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Opinion needed: Time for Meds or Keep Addressing Underlying Issues?
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Opinion needed: Time for Meds or Keep Addressing Underlying Issues?

Hello, all. I have a fairly straightforward question. First some context: I have been suffering from anxiety (ranging from intermittent pressure/nervous feeling to full-blown "I am going to have a heart attack right now" panic attacks) and some depression since 2011. I have a psych doctor and a primary care physician. They issued me a vial of 30 Ativan (1mg) to use back in October. I have two left (I only take them when I feel a full blown attack coming on).

Intellectually, when my brain isn't telling me that I am terminally ill, I understand that there is clearly a linkage between unfamiliar/unstable aspects of my life and my anxiety.

My question is this: Given the negative experiences on the board with [the usual suspect] medicines, I am torn as to whether to go on them. I am fairly certain that my doctors believe that I should give them a try, despite the side effects, but I just dont know if I am suffering enough to risk the meds. I feel like I should just focus on 'fixing' the aspects of my life that are out of whack, but easier said than done. I am so tired of suffering from this - my anxiety screwed up a dinner I had tonight where I clearly should have been able to relax and enjoy. I am so frustrated.

How does one decide when meds are appropriate?


- Male / 38 / Blood work all good / Highly-pressured Executive / Pretty out of shape / Separated from family due to work for nine months (but I had anxiety before that) / Father got terminally ill at 43 / Takes 1mg Ativan as needed (when sensing onset of full panic attack) but not daily  
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This is not a question with an answer.  Most of the people on this board are very pro-medication, and this is basically a medication board -- to get the anti-medication people to another place Medhelp even created the complementary medicine forum.  Yet you will still see some variety of opinion on this question no matter where you ask the the question.  My own opinion is that no drug should be take unless absolutely necessary for any condition, as all medications have possible adverse consequences.  Doctors will always turn to medication first as that's how medicine is practiced in the US, just as a naturopath will always turn to natural remedies and just as surgeons are more likely to recommend surgery than seeing some other type of physician -- people recommend what they know and what makes them money the easiest way possible.  My own opinion is that you don't need medication for anxiety until the problem gets so bad your life is seriously impaired.  I speak as someone who is on medication.  I had phobias that just kept spreading after years of therapy and it just didn't work and my world was closing in on me.  But as you describe it, you're still functioning fairly well most of the time, so you still have time to find a therapy or relaxation program that works for you.  Drugs don't cure, they only treat symptoms, and they artificially alter the way the brain operates, so while many will suffer no adverse consequences from this others will, just as with surgery, so if you can avoid it you do and if you can't you take your chances.
I personally are not really pro medication but rather pro patient and for someone feeling the best they can.  That often does require medication for clinical anxiety and panic attacks.  

I would add to the mix of psychiatrist and general practitioner a psychologist though.  As talk therapy is very very helpful to helping with identifying true stressors/triggers, coping mechanisms, plans to overcome as well as a safe place to vent and be heard.  Different approaches are used by therapists but all have the goal of helping you learn to deal with the anxiety and life the best life you can.  

There are lifestyle things you can add as well if you haven't already such as exercise on a regular basis (definately helps modulate/regulate mood as well as relieve stress), meditation, yoga, deep breathing, journaling, eating right, etc.  These too are good to add to the mix.  

However, medication can often be life changing in a positive way for someone suffering anxiety and are diagnosed by a professional with such.  Today's medications are much easier to take than those of decades past.  While they have side effects, one must measure the benefit they provide against that.  Best as a discussion between you and your doctor.  

Often you find untreated anxiety does carry over though in areas such as our relationships.  Many times, a person with untreated anxiety has difficulty with their loved ones and friends and they encourage them to do more to treat it.  I mention this because living with someone with chronic, untreated anxiety can be difficult.  If you find areas of your life like this also affected, absolutely, I'd take the next step with your treatment plan.  

Have this same discussion with your psychiatrist and GP.  They are good sources of information.  peace and luck to you
However, medication can often be life changing in a positive way for someone suffering anxiety and are diagnosed by a professional with such.  Today's medications are much easier to take than those of decades past.  While they have side effects, one must measure the benefit they provide against that.  Best as a discussion between you and your doctor.  

I couldn't agree more with the above comments.

While I definitely am a person that can appreciate medication, I don't always recommend it.  I fully admit that I'm biased towards meds in my own way because of my past positive experiences, but I don't give cookie cutter advice where I always recommend meds.  

I don't view your situation as an "either or" type of conundrum.  The way I view meds and the way I have USED meds to treat my panic disorder is to consider it just one more tool in my battle against anxiety.  It's true that meds aren't a "cure" for anxiety, but they CAN be a very helpful part of treatment.  Basically, I feel that medications help to control the symptoms of anxiety WHILE a person works on themselves, maybe with lifestyle changes, therapy, relaxation approaches, and anything else they find helpful.  I have to admit that for ME, it was awfully hard for me to get anywhere in therapy initially because my anxiety was so high that even concentrating was a task.  That improved by leaps and bounds once the antidepressant was helping to control my symptoms.

I think there are definitely times when choosing to take an antidepressant is very premature and not warranted.  For instance, if someone has experienced a sudden and tragic loss, anxiety is appropriate and understandable.  If that person was experiencing anxiety, I wouldn't recommend an anti-depressant, as the anxiety is situational.  Maybe an anti-anxiety med for a period of time if anxiety levels were high, but my opinion would be to address that anxiety with things like grief counselling, and giving that person time to heal.

Also, if someone has JUST started experiencing anxiety, and the anxiety isn't severe or debilitating, then I think jumping the gun and going on a med would be premature.  I definitely agree that most doctors tend to jump to the meds without maybe exploring other options with people, which is why I always recommend turning to a specialist versus dealing with a PCP for things like anxiety and depression,  Even if the psych still recommends a med, they will be much more likely to prescribe concurrent therapy as well.  

Also, IMO, there are some cases where I think meds are a no-brainer and absolutely should be tried.  The one would be when a person has been experiencing anxiety for a lengthy period of time, and other methods have done very little to help.  Another would be when a person has very severe and debilitating anxiety to the point where they are struggling to function in daily life.

It boils down to you can tell, there are varying opinions when it comes to meds, and a lot of times, that is based on personal experience...and all of those opinions are valuable.  I always tell people that while it's good to ask for input, every person should allow themselves to have their OWN experience when it comes to meds, and no one should put too much stock in either kind of personal experience, as theirs may vary considerably.

I cannot say enough positive things about how helpful meds were to me with my panic.  They literally gave me my life back (along with my own hard work).  They allowed the panic attacks to decrease and improve to the point where I could function again and to the point where I could be MUCH more productive in therapy.  I have NO doubt that the meds were a VERY intregal part of my anxiety treatment.  Crucial actually.

In the end, all of our replies are helpful to you, and I'm sure you will take what we all have to say into consideration, but at the end of the day, this is YOUR choice to make.  NO ONE else can make this decision for you, it's your unique decision to come to after weighing the risks and benefits with your doctor.  I think it's very good that you recognize that something needs to change, that your treatment isn't getting the job done quite well enough.  

Wish you luck, please let us know what you decided and how you're doing.
Like others have said, there are different opinions when it comes to medication. I have suffered from anxiety for several years now. I was put on medication and diagnosed with generalized anxiety disorder by a doctor. When my anxiety was seriously affecting my job, I decided to go for help. The medication WAS life changing for me. Gone were the days of that constant pressure/tight/nervous feeling in my chest, intermittent chest pains, irritability, shaking/sweating, etc...I nearly forgot what an anxiety attack was if it weren't for the very rare attacks I still experienced - "breakthroughs" as I called them.
From another perspective my sister also suffers from anxiety. She has gone the route of counseling, and from what it sounds like she is still suffering. While I will say that she hasn't been in treatment that long, she still experiences frequent and regular vertigo that is triggered by stress. She sought the advice of a nurse practitioner who suggested counseling. I tend to disagree that "counseling" will help a mental illness. IF one is to seek that type of therapy, a licensed psychiatrist makes much more sense.
Good luck!
Wow! Thank you all so much for your thoughtful and thorough replies. Its such a tough call. I'm afraid I am going to have to suffer a major attack or disruption before I am convinced that meds are worth a shot (a little like what happened when I finally went to the ER after suffering a series of confusing panic attacks).

A follow-up question - maybe an easy one for you guys. Has anyone ever 'healed' or simply grown out of panic/anxiety? Worked their way through it to the point that it simply a bad memory? Is it possibly a temporary ailment or something that is now fundamentally broken in my brain?  Will I always be sensitive to it?

I assume that everyone here on these boards is still suffering (there are more fun things to do on the Web than this) but perhaps someone knows of someone who fought their way through and 'healed'.
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