by R. Reid Wilson, Ph.D.

If you would like to consider medication as a form of treatment for your anxiety symptoms, here are a few suggestions that may make your decision easier.

Begin by Obtaining an Accurate Diagnosis. If you are having anxiety symptoms, first see your primary physician to find out if there is any physical cause. If your physician makes no physical diagnosis, he or she should refer you for an evaluation by a licensed mental health professional who specializes in anxiety disorders. Once you receive a diagnosis, your options for medications will be clearer.

There Is No Magic Pill. Among clinicians who specialize in anxiety disorders, there is general agreement that medications can be beneficial for some anxious patients when used in conjunction with a treatment approach similar to the one outlined in this book (that is, one that directs you toward altering your dysfunctional thoughts and encouraging your ability to face those situations that you fear). Although we base treatment on the specific problems and resources of each patient, the key to successful cure lies in each individual's sense of his personal ability to face the fearful situations and master his symptoms. All professional interventions, whether individual therapy, group therapy, medication, behavioral techniques, or practice exercises, should have but one purpose: to stabilize your belief that you are able to exert personal control over your body and your life.

Take medications within this context. Often medicines can be a beneficial short-term crutch to help while you heal yourself. They do not heal you any more than a cast heals a broken leg. The body heals itself of many problems, given the proper support. For some people, medications offer a good long-term support for a disorder that can be chronic and cyclical in nature. Without medications they seem to relapse into troubling symptoms.

Complex problems do not have simple solutions, although many people will look for a quick cure and a magic pill. If they can find a sympathetic physician, they will begin a regimen of medications as their only means of removing all discomfort. Unfortunately, reports in the media that present a limited analysis of a complex problem reinforce the belief that medications are the only answer. By deciding to believe that they have an uncontrollable physical disorder, some patients surrender themselves to anxiety and panic. And in the process, they lose self-esteem, determination, and the willingness to trust in the healing power of their body and mind. They remain dependent on medications, physicians, friends, and family as they continue to limit their personal freedom.

Don't Suffer Needlessly To Prove You Are "Strong". On the other hand, some people believe that medications are for "weak" people, and they don't want to be "dependent". These people tend to make three mistakes. They avoid taking medications at all, when medications could play an appropriate and significant part in their self-help program. They under-dose the medication they are taking, falsely believing that "less is better." Or they prematurely decelerate from a medication that is currently helping them. Medications can be effective, and they can be appropriate for you, depending on your problem. There is a specific dose that will be best for you, that your physician will help identify. And there is justification for some people to remain on medication even for years if the side effects are not troubling them, they are not trying to get pregnant, and symptoms tend to return when they experiment with withdrawing from the medication.

If You Decide to Use a Medication, Give It a Fair Trial. To evaluate the benefit of a medication, you must give it enough time to provide its therapeutic effect. Work with your physician, especially in the early weeks of your medication trial, to adjust the dose and to relieve any worries you might have. Most physicians will initiate any of these drugs at a low dose and then increase it slowly according to your response. You will need a trial of several weeks at full dose to determine the benefits.

Be Willing to Tolerate Some Side Effects of Medications. Side effects are unwanted psychological or physical changes that are typically not directly related to a medication's capability to treat a disorder. All medications have side effects. Rarely, they can be serious. Most will be minor symptoms that may be bothersome to you but do not require medical attention. These side effects may also diminish or end in a few days or weeks as your body adjusts to the medication. Before using one of these medications, ask your physician about the possible side effects: which can you expect, which might diminish over time, and which need his or her attention. Report any persistent or unexpected side effects to your prescribing physician.

As an example, you can relieve a dry mouth by frequent rinsing or by sucking on hard candy or chewing gum (preferably sugarless). Blurred vision may clear up in a couple of weeks. If not, a new eyeglass prescription can help. You can counterbalance mild constipation by increasing your intake of bran, fluids (at least six glasses a day), and fresh fruits and vegetables. Laxatives may also help. To assist with problems urinating, your doctor may prescribe bethanecol (Urecholine).

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Dr. Wilson is Associate Clinical Professor of Psychiatry at the University of North Carolina School of Medicine. He is an international expert in the treatment of anxiety disorders, with books translated into eight languages.

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Reviewed: 02/2006