TO CONTROL MY ANXIETY, WILL I HAVE TO TAKE MEDICATIONS ALL MY LIFE?

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How long you need to take medication depends on many factors including the type of anxiety disorder, the presence of other disorders or illness, and whether you've gone through a course of psychotherapy. It also seems that the earlier the disorder started (e.g., age 10 or 11), the more chronic and tenacious the illness may be, and the more likely medications might be needed long-term. Another factor that may suggest a more persistent illness requiring medication is the presence of serious psychiatric disorders among many close relatives.

Fortunately, as a result of comprehensive research studies, physicians have guidelines that recommend the length of medication usage for particular problems with anxiety. The good news is that you do not need to make this call on your own. Let your prescribing doctor and your therapist, if you have one, help you determine if and when you are ready to discontinue your medications. Gradually decreasing the dosage often makes it easier to wean off a medication, and sometimes, this is the only safe way to go.

Further, there are psychotherapies that have been shown to treat anxiety disorders effectively. In fact, certain types of therapy have proven superior to medication in the long-term treatment of some anxiety disorders (e.g., cognitive-behavioral therapy for panic disorder). This may be because the skills learned in cognitive-behavioral therapy help an individual cope with panic on his own. Moreover, these skills are with him for the long-term and not discontinued like medications.

In pursuing psychotherapy for the treatment of anxiety, the individual should be prepared to assume responsibility for tackling the problem. Neither a prescribing physician nor a psychotherapist offers a magic remedy to remove anxiety. Ultimately, the patient must face her fears and demonstrate to herself that she will survive in spite of them.

It is not unusual to stop medicines and go many years without a return of anxiety symptoms, only to have them appear again. Do not despair. This often stems from severe stress or the development of another mental or physical disorder. With proper evaluation and treatment—a course of medications and/or psychotherapy—it is common to see anxiety symptoms diminish again.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD 

IF I STOP TAKING AN ANTIANXIETY MEDICINE, WILL I GET ANXIOUS AGAIN?

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If nothing else has changed, you may become anxious again. The reason is that most anxiety disorders are chronic and wax and wane over time. You may feel better with the anxiety medication, and then assume you are ready to stop your treatment, only to find that the anxiety returns. Here are some important exceptions:

Sometimes, our anxiety is associated with a life crisis—e.g., disaster, loss of a loved one—and will resolve on its own whether or not we use medication to aid our adjustment. In these cases, stopping the medications after a few months may not lead to increased anxiety.

If you have completed a successful course of psychotherapy while on medication, you may not experience a return of symptoms when you stop the medicine. Many factors contribute to the production of anxiety symptoms, including past experiences, your defenses, avoidance behaviors, and the way you think. These factors can often be identified in psychotherapy and remedied accordingly.

If you decide to stop your medications, talk to your physician about how to do so. As noted earlier, some anxiety medications are dangerous to stop abruptly.

 Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD 

WHAT SHOULD I BE AWARE OF IF I DECIDE TO TAKE MEDICATION OF MY ANXIETY?

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When considering medication for the treatment of anxiety, here are some suggestions.

1.When you tell your doctor about medications you are already using, make sure to include any over-the-counter drugs or alternative medicines, such as herbal supplements. Although we may think of these medicines as harmless, some can cause serious problems when combined with prescription medication.

2.If the prescribing doctor is new to you, make sure he or she is aware of any medical conditions—such as cardiac problems, high blood pressure, low blood pressure, pregnancy, nursing, and addictions—that could complicate your treatment.

3.Ask your doctor how the medication works and what to expect when you take the drug. What are the intended effects, and what are the side effects?

4.Find out what side effects signal the need for medical attention.

5.As much as we like to think of doctors as magicians, they rely on you to let them know what works and doesn't work. Sometimes, the initial prescription and dosage are just right for you. Other times, you need to work with your doctor to figure out the right dosage of the right medication. The process can sometimes feel discouraging, but stick with it. The rewards are worth it.

6.Ask your doctor up front how you would go about stopping the medication if it would need to be discontinued. It can be dangerous to stop certain medicines abruptly, and these need to be tapered off slowly under your doctor's supervision.

7.Follow your doctor's directions for when and how to take your medications, and expect the best.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD 

WHAT ARE THE LONG TERM SIDE EFFECTS OF MEDICATIONS ADVERTISED ON TELEVISION LIKE ZOLOFT AND PAXIL?

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The long-term side effects of the SSRIs, like Zoloft and Paxil, are fairly benign for adults. In general, they may cause weight gain or interference with sexual function. In some cases, sleep disturbance may be a long-term effect. A few people also complain of losing their normal range of emotions and may describe their feelings as numb.

When SSRIs are combined with a number of other drugs, other concerns may arise, such as the increased risk of liver toxicity. This risk is most likely in a small subset of the population (about 5 to 10%) who has a genetic predisposition to poor metabolism of medications.

Women who want to become pregnant or breast-feed should consult with their physicians or pharmacists regarding taking any of these medications. There can be adverse consequencess on the developing fetus or the nursing child. The long-term effects of these drugs on children and adolescents are less well-known.

Of course, if a person develops other illnesses and/or takes other kinds of medicines, the side effect profile might change considerably. Again, it is wise to consult with your physician.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

WHAT NEW DRUGS ARE BEING STUDIED FOR ANXIETY? HOW ARE RESEARCHERS HOPING TO IMPROVE ON CURRENT MEDICATION?

theage.com.au

Researchers are trying to develop new drugs that combine the benefits of benzodiazepines (the fast action) with the benefits of the SSRIs (effectiveness with fewer side effects). Parallel to new brain research, drug studies are focusing on the receptor for the body's natural tranquilizer, GABA. While GABA's anxiety-inhibiting effect was the basis for the development of the benzodiazepines, new research is zooming in on the receiving center for GABA and identifying specialized subunits—sort of like different lines coming into a phone center. Whereas benzodiazepines, like Valium, work across all the subunits at once, new drugs aim to specify which combinations of subunits to activate. Several pharmaceutical research labs are currently trying to produce fast-acting anxiety medications that don't include the addictive potential, sedation, memory impairment, or lack of coordination associated with existing benzodiazepines.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

MY DOCTOR MENTIONED THAT DRUGS LIKE NEURONTIN AND INDERAL ARE BEING USED TO TREAT ANXIETY? ARE THEY SAFE? WHAT ARE THE SIDE EFFECTS?

webmd.com

Neurontin (gabapentin), an anticonvulsant, is a relatively safe medication, and is popular with psychiatrists and patients because it doesn't require monitoring of blood levels, as do other anticonvulsants. The side effects of Neurontin include dizziness, blurred vision (diplopia), lack of balance (ataxia), sleepiness (somnolence), and fatigue. Patients are advised not to drive or operate complex machinery until they have enough experience with the drug to know that it will not affect their performance. Another warning with Neurontin is that very rarely, the sudden discontinuation of the medication could result in a seizure.

Inderal (propranolol), a beta-blocker, is usually safe to use, but requires medical supervision. As with any prescription drug, don't be tempted to use a pill offered by a friend or family member. Inderal is not safe for individuals with asthma or severe breathing problems, as it can worsen these conditions. Side effects of Inderal include slowing of heart rate (bradycardia), lowered blood pressure (hypotension), cardiac arrhythmia, congestive heart failure for those at risk, depression, fatigue, lightheadedness, nausea, vomiting, diarrhea, and cramping.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

WHAT ARE THE SIDE-EFFECTS OF THE SSRI AND SSRI-LIKE ANTIDEPRESSANTS?

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Initial side effects of SSRIs often include mild nausea, loose bowel movements, anxiety, headache, and sweating. They usually disappear after a few weeks. Individuals taking SSRIs for an extended period of time may complain of weight gain. With some of the SSRIs, it is not uncommon to have sexual dysfunction. This is a later side effect and may remain until the medication is discontinued. For men, it may mean low desire, difficulty achieving an erection, trouble ejaculating, or delayed ejaculation (which is why this class of drugs is used in treating premature ejaculation). For women, it may mean low desire, trouble lubricating, or difficulty having an orgasm. Some people complain of sedation with these medications. It is usually helpful to have them taken before bedtime if that occurs. An additional side effect of the SSRIs is that patients occasionally report very vivid dreams.

The most harmful side effect, though rare, is serotonin syndrome. It is most likely to occur if two or more serotonergic medications are used simultaneously. Although there are isolated examples of this syndrome with one SSRI, the most important combination of drugs to avoid is that of an SSRI and an MAOI. Serotonin syndrome starts out with lethargy, restlessness, confusion, flushing, sweating, tremor, and sudden jerking of the feet. It can progress to increased temperature, generalized muscle rigidity, kidney failure, and even death.

In general, however, the side effects of the SSRIs are easier to tolerate than those of the tricyclics or the MAOIs. SSRIs are also much safer to use and are less dangerous if someone overdoses on them.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD