Anxiety is commonly observed in individuals with Angelman syndrome, a rare neurogenetic disorder characterized by developmental delays, communication issues, seizures, walking and balance problems, sleep difficulties, and behavioral issues.
What is anxiety?
Anxiety is an emotional feeling where a person is tense, restless, and apprehensive.
In people with Angelman syndrome, anxiety is exhibited by clinginess, inability to relax, nervousness, irritability, restlessness, and crying.
Anxiety in Angelman syndrome can sometimes lead to self-injurious behavior such as head-banging, slapping or biting, cyclic vomiting or retching, pacing, refusing to move, and repetitive behaviors or sounds.
A study published in the American Journal of Medical Genetics showed that 47% of adolescents and 71% of adults with Angelman syndrome had anxiety issues. Furthermore, anxiety affected the daily life of 51% of all patients.
What triggers anxiety?
In Angelman syndrome patients, anxiety can be triggered by changes in routine, unfamiliar surroundings or people, separation, and fear of crowds or noise.
Separation is a very common cause of anxiety, especially when the patient’s preferred caregiver is not present. One possible reason is that the patient’s reduced ability to independently navigate the world results in increased reliance on a caregiver, thereby increasing anxiety when that safe person is no longer present.
Patients may have difficulty verbally communicating their thoughts and feelings, which can result in helplessness, causing anxiety.
How can anxiety be managed?
There are three major types of therapy that can be used to treat anxiety in Angelman syndrome patients. These are psychotherapy, anti-anxiety medications, and complementary therapies.
Psychotherapy
Psychotherapy involves a trained therapist talking and interacting with the patient to find out the reasons that are causing anxiety in the patients and helping them overcome those anxieties. Some of the approaches that can help people with Angelman syndrome include:
- Keeping to a routine, which is very important for Angelman syndrome patients who usually feel overwhelmed or scared when a situation is beyond their control
- Giving reassurance using pictures or symbols in the form of a visual timetable or with social stories
- Talking softly and offering physical assistance by hugging or holding arms with patients to help them relax
- Helping with communication skills to help overcome anxiety
Medications
There are several types of anti-anxiety medications available that can be prescribed when anxiety adversely affects daily life. Many of these medications can also be used to treat depression, which is hard to identify in Angelman syndrome patients given that they may have difficulty speaking and communicating. The commonly used medications include:
- Selective serotonin reuptake inhibitors (SSRIs), which increase the amount of a neurotransmitter, serotonin, in the brain. Some examples of SSRIs include Celexa (citalopram), Paxil (paroxetine), Prozac (fluoxetine), Lexapro (escitalopram), and Zoloft (sertraline)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs), which increase the levels of serotonin and norepinephrine neurotransmitters in the brain. Examples include Effexor (venlafaxine), Pristiq (desvenlafaxine), and Cymbalta (duloxetine)
- Norepinephrine-dopamine reuptake inhibitors (NDRIs), which increase dopamine and norepinephrine, for example, Wellbutrin (bupropion)
- Remeron (mirtazapine), which targets specific serotonin and norepinephrine receptors in the brain, thus indirectly increasing the activity of several brain circuits
Anti-anxiety medications need to be administered with caution because they can have several side effects. The side effects of SSRIs and SNRIs include insomnia and nausea, among others. NDRIs may cause anxiety in some patients but are effective in treating anxiety in others. The side effects of Remeron are weight gain, sedation, and sleepiness.
Complementary and alternative treatments
Complementary medical approaches include non-traditional and alternative methods of treatments that can be used in addition to psychotherapy and medical treatments. These include food supplements, mind and body treatments, and hippotherapy.
Several studies have shown that omega fatty acids and folate can help overcome anxiety and depression. Supplements or foods that are rich in these natural vitamins may therefore also be beneficial for people with Angelman syndrome. Please note that vitamins and supplements should never be taken without consulting with a doctor.
Mind and body treatments such as yoga, massages, breathing exercises, and meditation can help overcome stress and anxiety.
Hippotherapy has been found to be beneficial from an emotional and behavioral standpoint and may benefit individuals with Angelman syndrome in overcoming anxiety issues.
Last updated: Sept. 22, 2019
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