ISSUE #53 cont'd --- Medications

Photo by Caer Weber

PART II cont'd

ANTI-ANXIETY MEDICATIONS:

SIDE EFFECTS

and

SAFETY CONCERNS

The problem of addiction:

One of the first big concerns and side effects from some anti-anxiety medications, particularly the Benzodiazepines, is the problem with addiction. So let me tell you what my understanding of addiction is. It is a strong and often disabling dependence on something, that something often being drugs of some kind. However, many people can become addicted to other things such as food, the internet, computers, work, sex, exercise, shopping and many other things.

Many of us, once something gives us a lot of pleasure and makes us feel really good, want that something over and over. Makes sense right? Now if we have been feeling really anxious and fearful and then we take a drug that helps relax us and bring us relief from that anxiety, well it’s not surprising that many of us are going to want to continue taking that medication.

But addiction isn’t just about consuming something over and over. It goes further than that. It’s about something called “tolerance” too. Addiction is also when the amount we take begins to not be enough to make us feel better and we need to take more to get the same effect as we did originally. Then that amount becomes “not enough” and we need even more and so on until we are taking a high amount of the substance.

Addiction is also about being mentally consumed and seriously preoccupied with whatever we are addicted to. We start to think about it more and more and become very preoccupied with the next time we are going to consume that thing or substance. Very severe addiction is all-consuming and blots out anything else in life. At that stage, we will stop at almost nothing to get what it is we are addicted to.

A number of years ago I was seriously addicted to Ativan, a Benzodiazepine. I started with only 2 pills a day (I think they were 1mg each). By the end of it I was taking about 20 to 30 pills a day. Amazingly, my body adjusted to the high amounts of Ativan and I could still function pretty well.

Not only is the addiction a serious situation but having to stop the addiction and suffer the withdrawal symptoms can be absolutely debilitating as well. Benzodiazepine withdrawal is particularly symptomatic with a very high number of serious withdrawal side effects. Bottom line ... don’t even get started. If you choose to take a Benzodiazepine be very aware and monitor the amount you take. If you are starting to increase the dosage in order to get the same relief you are in trouble and should immediately talk to your prescribing doctor about it. Don’t let it drag on because you will pay physically and mentally for it when you have to stop taking it. As well, your doctor should have you come off a Benzodiazepine quite slowly so that you will suffer less withdrawal side effects.

So, there are some signs to watch out for that might, and I emphasize “might”, be saying you have an addiction problem and should talk to your prescribing doctor about it. Not everyone gets addicted. However, if you have been taking the medication for about 4 months or more and you ...

- rely heavily on them to cope

- have tried to cut down or stop them and felt ill, anxious or had unusual   
   symptoms such as sleeplessness
- feel they are not having the same effect as at first and so you have increased  
  your dosage
- take extra during stress
- find they are interfering with your life such as taking lots of sick days, having
  more relationship problems than before, have difficulty coping or  
  remembering things
- are always making sure you don’t run out
- are carrying them with you “just in case”

If you do become addicted and want to quit get help from your prescribing doctor or pharmacist on how to do it and slowly decrease the dosage over a period of time. If you stop abruptly you will most likely experience some very nasty symptoms such as increased anxiety, insomnia, confusion, pounding heart, sweating and/or shaking. And even if you do withdraw slowly you may still experience symptoms such as anxiety, insomnia and/or depression which may last for months. Often people return to the medication thinking their original problem has returned.

Side effects of Benzodiazepines and tranquilizers:

You might ask what’s wrong with being addicted to an anti-anxiety medication. So what if I’m taking higher doses? Well there are usually side effects from many medications and Benzodiazepines and other tranquilizers are no exception. These drugs reduce your brain activity and can cause you to feel sleepy, quite foggy and not very clear-minded, uncoordinated and clumsy, and can cause problems with driving and with you functioning well at work or school. Some people feel a “hangover” the next day which isn’t a lot of fun either. Your speech may become slurred, and you may become confused and disoriented. You may experience depression as well. You may have dizziness, lightheadedness, impaired thinking or judgment, memory loss, forgetfulness, or nausea. Your vision may become blurred or doubled. Long-term use may also increase the risk of depressive symptoms and suicidal thoughts and feelings or cause emotional blunting or numbness. They may also block feelings of pleasure or pain

Side effects of other medications:
You may be taking an anti-depressant, beta-blocker or Buspirone, instead for your anxiety. These drugs too, can give you side effects. Anti-depressants can cause nausea, nervousness, headaches, sleepiness, sexual dysfunction, dizziness, stomach upset and/or weight gain. Also, although dependence is not so much an issue with antidepressants, withdrawal from them can be difficult. If stopped too quickly they can trigger symptoms such as extreme depression, fatigue, irritability, anxiety, flu-like symptoms and/or insomnia. Consult your doctor about withdrawing any medication

Buspirone can cause nausea, headaches, dizziness, drowsiness, constipation,

diarrhea, and/or dry mouth. Beta-blockers can cause light-headedness, sleepiness, nausea, and/or an unusually slow pulse.

Paradoxical effects of anti-anxiety medications:

Although most people experience more sedating type symptoms some people may actually experience the opposite and have “paradoxical excitement” where their anxiety is increased rather than decreased and they may also feel quite irritable and agitated as well. More severe but quite rare effects can be mania (see Glossary up top), hostility and rage, aggressive or impulsive behaviour or even hallucinations (see Glossary).

Safety concerns:

There is always the possibility of drug interactions and even drug overdose with any medication. ALWAYS MAKE SURE you tell your prescribing doctor and/or pharmacist what other medications and even over-the-counter drugs in case of any possible negative interactions. If anti-anxiety medications are combined with other central nervous system depressants, the risk of toxic effects increases. Mixing some of these medications with alcohol, prescription painkillers or sleeping pills can be deadly. There can sometimes be dangerous interactions with antihistamines that are found in many over-the-counter cold and allergy medicines.

If you decide to take an anti-anxiety medication

• Avoid alcohol. Alcohol and anxiety medications don’t mix. The combination can be lethal. But even in less toxic doses, alcohol and anxiety medication can cause poor coordination and impaired thinking, increasing the risk of motor vehicle accidents and other injuries.
• Monitor your medication response. Keep a close eye on your reaction to the anxiety medication, including any physical and emotional changes you’re experiencing. Everyone reacts differently to medications, so it’s impossible to predict what side effects you will have or how well your anxiety drug will work. If you’re taking benzodiazepines (Valium, Xanax, etc.), don’t drive or operate heavy machinery until you know how the drug affects you.
• Talk to your doctor. Be open and honest about any side effects caused by your anxiety medication. Don’t be afraid to discuss problems or concerns. And while you should never stop your anxiety medication without talking to your doctor first, ultimately the decision is up to you. If you’re unhappy with how the drug makes you feel, ask your doctor to help you taper off.
• Continue therapy. Medication can control the symptoms of anxiety, but it doesn’t treat the underlying problem. Therefore, it’s crucial to pursue therapy or some other form of anxiety treatment. Therapy can help you get to the root of your anxiety problem and develop better coping skills.

Next time ...

Part IV

Other options for relief of anxiety