Medications

by Ken Strong
Any gathering of anxious people will undoubtedly produce questions on medications--such as these from the Internet.  
 
-- "I'm starting Inderal tomorrow. What can I expect?"  
 
--"My doctor just gave me Elavil. Should I take it?"  
 
--"I started Luvox 2 days ago and feel electric shocks.  
 
Is this normal?"  
 
--"I don't believe in medications."  
 
--"I'm frightened to take anything. I hear such terrible stories."  
 
--"After that experience I won't try another drug."  
 
--"My doctor tells me I am microsensitive to medications."  
 
--"My doctor wants me to change drugs but I don't want to."  
 
--"I'm going to just quit that drug."  
 
--"I'm taking Paxil and it turned my life around."  
 
--"I'm now taking Rivotril and find myself much better. It wasn't the first drug I tried and it isn't the complete answer."  
 
Some of the anti-anxiety drugs are very potent. Some of the drugs do produce severe side effects in some people. Some can be addictive. Some people take the drugs with very few or no side effects.  
 
So which of the above statements are valid?  
 
All of them. Let's take them one at a time.  
 
"I don't believe in medications." Fair enough. It's their body and they have a perfect right to refuse the drugs. The problem here is that their type of anxiety may respond very well to one or more of the wide variety of relatively safe medications. The support person may want to ask a number of questions about why medications are refused so adamantly. What is the reason for the refusal? Is it based on fear of drugs or a philosophical/religious belief? Is the fear of swallowing involved? Is it a fear of giving up control of the body's chemistry to an outside force? Is it fair to themselves and to the family not to try the drugs? What will insurance companies do if the doctor reports that the patient is not following instructions? These questions have to be worked out at the family level but not in a way which adds unmanageable fear, stress and guilt. (Who said you didn't have to have the wisdom of Solomon at times -- and the patience of Job?)  
 
"My doctor just gave me Elavil. Should I take it?" Here they are going to be receiving feedback from several people. More than likely they are looking for reassurance, but whether or not they receive it depends upon the group they ask. When asking others for feedback on taking new drugs, it is likely that a variety of answers and contradictory experiences will be offered. If the decision is made not to take the drugs then the doctor should be notified. Perhaps the doctor has some other ideas or can alleviate the fears.  
 
"I started Luvox 2 days ago and feel electric shocks. Is this normal?" Again, the person is probably looking for reassurance that this is not some horrible unknown side effect. The doctor can give the assurance. Several inexpensive paperbacks are now available describing possible side effects. You should also know that anxious people are hyper aware of changes in body states e.g. a small change in heart beat pattern will be quickly noticed.  
 
"I'm frightened to take anything. I hear such terrible stories." Many drugs do have unwanted side effects. The doctor will probably mention some of the common ones as well as those that can be dangerous--if any. The doctor probably will not mention side effects, which occur in only 1% or 5% of the people taking them.  
 
So why do they hear such terrible stories? The side effects do occur; get a large enough group together and several people have either had the side effect or 'know someone' who has. Couple this with the high anxiety level present in these people and it is a situation which, while very much a concern to them, is blown out of proportion. It does little good to cajole or ridicule; their fear is real. I have always made it a habit to be around for a while when a person starts a new drug.  
 
Another aspect is that people with anxiety disorders have already lost some control over the way their bodies react and don't want to give up any more control by using drugs.  
 
"After that experience I won't try another drug." If a bad experience is had with one drug it is only natural that some fear will be involved in trying another one. Again, I don't give them meaningless statements like, "Nothing will happen." You can't guarantee that. You can just promise to be present when they do start it. Some prefer to start off with a small piece of the tablet if the doctor agrees. However, don't push; many will come around to taking it in their own time. If not, there is little you can do. The final decision is theirs.  
 
"My doctor tells me I am microsensitive to medications." Some people are so very sensitive to medications they react to normal amounts as though they have been huge amounts. If the cause is not found early, they develop the feeling they can't take anything.  
 
Cutting the pill into smaller pieces may help. Another method is to dissolve the pill in water and drink just a certain amount of the water. For instance, To take 1/8 of the pill, dissolve it into 1 cup of water and drink 1/8 of the water. Even if the pill does not dissolve it may be possible to smash it into small pieces and swirl the water so rapidly, the pill particles are not sitting in the bottom. Before the particles settle, pour off the desired amount.  
 
Also, you could see if the medication comes in a liquid form. With the liquid form, any small amount can with taken.  
 
Before cutting, smashing or dissolving the pill, ask your doctor or pharmacist if it is safe to do so. Some pills have a coating on them, which prevent them from dissolving in the stomach where they may be deactivated. The coating does not allow them to dissolve until they reach the small intestine. Others have a coating to protect the esophagus from irritation.  
 
A word of warning. If you are going to smash or cut a pill first place it between two sheets of wax paper. This way the family will not be searching the whole kitchen for pieces which flew away and/or your family pet will not be licking up pieces of pills which could do strange this to them.  
 
"My doctor wants me to change drugs but I don't want to." Why does the doctor want them to change drugs? Is there something better out now or is insufficient progress being made with the current drug? Ask. If the person isn't capable of making sure they get a clear answer have them give the doctor permission to talk to you about it. It would be very helpful to find why the anxious person does not wish to change drugs. It may be a fear of reacting to something new or a Psychological dependency on the current drug. Talk it out if you can - calmly. Don't expect to always receive entirely rational reasons. Remember the person may be acting from a fear base, not a rational base. That they may be acting from a fear base does not make the reason any less valid or less real to them.  
 
"I'm going to just quit that drug." No way! Get medical advice. Just stopping many of these drugs cold can have dangerous effects. It is also a good idea to keep a few weeks supply of the drug on hand at all times in case some natural disaster occurs which prevents the prescription being refilled when required.  
 
"I'm taking Paxil and it turned my life around." Most people do report some to a great deal of improvement with the prescriptions they have been given. They take the medications and find positive effects with few, if any, uncomfortable side effects.  
 
"I'm now taking Rivotril and find myself much better. It wasn't the first drug I tried and it isn't the complete answer." This is a more realistic situation. It may take a few attempts to find the correct drugs and dosages. And the drugs may alleviate the symptoms to give a jump-start to the necessary changes in thinking patterns.  
 
Recognizing the problems in finding the correct drug, some pharmacies will give a person a few pills to try to see if they can be taken without problems. It is little use paying for expensive drugs if you just have to throw them out. For example, a local pharmacist in Victoria charges his fee up front on the first few pills but just charges the drug cost on filling the remainder of the prescription. Ask the pharmacist about this method or ask the doctor if he has any free samples.  
 
There are a very few unfortunate people who find they cannot take any of the medications. They react to them so severely they cannot continue on. I am aware of one family in which the mother and 3 grown children plus a maternal aunt all suffer from clinical depression yet they cannot take any currently available medications. They even react to the naturally occurring herbal remedies of St. John's Wort and Kava Kava. The additional burden they bare is that they felt much better taking some of the medications but had to stop them due to side effects and had return to their depressed states.  
 
THE MEDICATIONS  
 
This is a very brief overview of the categories of the medications. More information can be obtained from the doctor or pharmacist.  
 
As mentioned above a number of the newer medications do not have the same problems associated with them as did some of the older ones. New ones are constantly in development and coming on line.  
 

I ANTIDEPRESSANTS
This group of drugs generally takes 2 to 6 weeks before the full benefit potential is reached. They are usually not physically addictive and the side effects are minimal -- dry mouth and a tired feeling. They are used for treatment of anxiety, panic attacks, depression and obsessive-compulsive disorders.  
 
1. Monamine Oxidase Inhibitors (MAOI)  
 
Generally not used much today as they can react with some foods and non-prescription drugs to produce serious, if not fatal, rises in blood pressure. Examples: Nardil, Parnate.  
 
2. Tricyclic Antidepressants (TCA)  
 
In Chapter One you read how the body is constantly keeping itself in balance. As part of this process norepinephrin (part of the slow down system) and serotonin (sort of a "feeling happy" chemical) are routinely taken out of action. The TCA's slow down the rate at which they are taken out of action. Due to side effects it may be necessary to try several different types of TCA's before a satisfactory combination of dosage and drug is found. Even so, tricyclics have been used safely for decades. Examples: Elavil, Tofranil.  
 
3. Serotonic Specific Uptake Inhibitors also known as Selective Serotonic Reputake Inhibitors (SSRI).  
 
Similar in action to the TCA's but, as the name suggests, they act on serotonin only. Examples: Prozac, Luvox, Paxil  
 
4. There are a number of smaller groups of antidepressants, which act in a manner similar to that of MAOI's and SSRI's. Examples: Manerix and Effexor.
II BENZODIAZEPINES
(Known as the minor tranquillizers)  
 
This group includes some of the commonest anxiety drugs prescribed today. They are fast acting, short lived in the body and used mostly for short periods of time as many tend to be physically addictive and, over time, the body may become adjusted to them so the dosage may have to be increased to continue to obtain the required results.  
 
Where, for various reasons, they may be used for longer periods at high dosages, it is important that they may be discontinued only under medical supervision.  
 
As a result of this description some may think these drugs should be avoided but remember this group does include some of the most commonly prescribed anxiety drugs being taken by literally millions of people, so don't discard them out of hand.  
 
Some examples: Xanax, Valium, Ativan
III ??- ANDRENERGICS (Beta-Blockers)
To make a complicated story simple, these drugs retard the effects of the "speed-up" system chemicals -- adrenalin and adrenalin-like compounds. They are used for anxiety.  
 
Example: Inderal.
IV OTHER CATEGORIES
There are a number of other drugs, which do not fit into the above categories. Their uses vary from anti-anxiety medication to antidepressants. Examples: Buspar, lithium drugs.
V NEW MEDICATIONS
New medications, such as Remeron, are constantly appearing on the market.  

Main Points
•There are numerous medications available. If one is not working, ask the doctor for another one.
•Many of the medications take several days to weeks before the beneficial effects are notice.
•It is not uncommon for people with anxiety to have a reluctance to take medications.
 © Oakminster Publishing 2001

Ken Strong lives in Victoria, B.C. Canada. His internet site for carers has won numerous mental health awards - http://www.pacificcoast.net/~kstrong/

Ken Strong is also the author of the highly recommended book,

ANXIETY, PANIC ATTACKS AND AGORAPHOBIA - Information For Support People, Family and Friends, which is now in its second edition. ISBN 0929028104

In Australia the book may be purchased through Bronwyn Fox by ringing (08) 8555-5012 or email her on hub@paems.com.au