Anxiety describes common and normal responses to everyday stresses and worries. A group of common anxiety conditions are more serious and can disrupt one’s day to day functioning. They include 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 mental health 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, difficulty concentrating, and physical symptoms such as sweating, dizziness, heart palpitations, and restlessness. Panic disorders may be accompanied disorders may be accompanied by sudden episodes of acute terror, feelings the loss of control, and physical symptoms that require emergency medical treatment. Generalized anxiety disorder is characterized by persistent and longer episodes of worry and concerns, often involving seemingly minor issues. Normal activities are increasingly 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 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, early life trauma such as an initial reaction to an HIV diagnosis can be the triggers for anxiety. These trauma might include the initial reaction to an HIV diagnosis. Psychotherapy can help address issues with trauma.
The complexities of anxiety may 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 approaches could avoid the need for your doctor to prescribe another medication that could interact with other meds you’re taking. However, medications may still be necessary.
What can you and your physician do to address the problem?
First, you should consult with your physician about possible physical causes for your anxiety such as heart, gastrointestinal, or nervous system problems.
Second, you should establish a good working relationship with your physician and a behavioral health professional and ensure the two are communicating with each other. This will help ensure coordination between your providers and ensure the best possible result of therapies.
Third, even if you are feeling better, you may still continue to experience issues, such as trouble sleeping, that will require intervention by either your physician or your mental health care provider.
What can you do?
Anxiety problems can have negative effects on your adherence to antiretroviral therapy and other medications you are taking. Your anxiety treatment may take a while to be effective. It is important that you keep taking all your medications. If your care team suggests non-medication therapy such as physical activity, yoga, or group sessions, you should do your best to comply with their recommendations. A combination of approaches may work best for you. It may take some time for treatment and other approaches to work. But you deserve the best quality of life possible.