Ask the Experts: Anxiety
Gabor Maté, Physician, Vancouver
Anxiety manifests itself in any number of ways. It can manifest as panic -- feeling terror or a loss of control. It can manifest as anger -- toward fate, the medical profession, a partner or oneself. Anxiety can also show up as physical feelings -- a rapid heart rate, dry mouth and abdominal upset. Some people address it head-on, but most of us try to soothe, suppress, escape or sedate it. To avoid feeling anxious, some people might drink alcohol or do drugs. It's well known that stress has a big impact on the immune system and can increase a person's susceptibility to illnesses, so it's important to deal with anxiety and what lies behind it.
Being diagnosed with HIV is a huge deal, so why wouldn't someone with HIV be anxious and scared? Stigma can add to this, and some HIV medications can cause anxiety. The natural dynamic is to think that all of our anxieties are due to HIV. However, when you ask people, "When in your life were you not anxious?" many will say that they've always been anxious. So the sources of anxiety for people with HIV are many, and you need to tease them out.
For example, if you're using drugs, what are the drugs doing for you? A person might say, "The drug makes me feel better -- it helps me escape or it takes away my bad thoughts." Then the next question is: "Why do you have bad thoughts? Why do you have a need to escape?" When exploring these questions, people realize that their anxiety is the result of emotional baggage they've carried from a young age.
It's important to talk about your anxiety, so you're not alone with it. Spend time with people who have gone through similar experiences. Support groups, where you can talk to people at different stages in their relationship to HIV and their anxiety, are really valuable. They allow you to see your issues from a different angle and that it's possible to come to a better place. See a private therapist if you can afford it or see one in the public health system if that's an option. In the right hands, cognitive behavioural therapy (CBT) can probably be helpful, too. The real issue is not so much which technique you use as how comfortable you feel with the therapist and how much you can really be yourself and be listened to. And, of course, yoga, meditation, any mindfulness practice can be wonderful.
Seeing your healthcare provider is an OK place to begin, as long as the doctor is open-minded and can listen to you. Medical training often gives psychology short shrift, so many doctors are not well-equipped to handle these issues. If you don't get help within the medical system, don't think you're alone. Just keep looking.
As far as anti-anxiety medications go, they can deal with the symptoms but not the causes. That doesn't mean we shouldn't deal with the symptom, too. (If you broke your leg and were in severe pain, it would be important to relieve your pain and deal with the broken leg.) So, in principle, I'm not against anti-anxiety meds, but they're overused. They are very difficult to get off when you've been on them for a long time and they can give the impression that you've dealt with an issue when you haven't.
Two classes of drugs commonly prescribed for anxiety are benzodiazepines and antidepressants called SSRIs (selective serotonin reuptake inhibitors). Benzodiazepines should only be for very short-term use, in the case of extreme difficulty functioning. If somebody's going through a terrible panic attack, a short course of SSRIs is better, but they don't solve the underlying problem either. They can calm you and help you cope so you can deal with the unresolved issues. [Note: These two classes of drugs interact with many antiretrovirals, especially protease inhibitors and, to a lesser extent, non-nukes. A lower dosage of anxiety medication is usually prescribed for people on these HIV meds.]
Dr. Maté is the author of In the Realm of Hungry Ghosts, When the Body Says No and other bestselling books. Visit drgabormate.com.
This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication The Positive Side. Visit CATIE's Web site to find out more about their activities, publications and services.
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