The word anxiety is used to describe common and normal responses to everyday stresses and worries. There are a group of anxiety conditions that are more serious and can disrupt one’s day to day functioning. These include the most frequent: Panic Disorder, Generalized Anxiety Disorder and Phobic Disorders. Add to those the more serious Obsessive-Compulsive Behavior Disorder, and PTSD, (Post-Traumatic Stress Disorder). These conditions are found to occur more frequently in older adults with HIV with estimates from 8% to as high as 26%. Often anxiety can be complicated with simultaneous presence of depressive symptoms.
Common symptoms of anxiety are fear, worry, difficulties with concentration along with physical symptoms, such as sweating, dizziness, heart palpitations and restlessness. In Panic Disorder there are sudden episodes of experiencing acute terror and feeling the loss of control along with a high frequency of associated physical symptoms which can lead to an emergency room trip. In General Anxiety Disorder there are persistent and longer episodes of worry and concerns, often involving seemingly minor issues. Normal activities become more and more difficult to perform and can lead to self-medication with alcohol or drug use to control the symptoms. Phobic Disorders involve irrational fears of various things, such as air travel, closed spaces, snakes, and social situations. Often these phobias are controlled by avoidance. Obsessive-Compulsive Disorder is triggered by various repeating thoughts about harms (obsessions) and these are then “controlled” by repeating behaviors (compulsions). This disorder can be quite disabling. PTSD is addressed in another part of the psychosocial section of this site,
The causes of the various types of anxiety are complicated and not fully understood. In fact, your doctor will need to make sure that there is no underlying disease process that is the cause of the anxiety. For the older person with HIV there can be early life trauma that triggers the anxiety. This includes the initial reaction to an HIV diagnosis. Therapy will address these issues,
The complexities of anxiety make it necessary for your primary care physician to consult with a psychiatrist to arrange for therapy that is customized to your needs. This might include non-medical approaches, such as yoga and exercise, or individual or group therapy. These would avoid the need for another medication and concerns about an interaction among medications. However, medications may be necessary.
First, it will be necessary to work with your physician to check various possible causes for your anxiety, such as heart, gastrointestinal or the nervous system.
Second, it will be important that you establish a good working relationship with your physician and the behavioral health professional. Good communication will be important to make certain that the therapies used are coordinated, so you get the best possible result.
Third, even if you are feeling better, if there are issues, such as continued trouble sleeping, which are not being addressed, you must ask for some assistance from either your physician or your mental health care provider.
Problems with anxiety can have a negative effect on adherence to antiretroviral therapy and other medications you are taking. It is possible that your anxiety treatment will take a while to be effective, so it will be important to keep taking all medications. If non-medication therapy is suggested, such as more physical activity, starting yoga, attending group sessions or other such activities, you must do your best to comply consistently. Possibly, the best therapy for you may be a combination of approaches. It may take some time to be successful, but you deserve the best quality of life possible.
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