More than 100,000 chemical reactions occur in your brain every second. This amazing organ is capable of more than anyone can yet imagine, but when anxiety rises, it can interfere with normal brain functioning.
Your Brain and Emotions
Three parts of your brain are especially important to your anxiety. Your hypothalamus, a pea-sized structure in your brain’s central core, controls biological rhythms that influence sleep cycles, energy levels, pleasure, and other important emotional experiences. When your hypothalamus isn’t functioning properly, you may feel fatigued, yet still have problems sleeping.
Your limbic system, which surrounds the hypothalamus, is often called the “emotional brain.” It’s a launching pad for felt emotions. When you feel afraid or anxious, the experience is set in motion by chemical activity taking place in the limbic system. This set of structures also inhibits and controls emotional actions.
The prefrontal cortex, the front part of your brain, inhibits emotional reactions, maintains attention and concentration, and assists in complex thinking and problem solving. Your brain has many interconnections between the frontal lobes and the limbic system. Although there is convincing evidence that the frontal cortex is dysfunctional in some psychiatric disorders, there is little or no proof of actual tissue damage.
Normal functioning of your brain is dependent on the appropriate action of neurons (nerve cells) responsible for turning particular brain centers on and off, somewhat like turning a TV or computer on and off. The neurotransmitting chemicals released by particular nerve cells are given the name of that cell. Thus, a dopamine nerve cell is a cell that manufactures and releases dopamine, while the nerve cells that release serotonin are called serotonin nerve cells, and so on. The list of nerve cells, neurotransmitters, and amino acids implicated in affecting mood and behavior is growing and includes: serotonin, dopamine, norepinephrine, gamma-amino butyric acid (GABA), glycine, histamine, acetylcholine, glutamate, and aspartate. (See chapter 5 for more information on how the food you eat can help you to develop healthy neurotransmitters.)
One of your brain’s many jobs is to produce chemicals that help you remember, go to sleep, think clearly, and feel good. Endorphins are your brain’s painkiller, and they are three times more potent than morphine.
Another opiate-like chemical in your brain and spinal cord is serotonin, a hormone. When your serotonin level is low, depression usually follows. When your brain produces serotonin, tension and anxiety are eased. When your brain produces dopamine or norepinephrine, you are more alert and react more quickly.
It is theorized that a dysfunction in just a tiny percentage of total brain cells can lead to a psychiatric disorder. What has not been proved is whether these chemical changes are responsible for causing the psychiatric disorder. Some experts, including Breggin and Cohen, believe psychiatric drugs can cause brain-chemistry imbalances and set off subsequent attempts by the brain to compensate that can create lifelong damage.
Drugs and Your Brain
Psychiatric drugs became part of the top moneymakers for the pharmaceutical industry in the mid-1970s. By then, drugs to treat anxiety and depression had been developed. Since then, their use has skyrocketed. According to the new president of the American Psychiatric Association, “Psychiatry’s relationship with drug companies is rife with the appearance of conflict of interest and frankly with conflict of interest itself.”
Breggin and Cohen maintain that some anti-anxiety drugs, such as Prozac, Ritalin, and Xanax, actually cause a chemical imbalance, rather than correct it. Peter R. Breggin, M.D., an expert in psychiatric drugs and their negative effects, says that all the commonly used minor tranquilizers, with the possible exception of BuSpar, are sedatives, or central-nervous-system depressants, and create clinical effects similar to alcohol and barbiturates. Bear in mind that one of the most common side effects of sedatives is depression!
All minor tranquilizers impair physical coordination and mental alertness, which is why it’s dangerous to drive or use other mechanical devices when taking them. Even at low doses these drugs can impact your brain waves on routine EEGs, especially in the frontal lobe of the brain.
Most drugs interact with specific receptors in your brain to produce their effects. Receptors are structures located on the outside surface of nerve cells. These structures interact with a variety of chemicals, including medications. Think of a chemical as a key and the receptor as a lock. But it’s not quite that simple. Other substances, including hormones, can also bind to these receptors and interact with them in certain psychiatric conditions, according to Stephen M. Stahl, MD, PhD.
According to Samuel H. Barondes, all psychiatric medications work on the same neurotransmitters—primarily dopamine, serotonin, norepinephrine, and gamma-aminobutyric acid (GABA). Although drug companies would like us to believe psychiatric disorders are the result of an excess or deficiency of these chemicals that can be fixed by taking a medication, the researchers who know how drugs work and how they effect the brain still don’t know how they effect the cause of an anxiety disorder, if in fact they do. Moreover, many psychiatric drugs frequently bind to more than one receptor, and so have more than one effect. Some of these effects can be worse than anxiety.
Medications are not magic bullets. They do not target a receptor upon entering your body, appear magically at their goal, perform their work, and then disappear. This false notion completely ignores the facts. It is possible that you can take anti-anxiety drugs, feel better, and experience no short-term side effects. Be aware that these drugs have not been tested for long-term use or on the unique individual that is you. (Research results only present averages, not individual responses.)
Be Cautious When Taking Anti-Anxiety Drugs
There are at least three reasons to be cautious when taking anti-anxiety drugs:
This is a caution against using any medication injudiciously. Work with your health care practitioner to monitor drug use carefully so you can decide when the costs are outweighing the benefits, and stop using any medication once it’s no longer needed or if it creates dangerous side effects. You may have to remind your health care practitioner how long you’ve been on a drug, and inquire whether a liver function test or some other test is needed.
Keep in mind that quick and easy treatments for difficult problems are rare, if not nonexistent. Still, your hope for a miracle drug may be strong, especially these days when the drug industry spends more than twice as much on marketing and administration as it does on drug research and development. It’s nearly impossible to turn on a TV without seeing an ad for this or that drug. The side effects are glossed over and many are promoted for uses that have never even been researched.
Keeping this in mind, you might want to consider becoming one of the many individuals who refuses to take prescription drugs, and thereby avoid their irritating and sometimes dangerous side effects. This book can help you do just that by showing you how to change your eating patterns, participate in daily vigorous exercise, use deep relaxation or meditation, alter your self-talk and basic beliefs, and find a life purpose. If you are so debilitated by anxiety that it’s impossible for you to leave your home, you can work with a cognitive-behavioral nurse-therapist who can use anxiety-reduction techniques to enable you to function. (See chapter 9.)
Keep several things in mind when considering whether to take drugs to quell your anxiety. Remember that drugs don’t cure you. They only work on symptoms. That is, they may (or may not) reduce your anxiety, but they work only as long as you take the drug, and will do nothing to stop the real cause of your anxiety. This means they provide temporary relief, while only nonchemical lifestyle changes can produce complete and enduring relief.
Another important fact to keep in mind is that all drugs have side effects. Drugs are prescribed for one of their many effects, but to get that result, you may have to put up with a variety of side effects. In fact, many individuals stop taking their prescribed anti-anxiety drugs because of their annoying side effects.
Also remember that any drug that is strong enough to have a significant effect has the potential for rebound and withdrawal symptoms. Breggin and Cohen point out that drugs that suppress anxiety or induce sleep when used over the long term should always be suspected of causing irreversible mental dysfunction.
You can also develop a reliance on drugs, so if you’re not currently taking them, I hope you will give the methods in this book a fair trial before electing to take them.
If you’re already taking a drug and decide to stop, only do so in concert with your health-care practitioner. Together you can find the best way to end your dependence so that you don’t have a very negative reaction. Gradually tapering off is the only safe way to stop taking a drug. This gradual approach is especially important if you’re taking a tranquilizer, because going cold turkey can be dangerous.
If you do decide to take medications, always be informed about what you’re taking, the correct dosage, what effects to expect, and any dangerous side effects and what to do about them if they occur. This holds true for all drugs, not just medications prescribed to reduce anxiety. (For example, one study has linked oral contraceptives to panic disorder. Once women taking triphasal oral contraceptive stopped taking it, their panic attacks disappeared. Researchers concluded that the oral contraceptives precipitated panic disorder with agoraphobia.)
Types of Anti-Anxiety Drugs
Several kinds of medications are prescribed for high anxiety. The major ones are tranquilizers, antidepressants, and non-benzodiazepines.
Benzodiazepine Tranquilizers
The minor tranquilizers, or benzodiazepines, include Ativan (lorazepam), Centrax (prazepam), Klonopin (clonazepam), Xanax (alprazolam), Serum (oxazepam), and Tranxene (chlorazepate). Benzodiazepine sedatives used for sleep include Dalmane (flurazepam), Halcion (triazolam), Versed (midazolam), and Restoril (temazepam).
These drugs reduce anxiety by depressing the activity of your central nervous system. All these drugs have the serious side effect of making you physically dependent on them, which means you’ll have a difficult time when you try to stop taking them, especially if you take high doses over a long period of time. If you’re taking Xanax or Halcion, withdrawal symptoms can occur daily between doses, worsening the original anxiety symptoms. To top it off, in one clinical trial, 70 percent of persons taking Halcion “developed memory loss, depression and paranoia.” Breggin and Cohen state that, like most psychiatric drugs, Halcion eventually causes an increase of the very symptoms that the drug is supposed to ameliorate.
Besides addiction and withdrawal reactions, if you take these drugs, you can face problems similar to those experienced by people who abuse alcohol, including intoxication without realizing it, slowed thinking, slurred speech, lack of coordination, clumsiness, impaired walking, tremor, poor judgment, drowsiness, drugged feelings, and hangovers with amnesia. These drugs work by impairing brain function and pose a risk of irreversible mental dysfunction. Students taking these drugs can experience severe amnesia and forget the material they studied.
These drugs may cause drowsiness, so avoid driving or other tasks that require alertness. Other possible side effects include depression, apathy, fatigue, decreased activity, light-headedness, memory impairment, disorientation, amnesia, restlessness, confusion, crying, delirium, headaches, slurred speech, loss of voice, stupor, seizures, coma, fainting, rigidity, tremor, abnormal muscle tone, vertigo, dizziness, euphoria, nervousness, irritability, difficulty concentrating, agitation, inability to perform complex mental functions, paralysis of half the body, unsteadiness, loss of coordination, strange dreams, glassy-eyed appearance, increased anxiety or hyperactivity, behavior problems, hysteria, psychosis, suicidal tendencies, constipation, diarrhea, dry mouth, coated tongue, sore gums, nausea, changes in appetite, vomiting, difficulty swallowing, increased salivation, stomach inflammation, incontinence, changes in sex drive, urinary and menstrual problems, changes in heart rhythm and blood pressure, cardiovascular collapse, retention of fluid in the face and ankles, palpitations, visual disturbances, twitching of the eyeballs, decreased hearing, nasal congestion, auditory disturbances, rashes, itching, hair loss or growth, hiccups, fever, sweating, tingling in the extremities, muscular disturbances, growth of breasts in males, milk production in the breasts of females, breathing difficulties, hepatitis or jaundice, changes in blood-cell counts, decrease in body weight, swelling of lymph nodes, and joint pain.
These drugs may increase levels or prolong the effects of barbiturates, narcotics, phenytoin, probenecid, and sedating antihistamines. They have potentially dangerous interactions with digoxin. When combined with alcohol and other medications, Xanax can cause death, even in low doses. When taking this medication or any other, never take more than is prescribed, and always ask to take the lowest dose that achieves the prescribed effect.
Xanax is the most popular tranquilizer and is used most often to treat anxiety disorders. If you have nonspecific, generalized anxiety, Xanax will probably be prescribed for you in doses of 0.5–2 mg/ day. If you have panic attacks, your health-care practitioner may prescribe 2–9 mg/day. Xanax is sometimes used temporarily for acute anxiety or agoraphobia.
Xanax, and other anti-anxiety drugs, are central nervous system (CNS) depressants. They affect the neurotransmitter gamma-aminobutyric acid (GABA) that facilitates communication between brain cells. Because brain cell activity is slowed, they can produce a drowsy or calming effect on those suffering from anxiety. In high doses, CNS depressants can be used as general anesthetics.
At first, Xanax may seem beneficial, but as your body becomes accustomed to the effects of the drug, its calming effects disappear as you develop a tolerance to it. This is when the potential for abuse of the drug occurs, as larger doses are needed to achieve the same initial effects.
While small doses may relieve tension, large doses produce staggering, blurred vision, impaired thinking, slurred speech, impaired perception of time and space, slowed reflexes and reduced sensitivity to pain. Accidental overdoses occur when children swallow pills—always keep all medication out of reach of children or adolescents—or when adults with increased tolerance are unsure of how many to take.
Researchers studying the 24 medical examiners in Florida in 2000 and 2001 concluded that in 939 cases of death (a tripling from 284 cases in 2000), prescription painkillers and benzodiazepine drugs such as Xanax or Valium were found. A U.S. Department of Justice website (www.usdoj.gov/ndic/pubs07/717.odd.htm) reported that the number of admissions to South Carolina publicly funded treatment centers for benzodiazepine abuse more than doubled from FY 1998 (43) to FY 2000 (99).
As a parent or individual, if you suspect you or someone else in the family is abusing Xanax, you can get a definitive answer by using a simple, private urine drug-testing kit available at www.homedrugtestingkit.com/zshop.
When prescribed an anti-anxiety drug, always read all the information provided by the pharmacist and beware of potential interactions with other drugs, foods, and substances such as alcohol.
A major problem with Xanax and other benzodiazepines is that they blunt not only your anxiety but your other feelings as well. I’ve had clients tell me that tranquilizers are like mental straitjackets that make them feel less human. If you’re simultaneously trying to work out your feelings in psychotherapy, tranquilizers will interfere with this process, especially if you’re on high doses of the drug. Like many other drugs, Xanax will only take away your anxiety, but it won’t remove the source of your feelings. When taking only tranquilizers, and not examining your lifestyle you may never be able to find out what is causing your anxiety or learn how to prevent or control your reactions.
A few people report becoming more emotional, more hostile, and have difficulty sleeping when taking Xanax. Panic can be doubled and seizures can occur if the dose is reduced too rapidly or if Xanax is abruptly stopped once dependence develops.
Xanax interacts negatively with melatonin, kava, valerian, grapefruit juice, and many other drugs, foods, and herbs. If you have alcoholic liver disease, are obese, or have reduced liver or kidney function, dangerous levels of Xanax may accumulate in your body. If you decide to take Xanax, use it for a short period of time on as “as-needed” basis rather than daily over a long time. Because rapid withdrawal may be life threatening, tapering off the drug should be done only under medical supervision.
Halcion can cause depression and paranoia. It has been banned in England.
Versed can cause behavioral abnormalities, and its emotionally disturbing effects are long-lasting. According to Breggin and Cohen, Versed should be considered a very hazardous drug.
Withdrawal from Klonopin may be easy for some people, although I’ve had clients who were unable to get off the drug completely even after protracted withdrawal. Abrupt withdrawal from these drugs is dangerous and can produce panic attacks, severe anxiety, confusion, muscle tension, irritability, insomnia, paranoid delusions, hallucinations, memory impairment, vomiting, headache, loss of appetite, tremor, voice changes, and even seizures.
In sum, Xanax and the other minor tranquilizers are more helpful for acute anxiety on a short-term basis than for long-lasting conditions such as agoraphobia. If you do take these drugs for more than two years, and especially if you’re over age fifty, you should have an evaluation of your liver function every six months or so.
Margaret, age thirty-three, a computer programmer, suffered from severe anxiety and panic attacks. Her physician prescribed Xanax, at a dosage of 5 mg a day. When Margaret started to develop frequent headaches, loss of appetite, strange dreams, and thoughts about killing herself, she increased her dosage without telling her physician. Luckily, her sister walked in when Margaret was trying to cut her wrists and brought her to the hospital. During her stay, her medications were reevaluated and she was taken off Xanax. She joined a cognitive-behavioral therapy group and learned ways to control her anxiety.
Antidepressants
Antidepressant medications are often prescribed to treat panic attacks, or agoraphobia with panic attacks. There are four different types of antidepressants:
1. Cyclic antidepressants such as Elavil (amitriptyline), Tofranil (imipramine), Pamelor (nortriptyline), Surmontil (trimipramine), Desyrel (trazodone), Sinequan (doxepin), Norpramin (desipramine), Vivactil (protriptyline), and Anafranil (clomipramine). According to Mindell and Hopkins, potential side effects or adverse reactions include dry mouth, blurred vision, problems focusing, increased eye pressure that can lead to glaucoma, dilation of the pupils, constipation, dysfunction of parts of the small intestine, urinary problems, drastic dips in blood pressure when going from lying to sitting or from sitting to standing, high blood pressure, heart rhythm abnormalities, congestive heart failure, stroke, electrocardiogram changes (suggesting damage to heart tissue), confusion, disturbed concentration, hallucinations, disorientation, impaired memory, feelings of unreality, delusions, anxiety, nervousness, restlessness, agitation, panic, insomnia, nightmares, mania, worsening of psychotic symptoms, drowsiness, dizziness, weakness, fatigue, headache, depression, excessive tension in the muscles or artery walls, sleep disorders, psychosomatic disorders, yawning, abnormal dreaming, migraines, depersonalization, irritability and mood swings, numbness, tingling, hyperactivity, lack of coordination, tremors, peripheral neuropathy (nerve changes in legs and arms), seizures, twitching, partial paralysis, allergic reactions (rash, itching, swelling), changes in blood-cell counts, nausea, vomiting, loss of appetite, diarrhea, flatulence, trouble swallowing, strange taste in the mouth, increased salivation, abdominal cramps, inflammation (stomach, throat, or esophagus), black tongue, indigestion, breast development and testicular swelling (in men), breast enlargement, spontaneous flow of milk, vaginitis and menstrual difficulties, changes in sex drive, painful ejaculation, voiding of urine during the night, cystitis, urinary-tract infection, changes in blood glucose levels, increase secretion of hormones (prolactin and vasopressin, an antidiuretic), pharnygitis, laryngitis, sinusitis, coughing, spasm of the breathing airways, nosebleed, shortness of breath, problems speaking, ringing of the ears, excessive tearing of the eyes, conjunctivitis, difference in the size of the pupils, inner-ear inflammation, eye allergy symptoms, nasal congestion, excessive appetite, body-weight changes, increased sweating, high body temperature, flushing, chills, hair loss, dental problems, abnormal skin odor, chest pain, fever, bad breath, thirst, back pain and joint aches, and increased sensitivity to the sun.
Henry, age twenty-two, a college senior, suffered from panic attacks. His primary-care physician prescribed Elavil. After two months Henry began to experience confusion, disturbed concentration, extreme anxiety, and worry that someone was trying to break into his room and poison him. His roommate took him to the university hospital ER, where he was admitted to the psychiatric unit and diagnosed with schizophrenia. When Henry was taken off Elavil his symptoms disappeared and he was discharged from the hospital. He worked with a cognitive-behavioral therapist on an outpatient basis and learned how to stay calm during stressful school situations.
2. MAO-inhibitors include Nardil (phenelzine), Parnate (tranylcypromine), and Marplan (isocarboxazid). These drugs can cause serious or even fatal rises in blood pressure when combined with: (1) foods that contain the amino acid tyramine, such as wine and certain meat; (2) stimulants and antidepressants; (3) over-the-counter medications, such as decongestants. If you are taking an MAO-inhibitor, you should be under close supervision by your physician. Be sure to watch for low blood pressure, extreme fevers, sexual dysfunction, daytime sleepiness, nighttime insomnia, muscle pain, and muscle spasms.
3. Selective serotonin reuptake inhibitors (SSRIs) include Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine). These drugs are used primarily to treat panic disorder, agoraphobia (six to twelve months), and obsessive-compulsive disorder (long-term maintenance). The SSRIs may also be used for generalized anxiety, especially when combined with depression.
According to Mindell and Hopkins, potential side effects include nervousness, insomnia, drowsiness, fatigue, weakness, tremor, increased sweating, dizziness, anxiety (especially with Prozac), headache (especially with Paxil), dry mouth (with Zoloft and Paxil), male sexual dysfunction (Zoloft), altered appetite and weight, and constipation (Paxil), and loss of appetite, nausea, diarrhea, and stomach discomfort (Prozac and Zoloft). Although weight loss may occur at first, many individuals experience weight gain after a period of months, which may lead to obesity.
Over 40,000 reports of adverse effects from Prozac have been submitted to the Food and Drug Administration since it was first marketed. No other drug comes close, according to Breggin and Cohen. They also state that these drugs can produce effects similar to amphetamine or methamphetamine, including an artificial feeling of well-being or energy, anxiety, agitation, and insomnia. Effexor (see below) and Prozac are stimulating, while the others cause drowsiness or insomnia. Like the amphetamines, these drugs can cause manic psychoses, and can also lead to less caring and loving attention to family members, as well as sexual dysfunction with mates.
Withdrawal from the drug can lead to “crashing” into depression and suicidal thoughts and actions. Breggin and Cohen report seeing patients who became very disturbed and violent when dosage was reduced, and others who reported feeling tortured from within, which may be related to the drug’s ability to cause self-destructive or violent behavior.
Numerous suicide and homicide cases have involved individuals who took SSRIs for as little as a few days. Because the drugs can cause agitation and anxiety, they may lead to increased use of alcohol and other calming drugs. SSRIs can cause drowsiness or dizziness. Use caution when driving, performing tasks requiring alertness, or operating machinery.
In research studies, between 15 and 21 percent of those on SSRIs stopped taking them due to unpleasant side effects. Rash, fever, joint pain, abnormal changes in blood-cell counts, swelling, excessive excretion of protein in the urine (indicating liver or kidney damage), and elevated enzymes in the bloodstream (also indicating tissue damage) have occurred in some people taking Prozac. If you are prescribed this drug and experience any of these symptoms, you are probably sensitive to it and should contact your health-care practitioner immediately to stop taking it. If you don’t, you may end up having a life-threatening anaphylactic shock reaction. In these cases the life-threatening nature of the reaction trumps the potential “crashing” reaction.
Connie, a thirty-eight-year-old university professor, was prescribed Prozac for her anxiety about lecturing to large groups of students. When she went to have her annual physical, the lab tests came back positive for liver and kidney damage. Her doctor immediately took her off Prozac and told her never to take the drug again because she was probably sensitive to it.
Serotonin syndrome is caused by taking an overdose of SSRIs or by an interaction of SSRIs with other drugs. It can be fatal. Symptoms include hallucinations, confusion, agitation, fever, fluctuating blood pressure, stiffness, irregular heartbeats, and seizures.
The effects of withdrawal from these drugs can include dizziness, headaches, nausea, poor concentration, fatigue, moodiness, and mental fogginess. Allow at least two weeks to slowly withdraw from these drugs and do it under the supervision of a health-care professional familiar with their use.
Clinical trials of these drugs have only lasted for five to sixteen weeks, except in the case of Prozac, which has been tested for up to a year. In other words, the long-term effects of these drugs have not been studied in any systematic fashion.
Avoid these drugs if you have impaired liver function, tend to be manic, have a history of seizures, or are using diuretics. If you are diabetic, Prozac can affect insulin levels, and your drug dose may need to be readjusted.
4. Other Antidepressants include Wellbutrin (bupropion), Asendin (amoxapine), Ludiomil (maprotiline), Remeron (mirtazapine), Effexor (venlafaxine), Serzone (nefazodone), and Desyrel (trazodone), and Zyban (buproprion).
Wellbutrin may be difficult to tolerate since its side effects include anxiety and insomnia, and it can produce a high rate of seizures and cause anxiety, nightmares, and manic psychoses. Asendin is converted into a neuroleptic within the body. Neuroleptics are chemical lobotomies that blunt the highest functions of the brain and result in apathy, indifference, emotional blandness, conformity, and submissiveness, as well as reduction in all verbalizations, including complaints or protests. According to Breggin and Cohen, these drugs are used in veterinary medicine to control violent animals, but only for a short period of time because they are considered so dangerous.
Ludiomil may produce seizures and involuntary abnormal movements, and Remeron can induce sedation, dizziness, weight gain, and low blood pressure. Heart and blood vessel problems have been reported in connection with both drugs, as well as toxic psychoses, including mania and delirium.
Effexor’s potentially negative effects are similar to Prozac’s and include anxiety, nervousness, insomnia, loss of appetite, and weight loss. Other effects of Effexor include agitation, mania, hostility, paranoid reactions, psychotic depression, toxic psychosis, and high blood pressure. Serzone is more likely to cause sleepiness than insomnia and can produce light-headedness, confusion, memory impairment, and low blood pressure, as well as hostility, paranoid reactions, suicidal thoughts and suicide attempts, depersonalization, and hallucinations. Desyrel is apt to cause sedation, dizziness, and fainting, as well as heart problems if you already have a cardiac diagnosis, and a kind of irreversible penile erection that may require surgical correction.
Drawbacks of all antidepressants include bothersome side effects (at least for the first week or two), which can be reduced by starting off with a very low dosage and gradually increasing the amount over two or three weeks. Other drawbacks are that antidepressants take two to four weeks to take effect, and panic and depressive symptoms can return after withdrawing from them.
Non-Benzodiazepines
Found in this category are Ambien (zolpidem), Atarax or Vistaril (hydroxyzine), Amytal (amobarbital), Butisol (butabarbital), Mebaral (Mephobarbital), Nembutal (pentobarbital), phenobarbital (generic), Seconal (secobarbital), and beta-adrenergic blockers (or, beta blockers), including Inderal (propranolol) and Tenormin (atenolol), BuSpar (buspirone), Miltown (meprobamate), and Trancopel (chlormezanone). Ambien, a sleep aid, can cause drowsiness, confusion, awkward gait, headache, nausea, fatigue (including dizziness and lack of coordination leading to falls), psychosis, hallucinations, nightmares, sensory disturbances, memory problems, and bizarre or dangerous behavior.
Atarax and Vistaril have antihistamine and sedative qualities.
Barbiturates (Amytal, Butisol, Mebaral, Nembutal, phenobarbital and Seconal) are prescribed to induce sleep and reduce anxiety. They are highly addictive and can produce toxic symptoms comparable to alcohol, including sedation, dizziness or light-headedness, vomiting, diarrhea, muscle cramps, slurred speech, poor judgment, clumsiness, and hangovers. They can also produce the opposite of what is wanted, namely hallucination, depression, excitement, hyperactivity, and aggression. Research has shown that phenobarbital can reduce IQ measurably.
Audrey, nineteen, a college student, went to the college health service because she was so anxious about taking tests and feared she wasn’t going to be able to stay in school. Seconal was prescribed to help her sleep and reduce her anxiety. Three days later, the college police picked her up on the road for acting confused, having slurred speech, and being unable to walk in a straight line. Her roommate, who was a student nurse, took her to see the physician who had prescribed the medication. Audrey was taken off Seconal and referred to an advanced psychiatric nurse practitioner to learn anxiety-reducing measures, which she did. A week later, Audrey was able to return to classes.
Beta blockers block muscular manifestations of anxiety, but may not reduce the internal experience of anxiety. They may be given in a single dose to relieve severe physical symptoms before a high-performance situation, such as public speaking, a job interview, final examinations, or a musical recital. The downside of these drugs is that they can cause congestive heart failure, heart attacks, strokes and asthma, irregular heartbeats, and may worsen blood vessel problems, which reduce circulation to the extremities, such as in diabetes. If you have asthma, avoid these drugs because they may trigger life-threatening airway spasms.
It’s not known how BuSpar (buspirone) works, but it is prescribed for the treatment of anxiety. Possible side effects include temporary or permanent damage to the nervous system, drug dependence, sedation, and withdrawal reactions. Adverse reactions have included dizziness, drowsiness, restlessness, nervousness, insomnia, nausea, light-headedness, headaches, numbness, dream disturbances, fatigue, sore throat, tinnitus (ringing in ears), and nasal congestion. Mindell and Hopkins advise thinking twice before taking this drug as there are so many other safer alternatives.
Buspirone may raise levels or prolong the effects of Haloperidol and MAO-inhibitors. An ordinary starting dose is 5 mg two to three times a day. It takes from two to three weeks before the effect of this medication is achieved. Some individuals get more anxious than they were prior to taking the drug.
Miltown is addictive and subject to abuse and can cause many of the adverse effects evoked by the other sedative drugs. Trancopel can also provoke many adverse effects, including depression, confusion, and severe skin rashes.
Procedure for Weaning Yourself from a Drug
If you’ve decided that you want to stop relying on prescription medications, observe the following guidelines:
1. Gain a level of mastery of the basic strategies for overcoming anxiety and panic presented in this book. For starters, establish a daily practice of deep relaxation and exercise, along with skills in deep abdominal breathing, self-talk, and muscle relaxation. Make sure you have adopted a healthier eating program and explore the use of herbs. These skills will help you through the withdrawal period from a drug. Be assured that any resurgence of anxiety is temporary and shouldn’t persist once you’ve completed the withdrawal process.
2. Consult with your physician to set up a program to gradually taper off the dosage of your medication. The tapering-off period is dependent on the dose you’re taking, but may go on for up to two months or longer.
3. Be prepared to increase your reliance on your new skills learned from working with this book during the tapering-off period. Additional skills you will need during this period include identifying and expressing your feelings and coping skills. Using these skills will provide you with the self-confidence to master your anxiety and panic without relying on medication.
Working with Your Physician
Before taking any medication, make sure you are fully aware of all the potential side effects and limitations of any drug you are prescribed. It is your physician’s responsibility to (1) obtain a complete history of your symptoms, (2) inform you of your diagnosis as well as the possible side effects and limitations for any drug you are asked to take, and (3) obtain your written informed consent to try out a medication.
As added protection, look up the prescription of a medication you’re considering in the Physicians’ Desk Reference (PDR). Your physician probably has a copy in the office, or you can look up the drug in the reference section of your library or search for the particular drug online.
Your responsibility is to fully inform your physician about any other drugs or supplements you are currently taking. Withholding information could lead to being prescribed a drug that interacts in a dangerous way with what you are already taking. It’s also important to tell your physician about any allergic reactions to drugs you’ve had, if you are pregnant, and if you are taking any over-the-counter medications or herbs.
Once you’ve exchanged this important information both of you will be fully informed, and you can make a mutual decision about whether taking a particular medication is in your best interest. If your current physician is unwilling to take this kind of collaborative approach, I strongly urge you to find another doctor—one who will. (See chapter 12 for more information.)
While anti-anxiety drugs may work well for you, use them safely by