(49) Anxiety
Suicide, Depression, and Anxiety. My story. -Miss America 2011 Teresa Scanlan
What is the relationship between other drugs and anxiety?
There are so many different drugs of use and abuse in our society; it is impossible to discuss more than a few in this text. Several appear commonly: marijuana, cocaine, heroin, prescription opiates, and ecstasy.
These are perhaps the most commonly abused after alcohol in the self-management of anxiety. Marijuana is a long-standing remedy used not just in this culture, but others historically, to help free people from the anxious chains that bind them. Many report that marijuana helps them to feel freer. It often creates a rebellious feeling, one of feeling able to do whatever one wants (the phenomenon commonly reported in adolescents wanting to belong to a group).
Marijuana can allow people to feel that their inner selves are acceptable in a social setting, thus illustrating the basic dynamic of an anxiety disorder-that the feeling of shame that commonly accompanies anxiety is unacceptable.
Cocaine has a similar effect. Often people with posttraumatic stress disorder or the anxiety that stems from depression report that cocaine allows them the energy to stay up all night with friends or lovers talking about many details of their past in a way that feels intimate at the time. Cocaine can create a false sense of energy, security, and intimacy; it often goes along with depression and with the self-medication of depression.
Heroin and other prescription opiates, readily available on the Internet via sham doctors with licenses who make opiates available to anyone for the right price, help people with the anxiety of rage. In my experience, it seems that patients who abuse opiates the most tend to have a primary difficulty with anger, and that the anger, because of its destructive nature, makes them feel unlovable and worthless. However, the opiate also provides a euphoric kind of feeling that recreates feelings of genuine love and belonging. A colleague of mine who works with heroin addicts reports that up to 85% of the opiate addicts whom she treats have been sexually abused. It is not surprising that these patients would create or seek a medium through which they could gratify their appetite for love, but yet do so via a drug that involves no human contact.
Perhaps the most popular anxiety drug of abuse would be ecstasy, also known as the “love drug.” Patients who have used ecstasy at parties and overnight raves often describe feelings of absolute euphoria, love, belonging, and connectedness. They feel safe touching and loving each other, staring at each other’s genitalia, or sensing a blissful, baby like kind of safety in the world. That ecstasy works so well to dissolve anxiety in the short term is entirely compatible with what we know of serotonin’s impact in the treatment of anxiety. Ecstasy increases serotonin quickly and provides immediate relief. The serotonin medicines do so over weeks, with a similar, but a more muted, effect. It is important to keep in mind that ecstasy, like the reported positive effects of many drugs, provides only an artifice of intimacy.
In fact, while people feel they are loving and sharing, they might also be acquiring sexually transmitted diseases or going home with partners they later regret having gone home with. Other users report grinding their teeth, developing high fevers, “disco dumping” (defecating in their pants), or ending up in a hospital from its effects on the body, none of which seems so desirable or loving.
What is the relationship between anxiety and depression?
Often, patients come to my office complaining of anxiety, and the more I listen to them, the more I realize they are in the middle of a full-blown depression, with anxiety and sadness as the major symptoms. The fear of bad things happening dominates the mental landscape.
Someone may fear going crazy. She may fear being left. She may fear bad things happening to her or to her family. She may fear being unable to provide for her family in the future. She may fear an inability to function and to sustain a life for herself. Or she may fear experiencing an unbearable psychic pain.
It is important to explain depression, briefly. Commonly spanning at least a two-week period, depression includes feeling low sex drive, decreased interest in life, increased rumination or sense of guilt, low energy, low mood, deep feelings of the blues, sadness, inability to rally, poor concentration ability, low appetite, decreased food intake, feelings of paralysis or heaviness, contemplation of suicide, and/or a basic listless quality.
Life may simply no longer feel worthwhile or worth living. It is not surprising that one of the most common elements of depression is anxiety. There are many ways to think about this relationship, and much thought has been given to this clinically. Often, a loss or a sad event takes place, either real or perceived. This injury, in turn, triggers the depressive feelings. Not attaining one’s desired status can leave one feeling less than ideal; this loss of ideal opens the floodgates of depression.
Anxiety stemming from depression can mushroom into the panic of hopelessness, which, in turn, can lead to frenetic behavioral attempts to manage the anxiety with impulsive decisions. At the time, these desperate attempts seem to provide relief, but longitudinally,
they can trigger further distress. For example, a patient who is acutely anxious about future terrorist attacks may decide to pack the family apartment, leave her spouse, and move the family to a rural setting. Once she relocated and thought the distress was confined to the urban landscape, this patient’s untreated depression might manifest further anxious symptoms. Now she may believe that the water supply of the town will be contaminated or preoccupy herself with rural terrorist attacks. This impulsive streak might make a doctor suspect bipolar illness (manic depression); however, often action-prone plans stem from the anxiety fueled by an untreated depression. Anxiety is a major piece of the larger clinical picture so common today. Now, in as much panic as before, the patient is isolated and without the social and community resources familiar from years in her former neighborhood. You can see how the cycle worsens without treatment.
I have thought of this particular anxiety as reflecting a question within the self.
Will the individual be able to return to an ideal sense of self? Anxiety serves as the substrate of this preoccupation. The internal anxiety, after a patient has been fired, might be, “will I be able to work and maintain a job at the level I did before?”
This initial worry can spring into anxiety over survival. This metamorphosis creates a vulnerable state, which, if not mended, can reinforce further depression. It is not surprising that as one’s depression gets treated, anxiety invariably lessens.
Rick’s comments:
It’s not always easy to tell, even about oneself, where one symptom ends and another symptom begins. At least I don’t find it easy and I doubt that I’m alone in this. I tend to think of my depressive tendencies as involving lethargy, sadness, a lack of enjoyment in life and a sense of being very alone and disinterested. Anxiety, for me, is more of a jittery feeling-more alive than the depressive ones, more active-yet not in a comfortable way. Maybe it makes sense to say that my depression is more like pain, my anxiety more like an itch, and my OCD like an attempt to scratch that itch.
Term:
Rumination - the process of going over and over the same thought in one’s mind to the exclusion of other thoughts and without any clear benefit.
What is the anxiety of suicide?
Suicide is a highly complicated psychiatric phenomenon; I often see it as falling into five major categories. The first would be an impulsive act in a person with a highly self-destructive nature who becomes disinherited enough through the use of alcohol-or another method leading to a lack of impulse control-which allows him to act on the actual pain he feels in life. In this situation, the anxiety is that of intense psychic pain and a wish to rid oneself of it. Victims of incest, survivors of overwhelming trauma, or end-of-life patients might be examples of those who struggle with fantasies of hopelessness or worthlessness that take the risk of acting on them one day.
The second is that person who realizes at some level that he is becoming psychotic or having a break with reality-he knows he is beginning to lose his mind. Patients describe this mind-shattering experience as profoundly disturbing; especially to someone who realizes some version of what he is losing. It is not uncommon for such patients to try to kill themselves. The anxiety may be a sense of annihilation or fragmentation which feels beyond repair. To leave this panic, a patient in this state might impulsively jump off the roof, out the window, or off of a bridge.
The third is the chronically suicidal patient. This patient spends years thinking of suicide and keeping suicidal thoughts and feelings a secret. It seems that this kind of patient feels trapped in a life of pain. Therefore, thinking of suicide serves as a way out, an option or escape hatch from the pain and seemingly enslaved nature of life. One day, often for reasons we will never know, the person decides to make fantasy a reality.
A fourth major category is the patient who has become majorly depressed. Symptoms can be an absolute wish not to wake up, a profound sense of hopelessness, or an inability to visualize life’s going on.
These patients can develop an impulsive pressure to kill themselves. The anxiety in these situations is similar to that of psychosis, in that the patient is suffering from a kind of pain that seems insurmountable. However, this anxiety represents distorted thinking. Patients who accidentally survived jumping from the Golden Gate Bridge all reported that they knew they had made a mistake the second they jumped.
The last category is the patient who receives bad news, possibly news of a worsening or progressive medical condition. These patients, it seems, become suicidal as a way to try to manage the overwhelming pain and anxiety that they are feeling in the moment.
One feature that we see clinically is that oftentimes the patient who is able to speak about wanting to kill herself is at least ambivalent about it. She leaves genuine room for intervention, but the person who feels deeply ashamed of his wish and is unable to speak with anyone about it might jump or shoot himself before anyone has had a chance to intervene. Anxiety is central to all of these types of suicide. Taking anxiety seriously and obtaining the right treatment can prevent suicide.
Term:
Psychosis - a state of thinking in which reality is distorted in a severe way.
