Anxiety is an inevitable experience in everyday life, and a certain level of anxiety is normal. “Signal anxiety” alerts us to an upcoming challenge (for example, a presentation to one’s colleagues at work, or an upcoming trip to tour colleges with one’s child); and mobilizes an increased energy level and sharpens our focus, to assist us in getting the job done. Signal anxiety facilitates improving our performance, and therefore does not warrant evaluation and treatment by a psychiatrist.

However, excessive anxiety may have deleterious effects on the health of middle aged women if it goes untreated. This anxiety may be expressed through increasing levels of generalized anxiety, anxiety attacks, panic attacks, the development of phobias, or obsessive thoughts or compulsive behaviors. When threatened, we are genetically programmed to respond with the “Three F’s” – Fight, Flight or Freeze – that are basic human reactions to perceived or real danger in our environment. This response results in a surge of anxiety. With sufficient frequency and intensity of experiencing emotional and/or physical threats, an anxiety disorder may develop in vulnerable individuals.

A large-scale recent study demonstrated that anxiety in middle aged women resulted in a 77% increased risk of premature death over a ten year period. 5 investigators from Tilburg University in Holland reported in the Journal of Clinical Epidemiology that in a 10-year follow-up study of 5073 healthy women aged 46-54 years, anxiety was associated with a 77% increase in mortality risk, particularly in those with a cardiovascular cause of death. At follow-up, 114 women (2.2%) had died. Lung cancer (23%), cardiovascular disease (18%), and breast cancer (15%) were the major causes of death. The authors concluded that anxiety did predict premature all-cause and cardiovascular death in middle-aged women, after adjustment for standard risk factors and depression.

Other studies show that anxiety, particularly resulting from the two types of stress known as “learned helplessness” and “defeat stress,” cause the DNA in brain cells to produce fewer “neuroprotective proteins.” Learned helplessness results when we are repeatedly subjected to environmental stress where we feel powerless and trapped. Defeat stress develops when we feel repeatedly defeated or “beaten down.” Important neuroprotective proteins such as BDNF and VEGF serve to nourish our brain cells, protect them from injury due to the age-related effects of what is called “oxidative stress,” and enable our brain cells to have higher levels of important neurotransmitters such as serotonin, dopamine and norepinephrine; and higher numbers of cellular branches called “dendrites” that are critical for our brain circuits to function normally.

The take-home message is that high levels of anxiety should be evaluated and treated using the Biopsychosocial Model. Evaluation of possible biological causes of anxiety such as a thyroid disorder, psychological factors such as earlier traumatic experiences, and social/environmental influences such as an emotionally abusive relationship at work or at home, can lead to effective treatment strategies. In treatment there may be a role for anti-anxiety agents, cognitive/behavioral therapy including desensitization, and tactics to reduce environmental stressors. Effective treatment has actually been shown to increase levels of BDNF in the brain, and restore a normal number of dendrites to brain cells, which correlates with greater life satisfaction, and improved longevity.

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