Managing the damage. But how?

November 29, 2009 12:05 PM

Anti-anxiety medication: blessing or cop-out?

About a year ago, I had my first panic attack. It didn't happen in response to any specific situation or trigger; I believe it was more the aggregate response to a lifetime of small but persistent stressors which I could no longer deny or put aside. After a few more episodes, I started seeing a psychiatrist, who eventually put me on 10mg/day of Celexa on the grounds that I was over-thinking myself into a spiral about it and needed to see what it felt like to live without the obsessive, tail-eating thoughts that anxiety disorders produce.

Now, I also have a close friend who has suffered from anxiety his whole life. He has experienced many hundreds more attacks than I have (in addition to managing other factors such as OCD and social anxiety). He, however, has chosen to forego medication altogether, choosing instead to conduct his own personal form of CBT with no medical or psychiatric input.

While I believe he's made very good strides through his own method, and I can admire him for his dedication to staring this thing down through sheer force of will, I also see him succumbing to it again rather more than he wants to admit. I trust his years of experience in this matter, but it seems to me that he ultimately forces himself to suffer unnecessarily.

I feel the Celexa has allowed me to "get out of my own way" and lighten my psychological burden in a way I'm not sure I've ever actually experienced before. Also, panic episodes are so debilitating that I think I've occasionally become sick (flu-like) from the sheer physiological drainage they cause when I let them run roughshod over me. He, meanwhile, believes that drugs simply turn people into "robots" and that they only enable people to hide from themselves and their issues indefinitely. He sees medication as a cop-out and an act of emotional cowardice. He also thinks there is no way to actually confront or reconcile panic disorder while on medication, believing that direct exposure to panic episodes is the only thing that allows you to get comfortable with and work through them.

I recognize the necessity of CBT and working with a therapist to address the individual underlying issues and stressors that cause anxiety triggers to begin with. And I can admire the purity of my friend's method, even if I think he'd get a lot farther by doing it in a more guided capacity outside the vacuum of his own mind. But I can't see any downside (cultural judgments aside) to keeping the attacks at bay through medication until I can afford actual CBT.

So, what's the reality of the situation? Is the use of medication for anxiety disorder just a cheat? Is the best thing just to suck up and let the panic batter you around until you can retrain your own brain? Obviously I'm also dealing with the feeling of being judged by my friend, but I'd like to know what the latest word is from the medical community on the subject. Articles and citations are endless on the Web, but I'd sorta like a boildown from someone with a better handle on reliable information.

posted by anonymous to health & fitness (20 comments total)

Strokes, folks. You're on your path, which is working very well for you. I don't understand why you are comparing yourself to someone else. If you think that medication is a cheat (I don't think you really do), well, then, me and most of my closest friends are cheats. So, screw that, live your life, be happy.
posted by ClaudiaCenter at 12:20 PM on November 29, 2009

You're experiencing a valuable benefit from medication. You're living your life in a more balanced way than you were pre-medication. Don't let what your friend believes unduly influence you. There are different paths that we each take through this life. None are more valid than the other.
posted by cooker girl at 12:28 PM on November 29, 2009

Would you ask the same question if this was about blood pressure meds? Say you go on Diovan, but your friend goes the eat better + exercise more route. If he still has issues with hypertension that he doesn't want to admit... well, that could lead to very big issues later. You may be medicated with Diovan in this example, but you don't have hypertension issues.

It's weird how things shake out a bit differently when you put them into physical symptom translations. I think there is way too much stigma still associated with depression, antiety, and other mental juice issues.
posted by kellyblah at 12:33 PM on November 29, 2009 [6 favorites]

3rding the different strokes for different folks thing. I had anxiety disorder for decades unmedicated and got rid of it eventually through getting very lucky and finding the right therapist for me. Other people I know have had just as good results (or even better if you count the immediacy of the effect) through medication. There are no judgments, just what you are most comfortable with and what works for you.
posted by merocet at 12:34 PM on November 29, 2009

(I'm a therapist but this is not advice meant to suggest any treatment or recommendations by any means.)

You know, a lot of people find medication to be really helpful initially in treating anxiety, and then once they learn more tools in therapy to handle it on their own, they decide to stop the medication, and that works for them. I don't really see that as a cheat, myself--especially if it allows you to return to functioning well in your everyday life. Doing the medication-but-no-therapy route is not my favorite approach because no one learns anything, and big pharma profits like crazy because that medication is probably part of that person's life forever. Doing the therapy-but-no-medication route may be right for some people, and can be very effective in itself. I personally work hard to assess the situation fully and attempt many possible avenues before referring for medication, but sometimes medication can really help. A no-meds-no-therapy option may be helpful for some, but many therapists have training in CBT administration that the average person may not have, which increases its effectiveness, so I don't know why it would be a terrible thing to start CBT with a therapist.

That said, it sounds like there is a little bit of you that is looking for 'permission' to choose what you choose, because of this comparison to others' preferences of treatment. You don't need permission from anyone else, you just need to be ok with what you're doing because it's working for you. The least helpful thing for anxiety is to have anxiety about the form of treatment you chose for your anxiety. :)
posted by so_gracefully at 12:36 PM on November 29, 2009 [5 favorites]

Better living through chemistry.
posted by dancestoblue at 12:44 PM on November 29, 2009

Medication is not a "cop-out". Everyone does what works best for themselves and their particular manifestation of an illness or issue.

If you had diabetes and used insulin with great success, and your friend also had diabetes but was able to manage his diabetes with food choice/timing and exercise, would you say, a) "I'm just copping out by using insulin," or b) "I guess my friend's body and mine are different"?

Your friend's brain and yours are different.
posted by Sidhedevil at 1:04 PM on November 29, 2009 [4 favorites]

I would do the drugs to show yourself that another way of living is possible, but I wouldn't rely on them as a way of achieving that state long term.
posted by phrontist at 1:07 PM on November 29, 2009

It sounds like your friend is being unnecessarily judgmental, and I am not sure how that helps anyone. Different things work for different people. I don't really think you can "cheat" at being healthy, and your perspective that meds help you get out of your own way makes perfect sense to me. Usually people need a combination of things to address their issues (meds, therapy, lifestyle changes, etc), and the utility of each method increases and decreases as their situation ebbs and flows.

Your friend is anti-medication, and that's fine for him, but taking anti-anxiety medication is no more a cop-out than taking Advil when you have a headache. Some people refuse to take any type of medication for any sort of ailment, and I never really understood what that proves, but they always seem very self-satisfied about this decision. My feeling is that's fine, you don't want to take something that will help your headache? Good for you, but I am not going to suffer more than I absolutely need to, so just like you don't want a lecture about why you should take Advil, I don't want a lecture about why I shouldn't.

So, that was a long winded way of saying, trust you are making the best choices for your own situation, and tell your friend that while he feels his way works best, he needs to chill because what works for him, isn't always going to be the answer for everyone else in a similar situation. If it were that easy, we would have resolved all of our issues long ago!
posted by katemcd at 1:10 PM on November 29, 2009 [2 favorites]

Obviously I'm also dealing with the feeling of being judged by my friend

I think you should stop discussing this issue with your friend. He's doing what works for him and that's fine. But it isn't helping you to continue discussing and comparing his treatment and yours. It sounds like he has an agenda or feels he has something to prove based on his own experience and his own choices: that puts him in a bad position to be thoughtful and supportive when talking to you about your similar situation.
posted by Meg_Murry at 1:17 PM on November 29, 2009 [3 favorites]

It doesn't necessarily have to be an on/off, yes/no question. If taking medication every day is bothering you, maybe talk to your therapist about instead getting something like klonopin or xanax that you only take when you feel the beginning stages of a panic attack? I have had stages in my life where I really needed the lexapro every day for depression and anxiety and other stages, like now, where I have a bottle of klonopin for emergencies - that I very, very rarely take; just having the bottle seems to be enough - and I go day to day with fish oil and am fine.

There are good arguments on both sides for taking or not taking meds every day and eventually it comes down to a very personal decision: what works for you and your body. There's no one great right way to treat this stuff; it's different for every person - and, in fact, it's different for each person at different times in their own lives. What's working for you or for him now might change completely a couple of years down the road.

And the robots thing? That's an old hippie argument that doesn't hold water. Do you feel like a robot? Or do you just feel like you without the freaking out and then worrying about freaking out and then freaking out about worrying about freaking out part? Yeah, I thought so. Anti depressants and anti anxiety drugs don't seem to turn people into robots that I have noticed. There are a ton of people out there who take daily meds for anxiety; have you noticed a sudden terrible influx of robots? I think you can - and should - laugh that one off.
posted by mygothlaundry at 1:29 PM on November 29, 2009 [4 favorites]

Which option benefits you more? Go with that option.

I toughed it out. And it was hell. But it worked, and I wouldn't have done it any other way. However, I don't view medication as being a cop-out at all. If I was diabetic and needed insulin, I'd take it without a moments hesitation. I'd look into all the options though - diet, exercise, insulin, whatever - weigh up all the options, and then make an informed decision to take whichever route seemed best to me.

If meds are working for you, that's good. You might find benefits in meds + CBT or meds + something else, or you might not. It might be worth looking into other options as well as, to see how you get on. But don't model your own treatment on someone else's. Each individual brain is way too unique to do that. If you're method is working, that's infinitely better than one that isn't. What someone else thinks of it is immaterial. It's working for you, and that's what matters.
posted by Solomon at 1:51 PM on November 29, 2009

I've been dealing with anxiety for a few years now, currently on a mixture of medication and CBT. And medication is not a cop out in any way. After my levels had settled down, the effect they had was actually very slight. What they did do is lower the barriers to change my own behaviours. Changing the way we think and live is already a slow, painful process. Medication makes it easier on you. I recommend you talk to your doctor and your therapist and find a balance that works for you.
posted by elephantday at 2:22 PM on November 29, 2009

I think you and your friend might be making each other feel defensive and uneasy talking about your treatments. I know that in order to manage my anxiety, I occasionally have to take a few steps back from people with similar issues and just not discuss it with them.

It's not that I think my friends' choices are bad or that I'm a hothouse flower who can't man up and talk about those topics, it's that it's easy to turn it into a competition or use it as a yardstick instead of framing it as a matter of how individual approaches differ. (Any time someone else is your yardstick in anxiety land, you're almost certainly going to find some reason why you find your own methods and experiences wanting in comparison to whatever they're up to. Anxiety likes cognitive distortions; it makes it easier to get stressed and panic.)

And yeah, my old coworker did exercise and portion control and his blood pressure is great now. Mine is great too now-- because my doctors said "You're getting eye damage from your BP, you need to fix that," and I opted to medicate immediately to solve the additional stress factor of eye problems. If the meds are making you feel better and clearing the deck of potential stressors, I don't think anyone else is allowed to tell you that it's a bad choice.
posted by fairytale of los angeles at 2:30 PM on November 29, 2009

It's not a cop-out. Tell your friend that you'll agree to disagree, and then stop discussing it with him. He doesn't like inside your head literally, so you shouldn't be letting him live there metaphorically, either.
posted by bingo at 3:28 PM on November 29, 2009

blessing or cop-out?

The answer is yes. Find you balance.
posted by caddis at 5:30 PM on November 29, 2009

I take 40 mg of Celexa daily. I am by no means a robot.

Do what you think you need to do, and stop talking with your 'friend' about it.
posted by ten pounds of inedita at 5:57 PM on November 29, 2009

Taking medication is far from a cop out. Some people can do it with CBT alone, some with medication alone. I firmly believe that when one doesn't work alone, you need both in order to feel better. By him chastising you, perhaps he isn't getting rid of his issue afterall? Meds are scary so I can feel for him. I hated going on meds again, which was Celexa (1/2 pill at 10mg) and I wound up so sick after two pills that I had to stop. But, I can't stand the panic attacks so I get up back on that horse and try again with a different med.

Good luck.
posted by stormpooper at 6:34 AM on November 30, 2009

Within an hour of taking anti-anxiety meds for the first time, I noticed a change. I wouldn't want to experience another day like my pre-Prozac life, ever.

CBT has helped me immensely, from overcoming compulsive, anxiety-encouraging behaviors, to understanding the causes that set these forces at work inside my mind. I wouldn't want to live without those gains, which are permanent (unlike the meds).

I want both in my life. I now take 20 mg of Lexapro daily, and on work days supplement with 0.1-0.2 mg of lorazepam (yes, that's a fraction of the minimum tablet size - powerful, addictive stuff!).

And, I simply MUST repeat these words from Sidhedevil:

Medication is not a "cop-out". Everyone does what works best for themselves and their particular manifestation of an illness or issue.

Amen.
posted by IAmBroom at 10:32 AM on November 30, 2009

I have some propensity towards panic attacks, made much worse by certain medications. It took a smart therapist to really help, and a good physician to help me get medications sorted out. It's a shame that people decline useful tools, but we all make our own choices. My therapist taught me that cold water on the face can stop a panic attack. Very cold water on the face stimulates the mammalian dive reflex, and the physiologic changes can stop a panic attack.
posted by theora55 at 2:47 PM on November 30, 2009