The Positive Side

Winter 2014 

Ask the Experts: Anxiety

“More and more, my heart will start racing and a feeling of panic takes over. And I’ve started to feel anxious about feeling anxious. What do you suggest?”
—T. N., Charlettown, PEI

Interviews by Pauline Anderson and Debbie Koenig

AnxietyGabor Maté
Physician, Vancouver

Anxiety manifests itself in any number of ways. It can manifest as panic—feeling terror or a loss of control. It can manifest as anger—toward fate, the medical profession, a partner or oneself. Anxiety can also show up as physical feelings—a rapid heart rate, dry mouth and abdominal upset. Some people address it head-on, but most of us try to soothe, suppress, escape or sedate it. To avoid feeling anxious, some people might drink alcohol or do drugs. It’s well known that stress has a big impact on the immune system and can increase a person’s susceptibility to illnesses, so it’s important to deal with anxiety and what lies behind it.

Being diagnosed with HIV is a huge deal, so why wouldn’t someone with HIV be anxious and scared? Stigma can add to this, and some HIV medications can cause anxiety. The natural dynamic is to think that all of our anxieties are due to HIV. However, when you ask people, “When in your life were you not anxious?” many will say that they’ve always been anxious. So the sources of anxiety for people with HIV are many, and you need to tease them out.

For example, if you’re using drugs, what are the drugs doing for you? A person might say, “The drug makes me feel better—it helps me escape or it takes away my bad thoughts.” Then the next question is: “Why do you have bad thoughts? Why do you have a need to escape?” When exploring these questions, people realize that their anxiety is the result of emotional baggage they’ve carried from a young age.

It’s important to talk about your anxiety, so you’re not alone with it. Spend time with people who have gone through similar experiences. Support groups, where you can talk to people at different stages in their relationship to HIV and their anxiety, are really valuable. They allow you to see your issues from a different angle and that it’s possible to come to a better place. See a private therapist if you can afford it or see one in the public health system if that’s an option. In the right hands, cognitive behavioural therapy (CBT) can probably be helpful, too. The real issue is not so much which technique you use as how comfortable you feel with the therapist and how much you can really be yourself and be listened to. And, of course, yoga, meditation, any mindfulness practice can be wonderful.

Seeing your healthcare provider is an OK place to begin, as long as the doctor is open-minded and can listen to you. Medical training often gives psychology short shrift, so many doctors are not well-equipped to handle these issues. If you don’t get help within the medical system, don’t think you’re alone. Just keep looking.

As far as anti-anxiety medications go, they can deal with the symptoms but not the causes. That doesn’t mean we shouldn’t deal with the symptom, too. (If you broke your leg and were in severe pain, it would be important to relieve your pain and deal with the broken leg.) So, in principle, I’m not against anti-anxiety meds, but they’re overused. They are very difficult to get off when you’ve been on them for a long time and they can give the impression that you’ve dealt with an issue when you haven’t.

Two classes of drugs commonly prescribed for anxiety are benzodiazepines and antidepressants called SSRIs (selective serotonin reuptake inhibitors). Benzodiazepines should only be for very short-term use, in the case of extreme difficulty functioning. If somebody’s going through a terrible panic attack, a short course of SSRIs is better, but they don’t solve the underlying problem either. They can calm you and help you cope so you can deal with the unresolved issues. [Note: These two classes of drugs interact with many antiretrovirals, especially protease inhibitors and, to a lesser extent, non-nukes. A lower dosage of anxiety medication is usually prescribed for people on these HIV meds.]

Dr. Maté is the author of In the Realm of Hungry Ghosts, When the Body Says No and other bestselling books. Visit

Claudia Medina
Person living with HIV, Toronto

Since becoming HIV positive 19 years ago, I have dealt with my fair share of life’s unexpected curve balls, including bouts of depression. But I didn’t start having anxiety until my depression worsened a few years ago. Now, my anxiety and depression seem to go hand in hand. To really tackle these issues, I’ve taken a leave from my job providing support to women living with HIV in prisons.

As with anyone, I think that stress is at the root of my anxiety. I tend to catastrophize things. For example, if something happens that shouldn’t really be a big deal, I make a huge issue of it and I become anxious about everything.

When I feel rushed, I get overwhelmed. My most stressful times are in the morning when getting ready for work. If I know I have to be somewhere at a certain time, I get the sweats. Some of my anxiety has to do with being around people or having to socialize. And part of my anxiety relates to worrying about my son, who is 20 years old and is now dealing with his own life issues.

But I’ve developed some tools to manage my anxiety. Using these strategies has really helped me hold things together over the last two years.

If I start to feel anxious, I take a few moments to “talk myself down.” I try to think logically and remind myself why I’m feeling this way, that this feeling will pass, that I’m going to be OK.

Another helpful tool for me is deep breathing­—taking slow, measured breaths instead of short, shallow ones. When doing these exercises, it’s important to use the diaphragm and to let your chest and tummy move in and out.

Meditation also helps relieve my anxiety. I have a 10-minute recorded meditation exercise saved on my phone that I listen to. It’s all about emptying your mind of thoughts and worries and stresses.

One thing I plan to get back to doing during my time off work is a regular exercise routine. Physical activity boosts those all-important endorphins (the brain’s “feel-good” chemicals) and makes me feel rested and at ease. I’ve also noticed a big difference in the last few weeks (since my leave started) as a result of being in my own comfortable surroundings, taking long walks, getting a lot of rest and meditating on my rooftop surrounded by nature.

To read the profile of Claudia Medina that appeared in the Winter 2013 issue of The Positive Side, click here.

Tasleem Kassam
Naturopathic doctor, Calgary

Although being HIV positive can understandably set you up for feeling anxious, the flip side is that it might force you to take good care of yourself, which can go a long way toward relieving stress and anxiety.

A cornerstone of mental health is proper digestion, as well as good overall health. There’s a strong connection between the gastrointestinal (GI) tract and the nervous system, which probably explains the terms “gut feeling” and “having butterflies in your stomach.” About 95 percent of the “feel-good” hormone serotonin is made in the gut, but our natural gut flora is constantly being challenged by the processed and genetically modified foods we eat. To help replenish good gut microbes, I recommend probiotics, such as lactobacillus (Acidophilus). Look for Good Manufacturing Practice (GMP) certification to ensure the highest-quality probiotic supplements. Glutamine, an amino acid that acts as a building block for proteins, can help get the digestive lining back on track, too.

Another tip for keeping anxiety at bay is to avoid foods that you have been diagnosed as having a sensitivity to, as some food intolerances may affect mood. It’s also important to get enough magnesium (magnesium deficiencies are common among people living with HIV), which the body needs to produce serotonin, among many other things. Foods that are natural sources of magnesium include wild halibut, leafy greens, black beans, and pumpkin and squash seeds, but it isn’t always easy to get enough from our diet. The most easily absorbed and best tolerated magnesium supplement is magnesium glycinate. I recommend taking 300 to 600 mg a day at bedtime, along with a B-complex vitamin. [Because magnesium can interact with some antiretroviral drugs, such as atazanavir (Reyataz), elvi­tegravir (in Stribild) and dolutegravir (Tivicay), as well as many antibiotics, talk to your pharmacist and doctor before taking these supplements.]

If you find your anxiety to be more related to the change of season, you may be low in vitamin D, in which case it’s important to have your vitamin D levels monitored and to supplement if necessary. Fish oil may also have a positive effect on your mood and help lower your anxiety levels. Make sure to tell your doctor and pharmacist about any vitamins and supplements you take.

And, of course, it’s important to control life stressors as much as possible. Stress increases one’s cortisol level, decreasing levels of serotonin and another neurotransmitter, dopamine, which in turn raises anxiety levels. Unfortunately, we tend to run ourselves ragged on the stress front, to the point where even getting good-quality sleep can be challenging.

Physical activity helps metabolize stress hormones. In my view, simply walking or doing a gentle yoga class is better than extreme body-blasting workouts. Over-exercising can add to your stress by increasing cortisol levels, and it can also be hard on your body.