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Anxiety and Stress Management

with Patricia A. Farrell, PhD

The Anxiety and Stress Management blog has now been retired. You can still find Dr. Farrell at the WebMD Anxiety & Panic Disorders Exchange. And you can visit the Anxiety & Panic Disorders Health Center for more information about these conditions.

Wednesday, May 31, 2006

Genealogy and Health

Genealogy has become an interest of mine and, in search of my long-gone ancestors I have found that there is more than family history as we know it here. In genealogy we find the clues to our own history of illness or lack thereof and so it is with interest that I saw the Surgeon General of the U.S. realized a software tool to help all of us with our health would be a good idea.

My Family History Portrait
is free software that you can download and use. The site describes it as: “a visual depiction of your family tree. It is constructed using circles and squares to see who is related to whom and how they are related. In terms of health and disease, a family health portrait can help show a health care provider how a particular trait or disease is passed on from generation to generation.”

So, in addition to helping you pass this valuable information on to other family members, it’s a way of seeing how health is a part of genealogy.

I remember one of my first biology classes in high school where they unraveled the mystery of eye color. There are a lot of people in my extended family and all of them have variations of grey, blue or green eyes, except for my mother. My mother had hazel eyes and, as such, she was the only brown eyed member among us.

How could this have happened? Simple genetics tells us that blue is a recessive gene (only comes out when it meets another blue/grey/green gene) and brown is a dominant gene (it rules the roost)

Voila’! My mother had light-eyed relatives in her family tree because that’s the only way we got to have these blue/grey eyed members. Brown-eyed people can have one gene for brown and one for blue/grey/green, but blue-eyed people have both of their eye color genes for that same blue/grey/green color. So while brown-eyed people can have children with either brown or light-colored eyes, light-eyed people can only have light-eyed children if they have children with a light-eyed mate.

When we start to look at a family tree in terms of genes and what they bring to us, we look at a connection to people we never knew, but who, nevertheless, passed on to us abilities that may now confound us.

What makes some of us so sensitive to the environment or to stress or anxiety? Somewhere, sometime in the long-distant past, one of our relatives managed to survive because of this genetic inheritance. Perhaps he or she managed to avoid the dangers of a saber toothed tiger or a giant lizard or to steer clear of a bog and those who possessed this inner programming survived to pass that survival gene on to us.

The environment has changed, undoubtedly, but we are still reacting in situations as though there were still real danger. So, it would seem, anxiety, panic and even depression runs in families and at one time they may all have had their place in helping our ancestors live in a hostile environment.

While science unravels the mystery of our genetic inheritance, we can do our own investigation via genealogy research. The internet is packed with sites that can help you find databases that will tell you more than you could have found prior to this age of computers. My search continues. I hope you begin yours.

Related Topics: Is Intelligence in the Genes?, Women’s Top 5 Health Concerns

Technorati Tags: genetics, family history, genealogy

Posted by: Patricia Farrell, PhD at 12:37 am

Tuesday, May 30, 2006

Oh, That Jaw Pain

One of the things I frequently see mentioned on my Anxiety/Panic board are questions from people who are experiencing jaw pain. The main concern, of course, is that jaw pain has been one of the warning signs of heart attack and it certainly is a concern.

I recently ran across an interesting article on the relationship between severe jaw pain and stress and it indicated that women appeared to be prominent in the 10 million Americans who suffer from TMJ Syndrome. The symptoms of this pain include muscle jaw tenderness, difficulty opening the mouth, a jaw that locks, and clicking or popping sounds from the jaw when opening and closing the mouth. Some dentists have referred to this problem as TMJ subluxation and it may run in families.

The article I saw referred to research out of the Johns Hopkins University School of Medicine where they found that, while TMJ isn’t new, it’s still poorly understood, but one thing stood out. One of the researchers indicated that TMJ is often associated with depression, anxiety, sleep disturbances, GI problems and frequent infection. If infection is involved, my immediate thought was that there’s an immune system relationship and we know that stress is a culprit here. Sure enough, the researchers thought this, too, and as they enroll patients into their studies, they are looking at behavioral interventions to help patients become more aware of such things as clenching their teeth or biting on pens or pencils.

One of the interests facts about the study is that they’re looking at people who have had a variety of treatments for TMJ before, so what this is then is a study of people who have “failed” other experimental interventions. This is a good idea, to my mind, because it means that even though other interventions didn’t work for you, there are still things that need to be explored and which may help you with TMJ.

Related Links: WebMD Video: Too Scared, Coping with Anxiety

Technorati Tags: TMJ, Temporomandibular, Anxiety, Depression

Posted by: Patricia Farrell, PhD at 12:38 am

Wednesday, May 24, 2006

Prozac and Brain Growth

The SSRI meds are known to have a rather unique ability and that is they can cause something called “upregulation,” meaning they cause receptor sites to mushroom. Where there were few, after the treatments, there are many, but how this was accomplished wasn’t understood.

Now, researchers at Cold Spring Harbor Laboratory on Long Island seem to have broken the mystery with Prozac (fluoxetine). The findings indicate that the SSRI med was vital in the second step of the process from stem cell to neuron and promoted the growth of cells called ANP (amplifying neural progenitors).

The researchers also believe this breakthrough may mean that a more efficient means of “training” stem cells to mature into new neurons may not be far away.

Now their task is to look at ways to devise new tools and approaches to see if other meds use the same pathways and action in the brain and if deep brain stimulation might also work in the same way. The open-access article appears in the May 15, 2006 edition of Proceedings of the National Academy of Sciences and is available on line.

Related Topics: Anxiety Often Missed in the Elderly, Why Memory May Falter With Age

Technorati Tags: SSRI, Depression, Anxiety, Receptor sites, Brain growth

Posted by: Patricia Farrell, PhD at 5:08 pm

Sunday, May 21, 2006

Women and Abuse

What price do abused women pay for their abuse? According to a study of almost 3,500 women, aged 18-64 who were members of a health maintenance organization, 44% of them were victims of violence by one or more past or present intimate partners.

Women who were abused, either physically or mentally, were “four times as likely to have severe depressive symptoms,” and twice as likely to have depression. In terms of health, they were three times as likely to have health problems. We know that stress, whether from physical or mental abuse, depletes the immune system, so it is no wonder that their health was affected.

The most common victims were younger women, those with low income, less education, single mothers or who had been victims of abuse as children. The results of the research appear in the June 2006 issue of the American Journal of Preventive Medicine.

Some of the women were currently in a dangerous relationship and were given code sentences to say if their abuser were present during the telephone survey. Just answering the survey could have put any of these women in additional peril.

The researchers suggested that physicians need to begin to find ways to address possible abuse. Unlike child abuse, which must be reported if there’s even a suspicion of abuse, abuse of partners is not a mandatory reportable action. Only in the past several decades have we seen changes in both our community police policies and the medical community where a greater sense of awareness has emerged as the result of newspaper reporting of significant cases of abuse.

To my mind, it calls for professionals to formulate a plan of on-going continuing medical education around this issue. Until we begin to be willing to ask, the cries of these women will remain unheard and their needs unaddressed.

Related Topics: Child Sex Abuse Affects Both Genders Long-Term, Bad Marriage Can Make You Sick

Technorati Tags: domestic violence, spousal abuse, women, health

Posted by: Patricia Farrell, PhD at 9:46 pm

Wednesday, May 17, 2006

Grapefruit Juice and Medications

Take a look at any medication you’re receiving now and see if there’s a warning that grapefruit juice is to be avoided. While most of us understand there must be a reason for this, few of us would know what that might be. People taking certain types of medications for hypertension, anxiety, depression or cholesterol were at risk if they drank grapefruit juice while on these medications.

The active ingredient normally found in grapefruit juice caused an intestinal enzyme (CYP3A) not to allow the normal breakdown of the medication and the result was higher-than-expected drug levels in the blood.

An article in the American Journal of Clinical Nutrition (May 2006, 83/5, 1097-1105) has now provided some insight into how this takes place. Looking at a sample of healthy volunteers to whom they fed three types of juice (orange, regular grapefruit and grapefruit without furanocoumarin), the researchers found that the grapefruit juice without the offending ingredient (furanocoumarin) caused no problem and this was a finding that has three benefits.

First, foods that contain the ingredient can now be identified for increased patient awareness and safety. Second, the ingredient could be removed from grapefruit juice making it safe for anyone to consume. Third, adding the ingredient to certain medication formulations could increase their action by controlling the normal elimination of the medication from the body.

Related Topics: Medication Interactions, Drug Interaction Checker (Medscape)

Technorati Tags: grapefruit juice, antidepressants

Posted by: Patricia Farrell, PhD at 11:30 am

Monday, May 15, 2006

Self-esteem and relationships

What can detract from your relationship and actually work against it? According to an article in the Journal of Personality and Social Psychology (90, 4) it’s your self-esteem. Low self-esteem had a negative impact on people’s judgment vis-à-vis their relationships. So self-esteem, according to the researchers, caused people to see their relationship in either a good or bad light. They also report more change in their view of their partners while the high self-esteem individuals are able to take the good with the bad and create a whole, more realistic, picture of their relationship.

Interesting, the view of those with low self-esteem also carried over this limited ability to evaluate into their judgments of other things in their lives. Therefore, it wasn’t just people who were subjected to these inaccurate perceptions. Their whole lives seem to be painted in this either/or fashion.

The researchers didn’t go into why this happens, but suggested that it is a way of offering more comprehensive help to those with low self-esteem.

Related Topics: Who’s Number 1 in Self-Esteem?, Surprising Spin on Women’s Self-Esteem

Technorati Tags: self-esteem, relationships, emotional health

Posted by: Patricia Farrell, PhD at 12:06 pm

Thursday, May 11, 2006

Distraction to the Rescue

How often have you felt that dread of a panic attack coming on and believed that there might be little you could do to thwart it? Researchers at Emory University were looking at the biology of dread and found, to their surprise, that the brain actually has a mechanism for dealing with this.

“Extreme dreaders,” in other words people who really focused on the experience of the dreaded attack or shock that they might receive, had more active “attention-to-pain brain areas” than other people. These more stimulated and focused areas were contributing to their feelings of dread because this biological anticipation was like gasoline on fire. The researchers called this “a pain of the mind.” So, it seems that the body works against our attempts to calm ourselves during periods of panic if we are one of these extreme dreaders. But what can be done about it?

Gregory S. Bems, the lead author of the article which appeared in the journal Science, believes that diverting your attention away from the dread through distraction can be just what is needed. So, next time you’re anticipating something dreadful or when a panic comes on, find a distraction that fits into your needs.

Related Topics: Dr. Farrell’s Anxiety & Panic Disorders Message Board, War’s Toll: Post-Traumatic Stress Disorder

Technorati Tags: panic disorders, panic attack, anxiety

Posted by: Patricia Farrell, PhD at 8:34 am

Wednesday, May 10, 2006

Benefits of Virtual Reality

Exercise has been seen as a valuable addition to our lives not only because it promotes physical health, but because it keeps our mental health. The question of whether outdoor exercise or virtual reality exercise is better. Read on.

The February 2006 issue of the International Journal of Stress Management carries a report of just such a study. Evaluating the results from 112 psychology students who were put in one of three situations: taking a brisk outdoor walk, walking on a laboratory treadmill while viewing a virtual reality video of the same outdoor walk or viewing the video without exercise. The psychologists measured mood and “enjoyment” measures before and after the trials and guess what they found?

The students who were on the laboratory treadmill with the virtual reality video were more relaxed and “experienced the least tension of the three conditions”. So, it seems that indoor exercise with a component that provides a bit of the great outdoors is beneficial to your mental and physical health.

Related Links: Common coping responses for stress
, The Absolute Beginner’s Guide to Exercise, Treating Phobias with Technology

Technorati Tags: Exercise, Stress Management, Virtual Reality

Posted by: Patricia Farrell, PhD at 7:27 am

Friday, May 5, 2006

Medical Illness and Anxiety Disorders

Medical illness sometimes brings with it anxiety disorders, and James L. Levenson, MD, has provided a good description of some of the more common ones in his article in Primary Psychiatry, 2006 (13:4, 27-30).  

Diabetes is one of these illnesses, and there is continuing debate about its relationship to stress.  The problem remains whether stress causes diabetes or whether it is a behavioral change vis-à-vis people under stress, which causes them to engage in behaviors that bring on diabetes.  Physicians know that diabetic patients have 2-3 times more depression than is found in the general population and that stress can contribute to difficulty in controlling diabetes.  

Undetected and undiagnosed thyroid disorders also contribute to a person’s anxiety level.   The symptoms often mimic GAD, as well as cognitive disorders, and patients may have symptoms of depression, such as lack of energy, fatigue, and some mild tremor.

Problems with adrenal disorders also cause depression, anxiety, hypomania/mania and even psychosis.   Symptoms often found in psychiatric disorders such as apathy, loss of interest in pleasurable activities, nausea, vomiting and weakness are also seen in these endocrine disorders.

A loss of libido in both men and women may not necessarily signal anxiety or depression, but a testosterone deficiency.  Although the level of testosterone has been established in men, it has not yet been identified in women.  

Related Topics: Depression May Up Type 2 Diabetes Death Risk, Mental Illness Common in the U.S.

Technorati Tags: chronic illness, anxiety, diabetes, stress

Posted by: Patricia Farrell, PhD at 8:40 am

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