What do you want the drug to do, and for how long?

Anyone who has either recently started or is contemplating the use of antidepressants or benzodiazepine anti-anxiety agents should ask themselves: what is it I am  asking of the drug and for how long do I envision availing myself of its services.

calendarThese drug classes are prescribed in droves, often cavalierly, for the wrong symptom set with few questions asked. Benign signs of depression and intermittent anxiety associated with the ups and downs of everyday life yield prescriptions in all but a heartbeat nowadays. Then users hitch their wagons to these drugs to pull them out of the muck and mire only to be disappointed because of faulty expectations, or even worse they become dependent.

The faultiest of expectations regarding antidepressants is that these drugs will fill some kind of happiness or contentment void. They don’t and that’s a displeasure just waiting in the wings. A less faulty outlook for antidepressants – but faulty nevertheless – is that they will change behavior, rescuing the user from having to do the often painstakingly hard work of identifying the who’s, what’s, where’s when’s and how’s contributing to or driving their discontent. In my experience, expectations are most often skewed among those who shouldn’t have been prescribed antidepressants in the first place; whereas the severely depressed tend to view these drugs as an opportunity to get a leg up, which is quite reasonable.

As for the benzodiazepines, the issue of what one wants these drugs to do and for how long is even more paramount, because dependence – psychological or physical – lurks in the shadows. Dependence on the benzodiazepines is most often psychological, providing a dissociative or numbing effect on anxiety. For those, however, experiencing a situational factor such as the loss of a loved one or being suddenly downsized from a job, short-term benzodiazepine use, for 2-3 days, to help tone down acute anxiety can be an asset. As such, the parameters of benzodiazepine use are clearly defined. Use of these drugs for months or even years though, begs an evaluation of what’s going on between the ears.

Then there’s the matter of sleep. Multiple factors affect sleep hygiene. Poor preparation for sleep accompanied by excessive stimulation too close to bedtime and physical factors such as sleep apnea or restless legs syndrome should be ruled out first. Situational factors listed above can influence insomnia, again warranting short-term use of sleep agents until the issue runs its course.

It’s natural for any of us to want to rid ourselves of any ill feeling such as a mood or anxiety problem. Life can be challenging enough without carrying this extra baggage, so logically we’d want to send these interlopers packing in a hurry. But the key for anyone using antidepressants or anti-anxiety agents is this: ill mood and anxiety issues didn’t develop overnight and they won’t be solved overnight either. So feeling better is contingent upon thinking better and both are a matter of self-reliance by doing the hard and humbling work of self-examination.

As for the drugs, they’re merely riding shotgun in the passenger seat, providing companionship for a while, but not doing the driving.

Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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