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