More People Are Taking Drugs for Anxiety and Insomnia, and Doctors Are Worried

Insomnia

source:- wsjcom

As coronavirus health concerns, social isolation and job-loss stress take a toll, people turn to medications; ‘It can very quickly become a habit’

Prescriptions for anti-anxiety medications and sleep aids have risen during the pandemic, prompting doctors to warn about the possibility of long-term addiction and abuse of the drugs.

“Many physicians have a low threshold for prescribing them. It’s very problematic,” says Bruce J. Schwartz, deputy chair and professor of psychiatry and behavioral sciences at Montefiore Medical Center in New York. “Many people do develop a dependency on these medications.”

Prescriptions for anti-anxiety medications, such as Klonopin and Ativan, rose 10.2% in the U.S. to 9.7 million in March 2020 from 8.8 million in March 2019, according to the latest data from health-research firm IQVIA. Prescriptions for antidepressants, including Prozac and Lexapro, rose 9.2% to 29.7 million from 27.2 million in the same period. The information doesn’t include data on whether dosages have increased along with prescriptions.

‘If you’ve lost your job, if you’re worried if you’ll have enough food for your kids, that will keep you up at night.’

Some companies have seen more dramatic increases. Express Scripts, a pharmacy benefit manager owned by Cigna, says prescriptions for anti-anxiety medications rose 34.1% between mid-February and mid-March, while prescriptions for antidepressants and sleep medications increased 18.6% and 14.8%, respectively. Ginger, which supplies video- and chat-based mental health services to companies, says its psychiatrists wrote 86% more prescriptions for psychotropic drugs, primarily antidepressants, in March and April 2020 compared with January and February.

Health concerns, social isolation and the stress of job losses are taking a toll on people’s well-being. More than one-third of Americans say the pandemic is having a “serious impact” on their mental health, according to a survey released March 25 by the American Psychiatric Association. Among parents with children under 18, 46% rated their average stress level related to the pandemic as 8, 9 or 10 on a 10-point scale, according to a survey the American Psychological Association released May 21. The nation’s top mental-health official recently warned that the suffering could deepen if there were a second coronavirus lockdown.

“This kind of chronic stress brings about, for all those people who have never had anxiety before, it sort of overwhelms them,” says Charles B. Nemeroff, professor and chair of the department of psychiatry at Dell Medical School at the University of Texas at Austin and president-elect of the Anxiety and Depression Association of America. “If you’ve lost your job, if you’re worried if you’ll have enough food for your kids, that will keep you up at night.” And for those with a history of anxiety and depression, stress can raise the risk of a relapse.

The most popular anti-anxiety medications are benzodiazepines that include Valium, Xanax, Ativan and Klonopin. These drugs enhance the activity of the central nervous system’s main inhibitory neurotransmitter, GABA (gamma-aminobutyric acid). GABA’s primary function is to reduce the activity of neurons. “They are powerful, and they are powerfully attractive in that they work instantly,” says James Potash, director of psychiatry and behavioral sciences at Johns Hopkins Medicine. “You take Ativan, and 30 minutes later you are feeling dramatically less anxious.” Sleep medications like Lunesta and Ambien are similar to the benzodiazepines in that they also alter the activity of GABA. The neurotransmitter is thought to facilitate sleep.

Doctors say that benzodiazepines can be a useful tool and are very effective for the short-term treatment of acute anxiety. Dr. Potash advises patients to limit their use to weeks, not months. The problem, he says, is that people can quickly develop a tolerance to their effects—sometimes in as little as two weeks—which can lead patients to increase the dose. This is especially the case with the shorter-acting drugs like Xanax, which are also abused as street drugs. The medications can be difficult to stop, too. Withdrawal symptoms can include a surge in anxiety, tremors and, in some cases, seizures. The medications can be particularly dangerous for older adults: In seniors, their use is associated with falls and cognitive problems.

Because benzodiazepines can reduce the body’s drive to breathe, overdoses can be deadly. That is especially true when they are combined with alcohol and opioids. Overdose deaths involving benzodiazepines more than quadrupled between 1999 and 2013, according to a study published in 2016 in the American Journal of Public Health.

People can also develop a psychological dependence, says Beth Salcedo, a psychiatrist in Washington, D.C., and the past president of the Anxiety and Depression Association of America. “If you have a boatload of Xanax, and you are slightly anxious, and you take one, you feel better. Next time you are anxious, instead of taking care of what is making you anxious, you’re much more likely to reach for the Xanax,” she says. “It can very quickly become a habit.”

Dr. Salcedo recommends taking other steps to address anxiety, including “exercising, eating well, avoiding alcohol and making sure we surround ourselves with our social support as much as possible.” If anxiety is interfering with work or relationships, she advises turning to the most evidence-based treatments for anxiety disorders, which are cognitive behavioral therapy, a type of talk therapy, and antidepressant medications like Lexapro and Prozac. Since it can take several weeks for the effects of antidepressant medication or therapy to kick in, some doctors will use benzodiazepines briefly in the beginning of treatment to provide patients with immediate relief.

Doctors have some of the same concerns with common sleep medications like Ambien and Lunesta as they do with the benzodiazepines, particularly when taken long term: They can be dangerous when combined with alcohol, and there are worries they can be addictive and abused. The drugs also come with side effects like daytime drowsiness, sometimes called the hangover effect.

For chronic sleep problems, experts recommend first trying cognitive behavioral therapy for insomnia, known as CBT-I. It typically includes “sleep restriction,” or limiting the amount of time people spend in bed when they are unable to sleep, and “stimulus control,” which means keeping the bedroom dedicated to sleep and sex.

“Changing behavior is usually a healthier approach,” says Dr. Potash. “It is pretty much all upside and very little downside.”

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