Substance-Induced
Anxiety Disorder Anxiety symptoms can be caused by many substances (medications,
"recreational"drugs or toxins). Withdrawal of some drugs or medications
are also able to cause anxiety.
Symptoms
can be indistinguishable at first from panic attacks, social phobias, obsessive-compulsive
disorders or general anxiety disorders. But on further questioning of the patient
it becomes apparent that the pattern of the anxiety disorder, the late onset of
a panic disorder in a patient 45 years or older does not fit. However, for a substance-induced
anxiety disorder there are no age limits; it occurs at the age of the person who
abuses a substance. Similarly, there are other "clinical clues", namely
the presence of other physical symptoms such as loss of balance or dizziness,
which comes from the toxic effect of a substance on the nerve cells in the balance
organ of the inner ear or in the cerebellum. The anticholinergic effect of drugs
and medications can interfere with normal bladder and bowel function. Intoxication
or withdrawal from a substance can lead to headaches, loss of memory, slurred
speech or in severe cases of intoxication even to loss of consciousness. The symptoms
of substance-induced anxiety disorder usually resolve within 1 month of withdrawal
from the substance. If the symptoms last longer than that, the psychiatrist
or psychologist will reconsider the diagnosis as it appears then that an underlying
primary anxiety disorder is now responsible for the continuation of the symptoms.
With some benzodiazepines it may take a month after cessation of the medication
before withdrawal sets in and the beginning of the symptoms at that time would
be taken as the beginning of the substance-induced anxiety disorder. Here are
some common substances.
Some substances
that can cause anxiety disorder: Withdrawal
causing symptoms: alcohol, hypnotics and sedatives,
cocaine, anxiolytics and probably others. Intoxication
causing symptoms: alcohol, caffeine, amphetamine and related substances,
cannabis(=marihuana), cocaine, hallucinogens including magic mushrooms and many
others. Medications that can cause anxiety
symptoms: Pain pills, thyroid medication, bronchodilators by inhalation(like
salbutamol) or aminophylline tablets for asthma, oral contraceptives(=the birth
control pill), antihistamines, antiparkinsonian medication, anticonvulsants(=medication
against seizures), medication to control high blood pressure or cardiovascular
disease, lithium carbonate used for bipolar disease, antipsychotic and antidepressant
medications. Ask your doctor if you have symptoms on any
of these medications. Do not change the present dosage yet, but see what your
doctor says. Sometimes blood levels can be done to determine whether the medication
you are taking has lead to a high or toxic level. All that is necessary may be
an adjustment of the dosage. In other cases it may be that you have an unexpected
reaction to the medication and an alternative medication would likely be used
instead. | Treatment of substance-induced
anxiety disorder: Once the offending medication, toxin or illicit drug
is stopped, the substance-induced anxiety will disappear in the majority of cases.
However,
if it persists the psychiatrist has to reevaluate whether there is a second problem
or whether the diagnosis was incorrect in the first place. Usually psychotherapy
is needed and behavior modification methods often are being used. Occasionally
non addicting drugs such as the SSRI antidepressants are used. Anxiolytics (such
as the benzodiazepines) should be avoided because of their addiction potential
on the long term. |
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| Disclaimer:
This outline is only a teaching aid to patients and should stimulate
you to ask the right questions when seeing your doctor. However, the responsibility
of treatment stays in the hands of your doctor and you. References: 1.
Dr. David Burns: "Feeling good --The new mood therapy", Avon Books,
New York,1992. 2. Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition, (DSM-IV),American Psychiatric Association, Washington,DC,1994.
3. Dr. Shaila Misri at the 46th St. Paul's Hosp. Cont. Educ. Conference,
November 2000, Vancouver/B.C./ Canada. 4. JM Loftis et al. J
Neurochem 2000 Nov 75(5): 2040-2050. 5. B. Zilbergeld et al. "Hypnosis
- Questions& Answers", W.W. Norton & Co, New York,1986: 307-312. 6.
MH Erickson & EL Rossi:"Hypnotherapy, an exploratory casebook",
Irvington Publishers Inc., New York, 1979: chapter 8, 314-363. 7.
G Steketee et al. Compr Psychiatry 2001 Jan 42(1): 76-86. 8. DS Mennin
et al. J Anxiety Disord 2000 July-Aug 14(4): 325- 343. 9. J Hartland:
"Medical &Dental Hypnosis and its Clinical Applications", 2nd
edition, Bailliere Tindall,London,1982, page: 326-336. Last
Modified: Jan. 12, 2009 | |
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