Hello, Intro and request for advice...

[BenSW]

Hi all,

I wanted to say hello and introduce myself, a fortysomething guy from very rural SW England.

I have had an official anxiety diagnosis for about 15 years, although in retrospect recognise these problems starting much earlier in my life. At my best I do OK, at my worse I have multiple panic attacks a day (including being woken by them... just love that :) !). I am not a worrier about the vicissitudes of life, I am just fearful about fear.

I have recently had a good patch keeping things under control with pregabalin (450/day) and lorazepam (occasional, perhaps 3mg / week). I now though can feel a return of symptoms after I am almost certainly developing tolerance to both (I have been on the pregabalin for about a year).

I have tried the usual range of SSRIs, Mirtazapine etc. I have had multiple periods of 1-on-1 CBT. I have no complaints about what the NHS has been able to offer but none of these things helped.

So now I feel that the combination of pills that has kept me doing OK is coming to an end and I don't know what to do. I feel I have exhausted all avenues open to me and the future looks bleak. In fact I am so desperate I have registered here :)

Any advice welcome.

tl;dr : Hi.

Ben

[venusbluejeans]

Hiya BenSW and welcome to NMP :welcome:

Why not take a look at our articles on our home page, they contain a wealth of information and are a great starting place for your time on the forum.

I hope you find the as site helpful and informative as I have and that you get the help and support you need here and hope that you meet a few friends along the way :yesyes:

[hanshan]

I'm going to go against conventional wisdom here and suggest that in certain cases of anxiety (of many years duration, treatment resistant) a regular daily dose of a long-acting benzodiazepine is preferable to intermittent dosage of a short-acting benzodiazepine, which may lead to an ongoing peak-and-trough effect. As many point out, it's not a cure and may have other negative effects, but I am talking about maintenance of something otherwise intractable.

[Michelle1]

The problem with taking benzodiazepines is eventually you are going to hit tolerance and then your left with 2 options. Keep increasing the dose or getting a withdrawal schedule and coming off it completely.

It's a very difficult position and I've been there myself. Done all the rounds on ad medication and pregablin and diazepam. Hopefully you have got a good psychiatrist working with you. I was on diazepam over 6 years and recently came off (not a pleasant experience). Best not stop on them long term if you can avoid it. I wish you all the best xx

[hanshan]

Hi Michelle – I appreciate your contribution. Please note that I am talking about people with longstanding anxiety over many years who have tried all the alternatives and are already taking benzodiazepines on an irregular basis. My feeling is that that may actually exacerbate their anxiety, and a regular lower dose of a long-acting benzodiazepine may be a better alternative.

Tolerance to the different effects of benzodiazepines develops differently. Tolerance to the physical and sleep-inducing effects of benzodiazepines develops rapidly, but for many people not to the anxiolytic effect. This is good for people with anxiety where insomnia is not a problem.

Psychiatric bodies recognize the long-term use of benzodiazepines for the control of anxiety in selected cases, eg the following:

First, from the Psychiatric Times (a publication with an editorial board and contributors from many leading US universities) – a discussion paper 2007:

‘Many practitioners draw on their own clinical experience to conclude that long-term therapy with benzodiazepines is relatively safe, even when compared with SSRIs. Long-term use must be understood in the context that, increasingly, many mental conditions are seen as recurrent or chronic disorders. Anxiety spectrum disorders certainly fit that model. In 1999, an international group of experts addressed this issue and recommended even the long-term use of benzodiazepines for anxiety disorders.

‘A study of persistent users of alprazolam or lorazepam who consulted the Addiction Research Foundation in Toronto, showed that most were not "abusing" the drugs nor were they "addicted" to them, as the terms are usually understood. A substantial proportion of patients were receiving appropriate maintenance therapy for a chronic psychiatric condition such as generalized anxiety or obsessive-compulsive personality disorder. Most patients used a constant or decreasing dosage of medication.’

Second, from the ‘Guidance for the use of benzodiazepines in clinical practice’ (2015) of the Royal Australian & New Zealand College of Psychiatrists:

‘In general, benzodiazepine use should be restricted to short term periods only. Longer term use should only be considered in patients who do not respond to adequate trials of other evidence-based pharmacological and psychological treatments.

‘Trial data indicates that there are a small number of patients, such as those with severe Generalised Anxiety Disorder (GAD), who are helped by long term benzodiazepine use, who do not escalate the dose, and for whom no other treatments prove as effective.’

[Vanilla Sky]

Hi and welcome to NMP :)

[BenSW]

Thanks to all for your replies and welcomes.

I am mightily confused about the risk / benefit balance with benzos and it appears the medical community (to some extent) feels the same way. Really difficult to know what to do as I have been offered long-term benzo prescription by one doctor ("When all else fails, it is an evil but the lesser evil") whilst told to avoid at all costs by another.


Thanks again though for responses.

Ben