For the 20 million Americans who suffer from depression, I explained last week how antidepressant medication is wonderful. It helps relieve some of the symptoms of depression without creating any, and it even relieves one of the causes.

Whereas antidepressants have no inflated street value because they give you no buzz or addictions, most medicines for anxiety are just the opposite. They are sold on the street at a profit, because they do provide a short-term habit-forming buzz.

Well over twice as many Americans suffer from anxiety problems as from depression, but here the most popular medicines in many cases end up doing more harm than good. For too many, a pill relieves some anxiety symptoms, quickly but not for long, so that they come back as strong or stronger after the pill wears off. Instead of relieving any of the causes of anxiety, a nerve pill creates the discomfort of withdrawal, which becomes a new source of anxiety.

Because its onset is gradual and felt all over the body, withdrawal discomfort is subtle and yet bothersome. Another anxiety-producing side effect of tranquilizers and sedatives is equally insidious: to some extent users learn to monitor their nerve and muscle tension closely for signs that they might be ready for another pill. In scanning for stress, they have in effect gone on psychosomatic alert.

Too many of my friends and clients have abused these pills and become dependent on them. After that, they’ve not been much good to themselves or others, except for the few fortunate ones who found recovery.

Sure, there’s research that says there’s not much risk of abuse or dependence with the milder sedatives ("nerve pills" like Valium, Xanax, Librium, Tranxene, and Ativan), or the heavier sedatives ("sleeping pills" like Tylenol PM, Ambien, Lunesta, Sonata, ProSom, Restoril, Halcion, and Dalmane).

But these studies have usually been sponsored by the companies who make these drugs, and the same was done and said in the old days when barbiturates and morphine came out. All of us who have had special training in treating drug abuse have seen the overwhelming research evidence that these meds carry a significantly greater risk for abuse and dependency.

This risk is especially great for the approximately 30 % of Americans who have had a parent get dependent upon alcohol or drugs. Because of genetics, modeling and the added likelihood of being born into a chaotic or detached family, they are almost twice as likely as everyone else to develop drug abuse or dependency in their own lives. The extra 10 or 15% who have had both parents to be drug abusers are three times more at risk with these medications.

Now I’m certainly not saying that no one should be taking medication for pain, anxiety or insomnia. I’m only suggesting as I did last week that alongside these medicines we take measures to resolve the underlying causes of our anxiety, and to avoid abuse of these pills. All this generally requires some form of counseling to pull off.

Counseling may also be needed to work through the denial that comes with any chemical dependency or abuse. So what might drug abusers be denying? Here are some common tendencies:

1. They deny there are other, better ways to relax, get to sleep or get through the day.

2. Before and after medication, they deny that withdrawal makes them tense, and act short or mean toward anyone that questions their drug use.

3. During medication, they deny how physically and emotionally unavailable they are to their loved ones, and how much their loved ones need them.

They deny how much they are hurting themselves with these drugs, given the medical and psychological side effects. They deny how their lives have gone downhill during their years of drug abuse. They forget how close they used to be to family, friends and God. They forget when they used to have self-esteem and self-confidence. They forget the hopes and dreams of their youth, which were more noble than what they long for now--calm nerves, pain relief and a good night’s sleep.

Once they begin to see the harm being done to themselves or others, they deny how bogus are their finger-pointing excuses for using the drugs anyway: "If you had my (wife, husband, kids, parents, boss, job, pain, life, whatever), you would need help relaxing, sleeping and coping with pain too."

So remember that an ounce of prevention for anxiety is worth a pound of cure. And realize that if you’re not careful with these pills, the cure you’re counting on for tension, pain or insomnia too often becomes a contributing cause.

A recent study found that about  one woman in three who went to a doctor’s office walked out with a prescription for an antidepressant, most without even a follow-up appointment to see how it would work. Today some 11% of American women and 5% of men are taking antidepressant medication.

The main reason these meds are so popular is that they work really well.  They resolve one of the causes of depression (chemical imbalance, most often serotonin), and relieve many of its symptoms: thinking, feeling and acting DOWN.

People with depression feel down on energy, sex drive, self-confidence and the desire to enjoy life.  They think negative thoughts about themselves, others, the world and their future.  They act down because they can’t work, sleep, eat or make love the way they’re supposed to.

Antidepressants would be much more effective if more people took them strictly as prescribed.  Since most of the bothersome side effects occur during the first 2-3 weeks, and as most of the symptom relief comes after those first 2-3 weeks, too many folks don’t give them a fair trial, and give up on them too soon.

A fair trial would be regular dosage for three or four weeks.  If the benefits are still being outweighed by the side effects, a second antidepressant should be tried for another 3-4 weeks.  But how do you know when you should take this medicine?

You should consult your primary care physician about antidepressants if you know what you need to be doing to make yourself feel better but you can’t make yourself do it.  Whe n making needed changes seems too difficult, you can level the playing field for yourself by trying medication.

Another way to tell if you need antidepressants is to give yourself the Beck Depression Inventory (Google it for a free copy of this quick 21-item test).  If your score is 14 to 19, you’d probably benefit from antidepressants.  But if your score is 20 or over, you might well be so depressed that efforts to cheer yourself up through counseling or willpower changes just won’t work without medication.

When you’re depressed, it’s a good idea to take that test (the BDI) once a week at the same time.  This not only measures your ups and downs, but the items that are elevated will also show you where you need to adjust your thinking and behavior.  Here are some signs that you are ready to cut back on your medication:

  1. When your BDI scores are consistently below 14 for 2-3 months
  2. When you are making the needed changes in your relationships, habits, and lifestyle
  3. When your losses (loved ones, health, job) have been resolved to the point you are now opening yourself to new experiences that seem likely to become fulfilling.

One final mistake people make with antidepressants is to take themselves off of them cold turkey.  Cutting antidepressants down and out should be done this way:

  1. Seek confirmation of your significant others and any professional counselor you are seeing.  These folks will make sure that the help you’ve been getting from your medication is going to be replaced by such mood lifters as lowered levels of alcohol, junk food, stress and conflict, and higher levels of appreciation, affection, inspiration, exercise, and fulfilling work to do.
  2. Consult your physician, tell him or her about the changes being made in your life from the previous paragraph, and follow doctor’s orders about exactly how fast to cut back on the medication.

Medicine can help you make significant changes in your relationships, habits, and lifestyle.  But don’t be foolish and lazy enough to think that medication alone will change your life. Antidepressants are only as helpful as the life changes they enable you to make.


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Dr. Paul F. Schmidt