Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


nervousNervous:  To determine if a patient has had past psychological problems, there is a simply and inoffensive way of asking key questions.
There are many ways to explore the question, but one of the easiest and most direct is: “Has any doctor ever prescribed a drug like Xanax or Zoloft for your patients, and do you recall when and why s/he felt they should take the medication?..or…did s/he or you feel you had periods of being very nervous.
While Xanax (alprazolam) is an anxiolytic (anti-anxiety) agent, it is often prescribed in a diffuse attempt to help a patient who is not sleeping, is tense and/or “feels down.”   It can also be prescribed when a patient complains of being depressed.  Thus, knowing if a patient has a past history of Xanax use can tell us if there was any time in life where the patient needed medical assistance in dealing with psychological problems.
Many are hesitant to prescribe Xanax since patients report developing a dependency upon it, and instead prescribe Zoloft (sertraline) which is, in fact, an antidepressant medication. Other drugs that may have been prescribed are Effexor, Celexa or Lexapro.   By determining if the patient has a history which includes the need for one or more of these agents, we can determine whether the patient was ever seen as depressed.
Unfortunately, while some patients become lethargic when they are depressed and completely lacking in energy, there are many patients who become very agitated when depressed. They are restless, tense, cannot relax and are in continual movement.  This agitated depression could have been misdiagnosed as anxiety, and the patient medicated with Xanax rather than an antidepressant.
Thus, the past need for Xanax merely tells us that the patient had a “bad period” at one or more points in life and that the belief at that time was this was merely situational anxiety.  The possibility of it having been a brief major depressive episode remains a concern.
Patients are much more willing to disclose the medications they have been prescribed than to admit to periods of what they would see as psychological “weakness.”
A final component of this involves the length of time the medication was taken.  If, for example, the patient took the medication over several years and/or if the patient found himself/herself unwilling to attempt reduction and/or alternate means of handling the anxiety, then we have concern for both physical and psychological dependency.
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