Posted by: thealienist | September 29, 2014

Treatment with Antidepressants for Anxiety Disorders

Some of my patients get very confused with they are diagnosed with an anxiety disorder and are prescribed antidepressants.  It is not uncommon for them to have mixed feelings about this and to delay starting medications.  They look on the internet and see that their medications are made to treat depression, and they forget our discussion about how antidepressants are also good treatments for most kinds of anxiety.  Because of this, I want to take a moment to discuss the role of antidepressants in comprehensive treatment for anxiety.

First of all, I would like to note that most kinds of anxiety can be well treated without antidepressants.  Behavioral therapy and cognitive behavioral therapy are excellent treatments for anxiety.  Why then, you may ask, would someone want to take medications if they could get over their anxiety without it?  If this question has occurred to you, it probably means that you have not had an anxiety disorder.

My patients generally come to seek help because their anxiety problems have become so severe that they are taking control of their lives.  The inability to control worries or tolerate extreme panic symptoms have left them desperate for relief.  When they are informed that behavioral and cognitive-behavioral therapies are delayed in their ability to control anxiety, they often want a treatment that can work faster.  Many people who have never suffered from an anxiety disorder tremendously underestimate how distressing and disabling these conditions can be.  It is not uncommon for patients with untreated or under-treated anxiety disorders to become suicidal or resort to drug abuse to seek an end to their misery.

In the face of such suffering, it is only proper that patients be offered whatever treatments can restore them to a self-controlled life.  Antidepressant medications (along with other medications and therapies) can play a role in the treatment of most anxiety disorders including, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, and social anxiety disorder.  They are not seen as helpful for simple phobias.

In the case of generalized anxiety disorder, antidepressants will not prevent you from worrying.  They will likely help with some of the physical symptoms, such as poor sleep, tension, poor concentration, irritability, and poor appetite.  With regard to worry, you should be able to worry if you have something legitimate to worry about or if you simply feel the duty to worry.  On the other hand, the kinds of worrisome thoughts that come into your mind may not change at all.  What should change is your ability to set these thoughts aside if you want to.  The main difference between normal worry and worry in a person with generalized anxiety disorder is the ability to control the worry, not the content of the worry.

The situation is similar in obsessive-compulsive disorder.  The antidepressants will not make you unable to obsess or prevent your compulsions.  They may, however, give you more control over your obsessions and allow you to withhold your compulsive behaviors.  Again, the difference between sick and well is not the content of your thoughts, it is control of your thoughts.

In panic disorder, antidepressants are used to suppress panic attacks.  In many of my patients, they stop having panic attacks altogether.  Frequently, this is preceded by a period of having “abortive panic attacks” in which it feels as if a panic attack is about to hit but never occurs.

In posttraumatic stress disorder, antidepressants have the ability to reduce a broad variety of symptoms.  They can reduce the number and severity of distressing memories.  They can reduce avoidance behaviors.  They can improve control of anxious and irritable moods.  And they can improve the body’s ability to slow down, sleep, and concentrate.  They will not, however, “take away the trauma.”  The goal of treatment is not to make you as if you had never been traumatized, it is to make you as in control as a healthy person who experienced a trauma.

Finally, in social anxiety disorder, antidepressants will not make you a social butterfly; however, it should make you tolerably comfortable in social situations.  It should reduce the demands for avoidance.  It should allow you to engage in whatever activities you decide you want to without being limited by social fears.

I hope that it is evident in the above information what antidepressants can and cannot do.  They can be very helpful in returning control to patients who have felt out of control due to anxiety.  What patients do with this control is up to them.  Many will re-engage with their surroundings and live full and satisfying lives.  Others, though, will continue their anxious behaviors and, by themselves, will not receive the benefit the antidepressants can deliver.  These patients need the help of behavioral or cognitive-behavioral therapists to alter their behaviors, develop confidence in their abilities to confront and tolerate anxiety-provoking situations, and reassert their wills in their lives.  Sometimes patients need extra encouragement not to accept half treatments that leave them at the mercy of their anxiety.

Of course, the above potential benefits of antidepressants in anxiety need to be balanced by awareness of potential side effects of these medications.  This will require discussion with your doctor and possibly independent research as well.

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Responses

  1. Thank you

    Like

    • You are very welcome. I hope you found the post interesting and useful.

      Like


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