Dear Therapist:

What is your opinion on taking medication for anxiety? I’ve tried quite a few therapists over the years, but it didn’t really help. Recently, my mother brought up the idea of taking medication, but I feel weird about it.

I’ve been going to therapy privately, and I’m pretty sure other people my age do too. But taking pills feels like a different level—like something more serious.

What’s your take on using medication for anxiety? Is it something to be hesitant about?

Response:

Medication is not my field, and I normally defer all medication-related questions to a prescriber (typically a psychiatrist). Your question, however, doesn't seem to be whether medication can help you or if it’s indicated in your situation. Rather, you’re wondering whether medication, in general, is something to be hesitant about.

Certainly, no decision about any form of medication should be taken lightly. Most people wouldn’t take an antibiotic unless there was a need. They wouldn’t begin a long-term course of immunomodulators or biologics without a clear understanding of their other options.

However, if someone’s physician advised them that an antibiotic was necessary for strep throat, they probably wouldn’t think twice about taking it. If they had seen multiple doctors for Crohn’s disease and short-term antibiotic and steroid treatments weren’t working, they would likely consider long-term treatment with immunomodulators or biologics.

You worry that medication represents “a different level”—that it’s more serious. But you can’t focus on the perceived seriousness of the treatment without also considering the seriousness of the symptoms.

Let’s imagine your level of anxiety is minor and only affects you intermittently. Although therapy hasn’t really helped, this may be because you’ve never stuck with one therapist for more than a few sessions. You’ve seen some progress, but haven’t followed through with the full course of treatment. In this example, you might view medication as overkill—not properly matched to your symptoms or to the therapeutic potential that hasn’t been fully tapped.

In another example, your anxiety is moderate to severe and affects you on a daily basis. You’ve been in therapy consistently and have followed through on your own. Despite trying various therapists and techniques, your anxiety hasn’t much changed. In this case, even if you still view medication as a serious step, your symptoms may be just as serious and may warrant a stronger intervention.

I think it’s good that you’re hesitant about the medication route. But I’ve had many clients who resisted medication for a long time and later regretted not starting it sooner—once they saw how much it helped.

Sometimes the very symptoms that bring someone to therapy can also interfere with their ability to engage in therapy. It may seem like circular logic to say that someone’s anxiety is preventing them from working on their anxiety—but this is often the case. In such instances, medication can reduce anxiety enough to allow the person to fully engage in the therapeutic process. Thus, medication doesn’t necessarily need to be a long-term solution—or even the solution.

When a client is hesitant about taking medication, I often encourage them to slow down and consider the steps involved. (People with anxiety often jump from trigger to endgame without acknowledging the steps in between.) I ask them to break the process into parts: You can get a referral to a psychiatrist and then decide whether to call. You can schedule an appointment and later decide whether to cancel. You can see the psychiatrist and hear their recommendation. If medication is prescribed, you can decide whether to fill the prescription. If you fill the prescription, you can decide whether to start taking the medication. If you start, you can always work with the psychiatrist to stop.

Sometimes, things can feel like all-or-nothing propositions. But remember: you are in control. These are your decisions. If your choices are thoughtful and considered—rather than emotionally driven—you’re more likely to be satisfied with the result.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Woodmere, NY

 adjunct professor at Touro University

 Graduate School of Social Work

 author of Self-Esteem: A Primer

 www.ylcsw.com / 516-218-4200