Aren’t There Drugs for That?

Yes, there are medications for anxiety. Why am I not taking them?

A year after my first panic attack, my therapeutic plan was to force myself to drive and continue to get onto highways, the stimulus for my panic attacks. You know, “getting back on the horse.” It wasn’t the worst strategy ever. One might charitably call it a version of exposure therapy, one of the most effective forms of treatment for phobias, such as the phobia I’d spontaneously developed of driving on the highway.

My therapy, not supervised by a trained cognitive behavioral therapist, but rather directed by my naïve ideas gleaned from an undergraduate second major in psychology, was pretty much a colossal failure. The panic attacks became more frequent, intense, and debilitating. I was pulling off the road with panic attacks at smaller and smaller intervals, and on smaller and smaller roads. Anxiety was creeping into other realms of my life. At that rate, it seemed that soon I wouldn’t even be able to drive myself to work.

At the same time, likely related, I was sliding into depression and desperation. Fortunately, that meant I finally sought help. At first I was adamant that I only wanted psychotherapy and not medications, because I believed psychological problems shouldn’t be addressed with medications. I’m not sure where this idea came from, a cultural bias, perhaps, but it crumbled quickly when my therapist reminded me that I wouldn’t refuse antibiotics for strep throat. Depression and anxiety have genetic components and are caused by (or cause) chemical imbalances in the brain. Why not treat them with chemicals?

The first disappointment about using medications for me were not the side effects, which I didn’t really notice until later (15 pounds later, to be specific). I began the medications during a swell of excitement for SSRIs (like Prozac and Paxil) a new class of anti-depressants that had very few side effects compared to older medications such as the tricyclics and MAOIs. To be fair, the side effects I experienced were mild: weight gain and later vivid daily nightmares respectively from two different SSRIs and some mental fog from the sedatives.

No, I was disenchanted because the medicines weren’t magic. I had apparently hoped they’d miraculously turn me back into the comparatively carefree person I imagined myself before the first panic attack. After months to get to a therapeutic dose, the antidepressant only took the edge of my depression and the added sedative (a barbiturate) took the edge off my panic. But I wasn’t cured. I could drive back and forth from work, but only as long as I’d taken my Xanax a half an hour before getting behind the wheel each time. And I could sleep at night—and not be awakened by panic—only if I took two Xanax before bed. And I still couldn’t drive on the highway. It felt like I had reached a very low plateau with little hope of getting better.

I was on my third or fourth therapist when I began to feel that psychotherapy didn’t seem very helpful, either. When I stopped seeing the last therapist I made a half-hearted attempt to find someone new.  (Though it wasn’t cognitive behavioral therapy at the time, the most effective therapy for anxiety disorders).

My psychiatrist, who was in charge of my medications (but not my therapy), was a smart, accommodating man. He tried me on various combination therapies; he explained new medications as they came out. After about ten years of seeing this psychiatrist on and off, I told him that this state—just barely able to drive, barely above clinical depression—wasn’t good enough. His solution was to add another medicine, and if that didn’t work, try yet another combination.

I thought about all the medications I was taking—two for allergies, one for stomach acid, an antidepressant, and a sedative around the clock. Suddenly I just wanted to get off that ride. I was exhausted by the raised and dashed hopes with each new medication regimen: upping my dosages, adding more drugs, and trying new ones. Each time I experienced side effects from taking or stopping another medicine. I also worried that no studies had been done on the long-term effects of these medications and in these combinations.  The drugs were shown to be safe for six months or a year, and were presumed to be safe indefinitely.

Maybe if the medications had worked more effectively for me the risk would have seemed worth it. But I was functional, that’s all. Worse, I hated the feeling that I needed to keep dosing myself with Xanax just to reach a tolerable level of anxiety (a kind of drug to which people often build up a tolerance, and has a significant risk for addiction with long-term use.) Additionally, I knew I was gaining none of the mental resources myself to quiet my mind. Wasn’t there a psychological toll of depending on medications to feel mentally okay?

I don’t mean to disparage anyone who is helped by psycho-pharmaceuticals, or a combination of drugs and therapy. I just despaired of these drugs helping me. Some people’s lives depend on these medications and the devastating effects of some psychological illnesses are far worse than any side effects of medication. My decision, with my doctor’s approval, to face the anxiety and depression without the medication, is a personal choice, not a suggestion for others.

Has it worked? At first, after stopping the medications, I was elated because I really didn’t seem any worse. Maybe I was slightly better, now that I had to actively practice dealing with the anxiety. I felt vindicated. Over the months, however, I became slowly more anxious and depressed. When it became unbearable (this is my pattern), I sought a new therapist. Since then I have improved and become much more hopeful. All that is to say, I know it’d be completely premature and naïve to declare any sort of victory, but right now, I am optimistic.

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