Pharmaceutical Interventions for Fear and Anxiety

Continuing with the theme of coping with fear and anxiety, I want to talk about pharmaceutical options for increasing your coping abilities.

ALWAYS get the advice of a mental health professional before deciding if meds are or are not appropriate in your situation. In my particular situation, they are not appropriate … at the moment. That could change. Everyone who takes care of me (my family, my therapist, my doctor) is on alert to watch for changes that might signify it is time to get out the meds. I am at high risk from taking medication (if there is a side effect to anything, I’ll have to deal with it, I can’t even handle children’s cold medicine) so it is lower on the list of choices for me than it would be for someone who tolerates medication better. Also, my anxiety symptoms (chest pain) are tolerable most of the time: I’ve had to use Ativan on occasion, but once I learned that the pain is not an indication of a pending heart attack and that although it hurts really badly it will fade if I just rest for awhile, I stopped trying to use the medication to make the pain go away. It didn’t really work anyway, I just had severe chest pain *and* I was sleepy. However, Ativan did help me get through a rather unpleasant hour in the dentist’s chair, so I’m glad I have a few tablets just in case.

Antidepressants can be very useful with chronic pain, with anxiety, and with several other issues. Don’t feel like you’re a loser if you need them: if you needed insulin, you’d take it, if your brain needs help balancing the chemicals, take the help. You’ll be very glad you did. St John’s Wort might be worth a trial. It is well tolerated by most people, and for me it starts making a difference in less than week (YMMV). TALK TO YOUR PHARMACIST before taking it though, as it may interact with other medications you are on, and absolutely never take it with other antidepressants. You won’t feel much different on medication, usually, you just manage to cope better with life. Side effects are real problems, though, so be sure to work closely with your pharmacist and doctor to find a medication and dosage that will make your life better and not worse.

If your body is giving you trouble with physical anxiety symptoms (panic attacks and so forth), getting those under control will allow you to do the mental work of resolving the underlying problems … harder to do when you can’t shut the body up long enough to think straight. With anxiety, it’s important to understand that just numbing the symptoms is not going to make the cause of the anxiety go away – you have to do that work yourself by changing the way you think (which will almost certainly require professional help). The anxiolytic medications are ‘compassionate measures’ that make life bearable and give you the ability to think clearly while you work on addressing the cause of the fear. If you’re terrified of going outside, for instance, the Ativan will make the shakes and queasiness and overwhelming feeling of panic go away, but you’ll still be scared to go outside the next time you try. It’s like taking painkillers when you have a broken arm: the morphine will take away the pain, but the arm still needs to be set and cast and taken care of so it can heal. Ativan is a painkiller, not a cure. Nothing wrong with painkillers though, so long as you are also treating the underlying problem!

For insomnia, be very careful with sleep medication. It has it’s place, believe me, but be careful as it can cause worse problems and is not safe for everyone, depending on other conditions (blood pressure issues, sleep apnea, kidney problems, etc). The first thing to do is get rid of stimulants in your diet: no caffiene, not at all, not even in the morning. Do all the things you’re supposed to do to have a good night’s rest. If that’s still not working, try some herbs. In order of increasing effectiveness in my opinion: Sleepytime Tea (which we can get at the grocery store and is safe for everyone, even children), catnip (yes, it’s a sedative for humans and makes a decent tasting tea), valerian root (get it in capsules, it tastes VILE, like someone’s old hockey gear or something), wild lettuce tincture (wild lettuce is legal in Canada and the US, you can get dried stuff from Richters’: soak in vodka or something similar for a few weeks, storing in a dark place and shaking daily, then strain and take one to three tablespoons at bedtime … it also tastes vile but it works without a hangover). You can also check at the health food store or the herbal aisle of the drugstore: London Drugs has a “Sleep Relax” mixture in capsules that works quite well, and is a mixture of several of these herbs plus chammomile and other relaxing things. These herbs are all believed to be safe for everyone (barring allergy to the plants involved), though pregnant and nursing women should exercise caution and speak to a health care professional before using them. Prescription or OTC sleep meds might be useful if the herbals don’t work, but unless you’ve been awake for weeks despite practicing good sleep hygiene and trying all the herbs you can think of, I wouldn’t try it. Too many risks involved, including dependency.

Above all, DO NOT MIX MEDS … if you take anything regularly, ask your pharmacist before trying anything, even “natural” stuff. Just because it grows on a plant doesn’t make it harmless … foxglove grows in the garden but it’ll kill you if you eat it.