Are All Anxiety Drugs Bad?

A reader asks:

In one of your recent articles, you mentioned that the use of some pharmaceutical drugs can be helpful for anxiety. But wouldn’t they all be bad in the long-run? Since most of, if not all, drugs are designed to alleviate or stop emotional pain, won’t they always be creating an unhealthy relationship with anxiety and reaffirming that it is dangerous and bad and so making it worse in the end?

Good question!

First of all, “bad” is a big word… For example, does bad mean morally wrong? Does it mean it will make your anxiety worse in the long run? Does bad mean it contains the potential for addiction? Does it mean unnatural? Does it mean unethical since by purchasing drugs you’re supporting the pharmaceutical industry?

These are all things I’ve heard when I ask people what they mean when they say it’s bad to use drugs to address emotional struggles. And while I assume you mean that they’re bad in the sense of actually making anxiety worse long-term, I wanted to call this out right away because there’s a bigger point here:

Be careful using moral language with emotional health.

While it might be appropriate in some cases, thinking about emotional health struggles in moral language is usually counterproductive because it so often leads to unhelpful judgment and criticism—either of ourselves or others.

That being said, let me slightly rephrase your question and then start to answer it:

Is there ever a productive use of anxiety medications given that they so often are used to avoid emotional pain and therefore end up making it worse in the end?

My first answer to this is that I’ve worked with a number of people who have successfully overcome some pretty serious anxiety problems while using medication for anxiety. To be clear, I don’t think the anxiety medication itself helped lower their long-term anxiety. And it’s possible it was actually counterproductive. But the point is, using anxiety medication doesn’t mean your anxiety will always get worse long-term when you account for all the variables involved.

Another possibility is that people take anxiety medication without much conscious intention to alleviate or reduce anxiety. I saw this sometimes with folks who were taking antidepressants for their anxiety (antidepressants are typically prescribed for anxiety first before benzos or other fast-acting anxiety meds). For years, they just took their Prozac or Lexapro or whatever every morning as part of their daily routine but never in response to acute bursts of anxiety (like you would with a benzo). In this case, the medication wasn’t being actively used as an avoidance behavior, and therefore, may not have had much if any long-term negative impact on their anxiety.

Let me reiterate this point because it’s really important…

Anxiety medications are often unhelpful for long-term anxiety when they’re used deliberately to reduce or avoid anxiety in the moment.

But not all anxiety medications are used this way. Good to keep in mind.

My last point is a bit more philosophical but maybe most important:

I don’t know what I don’t know. And I try to stay open to the (very likely) possibility that I may be wrong.

In my experience, when people use drugs to alleviate or avoid acute anxiety, it tends to be counterproductive because—while there might be some immediate relief—the long-term consequence is that they reinforce the belief that anxiety is dangerous, which leads to more frequent and intense anxiety in the future.

But that doesn’t mean all anxiety medications are always bad for everyone.

The story of science is one long progression of very smart people thinking they’re right only to have their theories proved wrong or incomplete by future generations. And that’s a good thing!

Okay, but what about all the research showing medication can be helpful for anxiety?

It’s true that there is decades worth of research showing that pharmacotherapy can be effective in treating anxiety. It’s beyond the scope of this article to go into depth about the issues I have with this body of research. But I’ll give you two quick ideas to reflect on…

First, nearly all of these studies (and this is true of just about all clinical trials, not just ones for drugs) have very short time horizons, which means it’s difficult to say how effective they were long-term. In my experience, most people have a significant relapse of anxiety once they stop taking their medication, which makes you wonder: Did the medication actually fix anything or simply treat the symptom?

Second, it’s very difficult to do a true double-blind study with anxiety medications (or any medication, for that matter) because it’s obvious when you’re taking the medication vs placebo. Which ironically means that the medication condition’s effects could very well be more the result of expectation modifications and subsequent beahvior change.

But the bigger idea is this:

It’s extremely hard to prove that anxiety medications actually improve the underlying condition of anxiety rather than simply making people feel better temporarily.

And I don’t mean that disparagingly… Alleviating painful symptoms can be a godsend to people. But we shouldn’t confuse that with addressing the underlying mechanisms causing anxiety in the first place.