Pubdate: Sun, 17 Sep 2006
Source: New York Times (NY)
Copyright: 2006 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Alex Williams

YOU ARE CLEARED FOR TAKEOFF

A FEW days after the terror arrests in London last month, a small
commuter plane with three tourists was banking off the coast of Costa
Rica when a sudden sound, like a muffled explosion, shattered the
calm. The rear door of the plane, improperly shut, had blown open.

There was a moment of panic for two of the passengers. But Roger Knox,
a graphic designer making a connecting flight before boarding a
jetliner home to San Francisco, was not worried. He had just doubled
his usual preflight dose of Ativan, a prescription anti-anxiety drug,
in anticipation of the ride on the small plane.

Mr. Knox, 46, said he is generally so drug-phobic that he doesn't take
aspirin for a headache. But he is also a white-knuckle flier, and over
the last few years, with advice from his doctor, he has experimented
with drugs to massage his nerves before flying.

"My meds never give me a feeling of being high or stoned," Mr. Knox
said. "They can make me a bit drowsy, but for someone used to
adrenaline-pumping, think-I'm-going-to-freak-out anxiety, that's a
welcome change."

Terror alerts. Long security lines. Overstuffed transcontinental jets.
It's all more tolerable with a prescription drug to round off the
edges, many people have found.

"I've kind of gotten over the stigma that I need to tough this out,"
Mr. Knox said.

As the era of populist anti-anxiety drugs has merged with the
post-9/11 era of fraught air travel, nervous fliers increasingly turn
to pills to make the hours of sealed confinement more bearable,
according to therapists, flight-anxiety counselors and nervous fliers.
For many stressed-out travelers, tossing back a prescription pill
before a flight - rather than a couple of bourbon and sodas, the old
method - is as routine as picking up a paperback on the way to the
gate.

"Everybody personally and professionally that I know who is afraid to
fly gets their hands on Xanax," said Jeanne Scala, a psychotherapist
in Roxbury, N.J., adding that she has seen an increase in patients and
friends talking about taking medication for flying jitters. "They'll
do anything to take the edge off the anxiety of sitting in a plane,"
she said. "They just want to zone out, they want to sleep. So they'll
take Ambien, Sonata, even pain medication like Soma, which is for back
pain. People use whatever they have - the pharmacy in their house."

Tom Bunn, a licensed therapist and a former commercial pilot who
started company called Soar in 1982 to counsel people with fears of
flying, said he saw an increase in chatter about anti-anxiety
medication on the message board of his company's Web site after 9/11.
"Everybody started saying, 'Take it like candy,' " said Mr. Bunn, who
is nevertheless skeptical about drugs' effectiveness and safety and
does not recommend them in his program.

Ron Nielsen, a pilot for US Airways who also leads a flight-anxiety
course, called Cleared 4 Takeoff, said scares like the London arrests
of men accused of plotting to blow up planes with liquid explosives
serve as a trigger for underlying fear, which leads many fliers to
consider medication.

"That's one of the first things that come up every class," Mr. Nielsen
said. "The average fearful flier is more likely to say, 'Give me
something, I gotta go to Boston.' I think every time you have a spike
in collective anxiety in culture, people get to desperate places,
people say 'O.K., I'm willing to do this, whereas yesterday I wasn't.'
"

There are plenty of options for the highly nervous flier. Xanax,
Valium and Klonopin - among the most popular - are benzodiazepines, a
class of anti-anxiety drugs often prescribed for use on an occasional
basis. All have slightly different characteristics, times of duration
and side effects, said Dr. Thomas R. Swift, president of the American
Academy of Neurology in St. Paul. (Benzodiazepines are different from
older sedatives like Seconal, a barbiturate, and from antidepressants
like Zoloft and Prozac meant to be taken daily when used to treat
panic disorders and other ongoing anxiety problems.)

Some fliers said they preferred a drug like Xanax to alcohol because
its effects are typically mild. It does not make them spacey or
fuzzy-headed, they said. They do not stumble off a plane as if their
legs are filled with putty, making it appealing to business travelers
who must attend meetings after landing.

"Benzodiazepines tend to be a relatively safe drug," Dr. Swift said,
adding that the main side effect in small doses is sleepiness. The
risk comes in, he said, when people borrow them from well-meaning friends.

"It's almost always a bad idea," said Dr. Swift, referring to
pharmaceutical-swapping. "The doctor that prescribed the medicine for
the person had it knows the person's medical history. That's not true
for person who borrowed it. There could be a contraindication to that
drug."

Doctors also caution against chasing an anti-anxiety pill with a
drink, because alcohol functions as a "powerful augmenter" to
benzodiazepines like Xanax, said Dr. William Rickles, an assistant
clinical professor in the Department of Psychiatry at the University
of California, Los Angeles. Unlike with powerful barbiturates, the mix
"doesn't drop your blood pressure and doesn't stop you breathing, so it
doesn't kill you," Dr. Rickles said. "But you might sleep for a long time."

FOR some fliers, sleep is the goal. Dr. Neil B. Kavey, director of the
Sleep Disorders Center at NewYork-Presbyterian Hospital/Columbia
University Medical Center, said he has witnessed a dramatic increase
in the number of patients who use these sleep drugs for flights - most
to combat jet lag, but some who simply knock themselves out to avoid
anxiety - over the last year or two. "When I noticed the increase, I
worried a bit if I would see people awakening on airplanes too heavily
drugged," he said. "But I don't think I've had any incidents."

The new generation of prescription sleep drugs, which includes Sonata
and Lunesta as well as the popular Ambien, is marketed as safer than
an older generation of sleeping pills. (Ambien became a cocktail-party
topic earlier this year, after reports that some users claimed they
went on eating binges or driving excursions they didn't remember. And
last summer, a London-bound plane was diverted after a passenger who
later said that he had taken Ambien - and drank two individual-serving
bottles of wine - tore off his shirt and made threatening remarks.)

Paul Taylor, a hair colorist in White Plains, was an unnerved air traveler
who had to experiment with anti-anxiety drugs to find one that worked
for him. Mr. Taylor, a native of South Africa who has been flying home
routinely for years, said he developed a severe aversion to air travel
after a trip in the late 1990's that required an emergency landing.
Then a few years ago, a sympathetic acquaintance gave him a Valium for
an upcoming trip to Seattle.

He tried it.

Nothing.

On the flight, Valium failed to "shut down the little people in my
brain, as I call them," said Mr. Taylor, 43, referring to his
neuroses. "I was literally grabbing onto the arm of my partner the
whole way and freaking out." A year or so later he confessed his fears
to a doctor, who prescribed Xanax. Thanks to that, combined with the
cognitive therapy he learned from the Soar program, for him the skies
have never been, well, quieter.

Although doctors and therapists confirm that drug use among jittery
fliers is common, it is impossible to measure how common, because many
people who pop the occasional pill do so without mentioning it to any
professionals, especially if they received it from a friend.

Others just have a few Klonopin that they got from their general
practitioner for anxiety issues in general, and decide to take them
for a flight as needed.

There are nervous fliers who have drugs in their pocket but don't use
them, said Marvin Aronson, a psychotherapist in Mount Vernon, N.Y.,
who treats flight anxiety. "It's just having them that can make the
difference," he said. (These fliers may want to bring the prescription
bottle; the Transportation Security Administration requires that
prescription drugs carried on board have a label matching the
ticketholder's name.)

And drugs are certainly not the only option for jittery
fliers.

"We have some people call up and want nothing but natural remedies,"
said Dr. Rickles, who uses techniques like biofeedback and
virtual-reality therapy to help many patients combat their fear of
flying. Some people with extreme phobias,
he said, "generally don't like to take drugs, because they are afraid
that a drug might do something and then they can't get it out of them."

Jerilyn Ross, president of the Anxiety Disorders Association of
America, a nonprofit group of health care professionals in Silver
Spring, Md., said that anxious fliers, like many people suffering
anxiety, "used to take Valium and hide it" because they believed there
was a stigma attached to self-medicating for anxieties like fear of
flying. But now, she said, "it's much less frightening" and "people
are much more open about it," due in part to the torrent of
information - and pills - available on the Internet.

Certainly, some people, particularly those suffering an acute fear of
flying, have turned to pills since the heyday of barbiturates like
Seconal and Nembutal in the 60's and 70's, doctors said. But these
days, there are even more reasons why tremulous fliers may want to
indulge.

For Kermit Morse, a computer systems analyst at a bank in Columbus,
Ohio, going through security lines at airports is an added
psychological hurdle as he tries to find a new peace with flying. He
flew routinely until a few years ago, when a growing sense of fear due
in part to the post-9/11 jitters stopped him in his tracks at the gate
at the Columbus airport just as he was about to board a flight to Dallas.

"I was at the gate and I could not walk down the jetway," Mr. Morse,
48, recalled. "So I went home."

He saw a doctor, who for a time put him on a daily regimen of Paxil, a
drug often prescribed for acute anxiety disorders. For his first
flight after that, it worked. Sort of. While on a plane flight, the
fear "didn't seem to be as he intense," he said, though he still
found himself "looking for anything that might indicate there's a
problem with the plane."

At least, Mr. Morse added, "I could actually get on the plane."
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