Anxiety and Medication
Dr Jonathan Haverkampf
Many medical practitioners prescribe short-term medication in the form of anxiolytics if a patient presents with symptoms of anxiety or outright panic attacks. While anxiolytics have their place in the treatment of anxiety and panic attacks, especially in reducing the patient’s anxiety about having anxiety of panic attacks in the future, they should be an add-on to a combination of psychotherapy and medication that can be given over a longer time, such as an antidepressant from the group of SSRIs.
Most anxiolytics belong to the group of benzodiazepines, and although they can be very effective in reducing anxiety for up to a couple of hours, they have three main disadvantages. The first is that they are potentially addictive if taken regularly, the second that they do not work instantaneously and their effect only lasts for a short time, and the third is that they can make one drowsy and affect the reaction time, which means that someone should not be driving a car or operating heavy machinery while taking them. If someone suffers from sudden anxiety bouts of anxiety or even panic attacks, it can be over by the time the medication starts working. However, many patients are helped quite effectively by merely having an anxiolytic in their pocket. This works because often the anxiety about feeling anxious and having all the physical symptoms associated with it is the main factor in maintaining the anxiety.
The long-term solution should be a combination of psychotherapy/counselling and, if indicated, an antidepressant from the group of serotonin reuptake inhibitors (SSRIs). Neurobiologically, all SSRIs can be effective in reducing anxiety and allowing even house bound patients to partake in daily life again, but a few of them are usually prescribed in practice. While they can take up to three weeks, and sometimes even more, to show their full effect, they are generally described as non-addictive and especially in the case of the newer ones, such as escitalopram, patients report few, and in many cases no side-effects. If there are mild side-effects, they often tend to go away after a couple of days. In the case of anxiety, increasing the dose slowly mostly eliminates subjective side-effects. The mainstream opinion is that they can be taken over many years and are quite safe as far as pharmaceutical treatments go.
SSRIs can be combined with a variety of other drugs. However, they should not be combined with MAO inhibitors (antidepressants), certain neuroleptics and other medication, which can increase the serotonin level and in combination lead to the rare but potentially life-threatening serotonin syndrome. They can increase the effect of alcohol, so additional care should be taken in this regard.
Being for at least six months to a year on SSRIs often seems to have the effect, that once the medication is discontinued anxieties are less likely to return for some time. The reason does not seem to be entirely biological but also an effect of learning. As the memory of feeling anxious becomes a distant memory, one is less likely to feel anxious.
Before an SSRI is given certain conditions should be excluded in a conversation with the patient. Among them are a certain type of heart arrhythmia (abnormalities in the QT interval). If the patient is treated for a medical condition, it helps contacting the GP or specialist and asking if there are any indications the patient might suffer from a condition that may be a reason for caution.
But overall, the SSRIs, with escitalopram as a personal favorite, have shown to be an enormous help in treating anxiety and allowing patients to lead normal lives. In combination with psychotherapy / counselling the long-term prognosis for anxiety disorders in most cases has become very good.
© Dr Christian Jonathan Haverkampf. All rights reserved.
Psychotherapy & Counselling; Dublin, Ireland
This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition.
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