Disclaimer: This podcast is for informational purposes only and is not intended to be used as personalized medical advice. Please note that we will be discussing anxiety during this episode, and that can be a trigger for some people.

Michael Smith, MD (Host): In today's episode, we are discussing anxiety with Dr. Stephen Mowery, who practices Family Medicine at Skagit Regional Health. I'm Dr. Mike, your host. Dr. Mowery, let's start with the very basic definition. What is anxiety? How do you define it as a specialist?

Stephen Mowery, MD: Great question. Anxiety is something that we see all the time. To talk about this at the most simple level, anxiety is a feeling of worry or fear. Things do get a little more complicated than that sometimes, but really sticking to that framework, feeling of worry or fear, is important. Thinking about these types of feelings, anxiety or worry isn't always a bad thing. If you can imagine your kid is running towards a busy street, it makes sense to be anxious. Or if you're out on a hike and you cross paths with a grizzly bear, you should probably be fearful. And anxiety is one of those things that can really help you in those situations.

But really, what I think we're going to talk a lot about today is what happens when anxiety goes haywire and when it comes up in response to very small events and gets kind of blown out of proportion. And when anxiety gets blown out of proportion, it can have huge impacts on your life. It can interfere with your daily life and activities. And that's really when we get into the realm of anxiety disorders. Once we're thinking about anxiety disorders, the best definition I've seen is that this is when excessive and persistent worry can cause significant distress or impairment to your life. And for some people, this may just be in one small aspect their life, such as work or school. And other people, it can just be in every single aspect of their life, with their family, with their sleep, with their work, absolutely everything. So, there really is a wide spectrum of severity and symptoms for anxiety.

Host: Yeah. Before we dive more into anxiety, I want to ask you a question about the difference between anxiety and, say, panic disorder. Are they kind of the same thing? Are they different? How do you define those? How do you separate those?

Stephen Mowery, MD: Sure. So when we think about the different anxiety disorders, the two most common ones that we see are called generalized anxiety disorder and panic disorders. And generalized anxiety disorders are things like I'm saying that the anxiety is kind of ruling all of the different aspects of life, and this is kind of on a very much routine regular basis every single day.

When we think about panic disorders, that's kind of the most extreme form of anxiety. And this is where a lot of people will describe having a panic attack or panic disorder as feeling like they're dying, feeling their hearts racing, like they can't stop sweating or they're feeling numb or even having chest pain. They feel like they're having a heart attack. So really, panic disorder has more of the most severe symptoms of anxiety.

Host: How common is anxiety and is the prevalence of anxiety increasing in our general population?

Stephen Mowery, MD: So, it's really, really hard to know how common anxiety is. What I can say is it's very, very common. It's the most common mental health disorder that we see in medicine. But putting an actual number to it is difficult because we always underestimate the prevalence of mental health disorders because we miss a big proportion of people who don't seek care. The best estimates that I've seen are from the American Psychiatric Association which says up to about 30% of adults at some point in their lives can experience an anxiety disorder. So, one-third of people will experience this at some point in their life.

And I do think, from my personal experience, that we have been seeing more and more anxiety and depression within the last few years. And I think in the future, studies will kind of shed more light on this, but one of the big things is we just got through the COVID-19 pandemic, and that was really a difficult time for pretty much everyone. I mean, it was very socially isolating, which can increase anxiety. We were seeing family members get sick or go into the hospital or even pass away. And some people have been dealing with long COVID symptoms or these new chronic illnesses that they need to deal with every single day. So for those reasons, I think we've seen a spike with anxiety and depression. And I do think that to some degree, over the last decade, the stigma related to mental health care has been slowly dissipating. So, we've been starting to see more of the populations that probably wouldn't have come to see a doctor about this, but they're starting to come in and understand that there are options and they want things to get better.

Host: But there still are a significant number of people maybe who are suffering with anxiety symptoms who don't bring it up with their doctor, right? What do you have to say to them? What could you say to make them feel more comfortable in bringing up some anxiety symptoms?

Stephen Mowery, MD: So, anxiety is really difficult for a lot of people to talk about, and a lot of people don't feel comfortable talking to even family members about their anxiety or feelings of depression, and going to a stranger or your doctor that you've seen a few times and talking about these very personal issues. But, what I can say is that we have a lot of really caring, really knowledgeable medical professionals who want to be talking about these things with our patients.

And the best guidance that I would have is that if somebody feels like worry or anxiety is negatively impacting their life, it's worth having a conversation with your doctor about it, because there are likely a lot more options for trying to improve it than you may think. Not everything is starting a medicine, but there are a lot of different ways to improve these symptoms. And that's our goal, is to help you live your most productive and enjoyable life.

Host: When you talk about if somebody is experiencing anxiety symptoms and maybe it's affecting their life, what do you mean by that? Are we talking about avoiding social situations? Are we talking about taking more time off from work? What are some examples of anxiety really affecting day-to-day living?

Stephen Mowery, MD: Great question again. And anxiety symptoms are incredibly varied. And sometimes it's just being worried about the future, or what's going to happen the next day, but other things that people may experience that even when they aren't undergoing stress, they may have difficulty relaxing, they may feel restless. You might be annoyed by really small things from loved ones or friends or strangers. And sometimes people may notice those panic attack symptoms like we talked about, like with the sweating and trembling and numbness or even chest pain. It's a varied spectrum of symptoms, but really intense worry is at the heart of it.

Host: When should somebody seek treatment then? I mean, we do have to admit that just life in general; there are times when all of us are a little anxious, right? So, when does my anxiety symptoms get to a point where like, "Okay, I got to go talk to somebody?" Do you have any tips or advice for that?

Stephen Mowery, MD: It's a very personalized decision. I think my best guidance is that if it's negatively impacting your life, it's worth talking about with a doctor. And for some people, that might be they're having trouble and not doing well with work. And if it's causing those issues, then talk to your doctor about it. Or some people, if it's interfering with relationships with family members, then come and talk to your doctor about it. But I think a lot of times there's fleeting anxiety or temporary anxiety, say, related to needing to go to a family reunion or go to a high school graduation or something like that. But whenever the worry and anxiety seems more persistent, it's lasting weeks and months and it's brought on by all sorts of different things and it's having a big impact on your life, that's probably the point that it's worth coming and trying to improve it.

Host: Boy, do I relate to the family reunion part of that, I got to tell you. Causes a lot of anxiety in me. But there does still seem to be kind of a stigma around mood disorders in general, right? Anxiety, depression, what have you. When you break a leg, it's like I'm going to go to the emergency room. I'm going to get it fixed. So, why is there a stigma with mental health? It confuses me that so many people, they don't want to talk about it. And I think that comes with a lot of, you know, personal history, what have you. But why are we so like, "No, I don't have a mood issue." But I break my leg, of course, I'm going in without a problem.

Stephen Mowery, MD: It's really difficult looking back in time at why this developed, but the mental health stigma has been around for decades, if not a century or more. We have historically kind of separated physical health and mental health. And physical health, like you said, if you break your leg or if you fall and dislocate your shoulder, of course, everyone agrees, like, yes, you should probably go and get help for that. But there's been this longstanding idea for mental health issues that, well, maybe you're doing something in your life that brought these symptoms upon yourself. Or if you go and seek care for your depression, you're less of a man for some reason. And really, we've moved, and we continue to try to move away from that to normalize seeking mental healthcare. Because what we've seen is that really taking good care of mental health improves people's physical health, improves their day-to-day functioning and it really is just as important as treating physical symptoms.

Host: Great answer. And I think more and more people need to hear that and understand that it's all connected, the mental aspect of who we are, the physical, it's all connected. And I think that's a fantastic response to that question.

Let's get into treating anxiety. And I know this could be a topic on its own, right? I mean, this could be huge, but what are some of the things? Like, if I were to come see you and you did diagnose me with, let's say, generalized anxiety or maybe just situational anxiety, what would you do? What are some of the steps you take in helping somebody deal with anxiety?

Stephen Mowery, MD: So, I think when I'm seeing patients and trying to approach anxiety, or depression for that matter, I generally break it down into what I call the three pillars of treatment. And the first of those pillars is something like psychotherapy, being able to get set up with a counselor or a therapist and try to better understand the root cause of your anxiety and mood challenges.

And this is super important, because if you're continuing to be exposed to the same stressors every single day, understanding those stressors and understanding healthy ways to cope with them and deal with them and improve them on your own is incredibly important. And that's kind of the big baseline treatment goal that we have is to help better understand the sources and to be able to improve them in your day-to-day life.

The second of the pillars are things like medications. Medications can be super, super helpful. They can help reduce anxiety, improve mood, and they can work great in combination with therapy. They aren't perfect, and they can come with side effects. They can take a while to have kind of peak effect, but they are a piece of the puzzle and a lot of people really benefit from them.

And the last of the three pillars, which I think is just as important as the first two, is just optimizing your general health. Kind of things that you would think about of, what does it take to live a healthy life? These would be things like eating a nutritious diet, taking part in regular physical activity, getting good sleep, avoiding substances like alcohol, drugs, or tobacco and doing a good job of maintaining social connections. And those things can be really, really vital in managing anxiety or depression.

So, I normally talk about kind of those three main approaches to anxiety, and the combination of those things is generally more effective than any one alone.

Host: Do you worry about people out there, patients out there, who aren't seeking the help, their anxiety is not being treated. How do you think that impacts them if they're not getting treated?

Stephen Mowery, MD: Untreated anxiety can really wreak havoc on people's lives. And it can just be one of those things that's kind of simmering and simmering then eventually it reaches a boiling point. And even when it's kind of low grade symptoms like being extra annoyed by people around you or getting bad sleep, that can affect your relationships, and it can eventually lead to becoming more isolated and fearful, not leaving the house, not wanting to do things with other people, being hopeless, depressed, or eventually leading for people to think about a way out, something like suicide. So, it can be very, very dangerous.

Host: I want to move on to loved ones, friends, family. If I feel a loved one of mine is maybe dealing with some anxiety, how do I really know that and how do I approach them, if I feel that seeing someone like you could be very helpful? Do you have any advice for that?

Stephen Mowery, MD: This can be really, really difficult because a lot of times people don't feel comfortable talking to others about their mood. And even when it's somebody that you can have confidence in, like a family member, it can still be a really difficult conversation. But I think really starting off talking to someone, like, "I'm concerned about things that I'm seeing. I want to help you do well. And I can see that you're annoyed more than normal, that you're having snappy responses to the kids, that you seem to be tossing and turning more at night. What's on your mind? What can I do to help? Do you think it'd be worth going and talking to someone about this?"

Host: You know, as a family practitioner, I'm a physician myself, general internist, could we be doing a better job in asking about mood issues like anxiety when people come to see us for a general checkup?

Stephen Mowery, MD: Oh, absolutely. Absolutely. Really, as we said, 30% of people will experience anxiety and a high proportion of people will have symptoms of depression as well. If we were just to be asking all of our patients, granted we don't have time to do this at every single visit, but if we're regularly talking to our patients, our neighbors, our family members about these types of things, I think we allow a more open conversation, which can be really freeing to people and at least put that little bug in their brain that maybe it is worth talking to someone about or maybe things can get better. I think a lot of people have this feeling that they have always had anxiety and are just kind of built that way, and they will have to deal with it forever. But there are a lot of things that we can do to help improve anxiety for people.

Host: I always just felt as, you know, as physicians, if we talk about it more, that normalizes it more. Like it takes away some of that stigma, I think, over time. What do you think?

Stephen Mowery, MD: Oh, absolutely. Absolutely. You're spot on.

Host: So, you know, this has been great, great information. I really appreciate you coming on. What's your take-home message? If somebody has anxiety or, maybe they have a loved one who does, what's your take-home message for the listener?

Stephen Mowery, MD: When we're thinking about anxiety, I think the most important thing is that even if you have been dealing with anxiety for a long, long time, if when you think about your worry or your stress, if it seems like it's negatively impacting your life, then that's when it's worth to come in and talk to a professional about it.

And there shouldn't be any stigma around seeking care for it. You're not going to get laughed at by your doctor, things like that. We're all here to help. We all want you to feel better. If anxiety is something that is causing you challenges in your day-to-day life, take that step. As difficult as it can seem initially, take that step and talk to your doctor about it, so we can at least talk about ways forward to try to get you feeling better and functioning better on a day-to-day basis.

Host: Fantastic. I love that. Thank you for coming on the show today and sharing your expertise. This was a great message and a great episode. If you or a loved one or experience a mental health crisis, you can call or text 988 for the 988 Suicide and Crisis Lifeline, which is available 24/7. If you are in crisis and need immediate assistance, please call or text 911 or go to the nearest emergency room. For more information, please visit SkagitRegionalHealth.org. And thanks for listening to Be Well, the podcast from Skagit Regional Health. If you found this podcast helpful, be sure to tell a friend and subscribe, rate and review this podcast on your favorite app. I'm Dr. Mike. Thanks for listening.