Doctors worry as the over-stressed turn to pills
Published Tuesday, June 26, 2012 8:12AM EDT
Last Updated Tuesday, June 26, 2012 8:50AM EDT
It’s often said we live in an “age of anxiety,” working longer and harder than ever, trying to stay connected, stay current and stay in touch, but feeling we can’t keep up.
We’re worried about our jobs, our kids, and our inability to “switch off” our brains at the end of the day.
It’s not surprising, then, that many turn to their doctors for help. Ask around and chances are good you know someone who is taking antidepressants to calm nagging worries, sedatives to sleep, or someone who keeps a quiet stash of some kind of "mother's little helper" to quickly calm them.
Back in the Rolling Stones era, it was Valium that got the chronically over-stressed “through their busy days.” These days, it’s Valium's cousins in the benzodiazepine family: Xanax, Ativan, clonazepam and others.
In the U.S., Xanax was the eighth-most prescribed drug in 2010, according to SDI, a data firm that tracks prescription drug sales.
In Canada, venlafaxine, or Effexor, an antidepressant frequently used to treat anxiety, was the seventh most dispensed drug in Canada in 2010, according to IMS Brogan, a Canadian-based tracking firm. Ativan and its generic version, lorazepam, were the 13th and 18th, respectively.
For many with severe anxiety disorders, these medications are literal life-savers, helping to keep them afloat amid a sea of drowning phobias. But concerns have been growing for years that too many prescriptions for these powerful medications are being written, with little concern for their dangers.
Those dangers have been starkly highlighted by a slate of Hollywood celebrities who have died recently with multiple anxiety medications in their systems:
- Actor Heath Ledger died by combining painkillers oxycodone and hydrocodone along with three benzos: Valium, Xanax and Restoril, a benzo often used as a sleep aid
- Anna Nicole Smith had four benzodiazepines and the sedative chloral hydrate in her system when she died in 2007
- Whitney Houston was taking a cocktail of prescription drugs at the time of her drowning death, including at least three benzodiazepines: Xanax, Ativan and Valium.
Anti-anxiety pills didn’t directly cause any of these deaths, but what’s striking is how many prescriptions these celebrities managed to obtain. And yet, it is somehow because “normal” in some circles for the highly successful to have a stash or two of pills to keep them going.
An article in New York Magazine this spring painted a picture of happily over-stressed Manhattanite professionals who seemed to wear their anxiety like badges of honour, believing it to be “the engine that keeps them going, that gives them an edge.” When the stress of their ever-so-busy lives became too overwhelming, they slipped tablets of clonazepam or Xanax, to help level them out.
“Anti-anxiety drugs are the salvation of those for whom opting out of the to-do list isn’t an option,” the article’s author wrote.
Dr. Peggy Richter, the director of Sunnybrook Hospital's Clinic for OCD and Related Disorders in Toronto, believes anti-anxiety medications are often mis-prescribed.
“A lot of people do get prescriptions for benzodiazepenes through lack of understanding and often, misdiagnosis,” Richter says.
The pills are highly effective at quickly reducing overwhelming feelings of stress and anxiety. But Richter worries that some are getting prescriptions for the wrong reasons.
“It’s not uncommon for patients to see their family doctor and say, ‘I’m feeling anxious, I’m not sleeping well, I fell edgy, I’m having trouble focusing.’ And the doctor will hear, ‘Oh you’re not sleeping well? There’s something we can offer’,” Richter says.
While Xanax and its ilk might calm worries in the short term, they are notoriously addictive. In fact, dependency problems can kick in after just a few weeks of regular use.
What makes these medications popular with doctors -- that they are highly effective and then leave the body quickly – is also what makes them problematic. Because the drugs quickly fade, it’s not uncommon for users to begin taking more, in an attempt to maintain their effect.
Soon, that “one pill, once in a while” becomes several pills, several times a day.
Richter says a regular user who suddenly decides to kick their benzo habit will typically find themselves smack up against withdrawal syndrome, with feelings of insomnia and anxiety rebounding worse than ever.
"So the drug symptoms that lead a patient to go on the drug seem worse and make it hard to get off it," she says.
Richter says many users also convince themselves they can’t get through panic symptoms without pills, not realizing that by the time any pill takes effect, panic symptoms often clear up on their own.
"So the drug may do nothing. But they attribute their improvement to the pill. They get on this cycle of taking a pill when they notice symptoms. And that's when the dose can escalate," she says.
Richter’s other key worry is that when doctors are quick to write a prescription, they may miss a diagnosis of a genuine anxiety disorder that requires more than just fast-acting pills to treat.
Ignoring deeper health concerns
According to Health Canada, about 12 per cent of Canadians suffer an anxiety disorder – a rate that hasn’t changed much in decades. These disorders run the gamut from social phobias to panic disorders, obsessive compulsive disorder and post-traumatic stress disorder, or PTSD.
Taken as a group, anxiety disorders are in fact the most common of all mental illnesses – more common even than depression, though the two conditions often overlap.
Those with the most severe forms often have phobias that fully debilitate them, sometimes leaving them unable to leave the house.
Then there are the so-called “functionally anxious,” those with milder forms of disorders who manage to appear healthy, but who harbour quiet storms of fear inside them.
Dr. Katy Kamkar, a clinical psychologist at the Centre for Addiction and Mental Health (CAMH) explains that while it’s normal to feel anxious from time to time, for those with an anxiety disorder, their “fight or flight” instinct is always turned on and can’t be shut off, even when there is no objective reason to be anxious.
Some may be able to hold down jobs, but they are often plagued by nightmares, struggle to concentrate and carry with constant worry they can’t shake.
“It’s really when anxiety becomes overwhelming and prolonged and we are unable to relax, this is the anxiety that has become dysfunctional,” explains Kamkar, who’s part of CAMH’s Work, Stress, and Health Program.
Those with anxiety disorders also typically feel they are incapable of handling their fears, Kamkar says.
“Maximum anxiety occurs when we overestimate the threat and we underestimate our capacity to cope. You need both for the recipe for maximum anxiety,” she says.
Both Richter and Kamkar say with proper treatment, severe anxiety can be managed. In fact, they’re considered one of the most treatable psychological disorders.
A form of talk therapy called cognitive behavioral therapy, or CBT, has been shown to be quite effective. The therapy involves identifying the thought processes that lead to the buildup of anxiety. Then, the patient is helped to find new ways to frame problems in their head and to find solutions.
The important thing for people who realize they are overwhelmed and exhausted from constant worrying and fretting is to speak up and ask for help.
“Many people suffer in silence,” says Richter. "They may think, ‘This is just the way I am’-- particularly those with mild social anxiety disorder or mild generalized anxiety disorder. They may think ‘I’m just shy, I’m just a worrywart’."
“What many don’t realize is that with proper treatment, they can overcome this.”