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L.Z. was in the office for a routine exam, when I noticed that she seemed a little jumpy and aggitated. She is a 27 year old mother of two, who recently returned to school to get her degree. Her husband lost his job, but has gotten a new day job, paying less, and is also working a part time night job.
I told her that I wanted to ask her a series of questions about symptoms that she may or may not have experienced, but I wanted her to focus on the the last 6 months.
“In the last 6 months, have you experienced any of these symptoms on the majority of days?”
1. Restlessness
2. Fatigability
3. Difficulty concentrating
4. Irritability
5. Muscle tension
6. Sleep difficulties.
Anyone answering “yes” to at least three of those symptoms is considered to be experiencing a generalized anxiety disorder. Mrs. Z answered “yes” to all except the first symptom.
I explained to her that she was experiencing an anxiety disorder, which is what normal people do when they are surrounded by alligators (metaphorically, not literally). Since they don’t know which alligator is going to snap at them next, they spin round and round, never focusing on any one alligator for fear another one will get them. Not only does this make them feel bad, tired, angry, irritable, exhausted, tense, sleep deprived, they can become dysfunctional, never really able to dispose of any of the alligators because they are so distracted by the others.
In her case, she is a normal person experiencing abnormal amounts of stress, with the demands of two small children at home, worries about childcare, guilt over pursuing her degree when her husband and children need her at home, worries over money, and absence of her partner for significant periods of time. It is not suprising that she would react in this way.
I also questioned her about possible depression, since these two mood disorders, anxiety and depression, are sometimes found to coexist in the same patient at the same time. She did not have evidence of depression.
I recommended treatment of her anxiety with a good SSRI. I explained that this medication won’t make her dopey or stupid, but will help clear her head and facilitate her ability to dispose of the alligators one by one.
Most patient feel better within a week and are much better and happy after a month. The medication doesn’t get rid of any of the alligators, it just helps her deal more effectively with them.
I explained that there are other effective treatments for this problem, notably psychotherapy, and specifically Cognitive behavioral therapy or CBT. But CBT is costly and time consuming and I’ve found most of my patients would rather just take a pill each day along with their multivitamin in the morning.
Without treatment, the anxiety disorder will probably be worse at times and better at times. If the situational factors were to change for the better, the disorder will likely improve. The big problem with waiting to see what will happen is that over time, her brain will adopt anxiety as its normal state, making it more difficult to eliminate in the future.
She agreed to start the medication and will see me in a month for a re-evaluation.
