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Cutting Through the Hype About Anti-Anxiety Medication

Dissecting Recent Research

Cutting Through the Hype About Anti-Anxiety Medication

Medications designed to treat mental health conditions can be true life-savers. Indeed, studies show that people with severe and untreated mental illness die, on average, 20 years earlier than the general population. The right medication can level the playing field and protect people with mental health conditions from suicide, chronic depression, and the wear and tear a lifetime of mental illness can cause. A recent study purports to show that anti-anxiety medication increases the risk of premature death, and the news has spread like wildfire. But the risk is minimal and the study is preliminary, which means the benefits of anti-anxiety medications still outweigh the risks.

What the Study Actually Found

The study, published in the British Medical Journal, was large and well-designed, so its results are likely reliable. Researchers tracked 105,000 people for an average of seven years. Of study participants, 35,000 had been prescribed anti-anxiety medications. Researchers controlled for other risk factors, such as socioeconomic status, sex, and age, but found that the medications still increased the risk of death. According to researchers, the group taking anti-anxiety medications saw four extra deaths per every 100 people each year, on average. The study's creators estimate that this equates to a doubling of overall mortality.

Putting Things in Context

While researchers controlled for a variety of factors that could contribute to early mortality, there's one crucial factor for which researchers could not control. People who take anti-anxiety medications are not identical to those who don't – even when both groups have an anxiety disorder. It could be that people who are prescribed anti-anxiety medication are more anxious than those who have anxiety disorders but are not prescribed medication. We already know that anxiety increases the risk of death, so researchers could have stumbled on evidence that more severe anxiety yields a higher risk of death.

Further, although researchers controlled for other factors that could increase mortality, the study didn't create a clear comparison between two groups. For a study to clearly show that anti-anxiety medications lead to premature death, it would have to compare two groups of people with anxiety disorders – one taking medication and one avoiding it. The groups would need to have the same diagnoses and similar manifestations of symptoms for the most accurate comparison.

It's also important to note the length of the study, which tracked participants for an average of seven years. The overwhelming majority of people who take anti-anxiety medications do so on a short-term or intermittent basis, often as a stop-gap measure while they wait for therapy and other treatments to work. Previous studies have shown that long-term use of some anti-anxiety drugs can lead to cognitive impairments and other health problems. Because the study tracked participants over such a long period of time, it could be picking up the effects of long-term anti-anxiety medication usage.

All Medications Have Side Effects

Even if we take the study at face value and assume that anti-anxiety medications do increase the risk of death, this is not necessarily a reason to throw out all anti-anxiety medications. Every medication comes with some side effects. Birth control pills can cause fatal blood clots, for example, and many people are seriously allergic to popular antibiotics such as penicillin. Most people don't contemplate giving up these medications, though, because they treat health conditions.

The inclination to give up on anti-anxiety medication is part of the ongoing challenge of mental health stigma. Because anxiety disorders affect the brain and not the body, the inclination is to conceive of them as less real, and perhaps even to blame people with these disorders for their conditions. When we believe that anxiety disorders are less serious than other health conditions, we're much more inclined to avoid treatment because of a small risk.

Anti-Anxiety Medication Can Save Lives

What the study did not evaluate and therefore cannot speak to is the ways in which anti-anxiety medications can save lives. People with anxiety disorders are at an increased risk of suicide and self-harm. One study even found that 75% of people who attempt suicide qualify for a diagnosis with at least one anxiety disorder. Anti-anxiety medication – when prescribed properly – can reduce this risk.

Anti-anxiety medications also improve overall quality of life. Some people with anxiety disorders struggle to work, complete daily tasks, or interact with their families. The right medication can make such an undertaking easier. In some cases, this may even improve life expectancy. For example, a person who is able to work a meaningful job will be better equipped to pay for potentially life-saving health care than someone who can't work at all.

Getting the Right Treatment

One issue to which the study does call attention is the over-reliance on anti-anxiety medications. We've long known that patients with anxiety disorders do best when they're given a combination of therapy and medication in conjunction with healthy lifestyle remedies, such as exercise. Perhaps this study can serve as a push for mental health professionals to embrace a combination of several treatments.

Anti-anxiety medications are also a common source of prescription drug addiction. This study may encourage addicts to get clean and give doctors an incentive to re-evaluate each anti-anxiety medication prescription they write. Caution in medicine almost always helps patients, and more cautious psychiatrists may be willing to try alternative treatments, lower medication dosages, and lifestyle remedies.

References:

Anti-anxiety drugs, sleeping pills linked to risk of death. (2014, March 31). Retrieved from http://www.sciencedaily.com/releases/2014/03/140331130846.htm

Lethal discrimination [PDF]. (2013, September). Rethink Mental Illness.

McAndrews, M. P., Weiss, R. T., Sandor, P., Taylor, A., Carlen, P. L., & Shapiro, C. M. (2003). Cognitive effects of long-term benzodiazepine use in older adults. Human Psychopharmacology: Clinical and Experimental, 18(1), 51-57. doi: 10.1002/hup.453

 

Joel Young, M.D., who teaches psychiatry at Wayne State University, is the Medical Director of the Rochester Center for Behavioral Medicine, near Detroit.

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