Anxiety, you’re not the boss of me

2013-02-12

By Richard Lucas, Special to CNN

Editor’s note: Richard Lucas was diagnosed with panic disorder, a type of anxiety disorder, about five years ago. He now lives in Virginia and manages his condition with drugs and therapy. He first shared his story on CNN iReport.

It was a morning like any other. I woke up and went through my daily routine, slopped on some hair gel and a few sprays of cologne, and made my way to work. I picked up breakfast, then headed outside for my traditional post-meal smoke.

There I was, sitting outside on a cool San Francisco Tuesday, when, suddenly and inexplicably, pain covered my chest. Squeezing pain, as if someone had picked me up from behind and given me a bear hug of massive proportions. I stood up, stretched and rubbed my chest, hoping for the pain to disperse. But it got worse.

I went back inside and sat down. My boss noticed my visible discomfort and asked if I was all right, so I described my symptoms. Then he asked a question that changed the course of my life forever: “Do you need to go to the hospital?”

I was a 25-year-old healthy man who’d never broken a bone or had anything more serious than an ingrown toenail. But that morning when I heard the word “hospital,” I was certain that I was about to die.

“Yes” I mumbled. “I need you to get me to the ER; I think I’m having a heart attack.”
I arrived at the emergency room and flew through the doors as a person in a life-threatening emergency would. “I’m having a heart attack,” I dramatically proclaimed. The nurse rushed me to the back as I heard the call go out over the radio: “Possible MI, male, room two.” (MI stands for myocardial infarction, i.e., a heart attack.)

The doctors entered and looked puzzled. I was pretty young to be experiencing chest pain. They confirmed I was the correct patient, then diligently ran a battery of tests. After several hours of being prodded and poked, they determined that there was nothing wrong with me, but that this was the product of stress.

When does anxiety need treatment?

I was utterly dumbfounded by the idea that I, always fearless and never really worried about anything, could have been reduced to a blubbering victim of stress. It made no sense. But hey, I thought. I wasn’t dying. I had that going for me, and to hear I was medically sound made me feel pretty good about myself. I’d been checked out and now it was over, right?

Wrong. On a business trip a few weeks later, it hit me again, so bad this time that I was racing down the shoulder of the interstate trying to get to the ER. Once again, the doctors said it was stress.

At their recommendation, I sought a regular primary care physician. I assume that he had never felt the feelings that I was having. He referred me for a full cardio workup, just to ease my concern, scratched off a prescription for Xanax and sent me on my way.

By this point, my occasional outbursts of despair — panic attacks — had forged a constant fear that another one was on its way. I checked my pulse constantly to make sure my heart was still beating, I lay in bed with my hand on my chest to feel my heart, and I went into panic mode daily.

Five years, 25 emergency room visits and upwards of 30 doctors’ appointments later, I have finally found some resolution in my battle with anxiety. For those of you who also suffer, or have someone in their life who suffers, I wanted to share what I’ve learned.

To those with a friend or loved one who has anxiety disorder:

I know that you don’t understand this apparent madness, and I hope for your sake that you never do, but please be supportive.

Do not, under any circumstances, disregard or downplay the victim’s feelings. For someone who has never suffered from anxiety, the idea of such an absurd and irrational thought process is difficult, if not impossible, to understand. But for those of us who have felt this way, it is very real and extremely scary.

We’re a fragile bunch, and telling us mid-panic attack there’s nothing wrong with us is the equivalent of kicking someone in the shin and then telling them the pain is all in their head. You may know for a fact that there is nothing wrong — and rationally, we often know it too — but the anxiety is very real and disregarding it just intensifies it.

Do remind us that we are going to be OK. That validates our feelings, helps us focus on how the situation will end and takes us out of the panicked moment.

To my fellow jittery friends:

My biggest piece of advice is to find a compassionate doctor who will give you the support and attention that you need. I finally found one after going through half a dozen or so, and she is amazing. So amazing that she even came to therapy with me, twice! Talk with your doctor and agree upon a medication or other course of therapy that will help you.

Find someone that you can talk to, someone who understands. You may find comfort in a support group, either online or in person. They’re full of people just like us who are there to vent and be supportive of one another. No matter what kind of anxiety you experience, there is someone else who knows exactly how you feel.

Here’s one for the moment when you decide that you are actually dying and are in need of immediate emergency care: Think about how it ends. Think about how it ends with you walking out of the hospital, carrying your discharge papers. This time, it will end the same.

Can anxiety kill your ability to love?

Am I completely cured? No, and I never will be. But I have learned to manage much better. I’m proud to say that I haven’t visited an emergency room in about nine months, a huge feat for a guy who was getting to know the staff by name. I have a network of very supportive people in my life, including my doctor, without whom I’d probably be doing my routine of pulling into a gas station and yelling for an ambulance, rather than writing this article.

I used to be a SCUBA diving instructor, fearlessly navigating the deep, coming face to face with sharks while keeping my students safe and alive. The last two times I dove, I was struck with panic and had to abort, but in a few months I will return to the depths of the ocean and I will conquer my fear.

I will conquer because I will not allow anxiety and panic to kill another day of my life. It’s my life, and anxiety can’t have it anymore.

You can find more information on panic disorder and other anxiety disorders at the National Institute of Mental Health.

The Most Stressed Out Generation? Young Adults

2013-02-11

By Alexandra Sifferlin

The latest survey shows stress is on the decline overall, but still hover above healthy levels, especially for young adults.

In the national Stress in America survey, an annual analysis by Harris Interactive for the American Psychological Association, 35% of adults polled since 2007 reported feeling more stress this year compared to last year, and 53% said they received little or no support from their health care providers in coping with that heightened stress. The survey involved more than 2,000 U.S. adults ages 18 and older who answered an online survey in August 2012.

The participants ranked their overall stress level on a scale from one to 10, with 1 being ”little or no stress” and 10 being ”a great deal of stress.” Overall, stress in America has been declining since 2010, when 24% of Americans reported experiencing extreme stress compared to 20% in 2012. And on average, the participants reported a stress level of 4.9, compared to the 5.2 they reported in 2011.

But that trend masks some concerning hints that those declines aren’t deep enough. Most adults said that they considered a stress level of 3.6 to be healthy, or manageable, and current levels remain stubbornly above this mark. The common source of stress involved money, with 69% of participants citing financial problems and conflicts as the primary cause of their anxiety, while 65% fingered work, 61% noted the economy, and 56% pointed to relationship angst.

The most concerning trend emerging from the data, however, is the fact that most Americans don’t feel they are managing their stress well, and that the healthcare system isn’t there to help them cope. A little over half of the participants said they received little or no support for stress management from their health care providers and while 32% felt it was important to discuss their concerns about stress with their health care providers, only 17% said they actually did.

Despite the fact that stress increasingly touches the life of almost every American, and that there are lifestyle changes that can help to relieve some of the worst aspects of stress, once the doctor’s office, it’s not a common topic of discussion. About 20% report never talking to their health provider about lifestyle changes to improve their health, 27% don’t discuss their progress in making behavior changes to curb stress, 33% never talk about how to manage stress and 38% never discuss their mental health.

These potential consequences are especially worrisome since the survey showed that young adults, between the ages of 18 to 33, reported the highest average level of stress at 5.4, meaning they may have to bear the brunt of the long term effects of stress throughout their lives. Thirty nine percent of this younger generation reported that their stress level had increased in the past year, compared to 29% of those aged 67 or or older. These young adults also admitted to feeling the least equipped to manage their stress well.

What is triggering all this worry? Among those aged 18 to 47, work, money and job stability contributed the most anxiety, while those aged 48 and older were more likely to be concerned with either their own health or that of their families.

“Millennials [those aged 18 to 33] are growing up at a tough time,” Mike Hais a market researcher and co-author of two books on that generation, including Millennial Momentum, told USA Today. “They were sheltered in many ways, with a lot of high expectations for what they should achieve. Individual failure is difficult to accept when confronted with a sense you’re an important person and expected to achieve. Even though, in most instances, it’s not their fault — the economy collapsed just as many of them were getting out of college and coming of age — that does lead to a greater sense of stress.”

Women reported feeling more stress than men, with an average rating of 5.3 vs. 4.6, and women were also more likely to feel that their stress levels increased over the past five years. Men, however, are making more strides in managing their stress, primarily through exercise or listening to music; 39% of men reported being able to cope with anxiety in the most recent survey, compared to 30% in 2010, while 34% of women felt they were able to manage their stress successfully.

Despite the encouraging signs that overall stress levels appear to be dropping, the researcher say that the lack of adequate stress management could end up reversing that trend. More discussions about stress in the doctor’s office, as well as support for lifestyle and behavior changes to cope with people’s major worries, could significantly improve the anxiety that inevitably comes with living in difficult economic times. As the authors write in the report, “If left unaddressed, this disconnect between untreated stress and chronic illness could contribute to a continued and unnecessary increase in the number of chronically ill Americans, along with a further escalation in health care costs.” Stress may be unavoidable, but managing it shouldn’t be so out of reach.

Bullying: For Gay and Lesbian Teens, Does Life Get Better After School?

2013-02-06

Two years ago, columnist and Seattle gay-rights advocate Dan Savage launched the “It Gets Better” project on YouTube. In reassuring video clips, adults promised homosexual kids — who are bullied and attempt suicide more than their straight peers — that life would get easier once they finished high school.

But does it really? Joseph Robinson, an assistant professor of educational psychology at the University of Illinois at Urbana-Champaign, decided to apply a researcher’s eye to the question. In a new study, he concludes that yes, it does get better — for the most part. “The sentiment of the It Gets Better campaign is that things will get better because chances are you are not going to be bullied later in life,” says Robinson. “This is the first time we have strong empirical evidence to suggest it does get better.”

Most existing research focused only on whether lesbian, gay and bisexual (LGB) kids were bullied in high school. No good data had followed students annually as they progressed through their teen years. So Robinson turned to information collected in 2004 from the U.K.’s Department for Education on the experiences of 4,135 children who were ages 13 and 14; he also looked at data from 2010 when the same kids were ages 19 and 20.

“I was particularly interested in these data because we don’t have anything like this,” says Robinson. “I thought, This is the perfect opportunity to see if it does get better.”

The survey, which asked the students about their experiences with bullying, provided the perfect opportunity for comparing how rates of bullying changed over their lifetimes. According to Robinson’s research, which was published in the journal Pediatrics absolute rates of bullying declined over time for all students, regardless of sexual orientation. In the study, over half of LGB students reported being bullied at ages 13 or 14; less than 10% reported bullying at ages 19 or 20.

LGB youth are bullied almost twice as often as heterosexual youth in high school. But the trends diverged after high school depending on gender. After high school, bullying rates became comparable for lesbian and bisexual females compared to heterosexual females. At ages 13 to 14, 57% of lesbian and bisexual girls reported being bullied compared to 40% of straight girls; at ages 19 to 20, 6% of young women reported being bullied, regardless of sexual orientation.

For gay and bisexual males, however, the relative rates of bullying actually increased following high school; they were bullied four times as often as heterosexual males. “We think that might be because people hold more negative attitudes toward gay and bisexual males and are less accepting toward them than toward lesbian and bisexual females,” says Robinson.

At ages 13 and 14, 52% of gay and bisexual boys report being bullied versus 38% of straight boys. At ages 19 to 20, 9% of gay boys report being bullied compared to a little more than 2% of straight boys. “It definitely gets better on average for all gay kids,” he says. “Rates for gay men are getting better but when compared to straight boys, it’s still much higher. We would be remiss to ignore that in relative terms, it gets worse for gay men.”

The current study can’t explain why, but Robinson hopes that additional research can reveal why bullying continues to occur after high school and why gay and bisexual men in particular tend to be singled out, says Robinson.

In a second part of the study that focused on emotional stress, Robinson found that straight youth have low levels while LGB youth have more moderate levels. At ages 14 to 15 and again at ages 16 to 17, the kids were asked questions about their happiness and feelings of depression and worthlessness. Not surprisingly, the higher rates of bullying experienced by LGB children appear to be partially responsible for their greater levels of emotional dissatisfaction. But half the disparities are unexplained.

Prior research tends to suggest that the anxiety and distress LGB kids feel can be alleviated by being in schools with gay-straight alliances and those with anti-bullying policies, and by teachers whom they consider allies.

But perhaps the strongest allies these students have in learning to cope with their sexuality are their parents, says Adelle Cadieux, a pediatric psychologist at Helen DeVos Children’s Hospital in Grand Rapids, Mich. “Parents should be open enough for their kids to even come out in the first place,” says Cadieux, who was not involved in the Pediatrics study. “A lot of youth aren’t comfortable telling their parents about their sexual orientation so they can’t even use their parents as a support system.”

Parents who are their children’s advocates can help by lobbying for anti-bullying laws in their states and policies at their children’s schools so that schools can become part of the solution. “Our kids do better emotionally and psychologically when they have good connectedness to their families,” says Cadieux. And even if that type of support can’t stop bullying, it can help students to confront it throughout their adult lives as well.

Bonnie Rochman @brochman

Bonnie Rochman writes about pregnancy, fertility, parenting — the ups and downs of being a kid and having one — for TIME.

Get Smarter: A Powerful Brain-Boosting Supplement You’ve Never Heard Of

Yesterday, more groundbreaking research came out demonstrating the impressive potential of the supplement phosphatidylcholine to improve brain health and smarts. Haven’t heard of it? You will – it’s looking to be one of the next anti-aging wonder pills.

The target in the University of Colorado study was schizophrenia – a subject both timely and topical after the mental illness-fueled massacres of the past year. Psychiatrist Robert Freedman, who also happens to be Editor of the American Journal of Psychiatry, led a team of researchers who gave pregnant women phosphatidylcholine supplements in the last two trimesters of pregnancy, and after birth while they were nursing.

Then they tested the babies’ response to an auditory test that’s used as a “marker” for elevated risk of developing schizophrenia later in life. The choline-supplemented babies had double the chance of responding appropriately to the test, which involves analyzing their response to a series of repeated clicking sounds.

Previous studies have also documented the effects of prenatal choline supplementation on developing brains. In one double-blind study published in Brain Research, the offspring of pregnant mice fed supplemental choline had better memories, learned faster, and had larger brain cells compared to those fed a normal diet. In another mouse study, prenatal choline supplementation helped babies born with Down’s syndrome learn better and even protected the mice’s brains from Alzheimer’s later in life.

In turn, too little choline has negative effects on brain development, according to researchers at Stanford, who demonstrated that when women had low blood levels of choline they were at higher risk of their babies developing neural tube defects. The reason that phosphatidylcholine is being studied so intensively for its effects on the brain is that it’s a precursor of choline and acetylcholine, which play a key role in brain activity.

Why do studies on prenatal supplementation matter to the rest of us? Because it’s not just the prenatal brain that’s stimulated and strengthened by phosphatidylcholine (PC). Neuroscientists have been studying the potential of choline to prevent cognitive decline and the onset of Alzheimer’s and dementia and even to regrow brain cells as we age. In several oft-cited studies by Elizabeth Gould and Charles Gross of Princeton University, phosphatidylcholine was found to stimulate the growth of new brain cells and neural connections, a process known as neurogenesis and once thought impossible after a certain age.

Researchers are studying phosphatidylcholine’s effect on numerous conditions that seem oddly unrelated to each other. That’s because it’s value comes from its role as a key building block of cell membranes, which means it protects the cells that line the digestive tract and the liver, as well as brain and nerve cells. Phosphatidylcholine can lower cholesterol, protect the liver from disease, including hepatitis, and appears to help alcoholics stave off cirrhosis.

Doctors often recommend PC to people living with hepatitis C for its liver-protective benefits, particularly in conjunction with interferon therapy. By protecting the cells that line the digestive tract and reducing inflammation, PC may also ease conditions such as ulcerative colitis and IBS.

Pharmaceutical companies are getting on the PC bandwagon too. PLx Pharmaceuticals of Houston has numerous products in the pipeline that use PC to protect the gastrointestinal tract from the caustic effects of NSAIDs. Called PLxGuard, the technology is being tested in an over-the-counter aspirin product and in drugs for osteoarthritis, chronic pain, gout, and other conditions.

In 2012, PLx received a half-million-dollar-grant from the Eunice Kennedy Shriver foundation to study the potential of using PC to prevent intestinal perforation in premature and low-birthweight infants being treated with IV indomethacin, an NSAID-based drug treatment used to treat a common congenital heart defect that’s the leading cause of death in these babies.

Lipid Therapeutics of Heidelberg Germany is testing a phosphatidylcholine-based drug therapy to treat ulcerative colitis. The drug, currently called, LT-02, completed a successful Phase IIB trial in 2011.

Weirdly, PC is also the substance used in cosmetic procedures that dissolve fat. Injected under the skin, phosphatidylcholine was first used by dermatologists to dissolve lipomas and other fatty deposits under the skin and is now used (in procedures known as body contouring) in areas like the thighs and under the eyes and, in recent studies, under the chin. Numerous studies are ongoing about the safety of this procedure.

If you’re confused and wondering about the connection between phosphatidycholine, soy, and lecithin, a supplement you may have experimented with in the past, here’s how the connection works. Phosphatidylcholine is actually a purified extract of lecithin, which contains several different phospholipids, and 10 to 20 percent of which are phosphatidylcholine. Soy is usually the source of supplemental lecithin and phosphatidylcholine.

In the past few years, as research has zeroed in on the specific benefits of phosphatidylcholine, lecithin products with higher levels of this specific phospholipid became available, and now supplements labeled phosphatidylcholine share the shelves with those labeled lecithin, or soy lecithin.

Eggs and soybeans are the best source of choline, followed by meat (particularly liver), seeds, and nuts. But it’s not easy to get enough phosphatidylcholine from your diet, particularly if you’re trying to cut down on meat and eggs to control cholesterol. Most of the experiments with PC have been done with upwards of 5000 mg (the schizophrenia study used 6300 in two doses), and you’d likely need a choline-rich diet and a supplement to get anywhere close to that level.

Note: When buying supplements, look closely at the number of milligrams in each capsule, and the dosage. The brand I bought, labeled confusingly (see illo), turned out to contain just 400 mg per soft gel capsule so I would need to take 6 pills to get the active dose used in the schizophrenia study.

Confusingly enough, there is another phospholipid that natural health gurus are also touting for its memory sharpening effects. Phosphatidyl serine (PS) is also being studied for its effects on mood regulation, cognitive function, and anti-aging.

How Your Brain Tells You When It’s Time for a Break

Are you reading this when you should be working? If so, then it may be because your brain signaled that continuing to work was not worth the cost in tedium of forcing yourself to stay on task.

New research published in the Proceedings of the National Academy of Sciences offers insight into how people decide when to keep going and when to take a break. That decision apparently hinges on a specific signal that at its peak— say, when your muscles are screaming that you can’t do another rep or your brain refuses to focus on the page — prompts you to quit. And when your body and brain are refreshed and ready to go again, the signal quiets down and gets out of your way.

The peaks and valleys that trigger these decisions, however, are not pre-set: they’re influenced by how much effort you’re expending and how big a reward you expect from the work. The bigger the reward and the smaller the effort required, the more likely you are to keep going until you’ve done what needs doing. As you work, it seems, your brain continuously calibrates your breaking point in relation to your expectations of gain.

To understand this signaling, researchers led by Mathias Pessiglione of the Motivation Brain and Behavior Laboratory of INSERM in Paris, France, studied 39 people using two brain imaging techniques—fMRI, which maps blood flow to particular brain regions as participants perform certain tasks, and MEG, which uses magnetic fields to follow the brain’s electrical signaling. They were tested while squeezing a handgrip at maximum effort to earn varying monetary rewards. The handgrip was calibrated to each person’s strength and the intensity of effort was displayed on a computer screen as a thermometer— participants had to keep the fluid level in the thermometer over a certain point in order to win the money.

While the volunteers were warned that the amount of effort required might vary during the test, they did not know when it would change. They were shown on the screen how much money was at stake in each 30 second trial— 10, 20 or 50 cents in Euros— and instructed to try to win as much as possible.

During the challenge, both types of brain scans showed activity in a region involved in pain perception, known as the posterior insula. The signal there became more intense when greater effort was required— but less strong when the same level of effort was connected with a bigger potential reward. Bigger rewards also led to a muted signal during rest periods between the tests, meaning people would both expend more effort and require less rest when more was at stake.

The authors write, “[This] process might implement the intuitive psychological phenomenon that, when motivated, we literally push back our limits,” allowing us to worker harder for longer. The study did not ask participants about whether they actually felt less pain or fatigue when expecting bigger rewards, although other research suggests that this change in perception may drive the way the signal affects behavior.

For example, research on pain perception shows that placebos and medications can both relieve pain by changing signaling in this region— and other studies suggest that situational factors like music, stress or the presence of an attractive potential mate also affect how much pain is seen as tolerable.

“[T]he brain can indeed adjust the sensitivity of these regions depending on expectations,” the authors conclude. To push yourself through the pain, it seems, it helps to expect great gain.