Learning from the past

By: John Scott
Submitted: 2008-05-15 10:33:52
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Looking along my bookshelf, my eye was caught by a title, Triumph Over Fear: A Book of Help and Hope for People with Anxiety, Panic Attacks and Phobias by Jerilyn Ross — originally published by Bantam Books in 1994. When I picked it up again, I was surprised to see how long ago it was published. It seems to have survived in my memory well as striking a good balance between the use of medications and the need for more resources to be diverted into cognitive behavioural therapy. Hospitals are often under pressure and it is economically convenient to limit treatment to oral medications. The moment you start talking about small group or one-to-one counselling, the staff overheads just take off.

After her book, Jerilyn Ross went on to found the Anxiety Disorders Association of America (ADAA), a non-profit organisation which both supports research to prevent, treat and cure anxiety disorders, and offers help to improve the lives of all people who suffer from them — the ADAA is a most useful resource for all who suffer from or have an interest in anxiety disorders. The importance of this organisation is its preference for long-term treatment through therapy rather than reliance on a quick fix through medication. It does not deny the value of medication, but it sees its role as being in partnership with therapy. In part, this reflects Ms Ross’ own experience of treatment at the Roosevelt Hospital Phobia Clinic in New York. After learning to live with her own phobias, she went on to obtain a postgraduate degree in psychology and has specialised in the study and treatment of those who have problems comparable to her own.

One of the most popular medications on the market for the treatment of anxiety disorders is xanax. This is one of the benzodiazepines and a sedative hypnotic. The reason for its success is that a sedative calms a person while awake and reduces the general level of excitement, while a hypnotic makes a person feel drowsy and can induce sleep. Getting the dosage right as tolerance builds up is critical to a successful use of xanax. It is inconvenient to fall asleep, but too little calming effect does not prevent panic or reduce acute anxiety.

Why has xanax maintained its pre-eminence? Let us go back to 1994 again (the year of Triumph Over Fear). The National Comorbidity Survey found that 17% of people living in the US suffered from an anxiety disorder in the preceding 12 months and almost one quarter had some lifetime history of disorder. The estimated cost of anxiety in 1994 was $65bn — the cost of all treatments was $15bn, but the cost of lost production was $50bn. Think what the costs of anxiety would be in 2008.

Medical insurance has already become a major headache for families. Medicare is struggling to cope. So while the idea of individualised treatment for anxiety disorders definitely remains the ideal, the problem of cost directs the vast majority of people in the direction of xanax. This is an extremely effective medication to relieve the major symptoms of anxiety panic and compulsion. Using xanax is an entirely rational response to the current political and economic situation in the US. As an outsider, I hope that a realignment of federal priorities will move in the direction of the policies so passionately advocated by the ADAA. Only then can ordinary Americans get personal care with longer-lasting results rather than "conveyor-belt" care out of the xanax bottle.

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