What do I need to know about benzodiazepines?
The benzodiazepines often work like a double-edged sword-highly effective in the right situation but also with hazards of their own. They work rapidly, efficaciously, and with a minimum of side effects if dosed properly. They can take a mind which feels like a hurricane in progress and settle it quickly to feel like a reasonably clear day. Benzodiazepines tend to work less well with time and may require greater dosages to achieve the same effect. Without starting a second medication which can be used more longitudinally and with a greater safety margin. Stopping benzodiazepines can be difficult and can risk creating rebound anxiety. As long as you know about the risks of dependency (it can be hard to get off of them without a careful, willful, downward taper of medication), withdrawal (it can be uncomfortable, if not life threatening, to discontinue them cold turkey), and long-term side effects of regular high-dose usage (like memory impairment), then the benefits can be maximized via judicious therapeutic use. I tend to prefer the longer-acting benzodiazepines, such as clonazepam, as they avoid the more sudden shifts in blood level and the accompanying rebound symptoms of anxiety that can occur. Starting a benzodiazepine immediately for relief at the same time as starting an SRI for longer term irrigation can allow a doctor to begin to wean a patient off of the benzodiazepine in several weeks after the SRI has taken root. This strategy works well and without undue complications most of the time.
Are antipsychotics ever used to treat anxiety?
The atypical antipsychotics have a unique place in the treatment of anxiety disorders. Most of us would begin with either or both of the above medicines (e.g., a benzodiazepine and an SRI). However, some patients cannot take benzodiazepines because of a history of substance abuse or would prefer not to because of that concern. Other patients experience a level of anxiety that can border on psychosis in its intensity, e.g., the patient who refuses to have surgery to remove a malignant cancer because of an overwhelming fear of surgical complications. Still others have mania or hypomania, which can add rocket fuel to speed the anxiously working mind. Usually these medicines can work well in these situations and require far lower dosages than those needed for management of schizophrenia.
Most of the more dangerous side effects of this class of medication occur at higher dosages taken for longer maintenance periods of time, making their usage in the context of anxiety mostly safe.
What do I need to know about the mood stabilizers?
The mood stabilizers primarily assist with the management of mood. Therefore, should you happen to suffer from some type of mood disorder involving more than just depression and the lower end of mood (i.e., some type or problem with mood swings) that also includes anxious features, one of these might be right for you. The particular details of why to choose one medication over another can be quite complicated and usually involve a detailed conversation with your doctor.
Time and again, however, patients present thinking that their problem is simply really bad anxiety-and it is-but have also never been properly diagnosed for their bipolar or bipolar spectrum disorder. In those instances, starting a mood stabilizer can make the ultimate difference in the management of the anxiety.
Terms:
Antipsychotic-a psychiatric medication that is used to treat psychosis (such as hearing voices or paranoia), as well as severe anxiety.
Mood stabilizer – a psychiatric medication that is used to balance mood states.
