If you aren’t a wee bit anxious, you have either been living in a cave for the last few years or you pay zero attention to the news. An awful lot of your friends, neighbors and family members have been suffering from anxiety. That’s in part because of frightening headlines about COVID-19, war and the economy. Are there ways of coping with anxiety that do not involve drugs?
If You Are Not Anxious Sometimes, You Are Unique:
Anxiety is a normal part of life. If you see a policeman’s blue light flashing behind you, adrenaline will start to surge. Standing up in front of an audience to give a talk can also make many people anxious.
Our ancestors required a dose of anxiety to survive. If they didn’t get a shot of adrenaline (aka epinephrine) when being chased by a saber-toothed tiger, chances were good they would not have survived. A little anxiety keeps us alert and prepared to flee when faced with danger.
Anxiety Alerts Us to Danger and Prompts Action:
The problems many people are facing today are quite different from short-term threats. Once the police car goes by you without pulling you over, you breathe a sigh of relief and go on your merry way. Your pulse and breathing return to normal and you stop sweating.
Sadly, many of today’s problems are not going away anytime soon. COVID cases are once again rising. The stock market has been on a roller coaster ride, but the trend has been down. Inflation is up and everyone worries about the cost of eggs. No matter what their political persuasion, breathless pundits drive a lot of people crazy.
Meditation vs. Medication:
When patients seek relief for long-standing anxiety, doctors often prescribe anti-anxiety medications. While these can be helpful, they have some well-recognized drawbacks. Is there an alternative? A randomized controlled trial demonstrated an effective way of coping with anxiety without drugs (JAMA Psychiatry, Nov. 9, 2022).
The study included more than 200 people compared mindfulness-based stress reduction to the medication escitalopram, also known by its brand name Lexapro. Trial volunteers took the medication or attended mindfulness training sessions and practiced at home for eight weeks.
Results of the Trial:
By the end of that time, people in both groups were measurably less anxious. (To assess this, the investigators used a standardized tool called the Global Clinical Impression of Severity scale.) During the trial, 8 percent of those in the medication group dropped out due to side effects. More than three-fourths of those taking escitalopram reported reactions such as trouble sleeping, nausea, fatigue, headache, daytime drowsiness or sexual difficulties. No one dropped out of the mindfulness group, although about a tenth of them felt more anxious at some point during the trial.
The bottom line: Mindfulness works as well against anxiety disorder as medication, without the complications. Psychiatrists commenting on the article pointed out, though, that the practice of mindfulness required time. Many anxious people may not feel they have the time they need to meditate or complete the daily 45-minute home practice.
Drugs for Coping with Anxiety:
To really understand the use of medicines for anxiety, a historical perspective might help. For centuries, people have used alcohol to try to calm their nerves. The trouble is that this drug creates many more problems than it solves, especially if people start to rely on it.
Doctors began prescribing sedatives in the 19th century. Chloral hydrate was an early version. It was developed in 1832 but it wasn’t used medicinally until 1869. That makes it one of our oldest anti-anxiety medicines.
It gained notoriety for its part in the “Mickey Finn,” also known as knockout drops. Folklore claims that bartenders in cahoots with sea captains would slip chloral hydrate into a drink. The hapless sailor would pass out and wake up on board a ship, miles from shore.
Barbiturates for Coping with Anxiety:
Barbiturates were synthesized around the same time, but doctors did not start prescribing them until the turn of the 20th century. While they proved useful as anesthetics, doctors also prescribed drugs like pentobarbital, phenobarbital and secobarbital to deal with insomnia or anxiety.
These medications were widely prescribed and commercially very successful for the drug companies that made them. At one point, there were 60 different barbiturates marketed around the world. It is estimated that 100 tons of barbiturates were sold in the U.S. in 1939, also a time of great anxiety (Journal of the Royal Society of Medicine, Dec. 2004).
These “sedatives” may have taken the edge off, but they were easily abused. In overdose or combined with alcohol, they could be quite lethal. People who accidentally died because of barbiturate overdose or a deadly interaction include Marilyn Monroe, Judy Garland and Margaux Hemingway.
Doctors began to realize that barbiturates were not a very good strategy for coping with anxiety. The drugs were classified as “controlled substances” in 1971 and were subject to strict limits on prescribing.
The Rise of Benzos for Coping with Anxiety:
Physicians treating patients for anxiety (or anxiety-induced insomnia) turned next to benzodiazepines (“benzos”). The first was chlordiazepoxide (Librium), followed soon afterwards by diazepam (Valium). Drugs in this category are still prescribed, although they are often considered inappropriate for older adults.
One reason for concern is a connection with dementia. Susan wrote:
“I read about a study that showed an increased risk of dementia in elderly patients taking clonazepam. My mother has been on this medication for about 18 months since my father died. (She’s now 87.)
“My sister and I are definitely noticing signs of confusion, memory problems and cognitive impairment. We wonder if it’s related to this drug.”
The connection between benzos and dementia is controversial. One recent review concluded that there seems to be an association in older adults (European Geriatric Medicine, Feb. 2022). Another analysis questioned the linkage and calls for future research to asses this risk carefully (British Journal of Clinical Pharmacology, Feb. 2022).
You can read more about benzodiazepines and dementia at this link.
Getting Off Benzos Can Be Challenging:
We do know that such drugs can be challenging to discontinue. Someone who is barely coping with anxiety may ask a doctor for “something to calm the nerves and help with sleep.” The doctor may not mention how hard it is to discontinue benzos, especially shorting acting ones like alprazolam.
Brenda offers her story:
“I took Xanax [alprazolam] for twenty years, never more than prescribed (0.5 mg at night and half that at noon). Gradually I weaned myself down to just half. Then I decided to get off it entirely, so I only took a quarter of a tablet for a long time.
“I started having severe dizzy spells that made me fall to the floor. I had no idea it was withdrawal from Xanax. Once I stopped altogether, I started having more symptoms like severe shaking.
“When the shaking happened, I took half a pill, and the shaking stopped. My doctor switched me to Valium [diazepam], which worked well at first. Now it’s two years later, and I’m having anxiety symptoms. I’ve been told it’s because I have reached tolerance.”
What Brenda’s doctors did was substitute a long-acting benzo for a shorter-acting one. That doesn’t do anything for her underlying anxiety and won’t be much easier to stop.
Non-Drug Approaches to Coping with Anxiety:
Discontinuation of anti-anxiety agents can take many weeks of very gradual tapering under medical supervision. Non-drug approaches to managing anxiety, such as cognitive behavioral therapy (CBT), offer another option.
Earlier this year we interviewed Jeffrey D. Rediger, MD, MDiv. He is medical director for the McLean SouthEast Adult Psychiatric Programs and an assistant professor of psychiatry at Harvard Medical School. He has a Master of Divinity degree from Princeton Theological Seminary and publishes in the fields of medicine, psychiatry and spirituality. Dr. Rediger is the author of Cured: Strengthen Your Immune System and Heal Your Life.
You can listen to radio show #1287:
Managing Stress and Anxiety During COVID
The pandemic has put enormous strain on young people, health care workers, and a range of other people. We have tips for managing stress.
Here is a link to the podcast. You can stream the free audio by clicking on the arrow in the green circle under Dr. Rediger’s photo or you can download the mp3 file by clicking on the link at the bottom of the page.
You may also find this free guide to Psychological Side Effects of some value.
Share your own story about coping with anxiety in the comment section below. How have medications like alprazolam or clonidine worked for you? If you think this article was helpful, please share it with a friend or family member.