Fixing Broken Lives: Young Women Turn to Pills and Therapy to Battle Anxiety

Imagine sitting in a classroom listening to a lecture when all of a sudden a screaming fear surges through your body-a panic so suffocating it seems to be paralyzing. In your daily life, you avoid the situations that may bring on the next attack and stay clear of others out of shame, guilt or fear they won't understand.

For some young women, especially during the college years, anxiety attacks lead to missing out on a normal life. In addition to skipping classes, missing work and staying home when friends are out, women suffering from anxiety feel they are battling a monster bigger than their own bodies.

Just ask Michelle Stevensen, a 24-year-old National Louis University in Chicago graduate who says her anxiety became a chronic and debilitating condition. At the height of it, a few years into college, Stevensen says her mind was always racing, making her feel like her "insides were going to come right out." The attacks would hit with such a force, she thought she was losing control or going crazy.

Stevensen says the first time she had an attack was in church four years ago, during Easter. "I had to leave in the middle of service because of this strange feeling I had while I was standing," she says. "I felt this shockingly hot feeling throughout my body and I thought I was going to pass out. My heart started racing and my palms got sweaty. I was afraid I was going to have a heart attack or a stroke."

A few days later there was another episode.

The attacks got so bad, she says, that she couldn't leave the house for fear of having another attack. Whenever she felt one coming on, her stomach tensed up, and she felt like she "was suffocating."

Yet, at home, she was fine.

Psychologists believe that social anxiety (also known as social phobia) has always been around, but due to the lack of education on this relatively new issue, it is often lumped with other forms of anxiety. This ignores a key fact that many young women may be unaware of: the chemical makeup of a woman's body predisposes more women to suffer than men. Many young women never receive appropriate care which plays a big role in the stigma of shame and guilt associated with this disorder.

Researchers believe the problem may reside in a brain disturbance caused by a change in how the brain handles anxiety-provoking information from sensory organs. The amygdala, an almond-shaped part of the brain that controls fear responses, sends neurotransmitters to the heart signaling it to pump blood to the muscles and send stresshormones and glucose into the bloodstream for extra energy. This response is what triggers symptoms like sweating, dizziness and a pounding heart, according to professionals.

Dr. Steven Hanus, a faculty member in Northwestern University Medical School's Department of Psychiatry, says, "When a person senses danger, even if it is not a true danger but something that triggers a dangerous thought-a feared situation like a birthdayparty or a meeting-the brain will react by sending a signal to the amygdala, producing the 'fight or flight' response."

Hanus says he defines social phobia as a persistent fear of public situations, such as public speaking or dating, as opposed to simple phobias such as fear of heights or flying.

"If someone has a social phobia, they'll basically either not go to an event or it will be so anxiety-provoking that it won't be enjoyed significantly or the anticipation becomes exhausting," he says.

"Eventually what happens is people with social phobia avoid feared situations altogether because they experience such intense anxiety that it interferes with their functioning," Hamus says.

Jerilyn Ross, president and CEO of the Anxiety Disorders Association of America in Silver Spring, Md., says that many primary care physicians lack knowledge in this area and oftentimes patients receive the wrong treatment.

Even though [doctors] want to do the right thing, they only have 10 to 13 minutes with a patient, and they're going to want to rule out any serious physical illnesses," Ross says. "So they're oftentimes more likely to give the patient a medication, rather than really educate them or let them know they have options and alternatives."

Psychologists say social anxiety disorder is something misunderstood both by the medical world and by society in general. According to a 2004 study by the ADAA, "The Economic Burden of Anxiety Disorders," misdiagnosis and the under treatment of anxiety disorders costs the United States more than $42 billion a year. More than $22.84 billion is linked to the repeated use of healthcare services for symptoms that mimic physical illness, the study says.

Ross, founder of the Ross Center for Anxiety and author of "Triumph Over Fear: A Book of Help and Hope for People with Anxiety, Panic Attacks and Phobias," says the ADAA is working with primary care physicians, educating them about what to look for in terms of signs and symptoms, and emphasizing the fact that people can and do overcome social anxiety. The disorder is a highly treatable condition that strikes 19 million Americans-women twice as often as men, according to the ADAA.

Biology vs. Environment

So why is this happening? Although it seems that social anxiety disorder strikes out of the blue, genetic and environmental factors explain why stress triggers the anxiety disorder in some people and not others, says Ross. Women tend to be predisposed to anxiety due to hormones and the chemical makeup in the body-a combination of neurotransmitters and hormonal change. Experts say a combination of factors such as biochemistry and heredity puts women at a greater risk for anxiety.

According to an ADAA article, "Being Female and Anxious," as soon as "a girl reaches puberty, her chances of developing anxiety and mood disorders are double that of the boy she sits next to in school (22.6 percent vs. 11.8 percent)."

The article, also states that, "the brain system involved in the 'fight or flight' response is activated more readily in women and stays activated longer than in men, partly as a result of the action of estrogen and progesterone." According to the ADAA, the female brain does not process serotonin as quickly as the male brain.

Anxiety disorders also run in families, so there is a hereditary, or genetic, component as well, Ross says. Just like acquiring a gene for blue eyes, a person who has a family member with anxiety disorder has a greater chance of developing it, though not necessarily the same type, she says.

Dr. Sara Yogev, a clinical psychologist in Skokie, Ill, who has specialized in anxiety and depression for more than 20 years, says another reason why women may suffer more than men is women are often in a pleaser role, where it's important for them to be liked.

"This is a stereotype, I know, but that seems to be what we see very often," she says.

Doctors say the problem usually strikes in the late teens and early 20s, because this is a time of transition for young women; many are starting college and reaching full physical maturity. Coping with a new environment and the transition from high school and everything familiar can also play a big role, according to Ross.

In fact, Ross says, the No. 1 reason women drop out of college is because of anxiety problems. "It's a time when women go away from home and experience a lot of change and separation," Ross says. "The realization that they're getting ready to go out into the world plays a big part in it."

Dr. Joan Sophie, a Lincoln Park therapist who specializes in social phobia, says that part of the task of becoming an adult is figuring out where you are socially. "So it doesn't seem surprising that there would be anxieties about it," she says.

"One of the factors that I think is distinctive to Americans is that we're much more individualistic, and that makes us feel much more alone," she says. "And of course that causes anxiety. But we're human. It's our nature. We do need other people. But it's very easy to be alone in our culture."

And with that fear of isolation, the thought of physical symptoms appearing in public may add an additional fear, creating a vicious cycle, Ross says.

Because a patient's first thought may be to think there is something physically wrong, a primary care physician is usually the first stop for getting answers.

Dr. Hoyee Chan, an internal medicine specialist at Evanston (Ill.) Northwestern Healthcare, says about 15 percent of the women who come to her suffer from social anxiety and many physicians in her field may be too quick to prescribe medication without a proper diagnosis.

"The person may accept whatever the doctor says might be the problem and begin taking medication that is not appropriate. Even worse, many people still do not know what really is troubling them," she says. "They may spend many more years and lots of money trying to find out. And that's if they even do find out."

She says the symptoms she asks patients about are the physical symptoms that accompany anxiety. She asks whether they experience trembling, dry mouth, nervousness, difficulty talking, nausea or other stomach discomfort when in public.

Chan says that if after examining and checking routine tests she finds nothing wrong with the patient, she will diagnose the problem as social phobia and will discuss options available with the patient.

Treatment Options

Two forms of treatment that have proven to be effective for social phobia are medication and talk therapy. Anti-depressents work by diminishing anxiety levels and blocking the panic response without the serious side effects of blurred vision, sedation, nervousness and weight gain associated with the older family of antidepressants, like Valium or Xanax, according to Mark Becker, a pharmacist for Kmart in Palatine, Ill.

Becker says it's a popular belief that anti-depressents are habit forming, but, this is not true. The antidepressants of today, the selective serotonin re-uptake inhibitors (SSRIs) are not addictive and are highly successful, he says.

The drugs that fall into the SSRI family are Paxil CR, Lexapro, Cymbalta, Zoloft and Buspar, all approved by the FDA for treating social phobia, according to Becker.

"Serotonin is a feel good drug that has a pleasure sense or a feel-good center in the brain," he says. "And SSRIs block the re-uptake by the nerve endings, and prevent the brain from reabsorbing too much of the serotonin, so there is more serotonin left, which stimulates more nerves to make you feel better."

SSRIs are usually the first types of medications prescribed for anxiety, which raise serotonin levels in the brain, Becker says. Serotonin is one of the chemical messengers in the brain responsible for moods and emotions and these drugswork by raising the level of the mood-regulating neurotransmitter serotonin in the brain which can reduce anxiety, he says.

But Chan says a major complaint from patients is SSRIs don't start working for several weeks or even months. This seems like a lifetime for those already waiting to get help.

Unpleasant side effects also are a problem for some patients on these medications. Chan says SSRIs are tolerable in most patients, but they often interact with other medicines a patient may be taking.

"It's a matter of trial and error and adjustment in dosage or a switch to another SSRI that a patient responds better to," she says. "And that will usually correct any side effect problems."

"Because these are serious medications, in order for them to work effectively they often have to be changed, or different doses prescribed. It's important that the patient gets a follow-up," Ross says.

But withdrawal symptoms such as nausea, vomiting, loss of appetite, headache, dizziness, insomnia, anxiety and panic can occur if a patient stops the drugs suddenly, according to Chan.

"A patient cannot quit cold turkey on these," Chan says. "Withdraw has to happen slowly over several weeks."

But for those who just want fast-acting relaxants, there are the "old school" family of drugs such as Xanax, Valium or Klonopin that serve as fast relief from anxiety symptoms until the SSRIs kick in. The downside of these drugs is they are considered to be mildly to moderately addictive. But tolerance can certainly be developed, Becker says.

Cognitive-behavioral therapy is an effective treatment for helping treat the effects of social phobia without turning to medication. The patient is subjected to short-term talk which teaches them to alter their actions and their thinking. Yogev, who says she uses this type of therapy, says patients learn new skills in order to react differently to the situations which trigger their anxiety or panic attacks. They learn to understand how their thinking patterns contribute to the symptoms and how to change their thinking to reduce or stop these symptoms, she says.

During cognitive behavioral therapy, Yogev says the patient learns to understand unrealistic and fearful thoughts, such as believing that everyone is talking about them or that others will think they are stupid if they speak up in a meeting.

Yogev says the process focuses on self-esteem, assertiveness, confidence and many other issues. Results, she says, can be seen in anywhere from three to four months to a year.

Therapy vs. Drugs

Psychologists like Sophie say that biochemical changes can be achieved through the behavioral changes as a result of psychotherapy. Learning and acting out new behaviors is how the brain chemistry changes permanently, Sophie says.

And although medication or pills can change brain chemistry temporarily by reducing physical symptoms, it usually leaves the underlying fears intact. This is where therapy comes in-helping in a way that drugs cannot, she says.

"For really lasting effects, therapy does something that medication can't do. Medication can't help you to learn and figure out how to manage problems, and all the intricacies of 'what am I thinking?'" she says. "Social relations are the most complex there are. All that complexity can't be solved by a chemical."

"Ideally, if we can get everybody into therapy, we'd make a huge dent in the problem," Ross says. "Unfortunately, a lot of people don't know that they can get that kind of treatment; they don't know where to go or they can't afford it."

Twenty-four-year-old Serena Carreno, an art historian and a graduate of the University of Illinois at Chicago, is a self-described believer in "exposure therapy." She says she became a nervous wreck during her late teens and was unable to lead a normal life. As someone who usually prefers to work out her own problems, she says she declined medicine, choosing instead to get help from a therapist.

"My argument was the meds are going to cover up the problem and I wanted to face it on my own," she says.

Exposure therapy involves a patient taking part in their fearful activities (such as group meetings, presentations) and learning to build tolerance to social situations, according to Yogev. The therapy involves using social skills to desensitize the person to feared situations.

Carreno's exposure therapy treatment, which was suggested to her by her therapist, involved set-up situations in which she acted out all the possible scenarios in front of others that made her anxious, such as talking in front of a group of people.

Carreno says she first read about the disorder a couple of years ago but only found the courage to seek treatment this year. "I'm the one who was creating these thoughts in my head, imagining situations that I know realistically won't happen," she says.

"It was an uphill battle. It took awhile. But I said to myself that I if I can make the right changes, then I will be able to deal with stress like a normal person again," she says.

"I believe this happened to me because my mind desperately wanted me to change. I was ignoring every other sign so it finally threw something at me I couldn't ignore," she says.

Carreno says she has always been negative toward herself. "I'm a perfectionist. It used to be I was afraid of everything new, thinking I would fail," she says.

Too quick to give pills?

There is a blurry line separating social phobia disorder and normal personality traits like shyness or self-consciousness for some young women, according to therapists.

In a Sept. 22, 2004 article in the Seattle Times, in June, the U.S. Food and Drug Administration (FDA) ordered GlaxoSmithKline to stop showing the ads for Paxil CR, which in 1999 became the first drug approved by the FDA to combat social anxiety. The article stated that TV spots for the drug featured actors in various social situations looking uncomfortable and wearing blue and white "Hello my name is" tags. One man at a party wore a tag that said "nervous" while another's read "panicky." The report stated that the FDA accused GlaxoSmithKline of expanding Paxil's use by "failing to distinguish between social anxiety disorder and the lesser degrees of performance anxiety or shyness that do not generally require psychopharmacological treatment."

But for someone like Stevensen, who has been taking 10 mg of Lexapro for the past five months after what she says was "years of missing out on a normal life," the fast relief the drugs provide is a "godsend."

"I've already wasted so much of my life with this. I just wanted it to go away fast. That awful heavy feeling of dread is gone," she says.

Although she admits she may come across as reserved to others, Stevensen says she never thought of herself as shy or insecure. The problems she was having, she says, were more than just personality based.

"I was so happy to hear (it was social phobia) after I left the doctor's office that day," she says. "To know there's a name for this and millions of others suffer from it as well made me feel kinda happy. I can't even tell you the relief that came over me," she says.

It's certainly a feeling Kristie Michaels, a 25-year-old Oakton Community College business administration major, can relate to. Five years ago, Kristie's life seemed blessed. She had a boyfriend, she was able to balance school and work, and overall was feeling pretty good.

That is, until the attacks began a couple of years ago when she "kept having periods of dizziness."

Michaels says her life was put on hold due to the physicality of the condition which caused her to delay graduation, quit her job and break up with her boyfriend.

"My ears felt plugged and I felt like someone was smothering me and I couldn't catch my breath," she says.

Michaels says her social anxiety is "a fear that is so deeply imbedded that it fully consumes you.

"I hated feeling so insecure, stupid and irrational. On a good day I could laugh about the absurd thoughts but even that sounds hollow because the fear is always there," she says.

She says she had blood work done for heart and endocrine disorders, but they all turned up negative. The doctor told her that what she had was a social anxiety disorder. She immediately asked for a Paxil CR prescription.

"I didn't care about the name [of the disorder]. I just wanted to feel OK," she says.

Michaels says the drug's effect made her jittery for the first couple of weeks, but it wasn't enough for her to stop taking them.

Therapy Plus Drugs

Psychologists say the best form of help is a combination of talk therapy and drugs. But Hanus, who has worked with patients for 20 years, says he prefers to try therapy before medicine. But, he says, in many cases it requires the use of both.

"If a disorder is severe enough, very often medicines will need to be used. My recommendation is to always use the medicines in combination with psychotherapy-not medicines alone," he says.

The majority of people who have had therapy find they can resume a normal life and function very well, Hanus says.

"Desensitizing people to the situation in behavioral therapy and in cognitive behavioral therapy, teaching them strategies to cope with assumptions and illogical thinking has proven to be very effective. Very often people will feel the sense of empowerment that they were able to do it without medication," Hanus says.

But one of the biggest concerns a patient might have is will they revert to their old ways if they quit the medication and/or therapy? According to therapists, it all depends on what initially was causing the anxiety-whether or not there was a chemical imbalance or if it was a specific situation, such as moving away from home or a relationship that was causing it.

"If they learn how to cope and there's a more stable structure, then it all depends on lifestyle changes and what kind of support mechanisms there are for the patient," Sophie says.

Hanus says the most important thing for people to know is this is a treatable disorder and that it should not be allowed to get in the way of one's occupation, relationships, or life goals.

"We don't want people to self-medicate with alcohol and other substances, because that tends to happen when people become anxious as well," he says.

Stevensen and Michaels both say they eventually want to stop taking the drugs and try cognitive behavioral therapy. But for now, the women say the drugs' calming effects help get them through work and continue on with their lives.

"I think of it like this: take each day at a time, understand how lucky you are to be alive, look at things around you and understand that everyone has their own problems to deal with," Stevensen says.

Before turning to drugs or talk therapy, there are other ways to help alleviate anxiety on your own. Although self-help is not a magic pill, it's definitely a good place to start, according to Alice Sirokh, a nutritional consultant and colon therapist at Partners in Wellness in Chicago. Sirokh says changing your lifestyle is a basic way to alleviate anxiety. This means cutting back on sugar and caffeine, which fuels adrenaline, causing more anxiety-which means, yes, a lot fewer of Starbucks.

"When you're very exhausted and very stressed out, your adrenal glands just push you to the max and eventually they get so exhausted and then you're drinking more coffee to keep up and exhausting your body that much more," Sirokh says.

Sirokh says exercising three to four times a week at 20 minute intervals burns up excess adrenaline. And even though Bally's may be offering a big discount to sign up for a yearly membership, but you don't have the time or the money to dedicate to the gym, there are other ways to get the exercise you need.

Anxiety sufferers like Carreno say just walking places instead of driving is a big help."Just getting some sunlight and fresh air for 15 minutes a day makes such a difference," she says.

Sirokh, author of the book "Gut Wisdom," says the one thing she always recommends to her patients is applying warmth to the abdominal area-a heating pad or a hot water bottle. "Because the abdominal area is an area that holds so much emotion, that's probably one of the most problematic areas, especially for women," she says.

According to Sirokh, "By applying warmth to the abdominal area and calming the nervous system, it helps bring blood back into the abdominal area. Because when you're stressed or anxious your blood is shunted to your arms and legs." Using warmth, she says, "empowers you from bouncing off the walls to being a little more centered."

Sirokh also recommends B-Complex supplements, which are important for the production of neurotransmitters. She also says calcium and magnesium are muscle relaxants which help the body calm down during an anxious period.

Another self-help treatment is yoga, a form of exercise that calms the mind by focusing attention on breathing. Steve Richardson, a yoga and T'ai Chi Chih instructor from Chicago, says the most immediate way to relieve anxiety is through breathing-lengthening and focusing the exhale that calms the nervous system.

"Using the breath is pretty universal," he says. "While somebody who is anxious really needs to lengthen and smooth out their exhale, someone who has depression needs to focus on the inhale. Even the most basic things can be overwhelming for a depressed person, and that person would focus on the inhale because it's the energizing portion of the breath."

Richardson says that another thing to do would be focusing on forward bends, which "promote the exhale, whereas backward bends are done with an inhale. A forward bend is more introspective; it's soothing to the nervous system. We're in a forward bend about 98 percent of the time," he says.

And then, of course, "It's all in how you place your attention on things which makes a big difference too," he says. "If you keep repeating anxious thoughts over and over again it will create anxiety; by using some meditation techniques you let go of the thoughts that are causing anxiety."

Richardson says those who suffer from anxiety have to "practice just letting go of things, which is done with meditation, involving focusing on something else. It may occupy the mind enough to provide a little bit of space."

Pick your pill...carefully

If you are considering taking anti-depressents for anxiety, talk to your doctor first about your options and the side effects of the drugs. Tell your doctor about any allergies, alternative therapies or over-the-counter medications you are currently using.

Here are some things to consider:

Never purchase a medicine online without consulting your doctor about which one is appropriate for you. This doesn't mean there aren't reliable companies out there, though, and the National Association of Boards of Pharmacy (www.nabp.net) is a web site that helps determine whether an online pharmacy is a licensed pharmacy.

Find out what money-saving methods there are out there, especially if you don't have insurance. Some patients, like Michaels, say buying bigger pills and cutting them in half gets you twice as much medication for your money.
Check out Helpingpatients.org, a patient assistance program dedicated to helping low-income, uninsured patients get brand-name medicines for free or at a low cost.

Finally, keep in mind that SSRIs may take weeks or even months to be built up in your system, and must be taken regularly. While these drugs are generally well-tolerated, here is a list of the most popular SSRIs and some of the side effects patients have reported:

Paxil CR, GlaxoSmithKline: Side effects include nausea, infection, diarrhea, constipation, decreased appetite, sleepiness, dizziness, yawning, sweating, dry mouth, insomnia, abnormal vision and sexual side effects.

LEXAPRO, Forest Laboratories, Inc: Side effects include nausea, insomnia, problems with ejaculation, somnolence, increased sweating, fatigue, decreased libido, and sexual dysfunction.

Zoloft, Pfizer Inc.: Side effects include an upset stomach, having trouble sleeping, diarrhea, dry mouth, sexual side effects, feeling unusually sleepy or tired, tremor, indigestion, increase of sweating, feeling agitated, and decreased appetite.

BuSpar, Bristol-Myers Squibb Company: Side effects include dizziness, nausea, headache, nervousness, lightheadedness and excitement.