How To Deal With Anxiety

By Michael Lemonick

With Anthrax in the mail and a war under way whose end is nowhere in sight, it's hardly surprising that a lot of people are feeling anxious these days. For most of us, the tightness in the stomach comes at moments of crisis, but it's manageable, and it goes away again. For others, though--especially those who tend to be anxious anyway--the feeling can be overwhelming. And while such severe anxiety can be transient, it can sometimes persist for weeks--or even longer.

Fortunately, there are plenty of things you can do about it, including taking medication--but that's a last resort. The first step in dealing with anxiety, says Richard Friedman, psychiatrist and director of the Psychopharmacology Clinic at New York Weill Cornell Medical Center in Manhattan, is realizing that "it's normal to feel anxious in reaction to the catastrophe. Don't avoid it; talk to your friends and family."

Next, says Friedman, "try whatever you normally do to relax." Not alcohol: that might take the edge off briefly, but the anxiety will return. Much better to try healthy anxiety reducers like deep breathing, exercise, yoga or meditation. A hot bath is also a good idea, and a cup of herbal tea like Tension Tamer can do just what it says.

But what if your anxiety is sustained and acute? If you have the following symptoms and can't shake them, you may want to see a professional: an inability to relax, a free-floating, persistent sense of distress, difficulty concentrating, trouble sleeping and rapid heartbeat. And for these, a psychologist or psychiatrist might recommend medication.

Which kind depends on the nature of the anxiety. If it's part of a chronic, underlying problem such as depression or something called "generalized anxiety disorder," the doctor would probably prescribe a so-called selective serotonin re-uptake inhibitor such as Paxil. Such inhibitors take up to six weeks to begin working. But by putting your brain chemistry back into balance, they can get rid of the outward symptom--the anxiety.

If your distress is a specific (though out-of-control) reaction to an outward stimulus like the current crisis, then Paxil and the others are "wrong, wrong, wrong," says Friedman. Episodic anxiety is best treated with an entirely different class of drugs known as benzodiazepines, including Valium, Xanax, Ativan and Klonopin. These work within minutes, not weeks--but they're potentially addictive, so they shouldn't be used for more than two weeks or so.

Finally, if anxiety is making it tough to fall asleep, there are sleeping pills. These include Halcion, Ambien and Restoril--and, like other true antianxiety drugs, they carry the potential for abuse. It's O.K. to use them if you really must. But it's better to deal with insomnia in other ways first--if you're tossing and turning, leave the bedroom and try reading. These pills are strong medications that should be used only with caution.

For more, visit www.adaa.org or e-mail michaellemonick@aol.com