WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUT (TM): ANXIETY, PHOBIAS, AND PANIC ATTACKS

Copyright © 2005 by Douglas Hunt, M.D.

All rights reserved.

Warner Books

Hachette Book Group

237 Park Avenue, New York, NY 10017

Visit our Web site at www.HachetteBookGroup.com.

First eBook Edition: November 2005

ISBN: 978-0-446-56151-8

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COULD YOU BE SUFFERING FROM ANXIETY DISORDER AND NOT EVEN KNOW IT?

Anxiety affects millions of people, and the signs can be more subtle than you think. You don't have to be someone who trembles at the thought of social interaction or is unable to keep a job because of obsessive hand washing or counting aloud.

The following patients were recently diagnosed with an anxiety disorder:

* Jill, age thirty, a costar in a television sitcom who lives in fear that her mind will go blank and she will forget her lines

* Sam, age forty-one, a well-known criminal-defense attorney who suffers from sleep disorder and fear of flying

* Matt, age twenty-seven, a bright doctoral student with a family history of phobias who has a fear of heights and social interaction.

This is the new face of anxiety disorders. If you see yourself reflected in these descriptions, know that there is hope. Like these patients, you can achieve a happy, stable life naturally—without drugs—if you begin to learn . . .

WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUT ANXIETY, PHOBIAS, AND PANIC ATTACKS

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This book is dedicated to Jeanne Manning for her tireless efforts in tediously reading and rereading the manuscript for corrections. Her "schoolteacher" comments made my job harder but more rewarding. The book is also dedicated to Debra Fulghum Bruce, Ph.D., who spent an inordinate amount of time reviewing and polishing the material. I also want to dedicate this book to my wife, Mary Hunt, who allowed me the time it takes for research, as well as writing. And, finally, thank you, Denise Marcil, my literary agent, for bringing this opportunity to me. Thanks, to all four of you wonderful ladies.

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Preface

This is a book about fear—and how to control it naturally. Fear is a tremendous handicap. Although it may not be a physical one, obvious to all, it is a disability and it affects millions. Fear is an intense sense of "substantial uncertainty" and it manifests itself in many ways with anxiety, stress, phobia, panic, nervousness, hypervigilance (acute awareness of your surroundings), and excessive worry.

The tragic events of September 11, 2001, reminded all Americans of our vulnerability, both as a nation and as individuals. Yet beyond the nagging fear of terrorism, each day we are confronted with more stressors—whether from job loss, divorce, death of a loved one, a rebellious teenager, caring for an elderly parent, or being diagnosed with a chronic illness. We all feel fear more now than ever before—and we are overwhelmed. Overpowering fear can incapacitate you just as much as blindness or a broken leg. Not only does fear disable motivation, it inhibits our ability to think clearly, make commitments, solve problems, and act decisively. Fear robs us of doing our best work and affects our quality of life; we can't experience any of life's pleasurable feelings when our stomach is in knots. Pervasive and intense uncertainty interferes with strong relationships, job performance, and social life. Fear is a challenging disability.

You might wonder why I make so much of redefining fear or describing uncertainty as a disability. That's because most people don't appreciate the damaging effects created by chronic fears such as developed anxiety disorders, panic, sleep problems, and more, and won't (or don't) take the appropriate actions to control these fears. I've seen people suffer with anxiety and worry for years before they finally give in and admit that something has to be done; fear is ruining their life.

For many of us, the only step we take to overcome fear is to see a doctor or therapist and get a prescription for some kind of medication and not much else—not even an explanation of how the drug works or its possible side effects. However, I know that drugs are not the long-term solution to the problem of fear. You don't have to take pills to recover from anxiety and panic disorders. I've learned this from more than thirty years as a practicing psychiatrist, treating anxiety, fears, phobias, and panic attacks without drugs.

Granted, some of us are born anxious; and others become anxious as a result of situational stress or threat to one's life, property, or relationships. The good news is that anxiety is a potent motivating force for needed change and a vital quality for survival. Yet, like all forces, anxiety can get out of hand and begin to do more harm than good. At that point, at the point of excess, we describe anxiety as a disabling disease.

Billions of dollars have been spent searching for a solution to disabling anxiety. What causes this disease is much simpler to answer than what perpetuates it. There is no doubt that fear causes physical changes, permanently or semipermanently. The drugs related to anxiety all reflect the changing viewpoints of scientists regarding what really perpetuates it. For example, the psychiatric view of the cause for chronic anxiety is multifaceted, including:

•  genetic factors

•  neurotransmitter excess or deficiency

•  memory disturbances

•  anatomical organ deficits in critical areas of the brain

•  adrenergic over-activity

Yes, this list is long and grows daily, as does the conveyer belt of new drug applications seeking approval because of the inadequacies of our current medications. While each new drug approaches the problem of anxiety from a different perspective, most pharmaceuticals that resolve anxiety come with a lengthy list of side effects.

Perhaps that's one reason a growing number of Americans are exploring alternative or natural therapies for relief of mild anxiety and associated problems, even as the potential benefits of conventional pharmaceuticals seem to improve. Seeking a healing relationship between patient and health care provider, these men and women hold true to the philosophy that natural or less invasive therapies can optimize a person's innate healing capacity. The best health care is based in good science, and it is also open to new paradigms and promotes the appropriate use of more natural, less invasive treatments whenever possible.

In 2003 alone, more Americans visited an alternative therapist (about 600 million) than a primary care physician and spent their own money for this opportunity (about $30 billion). Annually, we spend about $250 million a year on homeopathic remedies, and more than $4 billion on natural dietary supplements, including herbs. Yet how is a person to know which of these alternative treatments are safe and effective? And what about conventional medications? Can prescribed pharmaceuticals even with all their rigorous testing be trusted to promote healing without causing undesirable side effects? (After all, more than 100,000 deaths a year occur in U.S. hospitals because of adverse reactions to common medications.)

There are credible answers, and this book provides them.

I wrote this book to present a revolutionary program for ending anxiety disorders and living fear-free with natural therapies that are substantiated by modern science without being inhibited by it. For this very reason, my 5-step program is multifaceted and focuses on many natural therapies and lifestyle changes rather than one answer to relieve anxiety disorders. I believe in addressing the mind, body, and spirit in a way that is effective, reasonably priced, and free of adverse side effects.

With formal training as a psychiatrist, I practiced as one for years before I transitioned from a drug-dominated conventional approach into a natural, complementary one. For more than thirty years, I have been practicing alternative and preventive integrative medicine. Integrative medicine is a method of healing that focuses on health rather than on disease, the oneness of mind and body, and the ability of the body to heal itself with the proper support. To do this, I utilize a considerable variety of nonprescription agents to improve health problems, including those involving mental health. I believe that the doctor and patient should work in partnership, employing therapies that support the natural capacity for healing we all possess.

The key to this book may be found in these few words: Mental stability reflects physical stability: unreasonable anxiety is a form of mental instability, often stemming from impaired physical health. Physical health is not exclusively organ health; it includes biochemical efficiency, and physiological and even genetic function. This book will help you to search out physical weaknesses and eliminate them. Sleep, energy, hormone balance, and immune strength, among others, all influence physical health and, ultimately, mental stability. Drugs can control anxiety, but so can a stronger and healthier body!

In this book, I provide you with my 5-step holistic program filled with practical and action-oriented alternative solutions and information for recovery. You are about to learn some simple lessons and explore some tools that will free you from your burden. Fear is an emotional disability, but I know it is one you can overcome.

Finally, this book is not meant to take the place of one-on-one therapy. Read it, take copious notes, and then make an appointment with your doctor to talk about the natural solutions that might help your situation. Good luck!

Douglas Hunt, M.D.

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Part 1

UNDERSTANDING ANXIETY

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Chapter 1

What Your Doctor May Not Be Telling You

Picture someone who suffers with an anxiety disorder. Do you immediately think of a withdrawn recluse who trembles at the thought of social interaction? Perhaps you envision a neurotic young man who cannot hold a job because of obsessive-compulsive behavior such as constant hand washing or counting aloud.

I want you to imagine the following patients who were recently diagnosed with an anxiety disorder in my clinic:

•  Jill, age thirty, a rising young actress and costar in a television sitcom who lives in fear that her mind will go blank and she will forget her lines.

•  Sam, age forty-one, a well-known criminal attorney who suffers with sleep disorder and fear of flying.

•  Carmen, age fifty, a boutique owner and mother of four whose husband ran off with a young business colleague without any warning, leaving her with feelings of rejection and fears of abandonment.

•  Matt, age twenty-seven, a bright doctoral student with a family history of anxiety and phobias who has a fear of heights and social interaction.

The truth is that most people wouldn't associate these men and women with having an anxiety disorder. But these people reflect the new face of anxiety disorders. Perhaps you even see yourself in their descriptions.

I've successfully treated these adults—and thousands more—from a host of anxiety disorders that used to engulf them in fear, phobias, panic, and obsessions. Today, they live happy, stable lives and have learned natural ways to alleviate the anxiety and cope with the uncomfortable symptoms.

OUR ANXIOUS NATION

If you or a loved one suffers with an anxiety disorder, you are not alone. The latest surveys show that more than 20 million Americans suffer from an anxiety disorder in any given year and another 30 million will have the problem at least once during their lifetime. From panic, fears, and phobias to obsessive-compulsive disorder and post-traumatic stress, anxiety manifests in mysterious ways and does not discriminate by age, gender, or race. Statistics indicate that specific phobias lead the list with 6.3 million people affected, and panic disorder affects another 2.4 million.

No matter what type of anxiety disorder you or a loved one might have, you know it can plague all aspects of life: your marital and family relationships, productivity and ability to earn a good living, sleep, eating habits, exercise and activity, and overall well-being.

While anxiety disorders impose a high personal burden, they are costly to society as well. Anxiety sufferers utilize up to a third of every dollar spent on health care in the United States, with doctor visits at nearly $22 billion a year. Along with emergency care, prescription drugs, and hospitalization, we have lost productivity, absenteeism, and a combination of malingering and genuine discomfort.

Anxiety disorders don't just disappear overnight. They usually are chronic problems and are just as disabling as any physical ailment. In the most severe cases, depression and suicide attempts often follow long-term unresolved anxiety.

Besides living with the burden of a chronic, dysfunctional state, the anxiety patient often endures a lack of respect for having this disease. Many physicians reflect societal prejudice that anxiety patients simply suffer from a flawed character. Despite the prevalence of significant psychiatric disorders, fewer than one in three adults ever seek help for this problem. And, when they do seek help, it's often for another medical reason and therefore confusing to the health care provider.

Very often, the first time a doctor sees a patient suffering from anxiety, the presenting symptom is a physical complaint. For instance, post-traumatic stress disorder (PTSD) patients often seek help for cardiovascular, neurological, respiratory, or musculoskeletal problems. During a doctor's consultation, they rarely mention anxiety unless the physician discovers the underlying problem and mentions it first. Generalized anxiety disorder (GAD) patients often seek help for nonspecific pains in the chest, which they believe to be angina or heart-related. Many anxiety patients see themselves as being less physically and psychologically capable than others and may even perceive themselves as having a disability.

UNDERSTANDING ANXIETY DISORDERS

The word "anxiety" means to anticipate future danger or misfortune, internal or external, and to be apprehensive about it. The body reacts to these thoughts by creating physical tension and significant discomfort. Throughout this book, I'll be talking about anxiety at a level exceeding that of the average person's distress, to a point where anxiety has become a disease. There are certain criteria that must be met if a condition is to be designated an anxiety disorder:

1. There must be significant mental distress; and

2. There must be impairment in the social, work, or other important areas of daily life.

When we categorize anxiety, this does not mean that nothing else may be going on. Categorizing by similarities is one method of organizing and nothing more. All of those patients who constitute a category are still people with different personalities and possibly other emotional or physical problems. The classifications of these disorders are strictly for clinical, educational, and research purposes. In reality, it has become part of a system necessary for third-party payment and various legalities. Perhaps, more than anything else, the system provides a method of communication between participants in the health system.

The official Diagnostic and Statistical Manual of Mental Disorders is commonly used as a guideline for diagnosis of anxiety, phobias, panic, and stress-related problems. However, as a physician, I believe that this manual is not the be-all and end-all when it comes to making an accurate finding. If you expect absolute precision in the diagnosis of an anxiety disorder, you will be disappointed, as there are no specific boundaries to encompass this type of disorder. That's because there are so many perspectives from which to view anxiety, including distress, adaptability, self-control, disability, inflexibility, irrationality, cause, a measure of deviation, and so on. There also is a great deal of leeway in the present diagnostic system, allowing room for a clinician's personal opinion. The openness of the system does not leave gaps as one might think, but rather it allows for greater flexibility. In other words, the experienced clinician can exercise her own personal judgment as to what she is seeing and treating with the patient.

To summarize, nothing is black-and-white in the present system of diagnosis for anxiety disorders. Many patients come to see me because they have already seen three to five health care professionals and are discouraged by a lack of concrete diagnosis or by what they suspect to be a misdiagnosis of their anxiety problem. They are also frustrated by the resultant ineffective treatment. With most medical problems, we are used to a laboratory test that determines the exact problem and medication that treats that problem. But there is no specific laboratory test or exact medication that will end anxiety disorders quickly. Rather, it takes time for you to work with your doctor to narrow down the diagnosis and then use trial and error to find the exact pharmaceuticals or nutrients that work with your body's chemistry to resolve the problem. I always remind patients that the boundaries of each type of anxiety disorder are flexible. This fluidity is primarily due to the many theories as to how people become ill. I will cover this more throughout the book.

ANXIETY KNOWS NO BARRIERS

As stated, anxiety knows no barrier in age or gender. In addition, increasingly more children today harbor high anxiety, which can lead to depression or other disabilities. The onset of anxiety at a young age, combined with some depression and moodiness, can significantly affect schoolwork and sabotage academic success. For instance, in findings published in August 2003 in the journal Archives of General Psychiatry, researchers set out to determine the level of disability in children incurred by problems such as anxiety. A representative sample of participants was followed for six years to measure the disability that occurred secondary to psychological symptoms. The authors identified three areas that were specifically affected, including family, school, and peer relationships. They concluded that boys had more trouble in school, while girls had more problems with their family. The childhood anxiety was as likely to result in disability, as was depression.

In a follow-up study, 1,420 children ages nine to thirteen were assessed annually for a psychiatric disorder until they were sixteen. During that period, 13.3 percent of the participants had at least one psychiatric disorder (panic, depression, anxiety, social anxiety, or substance abuse), although it was not necessarily chronic or long lasting. Girls, in particular, seemed to cycle back and forth from anxiety to depression. The authors concluded that the risk of a child having at least one psychiatric disorder by age sixteen is much higher than previously suggested and that girls are more likely to be affected.

Although the initial cause of anxiety may emanate as much from family situations as from other factors, the existence of the anxiety state further destabilizes all other aspects of a youngster's life. If the trigger that initiates the anxiety is particularly severe stress, then the victim may feel as if her life has changed forever.

Older Adults

Anxiety rears its ugly head among older adults as well, with 15 percent of older men and women reporting anxiety symptoms (feeling fearful, tense, or nervous). Moreover, 43 percent of those with depression experience anxiety, according to research published in the April 2003 issue of the Journal of the American Geriatrics Society. In this particular study, 3,041 patients were asked if they experienced at least two episodes a week of intense anxiety. The results were no surprise—they did. Other studies have indicated a higher incidence of anxiety. If there were difficulties with hearing, or if they experienced incontinence, hypertension, or poor sleep (common in the elderly), the number of patients reporting anxiety increased significantly. Patients whose social functioning was poor and who needed extra emotional support were more likely to have greater and often chronic anxiety symptoms.

It is believed that anxiety in the elderly may be a better predictor than depression of eventual dementia. One illuminating study published in the July 2002 issue of the journal Medicine and Science in Sports and Exercise revealed that chronic anxiety might lead to memory impairment, further cognitive decline, and finally senility.

Lifetime Relevance

Although intense anxiety is commonplace in modern-day urban life, it is not considered a disorder until it interferes with normal activities. If you don't have an anxiety disorder, you might wonder what your risk is of developing one in the future. Here are some of the latest statistics:

•  25 percent chance of an anxiety disorder

•  2 to 3 percent chance of a panic disorder

•  4 to 5 percent chance of agoraphobia

•  3 percent chance of obsessive-compulsive disorder

•  13 percent chance of social phobia

•  11 percent chance of any specific phobias

•  7 to 8 percent chance of post-traumatic stress disorder

MY PROBLEMS WITH DRUG THERAPY

So, if you are diagnosed with an anxiety disorder, you simply pop a pill to alleviate it, right? Wrong! While some anxiety disorders respond to pharmaceuticals, there are short- and long-term adverse effects to be considered that can often be more crippling than the disorder itself. In addition, pharmaceuticals are extremely costly compared to natural therapies, which are usually found over-the-counter at your local health food store. My holistic program will show you a safer, cheaper, and more effective way to strengthen the body and increase wellness, and in doing so, reduce anxiety.

When I started my practice in the 1960s, pharmaceuticals were usually reserved for hospitalized patients and psychotics. Of course, there were many other modalities available then, and I'll get to them in a moment. But first I want to share with you my initial experiences with psychotropic drugs, which explain why I resisted the pressure of joining other doctors in embracing prescription drugs as mainstream psychiatric therapy.

Keep in mind that "psychotropic" and "psychoactive" have virtually the same meaning and are often interchangeable words. They describe a drug, generally used to treat mental illness, which has the ability to alter moods, anxiety, behavior, thinking processes or mental tension.

Short-Term Side Effects

I'm a prime example of someone whose body and mind are not the least bit compatible with mind-altering drugs. For example, if I take a stimulant such as a mild appetite suppressor or even a cup of coffee, I will develop tachycardia (rapid heartbeat) and an arrhythmia (irregular heartbeat) that lasts anywhere from hours to days. This is dangerous, to say the least—not to mention unpleasant. When I am in this altered, medicated state, I am unable to focus my thoughts or do any constructive work. If I ingest a tranquilizer (a downer), I am zonked out for a day and a half.

To give you an idea, when I was an intern, I once took a 10 milligram (mg) Valium (diazepam), a commonly prescribed class of drug called benzodiazepine, before going to work. After taking this anti-anxiety agent, I literally was unable to get off the couch for a full day. I had to call in sick—the only day of my entire internship that I missed. Psychoactive drugs and I simply do not get along.

Many of my patients have experienced the same adverse effect with benzodiazepines. Along with the drowsiness, they have reported slurred speech and dizziness. One patient, thirty-two-year-old Victoria, said she was unable to wake up until noon after taking medication the night before for mild anxiety. When she awoke, she discovered that her two preschoolers had unlocked the front door and were playing in the front yard near a busy highway. I'm sure Victoria's mild anxiety turned into outright panic when she thought of what could have happened to her unsupervised young children.

Another woman, Caroline, age forty-seven, took Valium to help ease anxiety during a lengthy divorce. She came to me for a natural therapy, saying the tranquilizer made her so numb that she was devoid of all emotions. "The drug calmed my anxiety," Caroline said, "but after taking it for a week, it also dulled any joy or enthusiasm I had for life."

People who do not have problems with drugs are often puzzled by or suspicious of those who say they can't take mind-altering medications. To them I say, why not see this for what it is—one extreme along the spectrum of responses to chemicals. At the other extreme are those who never feel normal without drugs. These people can easily become abusers. In between, we find the average person, who can tolerate the majority of drugs pretty well. Still, there is more to the problem of taking drugs than simple tolerance.

Long-Term Adverse Effects