Dear Dr Nina: I'm worried I'll never get off medication for my anxiety

Question: I had a mental breakdown in the past and spent time in St John of God Hospital. I was a young man at the time and was drinking and doing a lot of recreational drugs. I’m now in my mid-forties with a young family and have recently started to suffer from anxiety again.

I no longer drink or take any drugs, recreational or otherwise. I exercise and am moderate in my intake of sugar and caffeine.

I am disappointed that these lifestyle changes are not enough and my GP has prescribed me an antidepressant. I’m hesitant to take it, as I feel like I should be able to manage my anxiety, but despite my lifestyle it’s back. I’m worried that I will never get off the medication. Can you advise?

Dr Nina replies: Anxiety disorders are very common in Ireland affecting up to one in eight people. They can occur with or without depression. We all suffer altered mood from time-to-time, in the same way we all have days where we feel extra happy. If mood was put on a spectrum of one to 10 – with one being profound depression then 10 being manic elation – most of us rotate between four and six throughout our lives. Anxiety can cause us to feel on edge, restless, feel physically sick and lead to poor sleep and social withdrawal.

The best cure comes from a multi-pronged approach. Medication can help in some cases, but is not the only treatment required. I often advise patients that medication is like a crutch – it keeps you standing while you engage in all the other forms of treatment that will ultimately enable long-term healing.

In most cases medication may ultimately be weaned, but in some, longer-term treatment is required.

It sounds like you are aware of the benefits of a healthy lifestyle. In mild mood change, lifestyle change and psychological therapies have been shown to be as effective as medication. Exercise releases endorphins, which are natural feel-good hormones, and simply taking a daily walk, can help improve mood. Eating a healthy varied diet also helps. Caffeine and alcohol should be kept to a minimum, as both have an adverse effect on mood.

Counselling or talking therapy is probably one of the next best places to start. Your GP may recommend practitioners in your area. Other good places to search are psihq.ie (psychological society of Ireland) or iacp.ie (the association of counsellors and psychotherapists). Finding a therapist you can relate to is very important. It may take several tries to find the right one.

Practice mindfulness. Join a group or course. If you prefer to do these things alone downloading an app such as, Calm or Headspace may be helpful. Other forms of spirituality can also help. The focus needs to be on clearing your mind of stressful thoughts and focusing on your being and the environment around you.

Bibliotherapy or reading therapy can be very effective. Jigsaw, the youth mental health charity, has compiled a list of helpful books called the ‘Read your Mind’ book project. You can look this up online for more information.

In more severe mood disorders, and if lifestyle, bibliotherapy, counselling and mindfulness aren’t working, medication is usually required, but should not be feared. Prescription medicine, when taken under medical guidance, can really help and does not leave people slowed up or flattened. In most cases an initial course of six months treatment is given.

Finally don’t keep your feelings to yourself. It is important to let friends and family know how you feel.

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