This week on our nationally syndicated radio show, we examine the consequences of prescriptions for anxiety or grief. All of us, at some point in our lives, will experience some of these emotions. If we discuss them with a healthcare provider, there’s a chance we’ll end up with a prescription. When are medications helpful and when do they cause more harm than good? Are there risks in medicating normal emotions?

For decades, neuroscientists have been telling us that mental illness is caused by a chemical imbalance in the brain. The logical conclusion from this premise is that emotional problems should be addressed with drugs that can alter the brain’s chemical balance. Unfortunately, however, the brain and its workings are still quite mysterious, much like a black box. The medications that may be prescribed could be thought of as a crude hammer–or, better yet, a giant experiment. This particular experiment is not well-controlled or randomized, though, and it wouldn’t pass muster as truly scientific.

When did we start thinking of everyday challenges as psychopathology? How can we change our perceptions? Both of the guests for this episode have been involved with an extraordinary documentary, Medicating Normal.

This film acknowledges that psychotropic drugs can be helpful or even lifesaving for some people. However, doctors are over-prescribing them, and the result is a public health crisis. The movie follows five individuals who experienced serious problems as a consequence of the prescription medications they were taking.

Among the most common psychotropic medications are the anti-anxiety pills called benzodiazepines. These compounds, such as alprazolam (Xanax), diazepam (Valium) or lorazepam (Ativan), can offer short-term relief from acute anxiety. Over months or years, however, the body adapts. As a result, the drug may stop working and the patient may need to take increasing amounts to get the same anti-anxiety effects. Withdrawal (a phenomenon doctors may call “discontinuation syndrome”) can sometimes result in anxiety symptoms far more severe than the original problem.

Psychiatrists actually have a lot of other options besides a prescription. Cognitive behavioral therapy, exercise, or other forms of therapy aimed at changing behavior can be effective, but they require time and repetition, and thus patience. Healthcare reimbursement incentives encourage prescribing medications rather than supporting behavior change. In addition, medical students may not learn much about these alternative approaches. Medical education on discontinuing psychotropic medicines has been especially sparse. Consequently, many doctors may not feel well-equipped to help a patient get off one of these medicines.

Anna Lembke, MD, is the medical director of Stanford Addiction Medicine, program director for the Stanford Addiction Medicine Fellowship, and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She is the recipient of numerous awards for outstanding research in mental illness, for excellence in teaching, and for clinical innovation in treatment. A clinician scholar, she has published more than a hundred peer-reviewed papers, book chapters, and commentaries in prestigious outlets such as The New England Journal of Medicine and JAMA.

She sits on the board of several state and national addiction-focused organizations, has testified before various committees in the United States House of Representatives and Senate, keeps an active speaking calendar, and maintains a thriving clinical practice. Dr. Lembke is the author of Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop and Dopamine Nation: Finding Balance in the Age of Indulgence. Her website is https://profiles.stanford.edu/anna-lembke The photograph is of Dr. Lembke.

Nicole Lamberson is a physician assistant who took Xanax for work-related stress. Over the course of five years, she developed many classic symptoms of benzodiazepine tolerance withdrawal. Now, years after stopping the medicine, she still has some residual symptoms.

The podcast of this program will be available Monday, May 13, 2024, after broadcast on May 11. You can stream the show from this site and download the podcast for free. This podcast has additional information about stimulant drugs, how to support people with different brains, the consequences of a shortage of therapists and what happens when psychiatrists add antipsychotic medicines to antidepressants.

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