Terri calls her mother and cries. “Every day I wake up in the morning with my heart racing and I’m too stressed to eat. I feel anxious all day and have trouble falling asleep. I’m afraid that if I catch COVID, I miss the lab for my class and I fail. Do you think I should take medication for anxiety?”
Terri’s mother responds, “I think everyone is worried about COVID. When rates go down, you will feel better. I don’t think you should take medicine.
Terri’s mom is right that anxiety levels are on the rise. Anxiety was already on the rise before COVID, but is now skyrocketing in the age of COVID. The Healthy Minds Study surveys thousands of college students with a Generalized Anxiety Disorder (GAD) questionnaire each year and found that pre-COVID (2018-2019) the rate of GAD was 31%, while during COVID (winter and spring 2021), the rate was 34%. GAD consists of at least six months of excessive anxiety accompanied by at least three other symptoms such as lack of concentration, muscle tension, fatigue, feeling jittery, irritability and poor sleep. These symptoms interfere with the student’s ability to function or cause significant distress. In the age of COVID, students are experiencing multiple triggers for their anxiety, including fear of loved ones contracting COVID, uncertainty about whether classes will be online or in-person, and social isolation from pandemic restrictions .
Should Terri take medication for anxiety? More students are using medication for anxiety than they have in the past. Research shows that 1 in 4 college students have used a psychiatric drug in the past year. In a study conducted by myself and my colleagues, we found that the use of drugs specifically for anxiety (benzodiazepines, buspirone) doubled between 2007 and 2019, from 3.0% to 7.6% of students. Use of antidepressants like sertraline and escitalopram, which are FDA-approved to treat depression and GAD, also doubled, from 8.0% to 15.3%.
Terri replies to her mother, “Well, I have to do something. I’ve been anxious for over six months and my grades are dropping.”
Terri’s mother said, “Why don’t you speak with a therapist at the counseling center on campus to see what he recommends?”
It’s always a good idea for someone with distressing anxiety to speak with a therapist. Not everyone with anxiety will need medication. The decision to start treatment depends on the severity of symptoms, impact on function, and patient preference. Both British and Canadian universities use a staged treatment model, matching the level of treatment to the severity of anxiety. In American universities, there is also a similar assessment that will lead to recommendations for the appropriate level of mental health care.
If anxiety symptoms are mild, students may be offered suggestions such as exercises, meditation apps, group therapy, or peer counseling. Peer counseling is increasingly popular among students. A recently released report shows that a fifth of university students have used peer counseling, while nearly 2 in 3 of those who have not had peer counseling are interested in pursuing it, stress and l anxiety being the main concerns.
Students with moderate symptoms may be offered individual therapy and/or a meeting with a primary care physician or psychiatrist regarding medication options. The student might benefit from a physical exam to assess the medical causes of the anxiety. Students with severe symptoms might consider treatment by a therapist and psychiatrist.
Terri meets with her campus therapist who diagnoses GAD with mild symptoms. The therapist refers her to the primary care physician on campus because she has not had a physical exam in a few years and describes daytime fatigue. The primary care physician learns that Terri takes an energy drink high in caffeine daily to relieve her fatigue, but it could also increase her anxiety and insomnia. Her primary care physician guides her on tapering off caffeine and recommends exercise to reduce anxiety and increase energy. Terri exercises and does cognitive behavioral therapy. Her anxiety lessens but continues to keep her awake at night; his grades plummet.
“Mom,” she said. “I want to try medication at this point. I will continue to undergo therapy, but it does not seem to be enough.
“I think taking medication is a good idea. Just make sure you don’t consume anything that you might become addicted to.
Terri’s mother may refer to benzodiazepines, which include drugs like alprazolam and lorazepam. Many academic psychiatrists choose drugs other than benzodiazepines because of their risk of abuse, dependence, and overdose. An alternative to benzodiazepines for short-term anxiety relief is an antihistamine called hydroxyzine. The best daily medications for treating GAD are antidepressants from the categories of selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). The SSRIs sertraline and escitalopram and the SNRIs venlafaxine and duloxetine are effective treatments for GAD.
Here are some things to know about these SSRIs and SNRIs:
- It is best to start medications at a low dose and increase slowly to reduce side effects.
- Patients should notice improvement in two to four weeks.
- Patients are recommended to continue taking medication for at least six to 12 months.
- If the decision is made to stop treatment, it should be tapered off gradually to reduce the effects of discontinuation.
- Antidepressants have a black box warning that they can increase suicidal thoughts and behavior in people 24 or younger. This doesn’t happen often, but if it does, the student should let their provider know.
After taking escitalopram prescribed by a psychiatrist, Terri manages to sleep better and her grades improve. She continues to work in therapy on how to stay socially connected with friends while being safe and how to deal with the uncertainty of college life in the face of COVID. She practices Tai Chi, which is extremely effective for her anxiety, and after nine months of use, she tapers and stops her medication.
If your student suffers from anxiety, encourage them to get assessed at their campus mental health service and explore different tools for dealing with their anxiety, which may or may not include medication. If your student is on medication, they will always benefit from working with a therapist who can teach behaviors to reduce anxiety and change catastrophic thought patterns. Although COVID has brought about a new era of anxiety, we can beat the symptoms with a step-by-step treatment approach.
To find a therapist, please visit Psychology Today’s Directory of Therapies.