Originally Posted by
Darkdays
The thing is I'm really frightened of becoming too reliant on them and getting addicted.
The bad news is that you're already addicted to benzodiazepines (BZDs). You have been all your life, possible from even before you were born. BZD receptors in the brain require BZDs to activate them. There are no known processes within the brain capable of producing them, and while there has been much speculation about how they might be synthesized in the body - gut flora was thought to be the most likely source - no internal mechanism has been found despite much research. So it is now generally accepted that we derive all the BZDs we need exogenously, i.e. from food.
It has been known since the 1980s that plants make benzodiazepine compounds, and that it is also found in animal flesh and organs [1]. Diazepam (Valium), its metabolites and lorazepam (Ativan) seem particularly prevalent in plants. My guess is that benzodiazepines are a plant poison to which life, including Homo sapiens, have become so adapted to that we can no longer function without them. If we were to eat a BZD free diet we would soon begin to experience continual seizures.
While the quantities we get from food are small, they are not insignificant. Benzodiazepine levels can reach pharmaceutical levels in patients with some liver diseases [2]. Levels may become so high that medical intervention is necessary [3].
That said you may become dependent on pharmaceutical BZDs if you take them regularly for more than a couple of weeks. However, that may not be the biggest issue as there is good evidence [4] they significantly reduce the effectiveness of antidepressants (ADs) by blocking hippocampal neurogenesis which is how ADs produce the therapeutic response (see also: How antidepressant drugs act: A primer on neuroplasticity as the eventual mediator of antidepressant efficacy).
In light of these studies benzodiazepines use should probably be limited to a couple of weeks when first taking ADs just to ease the initial increase in anxiety levels, for a while after AD dose increases for the same reason and thereafter for occasional breakthrough anxiety.
Guess I was taking them every other day on average...sometimes I'd take a whole one just to block out everything and it would make me sleepy. I decided I'd try do without them..well I just couldn't do it..just had to take half tablet as I was in such a state of anxiety...
There are two issues. The most pressing being getting you some relief without overdoing the lorazepam. You could try asking your doctor for something else to use to get some lorazepam washout periods once or twice a week which can reduce the dependency risk. The antihistamine *hydroxyzine has pretty strong anti anxiety properties, not quite as potent as the BZDs, but often potent enough. It is non habit forming. Beta blockers may also help. They have no direct affect on anxiety, but block the adrenaline surge symptoms of the flight-or-fight response and this can often be enough to ease anxiety levels. The problem with both is that apparently UK GPs are kept on a much tighter prescribing leash than is the case elsewhere and as these meds are off-label for anxiety your GP may not be prepared to prescribe them. But you might be able to get mirtazapine at small doses and its sedating affect may help.
*Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic. Just how true this is may be debatable, however, if you have the choice ask for Vistaril.
The second things that needs to be addressed is why the antidepressant isn't giving your better results than seems to be the case. What are you taking, at what dose and how long have you been at that dose?
Read about horror stories of coming off them..Are they ok just to use now and again? Really frightened of becoming dependent. Any advice appreciated.
The problem with BZDs is that there is more to the horror stories than just physical dependence. Psychology is also a major factor, as is relapse of the anxiety disorder. The best evidence for this is that the other main BZD taking patient cohort, epileptics, seem to have far fewer issues discontinuing BZDs than those taking them for anxiety, despite sharing many of the same brain deficits in BZD binding site densities and often being prescribed BZDs at much higher doses.
References:
[1]
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Potato (Solanum tuberosum) juice exerts an anticonvulsant effect in mice through binding to GABA receptors.
Planta Med. 2008 Apr;74(5):491-6. (Abstract)
Kavvadias D, Abou-Mandour AA, Czygan FC, et al (2000)
Identification of benzodiazepines in Artemisia dracunculus and Solanum tuberosum rationalizing their endogenous formation in plant tissue.
Biochem Biophys Res Commun Mar 5;269(1):290-5 (Abstract)
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Naturally occurring benzodiazepines: current status of research and clinical implications.
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Occurrence of "natural" benzodiazepines.
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Presence of lorazepam in the blood plasma of drug free rats.
Life Sci. 43(15):1257-60. (Abstract)
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Increase of natural benzodiazepines in wheat and potato during germination.
Biochem Biophys Res Commun. Dec 30;157(3):1436-43. (Abstract)
Wildmann J, Vetter W, Ranalder UB, et al (1988)
Occurrence of pharmacologically active benzodiazepines in trace amounts in wheat and potato.
Biochem Pharmacol. Oct 1;37(19):3549-59. (Abstract)
Sangameswaran L, Fales HM, Friedrich P, De Blas AL. (1986)
Purification of a benzodiazepine from bovine brain and detection of benzodiazepine-like immunoreactivity in human brain
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[2]
Baraldi M, Avallone R, Corsi L, et al (2000) Endogenous benzodiazepines. Therapie Jan-Feb;55(1):143-6 (Abstract)
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Als-Nielsen B, Gluud LL, Gluud C. (2004)
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Zeneroli ML, Venturini I, Stefanelli S, et al, (1997) Antibacterial activity of rifaximin reduces the levels of benzodiazepine-like compounds in patients with liver cirrhosis. Pharmacol Res , Jun;35(6):557-60 (Abstract) [Note: no benzodiazepine synthesizing gut flora has been isolated and they almost certainly don't exist in humans]
[4]
Boldrini M, 2014; Nochi R, 2013; Sun Y, 2013; Song J, 2012; Wu X, 2009; Stefovska VG, 2008).