There are more options to treat anxiety than you realize
You might be surprised that one of the most difficult psychiatric conditions to treat is clinical anxiety. For most folks, pathological anxiety begins in childhood, and by the time someone gets to see a medication specialist in my area, a person has often been struggling for decades, and has already seen a therapist and tried medication offered by the primary care physician.
By pathological anxiety, I don’t necessarily mean the nervousness that comes before public speaking or watching your kid perform at a recital…anxiety can be a good thing, to help us prepare and get things done. If we didn’t have anxiety about the possibility of being evicted, we might not be on top of paying the rent every month. When anxiety becomes crippling, when it prevents you from going out, from enjoying social interactions, or becomes so pervasive that you are worried all the time with chronic physical symptoms like headaches or irritable bowel…then it crosses the line into the pathologic.
Anxiety is also a driving force and complication for many other psychiatric issues, such as clinical depression. Many folks with ADHD use anxiety to help them focus and get work done (the classic example is waiting until the last minute to get a project done, then anxiety drives you to stay up all night and hyper focus on making a great paper.) While there’s nothing necessarily wrong with that in the short term, over the long term, chronic stress and anxiety will affect sleep, cardiovascular health, and enjoyment of life in general. I’ve met plenty of people who not only cannot relax, they actively resist doing so, as they’ve been relying on anxiety to keep them going for so many years. The same sorts of folks tend to hate interventions like mindfulness, yoga, or meditation, as it feels extremely uncomfortable and a waste of time. After all, they are super busy and stressed out, and now we want to add more things like…sitting still and clearing the mind to the schedule?
For a psychiatrist, this presents a clinical conundrum. The early interventions like therapy and an SSRI or buspirone have failed, but you have someone sitting in your office whose life is devoured by stress. Maybe they are smoking a lot of pot or drinking to get to sleep at night, so they wake up more anxious with rebound anxiety in the middle of the night. At this point we don’t have too many options left…more meds, now with more risk and side effects than the ones already tried (and someone with a bad experience with prior meds *and* anxiety may reasonably balk at trying another). Now you’re in the position of trying to help a strung out and overwhelmed person not only give up the nightly three glasses of wine that is the only thing that settles them down and asking them to take on a part time job of self-care (exercise, plenty of sleep, down time) before everything gets worse.
As I discovered a year or so ago, there is another non-medication option for treating anxiety with several positive randomized controlled trials and decades of clinical use, especially in the military and in dentists’ offices. Various Cranial Electrostimulation (CES) devices are FDA cleared for this purpose. I have most experience with the Alpha-Stim. It uses a small current that has the result of increasing alpha waves, decreasing deep sleep delta waves, and decreasing feelings of stress and improving sleep. While some folks can’t tolerate it (due to headaches or a seasick feeling), most people do well, and many notice anxiety melting away in the moment, leaving you with a feeling of calm alertness that can last for a day or more. It’s not addictive, and if used properly has few if any self-limited side effects. The main down side of the treatment is cost…the retail price is $800 in the US. While that is less than a single day’s hospitalization, since it is often not covered by insurance, it can be out of reach for many people (especially as financial worries are often a cause of chronic stress and anxiety).
The NHS did an open label study published in May in the Journal of Affective Disorders offering Alpha-stim to patients who had generalized anxiety disorder, had failed minor therapeutic interventions, and were on the waiting list for more intensive Cognitive Behavioral Therapy (CBT) for anxiety. Half the patients out of 161 recruited had their anxiety symptoms remit with 6 weeks of Alpha-stim and so they did not have to go into the more intensive therapy. The researchers estimated that they saved 540 pounds ($685) per patient by using the CES device rather than CBT. Without a control group or blinding, the study has limitations, but other blinded, randomized controlled trials have also shown CES to be beneficial for anxiety.
The paradoxical thing about chronic anxiety is that someone who is feeling better has more time and energy to take on better self-care. They have the confidence to say no to bosses and family members asking for more and more. They are sleeping better so they feel more like exercising…which will help them sleep better. They don’t desperately need that drink or three or the dose of clonazepam when they get home from work to wind down and get to sleep in the first place. We need more interventions to break the cycle of anxiety and help folks take control of their lives.
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