In terms of anxiety, Sam also had problems with word retrieval. There was so common dyslexic readers and we're especially exacerbated by his anxiety. Let's consider for the basis for such word retrieval problems which are so commonly seen in individuals who are dyslexic. I will begin with identifying and naming an object, a two-step process. Let's first start with a typical reader. What does a typical reader usually do? In this top portion of the figure, a typical reader uses his intact, higher-order thinking abilities to develop a concept and identify the abstract semantic representation of the word that represents this concept. For typical readers, the next step in this two-step process, using the word is preferred perform smoothly. For instance, in this figure, for the typical reader would say bat and it's broken down to bat, but for the dyslexic reader, the first step, using his cognitive or using his or her cognitive ability is performed well. But the second step, the second step where one assesses the sounds making up the word and then smoothly uttering the word is disrupted and anomaly disrupted, it's made even worse by co-occurring anxiety. With an individual with anxiety and dyslexia, it's almost cyclical, whereas the individual's anxious and the dyslexia and the anxiety almost feed off each other. In terms of treating the Sam's anxiety, Sam had always been very resistant to taking psychiatric meds, as many people often are leaving with a sign of weakness and that he should be able to be "strong and powerful way through it." However, when his psychiatrist poses question, Sam, if I told you you had high blood pressure or diabetes, would you even think twice about starting those medications? Sam knew it was really the stigma of being on psychiatric medications that bothered him than the actual medication itself and he agreed to give it a chance. There's unfortunately such stigma with mental health and medication that, that's quite common. In looking at what are the medications, the arsenal, if you will, that are available for anxiety that Sam had at his disposal, then in general, the medications are effective in treating anxiety as well as ADHD generally work by acting on neurotransmitters chemical messengers that either stimulate or inhibit nerve impulses in particular areas of the brain. The core first-line medications employed include the SSRIs, which stands for the Selective Serotonin Re-uptake Inhibitors. They include medications like to Occitan, Prozac, Paroxetine, Paxil, Sertraline, Zoloft. Other medications that are also commonly used are the serotonin and norepinephrine reuptake inhibitors. Those include venlafaxine or Effexor and the norepinephrine dopamine re-uptake inhibitors, that's like bupropion or Wellbutrin, and the Alpha-2 adrenergic receptor antagonist, which is mirtazapine or MRI. It's important to know, and this was explained to Sam, that these medications are equally effective in treating anxiety. There have been no head-to-head long-term studies demonstrating superiority of one medication over another. If there's no superiority in selecting an anxiety medication, it is important to consider the history, the family history, which has a history of a family member who has been effectively treated on the medication, other medications the patient is currently on to avoid any negative drug-drug interactions and the possible side effects and how long the medication would stay in that person's system. Sam was placed on an SSRI which was Zoloft. All SSRIs can take the onset, can take up to four to six weeks to become effective, and have similar side effects. The most common of those side effects include gastrointestinal disturbances, which include diarrhea and nausea, and sexual side effects, which include anorgasmia and decreased libido. There's also a potential weight gain and some sedation with these class of medications. Another class of medications that are and were employed in the treatment of anxiety include the benzodiazepines. The common benzodiazepines include Diazepam, Valium, Alprazolam Xanax, Clonazepam, Clonazepam or Klonopin and Lorazepam or Ativan. In addition regarding these medications, to the concerns about tolerance and dependence, side effects include drowsiness and potential cognitive impairment at higher doses. One of the advantages though of the benzodiazepines is unlike the SSRIs or SNRIs, the onset is quite rapid and so benzodiazepines are immediately effective, which is particularly helpful when individuals are having a panic attack. When Sam was hearing all this as psychiatrists had discussed, all this was Sam and explained in another class of medications called the beta blockers, which were helpful in controlling the physical symptoms of anxiety, such as sweating, trembling, increased heart rate, and blushing or giving a talk or taking a test. The Beta-blockers symptoms are believed to help reducing the result of epinephrine release, which is inhibited by these Beta-blockers. These medications do not affect the Beta blockers, do not affect the cognitive aspects of anxiety, and affect only the physical symptoms. They're often used by musicians or folks that give talks a lot because it doesn't affect their cognitive ability but really helps with the sweating and the trembling with their hands. One of the more popular Beta blockers are the medication called Propranolol Inderal. Its onset is immediate and its potential side effects include decreased heart rate, weight gain, and depression. Again, Sam was informed that these medications are only part of the treatment for anxiety disorders and this is really an equally important treatment involves undergoing individual behavioral therapy, particularly CBT or cognitive behavioral therapy.