High Strung

The anxiety epidemic in the U.S. has driven many sufferers to short term treatment.
January 2014

jenThe University of Arizona– and Columbia-trained psychiatrist and former president of the American Holistic Medical Association is a pioneer in integrative psychiatry: In 2001, he penned its first textbook and followed that up with two more books on the subject, including Mental Health for the Whole Child, released this past July, and Parenting the Whole Child, released in November. He describes his philosophy as one that evaluates all the external influences that might affect a patient’s mental well-being. “I try to understand people as a comprehensive whole,” Shannon says. He does this by focusing on how an individual’s diet, exercise, traumatic life events, stressors, and relationships impact his or her mental health. Once he has a grasp on what may be causing an individual’s anxiety (or any other psychiatric affliction), he offers what he says are safe, effective, evidence-based techniques—meditation, cognitive behavioral therapy, nutritional supplements, acupuncture, and diet modifications—to bring relief. While he’s not opposed to writing a script, it’s not his starting point. And he rarely, if ever, prescribes benzodiazepines.

The first benzo, Miltown, hit the U.S. market in 1955, followed by a slew of others including Librium in 1960, Valium in 1963, Klonopin in 1975, Ativan in 1977, and Xanax four years later. All of these drugs affect gamma-aminobutyric acid (GABA), a chemical—or neurotransmitter—in the brain that helps calm the mind and ease anxiety. Think of GABA as a key roaming the brain looking to find the right lock, or receptor, to open. When it does, it attaches to its corresponding GABA receptor and unlocks GABA’s soothing effects. Benzodiazepines work by attaching to GABA receptors and amplifying the neurotransmitter’s effects, thereby creating an artificial sense of peace. By 2011, Xanax had emerged as the most popular antianxiety medication in the country with nearly 50 million prescriptions dispensed in that year alone, making it the most prescribed psychiatric drug (besting antidepressants Zoloft and Prozac) and the 10th most-prescribed medication overall.

It’s not difficult to understand why benzos are all the rage in the United States: According to the World Health Organization, we are the most anxious country on the planet. More than 40 million American adults (including about 627,748 Coloradans) currently live with a diagnosis of anxiety—a disorder with many variations—which is generally defined as excessive fear or unrealistic worry even if there is little to incite those feelings. And it seems that our fears are growing exponentially: Diagnoses have seen a 600 percent jump since 1990.

Likewise, prescriptions for benzodiazepines have jumped—17 percent since 2006 and 44 percent since 1981. The drugs are a hit because in the short term, they’re cheap, effective, and have relatively few side effects. With the pop of a pill, all that stress about work, family, finances, and your dying mother melts away.

But here’s the issue: There is no medical study that shows long-term benzo use improves anxiety. What researchers have demonstrated is that long-term benzo use can cause structural changes to the brain and central nervous system, depression, and memory loss and may lead to other psychiatric diagnoses. Reports have simultaneously shown that even short-term benzo use can damage cognitive and intellectual abilities. And, ironically, benzos have been known to worsen symptoms of anxiety.

Still, doctors from New York to California—and here in Colorado—continue to prescribe the drugs. Mainstream psychiatrists like Dr. Robert Davies, an associate professor of psychiatry at the University of Colorado School of Medicine who specializes in anxiety disorders and sometimes prescribes the drugs (though he prefers selective serotonin reuptake inhibitors, like Prozac, for treating anxiety), acknowledge benzos’ double-edged sword. While Davies says the drugs can provide short-term benefits for many people, he cautions about their potential for addiction, abuse, and the development of tolerance and depression and says, “There are a variety of reasons they shouldn’t be used long-term.”

The hours of lying awake, staring at the ceiling had finally gotten to Roeder. It was April 2003, and she had been suffering from insomnia for what seemed like forever. She ultimately decided it was time to visit a mental health clinic in Durango. “I told the nurse practitioner I was having trouble sleeping from anxiety that I felt was caused by stress,” Roeder says. At the time, she was 37, a single mom to a five-year-old daughter, and she worked part time while pursuing a bachelor’s degree at Fort Lewis College. With her time and energy stretched, she worried about meeting her young daughter’s emotional needs. She stressed over paying the bills and juggling her responsibilities. She asked for something that would ease her anxiety and help her sleep. She also requested the prescription drug be non-habit-forming. The nurse practitioner prescribed her one milligram of Ativan, a low dose of the benzo, and told her not to worry. “You’ll be fine,” Roeder remembers him saying.