When I was an adjunct, teaching pharmacology to prospective pharmaceutical science degree candidates, I had a student who was an amateur actor with a local theater. He was preparing to perform in a musical called “Next to Normal.” To support my student, I attended the production. To my delight as a pharmacist and educator, the play was about how a typical American household deals with mental health disorders.
Although the play addressed manic depression, there is a song in the play called “My Psychopharmacologist and I.” The lyrics explore the plethora of medications available today for a variety of mental health disorders and were sang in a melodious and humorous way, poking fun at the various drugs, shapes, sizes and the side effects associated with adjusting to the changes the body undergoes when trying to find the right combination to make the patient feel “Next to Normal.”
This raised the question: what is normal today and what is my role as a health care professional in defining and treating illnesses that fall out of center from defined normalcy? This article will focus on anxiety disorder and the modern treatments available today.
When to approach a doctor?
Everyone has feelings of nervousness or anxiety. When these feelings are prolonged or interfere with function level to conduct everyday tasks, it might be time to see a doctor to discuss if the problem is serious enough to consider treatment.
The mental health professional will have the tools necessary to assess anxiety levels and explore treatment options. There are a variety of symptoms associated with anxiety disorder that range from feeling edgy, tightness in the chest or stomach and even tiredness. Certain patients experience nausea and vomiting.
Treatment regimen recommendations may include psychotherapy and medication. Medicine can be used to treat severe depression or anxiety. Your doctor will decide the right medicines based on assessment results.
A population of patients may opt for self-treatment or herbal medicines. Kava kava and valerian are often sold with claims of anxiety treatment but there is no verifiable evidence of the efficacy or safety when using these products. They may interact with other medicines or supplements that you are taking so always check with your doctor or pharmacist before starting an herbal supplement.
Prescription medications include the following drug classifications:
- Anti-anxiety (Xanax, Valium)
- Selective serotonin reuptake inhibitors (SSRI)
Anti-anxiety drugs. Celexa, an antidepressant SSRI would be one example in this class although there are several drugs in this class. Xanax and Valium are also known as benzodiazepines and often calm patients with anxiety due to their sedative hypnotic properties. Benzodiazepines have a calming effect due to their sedative properties. Benzodiazepines work by inducing the feelings of drowsiness and sleep.
Benzodiazepines interact with barbiturates and a TB drug called rifampin. Patients taking any of these medications should not use alcohol. Benzodiazepines have an immediate effect.
Antidepressants relieve symptoms by affecting brain chemicals called neurotransmitters and make more of certain chemicals available such as serotonin which plays a key role in moods, sleep and other body functions.
Selective serotonin reuptake inhibitors (SSRI) examples include Citalopram, Escitalopram, Fluoxetine, Fluvoxamine and Paroxetine. SSRIs work by keeping the serotonin your brain produces available instead of reabsorbing or re-uptake. Clinical studies show that patients with depression and anxiety have lower levels of serotonin. It generally takes two to four weeks for patients to feel the full effect of SSRIs. Patients taking SSRIs should not take non-steroidal anti-inflammatory drugs such as ibuprofen, medications for blood clots such as warfarin.
Other drug classes used to treat anxiety may include anticonvulsants, antihistamines and buspirone (an old drug called Buspar).
Patients who are using any of these medications long term should be monitored regularly. If discontinuation is desired it may be helpful for the patient to undergo cognitive behavioral therapy prior to discontinuing treatment. Those who are wishing to discontinue therapy should be tapered and monitored.
Side effects may be out-weighed
Side effects are one of the major concerns of anti-anxiety medications. Some of the side effects of SSRIs include nausea, vomiting, headache, appetite loss, weight loss or gain, dizziness, blurred vision and dry mouth.
Benzodiazepines cause drowsiness, dizziness and increased appetite. Patients should drive with caution and use caution when operating machinery.
Sometimes the medications will have the opposite effect instead of the intended one. This is why finding a caring physician who is willing to help you navigate what works for you and what does not is important.
Other times, the therapeutic effect will out-weigh a side effect. Results are individualized and subjective to patient experience.
There are ongoing trials that are necessary to decide the effects, side effects and therapeutic effects for every medication.
The good news is there is much less of a social stigma in seeking treatment for mental health disorders than there was in the 1980s or before when such illnesses were less defined. There is no shame in asking for help.
There is often humor found in the ordinary and the extraordinary. If you want to experience a fun poking at the modern view of mental health, I suggest you find and read the lyrics to “My Psychopharmacologist and I.” You can listen to it on YouTube. It will make you feel better about yourself and the problems we face together as a society.
The mental health professional will have the tools necessary to assess your anxiety levels and explore treatment options.
Treatment regimen recommendations may include psychotherapy and medication. A population of patients may opt for self-treatment or herbal medicines.
Prescription medications include SSRIs, benzodiazepines (also known as sedative-hypnotics), anticonvulsants, antihistamines and buspirone. This article has focused on SSRIs and benzodiazepines as these classes are the more standard treatment today.
They may interact with other medicines or supplements that you are taking so check with your doctor or pharmacist before starting any treatment.
Side effects of anti-anxiety drugs may be out-weighed by the therapeutic effect. Results are individualized and subjective to patient experience.
Cartwright, C., Gibson, K., Read, J., Cowan, O., Dehar, T. (2016). Long-term antidepressant use: patient perspectives of benefits and adverse effects - PMC (nih.gov). Patient Prefer Adherence.