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Anxiety: FAQ
 
q How long will it take before symptoms go away?
a If a benzodiazepine like Xanax or Ativan is used, symptoms can start to subside within a very short period of time. If the anxiety is severe, doctors try to alleviate symptoms as quickly as possible and, at the same time, may introduce an SSRI which takes longer to work but which is safer than benzodiazepines, has no addictive potential and from which there are no problems with tolerance (where the drug loses its therapeutic effect). Once the SSRI begins to work - usually within three to four weeks - the dose of the benzodiazepine will be slowly tapered off. However, many people do well on the benzodiazepines and do not develop tolerance to the drug's effects. Treatment thus must be individualized depending on symptom severity and individual therapeutic response.
   
q I suffer from panic disorder and worry that I may pass the illness on to my children. How likely is this?
a Evidence does exist that panic disorder tends to run in families and 30% of first-degree relatives of people with panic disorder develop the same problem. High rates of other anxiety and depressive disorders as well as alcohol abuse tend to occur in family members of people with panic disorder as well.
   
q Will I become addicted to the benzodiazepine I'm taking?
a With any of the benzodiazepines, the body usually grows accustomed to the drug's effects and in some cases, the dose needs to be increased for continued effectiveness. However, many people do not develop tolerance, and symptoms remain well-controlled over time. The most important problem with benzodiazepines is the so-called withdrawal effect. Because the body does get used to having the medication around, anxiety, insomnia and other symptoms can become quite severe if the drug is stopped abruptly. Even when the dose is gently tapered over months, people can experience some symptoms of withdrawal. Longer-acting benzodiazepines tend to cause less withdrawal and if people require longer term treatment for symptom control, a long-acting benzodiazepine may be a better choice.
   
q What's wrong with staying on benzodiazepines indefinitely? Are there serious long-term effects?
a The most troubling long-term effects of this class of agents include forgetfullness, an inability to concentrate and related memory changes. Over time, it's felt that these so-called cognitive effects may be important, especially in the elderly in whom similar changes tend to occur with age. The elderly are also more prone to become dizzy, especially on standing, and the benzodiazepines can make this tendency worse.

If a person is doing well on a benzodiazepine and nothing else works, people need to discuss the risks and benefits of long-term medication with their doctor. The average recommended time for people to be on a benzodiazepine is six weeks but if the problem is chronic, the prospect of the illness returning must be weighed against potential long-term risks associated with any medication.
   
q Can I have a drink while taking an anxiolytic?
a For most antidepressants, an occasional drink is permissible. However, both alcohol and the benzodiazepines depress the central nervous system and together, they can have a substantial depressive effect. If you do have an occasional drink with either type of medication, it's important not to drive or to operate any machinery.
   
q Are there any serious long-term effects associated with the anxiolytic medications?
a Most of the newer anxiolytics seem to be safe and fairly well tolerated, even with long-term therapy. If a serious side effect is going to happen, it is most likely to develop within the first three months of being treated. These effects might be on the liver, blood system, nervous system or allergy-related. Following the initiation of medical treatment, any unusual physical or emotional change should be reported to your doctor immediately.