Should Doctors Treat Trump Anxiety?

by Danielle Ofri
Slate Magazine

“Just one tablet, doctor. I just need you to prescribe one tablet to calm me down.”

As a primary care doctor, I frequently get requests for sedatives from my patients. Because of the side effects—including addiction—I use these medications gingerly and most of my time is spent sorting out the issues, triaging the needs, and seeking alternatives.

But this request wasn’t thanks to usual symptoms—the generalized anxiety brought on by life, relationships, economic situations. This was about an immigration hearing the following week.

“If my hearing doesn’t go well,” my patient told me, visibly upset, “I don’t know what will happen to me.” Her Central American country of origin is not known for its human rights or safety record.

Doctors deal with side effects all the time—side effects of medications, side effects of diseases, side effects of treatments. But side effects of an election is new territory for us. We can report medication side effects to the FDA, but to whom do we report election side effects?

It will take time for traditional medical research techniques to identify, and document medical fallout of the Trump presidency. There will of course be very specific “side effects” for people who lose their insurance or are deported. But it’s remarkable how many side effects doctors are already observing in their practices, before Trump has even set foot in office.

One physician told me of a patient who became suicidal in the wake of the election. He had been brought to the United States as a baby, grown up here, created his life here, and now worried that everything he’d ever known could be destroyed in a flash. Another doctor told me of a patient for whom the election results and fear of deportation pushed his anxiety over the edge. He ended up in the emergency room with suicidal ideation.

Another patient with a transgender partner and no prior mental health issues experienced an episode of psychosis, brought on, according to the doctor, by overwhelming fear for the future. Another patient had to cancel a planned biopsy because he was simply too anxious to lie still on the table. A family practice doctor wrote to me that in a single day she had to treat three patients with anxiety and inability to sleep. “I felt like a psychiatrist,” she said.

There are also physical ramifications. One doctor told me of an African–American patient whose rheumatoid arthritis flared, likely from the post-election stress. Another patient’s asthma has worsened, with increased wheezing and coughing since the election.

A doctor told me about a patient for whom the recent increased acts of hatred triggered memories about KKK activity in her Mississippi childhood. The nightmares awoke her from sleep with acute chest pain, necessitating a cardiac work-up. Another doctor told me of a patient who ended up in the emergency room with stress-induced cardiomyopathy.

The realm of birth control is the one area where there is some data. The demand for IUDs, one of the longest-acting forms of birth control, was up five-fold at Planned Parenthood of Illinois. The demand is likely in response to women’s worry that they will lose the free birth control benefit provided by the Affordable Care Act, and about abortion becoming even more restrictive.

Among my own patients, most of whom are immigrants, there is a palpable surge of distress. In our visits, diabetes and heart disease are pushed aside as we use our medical time to address the fear that has infiltrated their lives. Worries about deportation and families being broken up occupy their minds, making it hard to concentrate on cholesterol levels and mammograms. Depression and anxiety symptoms are exacerbated. One of my colleagues described a South Asian refugee who was “despondent” during his most recent check-up, petrified that the anti-immigrant sentiment would close off opportunities to obtain political asylum and he’d be deported back to his country where his life would be at risk. Even those who are legal immigrants worry that it wouldn’t take much rhetoric to expand the deportation mandate. (And being a legal immigrant doesn’t resolve anxiety about hate crimes—as one patient told me, no one asks about your green card before they hurl an insult.)

It’s true that after every election half of the population is thrilled and half is dejected. I’ve been a doctor through a number of Democratic and Republican victories, and there’s always a bit of political chitchat in the exam room post-election. Some patients are energized; some are down.

But this is different. These are real medical side effects, and they are occurring even before changes in the ACA, the Supreme Court, immigration policy, and environmental legislation alter the landscape of our country. Add up the additional medications prescribed, extra ER visits, delayed procedures, missed work, plus the fallout of other illnesses being relegated to the back burner, and you have the makings of a major medical toll from this election.

The FDA engages in post-market surveillance to monitor the safety of a new medication or device after it has been put on the market, because many side effects only become apparent later on. That’s what happened with Vioxx, the ibuprofen-like painkiller that was withdrawn five years after being put on the market due to increased heart attacks and deaths. I wonder if the FDA will now have to consider a post-market surveillance of election-related side effects, which are likely to only get worse once Trump actually takes office. Unfortunately, a Vioxx-like recall for the cause of these bad side effects does not fall under their purview.

For my own patient, I debated over whether I should prescribe a sedative for her immigration hearing. The patient was very clear that while she’d been little bit nervous about the hearing all along, it was the election that made her anxiety insurmountable. She didn’t think she could physically make it through the day.

This would be a first for me—changing my medical practice in response to an election. But her circumstances seemed dire and the consequences grave, so I wrote her a prescription for a small number of pills in the Valium category. As the new administration prepares its ax for the Affordable Care Act (as well as many other protective acts and regulations), doctors will have to remain vigilant. We must look for the medical side effects of the 2016 election, and treat them as best we can. If only this were enough.,,,