There was a scene in a movie from about 30 years ago, in which a woman is having what appears to be a panic attack in a department store. She starts to sweat and become jittery as she lies down on the floor. Her concerned partner leans over her as a crowd gathers around.
The partner looks about and anxiously asks, “Does anyone have a Valium?” About 10 people reach into their purse or wallet and each hands the man a pill.
Around 9.7 million Americans take anti-anxiety medications, according to the health research firm IQVIA. Some 29.7 million Americans take antidepressant prescriptions such as Lexapro and Prozac.
There was a 34 percent increase in anti-anxiety medication prescriptions during the COVID-19 pandemic, according to Express Scripts, an online pharmacy and pharmacy benefit manager. Compare that to a 14.8 percent increase for insomnia aids and an 18.6 percent increase for antidepressants.
B.R. is a 42-year-old mother of two teenagers, married, and in what seems to be a strong relationship. She was referred to me because she was suffering from decreased libido. She loves her husband, finds him attractive, but she still has no desire. Her exam was normal, except for the fact she was taking an antidepressant. She’s been on it for almost 10 years. Mind you, she isn’t depressed. She was told to stay on them because she was under a lot of stress. COVID-19 just made things worse.
I gently confronted her with this and suggested she find a better mechanism for coping with her stress and wean herself off. She became quite defensive and was afraid to stop. She wanted her “testosterone” levels checked first. She read on the internet that low testosterone levels are the cause of low libido.
I admit, one of the problems with all of these antidepressants and anti-anxiety medications being written is that it’s easy to do just that. We physicians tend to have a low threshold to prescribe them. It’s just so easy to prescribe, and we don’t need to play therapist. Over the years, I have become much more resistant and try other measures first. I am a firm believer in the power of one’s mind and its ability to treat and heal oneself for stress-related issues. There is definitely a place for medication and a need to help alleviate anyone suffering, but it’s my job to help find the best solution, not necessarily the quickest and easiest.
Depression is different from anxiety. There are all sorts of depression, all of which need to be evaluated by someone who knows what they are doing. Situational depression, such as getting fired, going through a divorce, or worse, is a short-term problem that needs attention. Endogenous depression needs even more work and involves long-term treatment. Many of these issues do require short-term medication in conjunction with therapy.
Anxiety issues can be multifaceted and every patient wants a quick fix. Taking Xanax because you are in a stressful job won’t treat or help alleviate the situation. You’re still in that stressful job. COVID is an obvious major stress factor. Confusing guidelines with no end in sight compounds the situation. For situational stress, I have written on a prescription pad “meditate twice a day and call me in the morning.”
Now, my meditation isn’t what you’re thinking, it’s a simple way to take a deep breath, and find a “tool” to help you control the situation. Sometimes just leaving the room, and walking outside for five minutes can do the trick. Getting up and getting a glass of water, or just breaking the mental cycle you find yourself in can be helpful. Exercise or yoga also can be very effective.
B.R.’s blood tests all came back normal. Her hormone levels were perfect. She still didn’t want to taper off her antidepressants. However, she agreed to see a psychiatrist I work with. She finally was able to taper off her meds and, funny thing, her sex life came back. Antidepressants can lower one’s libido; she didn’t believe me at first. She is still under stress, but found a way to take control. Now, not every case has such a simple solution. It just shows how dependent we can become on medication to treat everything.
Most antidepressants and antianxiety medications were originally for short-term use of about six to 12 months. Some people do need long-term therapy, but that isn’t for most of us. The overprescribing of all these psychotropic medications is harmful. The discontinuation syndrome of quitting can be very powerful and is the reason for so many failed attempts to get off these addictive drugs.
Meditation in one form or another can be extremely beneficial for one’s health. Very little was taught about it in medical school. Meditation doesn’t have to be in a formal setting; find a form that works for you. You’re never too old to start. About 14 percent of Americans say that they have meditated in one form or another. In 2019, some 52 million Americans downloaded a meditation app.
I have always used my own personal method of meditation to get me out of an uncomfortable stressful situation. I hate tight spaces, but have had several MRIs for chronic migraines. I find what I call my “Zen mode” before entering the MRI. I still hate the close space, but I’m able to get through the process with very little anxiety. I’ve even found my “Zen mode” at dinner parties I just don’t want to be at. Sometimes, my wonderful wife has to elbow me back to reality. Why should she have to suffer alone?
The benefits of meditation are numerous, including improved sleep and decreased insomnia.
Some studies have shown that meditation can reduce anxiety levels by as much as 60 percent. It also reduces depression relapse by about 12 percent. The positive benefits are on both mental and physical well-being, such as lowering blood pressure in the majority of those who meditate in one form or another.
I am one physician who hates psychobabble, but also I am one who isn’t afraid to write a prescription for you to “meditate twice, and call me in the morning.”
