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Anxiety: Medication adherence and psychotherapy

Adherence to medication and psychotherapy to control anxiety

Is anxiety a disease? a disorder? an emotion? what is the treatment medication and psychotherapy? is it increasing is it over

These and other questions are answered by a new edition of the video blog Your medicines, the joint project of EFESalut and the Viatris Foundation for Health, with the aim of improving therapeutic adherence.

Anxiety and medication adherence is the aim of this new video blog where we have brought together a doctor and a patient representative at the headquarters of the Viatris Foundation.

They are the doctor Antonio Torrescoordinator of the Mental Health Working Group of the Spanish Society of General and Family Physicians (SEMG), i José Ramón Pagésnational coordinator of the ANAED Foundation, an organization that helps and assists patients with depression, which also addresses anxiety.

Doctor Antonio Torres: Anxiety is increasing, but it can be overcome

Doctor, what is anxiety? what is the prevalence is it increasing

Physiological anxiety must be differentiated from pathological. Physiological is a mechanism of adaptation to a negative stimulus, a threat or a risk that has allowed us to survive as a species. It is what activates our basic systems to better cope with risk.

But when these mechanisms are disproportionate to the stimulus, this stimulus is very intense or lasts a long time, we are dealing with a pathological type of anxiety.

Pathological anxiety is characterized by the fact that the patient is absolutely unable to control this situation, with a feeling of serious illness and fears that may lead to thoughts of going mad or death.

It is a disabling mental disorder that, since the beginning of the century, has followed a progressive increase, since the economic crisis of 2008 there has already been a rise that goes from 4% to 6%.

Before the pandemic, the prevalence was between 7 and 7.5%, reaching up to 10.5% adding other processes of anxious manifestations.

What happened during the pandemic?

In the hard stage of confinement, a significant increase of 26% was generated, which placed the prevalence of anxiety at 14%.

It is known that one out of every 4 citizens during the pandemic has had an emotional or behavioral disorder that could include anxiety, depression, insomnia, etc. And these types of processes continue to increase.

These disorders can be generalized anxiety, panic, phobias, anxiety or separation disorder and selective mutism, among others.

And let’s not forget that there are legal and illegal drug substances that can generate anxiety.

Dr. Antonio Torres during the recording of the video blog/Photo: Manuel Valenzuela and Enrique Falcón

Doctor Torres, what is the role of medication in anxiety?

The role of drugs in the treatment of anxiety disorders is to control the organic overactivation suffered by the patient, which allows the development of adaptation mechanisms and overcoming the conflict generated.

We have three large blocks of drugs.

Within the anxiolytics, benzodiazepines, useful in acute crises and in the first phases, are very badly used because they are used for too long and generate addiction, which is a serious problem for this disease.

Gabapentinoids such as gabapentin and pregabalin have subsequently emerged, with a good effect on generalized anxiety disorder, they are very powerful long-term mood stabilizers.

And thirdly, antidepressants, safe long-term anxiolytics.

What other therapies can be used to manage anxiety besides medication?

Psychotherapy, no one conceives of a treatment for anxiety without the use of any psychotherapeutic technique, undirected, directed, individual or group self-help, or specialized, behavioral techniques.

There are others not supported by clinical trials, such as yoga or mindfulness, although mindfulness is starting to show positive mind control studies with good results.

Doctor, how is therapeutic adherence to anxiety treatment?

It is frankly low, two out of three patients do not comply with the indicated treatment. This may be due to forgetfulness, but the great majority have no true understanding of the essence of the disease, nor of the improvements sought by the indicated treatments. Add to that the fact that there are patients who fear adverse effects, even if they are not justified, and these types of rejection occur.

With regard to non-pharmacological therapies, a paradoxical situation occurs. The most severe patient is the least adherent to these associated therapies, as 85% of severe patients discontinue therapy, while 85% of mild patients follow it.

Do you overcome anxiety?

If we understand that only 43% of people who suffer from anxiety, less than half, consider that they should be treated by their doctor, or by behavioral specialists, such as psychologists or psychiatrists, and we associate that the concept of disorder is chronic and fluctuating, the truth is that the overcoming of anxiety is low, but above all this occurs in patients with a long evolution of 15/20 years.

Anxiety is a growing disease, but with early diagnosis, prompt initiation of treatment, and full and sustained follow-up, it is possible to overcome it.

José Ramón Pagés: anxiety is increasing at a clinical and social level

What data does the Foundation have regarding anxiety?

There is a lot of data, from all the provinces and the 17 autonomous communities. This jungle of data increases anxiety, both clinically and socially. There is a problem in society, and it is that we do not stand the thresholds of frustration, we do not manage problems well, we do not teach our children to go from a bed full of cotton, to not having a job, a house, money or not to be able to marry

José Ramón Pagés during a moment of the recording/Photo: Manuel Valenzuela and Enrique Falcón

How important are medications and medication adherence in managing anxiety?

All anxiolytics, medications, and therapies help with anxiety.

But I would also talk about emotional management. A lot of the anxiety problems have to be solved by the day-to-day work and management, and how we use the drugs. No problem can be replaced by a drug.

Medicines are for something else, but there are many people who, when they come to a consultation, ask for a medicine from the GP.

The drugs work well, but we must know that not everything can be solved with drugs and we must do our part and work on emotional management.

How do patient associations work this problem?

We try to solve problems that the health system does not solve. If you have a good doctor, psychologist, psychiatrist, everything works, but if there are shortcomings, there are more and more mental health problems.

We must be co-authors of mental healing, with adherence to medication, but without abusing it, and I insist, with good emotional management.

Do you overcome anxiety?

In a majority yes, but it depends, doctors can do many things, but if there is no cooperation from the patient, it cannot be overcome.

There are chronic patients who are almost professional, they don’t want to solve the problem, they adopt the victim position and they need medicine, care and attention.

Anxiety can be cured by people putting their side together with the environment around them.

From left on the right, Dr. Antonio Torres; the journalist Javier Tovar; the director of the Viatris Foundation for Health, Javier Anitua; and José Ramón Pagés/Photo: Manuel Valenzuela and Enrique Falcón

EFEsalut and the Viatris Foundation maintain the common goal of raising awareness in society about the importance of taking medicines correctly and improving levels of therapeutic adherence.

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