The Checkup With Dr. Wen: Anxiety disorders are underdiagnosed and undertreated

This is the first time this national group of experts has added anxiety to the list of conditions that clinicians should be routinely screening for.

When I first heard about the recommendations, I wasn’t convinced. After all, there are many things that health-care providers should be asking patients but might not be able to due to lack of time, such as food security, safe housing access and children’s school attendance. Does anxiety disorder meet the high bar that’s needed to fit into an already very compressed medical visit?

After reading the evidence behind the draft guidelines, I believe the task force is right to call attention to this underdetected and undertreated problem.

To begin with, the task force cites research that shows the lifetime prevalence of anxiety disorders is 26 percent for men and 40 percent for women. That’s a significant proportion of the American public who will suffer from mental health conditions classified under anxiety disorders at some point in their lives.

It’s important to differentiate the feeling of anxiety or nervousness from the medical diagnosis of anxiety disorder. Anxiety is a normal reaction to stressful situations that everyone experiences. Disorders are characterized by excessive anxiety that interferes with someone’s ability to work, socialize or otherwise function in society.

Some patients with anxiety disorder experience a persistent feeling of doom. Others experience panic attacks. Many have trouble sleeping and might develop physical symptoms such as headaches, abdominal pain and debilitating fatigue.

There is a strong association between anxiety disorders and depression. One study, published in the Journal of Clinical Psychiatry, found that people with depressive disorders have a 67 percent likelihood of also having an anxiety disorder.

Detecting an anxiety disorder can be helpful in finding other treatable conditions. Anxiety disorders themselves can be effectively treated through medications, psychotherapy or a combination of both. Treatment allows many people to regain control of their lives.

The task force is not asking for clinicians to screen patients for anxiety disorders at every visit. Rather, the recommendation is for providers to screen patients who have not been screened before and then to use their best clinical judgment for when to do so again. This is reasonable, especially since screenings can take the form of a questionnaire that’s completed at home or in a waiting room before seeing a physician.

I think it’s good practice for every patient to receive at least one screening and then for clinicians to consider anxiety disorders again if there are particularly stressful life situations, such as unemployment or death of a family member. Health-care providers should also consider the possibility of anxiety disorder manifesting as other physical symptoms.

Ultimately, the value of the task force’s guideline change is to raise awareness of the high prevalence of anxiety disorder. This common, treatable mental health condition should be regarded with the same level of care and compassion as any other health diagnosis. That means people should be aware and report symptoms to their doctor, and doctors should be far more proactive in looking for signs of it in our patients.

Ask Dr. Wen

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“I’m a 69-year-old woman in good health. I have diligently followed the recommendations of the medical and scientific communities regarding the coronavirus. At this point, I’ve had five covid vaccine doses (all Moderna), including the bivalent booster. It perplexes me to read that I should take Paxlovid if I test positive for covid. If the covid vaccines are so good at reducing severe disease and death, why do I need to take Paxlovid?” — Beth from Pennsylvania

Think of both the vaccine and Paxlovid as layers of protection against severe disease. Keeping up-to-date with boosters reduces the risk of hospitalization and death substantially. A recent study from the Centers for Disease Control and Prevention shows that a second covid booster was 74 percent effective at preventing severe cases and 90 percent effective at preventing death. Paxlovid further reduces risk. A large Israeli study found that for those 65 and older, early treatment with this antiviral cut the rate of hospitalization by a factor of four and death by a factor of five.

Neither the vaccine nor Paxlovid is 100 percent effective. Few therapies are. The protective effects are additive, and I recommend that older individuals and people with chronic medical conditions take advantage of both tools.

“A group of 20 friends enjoy an annual holiday party in early December. The setting is a very small residence. There will be lots of talking and laughing, along with food and drink. My husband and I take great precautions to avoid illness and are both fully covid-boosted. I’m wondering whether my wearing a high-quality mask to this event will greatly reduce my chances of being infected with whatever may be circulating at that time. No one else is likely to be masked.” — Linda from Colorado

Yes, wearing a high-quality N95 or equivalent during the holiday party will greatly reduce the risk of your contracting covid-19. I think that’s a reasonable measure to take to prevent getting the coronavirus while still enjoying time with your loved ones.

If it’s really important to you to avoid contracting covid, you and your husband could keep your masks on at all times while indoors with others. Perhaps the host can set aside a room where the two of you can unmask to eat and drink, then you can don your masks again before joining the others.

“We have plans to go on a cruise from New Zealand to Australia in mid-March 2023, conditions permitting. I am 65 with no underlying health conditions and was last boosted in June. When should I receive the available bivalent booster for maximum protection while on the cruise?” — Don from North Carolina

You will reach optimal protection from the vaccine 10 days to two weeks after receiving the shot. To have maximal protection against infection during the cruise, you could time the vaccine so that you receive it a couple of weeks before leaving.

You might decide to get the vaccine sooner if you have high-risk events before the cruise, though keep in mind that protection against symptomatic disease probably wanes within a few months.

The Post has also compiled Q&As from my previous newsletters. You can read them here.

What I’m reading

A well-designed Israeli study published in the New England Journal of Medicine bolsters the case for coronavirus boosters. The study followed more than 11,000 health-care workers as they received two boosters. It found strong and durable neutralizing antibody response, suggesting good protection against severe disease. But protection against symptomatic disease was not as durable. After the second booster, vaccine effectiveness decreased from 52 percent during the first five weeks to virtually zero at 15 to 26 weeks. This study underscores the need to reset expectations around vaccines; their primary purpose is to prevent progression to severe disease.

A study led by researchers from the American Cancer Society found that breast and cervical cancer screenings among American women decreased by 6 percent and 11 percent, respectively, in 2020 compared with 2018. These might seem like small numbers, but they represent a decrease of 2.1 million fewer women who did not receive breast cancer screenings and nearly 4.5 million fewer women who did not receive cervical cancer screenings. As we are transitioning out of the emergency phase of the pandemic, there needs to be a concerted effort to help people catch up with their routine health maintenance.

Tuberculosis is the second-leading cause of death from infectious disease globally. Detection is essential for containment and treatment. Yet a study in BMC Medicine shows that more than 1.5 million people in 45 countries had a missed or delayed diagnosis of tuberculosis in 2020 because of covid-related disruptions. Children and the elderly appear to have been disproportionately affected. “These findings suggest that a large number of individuals are likely suffering from untreated TB disease directly as a result of the pandemic,” the authors wrote.