Q: I have been diagnosed with GAD following 2 bouts of cancer. Although cancer free for 3 years i experience chronic anxiety mostly controlled by CBT & occasional 1mg of Ativan. I have tried several SSRI’s & SNRI’s with minimal effect & intolerable side effects. I get extensive relief from ativan but experience anxiety using them because of all the negativity. Antidepressants do not work for me, ativan at least affects my quality of life tremendously. Why should I not continue doing what is effective rather the continuing to be miserable and spend another 3 years trying more antidepressants and becoming depressed as a result? I’m am experiencing so much anxiety because I take anxiety that my GAD is getting worse because of it. All of the negativity surrounding BZDS is a major cause of increased anxiety.
– John S
A: I think people suffering from generalized anxiety disorder are not really suffering from an illness such as a major depression. They are people who are anxious all of the time because they are worried all of the time about different fears. The best way, I think, of dealing with that situation is to confront each of those fears separately. If it is a realistic fear–perhaps that a cancer might return– the next step is to do something that will lower the risk. If it is unrealistic, confronting the fears will lower the level of anxiety–as the danger is seen not to be real. Using tranquilizers is a second best alternative. I’m reminded of a patient who kept cracking up his cars when he refused to slow down on a turn. His solution was to buy better tires.
Having said that, though, I think there is a place for tranquilizers. Someone upset during the day, I think would be best treated as above by dealing with whatever is causing the anxiety. If someone is upset in the evening because of something that cannot be addressed as that time, I think it is perfectly reasonable to take a benzodiazapene to go to sleep. The usual dose I give is a half-mgm of ativan, or xanax, or klonopin. A one mgm dose risks memory problems.( People wake up in the morning with crumbs on them from food they do not remember eating.) Also there is a risk of falling in older men and women.
The major problem with these drugs, however, is that they encourage the idea that they are truly necessary to cope, and they are not. Many people also tend to use them more frequently and in higher doses as time goes on. It is usually said that the minimum addicting dose is about three milligrams a day used every day for a period of months. Most people who use the drug the way you describe will not get into trouble. I usually prescribe these drugs to patients if they feel as you do. My general inclination, however, is to encourage taking as little as possible.
– Dr. Neuman