Archives for Anxiety

Is Xanax or Klonopin Killing You?

I’ve written about the dangers of Xanax (alprazolam), Klonopin (clonazepam), and other drugs in a class of drugs called ‘benzodiazepines’.  The drugs are grossly over-used by patients, and over-prescribed by psychiatrists, usually for patient complaints of anxiety.

My primary concern over use of benzodiazepines is that when used to treat anxiety, they are more likely to aggravate than improve a patient’s symptoms, especially if taken regularly.  Patients develop physical and psychological dependence to benzodiazepines very quickly.  Once physically tolerant, patients experience withdrawal symptoms if...
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The End of Times: Aren’t We Special?!

Several of my patients have warned me about the world ending in a few days, on December 21, 2012.  There are variations on the theme, but the basic idea is that the Mayans, who were accomplished mathematicians and astronomers, used an advanced calendar to measure planetary cycles… and that calendar ends at the end of this week.   Some patients tell me that the end of the Mayan calendar coincides...
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A Tool, Not a Cure

Please review my prior post, as my comments will refer to an email in that post.

There are many directions that we could take as we review that message.  My overall impression, as I read the letter, was of a person struggling to accept the reality of his condition.  Over and over, the person repeated the same behavior, starting Suboxone, stopping, and thinking this time will be different.

One thing I’ve learned as a psychiatrist, more than anything, is that change is difficult, and rare.  The writer ends with the thought that maybe this time will REALLY be different.  I have no idea if it will be, and for his sake, I hope it is… but unfortunately, the odds are that history will repeat itself.
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A Typical History

I received the following email last week.  I considered trimming it down, but the story is well-written and describes a history that is similar to that of many of my patients.  As usual, I will write a follow-up post in a week or so.

Dear Dr. J,

I have read many of your posts over the past few years. Like many, I started out disagreeing with your comments and insight, while blaming my inability to manage my addiction on the Suboxone treatment. My active addiction to opiate pain medications was brief, about 4 months of hydrocodone/oxycodone use in the end of 2007. In early, 2008), I reached out to my primary care physician who directed me to an inpatient stabilization followed by Suboxone maintenance/addiction therapy.

When I entered treatment I maintained the belief that I was not an addict, and my doctor initially supported this attitude. He described my situation as physical dependence stemming from treatment of pain. I was a recent college graduate, I had a wonderful upbringing, a bright future…I believed that “people like me don’t become drug addicts.” So of course I wanted to minimize the seriousness of my illness.

I convinced myself that this physical dependence “happened to me,” and I was doing what needed to be done to resolve the issue. So I saw my doctor monthly and went to weekly addiction therapy sessions. I did not use “street drugs,” or any other RX meds, so my UAs were always clear, and eventually I was seeing the doctor for a refill every few months.
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How Should Addicts Treat Anxiety?

In a response to an earlier post, a woman wrote that her son, an opioid addict, developed a new addiction to alprazolam—a medication prescribed by his physician to treat opioid withdrawal while starting buprenorphine. I’ll soon write about the use of buprenorphine for opioid dependence, but for now I will note that the opioid withdrawal that occurs when starting buprenorphine is short-lived, and does not generally warrant treatment with an addictive substance like alprazolam.

I did not, of course, witness her son’s anxiety, and I know nothing about the details of the case. But her remarks reflect a common phenomenon that deserves examination.
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