Anxiety

Anxiety is a feeling of distress, fear, or uneasiness. While feeling anxious is a natural response for someone with cancer, it can develop into a debihilitating disorder in some people.  If left untreated, anxiety disorders can grow progressively worse, making it difficult to function in everyday life.

There are many different types of anxiety disorders. Some examples include:

• Panic disorder
• Obsessive-compulsive disorder
• Posttraumatic stress disorder
• Phobias
• Generalized anxiety disorder

While each of these have their own distinct set of symptoms and features, they are all bound together by the characteristic symptoms of excessive, irrational fear and dread. Posttraumatic stress disorder and generalized anxiety disorder may be associated with being diagnosed with or treated for cancer. For more information, go to Posttraumatic Stress Disorder.

What causes anxiety?

Anxiety disorders develop from a complex combination of factors, including:

• Genetics
• Brain chemistry
• Personality
• Stressful life events

Being diagnosed with or treated for cancer may cause symptoms of an anxiety disorder in some people.

What are the symptoms of anxiety?

Generalized anxiety disorder is characterized by excessive, unrealistic worry that lasts 6 months or more. In adults, the anxiety may focus on issues such as health, money, or career. In addition to chronic worry, symptoms of generalized anxiety include:

• Trembling
• Muscular aches
• Difficulty sleeping (insomnia)
• Feeling of loss of control 
• Dizziness
• Difficulty breathing
• Racing pulse
• Exhaustion

What is the treatment for anxiety?

Anxiety is most often treated with a combination of medication and psychotherapy. Medication is often used to ease symptoms so that other therapy can continue. Your doctor may prescribe medication for a short-term therapy, or it may be required for a lengthy period of time, depending on your circumstances.

Drug treatment - A number of medications that were originally approved for treating depression are also effective for anxiety disorders. Most of these medications take 3 to 6 weeks to begin working and may be associated with some side effects. Your doctor may try several different drugs to find the best treatment for you.

Some of the newest of these antidepressants are called selective serotonin reuptake inhibitors (SSRIs). SSRIs increase the level of the neurotransmitter serotonin, a chemical in the brain thought to be linked to anxiety disorders. Although SSRIs have gained popularity because they have fewer side effects than other medications, they still do have some side effects.

Examples of SSRIs include Paxil^® (paroxetine), Prozac^® (fluoxetine), and Zoloft^® (sertraline). Common side effects associated with these medications include agitation, nervousness, decreased sex drive, nausea, insomnia, and headache. An increase in some of these symptoms is common when the drugs are first taken, but side effects usually decrease with time.

Another type of antidepressant drug called a tricyclic antidepressant (TCA) may be prescribed for anxiety. TCAs are associated with more side effects than the SSRIs. TCAs also work by regulating serotonin levels.

Examples of TCAs include Elavil^® (amitriptyline), Pamelor^® (nortriptyline), and Tofranil® (imipramine). Common side effects associated with these medications include increased heart rate, blurred vision, drowsiness, sexual problems, dizziness, difficulty urinating, dry mouth, constipation, and moderate weight gain.

Another type of medication commonly used for anxiety is a class of drugs called benzodiazepines; an example is Valium^® (diazepam).

Psychotherapy (talk therapy) - There are many different kinds of psychotherapy, also known as talk therapy. The approaches that are commonly used to treat anxiety are behavioral therapy and cognitive therapy. Behavioral therapy seeks to modify unwanted behavior and find ways to cope with difficult situations. This provides a sense of having control over your life. Cognitive therapy aims to change harmful or unproductive thoughts that cause anxiety. A combination of these two approaches may also be used.

What else can I do?

Make sure you are getting enough sleep and try to exercise daily. Being well rested will help you cope with difficult situations, thoughts, or other triggers of your anxiety. Exercise increases the release of natural chemicals in your body called endorphins, which promote a feeling of well-being. A daily exercise program can be as simple as 20 to 30 minutes of walking.

Also, cancer support groups may help you deal with your anxiety. Support groups have been shown to improve mood, encourage the development of coping skills, improve quality of life, and improve immune response. Support groups can be found through the American Cancer Society, Cancer Care, or by asking your doctor. You can also consider seeing a psychologist, psychiatrist, or social worker on a one-on-one basis.

To help you manage your anxiety, you may wish to try relaxation techniques, such as:

• Meditation
• Yoga
• Deep breathing

You may also find it helpful to keep a cancer treatment journal and jot down your feelings and side effects. Where possible, take action to resolve those matters that are bothering you. It's important to realize, too, that your loved ones also may be experiencing anxiety over the "unknowns" and unanswered questions in this journey. Communicate your feelings and thoughts to strengthen this journey.