The Downside Of Medication As First Line Treatment For Anxiety + Depression

I watched a video recently about Lil Xan, a rapper from California who has been very candid about his drug abuse. In the past, he was very reliant upon benzodiazepines and opioids but he is supposedly clean or becoming clean now – although this has been disputed by many. There was one part of the video that stood out to me and that is when the focus turns on his mother, who explains that he was initially prescribed benzodiazepines for anxiety, which helped. It got me thinking about the fact that medication is such a common first line of treatment for things like anxiety when it perhaps shouldn’t be.

One of the first things we got told about hypnotics and anxiolytics like benzodiazepines in my pharmacology class is that they cause dependence and tolerance and that they should only be prescribed for short-term use. In the UK, each NHS Health Board has a formulary which outlines prescribing guidelines for their region. Where I’m from, diazepam is the first line of treatment for anxiety. In the section for hypnotics – drugs used to induce sleep – it states that the underlying cause of the insomnia should be established and that underlying factors should be treated before prescribing treatment. It doesn’t say this for anxiety. And I think that it should. When I first presented to my GP with anxiety at the age of 15, I was prescribed a beta-blocker, propranolol, to alleviate the physiological symptoms such as shaking and a fast heartbeat. This didn’t really work and I was scared to increase the dose because of how it affects your blood pressure but I am glad that it didn’t work. I’m glad I didn’t become reliant on a form of medication. Only through cognitive behavioural therapy (CBT) and examining the reasons for my anxiety was I able to heal from it (I have a blog post on anxiety for those who are interested). Had I been prescribed diazepam – which certainly would’ve worked – maybe I would’ve become dependent on it and maybe I would’ve become too scared to look within. Medications for anxiety can act as a buffer – something external to gloss over an internal problem. And especially with drugs like diazepam, the longer you take them the higher your tolerance becomes and the more you need to achieve the anxiolytic effect. That’s likely what happened to Lil Xan, along with the drug misuse that goes with becoming increasingly involved in the hip hop scene. When you have had that build-up over time, the tapering-off process can be brutal.

Someone I met at college told me that they take diazepam every now and then when they feel very anxious. I asked her if she’s thought about counselling and told her how much CBT had helped me and she said that she hadn’t ever received counselling. Some people vaguely know the reasons that they’re anxious and because of this think that it’s not going to go away. They had a bad relationship which the anxiety was a product of and that’s the end of it. I think we all deserve so much more than that. We don’t have to be the powerless products of our experience. If we could delve to the darkest corners of our minds with love and patience and face our greatest fears – a whole new world could open up. It helps to have someone guide you through this journey and that’s where counsellors come in. Unfortunately mental health is notoriously underfunded in the UK and beyond and the only reason I was able to get extended counselling was because I accessed it through my local Women’s Aid. I had gender and youth on my side which helped. Some people are not so lucky. If we are in the place to be able to fund a few sessions, though, it could be extremely beneficial. Some counselling agencies are dedicated to helping those from a lower income and will accept a donation. The counselling agency I accessed a few months ago was understanding of my financial circumstances being a student and lowered the cost for me. It still took a big dent in my dwindling finances but I was investing in my mental health and to me that is the most important thing. There are also resources online for cognitive behavioural therapy for those who feel a bit more self-sufficient. Basically the point I’m trying to make is that treating anxiety with medication doesn’t always solve the problem and can make people feel even more powerless. With medication you are treating the symptoms not the illness and it can prevent you from solving the issue at the root of the neurosis.

Unfortunately, some healthcare professionals (HCPs) aren’t sold on the idea of talking therapy. When I first moved to Edinburgh and went to the GP to talk about my urges to self harm and the recommendation of therapy from the mental health team back home in Shetland, the GP stated that there was “no evidence that counselling helps”. My heart sunk. What a shame to have a perspective like that. I wanted to tell him about my success story with anxiety but I knew there was no point. You can explain all you want, most people just hear what they want to hear. I’d been offered medication on two separate occasions over last summer – one of the recommendations actually coming from the counsellor from the mental health team – but I declined both times. I had a similar experience with medication and depression as I did with anxiety. I tried antidepressants when I was 18 and suffering from my third major episode of depression. I was going through a very difficult time at university and needed all the help I could get. They worked for a while – improving my motivation and outlook – but then things went back to the way they were. Again, I’m glad that this happened. I wasn’t glad at the time but it put this idea in my head that antidepressants didn’t work for me and that I’d have to try something “non-pharmacological”.  Always in the back of my mind is: “What happens when it’s time to stop taking the medication?” You get almost no support when you’re on medication for anxiety or depression. One six-week follow up – if you’re lucky – and that’s that. When I stopped taking antidepressants, I didn’t even talk to the GP about it – I didn’t see the point. I researched it online and got on with it.

I’m aware that some people feel they could not function without their meds. I know how that feels and I am not judging them or trying to demonise them. When the antidepressants stopped working for me, I panicked and begged the GP to prescribe me an increased dosage. I also know that there are varying levels of anxiety and depression and for some people, counselling alone may not work. I’m just trying to explain that, for those who feel able, learning to cope without medication can lead to a greater quality of life and a resilience you didn’t know you had.

What’s funny is at the moment I’m going through such a massive change in my life right now that diazepam would be great. I’d love to not feel everything I’m dealing with right now: a lump in my throat, an ache in my heart, financial issues and uncertainty about what lies ahead. But I have faith in my resilience and that this will be another thing in my life to shape me into the woman I will become. I haven’t properly meditated in over a week. I’ve taken a day off work for my mental health today and I’ll be down around £70 the next time I get paid. I haven’t cleaned my room in a month and today is the first shower I’ve had in three days. But I know I’ll be fine.

Thank you so much for reading. Sorry that today’s post has been a bit rambling – I’m all over the place.

– SMUT. ❤ xxxx