Many people are reluctant to try medication and would rather overcome anxiety on their own, and I’m in favor of this. Unfortunately, sometimes this is not possible, and medication is essential. But many anxiety sufferers have an intense fear of trying medicine. It’s ironic that medication can be both the object of anxiety and the solution to anxiety.
Some people avoid medication because they believe it’s a sign of weakness and they can overcome anxiety on their own but more often the reluctance is due to a variety of worries. Worries about dependency, side-effects, long-term effects and personality change are the most common fears. Perhaps you have been intimidated by these questions: What if the medication makes me feel worse? What if I become addicted? What if it changes my personality? What if I gain weight? What if it makes me feel out of it?
Have you considered these more helpful questions?
What if medication eases my suffering? Is it possible that I’m depriving myself of a remedy? What if the medicine does not cause me any side-effects? What if it’s not possible to conquer anxiety without medicine? What if it’s just what I need to beat this?
The Two Primary Medications Used to Treat Anxiety
Anti-anxiety medications (benzodiazepines) reduce anxiety quickly but have the potential to be addictive if used irresponsibly. They are commonly used as needed: when experiencing a panic attack or to reduce anxiety when in a fearful situation like flying in a plane. Many patients with panic disorder seldom take their benzodiazepine but keep it with them at all times. Just knowing they have it available enables them to face their fears more easily and provides a sense of security and comfort when outside their comfort zone. Some psychiatrists prescribe a small dose once or twice a day to help patients cope, particularly if antidepressants fail to reduce anxiety.
Antidepressants are prescribed for depression and anxiety. They are taken on a daily basis and after four weeks many notice their level of worry and symptoms of anxiety have reduced in intense and frequency. Over the course of months patients can continue to improve as medication is increased as needed. Most anxiety sufferers find the best results when they utilize antidepressant and cognitive behavioral therapy (CBT) simultaneously. Medication can help patients feel less anxious when facing fears and help them stop avoiding. Some people worry that it will change their personality. Street drugs do this but antidepressants do not. Antidepressants are not addictive but once people feel the medication is helping, there is a reluctance to try to come off.
It’s important to understand that therapy alone is sometimes not enough and a prescription for an antidepressant becomes essential if you experience any of the following:
sufficiently for many months but you are not improving.
If you are experiencing any of the above, you are suffering needlessly and should see a psychiatrist to discuss mediation as an additional source of support.
Do not Google side effects. Although you might be terrified to try medication due to potential side effect, for legal reasons, all possible side effects are listed. Do not confuse possibility with probability. Just because a side effect is possible does not mean it’s likely. Do not research side effects online. This will only scare you away and prevent you from trying what can heal you. Keep this in mind, if you experience physical symptoms after trying a new medication, those symptoms might not be side effects. They could be symptoms of your anxiety due to your worries about the medication. These symptoms will subside and disappear as your anxiety settles.
Many of my patients don’t experience any side effects while others have minor ones they can tolerate. It’s common to experience side effects for one to two weeks and once the body acclimates, the side effects disappear. This will require you to be patient and persistent. Start off on a small dose and work with your doctor to increase the dose as needed. If you experience side effects that are persistent and intolerable, consult your doctor. Once you stop taking the antidepressant, the side effects will cease.
Fortunately, there are many different types of antidepressants to try. You might hit the jackpot with the first medication but some patients suffer through trials of various ones until they find the right combination (sometimes two are needed). This can be an arduous process but worth it in the end.
Unfortunately, some people experience intolerable side effects from all antidepressant. If this is the case you must rely on cognitive behavioral therapy and the skill of a good psychiatrist who can try other types of medications (mood stabilizers, major tranquilizers, blood pressure medications, antihistamines, and supplements). If you have tried all the anti-depressants without success, do not give up hope. With a lot of hard work, dedication, and persistence, you can free yourself from anxiety. It just might take a bit longer.
Some people do not experience side effects from antidepressants but fail to improve despite trials of various brands. If you are not doing CBT at the same time, the medication will only have minimal impact. It’s also possible the dose was not high enough. It’s worth speaking with a psychiatrist and trying again while doing therapy at the same time.
Medication is like the training wheels on a bike and therapy is like pedaling
Think of antidepressants as training wheels on a bike and therapy as pedaling. To learn how to ride a bike, children need training wheels and a lot of practice. If a child tries to ride without training wheels they fall and injure themselves, become afraid, and give up. They need the security of the training wheels (medication) to practice pedaling (therapy). If a child sits on a bike with training wheels (medication) but never pedals (therapy), they also won’t learn to ride. To learn they need both the training wheels and pedaling just as you might need medication and CBT. Ideally medication (the training wheels) will help reduce your symptoms and give you enough security so you can do the exposure work (pedaling) more effectively.
Once you have minimal symptoms for eight to twelve months, you can slowly take off the training wheels (the medication) and continue to ride (live your life). As you reduce the medication slowly over several months, make sure you are doing exposures and the other self-help tools you learn in therapy on a regular basis.
I asked one of my former patients who had a fear of vomiting about her medication experience and this is what she wrote: I was very reluctant to try medicine. I felt I was strong enough on my own and I was also terrified it would make me sick. In fact, I was convinced antidepressants would make me throw up especially after I researched side effects online. This was a big mistake. As time went on it was very clear I need more help. I was suffering terribly. I took a big leap of faith and reached out to a psychiatrist and honestly, I’m so thankful I did. When I first started there were some side effects. In reality, it was just my anxiety about the medication that was creating what I thought were side effects. But I stayed with it and after a few weeks I started to see a drastic change. That medication turned out to be a godsend. It gave me an appetite and I started sleeping regularly. And it did not make me throw up. Getting me to the right dose and medication was a journey. It was a long process because I delayed doing what was recommended because of my fears of what might happen. Eventually I was prescribed a second antidepressant because the first one wasn’t enough. I had to try different doses of that one. Now I’m on a combination of two antidepressants which thankfully work really well together. For me the antidepressants make things easier. I was finally able to utilize Ken’s tools and strategies when doing exposures. I could literally feel my brain changing because I was able to do the exposures correctly. I have taken huge leaps forward where as before I was taken smalls steps forward and several back. The medication has helped dramatically.
Whether medication is what you need to get on an airplane or reduce your overall level of daily anxiety, it’s worth a try.