Written by Ron Sterling, M.D. and Published in Northwest Prime Time Magazine
by Ron Sterling, M.D. -- January 2005
It should be noted that there is a large amount of misunderstanding and stigma related to the use of anti-anxiety medications. Although anti-anxiety medications can be very helpful, unlike most antidepressants, they do not appear to provide our brains or bodies with a biological fix that lasts, so they are vulnerable to being classified as "habituating."
"Addiction" and "habituation" are complex and value-laden terms. In a society that values willpower, independence, and discipline, people with chronic anxiety often find themselves wondering why they "just can't get it together." Addiction is possible, but does not occur very often with appropriate use of anti-anxiety medications. The primary sign of addiction is the development of tolerance -- having to use larger amounts of medication to get the same positive results. What does take place more often with anti-anxiety medications is a "discontinuation syndrome" that mimics some of the well-known addiction withdrawal symptoms. A discontinuation syndrome does not necessarily indicate addiction.
Providing a long-term medication solution for a biological deficit, such as diabetes, is not viewed as producing "habituation," although a person with diabetes will likely always need to take a medication. "Withdrawing" from such a necessary diabetic medication could not only be difficult and ill-advised, but also life-threatening. It seems that only in matters of the brain do we have difficulty accepting that a brain deficit may require long-term use of a medication.
Many medications, including antidepressants, can have positive effects on anxiety. Anxiety can be part of clinical depression, attention deficit disorder, schizophrenia, bipolar disorder, and other, primarily brain-based mental illnesses. By treating the underlying disorder, the medication may clear up many of the anxiety symptoms.
In this column, I am only going to address the more specific anxiety of disorders such as phobias, obsessive-compulsive, general anxiety, social anxiety, panic, posttraumatic stress, and performance anxiety. I classify anti-anxiety medications into two categories: (1) assist more with anticipatory anxiety or (2) assist more with the peripheral symptoms of an anxiety episode (reduce shakiness, sweating, blood pressure, flashbacks, etc.).
Those that assist more with anticipatory reactions are primarily the benzodiazepines -- alprazolam (Xanax® -- short-acting), clonazepam (Klonopin® -- medium-acting), diazepam (Valium® -- long-acting). Several antidepressants are known to be helpful with panic disorder in preventing panic attacks, but they often can cause side effects if there is no co-existing clinical depression. Therefore, sometimes, the side-effects of antidepressants may need to be tolerated to get the positive effects of preventing panic attacks. One class of antidepressants has been shown to be very helpful for social phobia, but they are not often used -- the monoamine oxidase inhibitors (MAOIs) phenelzine (Nardil®) and tranylcypromine (Parnate®).
Those that assist more with the actual symptoms of an anxiety episode are primarily beta blockers and one alpha-blocker, which are more often used to treat heart conditions and high blood pressure. These include the alpha blocker, prazosin (Minipress®), and the beta blockers, propranolol (Inderal®) and atenolol (Tenormin®).
Prazosin has been shown to be effective in reducing the night terrors, nightmares and flashbacks of posttraumatic stress disorder, and the beta blockers have been shown to prevent the shakiness, numbness, disorientation, and increased blood pressure associated with performance and social anxiety. The beta blockers are used on demand, just prior to a potentially challenging social or performance situation. Many symphony musicians and other performers utilize beta blockers to reduce the peripheral effects of anxiety so that performances are improved.
I hope this is helpful. For more information about anti-anxiety medications, please visit www.MentalWellness.ws. -- Best wishes, Dr. Ron.
Ron Sterling, M.D. is a 64 year-old General and Geriatric Psychiatrist with a private practice in Seattle. He invites you to e-mail him at with any questions about mental wellness or emotional, relationship, or aging concerns. He is the only person who reads e-mail sent to Dr. Ron. Please be assured that your questions and identities are completely confidential and protected. For more information about Dr. Ron and for resources related to senior mental health, please go to SeniorMentalHealth.org. The content offered through Mind Matters is for information only and is not intended for medical, psychiatric, or psychological diagnosis or treatment. Never disregard professional advice or delay seeking it because of something you have read in this column. Read our Disclaimer. If you wish to understand more about Dr. Sterling's potential biases in health care advocacy, please check his Conflicts of Interest Disclosure Statement
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RON STERLING, M.D.
General Psychiatry with Specialization in Adult Attention Deficit Disorder
Updated October 7, 2007
Copyright 2000-2007. Ron Sterling, M.D. All Rights Reserved.
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