Xanax, helpful for my panic attacks, or addictive?

Dear Dr. Guterson:

I've been taking Xanax 0.5 mg twice a day for two years and it's really helped my panic attacks. But my husband says it's addictive. What should I do? -DH

Dear DH - Thank you for your question. You should know that you are not alone with this issue - and I applaud that you are asking.

To start, panic attacks can certainly cripple a person's functioning. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes. And it could start unexpectedly; yes, you could be calm one minute, and then suddenly get panicky the next. Symptoms can include heart palpitations, sensations of shortness of breath or smothering, excess sweating, feelings of dizziness, fear of losing control or 'going crazy', amongst others. The effects can feel crippling and therefore can have a profound impact on all areas of functioning (relationships, work, academic). As a result, people with panic attacks will often run to the emergency room, convinced they are having a heart attack or dying. The term 'addiction' is not used diagnostically anymore in the psychiatric manual because the word is so overused and misunderstood. But generally, an addiction is when someone needs more and more of a substance to achieve a desired result - and/or efforts to cut down or control the substance are unsuccessful. And social and/or work performance are profoundly affected.

Your medication, Xanax, is in the category of benzodiazepines, known as benzos for short. Medications like Ativan, Klonopin, and Valium are also benzos. We know that benzos essentially work in the brain like alcohol. And so, yes, just like alcohol has addictive potential, so do the benzos. However, in your case, your Xanax dosage has stayed the same (not a high dose) and has controlled your panic. Obviously, the decision is between you and your doctor, but it sounds like you could continue to enjoy your life, basically panic free, with Xanax. A life with no guilt about taking Xanax, no pressure, no getting worked up about being an addict - because it sounds like you aren't. Again, this requires a conversation with your doctor who knows you. I should add that in my office practice, I've had some patients on the same benzo, the same dosage, for 25 years. They are functioning at a high level, no damage is being done, and they don't want to stop it. They are living active, productive lives. What we know in this year of 2022 is that panic anxiety probably has a genetic basis. Which means that it's there in your DNA. Fortunately, we have medications and therapy approaches that can help. And finally, nurturing a spiritual consciousness and connection can be a powerful way to alleviate anxiety. Wishing you the very best, as you continue going forward. Dr. John Yaakov Guterson

Bipolar or Moody?

Question: What are the differences between bipolar disorder and just being a moody person?

Answer: Thank you for your excellent question; I'm sure you are not alone because I run into this "dilemna" virtually every day at the psychiatric hospital.

It is a mistake to think that swift mood shifts during the course of a day means you are

'Bipolar'. If that were the case, there certainly would be tons of people with the Bipolar diagnosis - because shifts in mood happen to many of us. If the innocent physician jumps to a Bipolar diagnosis, then before you know it, you are suddenly put on mood stabilizing medications perhaps unnecessarily - which then could lead to a cycle of meds and side effects and then more meds.

In contrast, Bipolar disorder, specifically the manic side, occurs over a discrete period of time - lasting many days or weeks - with a combination of abnormally elevated mood, along with many of the following: a profound decreased need for sleep and yet still having tons of energy, going out on spending sprees buying ridiculous stuff, sexual promiscuity, getting super involved in certain projects, impulsivity with little regard for consequences, easy irritability, risk taking behaviors, and in more serious episodes, paranoid and /or grandiose delusions. And almost always these symptoms are accompanied by a profound lack of insight, a lack of awareness of how poorly they are doing, how much chaos they are creating.

Like everything in the field of medicine, good treatment starts with correct diagnosis.

Dear Dr. Guterson:

Dear Dr. Guterson: I’ve been seeing psychiatrists for ten years now and no one can help me. I’m 29 years old and go into bouts of depression and get panicky. Still single and don’t know what kind of career I want. I’ve tried different meds for my moods and anxiety but nothing works. I’m sick of therapy, just a bunch of talk. Please help. Signed, JM

Dear JM -

Thank you for your frank and honest words.

It is always difficult to interpret what is going on inside of someone else, but I suspect that medications are not the answer to your dilemmas. Getting a handle on one’s life starts with identity and mission. Without these, then one day just drifts into the next - and suddenly you’re 50 and wondering what happened.

Everyone - and I mean everyone - has their own unique mission in this world. Look deep into your talents, your gifts, the kinds of things that have resonated with you since you were young.

No one can change the trajectory of your life except you.

Signed,

Dr. Guterson