Dear Dr. Roach: I recently read a book where a person who suffered from anxiety and depression found that Adderall gave relief from the effects of anxiety and depression. My initial thought was that this could help a person focus and perform, almost like a stimulant. Currently, Xanax is a nice option that appears to help with my anxiety issues. What are your thoughts?
M.B.
Anxiety and depressive disorders sometimes go hand in hand in the same person. Even though they may seem to be opposites, both anxiety and depression symptoms respond to similar medications, which suggests similar brain mechanisms.
Adderall, a combination of dextroamphetamine and amphetamine, is, indeed, a stimulant. Stimulants have been proven to be useful in a minority of people with depression that has been resistant to other treatments. As a primary care doctor, I generally do not prescribe these kinds of medications, and I refer patients to a mental health expert, like a psychiatrist, whenever possible. Unfortunately, we have been living through a mental health crisis for years now, and many of my patients are simply unable to get expert psychiatric care. So, primary care doctors, like me, have to do the best we can, sometimes in consultation/liaison with a psychiatrist.
Also, stimulants can make anxiety symptoms worse, so I am cautious about using stimulants in a person with both anxiety and depression. Clinical judgment and experience is even more important in this situation.
Xanax is an effective medication for anxiety, but the body can get used to it quickly. Similar to Adderall, it has some potential for misuse. I only prescribe benzodiazepine medications like Xanax for the short-term or for very occasional use, although, again, my colleagues in psychiatry sometimes do prescribe them. I have patients who have done very well on stable doses of benzodiazepines for years.
However, I have seen too many cases where people become dependent on these drugs and have difficulty quitting. Finally, the way the body gets used to these drugs can lead to some people developing withdrawal symptoms, even when taking a stable dose. Most people do very well with safer medications for anxiety disorders.
Dear Dr. Roach: I am a nearly 90-year-old woman in relatively good health. I have osteoporosis, for which I’m given Prolia injections twice a year. I brush and floss regularly, and I have excellent teeth. I’ve always had cleanings twice a year. However, my dentist has recommended cleanings every three months. Do older patients require more frequent cleanings?
C.H.
For most older adults and most people taking antiresorptive medicines for osteoporosis (Prolia, Fosamax, Actonel, etc.), a cleaning every six months is appropriate. These drugs have a rare side effect called osteonecrosis of the jaw, and regular dental evaluation and cleaning may further reduce this small risk (approximately one case per 10,000 patients who were followed for one year).
If your dentist has recommended cleanings every three months, they may have found a dental issue they are concerned about. While I would listen carefully to their recommendation, it is certainly worth asking why.
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