We have a special treat for you today on Anxiety Connection. I have had the honor of interviewing Doctor Nitin Sethi who is a neurologist and the Assistant Professor of Neurology at New York-Presbyterian Hospital, Weill Cornell Medical Center. I was primarily interested in asking Doctor Sethi about the role of anxiety in exacerbating or even causing other medical conditions and illnesses related to the brain. We talk about a "mind-body" connection in that emotions can play a huge part in how our body physically reacts to stress and anxiety. But can anxiety affect the physical brain as well?
Doctor Sethi helps to answer some of these questions based upon his medical knowledge as a neurologist who treats brain diseases.
Thank you Doctor Sethi, for sharing your expertise with those of us on Health Central and Anxiety Connection.
My first question is: What are some of the overall general physical or neurological reactions to stress and anxiety?
I feel stress and anxiety are omnipresent in today’s life. We encounter stress and anxiety provoking situations all the time. When we get sick, this stress and anxiety only increases. This is especially true when someone is confronted with a chronic debilitating disease such as multiple sclerosis. Unfortunately many neurological diseases such as multiple sclerosis, cerebrovascular accidents (ischemic stroke and intracranial hemorrhage), brain tumors (primary and secondary tumors), migraines, chronic pain syndromes (such as fibromyalgia and chronic fatigue syndrome), lower back pain due to herniated disks and amyotrophic lateral sclerosis (also called Lou Gehrig’s disease) strike in the prime of life. Patients are frequently afflicted in their 40s and 50s and many are left behind with severe and permanent disability.
Let’s talk about specific neurological conditions which can be affected by stress.
How about Multiple Sclerosis?
The disease usually first strikes a healthy person in his or her early 20s. The course of disease then varies. Some patients experience a relatively benign course with few attacks and no major disability while others are not so lucky and experience multiple attacks separated by time and incur increasing neurological deficits such as weakness, problems with gait and balance, tremors and urinary incontinence. Psychopathology such as anxiety and depression is well known in MS. For a long time it was felt that it was the increasing disability which led to patients becoming depressed and anxious. Many in fact attempted suicide. When the incidence of depression and suicide in patients with MS was compared to that of patients with another equally disabling condition such as chronic inflammatory demyelinating polyneuropathy (CIDP) which is a demyelinating disease of the peripheral nervous system something very interesting came to light. In spite of equal disability, MS patients still had a higher incidence of depression and anxiety. What does this tell us? It seems diseases like MS and epilepsy which affect different parts of the brain such as the temporal lobes are themselves associated with psychopathology such as anxiety and depression.
Stroke or heart disease: When it comes to stroke the incidence of anxiety and depression varies. If the stroke is mild and the patient makes a full recovery and becomes independent in all activities of daily living then usually they do not suffer from depression. On the other hand I always ask my stroke patients if they are depressed especially the ones who have been left behind with neurological deficits such as inability to speak (aphasia) or significant weakness in the arm or leg (hemiplegia). Untreated anxiety and depression hampers neurological recovery. How can the patient participate in physical therapy if he is depressed? In this case the depression may be situational and due to the disability per-se.
Migraines: Migraine is the most common primary headache disorder which as a neurologist I encounter in my office practice. Migraines are frequently disabling. It is well known that stress is a migraine provoking factor and untreated disabling migraine frequently provokes anxiety and may lead to depression in the long term. Many studies have shown that migraine, anxiety and depression frequently co-exist. Whether this is on account of shared genetic or environmental factors is still not completely elucidated.
Chronic Pain: Chronic pain for example due to a herniated disk can be quite disabling and hence anxiety provoking. As a rule I attempt to alleviate the pain quickly and effectively. Physical therapy forms the cornerstone and helps tremendously in this respect. The flip side of this equation is equally important to understand. Patients who have pre-existing and untreated depression or anxiety are notoriously difficult to "cure". They fixate on their pain and hence are poor responders to medical and surgical therapy for herniated disks.
Do you feel that stress and anxiety can play a part in causing certain disorders or medical issues? Or does stress and anxiety only exacerbate already existing medical problems? Is it possible to prevent certain neurological disorders from happening if one learns to control their stress and anxiety?
Stress and anxiety have been implicated in many medical conditions. Even if the stress or anxiety is not the underlying cause of the medical condition such as stroke or epilepsy it certainly confounds and impairs its effective treatment. Biofeedback therapy has been found useful to some extent in treating disorders like elevated blood pressure (hypertension), irritable bowel syndrome (IBS) and insomnia. Its principle is quite simple and involves using devices such as a surface electromyogram (EMG) to record the activity from the muscles. The audio feedback from the machine acts as a "biofeedback" and the idea is to learn how to relax and lower your tension.
Are there any neurological disorders which affect the mood centers of the brain and can cause anxiety related symptoms?
As I stated before there are indeed certain neurological diseases such as epilepsy which preferentially involve the temporal and frontal lobes and hence frequently are associated with psychopathology such as anxiety and depression. In addition frequently drugs used to treat conditions such as multiple sclerosis (interferons) and epilepsy (anticonvulsants) have psychogenic side-effects such as anxiety, mood changes and depression.
What recommendations do you give to patients who are feeling great stress and anxiety as the result of their disorder?
I have come to realize that patients frequently “internalize” their stress and shall not volunteer the information unless specifically asked for. As a result anxiety and depression may go untreated in spite of regular visits to a doctor. So I make it a point to ask a few simple screening questions during the office visit. How is your mood? Are you anxious? How are you handing the situation? Would you say you are depressed? This frequently gives me an indication if my patient has untreated anxiety or depression. On a case by case basis, I may elect to either treat them myself or refer them to a psychiatrist. So my advise to your readers is that if you or your loved one is suffering from anxiety and depression in the context of a medical illness please do bring it to the attention of a doctor.
Any last thoughts?
The Vedas (ancient Indian Text) say and I translate "your mind is your best friend. Do not hurt him for whomsoever and whatsoever". Untreated anxiety and depression hurts the mind. It should be timely identified and aggressively treated.
For those of you who might like to contact Dr. Sethi or ask further questions he may be found by visiting his blog called, Brain Diseases Weblog.