I have seen first-hand how prescription drugs can improve the lives of people with mental illness. I have also seen how their use can backfire. In fact, sometimes drugs do the opposite of the intended effect. Even when prescribed correctly anti-depressants may intensify the symptoms of depression and increase suicide risk.
Anti-anxiety medications pose a special problem. While approved by the FDA for the short-term management of anxiety, many physicians prescribe drugs like alprazolam (Xanax), lorazepam (Ativan) and diazepam (Valium) for months or years. Prolonged use, typically more than one month, can actually increase anxiety, leading to increased use and abuse. Ironically, the longer the patient uses anti-anxiety medication, the more they need it to experience relief. This sets into motion a cycle of addiction and withdrawal that does little to address the original problem.
The Downside of Anti-Anxiety Medication
The standard treatment protocol for those suffering from anxiety disorders is a combination of anti-anxiety medication and psychotherapy. But is medication the best prescription?
The drugs most commonly used to treat anxiety are benzodiazepines, a class that includes Valium, Xanax, Klonopin and Ativan. The most obvious danger of these tranquilizers is that they are highly addictive. People taking benzodiazepines for a few weeks or more will likely develop a physical dependence, and may find that they have become psychologically dependent if they try to stop taking the medication.
Over time tolerance builds leaving the patient in need of higher doses and progressively stronger medications. If a patient abruptly stops taking the drug, they may experience withdrawal symptoms that range from minor complaints like dizziness, headaches, blurred vision and nausea to more severe problems such as excessive weight gain, memory loss and suicidal thoughts.
The concern about addiction is playing out in treatment centers nationwide. Between 1998 and 2008, admissions for treatment of substance abuse rose 11 percent, while admissions for benzodiazepine abuse nearly tripled, according to the Substance Abuse and Mental Health Services Administration.
Although addiction is a significant risk, it isn’t the only one. According to a report in the 2010 Canadian Journal of Psychiatry, people who use anti-anxiety medication have a 36 percent increased mortality risk. By numbing responsiveness to stress and other stimuli, these drugs may also hinder learning and development of long-term coping skills.
It is important to note that anti-anxiety medications do not cure anxiety. They provide temporary relief from anxiety symptoms, which will likely return when the individual stops taking the drug. Sometimes this immediate relief is critical and life-saving. Other times, there are better options. Rather than focusing on the symptoms, go straight to the cause by trying approaches aimed at the underlying issues that drive anxiety.
Six Alternatives for Treating Anxiety
For many people, the best treatment for anxiety with the fewest side effects may be a combination of therapy and alternative interventions. Instead of feeling foggy and disconnected, these approaches help people re-engage and find healthy ways to cope.
To sustain their progress long-term, individuals suffering from anxiety must process the underlying feelings or situations that trigger distress. CBT tackles anxiety where it starts – in the mind – and produces changes beyond the neurochemical ones brought on by medication. A therapist helps the patient identify maladaptive thought and behavior patterns and learn new coping skills that reduce anxiety.
Certain herbs, such as passionflower, valerian and theanine, have been used to treat anxiety. Amino acids such as gamma aminobutyric acid (GABA) and omega-3 fatty acids may also have benefits. While these remedies appear to be safe, drug interactions are a concern and research on their side effects and effectiveness is limited.
Yoga, tai chi, exercise, meditation and biofeedback are a few of the mind-body techniques that can reduce anxiety. Studies show that daily meditation has long-lasting physiological benefits and yoga and other stress management practices can boost energy, reduce tension, and improve concentration and mood.
Because anxiety and depression often go hand in hand, anti-depressants such as Prozac and Cymbalta may be an effective treatment option. Side effects can include nausea, drowsiness, weight gain, sexual dysfunction and loss of appetite, but are typically less problematic than benzodiazepines. Although antidepressants and other non-addictive drugs may reduce anxiety, they should be combined with psychotherapy to ensure that the underlying issues are addressed.
Hope Doesn’t Come Packaged in a Bottle
It isn’t difficult to understand the widespread use of anti-anxiety medications. They provide fast-acting relief from panic attacks, post-traumatic stress and debilitating anxiety with little effort on the part of the patient or doctor. As a short-term solution to an unusually stressful situation, or a longer term solution for severe anxiety, anti-anxiety medications may be an effective choice.
Every individual has to assess their own situation with their doctor, though in many cases, the risks of anti-anxiety medication outweigh the benefits. Anxiety can be limiting, but treatment options are abundant. A number of therapies used synergistically can dramatically improve quality of life for anxiety sufferers.
No one approach can be expected to work for everyone but lifestyle changes, which are more long-lasting than medication, are certainly worth considering. Medication will always be there as a last resort.
David Sack, M.D., is a sought-after addiction specialist who has been featured on CNN, Good Morning America, and Dateline NBC. Board certified in psychiatry, addiction psychiatry, and addiction medicine, Dr. Sack is CEO of Elements Behavioral Health, a network of treatment programs for drug addiction, sex addiction, eating disorder treatment, and psychiatric disorders. You can follow Dr. Sack on Twitter http://www.twitter.com/drdavidsack.