Anxiety disorders are one of the most common psychiatric disorders. According to the National Institute of Mental Health (NIMH), about 40 million American adults ages 18 and older suffer from them each year. The good news is that they also are highly treatable. But getting an anxious person to seek treatment can be a struggle.
Jason Eric Schiffman, MD, MA, MBA, a psychiatrist at the UCLA Anxiety Disorders programs and editor of Anxiety.org says it’s one of the paradoxes of anxiety disorders. The severity of the disorder, the fear of being stigmatized, and general mistrust of conventional treatment may create obstacles to seeking help.
What Makes Complementary and Alternative Treatments Attractive Options?
The fear of conventional therapy could explain why complementary and alternative therapies (CAT) — such as vitamin supplements and yoga and meditation — are becoming increasingly popular. There was a time not long ago when we trusted Western medicine more than alternative treatments, but today the opposite is said to be true.
What accounts for this shift? Schiffman identifies four reasons why patients may be leaning toward complementary and alternative techniques to relieve their anxiety.
1. General mistrust of pharmaceutical companies.
The 2010 movie Love and Other Drugs does a good job of explaining patients’ growing mistrust of pharmaceutical companies. In a sentence, the relationship between pharmaceutical companies and physicians has become blurred. While Hollywood exaggerates the issue, the movie raises a legitimate concern: How much influence do pharmaceutical companies have on a doctor’s decision to prescribe certain medications? “The pharmaceutical companies are, by and large, publicly traded health companies, which means they have a fiduciary responsibility to their stockholders to maximize profit and that does not always align with the goal of doing what’s best for the greatest number of people,” says Schiffman. Although there have been recent efforts to prevent bias by limiting the way physicians and pharmaceutical companies interact, the general mistrust has stayed.
2. Side effects from commonly used SSRIs.
Schiffman says there is a correlation between the “amount of desired effects that a medication has and the amount of undesired side effects.” In other words, pharmaceutical treatments used are more effective than nonconventional treatments, but they tend to come with more side effects. In the case of selective serotonin reuptake inhibitors (SSRIs), a class of medications commonly used to treat anxiety disorders, sexual side effects can be perceived as intolerable. A previous post written by Psych Central founder and editor-in-chief John Grohol on Managing the Painful Side Effects of Antidepressants lists several of these common side effects. These reasons may be enough to pique patients’ interest in seeking alternative treatments.
3. No relief from SSRIs or difficulty in treating certain anxiety disorders.
According to Schiffman, “Only somewhere between 30-40% of people respond to their first treatment with SSRI’s.” And for some anxiety disorders, such as severe obsessive compulsive disorder (OCD), conventional treatment approaches may not always work. In fact, he says some patients in a “heroic effort to get relief” have even tried neurosurgery. The truth is that in comparison to Generalized Anxiety Disorder (GAD), OCD patients will require a higher dosage of medication. “If people have tried conventional approaches and are still suffering, it makes sense that they would then be willing to try complementary and alternative approaches.”
4. It’s human nature to believe natural products are better than synthetic.
When you hear the words “all natural” do you immediately associate it with low- or no-risk products? Equating natural products with safety and trust is a common and prevailing misconception with CAT. In fact, Schiffman says, “Natural products can be just as dangerous as synthetic products. Just because something is marketed as a natural supplement doesn’t mean that it is without risks.” In March 2002, the U.S. Food and Drug Administration (FDA) issued a warning about kava kava, a supplement used to treat anxiety, because of its potential negative side effects such as severe liver damage.
Yet, people who take supplements are more likely to trust companies and individuals promoting alternative treatments and supplements than pharmaceutical companies and the FDA. Instead Schiffman says, “the FDA and pharmaceutical companies and the marketers of supplements deserve the same degree of healthy skepticism.”
The Challenge with Seeking Alternative Treatments
It is understandable that individuals suffering from anxiety disorders want to seek alternative therapies — even more so because they can find information about them via the Internet in the comfort of their own homes. But because what’s out there on the World Wide Web isn’t regulated, patients may get misinformation that could have costly consequences.
Another problem is that many psychiatrists are not up to date with the latest research and information on alternative therapies. And if they are, Schiffman says they may be reluctant to comment on them either way. “One of the problems is that these medications have not been evaluated by the FDA [and] they’re fearful of the liability associated with recommending treatment that hasn’t been thoroughly evaluated or approved by the FDA.” As a result, people who are most qualified in terms of training and experience (such as psychiatrists) are less likely to evaluate potential treatments than people who aren’t trained because of the fear of liability issues.
What to Do if You’re Interested in Seeking Complementary and Alternative Therapies
If you think you are experiencing an anxiety disorder, you should always seek treatment from a mental health provider. If you are working with a therapist and are interested in pursuing an alternative route, consider asking them about potential treatments. In addition, a pharmacist or physician may also be able to answer your questions on supplements and provide information on any potential negative interactions with medications you are taking.
And while Schiffman has seen the positive effects of behavioral interventions such as yoga, meditation and deep breathing on anxiety patients, he advises individuals to avoid making decisions based on anecdotal evidence. Sites such as PubMed that publish current and evidence-based research are the best route for obtaining information via the Internet.
If you are suffering from a less severe anxiety disorder such as General Anxiety Disorder, Schiffman suggests “non-pharmalogical approaches first whether those approaches are complementary or alternative approaches like yoga or meditation or conventional approaches like cognitive behavioral therapy.” This is because there is less risk involved and fewer physiological side effects. However, it is important to note that if you are experiencing more severe symptoms or in the moment anxiety as in the case of phobias or panic attacks, CAT may be less effective. Cognitive Behavioral Therapy (CBT) alongside complementary and alternative techniques might work best in those situations.
Knowing all the work and research involved, is it worth seeking complementary and alternative therapies?
Schiffman wholeheartedly says yes. “When someone gets better from anxiety through a practice such as yoga, meditation or through therapy, they get better because they’ve learned something rather than getting better because a pill has made a change or caused a change to their neurochemistry.” Making an effort to change your lifestyle by learning ways to reduce stress and anxiety not only empowers individuals, but creates change that is “much more profound and long-lasting.”
The choice ultimately is yours. But Schiffman leaves us with this final thought to mull over: “If the goal is to increase the quality of life of the person who’s suffering from anxiety, it doesn’t make sense to limit one’s self to either conventional or non-conventional treatment.”