The frenetic pace of life today can take its toll, resulting in mood disorders, poor sleep and ill health – particularly among younger people. What can pharmacists do to help?

 

Learning objectives

After reading this feature you will be:

  • Aware of the impact stress, anxiety and insomnia can have on people’s lives
  • Able to spot these conditions in the pharmacy setting
  • Able to provide practical self-help advice
  • Aware of potential patient issues related to hypnotics including side-effects, tolerance and dependency.

 

Almost one in five people aged 16 years or older show signs and symptoms of anxiety or depression, according to the charity Anxiety UK.1 Stress, too, appears almost universal, with 85 per cent of Britons experiencing occasional stress and 15 per cent suffering from it every day.2

Recent research by Mintel suggests that younger people are particularly vulnerable to these mood disorders, with daily anxiety and stress peaking among 16 to 24 year-olds.2 A quarter of people in this age bracket reported feeling anxious or stressed every day, compared to less than one in 10 over-55s.2

“Britain’s young are feeling pressure on several fronts, including academic, work and financial factors, and for some this is causing anxiety and stress on a daily basis,” notes Richard Caines, senior analyst at Mintel. “The greater visibility of mental health issues can help drive awareness of less severe manifestations of anxiety and stress.”

Stress and anxiety — what’s the difference?

Stress is a subjective term that defies standardised medical definition.3 Broadly speaking, it describes the emotional, mental and physical impact of changes in the body, the so-called ‘flight or fight’ response – an evolutionary development to deal with difficult and dangerous situations or threats.4

Anxiety is a blanket term that covers mild to severe feelings of unease, worry or fear.4 Many anxiety symptoms overlap with those caused by stress and the two conditions are often indistinguishable. To help pinpoint pharmacy customers suffering with potential anxiety or stress, it can be useful to break down the various different manifestations.

Psychological signs of stress and anxiety include trouble sleeping, feelings of being overwhelmed, depressed, irritable or fearful, lack of self-esteem and loss of self-confidence. Sufferers may also have racing thoughts, constant feelings of worry and difficulty concentrating or making decisions. Physically, stress and anxiety can cause headaches, a rapid heart rate, fast breathing, muscular tension or weakness, sweating, dizziness, dry mouth and gastrointestinal upsets.

In total, Anxiety UK lists 25 different types of anxiety conditions, ranging from agoraphobia to trichotillomania.1 Generalised anxiety disorder (GAD) is one of the commonest anxiety conditions, encompassing panic disorder (with and without agoraphobia), post-traumatic stress disorder, obsessive-compulsive disorder, social phobia, specific phobias and acute stress disorder. Its central feature is excessive, difficult-to-control worry about a number of different events or activities associated with heightened tension.5

GAD affects up to 5 per cent of people in the UK and is most frequently diagnosed in adults aged 35 to 59 years of age.4 Anxiety disorders like GAD can exist in isolation but most commonly occur hand-in-hand with other anxiety and depressive disorders.5

Sub-threshold anxiety is a pervasive but often overlooked condition where people experience mild, atypical or brief anxiety symptoms that fail to meet the diagnostic criteria for GAD. Evidence indicates that twice as many people may actually be suffering from sub-threshold anxiety as GAD itself, with one systematic review estimating the lifetime prevalence at over
12 per cent.6

Sub-threshold anxiety is typically persistent and has been linked to impairment in psychosocial and work functioning, as well as increased benzodiazepine and primary healthcare use. Sub-threshold anxiety can also be associated with co-morbidities including other anxiety/mood conditions, somatoform disorders and chronic pain.6

Key facts

  • Anxiety affects one in five of the UK population and around 15 per cent of people suffer from daily stress
  • Insomnia is a major consequence of stress and anxiety, affecting up to a third of Britons
  • Self-help advice can encourage customers to develop effective strategies for dealing with stress and insomnia

Management

Anxiety UK provides a useful analogy to describe anxiety, which helps to put the condition, its causes and strategies for management into perspective for sufferers. According to the charity: “A way of thinking about anxiety is to imagine stress levels as being like a bucket of water. If we keep adding stressors to the bucket (even tiny ones like the school run or commuting to work), over time it fills up until one day it overflows.

This can be a good way of looking at anxiety as it explains why sometimes it can seem to come out of the blue with no significant trigger.

“However, what has happened is that the trigger was just a very small stressor that tipped us over the edge and allowed our bucket to overflow. What we need is a leaky bucket with lots of holes in to reduce overall stress levels. Each one of these holes could be something positive to do to manage anxiety, such as yoga, exercise, reading, listening to music or spending time with friends or family.”1

In many cases, simple self-help steps can prove effective in alleviating the burden of everyday stress and anxiety – thereby stopping the bucket from overflowing. Important options the pharmacy team can recommend include:

• Books and courses targeted at managing anxiety
NICE recommends approaches based on the principles of cognitive behavioural therapy (CBT), which aims to help sufferers modify negative or unhelpful thoughts or behaviours that contribute to anxiety and stress.

• Regular aerobic exercise
Physical activity helps combat stress, relieves tension and triggers the release of natural serotonin from the brain, making it key to good overall mental well-being. Customers should aim for at least 150 minutes of moderate-intensity exercise a week.

• Relaxation techniques
Examples include breathing exercises, meditation, yoga, pilates and mindfulness techniques. Individuals should be encouraged to explore the wide variety of available options and find an approach that best suits their personality and lifestyle.

• Avoid caffeine, smoking and alcohol
For many people, caffeine, smoking and alcohol act as crutches for coping with short-term stress – but they are proven to worsen anxiety and can also exacerbate physical symptoms such as tachycardia and insomnia.

• Seek support
A wide variety of specialist services are in place which customers suffering with anxiety or stress can be signposted to for further support. Examples include Anxiety UK, Mind and Rethink Mental Illness.

Self-management strategies can help all sufferers with stress or anxiety regardless of severity, but those with a formally diagnosed or long-term anxiety disorder such as GAD may require more intensive psychological therapy or medication, overseen by a GP or mental health professional.

Pharmacotherapeutic options include selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), pregabalin or benzodiazepines for short-term periods of severe anxiety.

References
1. Kasper S et al. Silexan, an orally administered lavandula oil preparation, is effective in the treatment of ‘subsyndromal’ anxiety disorder: a randomized, double-blind, placebo controlled trial. Int Clin Psychopharmacol 25: 277-287
2. Kasper S et al. Lavender oil preparation Silexan is effective in generalized anxiety disorder – a randomized, double-blind comparison to placebo and paroxetine. International Journal of Neuropsychopharmacology doi:10.1017/S1461145714000017
3. H. Woelk, S. Schlafke. A multi-center, double-blind, randomised study of the lavender oil preparation Silexan in comparison to lorazepam for generalized anxiety disorder. Phytomedicine 17 (2010) 94-99 doi:10.1016/j.phymed.2009.10.006

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