Question:
A day or two ago a caller mentioned that she had panic attacks, and DrL
questioned her about her treatment. DrL said she was very experienced
with panic attacks, and that drugs only dull or blunt your entire
affect, are the worst way to treat panic, and that cognitive therapy is
the way to go.
Although I am not an expert I was quite surprised by DrL's advice. I
thought drugs were a very good way to treat panic. While I understand
and agree with her statements if she is referring to using
benzodiazepines to treat panic, I thought that I heard that SSRIs and
similar medicines were very effective; I would not expect a general
blunting of the affect from SSRIs.
Can anyone comment on this? Are SSRIs effective for panic? Would they
cause a generalized dulling of the personality?
Answer:
there's a big debate about this among those who deal with panic/anxiety.
clinical studies show that cognitive behavioral therapy leads to higher
rates of "recovery" over the long term -- those who go this route (it's the
way i overcame debilitating anxiety in the early 1980s) tend to do better
over time than those who exclusively use medication. right now the
consensus seems to be that if medication is used it should be in
combination with cognitive behavioral therapy.
btw, cbt is _not_ a traditional "talking therapy." it doesn't deal with
causes, but with changing behaviors -- the idea behind it is that changing
behavior changes the thinking, not the other way around. rather than
talking about childhood issues, etc, the therapist instead helps the client
to set measurable/attainable goals, and in achieving them to gain a sense
of control and self-reliance. it's simple and pragmatic, and has helped
many to regain their lives.
If you can fix it without drugs, why not go this route? Drugs can
have short and long-term medical side-effects. The conservative
therapy route sounds like the best in the beginning at least. Don't
SSRI's reduce sex drive?
The National Anxiety Foundation (a not for profit org) contradicts
everything Dr. L said to this caller. True panic and not generalized
anxiety is quite often resolved satisfactorily by prescription
medications and the care of a physician who specializes in its
treatment. Since Panic Disorder has a biological component it requires
appropriate prescriptions and medical care. Cognitive therapy is a "feel
good" but totally useless answer from Dr. L but it does little or
nothing to help people with Panic Disorder, Anxiety or Obsessive
Compulsive Disorder.
Panic victims are extremely at risk of suicide so Dr. L's advice on this
matter was worse than uninformed. It was bordering on negligent. But
since we all know she holds no degree in these areas her advice is equal
to that of a well meaning but misguided neighbor. Ignore her.
For people with Panic or Generalized Anxiety there is an international
directory of physicians and clinicians specializing in this area. The
web site also has extensive information on the appropriate drug
treatments, reading lists and information about withdrawal from certain
prescription medications.
