Arkowitz and Lilienfield, 2007 (pills) PDF

Preview

Summary

Pharmacology article on anxiolytic drugs, from the online course of PSYS 115 taught by Jom...

Description

A Pill to Fix Your Ills (Arkowitz and Lilienfield, 2007) 







2.5% of Americans will develop an anxiety disorder o panic disorder, generalized anxiety disorder, phobias, obsessive-compulsive disorder, posttraumatic stress disorder o many others will experience significant problems w/ stress and anxiety that are not severe enough to qualify for a formal diagnosis  since many people experience stress/anxiety to some degree, it’s understandable that effective treatments to aid them would be sought after Psychologists: psychotherapy o Cognitive-behavioral therapy (CBT) has been one of the main treatments helpful with anxiety  Involves gradual exposure to feared situations, and involves implementing cognitive methods to reduce the catastrophic mindset that is often common with anxiety (helps with teaching of more logical thought processes, instead of catastrophizing)  Yields positive effects in approx. 16 session, though it can last longer for more severe and significant psychological problems Psychiatrists: drug therapy o Selective serotonin inhibitors (SSRIs)  Prozac, Zoloft, Lexapro: common drug therapy for depression, helpful for anxiety  Typically require 2-4 weeks before they start to work, need to be taken daily o Benzodiazepines  Work shortly after swallowing the pill: feelings of relaxation within 10-30 min  Can be taken either regularly or on an as-needed basis  One of the most common prescribed medicines for anxiety  All have calming effects, differ in strength (and dosage)  Most people take them for short periods of time, although most anxiety disorders are chronic and require prolonged treatment  This can result in an increased rate of side effects

 Side effects and withdrawal from benzodiazepines o Regular and extended use:  physical and psychological dependence  withdrawal symptoms  reduced alertness  drowsiness  physical fatigue  impaired physical coordination  memory loss o Benzodiazepines + alcohol = strength of those side effects increases  Both are central nervous system (CNS) depressants  Results can be fatal o Common withdrawal symptom: rebound anxiety  Anxiety can return at the same or worse levels









50-75% of people with a panic disorder relapsed when they stopped using benzodiazepines o Other possible withdrawal symptoms:  Abdominal pains and cramps  Depression  Dizziness  Lethargy (physical and mental inertness, not being as attentive)  Flulike symptoms  Palpitations: a noticeably rapid, strong or irregular heartbeat  Insomnia  Irritability o People who experience withdrawal symptoms often return to their medication in an effort to avoid the undesirable symptoms  can result in vicious cycle of dependence New options besides benzodiazepines o Newer medications for sleep such as Ambien and Lunesta are prescribed for people with insomnia, which is often associated with anxiety disorders  Rozerem has a possibility for not having a potential for substance abuse or for motor or cognitive impairment (psychological dependence is still possible though) o Any kind of CBT  Those who relied on benzos for treatment experienced higher rates of relapses  If patients keep taking the drug, generally they’ll have lower relapse rates, but risk side effects associated with regular and long-term use (these problems don’t exist with CBT)  Drug therapy is more expensive because medications must be taken continuously in order for their effects to last (effects of CBT last fairly well after treatment has ended) o Benzos (or SSRIs) and CBT  Don’t do any better than either treatment alone  subjects had significantly higher relapse rates when treatment is discontinued Good VS Bad news for using Benzos o Bad News  Only work as long as you continue to take them  Can cause psychological and physiological dependence  Can lead to serious withdrawal symptoms, as well as several other undesirable consequences o Good News  When used on an as-needed/short term basis, they can alleviate anxiety problems while minimizing side effects  When used regularly, they’re effective at reducing anxiety problems, but may cause side effects  Tapering off the drug (instead of stopping abruptly) can minimize problems that can come with withdrawal What to do when seeking treatment for an anxiety problem o First consider CBT  More effective + cheaper than drug therapy  Doesn’t cause dependence, withdrawal, or the side effects o Consider taking SSRIs  They have fewer problems with dependence and withdrawals o Take benzodiazepines  They can be helpful when closely monitored by a psychiatrist or another knowledgeable medical professional...