We can get a picture of suffering from panic disorder because we’ve all experienced it. In the moments before he spoke in public (his face was sallow and his hands were cold with sweat), in the midst of that unbearably turbulent flight (pointlessly clutching the armrest, stepping on an imaginary airbrake pedal), in that crowded downtown commercial , from which, for no apparent reason, one had to flee. It’s just that patients have these horrible sensations almost constantly, with a disabling intensity and often in ways inconsistent with a life, let’s not say happy, but acceptable.
They live 24 hours a day with an anxious attitude, expecting the worst, installed in a threatening future. And his long-suffering body responds with a state of intense activation, with racing heart, palpitations, sweating, lack of air, chest tightness, dizziness, or indigestion. It is understood that anxiety multiplies the likelihood of going to the doctor by 6. And how many of us have a true anxiety disorder? The answer, of course, lies in the line we draw between “acceptable” symptoms and the disorder: the most restrictive studies suggest that 1 in 14 people meets the criteria for suffering from a clinically relevant disorder.
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The problem is sometimes the means we resort to, which can be harmful or counterproductive. Here are six not advisable:
1. Fill up on anxiolytics. It’s clear: it’s the same logic to resort to painkillers when you have a headache. Benzodiazepines (lorazepam, diazepam, bromazepam, etc.) act on the brain’s GABA inhibitor system and promote rest, muscle relaxation, and sleep. However, clinical guidelines recommend limiting use to two months (and one more of gradual withdrawal) because of the risk of tolerance (that we need increasing doses for the same effect) or dependence (that we lack the medication when we don’t have the medicine) consists of climbing up the walls).
Some “benzos” (especially the strong and fast ones like alprazolam, which produces a “calm shot”) circulate on the black market as another drug. This does not mean that “all psychiatric drugs are drugs” or that the controls a box of diazepam passes for dispensing at the pharmacy are the same as the camel’s Coke line on the corner. Fortunately, we have national and international authorities that guarantee strict criteria for quality, safety, effectiveness and correct information about medicines. The broad discourse, in this sense, does not help in my opinion. For example, antidepressants (despite their misleading name) are very useful for anxiety disorders because they work long-term, preventing panic attacks and reducing general anxiety. This option is of course compatible with psychotherapy, the main validated treatment.
2. Consuming alcohol or cannabis and looking for a counterbalance. They are the two most normalized toxins in our society, and their risks and negative effects on the brain are often downplayed. We’ve seen many times that anxiety can be the gateway to serious alcoholism, and that between 7% and 10% of those who try cannabis “for tranquility” develop an addiction. These substances cannot be the solution.
3. Flee and avoid. The bad news for those who suffer from anxiety is that constant flight from discomfort increases anxiety. The hopeful converse is that the patient who faces his fears and increasingly exposes himself, better with professional help, has a good chance of recovery. Avoiding it is to stay at home and wait for the anxiety to stop spontaneously. Or, if the anxiety was triggered at work, take refuge in the situation of medical absence for as long as possible: returning will be difficult. Of course no one is ill for pleasure and the honesty of a sufferer should not be questioned.
But sometimes the avoidance tendency characteristic of these disorders is fatally linked to the inefficiency of the system: discharge from family doctor, psychiatric appointment in 3 months, review in 2 months, no clinical psychologist is available … and we see ourselves with victims through fear of 6, 8 or 10 months in duration and the patient is afraid of the possibility of reintegration. In Spain, mental disorders are the second leading cause of temporary disability leave, estimated to be one per 100 workers per year, resulting in temporary disability expenses of 30 million euros. Have the benefits of a rapid and quality mental health intervention, favoring immediate reintegration (in one position or another) and minimizing the chronicity of the disease, been calculated?
4. Go to Pseudotherapies. Product of desperation or suggested by postmodern anti-scientific discourse, some patients seek healing in hot stones, acupuncture, or Reiki. There will be people who will help you, but they cannot be an alternative on the same level as scientifically validated pharmacological or psychotherapeutic treatments. They are seductive options that sometimes offer the fantasy of a more holistic look (which may be true), but why not stick to a transparent and reproducible method to convince us of their effectiveness?
5. Always look for a reason. Popular psychoanalysis and some films (funnily those of Hitchcock, Marnie the Thief or Remember) have told us that every mental disorder is the result of a complicated intrapsychic conflict that needs (long) therapy to uncover. When the patient solves the puzzle (or insight is the word used), the symptoms subside. Unfortunately, the reality is usually not like that. There are patients who are healed without knowing exactly why they are developing anxiety, and others who fully understand the historical origin of the condition but remain anxious and distressed, ruled by a hyperactive physiology resting on a permanent ‘fight or fight’ -Escape” mode.
6. Try to eliminate fear. Scott Stossel tells it in his wonderful book Anxiety. Fear, Hope and the Search for Inner Peace (Seix Barral). The first-person writer, anxious and frustrated by decades of unsuccessful therapies, finally considers living with the fear of not hating her anymore. Remember there have always been people who were more shy than normal, wary, sensitive to rejection, overly empathetic, which today clashes with our competitive world and is considered an anxious temperament. These traits can foster unbearable, terrifying anxiety; but they also represent the flip side of the coin with wonderful qualities such as empathy or artistic sensitivity. A tall, timid genius, several of Proust’s characters delve into the relationship between nervous natures and sensitivity. It is the closeness of the wound and the gift, the idea that in weakness and shame there is also a potential for redemption.
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