Yes, you can beat anxiety without taking tablets . . .

I’VE had anxiety for several years and it’s getting worse. It’s particularly bad in large groups, or situations that disrupt my routine. It’s affected my ability to interact with new people. I’m reluctant to try medication, partly because I’m concerned about dependence. I am 28. Elizabeth, Brighton.

Thank you for writing — it must have taken some courage. anxiety disorders affect up to 10 per cent of the population and there are many different types.

In your case a major component is social anxiety, a sense of fear in situations that involve interaction with others, leading to feelings of embarrassment and intense anxiety as well as concern about being judged.

anxiety varies widely but typically it begins in adolescence and often resolves as confidence builds in adult life. however in your case it’s increasing, rather than fading, with age.

There are probably genetic factors that predispose an individual to anxiety, just as there may be a genetic component to depression.

however there is no doubt that anxiety disorders in adult life are also associated with traumatic experiences in childhood, and that might be something for you to address in due course.

But be reassured that there is effective treatment available. This may involve medication or psychotherapy, or both.

not all drugs prescribed for anxiety cause dependence, but I respect your reluctance to take medication — many people feel this way.

The form of psychotherapy that is proven to be beneficial is cognitive behavioural therapy (CBT). although clinical trials have not shown it to be superior to drug treatment (nor have trials established drugs as the superior option, either), I am of the belief that CBT provides a better longterm solution.

For one, it avoids the need to keep adjusting the dose of medication; it also puts control back in the hands of the patient.

During CBT, the negative patterns of thinking that you experience in social situations will be identified, and you will learn coping skills to overcome them. a course of 12 weekly sessions is typical.

This therapy works best for patients who are highly motivated. The fact you have written a detailed letter suggests that you fall into this category. Meanwhile, I would encourage you to engage in some form of regular relaxation therapy, such as meditation. It needn’t be time- consuming: try looking at the apps Pzizz or headspace, which offer daily relaxation exercises.

AT THE age of 70 I have been diagnosed with primary biliary cirrhosis, in the early stages. My symptoms include dry itchy skin, occasional insomnia and tiredness. I have been prescribed ursodeoxycholic acid. I drink minimal alcohol, eat healthily and walk every day, so the diagnosis is a shock.

Gina Watson, Spain. primary biliary cirrhosis is now known as primary biliary cholangitis. This new term (‘cholangitis’ means inflammation of the bile ducts) reflects what is actually happening in this area.

It is a disorder affecting the bile ducts — small tubes that connect the liver and small intestine — rather than a form of cirrhosis (scarring of the liver); cirrhosis may occur in the later stages of the condition and, fortunately, is preventable.

This is an autoimmune disease, where the immune system attacks healthy organs and tissue — in this case the cells lining the bile ducts in the liver.

also, because noxious bile acids are no longer able to flow so freely through the bile ducts, they may cause further damage. Untreated, the loss of bile ducts leads to a gradual build-up of bilirubin, a by-product of old red blood cells being broken down. This, in turn, results in jaundice (where the skin turns yellow) and can eventually lead to cirrhosis and liver failure.

It’s not known what causes primary biliary cholangitis, though genetic and environmental factors are thought to be involved, and patients are often found to have other autoimmune diseases as well, such as Sjogren’s syndrome (which causes dry eyes and mouth).

Common symptoms in the early stages include fatigue and widespread itching. a small proportion of patients have right upper abdominal pain — the site of the liver.

BUT many people are diagnosed before any symptoms develop, when abnormalities in their liver function are detected in blood tests given for another reason. The diagnosis is then confirmed by checking the blood for certain antibodies.

Patients may also be given scans to rule out other things that may be obstructing the bile ducts, such as gallstones.

Some people are investigated further with a liver biopsy. however this is usually only carried out when there is uncertainty about the diagnosis.

The main treatment is tablets of ursodeoxycholic acid — a synthetic version of one of the bile acids found naturally in the body. It works by replacing your own, more harmful bile acids.

Since first being used ten years ago, it has revolutionised the prognosis for patients. Most people, particularly if diagnosed early like you, will have a normal life expectancy if they respond well to this treatment. In 40 per cent of patients, liver function tests return to normal after one year.

as this is a life-long condition, it is essential to avoid any other threat to your liver. you should, therefore, avoid alcohol, and make sure that you are immunised against both hepatitis a and hepatitis B, viral infections that can cause liver damage.

In your longer letter, you mention that your MRI scan also revealed a problem in your pancreas, and that your consultant has ordered a colonoscopy (an inspection of the lining of the colon) to investigate this.

Something must be lost in communication here as a colonoscopy is not relevant to the pancreas. Do write again with more details.

WRITE TO DR SCURR

TO CONTACT Dr Scurr with a health query, write to him at Good health Daily Mail, 2 Derry Street, London W8 5tt or email drmartin@dailymail.co.uk — including contact details. Dr Scurr cannot enter into personal correspondence. his replies cannot apply to individual cases and should be taken in a general context. always consult your own GP with any health worries.