Madeeha Syed

Managing anxiety and panic attacks is often challenging for people. Identifying triggers, breathing slowly, and self-talking may help with anxiety symptoms.

How to Manage Anxiety

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How To Manage Anxiety

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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

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Do Supplements And Herbs Cure Depression?

Introduction

As predicted earlier by the World Health Organization (WHO), major depressive disorders now account for a major illness in the world<a href="#accordion">[1]</a>, especially since the emergence of <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a>. As the pandemic rapidly swept across the globe, it induced a considerable degree of fear, worry and concern in populations at large. Additionally, social isolation and loneliness worsened mental health worldwide.&nbsp; 
&nbsp;

Major depressive disorder is a major contributor to the incidences of suicide and ischemic heart disease. Moreover, it is the second leading cause of years lived with disability (YLDs) worldwide<a href="#accordion">[2]</a>. <a href="https://www.merisehat.pk/disease/depression">Depression</a> not only affects day-to-day activities but also decreases the quality of life and well-being of people. The mood disorder can present with mild to potentially debilitating and life-threatening symptoms.&nbsp;

&nbsp;

Over the years, the increase in the prevalence of psychiatric disorders, depression, anxiety, and insomnia has led to a search for more effective treatments. For this reason, people look to manage depression with more natural remedies. Hence, treatment (often self-treatment) with supplements and herbs continues to gain popularity. But natural does not always mean safe or effective.&nbsp; 
&nbsp;

Herbal formulas are commonly prescribed for the treatment of mental illnesses. More people are now turning to herbal medications because of the various side effects, high prices, and increased relapse rates associated with prescription medications. Over the past decade, several studies have been conducted on the mechanism of action of supplements and herbal medications for treating depression, anxiety, and insomnia.&nbsp;

&nbsp;

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Understanding the role of natural remedies  in treating depression

Below are some supplements and herbs that are most widely used for the treatment of depression:&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Omega-3 fatty acids&nbsp;</h5>
	</li>
</ul>

Omega-3 fatty acids are essential fats that help with treating depression. A randomized control trial conducted on pregnant women in 2020 concluded that omega-3 fatty acids significantly improve symptoms of depression and postpartum depression<a href="#accordion">[3]</a>. Supplements containing the two omega-3 fatty acids eicosatetraenoic acid (ECA) and docosahexaenoic acid (DHA) are most effective. Omega-3 supplements containing 60% or more eicosapentaenoic acid (EPA) show an overall positive effect on treating depressing symptoms<a href="#accordion">[4]</a>. While there is a lack of research to support the argument, the supplement is a well-tolerated and considered healthy addition to your diet that may help treat the mood disorder.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>NAC (N-acetylcysteine)&nbsp;</h5>
	</li>
</ul>

NAC is a precursor of glutathione, an important antioxidant in your body. It is essential for protecting cells against oxidative damage and regulating inflammation<a href="#accordion">[5]</a>. Studies have shown that people with depression are more likely to have higher levels of inflammatory markers. Thus, taking NAC may reduce inflammation and relieve the symptoms of depression. Doses of 2 to 2.4 grams in a day are thought to help treat mental health conditions. 
&nbsp;

<ul>
	<li>
	<h5>Vitamin D&nbsp;</h5>
	</li>
</ul>

Vitamin D is an essential nutrient for the body. However, many people, especially in Pakistan don&rsquo;t have sufficient vitamin D. Studies have further shown that people with depression are deficient in vitamin D. Similarly, people with vitamin D deficiency have more severe depressive symptoms<a href="#accordion">[6]</a>. Vitamin D helps curb depression by reducing inflammation and regulating mood. A randomized control study highlighted that vitamin D supplements are beneficial for people with clinical depression<a href="#accordion">[7]</a>. Another study found that 300,000 IU of adjunctive vitamin D significantly improved the severity of illness and overall quality of life in people with clinical depression<a href="#accordion">[8]</a>. 
&nbsp;

<ul>
	<li>
	<h5>B vitamins&nbsp;</h5>
	</li>
</ul>

B vitamins play an essential role in the regulation of mood. These vitamins include folate, B12 and B6, and are needed to produce serotonin or the &ldquo;happy hormone&rdquo;. Studies have shown that a deficiency in vitamin B12 and folate increases the risk of depression. Whereas, supplementing vitamin B12 may help reduce depressive symptoms. According to a study published in 2020, low vitamin B12 levels are associated with a high risk of developing depression<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Zinc&nbsp;</h5>
	</li>
</ul>

Zinc is an essential mineral for brain health and a deficiency in the mineral may increase the risk of depression and the severity of symptoms. Studies have further shown that zinc when used alongside antidepressant medications may reduce depressive symptoms.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Magnesium&nbsp;</h5>
	</li>
</ul>

Magnesium is an important mineral that may help with the symptoms of depression. A randomised study concluded that 248 mg of magnesium per day for 6 weeks can significantly reduce the symptoms of depression<a href="#accordion">[10]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Creatine&nbsp;</h5>
	</li>
</ul>

Creatine is an organic compound that is essential for maintaining brain energy, which has shown to be involved in the development of depression. Some studies have shown that supplementing creatine can help with the symptoms of clinical depression.&nbsp; 
&nbsp;

<ul>
	<li>Rhodiola Rosea&nbsp;</li>
</ul>

Rhodiola Rosea is a popular herb that has several health benefits when taken in the form of a supplement. In addition to helping the body cope with stressful situations, the herb is known to reduce symptoms of depression. The herb when used in combination with saffron can significantly reduce depression and anxiety symptoms of mild to moderate depression<a href="#accordion">[11].</a>&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Saffron&nbsp;</h5>
	</li>
</ul>

Saffron is a spice that is commonly used in Asian foods. The spice is packed with antioxidants that have been shown to improve the symptoms of depression. While the exact mechanism behind it is unknown, studies have shown that saffron increases levels of the &ldquo;happy hormone&rdquo; in the brain 
.

<ul>
	<li>
	<h5>Ginseng&nbsp;</h5>
	</li>
</ul>

The ginseng plant has been used by the Chinese for thousands of years to help reduce the effects of stress, and improve mental clarity and energy. Derived from the plant, ginseng supplements have properties that help with low energy and motivation levels in people with depression. However, currently, there are not many studies to support the benefits of ginseng for depression&nbsp;&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Chamomile&nbsp;</h5>
	</li>
</ul>

Studies have shown that chamomile is useful in the management of depression and anxiety. The herb provides significant relief from depressive symptoms. However, there is a need for further studies to support the benefits of chamomile to treat depressive symptoms.&nbsp;

&nbsp;

Key Points

<ul>
	<li>While herbal and natural supplements may work for some people, they are not a substitute for conventional treatments. Especially, for people who also struggle with thoughts of self-harm or suicide.&nbsp;</li>
	<li>Depression is a treatable illness, and you may try different herbs and supplements, but they may have potential side effects.&nbsp;</li>
	<li>These herbs and supplements can also interact with other drugs, reducing their potency.&nbsp;</li>
	<li>If you struggle with depression or have thoughts of suicide or self-harm, seek professional help immediately.&nbsp;</li>
</ul>

&nbsp;

[1].Depressive disorder (depression). World Health Organization. Accessed May 18, 2023

[2].Ferrari, A.J., Charlson, F.J., Norman, R.E., Patten, S.B., Freedman, G., Murray, C.J., Vos, T. and Whiteford, H.A., 2013. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS medicine, 10(11), p.e1001547.

[3].Zhang, M.M., Zou, Y., Li, S.M., Wang, L., Sun, Y.H., Shi, L., Lu, L., Bao, Y.P. and Li, S.X., 2020. The efficacy and safety of omega-3 fatty acids on depressive symptoms in perinatal women: a meta-analysis of randomized placebo-controlled trials. Translational psychiatry, 10(1), pp.1-9.

[4].Liao, Y., Xie, B., Zhang, H., He, Q., Guo, L., Subramanieapillai, M., Fan, B., Lu, C. and McIntyre, R.S., 2019. Efficacy of omega-3 PUFAs in depression: a meta-analysis. Translational psychiatry, 9(1), pp.1-9.

[5].Šalamon, Š., Kramar, B., Marolt, T.P., Poljšak, B. and Milisav, I., 2019. Medical and dietary uses of N-acetylcysteine. Antioxidants, 8(5), p.111.

[6].Menon, V., Kar, S.K., Suthar, N. and Nebhinani, N., 2020. Vitamin D and depression: a critical appraisal of the evidence and future directions. Indian journal of psychological medicine, 42(1), pp.11-21.

[7].Vellekkatt, F. and Menon, V., 2019. Efficacy of vitamin D supplementation in major depression: A meta-analysis of randomized controlled trials. Journal of postgraduate medicine, 65(2), p.74.

[8].Vellekkatt, F., Menon, V., Rajappa, M. and Sahoo, J., 2020. Effect of adjunctive single dose parenteral vitamin D supplementation in major depressive disorder with concurrent vitamin D deficiency: a double-blind randomized placebo-controlled trial. Journal of Psychiatric Research, 129, pp.250-256.

[9].Sangle, P., Sandhu, O., Aftab, Z., Anthony, A.T. and Khan, S., 2020. Vitamin B12 supplementation: preventing onset and improving prognosis of depression. Cureus, 12(10).

[10].Tarleton, E.K., Littenberg, B., MacLean, C.D., Kennedy, A.G. and Daley, C., 2017. Role of magnesium supplementation in the treatment of depression: A randomized clinical trial. PloS one, 12(6), p.e0180067.

[11].Bangratz, M., Abdellah, S.A., Berlin, A., Blondeau, C., Guilbot, A., Dubourdeaux, M. and Lemoine, P., 2018. A preliminary assessment of a combination of rhodiola and saffron in the management of mild–moderate depression. Neuropsychiatric disease and treatment, 14, p.1821.

Staff Writer

Can't Go To Sleep? Here’s Why And How To Fix It

Overview

You&rsquo;re lying in bed, trying to fall asleep. You&rsquo;ve tried everything: reading a book, taking a bath, meditating, nothing seems to work. If this sounds like you, don&rsquo;t worry, I&rsquo;m here to help. In this article, we&rsquo;ll explore some of the most common reasons why people can&rsquo;t fall asleep and what you can do about them. 
&nbsp;

trick your body into sleeping

It&rsquo;s hard to shut down the mind, but if you can allow yourself to be free of all thoughts, worries and overthinking, it&rsquo;s easier to get a good night&rsquo;s sleep. This is why meditation has become so popular as a way to relax and clear your mind.

If you are having trouble going to sleep at night because you have too much on your mind, try focusing on relaxing exercises, such as taking deep breaths for 10 minutes or listening to calming music before bedtime.

If you feel like there is simply too much for your mind to process before bedtime, try not to think about anything at all until after midnight (or whenever you plan on falling asleep). That means no worrying about things that happened earlier in the day or what needs doing tomorrow morning&mdash;just let everything go until it&#39;s time for bed!

&nbsp;

Your environment can also influence the quality of your sleep. If you are sharing a bed with a partner who snores, or have pets that are noisy at night, this can affect your ability to get into REM and deep sleep stages of sleep. If you suffer from these problems, try to keep your pets out during night time.

&nbsp;

If you nap during the day, this can make it harder to fall asleep at night. This is because napping reduces your total sleep time and delays your internal circadian rhythm. In other words, it makes for a long period of time with reduced sleep quality and quantity, which makes falling asleep at night even more difficult.

Napping during the day also makes you feel groggy when it&rsquo;s time to go to bed. It&rsquo;s like drinking coffee in the morning. Once the caffeine has worn off, you may find yourself struggling to stay awake until lunchtime, instead of the usual 3pm!

If you want an afternoon nap but don&rsquo;t want these side effects on your nighttime slumber, consider power naps (naps lasting between 15 minutes and 1 hour), instead of full-on snoozing sessions (which can last longer than 90 minutes). Naps are great if they help improve alertness or performance, however, they shouldn&#39;t be used as a substitute for nighttime sleep if that&rsquo;s what you need most!

&nbsp;

You may have heard that it&#39;s important to go to bed at the same time every night and wake up at the same time every morning. This is true, but even more important is your schedule on weekends and weekdays. If you get enough sleep every night, then it doesn&rsquo;t matter if you sleep in on Saturdays or stay up late on Sundays, your body will adjust to these changes when they happen.&nbsp;

However, if you&rsquo;re not getting enough sleep overall, especially if it&rsquo;s because of inconsistent nighttime habits, then your body might have trouble adjusting to irregular schedules.

&nbsp;

Imagine this scenario: you go to bed at 10pm as usual, but you&rsquo;re not tired. You try and get comfortable, but you can&rsquo;t stop thinking about all of the things that happened during the day &mdash; the conversations you had with colleagues, how much work is left to do tomorrow, or what your friends are doing right now. You start worrying about them and then feel guilty because they don&rsquo;t have time for a phone call when they could be sleeping.&nbsp;

Then another thought pops into your head: did I switch off my iron? Should I check? Now we all know that checking whether an appliance is turned off isn&rsquo;t going to help us sleep any better than worrying if our friends are safe (unless there&rsquo;s a fire nearby somewhere), but this process repeats itself over and over again until suddenly, it&rsquo;s 2am, and there&rsquo;s no hope for rest tonight either!

So how can we avoid these situations? The key is finding something else, anything else, to occupy our minds instead of keeping track of every single little thing that crosses our minds throughout the day.

&nbsp;

Pillow size is another important consideration. Your pillow should be firm enough to support your head and neck, but soft enough to mold around your head and neck as you sleep. A proper pillow will also allow you to keep your spine in alignment while sleeping on either side or on your back, which helps with good posture.

If you have been using the same old pillows for years, it may be time for an upgrade. If a new pillow doesn&rsquo;t work right away, try adjusting its height (keep adding or removing stuffing) until you find one that works for you 
&nbsp;

Don&rsquo;t forget about the other side of the bed - do not share a bed with someone if that person snores heavily. Snoring can really affect quality of life. If a partner snores loudly enough at night that it keeps other people awake or keeps them from getting enough sleep themselves, then this could lead to fights between couples over who gets up earlier so they don&rsquo;t disturb their spouse&#39;s slumber. This problem can be resolved by setting up separate bedrooms for each person or getting rid of noisy beds altogether by buying two twin mattresses instead!

&nbsp;

If you can&rsquo;t get to sleep, it could be for any number of reasons. There are a lot of things that can keep you from drifting off into blissful slumber.

<ul>
	<li>You have too much going on. If there&rsquo;s something weighing on your mind, or if you&rsquo;re in an environment that&rsquo;s too stimulating (like a loud restaurant or party), try taking a moment to reflect on everything that&rsquo;s stressing you out and how it might affect your sleep quality. Try jotting down some notes and setting aside time tomorrow to talk over those issues with someone else so they&rsquo;re not still bothering you when it&rsquo;s bedtime.</li>
	<li>You napped during the day or had too much caffeine/food/alcohol before bedtime. When we nap during the day, we tend to wake up feeling more alert than usual, and while this can be helpful if we have somewhere important to go after work and need the extra boost, it can also hinder our ability to fall asleep at night when all we want is rest.</li>
	<li>Your sleep schedule is off-kilter or irregularly shifted throughout the week due to travel changes etcetera. This will make it harder for us humans whose bodies are programmed over thousands of years by evolution just like all animals&rsquo; bodies, except ours has evolved way faster so now sometimes ours needs work done on them sometimes too. Thus, needing proper rest does matter, so here are some tips. 
	&nbsp;</li>
</ul>

If you are listening to music, watching TV, or playing video games, shut it off! Your brain may be losing focus and this makes it hard for you to sleep.

If you can&rsquo;t sleep, get up and do something else before going back to bed. The more time spent lying awake in bed the more difficult it becomes to fall asleep again.

&nbsp;

On a personal note, I have always <a href="https://merisehat.pk/article/are-you-sleeping-on-your-sleep-cycle" target="_blank">struggled with sleeping</a>. When I was younger, I had to have my mom read me bedtime stories to help me fall asleep and would still be up way past midnight reading under my covers. These days, it&rsquo;s not as bad but there are still nights where my mind won&rsquo;t shut off and I find myself lying awake for hours. Sometimes it&rsquo;s because of something that happened earlier in the day or week; other times it&#39;s just a matter of getting enough rest.

As you can imagine, this can be frustrating when you want nothing more than to turn off your brain and go to sleep! But there are ways you can get better at falling asleep faster, and even staying asleep all night long if you want.

&nbsp;

Bottom Line

If you have tried all of these tricks and still can&rsquo;t sleep, there&rsquo;s nothing left to do but wait it out! Just remember, sometimes things happen in life that are out of our control. If you are lying there tossing and turning, just try to breathe deeply and stay calm. It may take some time for us humans to get back into a <a href="https://merisehat.pk/article/are-you-sleeping-on-your-sleep-cycle">regular sleeping cycle</a> again, so don&rsquo;t be discouraged if you&rsquo;re stuck in bed all day without any hope of going anywhere else anytime soon!

Umna Salah

Humza Khizer

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

Should I Be Anxious About My IBS?

<a href="https://www.merisehat.pk/disease/irritable-bowel-syndrome-62">Irritable Bowel Syndrome (IBS)</a> is defined as a type of gastrointestinal condition that causes problems in the digestive system. IBS affects 10 to 15 percent of the world&rsquo;s population. However, the symptoms are different for every person. While IBS is not a life-threatening condition, it can have a significant impact on one&rsquo;s well-being by affecting one&rsquo;s quality of life. The situation worsens when a person suffers from anxiety and IBS.

&nbsp;

Understanding Link Between Anxiety And IBS

Anxiety disorders is an umbrella term used for general anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD) and social anxiety disorder. A shared symptom of these disorders is excessive worry or anxiety.&nbsp; Physical symptoms of anxiety disorders include fast heart rate, sweating and fatigue. This may interfere with one&rsquo;s ability to get through normal everyday activities.&nbsp;

&nbsp;

IBS is a disorder of the digestive tract that causes abnormal bowel movements. Unlike Crohn&rsquo;s disease or ulcerative colitis, the physical structure of the digestive tract is unaffected, i.e. IBS is not a functional disorder. Common symptoms of IBS include diarrhea, constipation, and abdominal pain. Anxiety disorders affect more than a third of all U.S. adults while IBS affects 7% to 21% of the U.S. population. However, there is no reliable data for how many people experience both anxiety disorder and IBS. Some studies have shown that anxiety disorders are more common in people with IBS. According to a study assessing the prevalence of anxiety disorders and IBS, 44% of people with IBS had an anxiety disorder, compared to 8% of people without IBS.&nbsp;

&nbsp;

According to scientists, the mind and gut are intertwined. This is what scientists refer to as the gut-brain axis, which is a two-way signaling system between the gut and the brain. In response to our thoughts, feelings, and environment, our bodies release chemicals that affect different processes in our bodies. However, in the case of anxiety and IBS, whenever you feel anxious, your body releases stress-related chemicals in the gut causing inflammation leading to abnormal bowel movements, abdominal pain, and a change in gut bacteria.

Additionally, a poorly functioning gut has also been linked with mental health problems. Scientists explain that this is because our brain depends on the chemicals and hormones made by the bacteria in the gut for e.g. 90% of the serotonin (which is an important chemical that controls our mood and keeps anxiety levels low) is produced in our gut. Mental health problems are associated with increased and decreased production of serotonin.&nbsp;

&nbsp;

Unfortunately, the causative factors of IBS have yet to be elucidated. However, there is reason to believe that it may depend on a person&rsquo;s mental health. Anxiety and other health conditions may trigger IBS.&nbsp;

Certain other risk factors may increase one&rsquo;s risk of IBS, including:&nbsp;

<ul>
	<li>Having a family history of IBS&nbsp;</li>
	<li>Females are at a higher risk of developing IBS than males</li>
	<li>Being younger than 50 years of age</li>
	<li>History of severe gut infections&nbsp;</li>
	<li>Chronic psychological stress either caused by traumatic life events or alcohol addiction&nbsp;</li>
	<li>Smoking&nbsp;</li>
	<li>Certain medications that cause changes in the gut bacteria</li>
</ul>

&nbsp;

Studies have shown that keeping stress under control can help prevent or ease the symptoms of IBS. This is because the gut has a brain of its own, known as the enteric nervous system which is why you get butterflies in your stomach when you are nervous. Also, this &ldquo;second brain&rdquo; of yours also controls how food is digested. This second brain is in constant communication with your brain via the gut-brain axis. Thus, this connection can help manage your IBS. You can try and get rid of the tension by incorporating simple things in your daily routine, for example, going shopping, listening to music, reading, or talking to a friend. Other ways to alleviate stress and anxiety include:

&nbsp;

<ul>
	<li>
	<h5>Exercise&nbsp;</h5>
	</li>
</ul>

Exercising, for example, walking, swimming, running or other such physical activities can help you cope with anxiety and depression. Exercise also helps with normal bowel contractions.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Mind-Body Exercise, Mindfulness, And Meditation&nbsp;</h5>
	</li>
</ul>

Meditation can help trigger your body&rsquo;s relaxation response. You can either sign up for meditation, breathing or yoga classes offered online or in person. They will help you manage stress by targeting the gut-mind connection and changing the way you think.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Relaxation Exercises&nbsp;</h5>
	</li>
</ul>

Relaxation techniques, such as deep breathing, can help you feel calmer. The purpose of relaxation techniques is to learn about visualization and to imagine a peaceful scene. These techniques will also help you get enough sleep and eat well. You can also consider joining a self-help group for people with IBS or other digestive disorders. Members of the group will know what it is like to deal with IBS and may also be able to offer more meaningful support that you may not be able to get from even your closest friends.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Diet And Lifestyle Changes&nbsp;</h5>
	</li>
</ul>

The food we eat has a huge impact on our overall health. Your stomach and intestines are some of the first organs that feel the effect of the food you are eating. For treating IBS, you must start with your diet. There are specific foods that can trigger the symptoms of IBS. However, these triggers differ for everyone. Maintain a food/bowel movement journal wherein you can write about how different foods affect your bowel movements. This journal could also be helpful for discussing treatment options with your doctor. Research shows that avoiding certain foods can help prevent symptoms of IBS:&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Gas-Producing Foods</h5>
	</li>
</ul>

People with IBS are more sensitive to foods that make a person gassy for example, beans, bananas, and brussel sprouts. These foods may trigger discomfort after eating them.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Dairy&nbsp;</h5>
	</li>
</ul>

Even if lactose is not an issue for you, you may be sensitive to other milk proteins due to your IBS.&nbsp; Try using dairy-free alternatives, such as soy or oat milk to ease bloating and other stomach issues.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Foods High In FODMAPs</h5>
	</li>
</ul>

Foods high in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are short carbohydrates, such as fructose and sorbitol that appear in many fruits, vegetables, honey, and wheat. Studies have shown that these FODMAPs can linger in our guts, absorb water, and ferment, which can then cause irregular bowel movements. If you struggle with constipation, then it is recommended you stay well hydrated and eat 4-5 small meals regularly rather than eating 3 large meals a day. A diet high in fiber and soluble fiber, such as psyllium may also be helpful. Similarly, alcohol, tobacco, and caffeine aggravate symptoms of both IBS and anxiety, so reduce their consumption.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Cognitive Behavioral Therapy&nbsp;</h5>
	</li>
</ul>

Studies have shown that cognitive behavioral therapy is an effective treatment for IBS. However, before starting with CBT, practitioners need to rule out alternative diagnoses. The most important medical conditions to rule out include inflammatory bowel disease, Crohn&rsquo;s disease, and celiac disease. Baseline blood and stool tests are generally enough to rule out these conditions. The next step is to educate the patient about the gut-brain link and how stress can directly impact gut health.

The CBT practitioner will first help train the patient in relaxation techniques including deep belly breathing. Once the patients are able to use the relaxation techniques CBT is introduced. The focus of CBT is to educate the patient that the beliefs that affect our emotions negatively can be baseless. For example, if a person is embarrassed to go to the bathroom in a public place, it can be helpful to send them to a movie theater and have them sit at the back of the theater to count the number of people who get up to use the bathroom and return. The patient will be able to see two things: the frequency of people getting up to use the bathroom and the lack of reaction towards this behavior by the surrounding people. This will help the patient understand that it is not a big deal to get up and use the bathroom.&nbsp;

Similarly, CBT exposure therapy focuses on patients overcoming their fear of doing things that they have been avoiding. For example, if a person is afraid of long car trips, make them sit in a parked car for thirty minutes. Once this gets boring, drive them around the area. Once this gets easy, drive them a mile away from home and back. If the patient worries about not being able to &ldquo;hold it&rdquo;, experiment with them to &ldquo;hold it&rdquo; for 30 seconds, then a minute, and then 5 minutes. This will prove that they can hold it and worry is unnecessary.

&nbsp;

<ul>
	<li>
	<h5>Medications&nbsp;</h5>
	</li>
</ul>

If diet and lifestyle changes are not enough to curb the problem of anxiety and IBS, many medications will help relieve symptoms.

<ul>
	<li>Metamucil, or soluble fibers available over the counter, for constipation relief.</li>
	<li>Miralax helps pull water into the intestines and encourages bowel movements.</li>
	<li>Medications approved by the FDA for IBS-related constipation, Amtizia, Linzess, and Zelnorm.&nbsp;</li>
	<li>Antidepressants, including tricyclic antidepressants and selective serotonin reuptake inhibitors.</li>
	<li>Imodium is a popular over-the-counter medication that slows down gut and bowel movements and treats IBS-related diarrhea.&nbsp;</li>
	<li>Antispasmodics relax the muscles of the digestive system and relieve IBS-related abdominal pain.&nbsp;</li>
</ul>

&nbsp;

<ul>
	<li>Although there is no clear answer as to how anxiety affects your IBS or vice versa, both conditions are triggered by many different factors.</li>
	<li>If you have IBS, then there are many treatment options (medications, cognitive behavior therapy, etc.) and lifestyle changes that have been shown to help relieve symptoms and stress.&nbsp;</li>
	<li>You can discuss these treatment options with a healthcare provider and implement whatever works best for you.</li>
</ul>

&nbsp;

[1] Banerjee, A., Sarkhel, S., Sarkar, R. and Dhali, G.K., 2017. Anxiety and depression in irritable bowel syndrome. Indian journal of psychological medicine, 39(6), pp.741-745.

[2] Locke, G.R., Olden, K., Peterson, W., Quigley, E., Schoenfeld, P., Schuster, M. and Talley, N., 2002. Systematic review on the management of irritable bowel syndrome in North America. Am J Gastroenterol, 97, pp.S7-26.

[3] Camilleri, M., 2018, December. Management options for irritable bowel syndrome. In Mayo Clinic Proceedings (Vol. 93, No. 12, pp. 1858-1872). Elsevier.

[4] Johns Hopkins Medicine: "The Brain-Gut Connection."

[5] U.S. National Library of Medicine: "Irritable bowel syndrome treatment: cognitive behavioral therapy versus medical treatment."

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

In Sickness And In Health

&ldquo;What did I even achieve?&rdquo;

&ldquo;Why can&rsquo;t I be how I want to be?&rdquo;

&ldquo;Is this it?&rdquo;

And a million other questions may arise when you are not feeling your best. 
&nbsp;

Depressive disorders, mood disorders, in fact the entirety of mental health, is a lesser understood subject. It&rsquo;s bad enough that mental health continues to be a taboo, at times shunned by the most educated even, but it&rsquo;s sadder that society has somehow categorised who should be &ldquo;allowed&rdquo; to have <a href="https://www.merisehat.pk/article/mental-health">mental health</a> problems. This scrutiny is done on the basis of gender, race, socioeconomic status and even profession. No matter how organised this categorisation sounds, it is incorrect, unfair and devastating. 
&nbsp;

Mental health is your psychological well-being that not only affects your personal, career and professional life, but also your health. Depression or any other mental health illness, can either directly affect your appetite and cause weakness, or bring your immune system down to an extent that it gets susceptible to harmful organisms. 
&nbsp;

Moreover, it is seen that symptoms, such as those in anxiety in particular, can alter the physiological processes of the autonomic nervous system i.e. respiration and heart rate. Thus, increasing the risk of certain malicious diseases.&nbsp; 
&nbsp;

Healthcare practitioners, including the nursing staff, paramedics, and all those involved in patient care are part of an extremely noble, but immensely stressful profession. Whether they are sick or healthy, patient care is an obligation they cannot ignore. Moreover, providing hope to patients who believe they will never recover is a major part of the job description. But do you ever think how scary it can be for healthcare professionals to provide this hope, regardless of their own fears?&nbsp; &nbsp; &nbsp;&nbsp;

&nbsp;

Understanding Mental Health Issues Faced By The Medical Community

According to the World Health Organization (WHO), in 2015, almost 4.4% of the global population was diagnosed with depression, which is around 320 million people<a href="#accordion">[1]</a>. Studies prove that except for the United States of America, where there are an equal number of depressed doctors as the general population, other countries report a greater incidence of depression among doctors and other related health professionals than the rest of the population.&nbsp; 
&nbsp;

Current statistics report the prevalence of depression as 27% in medical students, 29% in registrars and up to 60% in practicing doctors<a href="#accordion">[1]</a>.&nbsp;Furthermore, a study conducted using Beck&rsquo;s Depression Inventory, revealed that 30% of the primary healthcare workers in a public setup were moderate to severely depressed<a href="#accordion">[1]</a>. In China, where health workers&rsquo; mental health wasn&rsquo;t taken into consideration until the 21st Century, the prevalence of depressive symptoms varies between 31.7% to 65.3%<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

There are no set criteria that enables only a certain population to be exclusive to mental health disorders. It can happen to almost anyone, but there are sure factors that have been proved to put healthcare workers at a greater risk than others. These risk factors include: 
&nbsp;

<ul>
	<li>Working longer hours</li>
	<li>Extensive workload</li>
	<li>Ever-growing intensity and complexity of the job description</li>
	<li>Relentless contact with patient&rsquo;s ill health and emergencies</li>
	<li>Higher responsibilities</li>
	<li>Post-traumatic stress due to the severity of the patient&rsquo;s condition</li>
	<li>Feelings of guilt, failure, shame and low self-esteem due to fear of failure, or actually failing to execute a task&nbsp;</li>
	<li>Discrimination in their licensing procedures specifically</li>
</ul>

&nbsp;

One term to understand while discussing the mental health of healthcare workers is &lsquo;burnout&rsquo;. According to the International Classification of Diseases (11th edition), or ICD-11, burnout is a phenomenon seen in workplaces where excessive pressure from the office surroundings can drain a person to an extent that they can&rsquo;t function properly anymore.&nbsp; 
&nbsp;

Burnout is characterised by three aspects:

1. Being unnecessarily exhausted.

2. Having negativity related to the workplace, in this case around patients.

3. Major reduction in efficiency. 
&nbsp;

Further research reports that a reason exclusive to low- and middle-income countries is the unfair ratio of physicians to the general population. This increases the workload which in turn raises the risk of burnout in healthcare providers. Thus, ultimately affecting patient care. Many cross-sectional studies signify that burnt-out medical practitioners were twice as likely to make errors, and had a 17% risk of being sued for malpractice<a href="#accordion">[3]</a>. This reduced efficacy can in turn aggravate burnout, as well as instill a factor of guilt for not being efficient enough. 
&nbsp;

According to a study carried out in the US, in 2017, almost 44% of physicians showed at least one symptom of burnout while the number was 54% in 2014<a href="#accordion">[3]</a>.&nbsp;

&nbsp;

Moral injury is defined as the psychological distress which results from the actions, or the restricted ability of the practitioner, that may violate their moral or ethical code. A fine example is a doctor having to decide between saving one patient over the other, purely on practical grounds. This may put profound emotional and psychological stress. Although the moral injury is not a disease itself, it may shake a healthcare practitioner&rsquo;s core and lead to feelings of self-doubt, unnecessary yet strong guilt and ambiguity in their actions. For example, paramedics hold themselves accountable for not being able to do enough on-site, regardless of correctly analyzing the severity of the condition<a href="#accordion">[3]</a>.

&nbsp;

An unjust stereotype that prevails in our society is that a person who works in the healthcare industry is not allowed to be compromised medically themselves. This puts unnecessary pressure on the healthcare workers as it is idealised that their efficiency is subject to their own health. Due to the unfair perception set, medical workers not only feel frustrated, but they use alternative ways for instant gratification which in turn makes matters even worse for them.&nbsp; 
&nbsp;

Studies prove that alcohol misuse in healthcare providers was 49%, five times higher than the general population (9%)<a href="#accordion">[1]</a>. Furthermore, a survey conducted in the United States in 2016 revealed that although 50% of the female doctors acknowledged that while they met the criteria for a disturbed mental state, they did not consider starting appropriate treatment as they wanted to deal with it independently<a href="#accordion">[1]</a>. Or, because they believed the diagnosis was shameful or embarrassing 
.&nbsp;

Therefore, there is a dire need of changing perceptions<a href="#accordion">[1]</a>.

&nbsp;

The treatment is as complicated as diagnosing mental health disorders in healthcare professionals. The relevance lies with the fact that professionals who have dedicated their lives to serving patients find it hard to fit in the role of a patient themselves. Nevertheless, it is important to ensure appropriate treatment. The treatment plan includes a pharmacological and psychological approach. Antidepressants are the first-line medications. The most widely used antidepressants are selective serotonin re-uptake Inhibitors (SSRIs). These are usually initiated for 9-12 months in the beginning, irrespective of the reason.&nbsp; 
&nbsp;

Studies also prove that medical practitioners have a higher suicide rate than the general population. Hence, encouraging treatment plans is of utmost importance. The psychological approach includes cognitive behavioural therapy (CBT) and support groups to normalise the conception of being unwell. Moreover, exercises like adopting new hobbies, restricting alcohol intake, and taking up healthy challenges might be helpful in the process<a href="#accordion">[1]</a>.

&nbsp;

<h4>"Worried? Anxious? Head on over to the<a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank"> sehat scan</a> to check your stress level!" </h4>

The mental health of doctors or other healthcare professionals was already a neglected topic, but after the pandemic things took a turn for the worse. Numerous studies have recently been dedicated exclusively to the impact of COVID-19 on the mental health of healthcare providers.&nbsp; 
&nbsp;

As of 30th July, COVID-19 has caused more than 6.4 million global deaths<a href="#accordion">[4]</a>. The sudden patient influx, presence of unorthodox symptoms, and their management, along with the unpredictability of COVID-19 have further increased the burden on healthcare practitioners. A meta-analysis conducted across 65 studies, involving 97,333 health care workers from 21 countries, identified a high prevalence of moderate depression (21.7%), anxiety (22.1%), and PTSD (21.5%) during the COVID-19 pandemic<a href="#accordion">[3]</a>. Another survey reported trauma-related stress, with a prevalence ranging from 7.4% to 35%, particularly among women, nurses, frontline workers and workers who experienced physical symptoms<a href="#accordion">[3]</a>. In fact, nurses have shown a higher incidence of depression and PTSD than physicians<a href="#accordion">[3]</a>.

&nbsp;

Conclusion

Doctors are mere humans; as fragile or strong as any other person alive. Just because their job involves treating illnesses, doesn&rsquo;t mean that they are not bound to get ill themselves. The stereotype built for healthcare professionals restricts them to get diagnosed, and if they do, prevents them from getting treatment efficiently. 
&nbsp;

The statistics collected have been recent and alarming, yet not much attention has been paid to the situation. This needs to change not only for the sake of humanity but also for the stagnant progress of our healthcare industry. Having our medical workers burnt out does not only put patient care at risk but also aggravates their mental health itself. 
&nbsp;

<ul>
	<li>Mental health is your psychological well-being that not only affects your personal, career and professional life but also your health.</li>
	<li>&nbsp;Healthcare practitioners, including nursing staff, paramedics and all those involved in patient care are an integral part of the health system.</li>
	<li>Data proposed by the World Health Organization (WHO) in 2015 shows that almost 4.4% of the world&rsquo;s population is diagnosed with depression, which is around 320 million people.</li>
	<li>Prevalence of depression was found to be 27% in medical students, 29% in registrars and up to 60% in practicing doctors.</li>
	<li>Risk factors that make healthcare practitioners vulnerable to mental disorders are working longer hours, extensive workload, ever-growing intensity and complexity of the job description, relentless contact with patient&rsquo;s ill health and emergencies, higher responsibilities, post-traumatic stress due to the severity of patient presentation, feelings of guilt, failure, shame and low self-esteem due to fear of failure.&nbsp;</li>
	<li>According to ICD-11, burnout is a phenomenon seen in workplaces where excessive pressure from the office surroundings can drain a person to an extent that they can&rsquo;t function properly anymore.</li>
	<li>Burnout is characterised by being unnecessarily exhausted, having negative thoughts related to the workplace, and major reductions in efficiency.</li>
	<li>In 2017 almost 44% of US physicians showed at least one symptom of burnout, while the number was 54% in the year 2014.</li>
	<li>Many cross-sectional studies signify that burnt-out medical practitioners were twice as likely to make errors, and had a 17% risk of being sued for malpractice.</li>
	<li>Moral injury is defined as the psychological distress that results from actions, or the restricted ability of the practitioner, that may violate their moral or ethical code.</li>
	<li>A survey conducted in the United States in 2016 revealed that although 50% of the female doctors acknowledged the fact that they had met the criteria for a disturbed mental state, they did not consider starting appropriate treatment.</li>
	<li>&nbsp;The treatment plan for depression includes pharmacological and psychological approaches, in which antidepressants are the first-line medications.</li>
	<li>However, any medication should be started only after being officially prescribed by a certified healthcare practitioner.</li>
	<li>Studies also prove that medical practitioners have a higher suicide rate than the general population.</li>
	<li>Summarising 65 studies, involving 97,333 healthcare workers in 21 countries, a high prevalence of moderate depression (21.7%), anxiety (22.1%), and PTSD (21.5%) was present among them during the COVID-19 pandemic.</li>
</ul>

[1] Ignacio Mora-Magaña, Sherman A. Lee, Isaac Maldonado-Castellanos, Carlos Jiménez-Gutierrez, José Mendez-Venegas, Azareel Maya-Del-Moral, Margarita D. Rosas-Munive, Amanda A. Mathis, Mary C. Jobe. (2022) Coronaphobia among healthcare professionals in Mexico: A psychometric analysis. Death Studies 46:2, pages 280-289.

[2] Gong, Yanhong et al. “Prevalence of anxiety and depressive symptoms and related risk factors among physicians in China: a cross-sectional study.” PloS one vol. 9,7 e103242. 22 Jul. 2014, doi:10.1371/journal.pone.0103242

[3] Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority.

[4] Coronavirus cases: Worldometer.

Arbaz Ansari

Understanding The Intensity Of A Panic Attack And Its Causes

A <a href="https://merisehat.pk/disease/panic-attack">panic attack </a>can be a terrifying and bewildering experience, leaving individuals feeling as though they are caught in a relentless storm of fear and discomfort. Understanding what a panic attack feels like is crucial to recognize the signs, provide support, and seek appropriate help. In this article, we explore the intricate nature of panic attacks, delving into the emotional and physical sensations that accompany them, as well as the underlying causes that trigger these distressing episodes. 
&nbsp;

Panic Attack and Its Causes

A panic attack is a sudden and intense surge of fear or anxiety that arises without warning and reaches its peak within minutes. These episodes are typically brief but can feel overwhelming and can occur repeatedly, creating a sense of fear about future attacks. Panic attacks can be symptomatic of panic disorder, a type of anxiety disorder, but can also occur in individuals with other anxiety conditions. 
&nbsp;

<ol>
	<li>Intense Fear And Dread: A panic attack is characterized by an overwhelming sense of fear and impending doom. Individuals may feel like they are in grave danger, even when there is no identifiable threat.</li>
	<li>Heart Palpitations And Chest Pain: Panic attacks often trigger a rapid and pounding heartbeat. Chest pain or discomfort is also common, which can mimic heart-related issues, causing additional distress.</li>
	<li>Shortness Of Breath And Hyperventilation: Breathing may become rapid and shallow, leading to a feeling of breathlessness and suffocation. This can further intensify feelings of anxiety and panic.</li>
	<li>Dizziness And Nausea: A panic attack can cause dizziness and lightheadedness, which may be accompanied by nausea or stomach discomfort.</li>
	<li>Sweating And Chills: Profuse sweating, even in a cool environment, is a common physical response during a panic attack. Conversely, some individuals may experience chills or shivering.</li>
	<li>Trembling And Shaking: Involuntary trembling or shaking of the hands, legs, or voice may occur during a panic attack due to the release of adrenaline.</li>
	<li>Numbness And Tingling: Some individuals may experience tingling sensations or numbness, often in the extremities, as a result of heightened arousal.</li>
	<li>Feeling Of Unreality Or Detachment: Panic attacks can lead to a sense of detachment from oneself or the surrounding environment, as if experiencing the world through a fog or a dream.</li>
	<li>Fear Of Losing Control Or Going Crazy: A common fear during panic attacks is losing control over one&#39;s thoughts, actions, or emotions, or the fear of going crazy.</li>
	<li>Fear Of Death: Many individuals experiencing a panic attack report fearing that they may die during the episode, even though panic attacks are not physically harmful. 
	&nbsp;</li>
</ol>

The exact causes of panic attacks are not fully understood, but they are believed to be a complex interplay of biological, psychological, and environmental factors. Some contributing factors include:

<ol>
	<li>Genetics: Family history of anxiety disorders or panic attacks may increase an individual&#39;s susceptibility to experiencing panic attacks.</li>
	<li>Brain Chemistry: Imbalances in neurotransmitters, such as serotonin and norepinephrine, which play a role in regulating mood and anxiety, may contribute to panic attacks.</li>
	<li>Stressful Life Events: Traumatic experiences or significant life changes can trigger heightened anxiety levels, leading to panic attacks.</li>
	<li>Phobias And Avoidance: Fear of certain situations or places, coupled with avoidance behaviors, can lead to the development of panic attacks.</li>
	<li>Sensitivity To Physical Sensations: Some individuals are more sensitive to bodily sensations, and when they experience physical symptoms of anxiety, it can escalate into a full-blown panic attack. 
	&nbsp;</li>
</ol>

Experiencing a panic attack can be an overwhelming and distressing ordeal. The physical and emotional symptoms can be all-consuming, leaving individuals feeling vulnerable and frightened. Recognizing the signs of a panic attack is essential for supporting those who are affected and encouraging them to seek appropriate help. With the right guidance, coping strategies, and, if necessary, professional treatment, individuals can learn to navigate the storm of panic attacks and find a path towards healing and emotional resilience.

How To Address And Overcome Sexual Performance Anxiety

Sexual performance anxiety can be a debilitating condition that affects both men and women. It is a psychological condition where a person experiences anxiety, fear and apprehension about their sexual performance, which may lead to difficulty in achieving and maintaining an erection or achieving an orgasm. This can cause embarrassment, frustration, and may negatively impact one&#39;s sexual relationships.&nbsp;

Given how stigmatized sex and sexuality is in the modern zeitgeist, many people suffer through these issues for ages before they ever bring up the courage to talk about it. Fortunately, sexual performance anxiety is treatable and can be overcome with the right approach.&nbsp; 
&nbsp;

Overcoming Performance Anxiety

<ul>
	<li>&nbsp;The first step in overcoming sexual performance anxiety is to understand the root causes. One of the most common causes of sexual performance anxiety is psychological stress. High levels of stress can cause your body to release stress hormones, such as cortisol, which can lead to erectile dysfunction, premature ejaculation and other sexual problems. Other common causes of sexual performance anxiety include stress, anxiety, depression, relationship problems and a lack of confidence.&nbsp;&nbsp;</li>
</ul>

Once you have identified the underlying cause of your sexual performance anxiety, there are several steps you can take to overcome it. The first step is to address any psychological factors that may be contributing to your anxiety. This can be done through therapy, meditation, yoga, or other stress-reducing techniques. 
&nbsp;

<ul>
	<li>Cognitive-behavioral therapy (CBT) is an effective treatment option for sexual performance anxiety, as it helps you identify and change negative thoughts and behaviors that may be contributing to your anxiety. Another effective way to overcome sexual performance anxiety is to practice mindfulness and relaxation techniques.&nbsp; 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/article/the-role-of-mindfulness-in-maintaining-sexual-health">Mindfulness</a> involves being present in the moment, focusing on your breathing, and letting go of any distractions or negative thoughts. This can help you relax and reduce anxiety during sexual activity. Relaxation techniques, such as progressive muscle relaxation and deep breathing exercises can also be helpful in reducing anxiety and improving sexual performance.&nbsp; 
	&nbsp;</li>
	<li>In addition to psychological treatments, there are several other ways to overcome sexual performance anxiety.One of the most effective is to improve your physical health through exercise and a healthy diet. Regular exercise can improve blood flow to the genitals, which can help improve sexual performance. A healthy diet that is rich in fruits, vegetables, and lean protein can also help improve overall sexual health. Another way to overcome sexual performance anxiety is to communicate openly and honestly with your partner.&nbsp;</li>
</ul>

Talking about your concerns and fears can help reduce anxiety and build trust in your relationship. It can also help you identify any issues that may be contributing to your anxiety, such as communication problems or unresolved conflicts.&nbsp; 
&nbsp;

<ul>
	<li>Finally, there are several medical treatments that can be helpful in treating sexual performance anxiety. Medications, such as Viagra and Cialis, can help improve erectile function and prolong sexual activity. However, it is important to consult with your doctor before taking any medications, as they can have side effects and may interact with other medications you may be taking.&nbsp; 
	&nbsp;&nbsp;&nbsp;</li>
</ul>

Sexual performance anxiety is a common condition that can negatively impact one&#39;s sexual relationships. However, it is treatable and can be overcome with the right approach. If you are struggling with sexual performance anxiety, don&#39;t hesitate to seek help from a qualified mental health professional or healthcare provider. Having safe and pleasurable sex is our god given right and we must do everything in our power to make this possible.

Dr. Safia Mehmood

The Impact Of Retirement On Mental Health And How To Manage Stress And Anxiety

Retirement is often thought of as a time of relaxation and rest, but it can also bring a significant amount of stress and <a href="https://merisehat.pk/article/how-to-manage-anxiety">anxiety</a>. The transition from a structured work routine to a more open-ended schedule can be challenging, and the loss of a sense of purpose can lead to feelings of depression and isolation. In this article, we will explore the impact of retirement on mental health and offer some tips for managing stress and anxiety. 
&nbsp;

Challenges Of retirement

One of the main challenges of retirement is the loss of structure and routine. Many retirees struggle to find a sense of purpose and meaning in their lives, which can lead to feelings of boredom and restlessness. This lack of structure can also make it difficult to maintain a healthy lifestyle, such as regular exercise and a balanced diet, which can further contribute to feelings of stress and anxiety.

Retirement can also lead to social isolation, particularly for those who were heavily involved in their work community. The loss of daily interactions with colleagues and clients can be difficult to adjust to, and retirees may struggle to find new social connections outside of work. This can lead to feelings of loneliness and depression, which can have a negative impact on overall mental health. 
&nbsp;

Managing Stress And Anxiety

To manage stress and anxiety during retirement, it is important to take proactive steps to maintain a healthy lifestyle and social connections. Here are some tips for getting started: 
&nbsp;

<ol>
	<li style="list-style-type:decimal">Create A&nbsp;Daily Routine: Establishing a daily routine can help provide a sense of structure and purpose, which can be particularly helpful during the early stages of retirement. Consider scheduling regular activities such as exercise, volunteering, or hobbies.</li>
	<li style="list-style-type:decimal">Stay Socially Connected: Maintain social connections by joining clubs or groups based on shared interests. Volunteer work can also be a great way to meet new people and contribute to the community.</li>
	<li style="list-style-type:decimal">Prioritize Self-Care: Prioritize self-care activities such as regular exercise, healthy eating, and getting enough sleep. Consider incorporating relaxation techniques such as yoga or meditation into your routine to manage stress and anxiety.</li>
	<li style="list-style-type:decimal">Set Goals: Setting goals can help provide a sense of purpose and meaning in retirement. Consider setting both short-term and long-term goals, such as learning a new skill or pursuing a hobby.</li>
	<li style="list-style-type:decimal">Seek Professional Help: If feelings of stress and anxiety persist, seek professional help. A mental health professional can provide support and guidance to help manage symptoms and improve overall mental health. 
	&nbsp;</li>
</ol>

In addition to these tips, it is important to approach retirement with a positive attitude and embrace the opportunity to explore new interests and experiences. Retirement can be a time of growth and personal fulfillment, but it requires effort and intentionality to manage stress and anxiety and maintain a healthy and fulfilling lifestyle. 
&nbsp;

In conclusion, retirement can have a significant impact on mental health, but with the right strategies and mindset, it is possible to manage stress and anxiety and maintain a healthy and fulfilling lifestyle. By creating a daily routine, staying socially connected, prioritizing self-care, setting goals, and seeking professional help when needed, retirees can approach this new phase of life with confidence and optimism. 
&nbsp;

Why 'Manning Up' Can Be A Dangerous Philosophy For Men With Anxiety

&quot;Manning up,&quot; a societal expectation often imposed on men, implies suppressing emotions, especially vulnerability and displaying stoicism in the face of adversity. While this philosophy may have been perceived as a sign of strength in the past, it can be a dangerous and harmful approach, especially for men with anxiety. Let&rsquo;s delve into the concept of &quot;manning up,&quot; discuss <a href="https://merisehat.pk/article/what-is-toxic-masculinity-how-to-deal-with-it">toxic masculinity</a>, and explore the detrimental effects it can have on men with anxiety. 
&nbsp;

Manning Up

The term &quot;manning up&quot; has been used to encourage men to adopt traditional gender roles, emphasizing traits such as emotional detachment, stoicism and the suppression of feelings, especially vulnerability. It suggests that men should handle challenges and stressors without showing signs of weakness or emotional turmoil. 
&nbsp;

Toxic masculinity is a harmful byproduct of &#39;manning up,&#39; perpetuating harmful stereotypes that link masculinity to emotional suppression and invulnerability. This societal pressure discourages men from expressing emotions, which can be particularly detrimental for those already grappling with anxiety. 
&nbsp;

<ul>
	<li>Repression Of Emotions &ndash; For men with anxiety, repressing emotions as encouraged by &#39;manning up&#39; can exacerbate their anxiety symptoms. Bottling up feelings can lead to increased stress, anxiety and even physical health problems.</li>
	<li>Invalidation Of Vulnerability &ndash; Anxiety is often accompanied by vulnerability and heightened emotional sensitivity. &#39;Manning up&#39; invalidates these feelings, making men with anxiety feel ashamed or weak for experiencing such emotions, worsening their mental health.</li>
	<li>Hindrance To Seeking Help &ndash; The pressure to &#39;man up&#39; may discourage men with anxiety from seeking professional help or opening up to loved ones. This reluctance to seek support can delay crucial interventions and exacerbate anxiety symptoms. 
	&nbsp;</li>
</ul>

Breaking The Stigma

Challenging the stigma surrounding mental health is essential for men with anxiety to access the support they need. Society and all of us on an individual level as well, must encourage open conversations about mental health and promote seeking professional help as a sign of strength rather than weakness. 
&nbsp;

<ul>
	<li>Embracing Emotional Expression &ndash; Encouraging men with anxiety to express their emotions in a healthy way can help alleviate the burden of &#39;manning up.&#39; Emotional expression should be seen as a sign of self-awareness and strength, not weakness.</li>
	<li>Fostering Emotional Intelligence &ndash; Promoting emotional intelligence is crucial for men with anxiety. Understanding and managing emotions can empower individuals to cope with anxiety more effectively and lead to healthier relationships.</li>
	<li>Cultivating Supportive Relationships &ndash; Building supportive relationships is vital for men with anxiety. Surrounding themselves with understanding and empathetic individuals can create a safe space to express emotions without judgment.</li>
	<li>Redefining Masculinity &ndash; Redefining masculinity is essential to challenge harmful concepts like &#39;manning up&#39; and toxic masculinity. Emphasizing emotional openness, empathy and vulnerability can create a healthier and more inclusive understanding of masculinity.</li>
	<li>The Power Of Therapy &ndash; Professional therapy can be immensely beneficial for men with anxiety. Therapists provide a non-judgmental and supportive environment where men can explore their emotions, understand anxiety triggers and develop coping strategies.</li>
	<li>Self-Compassion And Mindfulness &ndash; Men with anxiety should practice self-compassion and mindfulness to cultivate self-awareness and emotional regulation. Engaging in mindfulness techniques can help manage anxiety symptoms effectively. 
	&nbsp;</li>
</ul>

&#39;Manning up&#39; can be a dangerous philosophy for men with anxiety, perpetuating toxic masculinity and suppressing emotional expression which simply deteriorates all aspects of a person&rsquo;s well-being. Recognizing the harmful effects of this societal pressure is crucial in fostering a more empathetic and inclusive understanding of masculinity. By redefining masculinity and advocating for mental health awareness, we can create a more supportive environment that empowers men to embrace their emotions and prioritize their mental well-being.

Physical Symptoms Of Anxiety: Decoding The Body's Response To Stress

<a href="https://merisehat.pk/disease/anxiety">Anxiety</a>, a normal and adaptive emotion, can become overwhelming when experienced excessively or persistently. Beyond its well-known impact on mental health, anxiety also triggers a myriad of physical symptoms that can be disconcerting and bewildering. Understanding how anxiety feels in the body is crucial for recognizing and managing this often-misunderstood aspect of the condition. In this article, we delve deep into the physical symptoms of anxiety, shedding light on the body&#39;s intricate response to stress. 
&nbsp;

Physical Symptoms of Anxiety

<h5>Heart Palpitations And Rapid Heartbeat</h5>

One of the most recognizable physical manifestations of anxiety is a pounding heart or palpitations. Anxiety triggers the release of adrenaline, the &quot;fight-or-flight&quot; hormone, which causes the heart to beat faster and stronger. This heightened heart rate is a physiological response aimed at preparing the body to cope with perceived threats. 
&nbsp;

<h5>Shortness Of Breath And Hyperventilation</h5>

As anxiety intensifies, breathing patterns can become irregular and rapid. Hyperventilation, characterized by deep and fast breaths, alters the balance of oxygen and carbon dioxide in the body, leading to dizziness, lightheadedness, and a sense of suffocation. This experience can be particularly distressing, further exacerbating anxiety. 
&nbsp;

<h5>Muscle Tension And Body Aches</h5>

Anxiety prompts the body to tighten its muscles in preparation for potential danger. This prolonged muscular tension can lead to aches and pains, particularly in the neck, shoulders, and back. Chronic muscle tension is not only uncomfortable but also contributes to a cycle of heightened anxiety and physical discomfort. 
&nbsp;

<h5>Gastrointestinal Distress</h5>

The gut-brain connection plays a significant role in anxiety, leading to gastrointestinal (GI) distress in many individuals. Symptoms such as stomach cramps, nausea, diarrhea, or constipation can arise during anxious episodes. The gut is highly sensitive to emotional fluctuations, making it a common site for somatic manifestations of anxiety. 
&nbsp;

<h5>Sweating And Clamminess</h5>

Experiencing anxiety can activate the body&#39;s natural cooling response, leading to excessive sweating and clamminess. The sympathetic nervous system, responsible for the body&#39;s stress response, triggers sweat glands as a way to regulate body temperature during heightened emotional states. 
&nbsp;

<h5>Tingling Sensations And Numbness</h5>

During anxiety, some individuals may experience tingling sensations or numbness, particularly in the extremities. This phenomenon occurs due to increased blood flow to the major muscle groups as the body prepares for action, leaving less blood available for the extremities. 
&nbsp;

<h5>Trembling And Shaking</h5>

Shaking or trembling hands, legs, or voice is another common physical symptom of anxiety. This involuntary response is linked to the release of adrenaline, which can trigger a temporary loss of fine motor control. 
&nbsp;

<h5>Chest Pain And Discomfort</h5>

Chest pain or discomfort is a symptom that can mimic heart-related issues, leading to considerable distress for those experiencing anxiety. However, anxiety-induced chest pain is usually sharp and fleeting, rather than the prolonged and crushing pain typically associated with heart problems. 
&nbsp;

<h5>Headaches</h5>

Stress and anxiety can lead to tension headaches or migraines in susceptible individuals. The constricted blood vessels and muscle tension associated with anxiety contribute to the development of these headaches. 
&nbsp;

<h5>Fatigue And Insomnia</h5>

Anxiety can significantly disrupt sleep patterns, leading to either difficulty falling asleep or waking up frequently throughout the night. The constant state of alertness and racing thoughts can leave individuals fatigued during the day, perpetuating the cycle of anxiety and sleep disturbances. 
&nbsp;

Anxiety is not limited to the realm of the mind; it profoundly affects the body, triggering a cascade of physical symptoms that can vary from person to person. Understanding how anxiety feels in the body is vital for recognizing and addressing these manifestations. While recognizing the physical symptoms is essential, it is equally important to seek professional help for managing anxiety effectively. Combining self-care practices, therapy, and, if necessary, medication can empower individuals to regain control over their mental and physical well-being, fostering a path toward emotional balance and resilience.

Anxiety During Student Life

Being <a href="https://merisehat.pk/article/why-you-feel-anxious-when-everything-is-going-well">anxious</a> now and then is quite useful. It can be the motivating factor that helps you think critically and achieve your goals. However, if you&rsquo;re experiencing it constantly and excessively to the extent that it starts interfering with your daily life, it&rsquo;s high time you do something about it.

As students, severe anxiety can leave you fearing your school or university and all activities within. It can make it difficult to take in, process, and retrieve information. This is why some experts consider severe anxiety as a learning disability because it shuts down the brain<a href="#accordion">[1]</a>.

All these worries consume the students&rsquo; minds, making it difficult for them to concentrate on that new math concept, follow instructions about an art project, or switch attention efficiently from reading poetry to answering questions in class. As a result, they have to work harder than their peers. 
&nbsp;

One research in 2021 showed that untreated mental health is linked to low self-esteem, substance misuse, suicidal thoughts, and relationship instability<a href="#accordion">[4]</a>. A 2020 study found that the COVID-19 pandemic had caused stress and anxiety in 71% of college students[<a href="#accordion">4]</a>. 
&nbsp;

Anxiety can affect any child, irrespective of age, academic achievement, or grade level. The mental disorder presents itself in different ways. It can be emotionally and physically draining and affect a student&rsquo;s social and academic progress development. Symptoms include<a href="#accordion">[2]</a>:

<ul>
	<li>Rapid heartbeat</li>
	<li>Sweating</li>
	<li>Tensed muscles</li>
	<li>Dizziness</li>
	<li>Dry mouth</li>
	<li>Shortness of breath</li>
	<li>Trembling</li>
	<li>Unexplained pain, such as stomach ache or headache</li>
	<li>Irritability</li>
	<li>Excessive worry</li>
	<li>Restlessness</li>
	<li>Sadness</li>
	<li>Crying spells</li>
	<li>Difficulty concentrating or impaired memory</li>
	<li>Sense of impending doom</li>
	<li>Feeling a loss of control</li>
	<li>Feeling self-conscious and avoiding some situations</li>
	<li>Unable to concentrate in class</li>
	<li>Refusing to go to school or clinginess</li>
	<li>Temper tantrums 
	&nbsp;</li>
</ul>

Research shows that students with anxiety have executive functioning deficits. They find it difficult to organize, plan, and prioritize their tasks, all of which are crucial to academic success<a href="#accordion">[1]</a>. They get easily agitated when triggers are present. They may ask repetitive questions. They may not complete homework or even stop attempting it because they&rsquo;re concerned about their perfectionism. 
&nbsp;

Understanding Anxiety Disorders

Anxiety disorders are not the same as a normal feeling of anxiousness. They are long-lasting and have a significant impact on one&rsquo;s quality of life. Instead of self-diagnosis and self-medication, getting a professional diagnosis and treatment is important. 
&nbsp;

Teachers, peers, and caregivers of the student should be aware of the common anxiety disorders that can affect students. These include<a href="#accordion">[3]</a>:

<ul>
	<li>Generalized Anxiety Disorder &ndash; Students may worry most of the time. They&rsquo;ll also complain of physical symptoms, such as muscle tension, headache, fatigue, and trouble sleeping. 
	&nbsp;</li>
	<li>Social Anxiety Disorder &ndash; Students will suffer from an intense perceived fear that everyone is judging them, which will affect how they behave in social situations, fearful of humiliation or embarrassment in front of everyone. Most of the time, they&rsquo;ll simply avoid events where they have to perform or meet other people (especially new students as in changing schools or even classes). They&rsquo;ll worry about their attendance and their ability to learn at school. 
	&nbsp;</li>
	<li>Panic Disorder &ndash; This is a sudden but intense episode of fear with symptoms like dizziness, pounding heart, and shortness of breath. Students with panic disorder usually withdraw from situations they feel can induce a panic attack. Given a panic attack is unpredictable, it leads to general avoidance. 
	&nbsp;</li>
	<li>Post-Traumatic Stress Disorder (PTSD)&ndash; A traumatic experience, like an accident, a natural disaster, or an assault, can lead to panic attacks. 
	&nbsp;</li>
	<li>Selective Mutism &ndash; Some students may feel comfortable talking in certain environments, like with their close friends and family members, but will feel afraid to talk in other situations. They&rsquo;ll probably use gestures to communicate or speak in low whispers at that time. 
	&nbsp;</li>
	<li>Certain Phobias &ndash; A phobia is an unrealistic fear of a certain thing. It can be a fear of an animal, an insect, etc. It can also include agoraphobia, i.e., fear of space where they can&rsquo;t receive help or escape if something goes wrong. 
	&nbsp;</li>
</ul>

An anxiety disorder may be present if the student worries about a particular area of life and that fear causes significant distress and leads to avoidance of events.

Sometimes, it may also be accompanied by other disorders, like depression, obsessive-compulsive disorder, and oppositional defiant disorder. 
&nbsp;

Girls are more likely to develop anxiety disorders compared to boys. 
 
Triggers usually include<a href="#accordion">[4][5]</a>:

<ul>
	<li>Discrimination and bullying</li>
	<li>A bad experience at school</li>
	<li>Social or performance anxiety (e.g., social interactions or tests)</li>
	<li>Being home for a long period due to illness or vacations</li>
	<li>Stressful events, like moving to a new home/school, the death of a family member, etc.</li>
	<li>Leaving home or separation anxiety</li>
	<li>Financial issues</li>
	<li>Academic pressure; work that&rsquo;s too hard, too easy, or a mismatch in learning/teaching style can provoke stress</li>
	<li>Sleep disruption due to all-nighters or drinking excess caffeine</li>
	<li>Internet addiction</li>
	<li>Low self-esteem</li>
	<li>Genetics and family history of anxiety disorders</li>
	<li>Certain health conditions, like thyroid or heart diseases</li>
	<li>New challenges, like living with roommates, developing an independent identity, and separating from the traditional support system, as seen in college students</li>
	<li>Loneliness 
	&nbsp;</li>
</ul>

There are multiple reasons why individuals do not ask for help. For instance, the stigma associated with mental health, denial of symptoms, financial problems, lack of adequate treatment options, and lack of time or not considering treatment urgent.

However, a combination of educational support, therapy, medication, and lifestyle changes can help manage symptoms of anxiety. 
&nbsp;

Parents, mental health professionals, and teachers should all come together to develop a treatment plan. Whether it&rsquo;s providing classroom support, making adjustments to the student&rsquo;s schedule, or encouraging the student to take part in social activities outside of school. 
&nbsp;

Parents and teachers can support students by:

<ul>
	<li>Educating themselves about anxiety</li>
	<li>Creating strong bonds with students</li>
	<li>Inculcating healthy coping mechanisms</li>
	<li>Teaching relaxation techniques</li>
	<li>Talking openly about anxiety and teaching students to recognize their unique warning signs</li>
	<li>Validating student&rsquo;s feelings</li>
	<li>Creating safe spaces at home and school</li>
	<li>Teaching inclusivity and equity</li>
	<li>Getting involved in their education</li>
	<li>Modeling positive behavior 
	&nbsp;</li>
</ul>

Psychotherapy includes cognitive behavioral therapy, exposure-response therapy, and dialectical behavioral therapy to help students identify unhelpful thinking patterns and cope with stressful situations.

In some cases, selective serotonin reuptake inhibitors (SSRIs) are prescribed to reduce anxiety and improve mood in children. Some students with severe school anxiety may be prescribed benzodiazepines. 
&nbsp;

Note: It&rsquo;s important to use them as instructed by the doctor as they can lead to dependence and tolerance besides other side effects.

Support groups are also helpful, allowing individuals to connect and talk about their experiences when they feel others understand their condition. 
&nbsp;

Most importantly, some self-care strategies can help ease anxiety. This includes meditation, spending time in nature, pursuing activities you love, exercising regularly, reducing caffeine intake, and eating a nutrient-rich diet.

Getting enough sleep is also essential. If, on average, your day begins at 6 am and ends after 10 pm, it will naturally leave you sleep-deprived. While aromatic essential oils are believed to reduce anxiety and improve sleep quality, research is limited, so it&rsquo;s best to consult a doctor. 
&nbsp;

Avoiding stressors by staying in bed all day and skipping classes is no solution. It makes anxiety worse with time. Practice approaching these situations. Find resources to cope with stress on campus.

If you or someone you know is experiencing anxiety, seek help from a mental health professional. 
&nbsp;

[1] Impact of anxiety/OCD at school. Anxiety In The Classroom.

[2] School anxiety: Causes, symptoms, and management. Medical News Today.

[3] Hasan S, ed. Anxiety disorders factsheet (for Schools) (for parents) - nemours kidshealth.

[4] Why is anxiety and depression in college students so high? Psych Central.

[5] Elizabeth Scott M. Why do children get so stressed with school? Verywell Family.

Shermeen Zuberi

Anxiety is the persistent feeling of dread and fear over future events. It also might happen when the person misconstrues a situation as being more negative or harmful than it really is, leading to them being constantly agitated and worried.&nbsp;This is what we call cognitive anxiety — where feelings are limited to a thought patterns and rumination. Once this starts manifesting physically, we call is somatic anxiety or somatisation. Some of the things the anxious individual might experience include muscle tension, stomach aches, chest pain, dizziness, headaches, insomnia, restlessness, muscle tension, nausea, vomiting, sweaty palms and difficulty focusing.&nbsp;Panic attacks are essentially a paroxysm of anxiety. The person experiences a sudden feeling of terror and stress. This is disproportionate to the situation at hand and some people even experience this while sleeping. People experiencing panic attacks report that it feels like having a heart attack. This makes sense since panic attacks are accompanied by a rapid heart rate, hyperventilation and severe, constricting chest pain.&nbsp;These feelings of overwhelm can happen for something as minor as public speaking or something as major as the death of a beloved pet.

Dealing Measures

Thanks to the world we currently inhabit, almost all of us have been through situations where we have experienced these feelings and symptoms. Most of the time we have no other option but to wait for them to pass. However, if you know that you are prone to such intense consternation and worry then it might help to have a toolbox of strategies you can employ to feel better. We can&rsquo;t completely eradicate these feelings, but we can definitely manage them.&nbsp;

Some of the ways you can go about this are as follows: 
&nbsp;

<ul>
	<li>Breathe Slowly: Taking a minute to take slow deep breaths helps calm down your entire body. A great method is to take a deep belly breath for four seconds, hold it in for seven seconds and slowly exhale over a period of eight seconds. Just a few of these breaths tend to make a considerable difference.&nbsp;&nbsp;</li>
</ul>

<ul>
	<li>Muscle Relaxation: Get yourself in a nice and quiet place and progressively tense and relax your muscles starting from your toes and ending at your face. This helps release the muscle tension that is accompanied by anxiety.</li>
</ul>

<ul>
	<li>Grounding: Since anxiety is usually due to apprehension about the future, it helps to root yourself in the present moment. One of the most effective ways to do this is to employ grounding techniques. This requires you to sit up straight wherever you are with your feet on the ground, now look around an acknowledge five things you can see, four things you can touch, three things you can hear, two things you can smell and one thing you can taste. It&rsquo;s also called the &lsquo;5-4-3-2-1 technique for anxiety&rsquo;.</li>
</ul>

<ul>
	<li>Improve Self-talk: A lot of the times the little voice in our head that talks to us isn&rsquo;t our own. We have internalised the voice of a parent or a caregiver we had gotten used to while growing up. Many of us haven&rsquo;t received the best of care in certain situations. Hence it helps to question what your brain is telling you about yourself in a certain situation. Working on the way you talk to yourself, being kind and compassionate and extending yourself the same grace that you do to others goes a long way. Similarly, you might be stuck in some negative thought patterns and might need to challenge those to arrive at better conclusions.&nbsp;</li>
</ul>

<ul>
	<li>Take Time Out To Worry: Many people who <a href="https://merisehat.pk/disease/anxiety">suffer from anxiety</a> are just taking time to prepare for all the possible outcomes in a situation, or that is what they tell themselves. If you&rsquo;re one of these people then it would be highly beneficial to allot yourself 10 minutes every few hours to sit and go over all your worries. This way you can get it out of the way instead of having your entire day be tinged with anxiety.&nbsp;</li>
</ul>

<ul>
	<li>Journal: This works on the same principle as above. Writing down your anxious thoughts and reasons behind them can help you externalise and understand them. This way you can not only gain control over them but also identify patterns. You can also chart out when your anxiety is at its worst and when you are having a calmer, more peaceful day.&nbsp;</li>
</ul>

<ul>
	<li>Identify Your Triggers: This doesn&rsquo;t just help you attain control of your emotions in the short term, it can also eventually be a long-term solution. Is it a certain situation? A person? A scent or even a song? Identifying what triggers you into feelings of overwhelm helps you reduce your exposure to it or eradicate it entirely. It can also help you assess what other strategies of stress management will work best on you.</li>
</ul>

<ul>
	<li>Aromatherapy: Certain scents have been identified as having a calming effect on the nerves. These could be lavender, chamomile, sandalwood, rosemary, jasmine etc. Surrounding yourself with these could effectively set your mind at ease. These could be used in the form of essential oils, candles, incense, air fresheners etc.&nbsp;</li>
</ul>

<ul>
	<li>Mild Physical Activity: A light brisk walk or some yoga can greatly improve your mood and ameliorate any negativity. It works to give your body a time out from stressful situations and then dissipate all the excess energy through gentle movement. 
	&nbsp;</li>
</ul>

Some of these strategies might work for you and some might not. It&rsquo;s important to note that everyone is different hence everyone responds differently to these tactics. Trial and error will teach you a lot about what is effective in your case. However, if nothing is working out and your anxiety and panic attacks are having a tangible impact on your social, occupational and personal life then it&rsquo;s a sign to seek professional help.&nbsp;

It&rsquo;s important to note that there is no shame in experiencing psychological distress and seeking help doesn&rsquo;t make you weak. Men, especially, carry this shame around this but there&rsquo;s no need to do so anymore. The human body just requires maintenance and upkeep and we are all more than capable of taking care of ourselves and procuring help.&nbsp;