WHY YOU DON’T NEED TO BE AFRAID OF ANTI-ANXIETY MEDICATIONS

Many anxious people come to see a psychiatrist when they can think of nothing more to do on their own. I can’t tell you how many times I hear, “Doc, I feel so bad that I figured I had nothing more to lose by coming to see a psychiatrist.”

Why is it that the psychiatrist, trained specifically to deal with emotional illnesses, is the person people go too as a last resort?

I am aware of the stigma associated with mental illnesses. It often comes from lack of understanding of what anxiety and other mental illnesses are. I am also aware of how little psychiatrists have done so far to reach out to the people in need, the direct beneficiaries of their knowledge and training, and explain to them how much we now know about how to heal their suffering; that anxiety is nowadays a treatable condition; people no longer need to suffer silently and be ashamed of it.

I often talk to my patients about when is the right time to consider anti-anxiety medication as an additional aid in treating their anxiety. Some examples of the clinical criteria are:

· When the symptoms of anxiety are overwhelming--panic attacks, feeling out of control, crying or being irritable, even angry, almost all the time, or when anxiety interferes with one’s ability to get through the day.
· A common complaint of anxious people who could benefit from anti-anxiety medications is: “I can’t relax no matter how hard I try or what I do. I feel I am wired and tense day and night. I feel exhausted and I don’t know what else to do.”
· Sometimes people first try psychotherapy or “talk therapy.” It can be very effective. When it isn’t, and people feel they are “spinning their wheels,” making no real progress, it’s time to consider the medication option in addition and not instead of therapy.

Anti-anxiety medications are very effective. The problems people usually have with them are because of the way they are used. Just as driving a car can get you where you want to go, but it can also get you into a tree if you are not careful, so the anti-anxiety medications can work for you or can create problems if they are not used carefully. Patients can help their psychiatrists with the selection and adjustment of the medications. They can give their doctors an accurate account of their past experiences with medications, if any, and they can provide them with important feed-back about how the medication is or isn’t working. The psychiatrist, in turn, needs to explain to the patient what to expect from the medication, its benefits and possible side effects. If a psychiatrist doesn’t address all these issues right from the beginning, or does not listen to the patient’s feed-back, the patient will be better off finding another psychiatrist that is more perceptive.

The three major groups of medications used to treat anxiety:

Benzodiazepines: These are the “as needed” medications. People use them in various specific situations, for example if they get anxious in planes or closed spaces. They can be used when the anxiety becomes sharp and unbearable—panic attacks. They work only for a limited period of time, 4-5 hours for Ativan or Xanax and 7-8 hours for Restoril or Valium. The most common side effect is sleepiness. Because of that, driving is not recommended after taking them. Care should be taken by the patient to understand exactly what “as needed” means for him. Benzodiazepines could be addictive.

Selective Serotonin Reuptake Inhibitors (SSRIs) are the medications from the Prozac’s family: Zoloft, Paxil, Celexa, Luvox, Lexapro. These medications need to be taken every day in order to work. With the exception of Lexapro, which works faster (about seven to ten days), all the others need about ten to fourteen days before they start working. They are used when high anxiety levels are experienced almost all day every day, with or without panic attacks. In these cases, an “as needed” medication will not be helpful enough. The SSRIs tend to increase the serotonin in the Central Nervous System and by doing that, they help “the brain relax.” The exact way of how that happens is still under research.
The possible side effects tend to be mild and transient: mild headaches, restlessness, nausea, sleepiness, to name only the most common ones. These medications are usually highly effective and well tolerated. If one of them causes side effects, switching to another medication in the same class may solve the problem.

Selective Serotonin-Norepinephrine Inhibitors (SNRI): These medications work on two receptors at the same time: serotonin and the norepinephrine receptors. They tend to have more side effects because of that. These medications are Effexor XR, Pristiq, Cymbalta. The SNRIs are not necessarily better than the SSRIs. The decision to use one versus another is made according to the severity of symptoms and past history of each patient. As always, the balance between the benefits and the potential side effects needs to be carefully considered.

None of the above medication should be taken without the advice and supervision of a physician, preferably a psychiatrist.

Whatever the medication plan decided upon, it needs to be followed consistently. Mixing any of these medications with alcohol or recreational drugs is a very bad idea. It will increase the propensity for side effects and it will decrease the efficacy of the medications.

Common mistakes in using

anti-anxiety medication:

· The starting dose is too high and the patient has side effects. Usually the side effects are not life threatening but can be very annoying: low grade headache, insomnia or excessive sleepiness, nausea and restlessness, etc. Reducing the starting dose and slowly going up to a more effective dose will help.
· In the desire to get a quick response to medications, psychiatrists sometimes increase the dose too fast. Increasing the strength in smaller increments and assessing the efficacy and the side effects at every level, will take care of this problem.
· Lack of communication between the patient and the psychiatrist can cause a great deal of mistakes in managing the medications well. The psychiatrist should encourage the patient to express his concerns. The patient should initiate a discussion of any and all concerns of his relevant to treatment and prescriptions.