A few days after the terror arrests in London last month, a small commuter plane carrying 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 flight home to San Francisco, was not worried. He had just doubled his usual pre-flight dose of Ativan, a prescription anti-anxiety drug, in anticipation of the ride on the small plane.
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, under the advice of his doctor, he has experimented with drugs to calm his nerves before flying.
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"My meds never give me a feeling of being high or stoned," 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."
"I've kind of gotten over the stigma that I need to tough this out," he said.
As the era of populist anti-anxiety drugs has merged with the post-Sept. 11, 2001 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, New Jersey, 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 a 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 the Sept. 11 attacks.
"Everybody started saying, `Take it like candy,"' said Bunn, who is nevertheless skeptical about the 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 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," 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 `OK, 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, durations and side effects, said Thomas Swift, the president of American Academy of Neurology in St. Paul.
Benzodiazepines are different from older sedatives like Seconal, a barbiturate, and from anti-depressants like Zoloft and Prozac that are 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," 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 Swift, referring to pharmaceutical-swapping. "The doctor that prescribed the medicine for the person who had it knows the person's medical history. That's not true for person that 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 William Rickles, an assistant clinical professor in the department of psychiatry at the University of California, Los Angeles.
Unlike powerful barbiturates, the mix "doesn't drop your blood pressure and doesn't stop you breathing, so it doesn't kill you," Rickles said. "But you might sleep for a long time."
For some fliers, sleep is the goal. 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."
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