England cricket Test captain Ben Stokes is the latest celebrity to admit publicly he suffers from anxiety and is receiving treatment.
Stokes took a four-month break from the sport last year to deal with his mental health issues, which he said had been worsened by the death of his father and his inability — due to having to play — to spend his last moments with him.
Stokes tells his story in the documentary, Phoenix from the Ashes, which began streaming on Amazon Prime Video on August 26.
Addressing media at the launch of the film, Stokes said: “I never thought I would be on medication to help me for that kind of stuff. I am not embarrassed or ashamed to say it, because I needed the help at the time. But it’s not done just because I’m back playing. I still speak to the doc, but not as regularly, and I’m still taking medication every day. It’s an ongoing process.”
He emphasised that his illness was not a sign of weakness and it was important to be open to treatment.
It was four-time Grand Slam tennis singles champion Naomi Osaka who seemingly set the ball rolling last year when she declared her intention to avoid media interviews, citing mental health reasons.
“I’ve often felt that people have no regard for athletes’ mental health and this rings very true whenever I see a press conference or partake in one,” she said on social media. “We’re often asked questions that we’ve been asked multiple times before or asked questions that bring doubt into our minds and I’m just not going to subject myself to people that doubt me.
“I’ve watched many clips of athletes breaking down after a loss in the press room ... I believe that whole situation is kicking a person while they’re down and I don’t understand the reasoning behind it.”
I have spent nearly 20 years experiencing anxiety attacks, which are exacerbated by media appearances and public-facing events.
— Jonah Hill
Osaka was fined $15,000 and threatened with disqualification for not attending the French Open post-match press conference. But her stand might have had a payoff: the star was back on the Roland Garros podium in front of the media this year, and appeared composed and natural. It also seemed the journalists were being a bit easier on her with their questions.
Also joining the ranks of celebrities coming out about their anxiety issues is American actor and director Jonah Hill, whose biopic, Stutz, named after his therapist, is showing at US film festivals. The star of The Wolf of Wall Street told Deadline magazine he would not be promoting the film in person: “Through this journey of self-discovery within the film, I have come to the understanding that I have spent nearly 20 years experiencing anxiety attacks, which are exacerbated by media appearances and public-facing events.”
He added that the purpose of the movie, named after his therapist, is to give “the tools I’ve learnt in therapy to a wide audience ... through an entertaining film”.
While a certain amount of anxiety is normal, mental health professionals consider certain categories, such as panic attacks and generalised anxiety disorder (GAD), as requiring treatment. GAD symptoms include excessive worry and tension; an unrealistic view of problems; restlessness or a feeling of being “edgy”; trouble concentrating; increased irritability and trouble sleeping.
“Normal anxiety can equate to ‘normal worry’. People are created in such a way that worrying, or pre-empting danger, is an evolutionary advantage to prepare and protect oneself,” says Johannesburg psychiatrist Kim Laxton. “Anxiety in the form of a disorder is when worry becomes paralysing and the person is not able to function within many aspects of daily living. It is an illness that requires intervention and treatment.”
Medication used to treat anxiety disorders are classified into various “families”, she says. “The most prescribed anti-anxiety treatments are the serotonergic agents/antidepressants, such as sertraline, fluoxetine and the like.” These are the selective serotonin reuptake inhibitors (SSRIs) with brand names such as Zoloft and Prozac.
“Other medications used to treat anxiety disorders over a longer period [used consistently, and daily] are the noradrenergic agents, (duloxetine) and dopaminergic agents (bupropion). They all act slightly differently in the brain and are used to treat both anxiety and depressive illnesses.”
Laxton says anxiolytics — benzodiazepines such as Urbanol, Alzam and Xanor — should be prescribed for short periods of time only, “to calm and/or abate significant anxiety episodes [such as panic attacks] while the antidepressants take time to fully treat the underlying anxiety disorder”.
Anxiolytics are prescribed for short periods because they are dependence forming and difficult to be weaned off. Retired Wits academic Demi Levendis described his battle to get off benzodiazepines: “Initially bromazepam was prescribed, 3mg per day when needed. This was for acute anxiety and panic attacks experienced especially during meetings at work. In 2016 my morning panic attacks became worse, and I experienced more serious anxiety during the day. The psychiatrist diagnosed general anxiety disorder on top of my bipolar condition and prescribed Xanor [alprazolam] 1mg at night. I have been taking it for five years now.”
He said that in the recent past, and especially when Covid-19 started, he resorted to drinking alcohol together with Xanor, “to “escape” or “withdraw” from the world, sometimes drinking in the early afternoon and sleeping for hours. This had a very negative effect and in 2021, I decided to try to give up alcohol. I attended Alcoholics Anonymous meetings and from the beginning of 2022 I have essentially given up all alcohol.”
People are created in such a way that worrying, or pre-empting danger, is an evolutionary advantage to prepare and protect oneself.
— Dr Kim Laxton
Levendis says the alprazolam “had a calming or sedative effect, as expected. It helped me get to sleep. However, neither of the benzodiazepines completely eliminated the panic attacks in the morning. I have tried other methods in conjunction with the medication, including meditation, mindfulness, and exercise, without much success.”
He says he is trying to get off Xanor because “like alcohol, benzos can become addictive. They also affect my concentration and memory. I felt it would be healthier to stop. The psychiatrist advised me that going off benzos has to be a slow process. It cannot be done cold turkey, which could lead to severe withdrawal effects. Starting in mid-2021, I cut my dose to 0.75mg and in May cut it to 0.5mg/day. I hope to cut it to 0.25mg or finally to 0mg by the end of the year.”
However, Laxton says most psychiatrists recommend other treatment in addition to medication. “Clinical and other forms of psychotherapy are mainstay treatments for anxiety disorders. Cognitive behavioural therapy is first-line treatment for anxiety disorders, especially GAD, phobias, panic disorder, social anxiety and the like. Often medications are an adjunct to therapy.”
Clearly, limiting or abstaining from using stimulants like caffeine and alcohol — which can also act as a depressant on the body — is recommended if you suffer from an anxiety disorder. As is a healthy diet, exercise and getting good sleep.
But Johannesburg clinical psychologist Levandri Pillay says it is vital to find out what is underlying the anxiety. “You need to get to the root of the condition. If you only use medication it is like putting a Band-Aid on a deep wound.”
Though medication can help you manage your condition and “calm down enough to think through what is causing the chemical imbalances leading to your anxiety,” she says “therapy will help you make sense of it”.
Pillay recommends coping strategies that focus on “bringing yourself out of your thoughts or mind and back into your body” when facing a panic attack or other manifestation of anxiety. “Do some deep breathing, counting backwards and focusing on the air coming into and out of your body.
“A strategy called 5, 4, 3, 2, 1 is also useful: start by doing a few deep breaths (in for three and out for five), then focus on your environment and name five things you see, four things you hear, three things you can touch, two things you can smell and one thing you can taste. It takes a few tries to calm down. It won’t just get better immediately.”
Like any health issue, the kind of treatment you seek for anxiety depends on the severity and whether it is affecting your daily functioning. Though extremely debilitating, the illness can be successfully managed, say Laxton and Pillay. And so it is hoped that people suffering with it will not need to take time off from appearing on the stage of their lives, missing important moments that could be life-changing.
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