After a stress crisis that led her to use anti-anxiety medications, Romina Paola Lieby, 40, learned that she needs to dedicate time to things that give her pleasure, such as cooking. She also began to practice meditation and physical activities to take care of her mental health.
BUENOS AIRES, ARGENTINA – It is a rainy winter afternoon in a middle-class neighborhood in Buenos Aires, Argentina’s capital.
In her apartment, Carina Duarte, a robust, straight-haired 42-year-old brunette, sits at a table and crosses her hands as if in prayer. She gazes about the room and sums up in a sentence the feeling that stress led her to.
“I woke up in the morning, looked out the window, opened it and thought, ‘What a lovely day to die,’” Duarte says.
Duarte felt overwhelmed by obligations. In addition to having to wake up at 4 a.m. to work at a street fair, she had to care for her family – her husband, 8- and 12-year-old children, and an elderly mother with heart disease.
Although chronically tired, she had trouble sleeping. She had heart palpitations. At times she was paralyzed by a deep fear.
Her general practitioner prescribed an anxiolytic, or anti-anxiety, medication. When the medication failed to alleviate her symptoms, her doctor referred her to a psychiatrist.
After confirming that her symptoms were generated by her daily responsibilities, the psychiatrist prescribed various anti-anxiety medications before achieving an effective treatment. The process took about a year.
Duarte no longer takes medication. She receives counseling to avoid a recurrence of crippling anxiety.
Nearly one in five Argentines has at one time taken anti-anxiety medications, or sedatives. The fast-acting drugs, most of which are prescribed by general physicians, provide immediate relief to most users.
Luis Antún, a pharmacist and executive director of the Official College of Pharmacists and Biochemists of the Federal Capital, says it is lawful for general practitioners and specialists other than psychiatrists to prescribe psychoactive drugs.
Antún stresses that physicians must be mindful of the potential negative consequences of prescribing such medications, including chemical dependency and the masking of problems that require more in-depth solutions.
Argentina’s rate of anti-anxiety drug consumption is comparable to that of other industrialized nations, but some Argentine experts say the drugs are overprescribed. They caution that these medications are used as quick fixes in place of more sustainable solutions, such as psychotherapy and lifestyle changes.
In Argentina, 18 percent of the population has at one time used anti-anxiety medications, with or without prescriptions, according a 2013 study by the Secretariat of Planning for Drug Addiction Prevention and the Fight against Drug Trafficking, which examined the use of psychotropic drugs by Argentines ages 12 to 65.
The Argentine government conducted this study in cities of 80,000 or more residents. Earlier editions of the study demonstrate sustained consumption over the past few years, with slight variations.
More than 70 percent of Argentines who have used anti-anxiety medications obtained them by prescription from a general practitioner or a specialist other than a psychiatrist, according to the study.
From 30 to 40 percent of Buenos Aires residents currently use anti-anxiety medication, says Dr. Ronald Gustavo Falcón, a psychiatrist and director of the Emergency Psychiatric Hospital Torcuato de Alvear, a hospital funded by the Buenos Aires city government.
Falcón bases his estimate on his experience as a private psychiatrist, member of the Argentine Neuropsychiatric Association, professor at Favaloro University in Buenos Aires and director of the hospital.
More than one-in-five Americans take anti-anxiety meds, according to 2010 data from Medco Health Solutions Inc.
Dr. Guillermo Di Girolamo, specialist in pharmacology and professor at the University of Buenos Aires School of Medicine, says general practitioners prescribe anti-anxiety medication excessively.
The problem is not that they are uninformed about the risks associated with such drugs, he says. Rather, they prescribe these medications as a quick solution to alleviate discomfort when they’re unable to devote sufficient time to their patients.
“The time of the consultation is short,” he says. “The doctor has to attend to many patients, and that makes it difficult to listen to them. Prescribing an anxiolytic, he or she gets rid of the problem. The anxiolytic is a patch.”
Falcón says the effectiveness of anti-anxiety medications allows a physician to quickly combat various symptoms.
“A doctor will prescribe it to the hypertensive to lower anxiety, and so his or her [blood] pressure does not rise, or to the person who has an irritable colon so that the stomach pains ease up,” he says. “But if some days pass and the symptom is not resolved, you have to investigate.”
Romina Paola Lieby, 40, of Buenos Aires, is a bank employee and mother of children ages 10 and 14.
Overwhelmed by the duties of motherhood and homemaking on top of workdays lasting up to 12 hours, she suffered stress symptoms such as anxiety, shortness of breath, headaches and heart palpitations.
A psychiatrist prescribed Clonazepam, a widely prescribed benzodiazepine used to treat anxiety, seizure and panic disorders. It gave her immediate relief, she says.
“Medication is the rescue when you feel that you passed to the other side,” she says. “With Clonazepam, I went forward. It helps you to contain the panic attack that palpitations give you. So, you take the pill and you are not afraid. Nothing perturbs you. You are sedated. Nothing bothers you. Nothing matters to you.”
Anti-anxiety medications quickly subdue various stress symptoms, including heart palpitations and shortness of breath, Falcón says. A physician may need to prescribe different medications to find the right one for a patient, he says.
María Gabriela Stefanello, a clinical psychologist in private practice, says medication can facilitate psychotherapy by lowering a patient’s anxiety.
“If a patient arrives who cannot speak because he or she cries during the 40 minutes that the session lasts, I send him or her to the psychiatrist to stabilize them,” she says.
This is a frequent occurrence, Stefanello says. Because she favors medicating patients immediately upon diagnosis, she works closely with a psychiatrist.
On average, a patient should take a full dosage of anti-anxiety medication for no more than six or seven months, Stefanello says. The prescribing physician should then reduce the dosage until the patient is off the medication, usually within a year, she says.
The patient should then continue undergoing psychotherapy, she says.
Some general practitioners say anti-anxiety drugs are best used with psychiatric supervision.
Ignacio Agustín Veltri, a general practitioner and addiction specialist at Avril, a Buenos Aires psychiatric center, says anti-anxiety medications pose a high risk of dependency. A patient who uses them for a prolonged period without seeing a psychiatrist is in danger of becoming a chronic user.
Anti-anxiety medications can generate psychological dependency because a patient may come to rely on them to calm symptoms, Veltri says. They can also produce physical dependency; as the body acquires tolerance of them, a patient needs increasingly higher doses to get the same effect.
To treat dependency, a psychiatrist must gradually lower the dosage or prescribe a replacement drug, he says.
Dr. León Knobel, day shift manager at the Acute General Hospital Dalmacio Vélez Sarsfield, a public institution, says both general practitioners and specialists have been losing the ability to listen to patients over the past decade.
“To listen to the patient was old-school,” he says. “The doctor previously acted like a family doctor: He or she used to take the time to talk with the patient and to get to know what was happening to him or her. Now this does not happen. But the worst is that this way of interacting cannot be taught.”
Di Girolamo, 58, the third generation of doctors in his family, has witnessed this change. In his grandfather’s and father’s eras, a family doctor knew each patient well. Doctors and patients engaged in in-depth conversations.
These days, a doctor visit typically lasts 15 or 20 minutes. Such brief visits do not allow for closeness, Di Girolamo says.
Falcón believes that before prescribing anti-anxiety medication, or sedatives, general practitioners should promote alternative treatments, such as psychotherapy and physical activity.
Physical exercise relieves anxiety naturally, he says.
“Anxiety is to always be anticipating the move of the other – what will happen with this or that thing when it still has not happened,” Falcón says.
Duarte says that although anti-anxiety medications relieved her symptoms, she would have preferred an alternative treatment. She now relies on psychotherapy.
Lieby also has turned to long-term solutions beyond medication. She practices meditation, exercises regularly, and tries to avoid overexerting herself.
“I learned that I cannot do everything, that I am human,” she says. “I try to enjoy the day to day with my family, although sometimes it is not easy.”
GPJ translated this article from Spanish.
