August 28, 2017
Benzodiazepines (“benzos”) are one of the most commonly prescribed psychotropic medications in the world. At PCH Treatment Center, we are referred many clients who have been on long-term benzodiazepine therapy for their anxiety. We find this problematic for many reasons.
First, a person taking this drug will develop tolerance and dependence, requiring ever-increasing dosages to maintain the same effects. If they have been maintained on a stable dosage regimen for a prolonged period, benzodiazepines may be doing nothing for their anxiety or actually increasing it. Further, benzos can be the cause of the anxiety being experienced.
Second, these drugs, especially when combined with other medications, can cause over-sedation or respiratory depression resulting in a risk of overdose. These medications also cause disinhibition, which can result in behavioral problems and risk-taking activities. Evidence is accumulating that chronic use of benzodiazepines is associated with depression, cognitive impairment and an increased incidence of developing dementia. The elderly are especially sensitive to benzodiazepines.
Discontinuation of benzodiazepines must be done carefully, as patients can develop severe withdrawal symptoms that can be life-threatening, such as seizures.
In 1955, Hoffmann-La Roche chemist Leo Sternbach identified the first benzodiazepine, chlordiazepoxide (Librium). Throughout the 1960s, benzos like Librium and Valium were used to treat issues ranging from insomnia to seizures. By the 1970s, benzodiazepines were one of the most commonly prescribed medications in the world.
In the present day, the benzodiazepine class, which also includes Ativan, Valium, Xanax, and Klonopin, is frequently prescribed for the treatment of anxiety and anxiety-related conditions. Many physicians will prescribe some variety of a benzodiazepine when presented with a patient who complains of anxiety or sleeping problems.
Initially, it presents as a miracle drug – anxiety is relieved and sleep quickly improves. However, these effects only last a few weeks or months for the majority of people that take them. Recent studies evaluating the effectivity of Xanax for anxiety have shown that after just 8 weeks, those that were on a Xanax prescription had worse anxiety than those who took a placebo.
Despite these results, doctors continue to prescribe these benzos for anxiety disorders at an alarming rate. In 2008, Olfson and colleagues reported that over 5% of adults in the U.S. had filled at least one prescription for benzodiazepines in that year. This overprescribing has led to sensationalistic headlines such as “Xanax Nation” in the press.
Anxiety disorders commonly present with Benzo use present in numerous ways, either in the form of generalized anxiety, anxiety related to specific issues (phobias), discrete panic attacks, or severe anxiety disorders, sometimes resulting in a person’s inability to leave their own home. Obsessive Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) are also considered anxiety disorders. Psychological trauma, whether experienced in childhood or later, also frequently manifests itself through the anxiety issues that often accompany benzodiazepine use.
While everyone can experience moderate amounts of anxiety, a clinical diagnosis of an anxiety disorder can be debilitating and affect an individual for their entire life. It is important to realize that anxiety-related problems are not solved or cured by a medication like a benzodiazepine. As an alternative to benzodiazepines there are specific talk and experiential therapies that target anxiety, and help people regain control of their life and improve their well-being.
At PCH Treatment Center, we have a highly experienced clinical team that specializes in the treatment of anxiety disorders. When a client is admitted, they are assessed and followed by one of our psychiatrists. When we find that our client is on a benzodiazepine, in the majority of cases we recommend that they discontinue the drug. We carefully explain to them the reasons that we want them to taper off the medication under medical supervision and that there are alternatives to benzodiazepine for their anxiety available. We find that this class of medication is counterproductive to our treatment goals and to the health and well-being of our clients.
We then develop a clinical plan for each client to ensure they are receiving the most effective therapies to resolve their anxiety issues. As an alternative to prescribing benzodiazepines for the treatment of anxiety disorders, we utilize psychotherapeutic techniques, including daily individual relational or cognitive behavioral therapy combined with somatic therapies (Somatic Experiencing, Sensorimotor Therapy, EMDR), Mentalization, Dialectical Behavioral Therapy (DBT), and mindfulness-based stress reduction.
We also integrate neurofeedback and holistic activities that have been shown to be effective in the treatment of anxiety disorders, including trauma-informed yoga, arts programs (such as pottery, knitting, music, and painting), and meditative practices.
Our psychiatrists may consider medications other than benzodiazepines to supplement our clinical program, but our general policy is to minimize medication usage and avoid addictive substances altogether. By teaching our clients the skills they need to control their anxiety, they are able to obtain long-term benefits that are missing from addictive benzo medication regimens.
Our goal is to ensure that each of our clients is able to leave PCH feeling confident and able to lead a happy, productive and enjoyable life, free from anxiety and benzodiazepines.