Wellness

Managing Anxiety During COVID-19  

Benzodiazepines are not the answer.

This post is the first in a series on the management of anxiety during the COVID-19 pandemic. Millions of people have been relying on benzodiazepines such as alprazolam (Xanax™), clonazepam (Klonopin™), lorazepam (Ativan™) and other prescription drugs to manage symptoms of stress and anxiety. While some medications are safe and effective treatments of anxiety, they have limited overall efficacy and potentially serious safety concerns. In this post I briefly review the complex mental health impacts of the COVID-19 pandemic, talk about the limitations of conventional treatments of anxiety and growing public health concerns over increased uses of benzodiazepines during the pandemic, and comment on the medical and psychiatric risks of benzodiazepine use among individuals infected with SARS-CoV2. In future posts I will review the evidence supporting non-pharmacologic approaches for anxiety including dietary change, exercise, relaxation and mindfulness, select natural products, as well as biofeedback and virtual reality graded exposure therapy (VRGET).

A multiplicity of mental health impacts

The COVID-19 pandemic has had enormous impacts on the daily lives of tens of millions of individuals globally. Widely shared concerns about becoming infected with the virus affect our day to day choices including how we work, how often we leave our homes, where we shop for essential needs, how we socialize and how we think about the future. The psychological and financial stress associated with the pandemic have resulted in high rates of anxiety, depressed mood, substance abuse, and—for survivors of pandemic-related illness—high rates of post-traumatic stress disorder (PTSD) and severe depressed mood. Mental health researchers are developing diagnostic tools to help clinicians better understand and more accurately evaluate the range and severity of mental health problems associated with the pandemic

Limitations of conventional treatments of anxiety

Research findings support that most currently available conventional treatments of anxiety are sometimes beneficial but have limited efficacy overall. The majority of individuals who use benzodiazepines to manage generalized anxiety initially respond well but continue to experience anxiety problems over the long-term. The severity and frequency of panic attacks lessen in response to benzodiazepines, however many individuals who use such drugs on an on-going basis are at significant risk of benzodiazepine tolerance, dependence and withdrawal. In this context over-prescribing and inappropriate prescribing of benzodiazepines (and other controlled substances) is a growing public health concern. A large cross-sectional study found that the rate for benzodiazepine prescribing doubled from 2003 to 2015 due largely to large numbers of prescriptions by family doctors and surgeons. This trend has accelerated since the start of the COVID-19 pandemic.  

The risks of benzodiazepine use—worse during the pandemic

There are growing public health concerns that widespread anxiety associated with the pandemic has resulted in rapid growth in the illicit market for so-called ‘novel psychoactive substances,’ non-prescription (i.e., unscheduled) benzodiazepines and other narcotics that are widely available on street corners in many cities, and via the internet. This trend is resulting in increased rates of addiction and potentially serious medical and psychiatric consequences that are now worse in the context of the pandemic. There are even greater risks associated with benzodiazepine use in individuals afflicted with COVID-19. The National Health Service (NHS) of the U.K. published a short article outlining the risks of benzodiazepine use in individuals with COVID-19 related illness. For example, benzodiazepines worsen respiratory drive in individuals whose breathing has already been compromised by infection with the virus. Benzodiazepine use in individuals with pre-existing respiratory illnesses such as asthma and chronic obstructive pulmonary disease (COPD) may lead to severe respiratory compromise. Further, long-term benzodiazepine use is known to increase susceptibility to becoming infected with and succumbing to pneumonia. Finally, a significant percentage of individuals who are hospitalized for management of acute illness related to COVID-19 experience delirium and other severe neurologic symptoms. Use of benzodiazepines in acutely ill or recovering individuals may exacerbate symptoms of delirium and increase fall risk, and should be judiciously prescribed or (preferably) avoided. 

Bottom line

The direct and indirect consequences of the COVID-19 pandemic have resulted in high rates of anxiety, depressed mood, substance abuse and PTSD. Conventional treatments of pandemic-related stress and anxiety have limited efficacy and unresolved safety problems. Benzodiazepine prescribing and the illicit market for benzodiazepines have increased significantly since the start of the pandemic in spring, 2020. Use of benzodiazepines in individuals with pre-existing medical conditions placing them at risk of infection, and in individuals with COVID-19 related illnesses, exacerbates the risk of potentially serious medical and psychiatric consequences.



More Resource Articles

Kava and l-theanine for COVID-19 Anxiety

This is the second post in a series of non-pharmacologic management of anxiety during the COVID-19 pandemic. In the first post, I commented on the limited efficacy of benzodiazepines for anxiety and highlighted the medical and psychiatric risks associated with benzodiazepine use, which are greater during the COVID-19 pandemic. In this post, I briefly review the evidence for kava-kava and l-theanine, two natural products widely used for stress and anxiety.
READ MORE

Parenting In a Pandemic

The coronavirus pandemic has thoroughly changed the time spent with our families. With parents and children working and learning from home, many of us are getting more family time than we ever expected. Furthermore, the coronavirus threatening public health as well as the current conditions breeding economic and political uncertainty are significant stressors on parents and children alike.
READ MORE

The Relationship Between Immune Health and Mental Health

The importance of cultivating a strong immune system has become evident as we navigate the coronavirus pandemic. It is no secret that a strong immune system can help defend against illnesses, but there may also be a hidden benefit to mental wellbeing. 
READ MORE

COVID-19 Pandemic Fatigue

It’s hard to believe that we are nearly one year into the COVID-19 pandemic. The initial panic and hoarding of toilet paper have worn off, yet for many the psychological impacts of the pandemic are still very much present and may last longer than the pandemic itself.
READ MORE

Locus of Control and COVID-19

The COVID-19 pandemic is causing enormous stress for countless millions of people in all world regions. There has been no crisis of comparable magnitude within living memory. Individuals, communities, and entire populations are acutely aware of "loss of control" over their health, their finances, and their daily activities. The impact of "loss of control" on our mental health is made even worse by uncertainty over the future that is unprecedented in modern times...
READ MORE

Lifestyle Choices for Good Mental Health During COVID-19

Simple lifestyle choices can enhance mental health Because of widespread unemployment and the closing of mental health clinics due to the pandemic, millions of individuals struggling with anxiety, depression, and insomnia do not have access to, or cannot afford psychotherapy or medications. These circumstances may continue for months or even years, depending on how soon effective antivirals and vaccines become available...
READ MORE

Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity)...
READ MORE

Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time...
READ MORE

Depression

Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness...
READ MORE

Eating Disorders

An eating disorder is an illness that causes serious disturbances to your everyday diet, such as eating extremely small amounts of food or severely overeating. A person with an eating disorder may have started out just eating smaller or larger amounts of food, but at some point, the urge to eat less or more spiraled out of control. Severe distress or concern about body weight or shape may also signal an eating disorder...
READ MORE

Generalized Anxiety Disorder

All of us worry about things like health, money, or family problems. But people with generalized anxiety disorder (GAD) are extremely worried about these and many other things, even when there is little or no reason to worry about them...
READ MORE

Panic Disorder

People with panic disorder have sudden and repeated attacks of fear that last for several minutes. Sometimes symptoms may last longer. These are called panic attacks. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger...
READ MORE

Post-traumatic Stress Disorder

When in danger, it’s natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This “fight-or-flight” response is a healthy reaction meant to protect a person from harm. But in post-traumatic stress disorder (PTSD), this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they’re no longer in danger...
READ MORE

Social Phobia (Social Anxiety Disorder)

Social phobia is a strong fear of being judged by others and of being embarrassed. This fear can be so strong that it gets in the way of going to work or school or doing other everyday things...
READ MORE

Obsessive Compulsive Disorder

Everyone double checks things sometimes. For example, you might double check to make sure the stove or iron is turned off before leaving the house. But people with obsessive-compulsive disorder (OCD) feel the need to check things repeatedly, or have certain thoughts or perform routines and rituals over and over. The thoughts and rituals associated with OCD cause distress and get in the way of daily life...
READ MORE