The Trouble with Fast-Acting Anxiety Pills

Practically every day in my clinic, I hear someone say, “I need a med for anxiety, and I need it to work fast!” I’m all for people reducing their anxiety, but I’m concerned about how they’re doing it. Many guys ask for drugs like Xanax or Ativan, which they’ve heard can help them feel better in minutes—and apparently, they’re getting them. Prescriptions for benzodiazepines, these types of short-acting medications, tripled between 1996 and 2013, and there are few signs of things slowing down.

While you do notice the effects of “benzos” quickly, those effects don’t last for very long. Using the drugs all the time can lead to tolerance, dependency, and addiction. It’s like icing your worries every day with tequila shots—in fact, it’s very much like doing that. Xanax and alcohol bind to the same receptors in the brain. And over time, they can both make anxiety a lot worse. Not only is it difficult to get off them, but abruptly stopping them can be dangerous—even life-threatening—by placing you at increased risk of seizures.

Though these short-acting medications have a role, they’re best reserved for the most extreme forms of anxiety, like if you’re having so many panic attacks throughout the day that you can’t get out of the house. Occasionally I’ll prescribe a short-acting drug for a specific phobia—for example, if just the thought of getting a flu shot makes you feel as if you’re going to toss your lunch. Because they work fast, they are also an effective temporary “bridge” alongside other anxiety medications that are less addictive but may take longer to kick in. Benzodiazepines are not meant to be taken every day, and they’re certainly not intended for longer than two weeks at a time. Benzos have a place in managing anxiety, but they shouldn’t regularly be front and center. If someone writes you a prescription for one, find out why and explore your other options before you open that potentially unhealthy and unhelpful bottle.

Instead of benzos, I recommend other ways to manage anxiety—some that come in pill bottles, some that don’t:

Antidepressants to manage anxiety

Many men are surprised to hear that meds like Lexapro, Effexor, and Wellbutrin are effective for anxiety, not just depression. They’re great options for the type of anxiety that doesn’t necessarily come and go but is with you almost every day. Their effects can take a few weeks to kick in. Most antidepressants are safe, effective, and well tolerated (and some have lower rates of sexual side effects). But they don’t all work the same way. I choose which one to start with based on a number of factors, including whether anxiety makes it difficult for you to focus or makes you tired (I might recommend Wellbutrin) or causes your thoughts to race and makes you feel jittery (I might go with Lexapro). Work with a doctor to find the one that’s best for you, and ask about a tapering and stopping plan. Some antidepressants, such as Paxil, can be difficult to quit, and others, like Effexor and Cymbalta, can be problematic if you stop taking them abruptly. But generally, if you taper, you won’t have severe withdrawal problems.

Supplements to manage anxiety

There’s an emerging body of evidence suggesting that certain compounds may be helpful in treating anxiety and depression, but it’s too soon to know exactly which would be helpful for which type of issue. Broadly, omega-3 supplements may help reduce symptoms of depression. (A diet rich in oily fish like salmon, mackerel, and tuna is beneficial, too; see page 98.) There’s research that ashwagandha, also called Indian ginseng, may be helpful for anxiety, and there are hints that L-theanine, an amino acid in green and black tea, may also be useful. While these are products from nature, that doesn’t mean they’re safe for everyone. Talk to your doctor before trying any of them.

Daily-life changes to manage anxiety

Trying to get rid of anxiety by ignoring it can actually make you feel more anxious. Sometimes accepting it is the first step to moving beyond it. A few years ago, I had a panic attack while sitting in my family doctor’s office for a routine physical exam. I know, I’m a psychiatrist, right? That’s what my doctor said, too. After that, I was worried the same thing was going to happen every time I went back, and I developed an embarrassing case of “white coat syndrome”—my blood pressure would go up when I saw the doctor. What helped was acknowledging that, like millions of men around the world, I’m not immune to anxiety. Eventually I talked to my doctor about it, which allowed me to make some changes, including the ones below. I recommend them to everyone—they can work better than benzos, without the side effects.

Breathe through your anxiety: Breath work is underutilized and incredibly effective. I love 4-7-8 breathing: Just inhale while silently counting to four, hold for seven, and exhale for eight. This activates something called the parasympathetic response, which can slow down your heart rate and increase alpha brain waves and levels of a calming neurotransmitter called GABA. Translation: You’ll feel calm and relaxed.

Move with your anxiety: Studies show that regular physical activity can enhance some of the same chemicals in the brain that anti-anxiety medications target. It can be a powerful tool for anxiety management as well. A patient I’ll call David, for instance, learned to pay attention to his heart rate while jogging and discovered how to use breath work to bring his heart rate down afterward. After some practice, he learned to apply this de-escalation technique to situations in which he felt anxiety, calming his breathing and his heart rate. Eventually he felt in better control of his body and his mind.

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