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Another possible side effect addressed in this chapter is postural hypotension, also called "orthostatic hypotension". This is a lowering of the blood pressure as you stand up from a sitting or laying position, or after prolonged standing. This disequilibrium can cause sensations of dizziness or lightheadedness, and sometimes fatigue, especially in the morning when you get out of bed. These are simply signs that your circulatory system needs a little more time to distribute blood equally throughout your body. You may also notice an increase in your heart rate (tachycardia or palpitations) to compensate for this brief hypotension. When this side effect is mild, doctors advise that you get out of bed more slowly in the morning, sitting at the side of the bed for a full minute before standing. In this way, take your time rising from seated position during the day. If you feel dizzy, give your body a minute to adjust to the standing position. You may also benefit from increasing your salt and fluid intake and possibly even wearing constrictive support hose.
Here are some ideas for addressing a few other common side effects of anxiety medications. Some medications have a sedating effect, making you drowsy. Physicians will suggest that you take those close to bedtime if medically appropriate. On the other hand, if a drug causes you to have difficulty sleeping, they may suggest taking the medicine in the morning. As an alternative for either of these problems, you may need to lower the dose or change medications. For increased sweating, be sure you increase your fluid intake in warm weather to avoid dehydration. For weight gain, there are no simple answers, but watching your calorie and fat intake, and getting regular exercise, can help. Sexual side effects such as inability to have an orgasm often diminish within a few weeks. If not, your doctor may lower your dose or change to a different medication. Occasionally the drugs bethanecol (Urecholine), cyproheptadine (Periactin), buspirone (BuSpar) or amantadine (Symmetrel) can help this problem. If the medication causes increased sensitivity to the sun, use suntan lotion with an SPF factor of at least No. 15 whenever out in the sun.
You and Your Doctor Can Decide How Long You Will Remain on Medication for Your Anxiety. It may take from three weeks to three months to establish the proper dosage of one of these medications. Most investigators suggest that a patient taper from a medication after symptoms are under control. This could be from several weeks to twelve to eighteen months (or even not at all), depending on the conditions. Throughout this time you should actively face your anxiety-provoking situations, using the skills described in this book. As you taper off the medications you may experience some return of your symptoms. Be patient as your body adjusts to being medication-free, and continue to practice your skills. After about one month, you and your doctor will be able to assess how well you are handling the stresses of your life without medication. If needed, you can discuss a return to that medication or some other alternative drug. If you and your doctor decide that long term use of the medication is the best alternative for you, he or she will help you reduce the medicine to the lowest possible dose that controls the symptoms.
You Must Taper Off These Medications Gradually. Once you have begun treatment with one of these medications, you should never abruptly discontinue your daily dose. Instead, your prescribing physician will direct you in a safe withdrawal process, which may take several days to several months, depending on the condition.
Medications for Treatment of Anxiety Are Optional. You always have a choice regarding the use of medication. Do not let anyone persuade you that you must take drugs as your only option to overcome an anxiety disorder or that they offer the only cure for anxiety symptoms. As you have read throughout this book, many forces come to bear on your anxiety. Symptoms can reflect any one of several different psychological disorders and a number of physical problems. Keep your mind open to all your options in resolving this difficulty. If you choose to use medications as part of your treatment, do so because of your values and beliefs and your trust in your physician. We know from research and clinical experience that these medications are of no benefit to some people and can make matters worse for others. If medications do not benefit you, continue to give your other options a fair trial.
Are You Dependent on Drugs or Alcohol?
About 24% of people with a long-standing anxiety disorder also have difficulty with drug or alcohol abuse. If you are having this kind of trouble, it is best to get treatment for your chemical dependency first. Consider participating in a long-term recovery program such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). Stopping your drug or alcohol dependency will give you a much better chance of achieving your goals of recovering from your anxiety problems. It is also most important that you inform your prescribing physician that you are currently having trouble with drug abuse or if you have in the past. That will help your doctor determine which of your symptoms relate directly to anxiety, and will help him or her to choose the right medication for you. For instance, antidepressants, SSRIs or buspirone are usually better choices for anxious patients who have been chemically dependent because they do not lead to dependency or abuse.
next: Anxiety Medication Profiles
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