post-Traumatic Stress Disorder (PTSD)- is a disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event. Usually, this event involves a threat of serious physical harm. The condition may last for months or years, with triggers that can bring back memories of the trauma accompanied by intense emotional and physical reactions. Symptoms include hypervigilance, hostility, mistrust in others, social isolation, flashbacks, insomnia, and nightmares.

 The link between PTSD and bipolar disorder is unique because both manic and depressive episodes can be perceived as traumatic events. Having such episodes may even increase the risk of traumatic events, triggering more anxiety. 

 Obsessive-Compulsive Disorder (OCD)- is characterized by unreasonable thoughts and fears,  or Obsessions that lead to repetitive behaviors or Compulsions. People with OCD perform behaviors such as constant hand washing, counting, or cleaning, in hopes of making the thoughts go away. 

There is a big debate over whether OCD is a true comorbidity of bipolar disorder OR if it’s actually secondary to it. Either way, the linked conditions frequently begin in childhood or adolescence. When OCD and bipolar disorder coexist, symptoms usually show up during depressive episodes and stop during manic or hypomanic episodes. 

 In the Diagnostic and Statistical Manual of Mental Disorders vol 5, or DSM-5, which healthcare providers use to diagnose mental health conditions, PTSD and OCD are no longer categorized as anxiety disorders, although they share many characteristics and symptoms.

 PTSD is now in an independent category of “Trauma and Stressor-Related Disorders” and OCD is in the new category “Obsessive Compulsive and Related Disorders.” I mention them here because of their link to bipolar disorder.

Anxiety disorders come with a host of symptoms and no one person has the same experience. Each disorder has its own set of symptoms, but some they all have in common include: 

Difficulty breathing, dizziness, dry mouth, feelings of nervousness, worry, panic, fear and unease, muscle tightness, nausea, rapid or irregular heartbeat, sweaty or cold hands and feet, tingling or numbness in the hands and feet, and unable to calm down, or hold still. 

 I used to think that panic attacks and anxiety attacks were interchangeable terms since they share many common symptoms, however the medical community distinguishes the two because they have different features.  The easiest way to describe the differences between panic and anxiety is to think of them in terms of intensity of symptoms and duration. Panic attacks usually peak around 10 minutes, while anxiety can last months. 

 A panic attack is sudden, lasts only minutes, there can be shaking and trembling, chest pain, hot flashes, sweating, heart palpitations and a sense of detachment.  Whereas, anxiety gradually builds, can last for months, there can be restlessness, fatigue, muscle tension, irritability, and difficulty concentrating. 

 I believe I had my first panic attack just the other day. I’ve had them before, but after my research, I now know what they are. I used to call it “freaking out,” and I freaked out the other day. There have been a ton of stressors lately: getting the podcasts ready, finishing up the book project, getting ready for Christmas, and this is the time that I normally cycle downward. So, when we started talking about the bills, and how much groceries have gone up, I found myself shaking from head to toe. My heart was racing, I started to sweat, and the muscles in the back of my neck clenched up on me. I had to leave the room, because it kept getting worse and I was afraid someone would notice. Once in my room, it took at least 10 minutes to settle down. 

I have to admit to being very surprised that it happened at all. I was calm up until that point, then all of a sudden, my hands are shaking like crazy, and I had no control at all! The fear of not being in control added to the anxiety I was feeling, and I think that made everything worse. I could feel my entire body shake; it felt like I was quaking on the inside as well…

 Calming down from a panic, or anxiety attack takes time. You must wait for your body to relax. There’s no way to hurry it, you have to figure out how to quiet yourself until it can pass. You have no choice; your body is in control. 

 Here are 10 tips from the Mayo Clinic to help manage an anxiety disorder. They won’t eliminate your stress, but they can make the anxiety easier to handle with bipolar disorder.

 1)Keep physically active. Exercise is a powerful stress reducer. It can improve your mood and keep you healthy. Therefore, you want to develop a routine so that you’re active most days of the week. Start out slowly, and gradually increase the amount and intensity of your activity.

 2)Avoid alcohol and recreational drugs. These substances can cause or make your anxiety worse. Not to mention the problems they provide on their own. If you can’t quit, please talk to your healthcare provider, or find a support group to help.

 3)Quit smoking and cut back or quit drinking caffeinated beverages. Nicotine and caffeine can worsen anxiety. There are several options to help you quit smoking now: gum, lozenges, and patches. However, caffeine seems to be in everything except water! 

 4)Use stress management and relaxation techniques. Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety. There are apps available today for guided meditation, yoga, and even breathing exercises. 

Anxiety focused apps are a fantastic and cost-effective way to get extra support when struggling with symptoms. You can pick up tools like breathwork, cognitive behavioral therapy exercises, journaling and more. Do some research and find one that works for you and your budget. There are free options out there as well. 

 5)Make sleep a priority. Do whatever you can to make sure you get enough sleep to feel rested. If you are not sleeping well, talk with your doctor. Restful sleep not only decreases anxiety, but it keeps moods stable as well.

 6)Learn about your disorder. Do some research and talk to your doctor to find out what might be causing your condition and what treatments would be right for you. Involve your family and friends—ask for their support.

 7)Stick to your treatment plan. Consistency makes a big difference especially when it comes to taking your medication, so take it as directed, for as long as directed. Keep your therapy appointments and complete any assignments your therapist gives you. Become a willing partner in your treatment and take control.

 8)Identify triggers. Learn what situations or actions cause you stress or increase your anxiety. Practice the strategies you’ve developed such as yoga and breath control to help deal with anxious feelings. There are many other suggested strategies to manage anxiety disorders such as finding a mentally challenging distraction, learning relaxation techniques to ease your muscle tension, or creating a self-sooth kit. You can find other suggestions online or ask your doctor. 

 9)Keep a journal. Keeping track of your thoughts and what’s going on in your personal life can help you and your doctor identify what’s causing your anxiety and stress. Besides, it’s a great place to blow off steam and say the things you can’t out loud. I find it very cathartic, and highly recommend it to anyone.

 10)Socialize. Don’t let worries isolate you! Do your best to get together with family and friends. Isolation only deepens depression, so go to the movies with your friends and attend that family reunion. You’ll be glad you did!

 One of my favorite coping strategies is coloring. I know that sounds infantile, but it works! There are a myriad of adult coloring books out there on the market now. I enjoy doing mandalas as they are intricate and take some thought—it’s a color puzzle. Coloring is very relaxing and slightly artistic, since you are choosing the colors of the design, but it’s not taxing. So, buy yourself some nice pens or pencils, and grab an adult coloring book that strikes your fancy. Once you’re done, you have something beautiful to show for your time, other than facial worry lines.

 So, other than coping skills, what else can you do for anxiety? Well, there are a variety of treatment options to deal with anxiety disorders. A mental health professional can help you find what works best for you. 

Our first option is Psychotherapy, which can help people learn to manage the emotional, cognitive, and behavioral aspects of anxiety. One particularly effective form of psychotherapy for anxiety disorders is Cognitive Behavioral Therapy (CBT). This approach focuses on helping people identify the automatic negative thoughts and cognitive distortions that contribute to feelings of anxiety.

Research has found that CBT can be effective in the treatment of anxiety disorders such as Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), and Specific Phobias. It can also be helpful for anxiety associated with Post-Traumatic Stress Disorder (PTSD) and Obsessive Compulsive Disorder (OCD) as well. 

 A second treatment option is Exposure Therapy, which is another form of Cognitive Behavioral Therapy that can be helpful for some types of anxiety.  In this approach, people are gradually exposed to the things that they fear, often while using relaxation techniques to help calm the body’s stress response. The goal of exposure therapy is to create a safe environment in which a person can reduce anxiety, decrease avoidance of dreaded situations, and improve the quality of life.

 Medications can also be prescribed to help relieve the symptoms of anxiety. Some of the meds most often used for anxiety include:

Antidepressants can help alter the levels of certain neurotransmitters in the brain to help relieve symptoms of anxiety. The antidepressants most widely prescribed for anxiety are SSRI’s such as Prozac, Zoloft, Paxil, Lexapro, and Celexa. These medications have been used to treat Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), panic disorder, Social Anxiety Disorder (SAD) and Post-Traumatic Stress Disorder (PTSD).

 Benzodiazepines work quickly and are often a short-term treatment due to the possibility of physical dependence. Physical dependence, on its own, is not the same as addiction. Signs of physical dependence include tolerance for the drug (when it no longer has the desired effect due to long-term use) and withdrawal. 

The benzodiazepines that are most commonly used for anxiety are Rivotril, Xanax, and Ativan. Klonopin and Valium are also used. The choice depends on which disorder is being treated and the duration of treatment. 

 Beta Blockers are usually used to treat high blood pressure, but they can also help relieve some of the physical symptoms of anxiety. Beta blockers work by blocking the adrenaline in your cells, so that you get a reduced “fight-or-flight” response from your body. But beta blockers only deal with the physical effects of anxiety, not the underlying chemical imbalance or psychological reasons for anxiety.  Propranolol and Atenolol are two beat-blockers that are often prescribed to help with anxiety. 

 Anxiety has such an influence on how a person with bipolar disorder responds to treatment that assessing anxiety is likely to become a standard part of care for bipolar disorder. Women are more likely to be affected by anxiety which is why experts now recommend that women, and girls over the age of 13, get screened for anxiety disorders as part of their routine medical care. 

 If you, or a loved one, are struggling with symptoms of anxiety disorder, please contact the Substance Abuse and Mental Health Services Administration Hotline at 1-800-662-4357 (also known as the Treatment Referral Routing Service) for information on support and treatment facilities in your area. That number again is 1-800-662-4357 (HELP). 

 As always, if you or a loved one are feeling suicidal don’t hesitate to get help. Please call 988 or 1-800-273-TALK (8255) for the National Suicide Prevention Lifeline, or you can text H-O-M-E (all caps) to 741741 if you’d rather chat that way.

 As you can tell by all the information we’ve gone over tonight, each form of anxiety disorder could be an episode of its own. I was overwhelmed by how much research has been done on this topic, so we may actually revisit anxiety disorders in more depth another time. 

 You can always reach me with any comments, questions or suggestions, you may have at bipolarforlife@myyahoo.com. Thank you for joining me this evening, and I hope you’ll join me next time when our topic will be Depression. I really feel like, with the Holidays coming up, this is a topic we need to discuss. I’m your host, Wendy Foard, be safe in all your travels and I’ll see you next time on Bipolar for Life.