interest are sometimes the underlying reason, but most often people just
stop because they think they’re cured. If someone in your life is on SSRIs,
make sure they talk to their doctors before discontinuing. There may be
withdrawal effects. Treatment usually lasts for at least six months.
SSRIs may be prescribed forever for chronic depression because
they’re considerably better than the alternative. I don’t think the case is
nearly as strong for lifetime use to control fear disorders. Medication
should calm fear enough for people to face it, and ultimately conquer it.
Controlling fear with medication makes people feel better, but in the end
it’s a hollow victory that should only be accepted when all else has failed.
BUSPIRONE(BUSPAR). BuSpar is a new kind of medication derived from
antipsychotics that regulates the amount of serotonin available to receptors
and, supposedly, makes them work better. It may also help dopamine recep-
tors as well. BuSpar is not addictive, but its effects are usually not strong
enough for use in fear disorders. It may be helpful in generalized anxiety
and for some of the things it does in combination with SSRIs. We’ll discuss
this medication in more detail in other chapters.
ANTICONVULSANTS. Medications like Depakote and Neurontin, which
were originally developed to control convulsions, are being more widely
used for fear disorders. These drugs are generalized inhibitors of synaptic
transmission that work through several different mechanisms. A few years
ago they began to be used to control the manic part of bipolar disorder. The
theory is that they inhibit “kindling,” and thus keep abnormal neural
responses from generalizing throughout the brain. Lately, anticonvulsants
are being more widely prescribed for anxiety and fear disorders. They work
for some people, but my clients generally don’t like them. The chief com-
plaint is that the anticonvulsants make them feel drugged and stupid.
Weight gain on anticonvulsants is an even bigger problem than with SSRIs.
Drugs Work
Drugs do work. They make people with explosive disorders feel better. This
has led to speculation that the neurochemicals that the drugs affect cause
the disorders, and the areas of the brain known to contain or be sensitive
to these chemicals are where the disorders dwell. You will undoubtedly
90 ❧Explosions into Fear