What Patients Think and Don't Say about Occasional Anxiety

// Corey Schuler, RN, MS, CNS, CNSC, DC


Comparing anxiety solutions

The therapeutic encounter between a doctor and a patient is almost always viewed through one perspective. It is impractical if not impossible to both participate in the encounter and objectively analyze it. Said simply, a patient, regardless of knowledge or experience, may not fully appreciate the thoughts and feelings a physician has during a visit. Similarly, a physician may not have the perspective of the patient in all cases.

What patients are thinking and not saying will continue to be a problem for physicians. However, many of the concerns that patients have about occasional anxiety treatment are consistent and can be predicted.

Imagine a situation where a patient has been experiencing occasional anxiety and is seeking care for it for the first time.

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Doctor may be thinking...

…I wonder if I could get by using an SSRI this time…I hope they don’t get hooked on this…I should really emphasize communicating the effects of this medicine…I don’t want her to have those nasty withdrawal symptoms…Should I warn her about some of the effects like feeling like a zombie or will I just seed a psychosomatic symptom that may be unnecessary? I’ll remind her to read the package insert…I bet she already knows a lot about this since it is fairly common knowledge and there’s a lot of information available online…I don’t really have time to go over this with her…I would love to refer her to a psychologist friend of mine but I know her insurance won’t cover it…I realize I’m not supposed to worry about that, but I do…I know how hard it is out there and much of her occasional anxiety is financially related…It’s stressful when I really care about my patients…I wish I had something I could recommend that works just as well, was well tolerated, and was not addictive…

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Patient may be thinking...

…What the heck? All doctors just push drugs…She didn’t even recommend anything besides a drug…What if it doesn’t work? Or what if I don’t react well to it? She didn’t even mention well tolerated options for me…I’ve heard these things have some pretty nasty side effects and she didn’t describe anything like that…Does she even care? All I want to be is normal and she isn’t even listening to me…Why did she become a doctor if doesn’t care enough to treat me well?

Now imagine an anxious patient who has already been prescribed an SSRI and is returning to a new physician. Her occasional anxiety is unresolved with the current medication.

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Doctor may be thinking...

…I wish there was a better way of doing this…While I start with paroxetine at 20 mg for occasional anxiety because it has fewer side effects than benzodiazepines, I don’t want to have to go through another SSRI, wait 1-3 months to see if she has a response, and then end up having to prescribe a different one…and then a different one again…We’ll both lose patience and probably lose track of what’s actually working…She obviously fired her last doctor…I’m sure I’ll be added to that list if this doesn’t work…At least with the benzodiazepine, we’ll know soon if it’s going to do the trick…I wish I could just add something to paroxetine that didn’t have an interaction…A well tolerated approach would be great if I had predictable results…

Comparing anxiety solutions patient sidebar2

Patient may be thinking

…I’m a little nervous about switching to a totally different and very powerful type of medication…My occasional anxiety is certainly more than an irritation, but it isn’t debilitating…Aren’t benzodiazepines dangerous? Am I really in that rough of a spot? Is this the only option? At least the SSRI isn’t addicting…If I remember correctly, this is the type of medication my mom was taking when she started drinking more heavily…I miss her so much and wish she was here…Did I forget to tell my doctor about this? It’s in the chart somewhere, I’m sure…I know I told my last doctor…I bet she knows but didn’t think it was relevant…

Finally, imagine a patient taking a benzodiazepine and her occasional anxiety is unresolved with the current medication.

Comparing anxiety solutions doctor sidebar3

Doctor may be thinking...

…This makes me nervous…We are certainly on the wrong path here…The last thing I want to do it up the dose, but I’m running out of ideas…This would be a great opportunity to add on a less dangerous medication so we can keep the benzodiazepine at the current or even lower dose…Based on her chart, it’s helping and I’m nervous about removing it from her plan…The next steps are going to the other psychotropic medications which I’m sure she won’t be willing to do…I wish I could be aggressive with other agents to get a result and then peel them off one at a time so she has stability long term as well as options when things go in the wrong direction…Is that just a dream?

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Patient may be thinking…

…I just want to get out of here…I don’t think I’m going to fill this higher dose prescription. I already can feel myself needing my benzo and I hate that feeling… I’m going to do something else…I don’t know what, but there’s has to be other options that my doctor doesn’t know about…I like her and I think she’s great but she’s missing something about me and my case…Here begins another rocky part of the path…

While the physician’s inner monologue will continue because doctors are caring, intelligent, and well-trained, awareness of a wider variety of tools may provide additional options. More options means fulfillment of unmet needs of both the doctor and patient.

What if there was a single ingredient, well tolerated approach to occasional anxiety that was not habit forming, well-tolerated, that had predictable results based on well-designed clinical trials, and could be combined with current medical treatments?

There is.

Comparing Anxiety Solutions


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