a case for benzo's

[carlos678]

ok i know many of you have had bad experiences with benzo's, and i know the addiction factor is very real. I have been on diazepam for 2+ years so i don't have as much experience as some of you, but at present the following applies to me (and apparently many others). I'm not trying to prove anything, i would just like to discuss the following issues; addiction vs dependence, dose escalation, tolerance and whether benzo's are appropriate for certain conditions/individuals.



A case for Benzodiazepines in the treatment of anxiety

Type the word ‘benzodiazepine’ into Google and these are some of the results you can expect to find ‘addiction, tolerance, dose escalation, dependence, abuse, destruction of lives, horrible withdrawals’ and the list goes on. Ask someone for advice (including doctors) regarding BDZ’s and the reply will be something along the lines of, “well they work at first but you will need more and more to get the same effects, after that you will become addicted. Then you will experience tolerance withdrawals and have to further increase the dose. Eventually you will reach the maximum allowed dose and will be forced to taper. This is when all hell breaks loose…” Sound familiar?
In contrast, conduct a thorough enough search and you will find a few individuals who claim the opposite; no dose escalation, continued efficacy, no tolerance withdrawal and while the withdrawals were harsh they were not intolerable. Considering everyone’s brain chemistry slightly differs, these were just a lucky minority, right?
According to academic literature (peer reviewed journals, books ect) no, they are the majority.

http://fampra.oxfordjournals.org/cgi.../full/20/3/347

Roy-Byrne P, Russo J, Dugdale DC et al. Undertreatment of panic disorder in primary care: role of patient and physician characteristics. J Am Board Fam Pract 2002; 15: 443–450.

This chapter examines prescribing, short and long-term use, and dependence, and concludes that "general concerns about the over-prescribing and misuse of medications often do not hold up when they are translated into specific research questions and confronted by relevant data".

The authors conclude that panic disorder is undertreated in primary care, even in this ‘best case’ scenario.

The Task Force Report, although over 10 years old, is still a standard reference for benzodiazepine use. Its points—that there is undue reluctance to use minor tranquillizers, and that many people are undertreated—still hold, and are borne out by the Roy-Byrne study

http://psychservices.psychiatryonlin...ract/54/7/1006

Lack of Relationship Between Long-Term Use of Benzodiazepines and Escalation to High Dosages (2003)

No clinically or statistically significant changes in dosage were observed over time. The incidence of escalation to a high dosage was 1.6 percent.
CONCLUSION: The results of this study did not support the hypothesis that long-term use of benzodiazepines frequently results in notable dose escalation.

http://www.springerlink.com/content/p574g416600n1205/

Addiction to Benzodiazepines 2004

Abstract- Benzodiazepines are sedative hypnotic medications that can induce a state of dependence. Dependence however is not the same as addiction. The development of dependence is a predictable phenomenon, influenced by dose, duration of treatment, and a number of other factors including individual characteristics of the benzodiazepine user. It is unclear whether there are meaningful differences among benzodiazepines in producing a state of dependence. Benzodiazepine dependence is also characterized by a predictable discontinuation syndrome. Benzodiazepines are rarely abused by non-substance abusers. The regulation of benzodiazepines although the legitimate therapeutic use has been significantly reduced.

http://www.psychopharmacology.com/pt/re/jclnpsychopharm/abstract.00004714-199912002-00002.htm;jsessionid=J5LBmh2vHXXyNh2yrZpNkCFYTHsFC dpp3VgyMJ0hGkjrRPg47v03!-2049359858!181195628!8091!-1

Effectiveness and Safety of Benzodiazepines. (1999)

There is a need for a more balanced assessment of the benefits and risks associated with benzodiazepine use to ensure that patients who would truly benefit from these agents are not denied appropriate treatment.

http://cat.inist.fr/?aModele=afficheN&cpsidt=16613669

Benzodiazepine use, abuse, and dependence 2005

Although benzodiazepines are invaluable in the treatment of anxiety disorders, they have some potential for abuse and may cause dependence or addiction. It is important to distinguish between addiction to and normal physical dependence on benzodiazepines.
Few cases of addiction arise from legitimate use of benzodiazepines.
Due to the chronic nature of anxiety, long-term low-dose benzodiazepine treatment may be necessary for some patients; this continuation of treatment should not be considered abuse or addiction.

http://books.google.co.uk/books?id=Y...sult#PPA138,M1

Molecular Neuropharmacology 2008


Unfortunately I can’t C&P from a book preview. The main point I wanted to take from this is that according to this author although tolerance to the sedative and anticonvulsant effects of BDZ’s occurs, tolerance to the anxiolytic effects may not.

http://books.google.co.uk/books?id=L...m=10&ct=result

Anxiety and its disorders: the nature and treatment of anxiety and panic 2004

Again another book; states the same things- few studies have shown tolerance to the anxiolytic effects and several studies show no evidence of abuse or dose escalation.

http://209.85.229.132/search?q=cache...nk&cd=20&gl=uk

This is a letter written to the messenger by someone or other. It’s very well written and includes references (that all check out). It addresses all of the above points.


So what should we believe? Why is there so much controversy? I have no doubt that those individuals posting about negative experiences are truthful, the stories on benzo.org almost had me in tears, but when you examine many of these stories a large proportion of these people didn’t need BDZ’s in the first place (work stress, depression ect) and were not informed of the risks (dependency, withdrawals). While I don’t blame doctors for over prescribing BDZ’s (probably following guidelines, didn’t know the risks) they have undoubtedly influenced today’s restrictions and further added to the ‘benzo-phobia’ you see posted across the web. BDZ’s have also been demonized due to their abuse potential with certain individuals using them for recreational purposes; unfortunately this has created further bias in the media.
This is not to say that BDZ’s (when prescribed legitimately) should be taken lightly, they are certainly not without their risks. I just believe they have been unfairly stigmatized, and for certain individuals with severe/chronic anxiety they can be extremely useful, even life saving medication. Obviously all other alternative methods (counselling, CBT, SSRI’s ect) should be applied before considering BDZ treatment.

I admit that this post is very pro-benzo and I know there are studies that conclude the opposite to the ones above, but from my research they are few and far between. I invite anyone to challenge this statement, in fact I hope someone will as I would be interested in reading the studies (although please try to exclude studies involving animals or studies conducted by Heather Ashton). I have nothing against Dr Ashton I just think her work is too subjective. (please ignore the irony, i know what i have written is slightyyy subjective as well)

Regards Carl

[CJH86]

oooooo thanks for posting the links, this is an interesting topic for me as im studying pharmacy and hence do a lot of pharmacology and whatnot....i'll have a little read when i got time!

Im not going to challenge the statement though. Im pro-benzo (for me personally)....ive taken them on and off for several years, i take them when needed, im not addicted, my dose hasnt gone up and they help me lead an almost normal life. Long term treatment with a myriad of antidepressants and 'talking' therepy hasnt helped me. I do get constant stick from people about taking them......but i dont see any reason that i should be denied something that improves my quality of life so much.

The fact is doctors follow set guidelines instead of individualising treatment for a patient....i feel that there is some people who could benefit from benzos and others who should never be given them in a million years x

[carlos678]

oooooo thanks for posting the links, this is an interesting topic for me as im studying pharmacy and hence do a lot of pharmacology and whatnot....i'll have a little read when i got time!

Im not going to challenge the statement though. Im pro-benzo (for me personally)....ive taken them on and off for several years, i take them when needed, im not addicted, my dose hasnt gone up and they help me lead an almost normal life. Long term treatment with a myriad of antidepressants and 'talking' therepy hasnt helped me. I do get constant stick from people about taking them......but i dont see any reason that i should be denied something that improves my quality of life so much.

The fact is doctors follow set guidelines instead of individualising treatment for a patient....i feel that there is some people who could benefit from benzos and others who should never be given them in a million years x

your welcome i have a load more studies bookmarked, but i thought the post was long enough as it is. PM me if your interested and i'll send you the links.

My situation is very similar, i exhausted all other methods and my condition didn't improve, infact it got progressively worse. Eventually i managed to persuade my doctor to prescribe me Diazepam and it has given me my life back. I know i am dependent and one day i will have to face withdrawal; but it was either take a BZD or spend the rest of my life in my room having panic attacks. I made an informed decision and i think (i hope) it was for the best.

Take care

Carl

[tom1]

All I know is, when I took diazepam for my anxiety that one time it knocked it on the head. It's a shame they can only be used for short periods, and that they become addictive, otherwise they would be a miracle pill for me. I'm actually quite thankful I said no a few times to using diazepam again. I guess I just couldn't trust myself to not get addicted and rely on them.

[carlos678]

All I know is, when I took diazepam for my anxiety that one time it knocked it on the head. It's a shame they can only be used for short periods, and that they become addictive, otherwise they would be a miracle pill for me. I'm actually quite thankful I said no a few times to using diazepam again. I guess I just couldn't trust myself to not get addicted and rely on them.

Hi Tom,

I don't know if your confusing addiction with dependence because BZD's are not necessarily addictive. They certainly have the potential to be addictive but the majority of people using them for therapeutic reasons do not become addicted.
But i understand your concern as there is the possibility that you would become addicted, and after long term use you would almost definately be reliant/dependant on them. Hopefully your anxiety is not of a chronic nature and can be treated by alternative methods; CBT has a much higher success rate at actually 'curing' anxiety than BZD's which just tend to mask the problem. If you haven't tried it already i would definitely recommend it.

All the best

Carl

[tom1]

Unfortunately I have already tried CBT and I was in therapy doing it over several years with a therapist. It has its strengths and weaknesses but it definitely hasn't overcome my anxiety. It might've made me more aware of my thoughts and the way I'm thinking but I don't find the methods that useful in stopping severe anxiety.

My anxiety has been with me pretty much all my life so far. I'm currently on anti-depressants which do help, but diazepam was very good when I was on it for a short while. I know you say they are usually very helpful for most people - which I totally agree with. However, to obtain these medications for any substantial period requires a very considerate GP and or access to a psychiatrist willing to do this. I think most people in experience, can say that not many GP's are willing to prescribe them nevermind for any substantial period (which I can understand when you consider some of the risks of potential abuse). Finally, psychiatrists are hard to see, unless of course you have £££ to show for it.

So I say you are in a very unique position to be in.

[CJH86]

An interesting point is i think addiction potential is variable for different benzodiazepines.

Personally i found temazepam very addictive after only taking it for a few months (i have serious sleep issues) i think this is because it has a shorter half life i.e. it remains in the body for shorter time..........so 50% of the drug is gone in abround 10 hours, in contrast with diazepam which takes up to 100 hours to remove half of the drug from the body so i can sleep well for a few days on just one dose. I think as im aware of this i dont take diazepam as regularly as maybe i would if i wasnt aware of this.

I mean BDZ's are not as bad as some drugs in terms of addiciton potential. Take crack cocaine for example where you can becomoe addicted within a manner of days, or strong opiates that can lead to addiction within a couple of weeks of daily use.

I see several general practice doctors at a couple of surgeries and they seem to prescribe them quite readily for me since i was quite young (about 17), i now cant take any type of antidepressants (ive had some very obscure reactions and i do try and persevere as i have faith in these things). I really envy people who can be stabilised on an SSRI as i feel ive no real options left in terms of long term therepy at age 22

[carlos678]

Unfortunately I have already tried CBT and I was in therapy doing it over several years with a therapist. It has its strengths and weaknesses but it definitely hasn't overcome my anxiety. It might've made me more aware of my thoughts and the way I'm thinking but I don't find the methods that useful in stopping severe anxiety.

My anxiety has been with me pretty much all my life so far. I'm currently on anti-depressants which do help, but diazepam was very good when I was on it for a short while. I know you say they are usually very helpful for most people - which I totally agree with. However, to obtain these medications for any substantial period requires a very considerate GP and or access to a psychiatrist willing to do this. I think most people in experience, can say that not many GP's are willing to prescribe them nevermind for any substantial period (which I can understand when you consider some of the risks of potential abuse). Finally, psychiatrists are hard to see, unless of course you have £££ to show for it.

So I say you are in a very unique position to be in.

I agree GP's are extremely reluctant to prescribe BZD's even to the most deserving individuals.

In 2006 my anxiety became unbearable (agoraphobic, depersonalization, constantly shaking- on the brink of insanity) so I went to my GP and explained my situation. He checked my history and even though I had tried CBT previously he recommended a second attempt. I agreed that CBT may be beneficial but pointed out the obvious fact that I wouldn't be able to attend the appointments because I couldn't leave the house (I even had to be escorted to the doctors by my mother). Eventually he agreed to give me a month’s supply of Diazepam at the lowest dose (2mg). Even at this low dose the results were amazing; I was still unable to leave the house alone, but when in a 'safe environment' my anxiety was 90% reduced- I felt almost normal. I decided to experiment with different doses so I skipped a day or two then took 4-6mgs; as expected I managed to leave the house and actually function. A month past and I received no letters or appointments for CBT so I went back to my GP. I decided not to tell him about my dose increases and instead explained that the prescribed dose had only been marginally effective and that I would require a much larger dose- say 10mgs. After some bartering he settled on 6mg's which was exactly what I had in mind. During the second month a received a letter for CBT but decided to ignore it, as I was well aware that one more repeat prescription would equal 12 weeks of BZD therapy and if they tried to discontinue I could play the dependency/withdrawal card. Fortunately after witnessing how much I had improved he decided to continue the therapy.
That was almost 3 years ago, but still to this day I have not been granted a repeat prescription and every so often when my GP is absent I have to deal with another 'well meaning' GP who thinks its time to stop. At first I would debate the same issues were discussing and the fact that I would have to leave work and put my life on stand-by, but they just won't budge. Finally I reached the end of my tether and simply told them if they won't prescribe and monitor me, I will obtain them by other means and self medicate (then hint how unethical that would be).

Sorry for the life story, I just wanted to highlight that I am not unique and the only way I have been able to obtain a prolonged prescription is through manipulation, mind games and petty threats. I had severe anxiety for almost a decade and no other treatment has been successful. Now I’ve found something that works and they want to take it away- strange…


I've never had access to a psych either (same reasons) but from what I've been told they are much more lenient when it comes to BZD's.

[carlos678]

An interesting point is i think addiction potential is variable for different benzodiazepines.

Personally i found temazepam very addictive after only taking it for a few months (i have serious sleep issues) i think this is because it has a shorter half life i.e. it remains in the body for shorter time..........so 50% of the drug is gone in abround 10 hours, in contrast with diazepam which takes up to 100 hours to remove half of the drug from the body so i can sleep well for a few days on just one dose. I think as im aware of this i dont take diazepam as regularly as maybe i would if i wasnt aware of this.

I mean BDZ's are not as bad as some drugs in terms of addiciton potential. Take crack cocaine for example where you can becomoe addicted within a manner of days, or strong opiates that can lead to addiction within a couple of weeks of daily use.

I see several general practice doctors at a couple of surgeries and they seem to prescribe them quite readily for me since i was quite young (about 17), i now cant take any type of antidepressants (ive had some very obscure reactions and i do try and persevere as i have faith in these things). I really envy people who can be stabilised on an SSRI as i feel ive no real options left in terms of long term therepy at age 22

I remember reading somewhere that certain BZD's bind more tightly to the gaba receptors than others. Correct me if I'm wrong but I think xanax isn't used in the UK for this reason. I think this is generally associated with the shorter acting BZD's as you say.

So do I, I was on the med-go-round for 9 years and had every side effect you can think- extreme weight gain to complete loss of appetite.

Apparently there are new anxiety drugs currently under going medical trials/testing which have shown similar efficacy to BZD's but without the risks. So theres still hope

I'll post the studies when i get time.

[tom1]

Yes, a newer anti-anxiety one is called buspar. I've used this a for a couple of months before and to be fair it felt like I was using a placebo. A lot of people do say the same thing, so it's probably extremely mild if is supposed to do something.

Xanax your right is not available under prescription from what I've heard. However I'm told privately this can be obtained through Bupa.

When I had diazepam it was because I wasn;t sleeping properly and so my doctor gave me a 2 weeks supply. When I discovered what is was, I found out that it could be taken during the day too. So I tried that, to see if it would stop my panic attacks and it did. I was out of a job during those 2 weeks, but while I was on diazepam I went for a couple of interviews and got offered the job on all of them. Which is something that has never happened before, because my nerves always get the better of me. Everyone even said to me, I seem so much more confident and less overly stressed. The positive effects were quite remarkable.

I've never asked for it again because I just can't risk going through dependence. I can't trust myself to use it for the time given and not wanting to go back to it. I feared that if I got another 2 weeks I would have almost definitely not wanted to come off.