Anxiety feels highly unpleasant. Anxious feelings can torment you. They can feel as unbearable as physical pain. Drug companies recommend anti-anxiety pills. TV ads promulgate pills. Many physicians write a pill prescription as the best route to feeling calmer. In my clinical practice, by contrast, I find that non-pill treatment methods help in all but the most and chronic extreme cases. And they help without the downsides of anti-anxiety medications.
Why not take anti-anxiety medications?
Medication as the first line of treatment for anxiety feels great. It's just the later down-the-line results that can prove to be significantly problematic.
The growing awareness of the dangers of taking opioid medications for physical pain gives an important perspective on the downsides of anxiety-pain pills.
Twenty years ago, physician Russell Portenoy, a prominent New York pain specialist, spearheaded the movement that encouraged doctors to prescribe painkiller medications. This movement helped many suffering patients and at the same time was based on naivete with regard to the dangers of addiction.
Now Portenoy has come full circle. He has become a leader in warning physicians and the general public of the addictive potential of painkillers. For brief acute pain like when someone is recovering from a surgery, painkillers pose less addiction risk. For on-going long-term problems, addiction is a major issue. The high from these drugs, and the body's craving for the drugs, takes over.
The Wall Street Journal reported back in December 2012 (12-15-2012) that 16,500 people die of overdoses annually from pain medications, more than from all illegal drugs combined. Opioid use has only increased since that time. Like Dr. Portenoy, many doctors by now have dramatically decreased the frequency with which they prescribe opioid pills to quell physical pain.
Is it as problematic to take pills for easing painful feelings of anxiety as it is to take pills for easing physical pain?
For patients with extreme anxiety, medication can feel like a godsend. Sufferers can relax. They can live normal lives.
Sadly, however, physicians often prescribe anti-anxiety medications to decrease milder anxious feelings like worry, stress, and stomach butterflies. Over-prescribing, rather than prescribing per se, is the main problem.
In addition, using anti-anxiety medications for any reason over many months or years invites addiction problems. While brief use to calm a short-term episode of over-whelming anxiety may be worthwhile, wariness is appropriate. Easing one's difficulty—anxiety—by causing an equal or worse difficulty—addiction—is inappropriate.
Here's what an early reader of this article wrote to me about her experience with anti-anxiety medications.
The reader's harrowing experience merits sharing, so I have added it to the article:
I have had anxiety for many years. I have tried different prescribed RX. Paxil, Valium, Xanax, SSRIs.
Paxil was very difficult to stop taking. I would try and lower the dose and felt I couldn't do it, I needed another RX. I quit cold turkey, didn't feel great and doctors do not recommend that method.
The most difficult was Xanax. Took it, felt great. In a short period of time I felt hooked. I would count the pills so I would be sure I had enough before my next renewal. Then I noticed I was taking a little bit more, a little bit more. It pulls you in and you feel you can't live without it.
When I would go to the grocery store for my renewal I felt shamed. I felt weak that I could not get out of this situation. Then they increased the milligrams. Even better, felt great. Nothing changed. I felt pulled in and owned by Xanax. Counting pills—I was sick of the whole situation.
One February, I decided this is it. We go through a couple months of juniper berry allergy season. I always felt lousy during that time anyway so I decided to get off the Xanax merry-go-round.
I felt miserable, sick to my stomach and body aches. Some of this may have been the allergy time of year. I know getting off the Xanax also was making my sick. It took probably a month. I wasn't violently ill every day. The beginning was the worst.
I did it, and I will never go back to that place of feeling hooked. In recent articles they are linking valium to dementia.
Like opioids for physical pain, benzodiazepine anti-anxiety drugs are highly addictive. SSRI medications create drug dependency.
Benzodiazepine medications, with familiar names such as Halcion, Klonopin, Librium, Resteril, Valium and Xanax, are among the most widely prescribed pharmaceuticals in America, and also the deadliest.
To prevent addiction from benzodiazepines, doctors and nurse practitioners are increasingly prescribing antidepressant drugs (SSRIs like Zoloft, Paxil, Prozac, etc.) instead to relieve anxiety because some of them have sedative (relaxing) side effects.
The drug companies claim that these medications are not addictive. That's because antidepressant drugs do not produce a craving. People do not get up in the morning thinking "I can't wait to take my next antidepressant pill!" These medications do, however, make you drug dependent.
Drug dependent is the same as addicted but without feelings of craving. Ceasing the use of antidepressant medications once you have been on them for some time can trigger an intense withdrawal-induced depression, a depression that may be even worse than the original anxiety and/or depression. The drug withdrawal reaction may also include physically ill feelings. Your doctor can help you to taper off very slowly—and sometimes even then ending the pills may trigger a drug-withdrawal response.
Can anxiety be good for you?
Anxiety, like physical pain, can serve as a valuable signal. It tells you that a troubling situation is brewing. Like a blinking yellow traffic light, anxious feelings signal, "Pay attention. There's a problem ahead that merits addressing!"
Because anxiety warns you to a potential danger, a best first response to anxiety is to gather information about the problem. Then map an effective plan of action. With an action plan, the anxiety is likely to lift.
Anxiety in this regard is like a good angel. It arrives to give you an important message. Once you have adequately addressed the problem that the anxiety is warning you about, the anxiety will have accomplished its mission. It then usually disappears of its own accord.
When does anxiety need psychotherapy treatment?
Sustained anxiety occurs when:
- the anxiety gets stronger and stronger because you are not yet moving forward to gather information and find solutions to the problem
- worrying—that is, repeated worst-case-scenario "what if" thoughts—keeps fanning the anxiety flames
- an earlier incident or prolonged difficult time in your life left your amygdala chronically aroused, leaving you prone to hyper-emotional responses to minor negative events and/or chronically feeling on alert for something bad to happen.
How can a psychological treatment potentially reduce anxious feelings?
Pill-giving is a get-rid-of-that-feeling-without-listening-to-its-message approach. Psychotherapists, by contrast, help anxious clients to identify the underlying concerns triggering their anxiety. They then help them to map a plan of action to address these concerns.
Therapists sometimes quote the mantra "the best antidote for anxiety is information." Think, for instance, of when you have worried that you have a serious physical problem. Speaking to a physician who explains that your symptoms are benign—or tells you what the problem is and how to handle it—dissipates the anxious feelings.
Therapists also reduce anxiety with cognitive-behavioral approaches (CBT). These techniques clarify thought patterns, such as worrying and catastrophizing, that exacerbate anxious feelings. CBT therapists then teach new options to diminish the likelihood of future anxiety episodes.
What if the anxiety doesn't go away once you have received its message?
Track down earlier life experiences that may have triggered a similar frightened feeling. For instance, if a dog once bit you, you are likely to feel anxious any time a dog comes near. Once those root experiences have come to light, overly strong feelings in response to a current situation make sense. Your body is reacting now as if the earlier experience were about to happen again.
Clarifying what is different now, in the present situation, from in the earlier one can release the anxious feelings. Practice this visualization on your own, or with the help of a friend or a therapist.
Here's a summary list of a number of non-pill anti-anxiety treatment options:
- Couples or family therapy if the stressful situation is occurring in your marriage or other relationship
- NLP such as Steve Andreas demonstrates in this video
- Emotion Code therapy
- CBT (cognitive behavioral treatment)
- Mindfulness training
- EFT, also called acupoint tapping or Emotional Freedom Technique
- Visualization self-help techniques
- Deep relaxation, yoga, exercise, sunshine, adequate sleep, time with friends, meditation, or use of the device called Resperate that trains your breathing to slow down to meditative-like rhythms
- EMDR to release impacts of prior trauma (which EFT also does)
In sum, should you use medications for anxiety?
Ending worry habits and utilizing the other non-pill psychotherapy techniques listed above generally can quell anxious feelings without your needing to resort to drugs. Use medications as a last resort.
For anxiety arising from a clear problem that you see ahead, start by using the following recipe:
- Look squarely at a problem that has triggered anxious feelings.
- List all the concerns that come to mind as you think about the problem.
- Gather further information about it, as needed.
- Create a plan of action for dealing with the situation more effectively.
For the problem-solving sequence above it can be helpful to talk with a friend or relative about the problem. Two are better than one for generating new ideas about a strategy for dealing with tough situations.
So next time you feel anxious, aim first and foremost to relieve your anxiety by addressing the anxiety-engendering problem. This strategy will reap additional bonuses. Find the blessing in the curse by gaining deepened self-understanding, self-acceptance, and psychological wisdom. Go for it!
Susan Heitler, educated at Harvard and NYU, trains therapists across the U.S. in anxiety therapy techniques and authored Prescriptions Without Pills.