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 doses are missed, and generally interpret the withdrawal symptoms as manifestations of their own anxiety disorder. The progression from taking alprazolam or clonazepam ‘as needed’ to taking them regularly is as predictable as any other biological process. And after physical tolerance has developed, symptoms that were once considered manageable become part of an unmanageable ‘anxiety disorder.’
I have learned over the years that the term ‘anxiety’ means different things to different people. The complaint shouldn’t cause doctors to automatically reach for the prescription pad. When asked to describe his ‘anxiety’ in detail, a patient said ‘I will pace around the house, looking for something to do. I will turn on the TV and change channels, but there is nothing interesting. I feel…. restless and bored. I need to get out of the house, but there is nothing for me to get outside to do. I’m like a caged animal. You know— anxiety!’
I responded, ‘you mean you were bored?’
‘No’, he said. ‘Boredom is when there is something to do that isn’t interesting. This is just having nothing at all to do. It makes me uncomfortable.’
There are other types of anxiety, of course. But this particular patient, after leaving my office empty-handed, received valium, 10 mg, three times per day from his general practice doc. And I see the same thing happen over and over again.
Even the patients with ‘real’ anxiety, i.e. fear –based dysphoria, are no better off on benzodiazepines than the bored person in the example above. Benzodiazepines cause amnesia, a function that is useful in the operating room. But amnesia and other cognitive impairments from benzodiazepines prevent people from learning to deal with the source of their fears. The mental slowing from benzodiazepines also prevents people from learning to tolerate normal fears that we all face in life. Whatever symptoms of anxiety were present before taking a benzodiazepine will be worse as the drug wears off, as a predictable rebound effect of the medication. I’ve described other negative effects of benzodiazepines on development, mood, self-image and self-confidence.
In case those issues are not enough, a recent study from the British medical Journal found another problem with taking benzodiazepines; early death. The precise impact of medications like benzodiazepines on morbidity or mortality is difficult to determine for a number of reasons. A typical study compares people taking the medications to a control of people who did not use the medications, and statistical measures are used to remove confounding variables. In other words, statistics are used to subtract the impact of health risks that are more likely in people who take benzodiazepines, but that are not directly related to the medications. If people taking benzodiazepines are more likely to have psychiatric disorders, then the study population should be compared to people who have the same incidence of psychiatric disorders. Many factors were taken into consideration for the recent study, including socioeconomic factors, smoking, and age, as well as sleep and anxiety disorders.
The study showed that people taking benzodiazepines have about twice the risk of death as people who do not take benzodiazepines. If you have a 1% risk of dying in the next five years and you do not take benzodiazepines, your risk of death would be 2% if you did take benzodiazepines. Studies with this type of design and outcome always generate big headlines, because having TWICE THE RISK OF DEATH is big news. But on the other hand, two times a small number is still a small number.
Each individual on benzodiazepines, and his/her physician, should take an open-minded look at the role of that class of medications in the person’s treatment. Stopping benzodiazepines is physically and psychologically challenging, and can cause seizures and death if done too abruptly, so NO person reading this post should try an at-home, cold-turkey detox. Even slowly tapering off benzodiazepines, under a physician’s care, is usually an arduous process with a number of sleepless nights and irritable days. The reward, according to patients I have helped off benzodiazepines over the years, can include greater mental clarity, less anxiety, and less fatigue. But for many people, the odds of successfully stopping benzodiazepines are so low that efforts should instead be focused on preventing dose escalation over time.
Those most likely to benefit from warnings about benzodiazepines are the young people who haven’t yet started them. Too many doctors are willing to reward the anxiety faced by teenagers with Xanax, three times per day. Many doctors mistakenly think that SSRI’s are drugs for depression and benzodiazepines are the proper treatment for anxiety. If the normal fears of adolescence demand treatment, an SSRI is the treatment of choice. Teens taking benzodiazepines attribute their successes to alprazolam, and miss out on the growth in confidence that occurs when anxious situations are learned to be tolerated. The natural result includes less confidence for social situations, increased tendency to focus on anxiety and somatic symptoms, and a deeply-engrained belief that ‘discomfort’ calls for a pill to make things feel better—a belief that is much easier to establish than to remove.