Anxiety and Dialysis

By DaVita^® Social Worker Rob Ross, LSW

Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.

Dialysis is a life-changing event that can create an overwhelming amount of stress for a dialysis patient. Facing end stage renal disease (ESRD) can be scary enough, but many patients may also cope with financial and insurance issues, juggling dialysis schedules and work, unsupportive family members, concern of physical pain from dialysis and fear of death.

For patients who endured a traumatic event in the past and felt as though they didn’t have control over it, the stress of ESRD, everyday responsibilities and dialysis may conjure up those same emotions.

If you think you’re experiencing anxiety, discuss this with your social worker, nurse and nephrologist. There are five anxiety disorders and each one needs immediate attention. Also keep in mind that depression often accompanies anxiety and should be treated as well. Discuss all of your possible treatments with your doctor.

General facts about anxiety 

Anxiety is a normal feeling that you may experience before an important event, such as speaking in front of a large group, a big exam or even a first date.

Yet if anxiety begins to interfere with everyday life, it may be more severe than previously thought. According to the National Institute of Mental Health (NIMH), “When anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling disorder.” Here are some statistics about anxiety:

• Anxiety conditions are the most common mental disorders in America.
• 19 million American adults are affected by anxiety disorders.
• Children and adolescents can also develop anxiety.
• Anxiety disorders may develop from different factors such as genetics, personality, brain chemistry and life events.

Symptoms of anxiety

Although many people just may feel anxiety about one thing, there are times when anxiety about many occurrences can hinder a person’s mental well-being. Here are the signs and symptoms of the five different types of anxiety disorders:

• Panic disorder: Repeated episodes of intense fear that strike without warning is a panic disorder. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal stress, feelings of unreality and fear of dying.
• Obsessive compulsive disorder: Also known as OCD, symptoms include repeated, unwanted thoughts or compulsive behaviors that seem impossible to control.
• Post-traumatic stress disorder: Post-traumatic stress occurs after experiencing or witnessing a traumatic event such abuse, war and natural or unnatural disasters.  Following a traumatic event, a person may have nightmares or flashbacks, depression, anger, irritability and startle easily.
• Phobias: Phobias are fears that tend to be overwhelming and disabling, and sometimes irrational, which can lead to avoidance and isolation.
• Generalized anxiety disorder: Constant exaggerated, worrisome thoughts and tension about everyday events, lasting at least six months, is generalized anxiety. Physical symptoms include fatigue, trembling, muscle tension, headache and nausea.

Treatment for anxiety disorders

In normal cases, anxiety can be treated by psychotherapy alone (also called “talk therapy”).  In more severe cases, medication prescribed by your doctor along with talk therapy can be very effective methods of treating anxiety. Although anxiety is treatable, only about one-third of people receives or seeks treatment. You may be reluctant to take medications for a variety of reasons:

• You assume that you’ll feel “loopy” or not like yourself when you begin medication.
• You feel like you don’t want to have to rely on medicine, or feel like it’s a crutch that you don’t need.
• You worry that you’ll become addicted to the medications.

Concerns like these are understandable, but there are advancements made in researching and developing medications all the time. Many new medications have fewer side effects and not all medications make you feel “loopy” or out of it. Once you and your doctor agree on medication as a course of treatment, the doctor may prescribe an antidepressant and/or an anti-anxiety medication to treat anxiety. Beta-blockers, which are used to treat heart conditions, may also be considered as a form of treatment.

Conclusion

Approximately 19 million American adults are affected by anxiety but only a fraction of them seek help or treatment. Anxiety disorders need to be evaluated by a physician who specializes in that area. Your healthcare team can help you locate resources to help diagnose and treat anxiety disorders. Yet if you feel generally anxious about receiving dialysis treatments, discuss this with your social worker, nurse and nephrologist. Once you’ve treated anxiety and overcome it, it may change your outlook on dialysis treatments.