Just wanted to post a few simple tips I think would be helpful for people thinking of using medication or who have questions. If it would be helpful to sticky this, please do. And if you believe any corrections need to be made let me know. I'm not a doctor, and these are just tips I believe would be beneficial. Medication has brought me back from the brink, allowing me to live a productive and normal life while working on my issues with my therapist.
Medication isn't for everyone, but it can help many people. If you are struggling to live a normal life, experience serious anxiety or panic attacks, and aren't finding relief through things like meditation, therapy, relaxation techniques, exercise, proper diet, etc., then medication can be the key to balancing your life, stabilizing things, and allowing you to reduce your anxiety to focus on true healing.
Before I start I just wanted to define the two major types of drugs used to treat anxiety.
Benzodiazepine- Benzo for short. These are fast acting drugs that are used to treat anxiety or panic attacks quickly and effectively. They can go into effect within 15 minutes to an hour of taking it, depending on the drug. The effects are quick and pronounced, producing a sense of calm. The correct dose is usually enough to firmly knock the edge off of steady anxiety, or pull you out of a panic attack. The most common side effect is drowsiness. Ideally, they should be used as needed, but many find they need them daily. Taking increasingly large amounts for a long period of time (months) can lead to addiction and tolerance, requiring more to get the same effect. If taken for an extended period of time, the use of them must be slowly reduced to avoid withdrawal symptoms. The most common benzos are Xanax, Ativan, Valium, Klonopin and Valium.
SSRI- Stands for Selective Seratonin Reuptake Inhibitor. While technically an "antidepressant", they are very commonly used to treat anxiety disorders. These take weeks, even up to a month or two depending on the drug, to begin seeing any positive effects. The drug takes time to build up in your system, but ideally will lower your overall anxiety. These are often prescribed with a benzo that you continue to take as needed, and can reduce as the SSRI begins to take effect. There are many possible side effects, and they vary widely based on the drug. Many can slightly interrupt your sleep or raise your anxiety at the beginning. Sexual side effects are also reported, ranging from lowered sex drive to increased difficulty in achieving orgasm. When used for a long period of time, they must be slowly tapered down to reduce withdrawal effects. The most common SSRI's are Paxil, Zoloft, Lexapro, Celexa and Prozac.
1. Don't be afraid of taking medication
It can be easy for the thought of medication to add to anxiety. The idea of taking a drug that will alter how you function and put you into some form altered state can be very disturbing. Don't be afraid. These medications were made specifically to work on anxiety, and are taken by millions of people around the world. It can and will help, and side effects can be minimized by following these tips.
2. If you can, meet with a psychiatrist instead of a general practitioner.
Often times normal doctors don't know very much about drugs for anxiety, and will not approach it correctly. I spoke with an individual here whose general practitioner simply prescribed her 1mg of Klonopin, 3 times daily. This was several times higher than it should have been, and in a few months she was horribly addicted. Psychiatrists are experienced with these drugs, and know how to start and stop them safely, as well as which drugs work the best. If money is tight, call around for a psychiatrist that offers a sliding scale. Normal doctors (and urgent care clinics) should only be used for small amounts of a benzo in an emergency or for a specific instance (ie a flight).
3. ALWAYS combine medication with therapy
Medication is a bandaid and will simply cover up the symptoms. While incredibly useful for being able to return to living a functional life, they will not address the symptoms, and the end goal is to be able to live normally without medication. Aggressively pursue therapy until you no longer need medication.
4. Benzos for short term relief, SSRI for long term
Some people need benzos for long term, but ideally you do not want to stay on a daily dose for an extended period of time as addiction and tolerance can set in within a few months and withdrawal can be painful. The standard medication plan involves starting an SSRI with a benzo on hand. You may need the benzo daily for the first few weeks, but as the SSRI kicks in you will need it less and less, only for when panic is very serious.
5. Start low and slow
With benzos, try and find the lowest effective dose and stick to it. For me, I found .5mg of ativan, a relatively small dose, was enough to provide relief for hours. There were only one or two occasions where I found 1mg to be necessary. Do your best to not increase the dose, but do it if necessary.
For SSRI's, the very beginning is when side effects are most pronounced. An inexperienced doctor may start you at the target dose. This is what produces heavy side effects and should be avoided. Slowly work your way up to a heavier dose. When I started lexapro, I did a week at 5mg, 3 weeks at 10mg, then topped out at 15mg and started to feel relief. I experienced very minimal side effects. Slowly introducing it to your body will reduce side effects.
6. When ready, slowly reduce the dose
If you have been on benzos for an extended period of time, work closely with your doctor to slowly taper off the dose. Do not immediately cease if you have been using them for months. The withdrawal effects can be severe. Slowly reduce your daily dose over a period of weeks (and in extreme cases, months) to slowly wean your body off the drug.
The same goes for SSRI's. It varies depending on the drug, but you will want to slowly teach your body to function without it. Immediately stopping can be a shock to your system, and cause "rebound anxiety". Slowly reduce the dose over a long period of time.
7. Discuss methods to reduce side effects with your doctor
In addition to starting low and slow, there are many ways to reduce side effects. Depending on the drug, taking it with or without food can be helpful with nausea or other stomach issues. Taking it before bed can largely eliminate side effects.
8. If you experience side effects, work to manage them and understand they will go away
Side effects often only last for a few days, or weeks at the most. It is simply your body getting adjusted to the drug. What you experience will dissipate quickly. Do your best to power through the rough days at the beginning (if it happens to you) and get to a point where the side effects go away.
9. Depending on your type of anxiety, do NOT research the drug or read side effect lists
Those with health related anxiety or certain types of anxiety should avoid researching reviews of the drug or reading side effect lists AT ALL COSTS. All it will do is add to your anxiety as you imagine yourself having extreme side effects. Every drug has a handful of bad reactions and extreme side effects, but these happen in EXTREMELY rare cases, almost all when not using these tips (like starting low and slow), or coming off of them immediately. Ask your doctor questions, but do NOT go online and end up scaring yourself by irrationally focusing on the most extreme, unlikely scenarios.
That being said, for some people online reviews may help. I remember reading some reviews for Lexapro right after being prescribed it, and feeling an immediate sense of relief after reading several rave reviews in a row. I was able to ignore the one or two bad reviews citing extremely unlikely effects. Only do this if you are sure you will be able to do the same- if you have the slightest thought that it may increase your anxiety, DON'T!
10. Work closely with your doctor
Ask any questions that come up. Get as comfortable as possible with them. Call if you have questions.
11. Don't be embarrassed
Tens of millions of people around the world need medication at some point to level out. We live in an incredibly stressful world and it can be tough.
Let me know if you have any questions, changes, or tips you think should be added. I wanted to share this because of the enormously positive impact the responsible use of medication has had on my life.