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Understanding anxiety (and when to seek help)

The word anxiety has figured prominently in the news since the start of the pandemic, however terms like anxiety and depression often mean something different for every individual. That’s why, when a patient tells me they’re experiencing anxiety, I commonly ask, “What does anxiety mean for you?”

All of us have experienced anxiety at times, whether before a big presentation or a job interview, or when we have to talk to someone about an uncomfortable topic. That occasional feeling is unpleasant and unsettling, but it’s also pretty normal.

The challenge is to determine when anxiety is impacting usual functioning, whether at work, home or school, and whether it’s severe enough that professional support would be beneficial.

Parents in particular are struggling with the concept of anxiety because it has become something of an epidemic among young people. In some cases, the term anxiety has become a catch-all for every unpleasant feeling. For other young people, their symptoms of anxiety are very severe, impacting their ability to attend school, find work or maintain relationships. Anxiety symptoms might also be a harbinger of another serious mental illness such as depression, bipolar disorder or schizophrenia.

I’ll first define “pathological” anxiety then discuss why it’s important to understand and quantify anxiety, and finally, suggest where you can look for help if you, or someone you love, is suffering from chronic, impairing anxiety.


The science of fear

Fear is a normal response to a real threat and it’s critical for our safety. When our safety is threatened, our brain sets in motion a series of evasive measures, called the “fight or flight” response.

The “fear centre” of the brain is called the amygdala. When confronted by a threat, your brain sends sensory information, including what you see, hear, touch, taste and smell, to the amygdala. This information moves at lightning speed and the amygdala then directs the rest of your body to respond to the threat, to keep you safe.

For instance, when an aggressive dog is running toward you, snarling with its teeth bared, you see and hear the dog and that sensory information is sent to your amygdala, which causes an increase in your heart rate and blood pressure. Blood is rapidly directed away from less necessary organs and toward body parts necessary to help you to run away, scream or pick up a stick to protect yourself. This is a normal reaction to an obvious threat.


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There are different types of anxiety

Those who have pathological or abnormal anxiety experience fear that is excessive, unwarranted, inappropriate and impairing. Rather than reacting to a threat that is obvious, like a charging dog, pathological anxiety is a response to threats that are vague, uncertain and sometimes, unknown. For instance, people experiencing generalized anxiety disorder (GAD) worry excessively about everyday issues, like health, finances or safety.

GAD is the “what if…” kind of anxiety. A person living with GAD might worry, “What if my partner gets sick and we can’t pay the mortgage,” even though their partner is perfectly well and their family is financially stable. Occasionally having these kinds of worries is not unusual, especially if there’s a good reason underlying the concern, which may lead to rumination and poor sleep. However, those living with GAD can’t stop worrying, the worry is often not rooted in facts, and the thoughts take over their life, impacting their sleep, relationships and ability to function fully at work and at home.

My patients with GAD know their anxiety is excessive and unwarranted. They tell me, “I know my worrying is over the top” or “I can’t understand why I keep worrying about this,” but they can’t stop worrying. Sadly, they also worry about the potential negative impact of their constant worrying. They know it’s not good for them to be worried all the time and it’s also causing problems at work and home, but they’re concerned that if they stop worrying, the things they worry about will happen, so they need to keep thinking about those worries.

Typical anxiety symptoms include: feeling keyed up or tense, feeling unusually restless, difficulty concentrating because of worry, fear that something awful may happen, difficulty sleeping due to worry and feeling like you might lose control. Anxiety symptoms can occur on their own but they also occur frequently in association with other mental illnesses such as depression, bipolar disorder, or ADHD. Research demonstrates that the presence of anxiety symptoms may significantly increase the severity of the disorder, make the disorder more difficult to treat and heighten the risk of suicide.

Anxiety disorders are psychiatric diagnoses that include a collection of anxiety-related symptoms that commonly occur together. GAD is an anxiety disorder, as well as panic disorder, post-traumatic stress disorder, and social anxiety disorder.

Chronic, pathological anxiety is not good for your brain. We know it can provoke an inflammatory process that can damage and even kill brain cells. It’s possible to measure the structural and functional brain changes associated with severe, untreated, chronic anxiety. Chronicity also makes anxiety more difficult to treat and can lead to more severe associated cognitive symptoms and heightens the risk for depression and self-medication with alcohol, cannabis or other drugs.

When to seek help

How do you know whether you or your loved-one should seek professional help for anxiety or any mental illness? It’s important to consider how severe the symptoms are (how difficult they are to live with), how much the anxiety is impairing functioning and how significantly anxiety is impacting quality of life.

If the symptoms of anxiety are present for most of the day, nearly every day; if the symptoms are getting in the way of working effectively, being social or maintaining your relationships; and if they’re causing misery, professional help would likely be beneficial. Talk therapy, especially cognitive behavioural therapy (CBT), has a great deal of evidence demonstrating its benefits for overcoming anxiety.

Antidepressant medications are used to treat anxiety and can be life saving treatments for severe anxiety. Whatever kind of help you’re seeking, the best place to start is by speaking to a family doctor or nurse practitioner about your concerns. They’re best to assess your symptoms, make a diagnosis and guide your next steps.

If you’re thinking, “My anxiety isn’t that bad, but I know it’s a problem,” you’d still likely benefit from some support (CBT can be helpful for less severe anxiety). Additionally, mindfulness meditation, exercise and good sleep hygiene can have a positive impact on anxiety.

Many of my patients initially believed that anxiety was their cross to bear, but I can assure you that even the most severe anxiety can get much better. If treated early and fully, it can completely resolve. The best advice I can offer is to ask for help, and if you don’t get the help you need or don’t feel heard, ask someone else. There is always a path ahead.


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About the author:

Dr. McIntosh played a pivotal role in developing Ontario’s new Mental Health and Addictions Centre of Excellence, the foundation on which the province will build a comprehensive and connected mental health and addictions system. The Mental Health and Addictions Centre of Excellence will, for the first time in Ontario’s history, drive the broad, systemic transformation necessary to enable significant improvements to the quality and availability of services. Learn more here.