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There are certain situations when anxiety is uncontrollable. In these situations, the anxiety may be so debilitating as to cause significant disability in social functioning and functioning at work. When this happens, anxiety can be very disruptive to a person's life. When anxiety is this pervasive, treatment may be in order. However, certain situations do not warrant treatment as treatment may thwart important goals. These are the situations I will mention below. For all of the situations below, a discussion with your doctor would be prudent prior to treating or not treating the anxiety.
(1) When anxiety signals threat: Anxiety is a physiologic response to threat, and as such, is a very useful signal that activates the fight or flight response. In this situation, it is somewhat indispensable in that it allows us to escape when danger is imminent. When anxiety signals threat, rather than treating the anxiety, removing the threat may be the solution. If we remove the anxiety, a person will constantly be exposed to danger without knowing this.
(2) When anxiety signals necessary change: For example, some people find being at their jobs increasingly anxiety-provoking. The stresses of work begin to add up, and they soon start to feel as though they can't tolerate the anxiety. At this point, rather than treating this "unbearable anxiety", they should ask: What if I did not treat this anxiety? I have often found that anxiety signals the need for change, and sometimes crisis-level anxiety is necessary to make the change. However, many people treat anxiety pre-crisis. This makes them revert to undesirable but familiar conditions and they feel less anxious about this. However, the necessary change never occurs.
(3) When anxiety signals letting go: Many people try for years to loosen up but are never really able to achieve this. However, for some people, this loosening up occurs gradually. Although it is very much desired, when they come close to loosening up, they panic and this anxiety of "letting go" can be so troublesome that they ask for it to be treated. Examples of loosening up are: socializing more, thinking of starting to date again and deciding to be more expressive at board and staff meetings. Just as people decide to "let go", they suddenly panic and look to return to their own ways. In this situation, it is much more important for them to be supported through their anxiety and the most helpful treatment would involve supporting initial jitters rather then preventing a necessary greater degree of self expression.
(4) When anxiety signals contact with the unconscious: Anxiety can be either conscious or unconscious. When it is conscious, it is known and felt, and often people have a reason for being anxious. Sometimes, however, people have what is called "free floating anxiety". In these situations, unconscious conflicts may be rising to the surface. Treating this anxiety may prevent future examination of these conflicts. Here, it may be more helpful to support the exploration of the conflicts.
(5) When anxiety signals antidepressant use: Early in the use of selective serotonin re-uptake inhibitors (SSRIs), there may be profound agitation or anxiety. However, this side effect often goes away within 7-10 days. People who opt to be on an SSRI should expect this side effect and know that it is most likely time-limited. Rather than discontinue the medication, waiting this out for 7-10 days may be worth the wait as the therapeutic effect of the SSRI often starts shortly after this.
(6) When it is "sympathy anxiety" with a partner with whom one lives: Often, when one partner is anxious, this leaves the other partner with more responsibilities and without a context to relax. As a result, the other partner may also get anxious. Or quite simply, since emotions are "contagious", your anxiety may not be your own. Treating your anxiety rather than focusing on the interpersonal dynamic may be a significant error.
(7) When anxiety signals transcendence: Sometimes people look within themselves for insightful answers, but as they get close to the "aha" experience, anxiety may increase. Treating anxiety at this point makes that person calmer and also further away from an insightful solution.
Thus, there are certain situations in which marked anxiety is either necessary to make desired changes, a transient phenomenon that does not require treatment, or simply someone else's anxiety that your brain has chosen to process. Although it is tempting to treat severe anxiety, you should seriously consider trying to understand the cause, as your anxiety may be signaling being close to the change that you desire. A doctor could help you exclude treatable causes (such as medical illness masquerading as anxiety) before you decide to weather these storms.
