There is almost always some level of anxiety when dealing with any illness (from the common cold to cancer, and everything in between). But autoimmune diseases are particularly vexing and frequently quite vague in presentation, which means that autoimmune patients are especially susceptible to the power of stressors and the effects that the resultant anxiety can bring.
And as most readers probably know all too well, the simultaneous presence of a medical illness and anxiety (known as “comorbid” conditions, because they occur together) can become a vicious cycle, where one fuels the other, making intervention that much more challenging. Below we take a look at some aspects of anxiety surrounding an autoimmune diagnosis and the treatment that follows.
Why is anxiety a typical symptom of autoimmune conditions?
While no one can say for certain why specific mental symptoms appear when dealing with autoimmune conditions, there are two general reasons that hugely contribute to the development of anxiety and its related components in autoimmune sufferers.
First, most if not all autoimmune disease are chronic illnesses – albeit with flares and remissions in many – which simply wears a person down over time. The realization that this is likely something one will deal with for the rest of his or her life can have devastating psychological effects initially. Fortunately, many people with autoimmune disease eventually get past this point, accepting their condition(s) for what they are, and finding various ways to manage what can sometimes become debilitating anxiety (see below).
The second important factor involves the massive uncertainty that surrounds initial symptoms and (mis)diagnoses, as well as the continuing hazy clinical picture, where many symptoms are non-specific, and the possibility of developing another autoimmune condition lurks around every corner. Uncertainty is one of the prime drivers of anxiety in most people, but for autoimmune patients, whose health and well-being hang in the balance, this lack of definitive diagnoses and treatments can become that much more daunting and overwhelming.
Thankfully, there is no lack of literature on the topic, as this appears to be an issue that is being actively addressed, with a host of studies and research dedicated to anxiety in relation to autoimmune conditions, as well as anxiety in the context of general medical conditions (above). And the relationships are being studied in both directions, meaning the impact of autoimmune disease on anxiety, and vice versa, which is helpful in teasing out cause and effect. Some of the studies cover topics such as:
- Chronic exposure to stress and autoimmune susceptibility
- Thyroid autoimmunity, depression and anxiety
- Mental illness and autoimmune disease
- Increase anxiety behaviors in autoimmune mice
- Link between autoimmune disorders and neuropsychiatric disease
- Psychological profiles in autoimmune disease
- Autoimmune rheumatic disease associated symptoms in fibromyalgia patients and influence on anxiety, depression
Much of this work offers more specific findings regarding the nature of anxiety in the face of illness, and the potential connections between such mental states and physical disease states. There is even some literature available discussing the topic in regards to specific diseases, such as Graves’, lupus, Hashimoto’s, MS, scleroderma and Sjogren’s.
This research, driven by an increasingly obvious mind-body connection and a desire to understand it more fully, has yielded some interesting findings and suggestions. Of course, the ultimate goal is to discover methods of reducing such anxious feelings, whether they are the cause or result of the medical illness (autoimmune and otherwise). Most often it is a combination of the two (cause and effect), which can embed one in a symptom cycle where one problem begets the other.
When anxiety hits from an external source of stress, does this typically pair with onset of a flare?
This is difficult to answer with any level of certainty, since every patient is slightly different in his or her triggers. Having said that, stress, in its various forms, is often a common and major precipitating factor for flares in many autoimmune sufferers. And many patients experience similar patterns in their lead up to flares, whereupon they can often identify specifically stressful events or times and predict an oncoming flare based on these observations. These warning signals can have important implications if the patient has figured out a way to act preventively to reduce the severity of oncoming flares.
It’s also very important to recognize that stress comes in many different forms. Most people think of stress as related to work or school or family issues, which may manifest as depression and/or anxiety, with any of the symptoms listed above. But stress also includes such things as infection, poor diet, lack of exercise, prescription/OTC medications, toxic environmental exposures, extreme weather and consumption of drugs or alcohol, to name a few. Essentially, anything that places “stress” on your body in some way (mentally, physically, immunologically; from overexertion, fatigue, obesity or a sedentary lifestyle, etc.)
One of many possible “unconventional” stressors/triggers for such psychiatric problems is infection with certain strains of Strep bacteria, especially during childhood. While the link has yet to be definitively demonstrated, there seems to be a correlation between these infections and later development of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection), with sudden onset of OCD type symptoms.
Additional connections are sure to be discovered between various stressors and autoimmune illnesses as research progresses and advances are made. But it is certainly a good sign that active investigations are ongoing or recently completed, as this indicates current interest in this area of study.
What are the typical symptoms of anxiety?
Anxiety tends to impact everyone a bit differently, but there are definitely common symptoms that many patients experience at some point. The range of possible signs and symptoms is quite wide, and what one experiences also depends somewhat on the type of anxiety (generalized vs. panic vs. phobias, etc.), since they can manifest differently.
However, some of the most prominent symptoms that patients typically present with include some combination of the following:
- A feeling of uneasiness
- Shortness of breath
- Heart palpitations
- Cognitive difficulties
- Gastrointestinal discomfort
- Sleep disturbances
- Changes in eating patterns (either increased or decreased)
- Dry mouth
- Muscle tension
There are of course other symptoms that are more specific to individual anxiety disorders (e.g., ritualistic behaviors in those with OCD), but the above list covers most of the more generic issues.
What are some treatment options for anxiety, and do pharmaceutical options interact poorly with some of the more common autoimmune medications?
There are a host of different avenues one can travel down in exploring what works best for that person. No single therapy will help everyone, and many patients need to incorporate multiple strategies to successfully combat their stress and anxiety. Anti-anxiety measures may include one or more of the following: medications to treat the primary autoimmune disease, medications (antidepressants or benzodiazepines) to address the manifestations of severe anxiety, various forms of psychotherapy (talk, cognitive-behavioral, dialectical, analytic, etc.) meditation, relaxation exercises, eating properly, and getting exercise, among others.
In terms of drug-drug interactions, this depends on the two or more specific medications being taken. Thus it’s impossible to state categorically that some anxiety meds will interact poorly with some autoimmune meds. Your doctor can easily check this in the Physician’s Desk Reference, or any other comprehensive drug guide.
As with any therapy regimen, there are pros and cons to each treatment method, and challenges to be overcome, regardless of which strategies you try. With medications, these may be such things as adverse effects that make the drug intolerable – many patients find benzodiazepines very helpful, while others have terrible reactions to them.
And with other treatment options, such as therapy, meditation or nutritional counseling, the success of the effort very much depends on a) the competence of the practitioner, and b) the dedication of the patient. Some of the non-pharmaceutical interventions – meditation or therapy – require intense “homework” and a real commitment to getting the most out of each method. Others, such as relaxation techniques, are more conducive to chilling out and getting lost in the moment. And then there are also several coping measures that are less specific for anxiety and widely applicable to many illnesses, such as having a strong support network, learning as much as possible about the disease(s) and connecting with others who share your diagnoses.
The only way to find out what works for you is to try various methods until you find one or more that yield real results. With so many possible options for anti-anxiety treatment, most autoimmune patients will find a way to alleviate their anxiety at least partially, which can mean the difference between misery and mild/moderate discomfort that is annoying, but tolerable.
As always, if one is experiencing any of the hallmarks of anxiety, it is important to address it with her health providers, sooner rather than later. This will give you the best chance at developing your own combination of anxiety-crushing tactics that work especially well (hopefully) for the patient and her ailments.
Questions for your doctor:
- Which measures do you recommend to combat anxiety? Which have worked for your patients in the past?
- Aside from those mentioned in this article, are there other strategies, medications or supplements you would suggest for the purpose of lowering anxiety?
- Should I try either medication or non-pharmaceutical treatments first, and wait to see how one affects me, before possibly adding another?
- With all the useless “self-help” books out there, can you recommend a good book or site that deals with anxiety symptoms and treatment?
- If my anxiety is severe or persists, can you refer me to good mental health practitioner (MSW, MD, PhD or PsyD)?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at [email protected].
Originally published on February 20, 2014. Updated on September 9, 2015.