The Problem with Health Anxiety Medications

People challenged by health anxiety (hypochondria) take health-related anxiety to a new level.

They get hooked on negative thoughts about their health, and stuck in a self-destructive vicious cycle of physical symptoms, fear and anxious behaviours that interferes with life - career, diet, exercise, finances, leisure, relationships, sleep and more.

So how does one challenged by health anxiety get their life back?

Many doctors recommend medication for health anxiety, generalized anxiety disorder, and other mental health challenges (this was the case for me, too).

Certain prescription drugs can help you function (and feel better) day-to-day in some cases - this is the single, albeit uncertain upside to the pharmaceutical approach.

But let me be 100% clear: Medications can’t cure health anxiety.

Anxiety medications can only mask the problem, without giving you an opportunity to uncover and resolve the causes and risk factors that led to health anxiety in the first place.

Drugs also come with:

  • Costs.

  • Risks.

  • Side effects.

  • Potential addiction or drug dependency.

  • Withdrawal symptoms (also known as discontinuation syndrome).

Depending on your unique situation, anxiety medications may have a role to play in your health anxiety recovery… but to me, treating one challenge (health anxiety) by introducing potentially more damaging challenges doesn’t feel like the best approach.

Types of Health Anxiety (Hypochondria) Medications

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There’s no shortage of options for doctors when prescribing anxiety meditations to their patients.

Your doctor may recommend one or more of the following classes of medications, depending on the specific challenges you’re facing, your medical history, the costs and side effects, and how they interact with other medications you’re taking.

Depending on how you respond, your doctor may have to try several different drugs to find the best one for you.

Antidepressants

Antidepressants were discovered in the 1950s by a team of Swiss scientists looking for a treatment for schizophrenia.

Antidepressants work by altering the balance of neurotransmitters (chemical messengers in the brain), based on the (unproven) theory that a chemical imbalance exists in the brains of patients with depression and anxiety.

However, as the authors of a 2005 report titled Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature noted, scientific evidence supporting this theory has yet to surface... anywhere:

"To our knowledge, there is not a single peer-reviewed article that can be accurately cited to directly support claims of serotonin deficiency in any mental disorder, while there are many articles that present counterevidence."

Additionally, no simple medical test exists to measure the balance of neurotransmitters in the brain. In other words, it's impossible to determine whether such an imbalance exists, and whether a hypothetical imbalance was the cause, or a result, of depression or anxiety - including health anxiety.

Antidepressants also cause physical drug dependency. Drug dependency is just like addiction, without the craving - you don’t want it, but your body needs it in order to avoid withdrawal symptoms (known as discontinuation syndrome).

For these reasons, as the popularity of antidepressant medications has risen, so too has the controversy surrounding their effectiveness.

Types of antidepressants include:

Tricyclics

Known as tricyclics due to their 3-ring chemical structure, these drugs provide some relief to severely-depressed patients by altering the balance of multiple neurotransmitters in the brain.

It's not known exactly how tricyclic antidepressants (TCAs) accomplish this.

Tricyclics prescribed for anxiety may include:

  • Clomipramine (Anafranil)

  • Imipramine (Tofranil)

  • Nortriptyline (Pamelor, Aventyl)

  • Amitriptyline (Amitid, Amitril, Elavil, Endep)

  • Protriptyline (Vivactil)

  • Doxepin (Silenor)

Tricyclics can cause numerous side effects, some serious, including: 

  • Dizziness

  • Drowsiness

  • Low energy

  • Dry mouth

  • Nausea

  • Vomiting

  • Constipation

  • Urinary retention

  • Weight gain

  • Low sex drive

  • Blurred vision

  • Tremors

  • Sweating

  • Fast heartbeat

  • Suicidal thoughts or behaviours (especially in patients under 25 years old)

  • Death from overdose

While still prescribed in certain cases, tricyclics have largely been replaced as treatment for anxiety by more modern drugs that can cause fewer side effects (SSRIs and SNRIs, below).

MAOIs

Monoamine oxidase inhibitors increase the amount of neurotransmitters that regulate mood (dopamine, serotonin, and norepinephrine) by inhibiting monoamine oxidase from removing these neurotransmitters from the body. Allowing more of them to remain present in the brain boosts mood.

  • Isocarboxazid (Marplan)

  • Phenelzine (Nardil)

  • Selegiline (Emsam)

  • Tranylcypromine (Parnate)

Unfortunately, monoamine oxidase is also responsible for reducing tyramine - which helps regulate blood pressure. For this reason, patients taking MAOIs are at risk for dangerously high blood pressure and therefore must avoid certain foods that contain elevated levels of tyramine (such as beer, cheese, red wine, cured or smoke meats or fish).

Like TCAs, MAOIs are prescribed less often as the popularity of SSRIs and SNRIs continue to rise.

SSRIs and SNRIs

In late 80s and early 90s, a new class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) were introduced.

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SSRIs work by inhibiting the reuptake of serotonin - a neurotransmitter that affects mood, appetite, sleep, memory and sex drive - allowing more serotonin to remain present in the brain.

  • Escitalopram (Lexapro)

  • Fluoxetine (Prozac or Sarafem)

  • Citalopram (Celexa)

  • Paroxetine (Paxil, Paxeva or Brisdelle)

  • Sertraline (Zoloft)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) block reuptake of both serotonin and norepinephrine.

  • Effexor XR (Venlaxafine)

  • Cymbalta (Duloxetine)

SSRIs and SNRIs can take several weeks to produce full effect and cause fewer, less serious, side effects than TCAs or MAOIs. They're generally well-tolerated - a factor in their rising popularity.

  • Dry mouth

  • Headache

  • Nausea or vomiting

  • Muscle weakness

  • Diarrhea

  • Low sex drive

  • Dizziness

  • Drowsiness

  • Nervousness or restlessness

  • Insomnia

Overdose

Serotonin syndrome can occur when taking too much SSRI or SNRI medication, or when combining SSRIs or SNRIs with other prescription drugs, dietary supplements or illicit drugs known to boost serotonin levels

Serotonin syndrome symptoms include:

  • Fever

  • Shivering

  • Goose bumps

  • Agitation

  • Confusion

  • Rapid heart rate

  • High blood pressure

  • Increased reflexes

  • Muscle rigidity

  • Headache

  • Tremor

  • Sweating

  • Diarrhea

Severe serotonin syndrome cases can be life threatening, presenting the following symptoms:

  • High fever

  • Seizures

  • Irregular heartbeat

  • Unconsciousness

Withdrawal

SSRIs and SNRIs are not addictive, but drug dependency can develop - causing withdrawal effects, known as discontinuation syndrome, to occur.

Symptoms of SSRI/SNRI withdrawal include:

  • Dizziness and vertigo

  • Headache

  • Confusion and irritability

  • Nausea

  • Lethargy

  • Flu-like symptoms

Benzodiazepines

Benzodiazepines relieve anxiety by enhancing the effect of a neurotransmitter called gamma-aminobutyric acid (GABA).

GABA is an important chemical in the brain, known for its role in the stress response by reducing the activity of nerve cells to help control fear and anxiety.

Benzodiazepines are powerful drugs that doctors sometimes administer them as anesthetic before certain medical procedures.

They work extremely quickly, resulting in patients building a tolerance - requiring higher and higher doses over time in order to achieve the desired effect.

Benzodiazepines commonly prescribed for anxiety include:

  • Xanax or Niravam (Alprazolam)

  • Klonopin (Clonazepam)

  • Ativan (Lorazepam)

  • Valium (Diazepam)

Side effects

Side effects of benzodiazepines can include:

  • Drowsiness

  • Dizziness

  • Nausea

  • Blurred vision

  • Headache

  • Confusion

  • Tiredness/fatigue

  • Nightmares

  • Birth defects if taken during pregnancy

Overdose

It's possible to overdose on benzodiazepines. Symptoms of a benzodiazepine overdose include:

  • Drowsiness

  • Confusion

  • Dizziness

  • Weakness

  • Blurred vision

  • Breathing difficulties

  • Coma

  • Slurred speech

  • Lack of coordination

Withdrawal

You can experience serious withdrawal symptoms if you stop taking benzodiazepines suddenly.

Benzodiazepine withdrawal symptoms can include:

  • Anxiety

  • Insomnia

  • Seizures

  • Death

If you take a benzodiazepine regularly, make sure you talk to your doctor before you stop taking it.

My experience with health anxiety medications

At the beginning of my health anxiety recovery, I was prescribed sertraline, an antidepressant commercially known as Zoloft.

Did it help? I don’t know… maybe. 🤔

My mood and function certainly increased, and my anxiety decreased, but I took sertraline alongside:

  • Intense cognitive behavioural therapy (CBT).

  • Acceptance and commitment therapy (ACT).

  • Massive lifestyle changes to reduce or eliminate anxiety risk factors in all areas of my life: Career, diet, exercise, language, leisure, mindfulness, relationships and sleep.

In other words, I have no way of knowing how large a role sertraline played, if any, in my 60-day health anxiety recovery.

What I can say is that as a result of the extensive research I did for this post, I’m (very gradually) weaning myself off of sertraline - and feeling better than ever! 😀

How to overcome health anxiety (with or without the aid of medication)

Prescription medications, such as antidepressants, are neither a quick fix nor a permanent solution for those challenged by health anxiety.

Settling for incomplete symptom-relief, partially (or fully) offset by a lifetime of costs, risks and side effects, is not the best option available to you.

Your best option is achieving a complete, lasting recovery with a holistic recovery plan that integrates your doctor's with intensive psychotherapy - including Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) - and a systematic plan to reduce or eliminate health anxiety risk factors in all areas of your life: Career, diet, exercise, environment, leisure, mindfulness, physiology, relationships and more.

Today, I’m enjoying a healthy, fearless life, free of anxiety - and so can you.

Apply

 💊 If you're taking anxiety medications, and not getting the results you were hoping for, consider augmenting or replacing them with a holistic recovery plan integrating CBT or ACT, identify what risk factors exist in your life, and create a plan to systematically reduce or eliminate them.

💬 If you're taking anxiety medications and have achieved complete, lasting recovery from health anxiety, talk to your doctor about whether reducing your dosage or stopping anxiety medications altogether is an option for you.

✏️ Take this 90-second health anxiety (hypochondria) quiz to measure your progress and find out your next steps to overcoming health anxiety.

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