ANXIETY:

 

If you cannot sleep at night or have so much muscle tension your body aches or you experience headaches, you may have clinically significant anxiety. Some people feel so restless they can't concentrate or need to be going all the time. Other people feel like they can't breath, they experience chest pain, or even get light headed and dizzy.

 

There are major advances in the treatment of anxiety and I always like to start with SKILLS before PILLS. The fast pace of our world means often we neglect rest. We don't take time to relax and we don't schedule enough time to sleep. Our brain is trying to learn our patterns. If we know how to signal our brain to rest, we can counteract the damage of stress in our lives.

 

For example, how does the brain get signals of going to sleep? Getting deep restful sleep is essential for treating anxiety and begins with waking in the morning. Arise with the sun, take a brisk walk or exercise and make sure the sunlight warms the skin for some vitamin D. Then eat a good breakfast to rev up your metabolism. For bedtime, do some light reading, dim the lights, and finish dinner 3 hours before bedtime. Use a foam roller to roll out your back or do some stretching. Then take a cold bath or shower or use cooling measures like a cold pack on neck and forehead before 30 minutes before bedtime. Your core body temperature drops when you go to sleep and cooling measures signal the brain it is time to go to sleep. Try listening to relaxing sleep induction songs and sleep in a quiet, cool, and dark room. Nutritional supplements like melatonin or magnesium glycinate may help. Set a regular sleep schedule and stick to it seven days a week, waking up at roughly the same time every morning, as it trains your brain to get sleepier early and get the sleep that it needs. Avoid naps, and don't consume any caffeine after 1-2 PM. You want to have at least 10 hours to fully metabolize caffeine before you go to bed.

 

It is usually best to avoid watching television, studying, or eating in bed, and shut off all your electrical devices (television, computer, smart phone, etc.) three hours before bedtime. This not only gives your brain a chance to prepare for sleep, but the blue light that's emitted from electronic devices can reduce your own melatonin production by up to fifty percent. 

For tension in the muscles, regular weight bearing exercise is a must. Stretching is important to signal the brain to relax. Pilates and massage are my favorite ways to release the muscle tension. Deep breathing is a must. 5 deep breaths, 5 times a day for a 5 count in, 2 count hold, and a 5 count out. Why? Because when you are stressed your brain signals the body to breath rapid and shallow. When you breath slow, deep breaths you are telling your brain it is okay to relax and chill out.

Some patients with anxiety benefit from nutriceuticals like Bacopa Monnieri. Did you know in a study published in J Altern Complement Med. 2008 Jul;14(6):707-13. found that using Bacopa 300 mg per day was found to be an effective and safe way to help anxiety, cognitive performance, and assist in treatment of depression? A study on the effects of Brahmi (Bacopa monniera) on human memory reported that seventy-six adults aged between 40 and 65 years took part in a double-blind randomized, placebo control study in which various memory functions were tested and levels of anxiety measured. There were three testing sessions: one prior to the trial, one after three months on the trial, and one six weeks after the completion of the trial. The results show a significant effect of the Brahmi on a test for the retention of new information. For patients who qualify, starting at 250 mg at bedtime then after 1 week, if you have no adverse side effects, increasing to 500 mg at night can be beneficial for reversing effects of anxiety.

Most importantly, I think it is important to know there are better alternatives than addictive medications like Benzodiazepines commonly used for anxiety, like Xanax, Valium, Ativan, and Klonopin.  Here are three examples:

Lyrica- Lyrica has an indication for neuropathic pain but can help for anxiety in the dose of 150 mg twice a day. It has been approved by the FDA for diabetic peripheral neuropathy, post herpetic neuralgia, and fibromyalgia.  It is also used, off-label, for mood stabilization, anxiety (generalized anxiety, panic disorder, and social anxiety), peripheral neuropathic pain, and some seizures.  It can reduce neuropathic pain and anxiety within one week.  No blood tests are required prior to treatment.  It does not have significant drug interactions.  It may increase the sedative effects of oxycodone, lorazepam, and alcohol.  Lyrica is one of the few agents that enhance slow-wave delta sleep, which may be helpful in chronic neuropathic pain syndromes.

Neurontin- Although Neurontin is a mood stabilizer/anticonvulsant; it has been used to treat anxiety, pain and to improve sleep.  Neurontin is given on a three times a day schedule.  The most common starting dose is 300mg at night.  After three to five days, a morning dose of 300mg is added and after another three to five days, a midday dose of 300mg is added.  Thereafter, the dose may be gradually increased by 300mg increments every 3 to 5 days as needed for optimal symptom control.   Occasionally, Neurontin is started at a lower dose of 100mg at night and then titrated on the same schedule.  The therapeutic range for Neurontin is broad and is based upon an individual patient’s clinical response.  Blood monitoring is not required.  Sedation may be a limiting side effect, if the dose is increased too quickly.  

 

BuSpar (buspirone)- is an antianxiety agent that is not chemically or pharmacologically related to the benzodiazepines, barbiturates, or other sedative/anxiolytic drugs. BuSpar is indicated for the management of anxiety disorders or the short-term relief of the symptoms of anxiety. The efficacy of BuSpar has been demonstrated in controlled clinical trials of outpatients whose diagnosis roughly corresponds to Generalized Anxiety Disorder (GAD). Many of the patients enrolled in these studies also had coexisting depressive symptoms and BuSpar relieved anxiety in the presence of these coexisting depressive symptoms. The recommended initial dose is 15 mg daily (7.5 mg b.i.d.). To achieve an optimal therapeutic response, at intervals of 2 to 3 days the dosage may be increased 5 mg per day, as needed. The maximum daily dosage should not exceed 60 mg per day.

We accept new patients with HMSA PPO, HMO, & FEDERAL insurance. Call (808) 202-0669 to schedule.

Garrett Halweg, MD

1188 Bishop St. Suite 2008

Honolulu, HI 96813

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