AN INTERVIEW WITH DR. PABLO TOBAJAS

“Effective and safe drug treatment for anxiety disorders requires supervision”

According to the Ministry of Health or the World Health Organization (WHO), an average of between 5% and 10% of the population suffer from anxiety, with the most affected being women.

According to the latest surveys, anxiety is the mental problem suffered most by Spanish people, In Spain we are leaders in anxiolytic (anti-anxiety) medicine consumption.

Q.- What exactly is anxiety?

A.- Anxiety is a state of constant worry and fear that causes interference in the usual functioning of the individual due to nervousness and the presence of palpitations, sweating, flushing or feeling of choking among other symptoms.

Q.- Are anxiety and stress the same?

A.- Obviously stress and anxiety are usually related and both can be felt together, although there are some differences. Anxiety can appear as a warning, and can be associated with fear and worry. For example, an animal in the face of the threat or the idea of anticipating something bad is going to happen. Stress on the other hand is a phenomenon that occurs because the person does not possess (or thinks he does not possess), the skills or necessary time to face a specific situation. That is, it is a mismatch between a specific demand and the resources to meet that demand.

Stress usually goes away when its cause is eliminated (e.g. once an exam has been done the person returns to normal). However when suffering from anxiety the cause may disappear but the person continues to suffer just by imagining possible outcomes.

Q.- Dr. Tobajas, is anxiety necessary or dangerous to our mental health in your opinion? Can you tell us anything about it?

A.- Anxiety is a very adaptable and normal mechanism we need to overcome the challenges of everyday life.

Problems arise is when it becomes pathological, for example as an irrational interpretation of a danger or a concern which becomes exaggerated. In these cases the intensity of anxiety is not proportionate to the objective situation.

Often when our patients come to Bonaire Salut, they have already explored other possible medical diagnoses after an episode of tachycardia or perhaps a blackout at the office.

They have undergone cardiology or digestive system tests and have been referred to the psychiatrist as a result of nothing found.

Others tell us how they started running because it was the only way they could feel control, and some others have read self-help books or meditation, etc.

This is different to stress, which is associated with stimulus in the present moment. Anxiety can appear over and over again. It´s then when the moment comes to treat it.

Q.- What does anxiety have to do with depression? Are they the same?

A.- In many cases there are similarities, given that 80% of cases do also involve anxiety, only 20% are without anxiety (usually with lethargy, apathy, disinterest in self-care this is more frequent in the elderly).

As for the feeling of guilt, patients sometimes come to the office expressing that they believe their problem is more anxiety than depression, as if having anxiety is ok but depression is a “weak” thing. It shows that taboo and mental health stigma is still present.

Q.- Is it sometimes wise to medicate these people?

A.- At Bonaire Salut we have a multi-professional team that evaluates cases that require pharmacological treatment and / or a psychotherapeutic approach.

Pharmacological treatment of anxiety disorders is at times treated as simple and often tends to be banalyzed, the idea that with an anti- anxiety drug all will be ok.

In my experience, nothing is further from the truth. Effective and safe drug treatment for anxiety disorders requires supervision by a psychiatrist. Plus be careful!! In Spain we are leaders in anxiolytic (anti-anxiety) drug consumption: 1 in 5 Spaniards consume anxiolytics or sleeping pills. Furthermore, a great majority of them do it by self-medicating.

P.- Dr. Tobajas, what do you think are the most common causes of anxiety and depression? How does developing anxiety affect our lifestyle?

R.- If depression was the maladie of the turn of the century, anxiety has become the disease of our age.

Google look ups are 10 times more for the term anxiety than depression. The result of all this is that anxiety has been revealed as the evil of the 21st century. In my opinion our lifestyle is key. Acceleration, stress, competitiveness, huge expectations and the frustration of not achieving them can be causes of anxiety.

I also consider that hedonism plays its part as we live in a society where everything is all about having fun. A society in which we do not accept that there are negative emotions.

We are sold a fantasy of happiness daily through marketing, the idea that in life we shouldn´t experience negative phases or sad times.

And of course anxiety doesn’t just appear when we start trying to figure out the meaning of life. It also appears when we lose a job, when a relationship ends and we feel isolated even if we are not. Sometimes it appears because almost without realizing it, we end up leaving ourselves in the “spam” tray so to speak. We forget to take care of ourselves and leave “me” in the unfinished business drawer, the last on our own list.

When we are in that tunnel without stopping to think or to look around, anxiety arrives in our lives. This is the day when our body tenses, our pulse races our chest contracts and it becomes hard to breathe.

P.- And to finish Dr. Tobajas, could you give us any tips or advice to prevent anxiety?

R.- Sleep 7 – 8 hours. Lack of sleep makes us irritable and moody. Sleep is very important in the processes of learning and memory consolidation; it helps concentration and can help reduce symptoms of stress and depression.

Exercise moderately (about 3 times a week). Physical exercise helps us by promoting the release of endorphins and serotonin which are related to the feeling of well-being.

Organize your time well. For both rest and other activities, establishing schedules is essential to be able to relax, to avoid worrying, to avoid continuous shocks or forgetting important things, etc.

Don´t turn a blind eye to your problems; face them more productively by making decisions.

Have sex. It helps to sleep, reduces anxiety and improves stress and self-esteem.

Aim to not complain more than 3 times a day.

As a general rule I propose the RULE of 8-3-3: 8 hours of sleep, do sport 3 times a week and no more than 3 complaints a day.

Original article published in issue 33 Salut I forca magazine, October 2019