Do we need another reason to avoid anti-anxiety medications? As a psychologist, I can’t prescribe medications, but I don’t find that to be a disadvantage. It’s seldom that clients who seek the holistic and mindfulness-based approach I offer want to take psychotropic medications. If they are currently using any, they usually want me to help them finding find other ways to cope or overcome their symptoms of anxiety so they can get off the medication.
Although some clients are satisfied with having fewer or no anxiety attacks which they attribute to taking the medication. They’ve come to a place where being dependent on these addictive medications is a price they are willing to pay. Sometimes via the work of therapy, they gain a desire, courage and skills to take a non-medicated path.
There are a couple of common but infrequent occasions when I understand my client’s desire to take a Valium-type pill. For example, when they take it to get through an upcoming surgery, some major dental work, a plane trip, or some other temporary circumstance that provokes their high anxiety. One to three low dose pills is what I’m thinking of here.
But, I share with you some new research out of concern that even a small amount taken at a particular time can cause more problems than it helps, and according to this study, they don’t help much at all.
I first read about this new research on anti-anxiety medications in the NY Times’ Wellness* section yesterday, and then in an abstract of the study published online in the Journal of the American Medical Association (JAMA).* I used both of these sources to discuss this topic and to compile the list below.
Benzodiazepine drugs are also known as sedatives, relaxants and anti-anxiety medicines. Some well-known ones are Valium and Ativan. Frequently patients will seek or are given these to relieve their overall anxiety about going into
surgery. I imagine that they may take it for a day or two before the operation. But now, this research suggests this may make recovery a bit worse for them after the surgery when general anesthesia was used.
Three groups of 354 patients each under 70 years of age, had elective surgery in one of five teaching hospitals in several French cities. Each group received no medication, or a placebo or lorazepam (Ativan).
The results: here’s how lorazepam made it worse for the patients in that group:
1. They had more post-surgery amnesia
2. It took them longer to regain their cognitive abilities
3. They experienced lower quality sleep
4. Ventilation tubes were needed for a longer period of time
5. The use of lorazepam did not improve the patient’s overall level of satisfaction post-surgery, including those patients who had heightened pre-op anxiety
6. There was no difference in pain level compared to the non-medicated group, but the placebo group reported more pain.
That said, the differences were modest between the groups, leading the authors of the study to conclude that “a lack of benefit with routine use of lorazepam as sedative premedication in patients undergoing general anesthesia.”
So what? My take is that the study suggests that the effects of the anti-anxiety medication, in this abbreviated view of a one time use, affects a person’s brain functioning and sleep quality.
After reading this, I am also concerned about the effect on one’s brain function and sleep with long-term use, typically due to the addictive quality. Some key questions I would ask are:
1. How do sedating medications used over the long-term
affect the user’s executive brain region where planning, thinking, analysis,
organizing, and controlling emotions occur, as well as the ability to stop
inappropriate behavior in social situations from occurring?
2. What’s the effect on their memory’s function?
3. Is their sleep disrupted for as long as they take the medication or longer?
Anti-anxiety drugs have been around for a long time and are seen as, compared to other psychotropic medications, fairly harmless, other than the addictive aspect after continuous use even for a short time. And that’s no small exception!
And there’s the psychological dependency that develops on the drug to avoid anxiety, in lieu of learning other ways of coping and overcoming anxiety in its many forms.
The addictive aspects and the huge amount of benzodiazepine medications prescribed each year is of no small concern to me. They are handed out in lieu of referrals for therapy which insurance companies seem to like.
What are your thoughts or experiences? Please comment below.
*A Time to Avoid Anxiety Drugs, article by Nicholas Bakalar , NY Times, March 9,
*JAMA Effect of Sedative premedication on Patient Experience After General
Anesthesia: A Randomized Clinical Trial published online March 3, 2015, Vol 313, No.9