by Michael Kahn, M.D., Harvard Medical School When I prescribe medication for a patient with a mental health problem, I'm frequently asked, "How long will I have to take this medication?" It's a good question. But for someone with an anxiety disorder, the answer is particularly complex. Here's some information from Harvard Medical School's special health report, Coping with Anxiety and Phobias. It's true that some anxiety disorders can be controlled with sporadic or short-term therapy. Sometimes a person does feel much better after just a few weeks or even days on an anti-anxiety medication. A specific phobia can be treated as needed, for example, just before getting on an airplane or giving a speech. But other anxiety disorders — for example, generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder — commonly require ongoing treatment. Experience shows that when drug therapy is stopped, symptoms often recur. Only 25% of patients who stop taking antidepressants for anxiety have relief for two years or longer. Two studies found that one in four people with generalized anxiety disorder relapse within a month of going off medications. Similarly, most people with obsessive-compulsive disorder relapse within a month unless they either continue drug treatment indefinitely or undergo behavior therapy. There are no controlled studies showing how long drug therapy should last. But experience has led to this general guideline: For most anxiety disorders, medication should be taken initially for six to 12 months. If the symptoms vanish or diminish to the point that the individual is satisfied, he or she can take a "holiday" during which the drugs are stopped. If anxiety symptoms return, the individual should take the medication again. For people with two or more anxiety disorders, it's likely that treatment will carry on for more than a year. The more complex the condition, the more difficult it is to treat. Even if symptoms don't recur, anyone who has had an anxiety disorder should have regular checkups with a mental health professional, preferably every three to four months. Those who are still taking medication should check in with a psychiatrist every three to four months to evaluate its effectiveness. Regular checkups can ensure prompt treatment should the symptoms recur or new ones develop. It's also important to talk with your doctor before stopping any medication. Discontinuing medication too early or abruptly can trigger side effects. For example, stopping benzodiazepines too quickly increases the risk for withdrawal symptoms and can even result in a flare-up of anxiety, panic, or depression. Many patients stop taking their medicine because they develop side effects. If you're having trouble tolerating a drug, talk to your doctor. Side effects are more common with some medications than others. Your doctor may be able to suggest a different drug or offer advice on how to prevent side effects. Have you, or someone you know, ever decided to stop taking a medication for an anxiety disorder? What happened? How would you advise someone else in a similar situation? Dr. Michael W. Kahn is an Assistant Professor in the Department of Psychiatry at Harvard Medical School, and is medical Director of Ambulatory Psychiatry at the Beth Israel Deaconess Medical Center in Boston.
Quiz by DR. JOYCE BROTHERS
SYNDICATED COLUMNIST
Many people get nervous or feel anxious during unfamiliar situations or novel experiences. Some people, however, are struck with such irrational fears during daily life that their panic becomes debilitating. This true or false quiz helps you test your knowledge about the symptoms, causes and treatments of these common disorders.
1. Most experts agree that about 10 percent of people suffer from panic disorder.
TRUE ( ) FALSE ( )
2. Agoraphobia, or an intense fear of public places, is a disorder that can commonly occur along with panic attacks.
TRUE ( ) FALSE ( )
3. Oftentimes, a panic attack can be triggered by a person's physical symptoms, such as heartburn or a headache.
TRUE ( ) FALSE ( )
4. Medication is considered the best way to treat panic disorders.
TRUE ( ) FALSE ( )
5. Physical symptoms of panic disorder can include nausea and vomiting, chills or sweats, feeling of choking or shortness of breath, fainting, trembling and numbness or tingling sensations.
TRUE ( ) FALSE ( )
6. There is only one type of anxiety disorder, and it has similar symptoms in all people.
FALSE ( ) FALSE ( )
7. People with severe social phobia may fear being judged or watched by others so much that any interaction with another person can cause them to experience debilitating broad physical and psychological symptoms.
TRUE ( ) FALSE ( )
8. Anxiety disorders can be present from an early age or can begin suddenly. They are most prone to appear during times of high stress.
TRUE ( ) FALSE ( )
ANSWERS:
1. FALSE. Most studies have found that 1 percent to 2 percent of people suffer from panic disorders. The Public Health Agency of Canada estimates that about 0.7 percent of Canadians between ages 15 and 64 suffer from panic. While many people have experienced panic attacks in their lives, panic disorders leave people in constant fear that an attack will strike again at any moment.
2. TRUE. Agoraphobia stems from a fear of being unable to escape to a safe location during a panic attack. Agoraphobics tend to try to avoid the situations that they think may have initiated the panic attack, and thereby close themselves off to new or unusual experiences as well as public locations.
3. TRUE. It is hard for those suffering from panic disorders to recognize the physical triggers that can set off attacks. Instead they associate the attack with the activity they were doing or the location where they were when the attack struck. This can lead them to avoid these circumstances.
4. FALSE. Cognitive behavioral therapy is thought by most in the field to be the most effective treatment for panic disorders. This method encourages those suffering from panic attacks to expose themselves to different experiences in a safe environment. Patients are taught to control their thoughts and actions during panic attacks. SSRI medications can be helpful in certain circumstances, but taking a pill that has short-term anti-anxiety effects every time a panic attack strikes can be counterproductive.
5. TRUE. All of these symptoms can be felt during panic attacks, either alone or in combinations. The physical symptoms go along with the emotional and mental symptoms usually associated with feelings of panic, such as nervousness and fear.
6. FALSE. There are five major types of anxiety disorders: generalized anxiety disorder, obsessive- compulsive disorder, panic disorder, post-traumatic stress disorder and social phobia. All five of these exhibit slightly different symptoms, and are brought about in different settings.
7. TRUE. Because this disorder can strike anytime a person is in a social setting, it can severely interfere with work, school and other necessary daily activities. This can lead to more extreme forms of the disorder, including agoraphobia.
8. TRUE. Anxiety disorder can be chronic. A family history of mental distress or trouble dealing with anxiety can be signs that you may have an anxiety disorder. Additionally, stress can bring out physical and emotional symptoms usually associated with panic attacks.
If you were able to answer six of the eight questions correctly, you're more informed than most on this subject.
