STOP Letting Anxiety Control Your Treatment Outcome!

This ten-minute presentation started out as a short that ran too long! The important thing is to recognize one's own anxiety, which can be difficult to discern when it is more-or-less constant, i.e., part of one's chronic baseline. In treating patients with lifelong, endogenous anxiety, embarking on even an agreed-upon treatment regimen can prove difficult, as patients often change their minds, or abort the trial after a few doses due to side effects or paradoxical reactions, but in truth because of the anxiety itself, the very thing being treated.
Anxiety masquerades as other conditions; it is loathe to be diagnosed, and often reluctant to submit to treatment. A "flight into health" is not uncommon in patients who become non-adherent with their medication; rationalization is the main defense mechanism used to deny the severity, and even the very presence, of their anxiety.
Taking a condition like Generalized Anxiety Disorder into remission requires the highest doses, and the longest period of time: up to 12 weeks or longer, and often combination strategies are required. It can be very challenging to get patients to stay on such a course. Even with adequate treatment, recurrence is the rule, and adjusting the treatment regimen is often an ongoing process.

[@notonanemptymind]

Please excuse the terrible sound…I forgot to use my microphone! I thought it would be a short. 😂

[@goral9693]

Excellent approach!! Im starting to wonder where are you based, and if online sessions are availiable. But then prescriptions would be a thing....

[@notonanemptymind]

Thank you, yes I do offer non-medical, question answer sessions online, but I cannot diagnose or prescribe outside of Texas. Thanks for watching, though!

[@Buzz1-th9io]

So what to do if a patient just can not get on an SSRI or SNRI even with very slow introduction and even with co-administration of a benzo; due to increased anxiety, insomnia, panic, internal tension and agitation?

[@notonanemptymind]

The scenario you describe could only be possible if the doses were inadequate; the administration of a benzodiazepine can render a person unconscious, at sufficient doses. Obviously, that’s not the aim in the treatment of anxiety, but if an individual is experiencing panic and they’re taking a benzodiazepine, they’re not taking enough of it, period. The same goes for most of the other symptoms you list: tension, anxiety, insomnia, agitation… I would encourage that patient to really explore the possibility of psychological factors impeding an adequate therapeutic trial of even the lowest doses of those classes of medications.