Many patients benefit from improving sleep hygiene and as a treatment for insomnia.
Others may improve using a sleep phase changes or treating the underlying problem such as sleep apnea, medical conditions, alcohol abuse, etc.
For many others, recent pharmacologic treatments prove effective and have minimal side effects. Targeting melatonin receptors is a novel and promising approach.
For many persons, however, existing treatments are ineffective, too expensive, result in side effects or conflict with their desire to avoid medications. Some side effects from medications are very disturbing, such as sleep associated behaviors that result in harm to self or others. For others, there is morning sedation, drug/drug interactions or rebound insomnia. When behavioral interventions are not effective, CES could be considered prior to initiating medications.
There are many non-pharmacologic interventions for reducing anxiety. Some of these include dietary supplements, acupuncture, meditation, yoga, and exercise. These interventions, however, are not employed by a large segment of society that suffers from anxiety. These persons instead seek medications from their physician to alleviate their suffering. Typical classes of medications for anxiety include the SSRI’s, benzodiazepines as well as the off label use of antihistamines and atypical antipsychotic medications and antiepileptic medications. In addition to the inherent problems with SSRI’s, there are also problems with the other classes of medications. A serious potential side effect of benzodiazepines is their potential for inducing physical and psychological dependence. In addition, withdrawal symptoms can prove life threatening, especially with the shorter acting benzodiazepines like alprazolam. When taken as directed, which is often not the case; this class of medications can result in compromised coordination, slowed reaction time, falls, disinhibition, delirium, and anterograde amnesia.
It is not uncommon to see suicide attempts involving a combination of a benzodiazepines together with alcohol and/or another sedative hypnotic. While buspirone is relatively well tolerated, it has poor efficacy and a 3 to 4 week lag time to have an effect. Medications such as gabapentin are used off label but there is no research to support its efficacy for anxiety disorders. Unfortunately, physicians have begun using the atypical antipsychotic medications to treat anxiety. This class of medications has a large and increasing number of very serious side effects. Recent attention has been focused on their causing metabolic syndrome. They frequently cause extra pyramidal side effects, sedation, elevated prolactin levels and drug/drug interactions. All of these medications should be avoided during pregnancy and used with caution in the elderly. In short, the side effect profile of current pharmacologic treatments for anxiety limits their safe use.
There is considerable controversy regarding the efficacy for evidence based treatments for depression. The controversy also involves the risk/benefit analyses of currently approved interventions. While the primary focus has been on medications, similar concerns have been raised regarding certain psychotherapies, transcranial electromagnetic stimulation, vagal nerve stimulation, ECT and herbal and dietary supplements.
Through articles published in the lay press, the general public has been apprised of the controversy involving the efficacy of antidepressant medications. For example, Time magazine recently cited Kirsch’s meta-analysis in PLoS Medicine that found little benefit of antidepressants for most patients as well as Dr. John Krystal’s findings that about 25% of patients did worse on antidepressants than on placebo”. They have been informed about the black box warnings for SSRI’s causing suicidal behaviors. One of the results of this publicity is a growing movement away from all medications to “holistic” or “folk remedies”. In fact, there many patients express fears of taking medications.
There is excellent data and clinical experience however to support the safety and lack of adverse side effects from CES and it should be included in the spectrum of available treatments as it poses very low risk of harm to patients.
Excerpts from “A View from the Trenches” written by Jason Worchel, M.D.
More CES Research – http://www.cesultra.com/research-resources.htm