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I spend a lot of my professional life dealing with anxious people. Of course, there are many ways to deal (or not) with anxiety.  There are two general approaches: a) suppress it or b) mitigate it. The latter is preferable for it actually ‘deals’ with anxiety. Unfortunately this takes time, energy – and courage – to master. Counseling, meditation, yoga, guided imagery, and breathing /relaxation techniques all have efficacy in the treatment of anxiety disorders. Unfortunately they take time, effort -and courage. Alas, it seems fewer patients are interested or willing to do so. *

When I diagnose a patient with anxiety I always point out the conservative option of non-pharmaceuticals such as cognitive behavioral therapy for their condition.

Most of the patients opt for tranquilizers.

Tranquilizers such as Ativan, Xanax,Klonopin, and Valium are in the benzodiazepine family, They work in the ‘a’ category viz. they suppress the sympathetic nervous system (the ‘accelerator”)

Non-pharmaceuticals work mostly by strengthening the parasympathetic nervous system (the ’brakes”).

To be frank, I don’t like working with tranquilizers. Thems that take ‘benzos’ are often very intolerant of feeling any anxiousness; they want it stamped out which often means desiring to take as much valium/xanax etc. as possible.  There is constant haggling to get more. I have to constantly police the refills to make sure patients are not taking more than prescribed. Because the patients are often not dealing with their issues, attempts at suppressing anxiety through medication (and habit forming ones at that) don’t often quite work enough.

There is more data coming-out long time regular use of benzodiazepine medications like xanax leads to earlier onset of dementia and puts one at risk for falls. Normally if I bring up ‘long time risks’ of medication this  evokes “Oh! I don’t want to take that then!”  Not so with tranquilizers. “But I need xanax!” is what I often hear when I propose they may not need them anymore.

The treatment of chronic anxiety is slowly assimilating the philosophy of chronic pain. The goal there is not to eliminate pain but to get it down to a dull roar and have the patient learn to live with pain and not let it consume or dominate.  Patients with chronic mood disorders are more accepting of this notion than patients with anxiety.

I’d be curious to find the statistics of how many tranquilizers are consumed in the USA compared to other countries.  We seem to be a very anxious nation, and we deal with it using drugs/alcohol, pills and foolish activities. In my job I try to get people to find better means. And for those who opt for prescriptions only, I set limits on expectations – and count the xanax pills as they go out.

 

* Of course there is a certain bias in the type of patient who comes to me. I see the types either ‘open to the notion of medication’ or seeking that.  People ‘against meds’ and/or  interested in non-pharmaceutical treatments for mood/anxiety aren’t coming in usually. They go to counseling, yoga class, etc.

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