Concerns about Medication
Concerns about side effects and withdrawal are common. Patients often worry that taking medication is somehow artificial, and some turn to herbal supplements and drugs like marijuana, Dr. Liebowitz said. The truth is exactly opposite: Medication serves as a correction. It doesn’t introduce new chemicals into the brain, but instead alters the level of certain neurotransmitters, Dr. Liebowitz said.
SSRIs, the first line of treatment, can cause insomnia, sexual dysfunction, and weight gain. If a medication is helpful, the prescribing physician can help you work around these side effects. One way is to adjust the time you take the medication: If you’re experiencing insomnia, you may take medication during the day or at night if you’re drowsy, Dr. Liebowitz said. If weight gain is an issue, you may need to watch your calories and exercise regularly.
“Because medication causes neurochemical changes in the brain, you may experience some withdrawal symptoms after discontinuing use, as the brain re-adjusts itself to the lack of medication,” Dr. Roy-Byrne said. This is true of all medication, he said, not just that for psychiatric disorders.
Abruptly discontinuing medication can have fairly potent effects, even with SSRIs, according to Dr. Liebowitz. Slowly tapering off the dose under a physician’s guidance reduces these problems.
Dr. Liebowitz recalled helping a patient taper off 40 mg of Paxil. The patient gradually went from 40 mg to 10 mg without trouble; however, going from 10 to 0 caused the patient dizziness and discomfort. After informing Dr. Liebowitz, he and the patient agreed to adjust the dose to 10 mg every second day for several weeks. Communicating with your doctor about your progress and any problems is vital to your treatment.
In addition to tapering off the medication, your physician may prescribe another medication to ease discontinuation syndrome. For patients taking Paxil, Dr. Roy-Byrne adds Prozac. They stop taking Paxil but continue taking Prozac for about six weeks before quickly tapering off this over a few days. (Prozac has a very short half-life, or the time it takes for a drug to lose half its activity in the bloodstream, thus making it ideal in such situations.) Using this technique can eliminate withdrawal symptoms, Dr. Roy-Byrne said.
And it may not be withdrawal after all. Patients can mistake the original anxiety for withdrawal symptoms. “If you stop an anxiety drug, the anxiety may come back, and with the passage of time, it could be worse than before,” Dr. Roy-Byrne said.
Tips for Taking Medication
- Before. Weisberg has seen many patients accept a prescription without asking many questions or without knowing what symptoms or disorder the medication is supposed to be treating. Remember that you and your prescribing physician are a “health care team,” she said. Before taking medication, Dr. Roy-Byrne and Dr. Liebowitz suggested asking the following:
- What is my diagnosis?
- What are my treatment options, including medication and psychotherapy?
- How will I know if this medication is working?
- What are the side effects, and what do I do if I experience them?
- When will the medication start to work?
- How long will I have to take it?
- If I take it for X amount of time, what’s the likelihood of reducing symptoms?
- What are the dose requirements?
- Will you be monitoring me throughout the course of this medication?
- When will you talk to me next?
- During. Dr. Roy-Byrne has patients keep track of symptoms and side effects using a rating scale. Recording your reactions to medication lets you and your doctor know if you’re getting better, whether your health problem is anxiety or high blood pressure. “I want to know if you’re 20, 40, 60 percent better, so I can know what to do next,” Dr. Roy-Byrne said. He also has his patients monitor their symptoms before they start medication, so they don’t attribute natural changes in their anxiety to the medication. “This is consistent with ‘measurement-based care,’ which is becoming the state-of-the-art approach to monitoring treatments and their outcomes,” he said.
- Other tips. Avoid skipping your medication and make sure you don’t run out, Dr. Liebowitz said. If you go away for the weekend and leave your pills at home, call your physician for an emergency prescription. For additional advice, see here.
Managing Panic Attacks
Patients can suffer panic attacks with any anxiety disorder. Corboy suggested four steps in managing them:
- Accept the anxiety. Individuals with an anxiety disorder become exceedingly sensitive to anxiety. “At the first hint of anxiety, they often become terrified that a panic attack is imminent,” Corboy said. Accepting that anxiety exists doesn’t mean liking it or resigning yourself to being anxious forever; “it just means accepting reality as it is.”
- Challenge distorted thoughts. People often interpret a panic attack as a significant threat, but it’s important to realize that “nothing catastrophic is going to occur as a result of being anxious or even panicking.”
- Breathe. Instead of hyperventilating, which energizes anxiety, “make a point of consciously breathing.”
- Resist the urge to flee. Running away from anxiety only reinforces the idea that you’re unable to handle it and that escaping the situation is your best solution. Instead, a long-term solution is to “learn that we can tolerate the discomfort, that it won’t hurt us and that it will naturally dissipate over time if we sit with it.”
Pitfalls and Pointers
You may hit some snags as you work toward managing your anxiety. Here’s a list of common ones and practical solutions for them:
- Keeping symptoms to yourself. A primary care physician can’t make a proper diagnosis or treatment recommendation without having all the information.“If you have been feeling uncontrollably worried, anxious, fearful, have been having panic attacks, or have found that you are avoiding things that are important to you or to those around you because of fear – tell your doctor,” Weisberg said.
- Fighting anxiety as if it were your adversary. It’s important to understand that anxiety is a helpful response and a normal part of life, Abramowitz said.
- Masking it. Whether it’s alcohol, illicit drugs, or benzodiazepines (such as Xanax or Ativan), these substances offer short-term relief and are akin to running away from anxiety, Abramowitz said. Because benzodiazepines quell anxiety quickly and strongly, they can increase avoidance and impair your ability to overcome anxiety-provoking situations, Dr. Roy-Byrne said.Instead of pursuing what maintains your anxiety — avoidance — face your fears directly with the help of a therapist.
- Giving up too quickly. Whether it’s medication or CBT, these interventions “can take a while to work,” Weisberg said. “Keep your long-term goals clearly in mind, giving each treatment enough time and effort.”
- Being too motivated. Jumping in head-first isn’t recommended either, Norton said. Instead of sprinting through treatment, give it time to sink in and strike a balance.
- Have realistic expectations. It’s unrealistic to think that you’ll eliminate anxiety forever. Instead, realize that you’ll be able to manage symptoms and stop avoiding certain situations.
- See stress as normal. It’s normal to feel stressed. You can’t fight stress, but you can work through it, Abramowitz said.
- Adopt a balanced approach. Rather than overestimating the magnitude of a situation, “step back and look at things in a more objective light,” Abramowitz said. Instead of thinking that you’ll lose your savings in today’s shaky economy, consider that the market will return and focus on the steps you can control to manage your money.
- Adopt an anxiety-free lifestyle. In The Anti-Anxiety Workbook, Norton includes the ingredients for an anxiety-free life: adequate sleep; a balanced diet (think food pyramid, not diets that delete food groups); exercise and a solid support system, all of which are powerful in decreasing anxiety. Like a pricey car that needs high-grade gasoline to run optimally, our incredibly efficient body functions better with the right nutrients, Norton said. How we treat our bodies also directly affects anxiety sensations. Being out of shape can make your heart race even when you’re just walking. Caffeine and poor nutrition can amplify anxiety, producing jitteriness and trembling. Simply curtailing one’s caffeine intake can be helpful, Norton said.
For more information on anxiety disorders, see Psych Central’s resources at http://psychcentral.com/disorders/anxiety/