“Understanding Anxiety and Anxiety Disorders” – with Dr. Shari Lusskin

On this podcast episode, Dr. Shari Lusskin joins Dr. Nathan Fox to discuss common concerns about anxiety and when its considered “normal.” Situational anxiety because of an upcoming test or stressful event is normal and not always a cause for concern but if the anxiety becomes chronic and affects how you function, it’s a problem that should be addressed with your doctor. In can be difficult for people to figure out on their own because of the non-specific labels used for emotional disorders. Drs. Fox and Lusskin also discuss diagnosis for different disorders and treatment options like systematic desensitization to decrease feelings of anxiety when exposed to phobias or triggers.

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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist, practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Dr. Lusskin Shari, welcome back to the podcast. So, nice to see you. How you doing?

Dr. Lusskin: Great. Thank you.

Dr. Fox: Happy birthday.

Dr. Lusskin: Thank you so much.

Dr. Fox: Not only are you an amazing doctor who takes care of your patients, not only are you an amazing friend and colleague who decides to come here and do this podcast for me and our listeners, but you do it on your birthday, so we’re celebrating.

Dr. Lusskin: I can’t think of a better way to celebrate.

Dr. Fox: You got any big parties coming on later because of this birthday thing?

Dr. Lusskin: Yeah.

Dr. Fox:Awesome. Good stuff. Well, many, many more birthdays and health and happiness, as we say.

Dr. Lusskin: Thank you so much.

Dr. Fox: Wonderful. So, I asked you to come back because you’re great, and because the last podcast we did together was very well received and very helpful for a lot of people. And I wanted to talk about anxiety because it’s pretty common, and I get a lot of questions about it, and we see a lot of people with it, and I’m sure a lot of our listeners either have it or know someone who has it or wants to know about it, or, do I have it? Is my anxiety normal? Is it abnormal? What do I do? And so, you are the top of the food chain when it comes to all of these things. So we’re happy to have you. Thank you.

Dr. Lusskin: You’re welcome.

Dr. Fox: Excellent. So, let’s jump right into it. Everyone knows what anxiety is, right? Fine. How would somebody who’s listening, let’s say, know, well, I get anxious from time to time? I worry about this or I worry about that, or I’m worried about my pregnancy, I’m worried about my job. When does that cross the line from, like, I’m just worried about something, to, I have an anxiety disorder, like, I’ve got a problem that needs to be addressed?

Dr. Lusskin: It’s a matter of degree and how much it interferes with your functioning. So a little anxiety is good, it kind of sharpens your performance.

Dr. Fox: Keeps us from getting attacked by lions and things like that. Okay.

Dr. Lusskin: Get You to study for a test. Do you take any tests in medical school?

Dr. Fox: We take a lot of tests.

Dr. Lusskin: A lot of tests in medical school. A little anxiety is good. Too much anxiety interferes with your ability to concentrate, to plan, and to be effective. And that’s when it’s a problem.

Dr. Fox: I guess my question is, everyone’s walking around the world with some level of anxiety, right? Obviously, situational based on what’s going on. Okay. How many people have an anxiety disorder and don’t know about it? Or how many people think they have an anxiety disorder, but they don’t? Do you think most people underestimate their amount of anxiety, meaning they think everything’s perfectly okay, but they’re walking around with a crazy anxiety disorder, or they overestimate it, meaning they think that they worry so much, but in fact, it’s really pretty typical and very normal? Or is everyone sort of spot-on with where they are?

Dr. Lusskin: People are definitely not spot-on. But a lot of your anxiety is situationally driven or situation dependent. So, the first time we did a podcast together was September of 2020. It’s in the throes of COVID. Nobody’s vaccinated yet. It was a tense time. If you weren’t anxious, you had a problem. Interestingly, patients of mine who had obsessive-compulsive disorder, who had spent a lot of time worrying about things that really weren’t a threat, all of a sudden, they calm down. It’s like, “Oh, I’ve been afraid of being contaminated by food left on the countertop, but now there’s a real threat to my existence, namely COVID-9. So, let me put that at top of mind and, you know, in my top priority and forget about the unwashed counter.”

A few months of COVID and people’s OCD-type symptoms started to creep back because we kind of accommodated to COVID, and whether it was handwashing or Purell or wearing masks, people kind of got used to the situation. So, their anxiety level dropped and their underlying anxiety disorder came back or it became more prominent. Sometimes people are really aware of how they’re feeling, and other times they’re not. Sometimes they function at a high level of anxiety, but they think they’re just functioning normally and effectively. But people around them feel the anxiety and it puts a stress on them, so they wanna do something about it. But until the person is willing to acknowledge there’s a problem, nothing gets done.

Dr. Fox: So, if someone is, let’s say on a deserted island, they’re alone, no other human contact, and that’s the way they are, and they have an anxiety disorder, is there any downside to it? I mean, depression, it can affect your overall health, you can’t sleep, and your mood and you don’t feel right in this. So, I get it, that’s something that itself is problematic. But if someone’s like, “I’m very anxious, but you know, this is cool. I’m fine with this.” Or is it just really the fact that you have to function in a society with other people?

Dr. Lusskin: That’s an interesting question, because if you’re really anxious on a desert island, you wouldn’t be comfortable with the anxiety. The anxiety is an indicator that you need to do something to protect yourself. So, it’s your early warning system, or depending on where you are, your later warning system. Your anxiety is, I better find some water I can drink, otherwise, I’m gonna die. I better figure out a way to signal a plane flying overhead to get rescued, otherwise, something is gonna kill me on this island, starvation, disease, volcano.

Dr. Fox: Yeah. I always sort of try to differentiate it, like you said earlier, that it’s whether it affects your function, you know, meaning if someone is, let’s say someone looking at them would say, “You have an anxiety disorder because, you know, what you’re doing is just way overboard.” But the person doing it is like, “Well, you know, I get outta bed, I’m happy. You know, I go to work. I function fine. I get to do what I need to do. I get my paycheck. I come home. The people I hang out with, it’s not affecting my friendships, my relationships, my marriage, whatever it might be. And I go to sleep at night totally content.” It’s hard to call that a disorder, you know?

Dr. Lusskin: It’s very hard to call it a disorder. And I don’t know that that person would. But if their partner feels stressed out being around them, or their kids do, or their coworkers, or their direct reports, then it becomes maladaptive.”

Dr. Fox: Yeah. I can’t go to work. I can’t do my job. I can’t, you know?

Dr. Lusskin: Well, but that’s the person who understands that they’re anxious. On the other hand, they may become the person who’s impossible to work for. Because they’re so worried about… We talked about perfectionism and rerecording a sentence at a podcast to get it just right. So, if you want things just right, there’s a time and a place for that. You’re a surgeon, if you don’t have the right instrument count or the right sponge count, and you, oops, well, there were 20 vessels and we tied off 19 and we left one un untied. That’s not a time to be relaxed. You need to be a perfectionist there.

But in other situations, if you’re too perfectionistic, it interferes with your ability to do your job or for other people to do their job. Like if you’re constantly micromanaging your direct reports because you don’t want them to make a mistake, you can have the opposite effect. Instead of enhancing their performance, you can impede their performance because they get tense. They fully recognize that they’re anxious in your presence. So, from a sort of management consulting viewpoint, if somebody gets feedback that they’re putting too much pressure on their employees, they’d have to examine their behavior and examine what their fears are, and kind of come to grips with the fact that they’re anxious about something. Just to give you one example.

Dr. Fox: Right. If someone came to you and they weren’t sure, they said, “You know what, I’m a pretty fastidious person and I have anxiety, and I’m not really sure if it’s a problem. Or I think it’s a problem, but I don’t really know.” What do you do to assess their life, their situation, their anxiety in order to help determine, is this someone who’s sort of maybe crossed a line and needs some sort of recalibration, whether that be, again, through therapy, through medication, whatever? So, what is it that you do?

Dr. Lusskin: Well, as a first step, I like to have the patient fill out a self-screening tool called the Generalized Anxiety Disorder, or Seven Items Scale, or the GAD-7. Let me read you some of the questions from that.

Dr. Fox: And this is like one of these validated tools that people use around the country, the world, or whatever it is?

Dr. Lusskin: Exactly. So the question is, in the past two weeks, how often have you been bothered by the following problems? And you can rate it from zero to three, where zero is not at all and three is nearly every day. Feeling nervous, anxious, or on edge, not being able to stop or control worrying, worrying too much about different things, trouble relaxing, being so restless that it’s hard to sit still, becoming easily annoyed or irritable, or feeling afraid as if something awful might happen. So, the reason I have patients fill that out before they’ve even seen me is it just gives me a ballpark idea of where they fall. If it’s, you know, zero all the way, they’re not going to be very anxious. If it’s a 21…

Dr. Fox: Or it’s the highest score, whatever. Yeah.

Dr. Lusskin: Yeah, which is the highest score, then I know they’re walking in anxious, then my job becomes figuring out what the anxiety indicates. So, anxiety is a very nonspecific symptom, it’s kind of like inflammation. Inflammation can be anything from a swollen joint in rheumatoid arthritis to pericarditis, for example,

Dr. Fox: Yeah. Or you just bumped your knee against a table.

Dr. Lusskin: Right, right, and you have a bruise. So, anxiety is kind of a non-specific marker. As a psychiatrist, we try to put it into some sort of diagnostic box, which then guides our treatment. So, a person can be very anxious because they have a really severe psychiatric disorder such as schizophrenia, and their anxiety is accompanied by or driven by hallucinations and delusions. So they’re gonna screen positive on this. But if they don’t have, like, sort of constant worry, they’re just anxious people, it’s much more than that. They could be anxious because they’re depressed. Anxiety is a very common symptom of depression. Or they could just be an anxious person who’s been anxious since they came out of the womb. Can you predict when the baby’s delivered who’s going to be anxious?

Dr. Fox: I’m gonna tell you a story about that. It is interesting because some of it is obviously someone’s just their own disposition, like who they are. And definitely, there are babies who are more jittery, more tense, more unrelaxed than others. Now, what the predictive value is of that to have an anxiety disorder versus just whatever, who knows? But definitely, newborns have personalities. And we actually see fetuses have personalities. I mean, ones that are very quiet inside versus very active inside. It definitely plays out. Again, you know, there’s nature and nurture. And so the nature part is gonna be present at birth and the nurture happens afterwards. What you said, it’s so interesting because I think part of the confusion, I would say part of the problem, but it’s certainly part of the confusion, is that the word anxiety is really a symptom, right?

Dr. Lusskin: Mm-hmm.

Dr. Fox: And it’s a condition. You could have the symptom without having the condition. Like you said, I could be perfectly fine 364 days a year, but tomorrow, I’m about to go to court because I’m getting sued for something, and I’ll be very anxious. I’ll have anxiety, but I don’t have anxiety disorder, because as you said, it’s normal. Like, it’s healthy to be anxious before something like that. And some may have more, some may have less, but it’s a symptom. Versus, you can have an anxiety disorder where your problem is you have too much anxiety, or it’s an unhealthy amount of anxiety, whatever. But then on top of that, it could be a symptom of something that’s a different disorder. You have schizophrenia and so you have a lot of anxiety, but you don’t have an anxiety disorder because that’s not your problem. You’re not even normal anxiety, you’re anxious because you think the government’s chasing you because you have delusions.

And all three of those, they use the same word. And I think that that’s part of the confusion. It’s same with the depression. Like, it’s normal to be depressed if someone, a loved one dies. But that doesn’t mean you have a clinical depression, it just means you’re sad.

Dr. Lusskin: Yeah. We touch on a central problem in psychiatry, which is that our labeling of emotional states is very non-specific. We can save that for later in the podcast. One way to think of it is this, I already mentioned that a little anxiety sharpens your performance. If you’re going to court tomorrow and you’re anxious, the idea is not to stay up all night worrying. What you’re supposed to be doing is reading through the records so that when you go to court, you know what you’re talking about. Whether you are being sued or whether you’re an expert witness, you have to be prepared. Think about it this way, if you’re walking down the street and a bus comes barreling down the street towards you, that should trigger your fight or flight response, which makes you move and get out of the way of the bus.

Dr. Fox: Right. Good anxiety.

Dr. Lusskin: Okay. That’s good anxiety. Bad anxiety is when you become paralyzed. I mean, I don’t know how many people that… If you go back to 9/11. If you were claustrophobic and you could only go in an elevator when you were the only person in it, you would have a lot of trouble getting on an elevator as you’re trying to evacuate the building where they’re 25 people stuffed into an elevator. And so you don’t get into the elevator, and that’s the end of the story because you didn’t make it out of the building. That would be bad anxiety. Clearly, if you had an elevator phobia to begin with, you weren’t working at the top of the World Trade Center.

But, you know, it’s another example of a time of high anxiety globally, nationally, locally, and personally. Interesting that the anxiety around 9/11 was in some ways less than the anxiety around COVID. Because COVID killed millions of people around the world. COVID affected everybody. Nobody was safe. So, like you said, it’s non-specific. And we come back to, does it interfere with your social relationships? Does it interfere with your work performance? Does it interfere with your academic performance? Does it interfere with your ability to reach the goals that you set for yourself in your life? And if the answer is no, no, and no, then you don’t have an anxiety disorder.

Dr. Fox: I almost view anxiety sort of like the word pain. If someone came to me, I’m a doctor, and said, “What’s your problem?” “I have pain.” Well, that can mean a lot of things, right? If you have pain because you sprained your ankle, I would say, “Sorry to hear that. It’s normal to have pain when you sprain your ankle. Let me give you something temporarily to relieve the pain, or not based on how much pain it is. And you’ll get better with time because your ankle will get better. Versus, I have pain because I have appendicitis. Well, then, okay, my problem is not to treat your pain, is to treat your appendicitis. Versus, I have chronic pain. I have pain every day, all the time, my whole life. They’re very,very, very different things and they mean different things, which is why the word pain, it can be a diagnosis, but it’s usually not. It’s usually part of something else or a symptom of something else.

And so, anxiety for probably more people have an anxiety disorder than a pain disorder, but it is a diagnosis. But someone’s saying they have anxiety does not mean death, their diagnosis necessarily. It could be manifestation of something normal or something abnormal or unhealthy or whatever you wanna call it, but not necessarily specifically anxiety. You said they could have depression, and you treat the depression, the anxiety will get better, or they have OCD or they have schizophrenia or whatever it might be. And you have to tease that out. That’s why, you know, people come to you to figure that all out. Right?

Dr. Lusskin: That’s exactly why they come.

Dr. Fox: Yeah. So, when you’re meeting with them, you do the screen, and then is it just by asking questions and it sort of becomes pretty obvious what the story is? Or does it take a long time to sort through all that? Like, how does it typically go?

Dr. Lusskin: Diagnosis in psychiatry is made based on the history and the interview at this stage because we don’t have specific disorders, we don’t have specific tests that we can do.

Dr. Fox: We can’t do an MRI and decide it, or a blood test.

Dr. Lusskin: Thank you. We can’t do an MRI to show… We can do functional magnetic resonance imaging studies, which look at brain metabolismand electrical conductivity, but again, non-specific. If the patient is anxious, you can see certain correlates and brain activity, but it doesn’t tell you what’s causing the anxiety. So it doesn’t help you design a treatment to fix the anxiety.

Dr. Fox: Yeah. Now, if we’re talking about anxiety as its own disorder, meaning not secondary to bipolar disorder or not secondary to just normal healthy, I have a test tomorrow, but an actual anxiety disorder, there are sort of like, I dunno if they’re called subtypes or if they’re called, like, different manifestations. I’ve heard like general anxiety disorder or GAD, there’s social anxiety disorder, there’s various phobias. Are they all part of the same problem? Are they different problems? In your own mind, how do you categorize them?

Dr. Lusskin: The presenting symptom may be I feel anxious. Then when we tease it apart, it may break down into somebody, for example, with an elevator phobia, so that person has trouble even getting upstairs to a doctor’s office if they have to take an elevator. They could have a dog phobia . Now, in New York, if you have a dog phobia…

Dr. Fox: Big problem.

Dr. Lusskin: …you’re going to be very anxious. Or, I’ve had patients who have a mouse phobia. And depending on what your building is like, there may be mice or rats or whatever. And that could really interfere with your ability to live because you’re constantly watching for that object of your phobia to appear in some way. So, if there’s a specific phobia, then we try to treat the specific phobia. And usually, when you’re treating a phobia, like a simple phobia, you do graded exposure. It can start with even saying the word of the thing they’re afraid of. “I’m afraid of dogs.” So, that can make people anxious just to hear the word. And then you can progress from speaking it to looking at cartoons of dogs, like cartoon pictures, and then to real pictures, and then gradually expose them to seeing an actual live animal.

And what’s remarkable about the brain when it comes to phobias is that you can desensitize the brain so that you learn to tolerate the stimulus and then your anxiety level decreases and your anticipatory anxiety decreases.

Dr. Fox: Yeah. If I recall from my high school psychology class, systematic desensitization. Right?

Dr. Lusskin: Perfect. Perfect.

Dr. Fox: Got it. See?

Dr. Lusskin: And if you have a patient who’s willing to do that work, it’s very effective.

Dr. Fox: We have a lot of, in our own lives, in our neighborhood, we’re in Jersey, a lot of people have dogs now. And there’s kids around the neighborhood, you know, X% of them whose families don’t have a dog and everyone’s got one kid who’s like, “This kid’s totally terrified of dogs.” And like you said, it’s a situational problem. It’s not a problem when they go to school, but it’s a problem if, you know, they go on a play date or this or that. And so, we’ve had a lot of kids in our neighborhood doing, it’s not dog therapy because they’re not using the dogs to give them therapy, it’s systematic desensitization. But our dog, we have two dogs, one of whom is kind of jumpy and one of whom is very calm and very pleasant and very sweet.

And so, she’s like one of the go-to dogs in our neighborhood for the kids who are trying to get desensitized to dogs because our dog is, like, low-level because she’s not too frightening. The worst she’s gonna do is lick your toes, you know, and she’ll just sit on your lap and not do anything. But we see a lot of it, and it works. I mean, it works. These kids go from literally, you know, running away in terror to taking our dog for a walk or holding her on their lap and petting her and it’s unbelievable.

Dr. Lusskin: Yeah. And if you’re a parent of a child with a phobia like that, the best thing you can do is model the behavior for them. So, show them that you’re able to sit with a dog calmly and pet the dog and, like, make it okay for them to try to challenge their fear. Now, very often I have seen that in families with a child who has a phobia, one or both of the parents or caregivers, not the caregivers, but, like, the parents have a phobia themselves. So, they have inadvertently modeled phobic avoidance to the child. And the phobias may have different objects.

Somebody could be afraid of bees and the kid is afraid of dogs. But either way, you’ve unwittingly shown them that when you see something you’re afraid of, you withdraw, move away, and avoid. So, sometimes you have to address phobic avoidance in the parents too in order to treat the child.

Dr. Fox: Right. What about, like, social anxiety? Because that’s another big one.

Dr. Lusskin: It’s another big one that’s also kind of non-specific. So, social anxiety involves a fear that something bad will happen to you if you’re in a social situation, that you’ll say something that will embarrass you, or that other people will be saying, you know, bad things about you. And it leads to social avoidance. And that’s a very, very superficial explanation of it. We were talking earlier about alcohol in pregnancy, and if you wanna find patients with social anxiety disorder, go to an AAA meeting, because what’s alcohol? It’s the great social lubricant.

So, people who are nervous in social situations drink, they feel more relaxed. Alcohol is the original tranquilizer. And then, they’re able to chat, but the alcohol in and of itself becomes a secondary problem. It’s always interesting to me that the field of psychiatry in many instances has drawn a distinction between substance use disorders and underlying psychiatric disorders as if you would just become an alcoholic or a drug addict without something going on inside you that would drive the substance use. You have to be treating something. It’s not self-medication, that’s not a good term, but you’re responding to some internal discomfort, and that’s why you may reach out for alcohol or drugs.

So, in the effort to achieve and maintain sobriety, it’s important to address the underlying anxiety or mood disorder or other psychiatric disorder that may be accompanying it. Now, I’m sure some people get hooked on painkillers that were prescribed by… I had surgery and I had one dose of codeine and threw up and somehow, I had a pill bottle full of 30 tablets of codeine when I went home. Like, I wasn’t taking it. It was just automatically given to me. So, you can see how people could get hooked on painkillers. But then there are people who seek out painkillers, narcotic pain meds, whatever, but they must be responding to something internally. What is your feeling on this matter?

Dr. Fox: I know too little about this to have an educated opinion. It’s hard. I mean, it’s one of these things where, you know, substance abuse, it runs in families frequently, so you know, there’s obviously a genetic component. There’s obviously an environmental component. I’m sure there’s a psychologic/psychiatric component to it. There’s gotta be something organic. I mean, their receptors respond differently than other, and there’s so much that goes into it. But I mean, obviously, so many people, their first exposure that’s gonna get them on the road to addiction is not typically, or maybe not often something just outta nowhere. There’s something, you know, that caused that.

Dr. Lusskin: There’s something, and you mentioned that it runs in families.

Dr. Fox: Yeah. Which is both, that’s both genetic and environmental.

Dr. Lusskin: Which is both genetic and environmental. And, you know, we know that certain enzyme profiles are different between different racial groups. So, your ability to process alcohol and metabolize it can vary depending on your ethnic origins. So, that may make you more or less vulnerable to developing an addiction because if you can’t tolerate the substance to begin with, you’re not likely to use it repeatedly. So, you talked about organic versus psychological versus genomic and environmental.

Dr. Fox: I know where you’re going with this because I remember from September 2020. So, hit us up. What do you got?

Dr. Lusskin: Okay. It’s all organic, it’s all neurobiological. It’s not in your mind.

Dr. Fox: Organic brain disorder.

Dr. Lusskin: Yes, it’s all in your brain. If we take out your brain, you are cured.

Dr. Fox: Absolutely. And that’s happened to some people and many of them run for office. Sorry to all you politicians out there who listen, I’m not making jokes about you.

Dr. Lusskin: Specifically.

Dr. Fox: We sort of have been talking about sort of specifics, but what is then a generalized anxiety disorder? You know, it’s not necessarily one phobia or it’s not necessarily a substance or it’s not necessarily social. Just like in general, you have anxiety for everything? Like everything you do has anxiety?

Dr. Lusskin: Well, if you recall that screening questionnaire that I read to you, generalized anxiety disorder means you worry a lot about a lot of things a lot of the time.

Dr. Fox: Right. People say that that is much more common now. You know, it’s on the rise, everyone has it, you know, 112% of kids have it. I mean, like, this is what you hear out there. What’s the reality? Is it really that prevalent? Is it really on the rise? What’s your knowledge and experience on this?

Dr. Lusskin: My experience is that people have gotten more anxious. Now, everybody’s seen the headlines I’m sure that the rates of depression and anxiety have increased in children and adolescents during the COVID-19 pandemic. You’ve seen that?

Dr. Fox: True.

Dr. Lusskin: Okay. Big headline this week, “The rates of anxiety and depression in the parents has also gone up.”

Dr. Fox: It’s everyone.

Dr. Lusskin: It’s everyone.

Dr. Fox: Is it anxiety the symptom or anxiety the disorder, would you say it’s going up or for both?

Dr. Lusskin: I’d have to say both. There are some people who are inclined to worry, who worry more. There’s some people who weren’t that worried who have gotten very worried. I have to tell you about a patient I took care of recently, who I first treated 14 years ago when she was pregnant. She was depressed, she was anxious, treated her during the pregnancy with psychotherapy, which parenthetically alters brain chemistry but in a less direct way than medication. But we had psychotherapy and medication. She got through the pregnancy. She did pretty well postpartum. And then she stopped treatment, although she did continue her medication with her primary care physician.

Fast forward 12 years, she calls me up during the pandemic, two years ago. And all of a sudden, out of nowhere, she is super anxious.

Dr. Fox: Outta nowhere.

Dr. Lusskin: Out of nowhere. I mean, she wasn’t so calm in hindsight over those intervening 10 years or 12 years, but now she was really, really anxious and starting to have panic attacks. Why am I so anxious?

Dr. Fox: Have you thought about the global pandemic?

Dr. Lusskin: Exactly.

Dr. Fox: Are you wearing a mask right now? Are you locked up at home?

Dr. Lusskin: Are you doom-scrolling at 4 in the morning when you wake up?

Dr. Fox: That’s a good term, dooms-scrolling. Oh my God.

Dr. Lusskin: Doom-scrolling.

Dr. Fox: I love that.

Dr. Lusskin: What’s in “The New York Times” today at 4 in the morning?

Dr. Fox: How many people died? I always said like, again, the pandemic was its own unique thing, but I was like, it did not help that no matter when you’re watching TV, there’s like a ticker at the bottom how many people died that day? It’s like, that’s not good.

Dr. Lusskin: Not good at all.

Dr. Fox: That’s not helpful.

Dr. Lusskin: And when you have a little child who’s… When you have two kids who are home, one who’s 12 and one who’s 4 and you’re trying to manage homeschooling, can you imagine homeschooling with a preschooler? It’s a nightmare. How about homeschooling with a 12-year-old? Also a nightmare.

Dr. Fox: Just home with a 12-year-old.

Dr. Lusskin: Home with a 12-year-old is a nightmare.

Dr. Fox: Sorry for all of you 12-year-old listeners out there, but yes, I’m giving you crap. All right.

Dr. Lusskin: And you have some underlying medical conditions that would make you extra vulnerable if you got COVID, shouldn’t you be anxious? Okay. Fine. So, back to therapy, adjust the medications, and the question keeps coming up, “Why am I still anxious?” Well, just when you thought it was safe to go back in the water, your husband got COVID. By some miracle, you didn’t get it, but somebody in your household has it. Or how about this one? Just when you thought you were getting better, the school’s opened up. So, now your kid is going to school and it’s frequent testing.

And every time, you know, people have been isolated. So, you put a bunch of four-year-olds together, people are gonna get sick. So, it was like constant stressors. There’s a better word than stressor. It’s like constant exposure to threatening situations, namely COVID. So, we had lots of conversations, why am I anxious? COVID. Why am I still anxious? COVID.

Dr. Fox: Right. Prior to then, we would just say Trump in New York. Why am I anxious? I’m anxious because of Trump. But now, COVID and Trump, bad combination.

Dr. Lusskin: Exactly. Very bad conversation and a very bad combination. And I won’t even go down that road today.

Dr. Fox: Yeah. I know. But we may not have the same political beliefs, but it was a reality in New York that everyone’s worried about Trump. That was a thing. It’s all I heard.

Dr. Lusskin: No, no, I’m on board with you. I just wanna stay focused on the topic for today.

Dr. Fox: I just had to say it. Oh my God, I can’t stop myself. The people are gonna try to edit that out. Don’t edit it out. It’s funny. It’s okay. For people, again, we’re gonna sort of talk about treatment for anxiety for a moment. That’s going to wrap up this podcast and we’re gonna move on to anxiety and pregnancy and have it as its own unit. But just for anxiety in general, for general anxiety, the treatment is pretty straightforward. It’s some form of psychotherapy or therapy or again, if it’s specific to a phobia exposure, like something related to therapy and then plus/minus medication, correct?

Dr. Lusskin: Correct. But because the diagnosis, generalized anxiety disorder is relatively non-specific, it’s not always a slam dunk that the person will get better or that they’ll get…

Dr. Fox: Because they may have a different condition as well.

Dr. Lusskin: They may have a different condition or they may be severely anxious. I have some people who are just wound tighter than others. Some people kind of come out of the… like we talked about what are babies like. We know there are different infant temperament. I mean, that’s been known forever. So, if you come out of the womb wound tight, you’re gonna have to do a lot more work to become calmer. And you’re never gonna be like hippie-dippy, but you can be a kinder, gentler, calmer version…

Dr. Fox: Functional.

Dr. Lusskin: …functional version of yourself. So, I’d say treatment is effective, but there isn’t a single treatment approach. You have to tailor it to the individual and to their circumstances. I know we’re gonna talk more about pregnancy in a second, but you know that when I see one of your patients, I ask their partner to come in too, and I don’t wanna reveal the trade secret. But the person in the patient’s chair may be the healthiest member of the family, and I can’t treat their presenting complaints without making sure that the partner gets the treatment they need because they’re causing a lot of stress for the index patient.

Dr. Fox: Right. My spouse is driving me crazy.

Dr. Lusskin: Yeah. And sometimes they don’t even recognize that, but it’s pretty obvious if you meet with them as a couple. You see how the people work together. So, psychotherapy changes brain chemistry and can change it in a permanent way by building new neural connections. You learn to think differently. It changes your brain chemistry. Medication changes your brain chemistry. And then sometimes family and couples counseling is necessary to cement those gains, which is more changes in brain chemistry. So, the treatment has to be individualized, it has to be comprehensive.

Dr. Fox: Yeah. I actually wanna talk about comprehensive because it’s not just the treatment, and this is where it makes a difference who’s treating you, it’s the evaluation has to be comprehensive, because so many people I know professionally, personally, they suffer for so long and part of it is because the diagnosis is wrong. Meaning, they’re just being treated straight-up anxiety but no one ever determined you actually have bipolar disorder or it’s a different diagnosis, you need a different treatment. Because, again, anxiety’s just a symptom of a different problem.

And so, you can give someone some Xanax and they’ll relax, you know, sort of from the medication or you can even put ’em on, you know, an SSRI, but like, why doesn’t it work for me? Why does it work for this person, not me? Well, if your problem isn’t straight-up anxiety, let’s say, but it’s a symptom of a bigger issue or a more complex problem, you’re never gonna get better. And I think that people don’t always realize that just because your family physician told you to take a little Zoloft because you’re anxious, one of the reasons you may not be getting better is because maybe you have something else going on. And to really make sure you’re getting a good thorough evaluation of what your “problem” is. And that’s critical, critical.

Dr. Lusskin: This is where being an educated consumer is so important and why your podcasts are so great because…

Dr. Fox: Oh, you know, thank you.

Dr. Lusskin: That was a plug.

Dr. Fox: Happy birthday to me. All right.

Dr. Lusskin: I wanna get it in before you’re too famous to talk to me with your new book coming out.

Dr. Fox: We’ll talk about that. All right. Go on.

Dr. Lusskin: I forget what I was gonna say.

Dr. Fox: About getting a thorough evaluation.

Dr. Lusskin: Okay, getting a thorough evaluation. So, when you get evaluated, it’s important to tell the doctor, you know, what you’re feeling, to report your family history, and to report your general medical history. So, that includes your obstetric history, your heart, lung, liver, kidney problems, dermatologic problems, everything, because it’s all connected.

Dr. Fox: Same person.

Dr. Lusskin: Yep. And I’ve personally dissected those connections. So, you wanna make sure that you’re covering all those bases. And if the healthcare provider doesn’t ask, volunteer the information and say, “You know, I did have a history of thyroid disease or three of my relatives had it. Could that contribute?” And then it’s the doctor’s job to rule out those other factors that can contribute. I always do a urine toxicology screen when I see patients. I like to say, “We trust in God, all others pee in a cup.” Because if you’re doing cocaine, it can cause panic attacks. And sometimes people tell you what they’re doing and sometimes they don’t. So, you do it. That’s an objective test that you’ve done.

Dr. Fox: It also removes judgment, meaning, I’m not selecting, “Oh, you’re the one who I think is using cocaine and you’re probably not.” Because then the doctor’s biases come into it. You just say like, “This is routine. We do it on everybody,” you know. It’s like a pregnancy test in the ER. Someone says, “Oh, there’s no way I’m pregnant.” “Great. Pee in the cup,” you know. We need to check everyone, otherwise, we could miss people or offend people. And understandably, it’s offensive if someone says, “You mean I’m singled out to be on drugs?” Like, “Why not everyone?” Like, “No, I test everyone, no judgment.”

Dr. Lusskin: Yeah. I test everybody routinely from age 18 to 80. And if they were 85, I’d test them too. I’m just not seeing that demographic at the moment.

Dr. Fox: God bless.

Dr. Lusskin: Well, I did have a dentist come in who was abusing marijuana, he was in his 70s, and this was back in the ’90s.

Dr. Fox: Good for him.

Dr. Lusskin: Well, God bless, he was ahead of the curve.

Dr. Fox: Ahead of the curve. He was the OG. Excellent. Shari, thank you so much for coming to talk about anxiety. We’re gonna wrap this one up, but we’re gonna jump right into anxiety and pregnancy and treatment, anxiety and pregnancy. But I really appreciate. Thanks for coming on your birthday. I know this will be very helpful for our listeners. And all of you, stay tuned for the next podcast, which we’ll drop next week, which we’ll talk about anxiety and pregnancy.

Thank you for listening to the “Healthful Woman Podcast.” To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day.

The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.