I am going to post tonight and talk about Anxiety.  There is a tremendous amount of worry and stress in the world.  Patients come in and talk about their hormones, and while hormones contribute to a worsening of symptoms……. de novo or new  SEVERE anxiety is not hormones only.
I can feel the anxiety when I walk in a patients exam room.  There are many variations to this including tears that are being held back, pressure of speech, perseverating on fears, thoughts, ideas without rationale basis.  I have had patients say “I am not a worrier” but “I go to an emergency room at least every 6 months with my heart racing and they can never find a cause”.  I have patients state “I just need something to help me sleep” because   they cannot stop thinking about their day or focusing on the next day.  I have people say “I get up to see if my children are breathing”  or “I think spiders are going to crawl up my sheet if they touch the floor” or “I can’t stop thinking that this pain is cancer”  .  But, when I ask,  are you anxious or worried?  They say no….. and they are the most resistant to therapy or medications because they are “concerned” about how the medication might make them feel or the long term effects of the medication.  THIS IS ANXIETY.  I listen and treat is every day.  I feel like patients need therapy, psychiatrists- an avenue to talk about it.  Primary care physicians often just hand out a prescription because they don’t want to talk about it. Psychiatrists are far and few, not covered by insurance and ALSO hand out prescriptions without talking about the fears.  Anxiety can be chemical but frequently, it has a root.  Learned behavior, trauma, phobias, depression , unhealthy home or work environments, body image, fear of death, spiritual crisis…. the list goes on.  If someone would pay me to help patients with anxiety, if I could bill for the time-  or physicians could take the time to talk to patients to guide, educate or help them-  they wouldn’t be so quick to hand a prescription to them.  I feel we have a society that medicates the problem rather than listens, guides, counsels.  Sometimes people just need a sounding board from a compassionate listener and a counselor to help them find a way through their fears.   I will treat with hormones at times, sometimes I listen,  sometimes I make suggestions but the resources I have, as a provider are nil.  Just wanted to talk about it.    Dr N