Ask Your Pharmacist

April 21, 2020
Q:

I suffer from Generalized Anxiety Disorder (G.A.D) but my symptoms are usually well controlled. Although I rarely need to take my “as needed” lorazepam, the physical isolation over the past several weeks is beginning to take a toll, and I have required several doses of lorazepam and the occasional drink of alcohol. Is this okay?

A:

The last several weeks have been challenging for many of us. Much is unknown, not to mention the fear of getting sick ourselves with COVID-19. The physical isolation measures required during the pandemic make it even more challenging because our traditional daily routines and social support networks are disrupted. For those of us with anxiety, this situation has all the elements to upset our balance, even if our signs and symptoms have been controlled for many years. 

For those people currently taking anti-anxiety medication, it is important to continue to take this medication as prescribed to control your symptoms of anxiety and prevent symptoms from recurring. When anxiety symptoms are controlled, it is easy to fool ourselves into thinking we no longer need the medicine. For this reason, you should adjust your medication dosing only in collaboration with your doctor, nurse practitioner, or pharmacist. These health care professionals can be objective with you about how to manage your anxiety.

During particularly stressful times, anxiety can worsen, and we need to be even more watchful. Requiring more than usual of ones “as needed” medication is an indicator that anxiety is not as well-controlled as it should be. Use this as a sign to contact your doctor, nurse practitioner, or psychologist to come up with a plan to help you cope during that period. If you are given instructions to take your medication differently, it is important that these prescription changes are communicated to your pharmacist. During the pandemic, if you have run out of your medication and do not have access to your prescriber, your community pharmacist has recently been granted authority to use her/his clinical judgment to continue care of this medication therapy for a time frame that allows assessment by your doctor or nurse practitioner.

There are other steps you can take to help minimize your anxiety at this time. Get information from reliable sources, such as Canada.ca/coronavirus. Knowledge is power. Stay informed but follow news coverage about COVID-19 in moderation. I found the following useful tips on the website for the Office of the Chief Medical Officer of New Brunswick. Take care of your body. Take deep breaths, stretch or meditate. Try to eat healthy, well-balanced meals, exercise regularly, and get plenty of sleep. Stay connected. Talk to friends or family about your feelings and concerns. Identify what is within your control.  

It may be tempting to briefly relieve the stress and anxiety caused by living through a pandemic with alcohol, but it is even more important than ever to resist this temptation. Alcohol is a mood depressant that will make your mood even lower and will worsen symptoms of anxiety. Drinking alcohol sets up a dangerous cycle of self-treating with alcohol to relieve symptoms of anxiety and depression that alcohol worsens.

Combining alcohol with antidepressant or anti-anxiety medication is dangerous because there are known drug-alcohol interactions. When combined with alcohol, antidepressant medications may cause significant drowsiness, clumsiness, incoordination, impaired thinking, and even respiratory depression leading to death.

If you need professional help to handle your anxiety, it may be challenging to meet with your health care provider for a face-to-face appointment during this time. However, it may be possible to schedule a phone appointment or FaceTime visit. Your community pharmacist is available to discuss in person or on the telephone, any questions you have about medications used to treat anxiety. If at any time, you feel as though you may harm yourself, this is a medical emergency. Go to emergency or immediately call 9-1-1.  If you need to talk about your symptoms anxiety you may call the CHIMO helpline: 1-800-667-5005 or the Kids Help Phone: 1-800-668-6868.

Check out these useful resources regarding mental health during COVID-19 available on the New Brunswick Department of Health website: https://www2.gnb.ca/content/gnb/en/departments/ocmoh/cdc/content/respiratory_diseases/coronavirus/mental-health-and-coping-during-covid-19.html or the Government of Canada at  www.Canada.ca/GCMentalHealth.

Dr Kevin Duplisea (PharmD BSc. Pharm, BSc. ACPR) is a pharmacist at Sharp’s Corner Drugstore in Sussex, New Brunswick. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.