Psychiatrists are first and foremost doctors; this is a fact never to be forgotten. This was brought to mind when a social worker I knew called me, urgently insisting that a patient of mine (“Kenny”) was having panic attacks and needed immediate prescribing of Xanax. I knew this suggestion was potentially concerning as Kenny had a history of substance misuse, and Xanax is not always the best solution for someone with such a history.
Kenny was a patient I had been working with due to his history of binge eating, which worsened every time he quit drinking alcohol. His initial treatment aim was to curb cravings for ice cream. However, since moving to New York, he had gained substantial weight due to increased restaurant availability and reduced swimming access. This weight gain became a major concern for Kenny, especially as he aimed to start some new romantic relationships and was trying to avoid slipping back into depression.
One solution that seemed promising was the use of glutides – glucagon-like peptide agonists. Following some anecdotal reports, it was thought these could suppress alcohol cravings, decrease appetite and facilitate weight loss. Kenny was approved for this treatment by his insurance and started receiving injections. For some time, everything went well. Kenny was losing weight, albeit not as fast he hoped for.
However, panic attacks soon struck. Kenny insisted he hadn’t returned to drinking, and no new stressors had surfaced in his life. After investigating, I discovered the problem might be Kenny’s eating habits: influenced by the initial success of glutides, he started eating only enough to barely sustain himself. As a result, he was likely experiencing hypoglycemia, the symptoms of which often mirror those of panic attacks.
Allocating the right treatment for such a patient is imperative. In this case, I suggested that he follow a simple diet involving peanut butter, as its high protein and fat content can prevent blood sugar levels from dropping. Kenny agreed to try this dietary change to avoid further instances of hypoglycemic episodes.
Shortly after this incident, the media started reporting cases of overdosing on Ozempic, a commonly prescribed glutide. The overdose cases usually involved patients accidentally injecting themselves with an excessive amount of the drug. Warnings became more serious when it became apparent that these prescription diet medications could be obtained easily through unauthorized online sources.
In such situations, it’s crucial for psychiatrists to remember our primary role as physicians undertaking thorough patient assessments and differential diagnoses before prescribing medications. In Kenny’s case, by not giving in to the initial impulse of prescribing Xanax and instead investigating further, we were able to identify the real problem and protect him from potential harm. This experience reinforced the critical nature of our role in patients’ health.
