Note:  This post is quite different from my typical posts and was inspired by the media coverage on Whitney Houston’s death.

As a specialist in anxiety, I am all too familiar with Xanax, one of the prescription drugs that Whitney was prescribed.  Xanax is benzodiazepine,  a class of drugs known to be highly addictive.  Xanax is one of the worst “benzos” because it is fast acting and sedating.  It calms anxiety within minutes – unfortunately the benefits are short term and actually negatively reinforce anxiety (see my post Working Past Panic) often making it worse in the long run and thereby requiring more medication to calm the anxiety. It is physically and psychologically addictive and there is a tolerance effect such that people often need more and more to get the same effect.

The media talked a great deal about how Xanax can be dangerous when mixed with alcohol.  However, I’ve heard very little about the fact that her physician prescribed a highly addictive drug to an addict. Just because a drug can be prescribed, doesn’t mean that it is safe and that it isn’t addictive. Much like alcohol – just because it’s legal, doesn’t mean it isn’t addictive.  We would all gasp if a doctor advised a patient to use alcohol to calm their nerves.  We would gasp even louder if the patient were an addict.  In my opinion, if you wouldn’t prescribe heroine to an addict, you shouldn’t prescribe Xanax either. Regardless of whether Xanax contributed to Whitney’s death or not, the prescribing physician was irresponsible (and my guess is it did play a role – even if it was a springboard to using more illicit drugs).  Xanax is used for anxiety and cognitive-behavioral therapy has been proven to be more effective in treating anxiety disorders than any medication. Nonetheless, SSRIs and other medications that are not addictive can be effective in treating anxiety.  Furthermore, exercise, chiropractic, herbs etc. can be very helpful as well. So if one chooses to not engage in therapy – there are better alternatives than giving Xanax to an addict.

Jennifer L. Abel, Ph.D.
author of Active Relaxation: How to Increase Productivity and Achieve Balance by Decreasing Stress and Anxiety.

Bad Light!  Flourescent lights are harmless for some people.  However, it is very common for them to cause a feeling of derealization and disconnectedness.  For some they can even trigger panic attacks.  Don’t be afraid to ask that the ones above your desk at work be disconnected and bring in a lamp with a more pleasant light source. Also, there are now full spectrum flourescent lights that are less offensive and cost less than $4/bulb.
Dr. Jennifer L. Abel

- author of: “Active Relaxation: How to Increase your Productivity and Achieve Balance by Decreasing Stress and Anxiety.”

What IS a Panic Attack? A panic attack is a sudden increase in intense fear that peaks within 10 minutes.  By definition you must experience at least four symptoms.  While most of these symptoms are physical, symptoms may also include fear of dying or fear of going crazy.  Although a panic attack may seem like it lasts for several hours, the peak of a panic attack subsides within twenty minutes.

Diagnosis Doc? Panic attacks may be an indication of Panic Disorder in which one suffers recurrent panic attacks.  There is also a persistent fear of having more attacks, worry that the panic attack is really something more serious (like a brain tumor or a heart attack), or behavior is changed to avoid the attacks (e.g., avoiding public places while alone). Panic Disorder with Agoraphobia is when an individual is fearful of having a panic attack outside of the home where escape would be difficult or where help is not available.  The grocery store, driving, and being in a crowd are some examples. People may also have panic attacks in response to a phobia. So for instance, if you have social phobia or a specific phobia (e.g., fear of dogs, heights, spiders) you might have panic attacks exclusively in these situations.

What Causes Them? While it may feel as though a panic attack comes out of the blue, there is always some trigger.  These triggers can be internal triggers (physical sensations or thoughts) or external triggers (an actual or perceived threat in your environment).  Examples of external triggers include: an argument, a loud noise, hearing bad news, or exposure to a phobic situation.  Internal triggers are thoughts (i.e., worry) or changes in how you feel physically.  The physical sensations can be caused by a variety of factors including artificial lighting (especially fluorescent lights), lack of sleep, dehydration, low blood sugar, side-effects to a medication, and even normal physiological fluctuations in your body.

The initial trigger is followed by a rapid spiral of thoughts, physical sensations, fear, and, sometimes, behaviors attempting to reduce the anxiety (e.g., escaping the situation, checking one’s pulse).  Soon the sufferer of panic becomes overly sensitized and develops a fear of fear.  The avoidance and checking behaviors usually strengthen the fear, causing the panic attacks to become more severe and occur more frequently. While there is some evidence of a genetic pre-disposition to having panic, there is more evidence that it is mostly learned.  Tune in later this week for information about overcoming panic attacks.

by Dr. Jennifer L. Abel – author of Active Relaxation: How to Increase Productivity and Achieve Balance by Decreasing Stress and Anxiety.