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Anxiety research seeks cause, treatment by Michael Baker Public Relations Add anxiety to the short list of life’s certainties.  Death and taxes? Sure.  But at some point, everyone feels the telltale nervousness, the flush of heat, the restless itch. For many people, anxiety is an occasional disturbance, fostered through procrastination or lack of preparation.  Consequently, “anxiety” has endured a kind of semantic watering-down, so much so that its severity frequently eludes many people.  People are often “anxious for the weekend to get here” or “anxious to get the presentation completed.” Neither of these phrases is particularly ominous; both  inspire a sense of giddy nervousness—not an emotionally debilitating feeling.  For some, however, anxiety is chronic. Anxious feelings arise without antecedent, and the effects extend further than occasional bouts of discomfort. MUSC’s anxiety disorders program addresses these hyperbolic feelings of anxiety. According to program director Olga Brawman-Mintzer, M.D., anxiety is an extension of fear.  “Fear is generally viewed as a reaction to danger,“ Brawman-Mintzer said, “whereas anxiety is a sense of fear that is out of proportion with any real threat.” So while fear arises from a concrete source, anxiety generally carries no inherent origin. Thus, anxiety remains intangible and frustrating. And expensive. Each year, Americans spend more than $42 billion on treatments for anxiety disorders. Hidden in that statistic, Brawman-Mintzer said, is the distribution of expenses. Less than 25 percent of the $42 billion comes from direct treatment. The remaining 75-plus percent derives from “morbidity costs,” which represent the costs of sickness and lost opportunities due to chronic anxiety.  “Often, anxiety disorders indirectly cause health problems,” Brawman-Mintzer said.  For example, side effects such as sleep loss and hypertension may result in poor health. These health problems lead anxiety sufferers to a physician’s office, where they incur large medical bills.  Chronic, social anxiety sufferers will often lose their source of income; anxiety prevents them from leaving the house and, consequently, from going to work. Substance abuse is also more common in people with anxiety disorders than in people with normal anxiety levels. The money spent on drugs, alcohol and substance abuse programs simply adds to the billions of dollars spent on anxiety treatment. These expenses aren’t incurred by just a select few, either. “Anxiety disorders, as a group, are the most common mental illness in America,” Brawman-Mintzer said. Each year, approximately 19 million adults suffer from illnesses such as agoraphobia, obsessive-compulsive disorder, and post-traumatic stress disorder. So if anxiety disorders are so common, should people avoid anxiety at all costs?  According to Brawman-Mintzer, no. “Anxiety isn’t abnormal,” she asserted. “We all get anxious, and to an extent, it isn’t bad for us. In fact, it often stimulates us to get things done.” Brawman-Mintzer has been getting things done at MUSC for 13 years, studying the nature of chronic anxiety.  She explained that anxiety disorders spring from varying combinations of genetic and environmental factors. Genetically, the risk of an anxiety disorder is greater for certain people than for others, but their environments also play a role in the “if” and “how” of anxiety disorder presentation. “Some people are genetically predisposed to heart disease, but they may not develop it,” she said. “The same is true of anxiety disorders. It depends on both genetic and environmental factors.” For example, while certain people develop anxiety disorders due to inherent genetic traits, others never experience acute anxiety until an outside source of trauma—Sept. 11, a loved one’s death or a horrific accident—induces post-traumatic stress. Brawman-Mintzer’s research helps her uncover why certain people suffer from anxiety disorders and also focuses on finding new FDA-approved treatments.  In a recent study, the program examined a new compound to combat generalized anxiety. Brawman-Mintzer believes the compound could help people whose limbic regions resist more standard forms of anxiety treatment.  “Although treatment is often successful, there’s still a substantial number of people who either have relapses after treatment or do not improve at all,” Brawman-Mintzer said. “We’re on a quest to find a treatment that will work for them.” The program also plans to collaborate with Mark George, M.D., and the Neuroimaging Center at MUSC, using neuroimaging to analyze the biology of anxiety disorders. By examining the brain through functional MRIs, Brawman-Mintzer hopes to discover the effects of certain treatments, allowing researchers to determine which treatments are more effective and why they work so well. The program also wants to integrate the health care community in a coordinated approach to anxiety disorder treatment. A physicians’ training program awaits further discussion, and collaborations with universities such as George Washington and Emory have furthered research as well. But all the research and treatment opportunities are useless if they aren’t utilized. The same disorders that prevent people from conducting their daily lives are also disorders that prevent these people from asking for help.  Therefore, Brawman-Mintzer said, increased interaction and awareness within the community is crucial. An educational program for patients and potential anxiety disorder sufferers is in the works, as is the program’s planned expansion to clinical services. Each move represents an integral part of the program’s dedication to anxiety disorder treatment. “We’ve been doing this for years,” Brawman-Mintzer said, “expanding and collaborating within the medical and public communities. We want to be at the forefront of treatment research.” For more information on the Anxiety Disorders Program, call 740-1592. Know Your Anxiety Disorders Panic disorder sufferers experience repeated episodes of intense fear, often without warning. Physical symptoms include chest pains, shortness of breath, dizziness, and feelings of distorted reality.  Social anxiety disorder sufferers experience an overwhelming fear of scrutiny, embarrassment, or humiliation in social situations such as public speaking, leading these people to avoid many social settings. Generalized anxiety disorder sufferers experience constant, exaggerated tension about everyday life, anticipating the worst even if there is little reason to expect it. Physical symptoms include fatigue, muscle tensions and nausea. Post-traumatic stress disorder sufferers experience persistent symptoms after experiencing or witnessing a traumatic event, such as rape war, child abuse, or natural disasters. Nightmares, flashbacks, and depression are common. Obsessive-compulsive disorder sufferers experience repeated, unwanted thoughts or compulsive behaviors that seem impossible to control.    Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.