Reducing Anti-Anxiety Medications : Risks and Rewards

By Alex Dimitriu, MD, January 22, 2019

With anxiety disorders ranking as the most common mental illness in the United States – affecting 18% of the adult population every year – perhaps it’s not surprising that more than 1 in 10 Americans take antidepressants, the class of medications used most often to combat anxiety.

But anti-anxiety medications, effective as they may be, are not the only way to tackle the condition. A three-pronged approach is often used combining psychotherapy, exercise, and medication. And some who take anti-anxiety drugs fervently want to cut down on their use.

Why? One simple answer is that the person’s life circumstances have improved – perhaps a chronic anxiety-provoking situation has eased – and a patient doesn’t feel they need medicinal help any longer. More complicated – but also more likely – is that their anti-anxiety medications have triggered various troublesome side effects they don’t want to continue living with.

Common side effects from anti-anxiety drugs can include nausea, dizziness, fatigue or drowsiness, lowered sex drive, insomnia, weight gain or loss, headaches, dry mouth, vomiting, and diarrhea. It’s no mystery why so many potential side effects can stem from anti-anxiety drug use since the same brain chemicals affected by these medications not only play a role in anxiety but a vast range of other bodily systems.

Reducing or eliminating these side effects is an obvious reward from cutting back on anti-anxiety medication use. But what are the risks? First and foremost, the process often isn’t instantaneous: Some medications must be gradually tapered off to avoid withdrawal symptoms. There’s also the risk that your anxiety could abruptly worsen, or that less medication in your system could decrease the effectiveness of other anti-anxiety approaches, such as psychotherapy.

Reducing Anti-Anxiety Medications: Strategies for Best Results

Clearly, a conversation with your doctor about the pros and cons of reducing anti-anxiety medications is in order before any firm decisions are made. But you can also go into this discussion being aware of the many various strategies that offer the best possible results.

Like any other therapeutic approaches to coping with anxiety, alternatives to medication vary in effectiveness from person to person. What do these strategies include?

• Staying active: Exercise is a proven stress-reliever, so daily physical activity is perhaps the best holistic anti-anxiety tactic.
• Sound sleep: Not being rested is a major stress trigger, so do what you can to promote good sleep habits.
• Relaxation techniques: Yoga, meditation, massage, aromatherapy, and other such tactics can all ease anxiety.
• Avoid alcohol, smoking, and caffeine: Even too much coffee can make you jumpy and anxious, not to mention nicotine. Stay away from these vices.

Dr. Dimitriu adds, “there is also what I call the “yoga principle,” which says that with help, in yoga, you can learn to touch your toes. The same is true with anxiety – with the help of meds, you learn what life can be like without anxiety or with reduced anxiety. If indeed the intent is to come off medication, the trick is to reduce the dose so slowly, that you don’t know when the medication ended, and you began. I’ve had the best success in weaning people off meds when it’s done so slowly, that they can’t even tell its happening. This maximizes placebo and overall success in weaning off meds.”

Alex Dimitriu, MD, is founder of Menlo Park Psychiatry & Sleep Medicine in Menlo Park, CA. He is dual board-certified in psychiatry and sleep medicine.