Stop prescribing benzodiazepines for anxiety

As a physician in a rural health clinic, I frequently see patients who complain of anxiety. The majority of these patients are in their 20s to 40s. Some have never been evaluated by a mental health professional, and many of these patients take benzodiazepines on a chronic basis. After current review, I wonder if we as primary care physicians are good at treating anxiety, or are we contributing to drug dependency?

Benzodiazepine dependency is a growing health concern. According to the Drug Abuse Warning Network (DAWN), visits to the emergency department involving benzodiazepines increased 141% between 2004 and 2010. Benzodiazepines were involved in 28.4% of emergency department visits involving pharmaceutical related suicide attempts during that time. The arrest reports in my local newspaper attest to the problem of the illicit sell of benzodiazepine in my area.

Most current guidelines recommend SSRIs and SNRIs as first line treatment for generalized anxiety disorder. Buspar and Lyrica have been shown to be effective adjuncts if needed.  A number of randomized clinical trials support the use of benzodiazepines, but for short term use only (up to 6 weeks).  Importantly, benzodiazepines are ineffective in treating depression, which often exists as a comorbid condition.  Cognitive behavioral therapy is also often helpful in treating anxiety.

We all know the physical dependency that benzodiazepines cause. The abuse of this drug is also well known. Most of us are familiar with current guidelines concerning their use. Why then, is the problem of benzodiazepine abuse getting worse?

One reason is that patients are often insistent on being prescribed benzodiazepines as first-line therapy for treatment. Patients already on taking them are reluctant to try a new medication due to the strong physical dependency that benzodiazepines cause.  I have had patients become angry when I tried to discuss weaning their benzodiazepines and trying other medications. Patients have also become accustomed to expect benzodiazepines.  They have family members taking the medication for anxiety and expect to have it prescribed to them also.

Changing our prescribing practices to conform to current guidelines and trying to use SSRIs and SNRIs as first line medications for anxiety disorders will be challenging for many of us.  The challenge will be due somewhat to prescribing habit, but mostly to patient insistence of their preferred medications.  We should discuss with our patients the risk of dependency to these drugs, and that alternative therapy is available. While we are not mental health experts, we can provide self-help literature and relaxation techniques.

The effort to confirm to current guidelines will eventually pay off in fewer patients being dependent on benzodiazepines, and eventually, in less pressure from our patients for these drugs as their expectations change.

Tara Reynolds is a physician. 

Comments are moderated before they are published. Please read the comment policy.

  • Racaille

    Sorry, but SSRIs are no better than placebos and often lead to incredible weight gain.

    They are completely ineffective for all but the most severe cases of depression. And even in those cases tricyclics actually perform better.

    • http://barefootmeds.wordpress.com/ Barefootmeds

      References, please?
      I have not done statistical analysis but I my patients respond overwhelmingly well to SSRIs. The newer ones, like citalopram, don’t cause so much weight gain either.

      • querywoman

        I like citaloprom! I posted elsewhere on this that it helps my “dropsy.” I’ve dropped so much stuff in the past 24 hours, but I’d be a bigger catastrophe without it. Plus, it’s a $4 generic.

  • http://barefootmeds.wordpress.com/ Barefootmeds

    I’m seeing this problem a lot too. I think a big problem is when doctors prescribe a month’s worth of tablets rather than, say, 10, to be used in emergencies. At least, that’s what we’re seeing in South Africa.

    • Daniel

      If we were talking about the emergency department, then sure, give a week supply and advise the patient to see their primary-care physician. (Please don’t send the patient home without meds if they’ve been diagnosed with something like major depressive disorder unless you want to kick start a disaster and waste a lot of medical resources… agh…) However, if you are the primary-care physician, unless you plan to see the patient again in a week, it makes no sense to prescribe only a few tablets. Treating anxiety cannot be done in a few days. The tablets need to be taken 1 – 2x per day, everyday, for as long as the treatment regimen is expected to last.

      The problem is when patients play around with their doses and become tolerant to the medications effects.. when they divert the medicines to others… when they illicitly obtain medicines from others… When they start exhibiting the types of behaviors that result from and lead to addiction.

      By giving only a small supply of meds, physicians can also become part of the problem by exposing patients to benzodiazepines in the first place, and by creating a situation in which patients may seek alternative supplies. Another aspect of the problem are physicians who prescribe medications with too many refills. Physicians need to become familiar with patients’ ability to adhere with treatment before giving them a larger supply than they can handle.

      When beginning a new treatment regimen, it’s appropriate to schedule follow-up visits to monitor patients’ progress and make appropriate dose adjustments. Perhaps some physicians, because of their schedules, wait too long before follow-up. Meanwhile, patients are taking doses that may be too high or too low (both can lead to bad outcomes).

      One approach is to wean off the benzo over several weeks after the patient has started on an SSRI. (If they’re already on a benzo. Otherwise, especially with how quickly some of the newer SSRIs begin working, maybe skip the benzo.) Go slow. Pay attention to drug half-lives. (A patient told me about a bad experience with a drug that a physician had tried weaning them off of by prescribing doses that were taken over 5 half-lives apart. Another patient had a physician prescribe a medication that was in the right class, but had a half life that was way too long, for the condition that was being treated. Don’t make those types of mistakes.)

      And don’t forget patient education. Even if your patient is another physician or healthcare worker, it doesn’t hurt to remind them. Being a patient changes your perspective, and it’s easy to forget things you should already know.

      Even though, I find it bothersome/annoying when primary-care physicians refer simple-simple cases to specialists when they should be able to handle it themselves… If a physician is not comfortable dealing with patients taking benzos (or any controlled substance, or any other medicine), they should perhaps not be prescribing them. Send the patient elsewhere so they can receive the appropriate care.

      • keifernny

        The evidence-based appropriate care for anxiety includes as first-line treatment Psychotherapy, and it often happens that providers do not make the referral to psychotherapy providers.

        In addition, while benzodiazepines have proven effective in short term studies, there is little evidence for long-term efficacy (but, as we know, there is physiologic dependence, of which the first withdrawal symptom noted by the patient is ANXIETY), which often leads to a “cat-chasing its tail” phenomenon with dosage escalation, worsening the dependence problem without reducing the patient’s documented anxiety levels.

        • M.K.C.

          Let me guess, you’re a psychotherapist?

        • Guest

          Anti-depressants have pretty nasty withdrawal symptoms as well.

        • Daniel

          Psychotherapy and medications often go hand-in-hand. But the way things are going, psychiatrists are doing less psychotherapy and more medication management. And how many primary-care doctors do psychotherapy?

        • Minh Nguyen

          When you threaten to take away a medication that the patient knows WORKS, and replace it with something he or she has no first-hand knowledge of, and for which there is no solid evidence of efficacy, of course they’re going to be anxious.

          Threaten to take away a diabetic’s insulin and have them do yoga and mediation instead, and they too will experience anxiety as a “withdrawal symptom”.

          • querywoman

            I hated doctors giving me the hard sell on BP meds. When my blood sugar started rising, I got really jumpy and anxious. Now I take 3 BP meds without arguing, but I’d really rather not.
            If a patient stops a BP med, and his or her BP goes up, isn’t that a withdrawal symptom?

  • usvietnamvet

    Could it be that many patients get angry about weaning because of their lack of knowledge about the differences between addiction and dependance? That they believe you are calling them an addict when you mention weaning?

    I only say this because of the public lack of knowledge about the difference between addiction and dependance.

    There are even health professionals that don’t understand the difference. As a drug education specialist, a counselor and a chronic pain patient I have spent a lot of time educating people about the differences.

    But many doctors don’t understand that some medications should be used short term rather then long term (ie pain medications such as percocet should be used for no more then 10-15 days yet I know many patients who have been on a 3x day dosage for years).

    • Guest

      Doctors want to take away the ONE thing that works for a patient, and replace it with … nothing. Nothing that actually works, that is.

      Let’s start demanding that we stop prescribing insulin for diabetics, or anti-seizure drugs for epileptics. Everyone should just SUCK IT UP, right?!

      • Daniel

        Perhaps physicians’ desire to take patients off of medications is based on a misunderstanding of the difference between addiction and dependence. Suppose a patient is taking benzodiazepines. If their problem is managed, they take their medicines as prescribed, they don’t divert pills, and they have no adverse effects; what’s wrong with that? Why not leave their medication regimen alone?

        • Guest

          Because alot of doctors are control freak sadists who hate to see patients’ pain controlled effectively with opioid analgesics, or their anxiety controlled effectively with benzodiazepines.

          You are right, addiction is a psychological issue while dependence is a physical one, and it’s paternalistic and demeaning to treat every single patient as an incipient addict when most responsible people in fact will NOT magically turn into an addict if offered effective pain or anxiety relief and if they take their medication as directed, any more than they will turn into an alcoholic the first time they take a sip of beer.

          As for physical dependence, that can be medically managed. And withdrawal? Try going off most of these newer antidepressants cold turkey and tell me that benzodiazepines and opioids are the only drugs out there that you need to taper down on if you want to stop taking them.

          My 66 year old father, healthy as a horse his whole life, started getting panic attacks whenever he had to leave the house, they started right after my mother died. They wouldn’t give him Xanax for the 3 or 4 occasions a week he might need it, instead they put him on antidepressants which bathed his whole brain in a chemical soup 24-7 and gave him a lot of problems and didn’t stop his panic attacks anyway. My brother who’s a scientist took him back to the doctor and the doctor just wanted to try another antidepressant, he said that the only way Dad would get any kind of tranquilizer is if he had a panic attack bad enough to end him up in the ER.

          And then they wonder why people start self-medicating with alcohol or illicit drugs?!

          • querywoman

            Hah! Xanax has to build up in the system after a day or so to work! Valium is better as as needed trank!
            The faith the American medical profession has in antidepressants is incredible! I don’t believe certain tales about Prozac, like that it turned a stay-at-home woman into a woman with several dates every weekend.
            They could have given your dad Geodon or Seroquel, STRONG antipsychotics that supposedly treat anxiety. You are lucky if they didn’t!

          • Minh Nguyen

            Geodon was another one Pfizer was charged with fraudulently promoting for conditions it wasn’t approved for.
            ——————————
            11. Pfizer: Bextra, Geodon, Lyrica; September 2009

            In what was the largest pharmaceutical settlements in U.S. history at the time, Pfizer reached a $2.3 billion settlement with the Department of Justice to resolve criminal charges and civil claims under the False Claims Act.

            The pharmaceutical giant was accused of off-label promotion of the anti-inflammatory drug Bextra; Geodon, an anti-psychotic drug; Zyvox, an antibiotic; and Lyrica, an anti-epileptic drug. The drugs were allegedly promoted for uses not approved by the FDA.

            ————————————–

            sources: “Pfizer Pays $2.3 Billion to Settle Marketing Case” (The New York Times); and “Justice Department Announces Largest Health Care Fraud Settlement in Its History” (on the Justice Department’s website).

          • querywoman

            Whoopee she–it! Seroquel and Geodon are strong @ss drugs! Why should they be better than a simple valium?
            Google the top 10 best selling American drugs – Seroquel is among them, when schizophrenia affects less than one percent of the population.
            I take occasional doxepin, a non-narcotic drug, for itching and it really knocks me out!

          • Suzi Q 38

            I used to sell Doxepin, that is how old I am, LOL.
            THAT drug will knock you out. Try taking it no later than 7:00 or 8:00 PM, and start it on a Friday night, if you are off on Saturday and Sunday.

            Beware, though, that this class of drugs may cause weight gain in certain people.

            This is not longer promoted because it is generic. This means it is cheap. Pfizer would no longer have an interest in it. Imagine, a drug being good one day, and then when it becomes generic, the company just stops promoting it and moves on to another….

            I was told to sell, promoting various indications that were not approved routinely. It was the way things were done for decades…long before me, and long after me. Pfizer was not the only drug company that did this, either.

            I am sad to say that there was little accountability back then, either.

            Things have changed. I have read about former colleagues that have been indicted. while I feel bad for them, it “comes with the territory,” unfortunately. You simply cannot do what people ask you to do if it is illegal to do so.
            Plain and simple.

            At the time, we did not view this as illegal. We viewed it as “advanced marketing.” Giving the medical community “the edge” with new information (indications) before the actual indication came out.

            Pretty dangerous assumptions……

          • querywoman

            I had my derm cut my doxepin dose from 25mg to 10mg a few years ago. I could take up to five at night if I really needed it to stop the itching and help me sleep.
            Normally I might take just one or two doxepin in a seven day period. Yeah, one small doxepin can make me sleepy the 2nd nite after I take it.

            I read that it is being used to help heroin addicts in Germany sleep.
            There is a new dose of doxepin, even less than 10mg, being sold in the US under a new name as a sleep med, but it’s expensive! Of course!
            I have a brother, who doesn’t speak to me, whom I knew was taking Restoril before our mother died to help him sleep. Since he has severe allergies, too, I suggested he try doxepin! He doesn’t want to hear anything from me! I bet it would work great for him too!

          • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

            Anti psychotic drugs cause diabetes also. I would rather take a small dose of xanax……..

          • Suzi Q 38

            I am sad for your father, and the panic attacks are understandable. For me, I just had to work it all out, rather than use drug after drug.

            Everyone is different.

            I had panic attacks for about 30 years.

            It is a long, sad, story how they got started, but mine did not stop until I went into instant menopause after my complete hysterectomy.

            I have never been on medication whatsoever.
            I just would talk myself through them.

            Everyone is different, so getting a really good psychologist is “key.” I had one as a teenager, but I realized later that the only person that could help was me. I got rid of the psychologist.

            Going to yoga, the gym. or walking, or some other physical activity helped too.
            Going to group therapy regarding the death of a may be helpful. Check with the social worker at your local hospital. They may be able to recommend a grieving group at a local church.

            A tranquilizer would just mask the symptoms rather than treat the problem, which may be shock and sadness. He has every right to feel both and more.

          • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

            Yeah well I would not recommend a hysterectomy for anxiety….my panic attacks got 10 times worse when I went into natural menopause (from hormones fluctuation imo). There is nothing wrong with my uterus, wth would I have it removed?????

          • Suzi Q 38

            I wouldn’t either, but it happened to work out that way. An incidental benefit.

          • querywoman

            Are you on metformin? I may have polycystic ovarian disease. Metformin is good for it. I’ve always had a good response to metformin. I no longer menstruate.

    • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

      What do you recommend for Fibro? I sure as hell don’t want to take any OPIOID medication whatsoever but from what I’m reading the alternatives such as Lyrica don’t seem to be much better. I also have hypothyroidism and am being treated for that………..with Armour thyroid.

      • querywoman

        Are you getting your blood sugar checked also? I had pains when my blood sugar ran high. You may need a good endocrinologist. Caution: I went to three dumb, arrogant endocrinologists before I got a good one. I’m currently on my sixth, and he’s marvy.
        How old are you? Endocrine disorders can be complex.

        • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

          My fasting blood sugar is usually between 79 – 82 every time I get a fasting blood test. I am careful not to eat too much sugar or bread/carbs. I am 53 y.o. I also have normal cholesterol. (199). All my problems started when I hit menopause….

      • usvietnamvet

        Why wouldn’t you want to take opioids? They are among the safest drugs created. They do no harm to your internal organs. If you’re taking them for pain then there is a very small chance of addiction (actually you have higher addiction rates with many of the psychotropic drugs).

        • querywoman

          usvietnamvet, my understanding is that opiods are very safe for those of us who aren’t addictive types. It seems that any kind of downer, like a trank, narcotic, etc., is safer for most of us than uppers like amphetamines.
          I like to point out that alcohol and opium are the oldest drugs, and so much more is known about them! Both very good if used appropriately1

        • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

          I don’t want to become addicted…..

          • usvietnamvet

            The chances of you becoming addicted are very small. Addiction is usually a reaction to the misuse of opiods. When taken for pain even former addicts do not normally become addicted. You do become physically dependent on the opioids but that is very different from addiction which is a complex psychological and physical reaction to the misuse of meds. You have more chances of becoming addicted to certain non-opioid medications such as many of the prescription sleeping aids and some of the psychotropics. Sadly many doctors don’t even know the difference between addiction and dependance.

  • keifernny

    Your JAMA article quotes studies for depression, not anxiety.

    There is exhaustive literature showing effectiveness of SSRI medications for anxiety.

    • Guest

      References, please? Modern ones. Now that it’s been proven that anti-depressants don’t do squat for depression, that that was all a big hoax, I wouldn’t be surprised that if they were to bother to do a study of anti-depressants for anxiety, they’d find that they were wrong on that one as well.

      SSRIs are a scam. You may as well prescribe homeopathic drops, at least then you wouldn’t be making people fat and screwing up their brain chemistry in other ways.

      Look at it this way: since the advent of SSRI anti-depressants, incidence of both depression and anxiety have SKYROCKETED.

      No other “cure” has seen the incidence of the disease it was meant to “cure” end up tripling.

    • Guest

      So they’ve been proven not to work for depression, which is what they were originally invented and marketed for, but they DO work for anxiety? What next, an antibiotic that’s a proven failure at killing bacteria but DOES help male-pattern baldness?

      • J.M.

        They lied to us about antidepressants being able to cure depression, but we should believe them when they NOW say, “Yeah, but, they DO cure anxiety!!11!!!” LOL.

  • Guest

    The SSRIs I was given for anxiety had as their side effects: Dizziness, agitation, anxiety, difficulty sleeping, and tremor. And in addition to adding insomnia and extra agitation to my existing anxiety, they caused me to gain weight as well.

    It’s not like anti-depressants are completely safe and effective and with no bad side effects. They’ve got a laundry list of bad side effects, as long or longer than benzodiazepines’.

    • Daniel

      Many of the effects you describe can be mitigated by changing the dosing schedule or by “titrating” the dose upwards to therapeutic levels. However, I have little tolerance for weight gain (which comes with its own set of issues), and would want to try a different medicine.

    • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

      Not to mention the horrendous brain zaps you get when you try to get off Effexor or Zoloft……that was after taking only 25 mg for 6 months too…..that shit is addictive imo.

      • querywoman

        Effexor used to work very good for me! I had serious anxiety and depression with ever-worsening blood sugar. Once I was really depressed, but when I finally got my sugar under 125, the depression lifted.
        With new diabetes treatment, I feel better all the time. I do take one generic Celexa, citalprom, daily.

        • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

          Effexor causes diabetes, I didn’t know that. I think a small amount of xanax is better than Effexor then. Been on a very small dose for years. No diabetes.

          • querywoman

            “Cause” is usually iffy – it may appear to be strongly linked in a few cases.
            I think Xanax is really very safe. I think an occasional Valium is safe, too! I couldn’t believe it way back when that disgraced televangelist Jim Bakker blamed a bizarre spell he had while on the way to court in chains on Xanax.
            Some drugs, like Accutane, are very strongly linked to problems. Accutane is very dangerous to a fetus. It is very risky to give Accutane to teeenage girls for acne!

  • Daniel

    The JAMA article says that that the more depressed the patient was before SSRI treatment, the greater the improvement will be. In the conclusion, they write: “For patients with very severe depression, the benefit of medications over placebo is substantial.”

    The worse someone starts out, the more room for improvement there is. Suppose two people fix 50% of their broken widgets. The one with 10 broken widgets fixed 5 of them. The one with 2 fixed only 1 of them. The ‘effect size’ of 5 is greater than 1.

    As for the other article… although I wouldn’t consider Newsweek to be a source of information on which to base clinical decisions, they state: “three quarters of the benefit from antidepressants seems to be a placebo effect” which is hardly ‘completely ineffective’. They also say, “To be sure, the drugs have helped tens of millions of people…”

    As for weight gain, that doesn’t happen to everyone, and it can be managed in various ways (including lifestyle changes and switching medicines).

    • Guest

      “To be sure, the drugs have helped tens of millions of people…”

      Well, yes. The worried well, who weren’t actually clinically depressed to begin with, “feel better” when they’ve got a tablet to take.

      If anti-depressants really worked that well, you’d think America, with the highest consumption of the things in the world, would be Happiness Central. And yet…

  • darbsnave

    For what it’s worth, DAWN monitors suicide attempts from antidepressants as well as suicide attempts from benzodiazepines. They used to monitor mortality from medicines, but I can’t find that anymore. SSRIs aren’t exactly benign. AZCERT lists citalopram and escitalopram as prolonging QT intervals and increasing the risk of torsades.

  • querywoman

    Insulin is not addicting, supposedly. But, if a diabetic goes off it without some kind of substitute med, he or she will have awful symptoms and may die soon.
    The doctors don’t have any trouble prescribing blood pressure and cholesterol reducing drugs to be taken forever.
    But tranquilizers? Something a patient actual wants for symptoms? Ditto narcotics for pain.
    Blood pressure and cholesterol drugs have side effects to.
    By the way, I do not take narcotics or tranquilizers regularly.

    • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

      Insulin is a hormone made by the pancreas. When the pancreas doesn’t make enough of this hormone you have to test your blood sugar and inject insulin. (that is type 1 diabetes which is different from type 2 diabetes where your cells become insulin resistant)…… Normal fasting blood glucose is under 95.

      • querywoman

        Su, not sure the purpose of your post Insulin and thyroid meds do correct deficiencies. Stopping the meds may not be considered addiction withdrawal, but will cause serious health problems. So far as I know, benzos and antidepressants don’t correct deficiencies. Benzos, like narcotics, and unlike antidepressants, are considered addicting.
        I am not comfortable with fasting blood surge under 110, and I am considered a very well-controlled diabetic.
        Benzos and antidepressants can treat a wide variety of symptoms, and it’s very specific to the patient. I have dropsy; I drop stuff constantly. I started Celexa years ago and noticed my dropsy was better almost immediately. I have taken generic Celexa for years, and the dropsy is better, so I don’t want to change. I still drop stuff!

        • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

          Sorry to hear about your “dropsy”. My normal fasting glucose is between 79-80 and I am considered to be not diabetic. My TSH went as high as 6.88 which put me in the ‘hypothyroid’ range.
          This occurred after menopause…. My GP wanted to wait till my TSH went over ten before starting to treat the condition with thyroid hormones, but then decided to put me on one mg of Armour for a few months and retest. Waiting for blood test results…..

          • querywoman

            It’s good that the citaloprom helps. Good luck. Thyroid can be tricky to treat. That’s a very high TSH. I still say maybe you should get an endocrinologist. Good luck to you!

          • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

            Is it high enough to cause all kinds of crazy symptoms though???? I have bad panic attacks, neuropathy, burning pain between shoulders which spreads down my arms, numbness which comes and goes in my extremities, jelly legs or rubber legs, dizziness, etc., etc…….these symptoms come and go daily…….I thought it was MS. Still wondering if it’s MS. I haven’t had any eye symptoms (optic neuritis) though. I am at a loss. I was previously very healthy….I believe menopause threw me into being hypothyroid.

          • querywoman

            Probably yes on menoP making you hypothyroid. Longer reply 2U elsewhere.

          • querywoman

            As for your symptoms, thyroid does effect your whole body. If you do have another diagnosable illness like MS, the thyroid being out of whack can intensify symptoms.
            You don’t have my spectrum on endocrine problems, but with such a high TSH, you really need to find a competent endocrinologist.
            I’m starting to see my current endo as my main doctor. We review my symptoms, discuss my general health, my immune system, etc. He’s quite pleased with my bounce back from pneumonia coupled with my weight loss on new diabetes meds. The serious illness and weight loss put me at risk of malnutrition, etc.
            My other doctors know he is strengthening my immune system all the time.

      • querywoman

        Su, please scroll down. I responded to several of your posts. I may have some similar problems.

        Of course, a Dr. Mike C on this thread thinks I am an idiot.
        Decide for yourself!

  • CMcGH

    I never comment on blogs, but just had to tonight…
    Some of these comments are just ridiculous, clearly made by people who do not prescribe and/or do not understand psychiatric
    research translation. There is a reason prescribers have to go through 8+ years of schooling and training… anyone who has would never make blanket (and factually incorrect) statements like the ones I have read here (especially those that trash SSRI’s… ).

    To those patients or family members who are angry because their doc is hesitant or unwilling to give you or your loved ones benzos…Get more information, or get more education. Your anecdotal comments are yours and yours alone, but are no substitute for good science. If you want a good review of the current literature on benzodiazepines, (global randomized clinical trials and longitudinal research) go to the Cochrane Database. Google it. Don’t think you know what you are talking about by citing one or two studies. Get the facts.

    Anyone practicing medicine should know that benzos are both psychologically and physically addictive. This is a no-brainer. If we knew who was most vulnerable, and how long it takes for the “relationship” between our patients and the drug to become one of dependency, thoughtful prescribers might be more willing to write orders for these medications.

    Because we do not, and cannot, know who will develop a dependency and when, the thoughtful prescriber will try all non-addictive options before prescribing anything addictive. That’s just good medicine.

    That being said.. lots of docs don’t do this… for the most part, prescribers want to relieve the patient’s suffering, but sometimes are too busy to argue when a patient becomes demanding, or they want to avoid a conflict in the office or the waiting room. Sometimes they are just lazy and want to get to the next patient – but mostly (hopefully) want to provide the patient some relief.

    The problem with benzos is that they work SO well for anxiety – initially. Then they require higher doses for the same response. Then they stop working,requiring higher and higher doses to alleviate symptoms or to avoid withdrawal. OR they create rebound anxiety – with greater
    objective distress than the original anxiety.

    Patient’s need to think about this when they get angry with us for not giving them what they want when they want it. We are not keeping the goodies from you. Believe me, my life would be a lot simpler if I gave my patients whatever they asked for whenever they asked for it, but my patients would eventually get much sicker if I did.

    For example… I have never seen patients get angry when they can’t get a dose increase in their Prozac, but have seen many patients throw temper tantrums (and in a few cases, chairs in my office) when I have refused to increase their benzo dose.

    This is not stated here to pathologize the patient – I am merely illustrating the fact that benzodiazepine dependence IS NOT SOMETHING THAT CAN BE NEGOTIATED WITH THE CENTRAL NERVOUS SYSTEM.

    As a responsible provider, I can help my patients avoid this dependence (both psychological and physiological) by not prescribing benzos in the first place, or by utilizing creative pharmacological and non-pharmacological treatment strategies; Unfortunately, this takes (a little) longer for them to feel better, but eventually they feel much, MUCH better. It also takes more time for me to do this, so I end up being paid less. However, it is a very worthwhile investment for my patients and for me.

    I use many different medication strategies with my patients. Most don’t work right away. In the interim, I provide patients with a list of good psychotherapists, and additional behavioral suggestions for self-care and anxiety reduction. Some patients leave my office in a huff, and I’m sure they go elsewhere and get their benzos. Most, however, stay with me, because I give them the time they need, answer questions and they know that I genuinely care.

    There used to be very few options that psychiatric providers had for anxiety disorders – now there are many. If your psychiatrist prescribes a non-benzodiazepine, be grateful. They have your best interest at heart over the long haul.

    • CMcGH

      A belated thanks to Tara Reynolds, for her article/post. It was very brave stance to take, and greatly appreciated.

      • Guest

        It’s hardly “brave” to use your government-granted position of power to deny patients relief from suffering.

        • CMcGH

          Governement granted??? Give me a break.
          This kind of comment disempowers both the writer and the reader. Get a life – or an education – or both. Then repost.

          • Guest

            The only reason you have the POWER to deny suffering patients any relief is that the government has granted you a monopoly on prescribing the medications that could help them. How can you deny that your power is solely due to a government-granted monopoly and nothing else, when it so patently is?

            TSA agents and high school rent-a-cops and the like get similarly up themselves when given too much power as well, and unhappily some of them seem to take glee in making less powerful peoples’ lives a misery too.

    • Guest

      “There used to be very few options that psychiatric providers had for anxiety disorders – now there are many.”

      And they work so well that anxiety disorders are more of a problem now than they have ever been in the past.

      Seriously, if any of this nonsense really WORKED, wouldn’t we be seeing a DECREASE in the number of people suffering daily from anxiety disorders?

      • CMcGH

        We are not seeing increases when people are treated well, with a combination of medication, therapy and lifestyle changes.

        It sounds like you want a pill to do all the work – sorry, it just doesn’t work that way.

        People with anxiety disorders need to figure out waht amkes them anxious, and change it… people just don’t get panic attacks or extreme anxiety out of the blue. There is always a precipitant, sometimes many. People need better coping skills, not addictive medicines. They need to change what needs changing (bad relationships, unhealthy lifestyle habits,unrealistic expectations), and not put this responsibility on doctors or the medical establishment.

        Find someone who previously struggled with anxiety/panic, and is now symptom free. Ask them how they did it. my guess is that they will tell you they had to:

        1) take their medications as prescribed, and wait for the dose(s) to reach an effective level in their bloodstream (4-12 weeks, usually)

        2) Find a good therapist

        3) stop all use of alcohol and other drugs

        4) get out of bad relationships

        5) identify, devlop and use more effective coping skills
        (emotional and behavioral)

        6) adjust expectations, and realize that recovery is a process, and cannot be maintained without change and a lot of work.

        7) accept what can’t be changed, make peace with the past and move forward.

        Anything short iof this is a quick fix that doesn’t last long. Reliance on medicine alone also keeps people whining and blaming others, and less likely to take responsiblity for their overall health.

        • Guest

          I expect you also refuse to prescribe insulin, blood pressure pills and cholesterol-lowering drugs; and are lobbying to end bariatric surgery for fat people too…. after all, shouldn’t they too just be forced to pull themselves up by their bootstraps and fix themselves?

          If you’re going to deny patients relief from their suffering, why not do it across the board? And if they can’t…? Let them suffer, these weak, loathsome, puling creatures!

          Hey guess what: MAYBE the reason so many people with anxiety self-medicate with alcohol and other drugs is because you all refuse to offer them anything which will actually help them?

          People suffering from anxiety and depression are sending America’s suicide rate UP for the first time in decades. Are you seriously going to argue that this is because your new treatments are so GOOD?

          • querywoman

            Agree with most of your points, but I oppose stomach-mutilating bariatric surgery! FAT is a great evil to the American medicos, kind of like benzos and narcotics!

        • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

          Many doctors don’t test thyroid function, hypothyroidism can also cause panic attacks and anxiety. Also doctors can’t even decide what the target range for treatment is. My gp didn’t want to treat me till my TSH WENT ABOVE 10. There are a lot of stupid doctors out there.

          • querywoman

            Sometimes they are so foolish in their inactivity. Thyroid should be a basic test when anxiety and depression.
            I once worked with a heavy African American who started losing weight, peeing a lot,, couldn’t hold down food, and had horrible boils, obvious symptoms of diabetes, common in fat people and African Americans.
            Her HMO idiot PCP referred her to the psychiatrist.
            Once she had gone to emergency, and our secretary suggested that she ask for a blood test. She had to beg for it!
            I think her blood sugar was over 500!
            Her PCP’s later reaction – “I never would have known!”
            Somehow she managed to get good enough treatment to have her first and only baby in her late 30s!

    • disqus_XpaeflETHK

      Cmc this blog is full of nonmedical people w axes to grind. In this case the nonmedical benzo addicted or benzo pushing community…

    • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

      I never asked for my dosage to be raised ever…..and Zoloft did nothing for GAD. Or panic attacks.

      • querywoman

        My tummy couldn’t tolerate Zoloft! Helped depression at first, but then the tummy gripes gave me new depression.

  • buzzkillerjsmith

    Cognitive behavioral therapy is also first-line for anxiety disorders, Dr. R. Just sayin’. If the pt requires meds I use benzos as a bridge (if the pt wants them) while starting an SSRI. I haven’t found Buspar or Lyrica to be that helpful. Most pts with an ongoing disorder will respond to an SSRI in combo with CBT but some will not. I usually get a phone consult for a formal consult from psychiatry in those cases.

  • http://beyondmeds.com/ Monica

    is there a reason you did not post my comment…it’s been close to 12 hours since I left comment…there was a link in the body so I suppose that is why it went to moderation…but there are now another dozen or more comments here as well.

  • karen3

    Tanya, the patient community considers Lyrica to be a “bad” drug with mind altering side effects and the potential of serious abuse. I really would not be pushing it. Maybe you have spent too much time with the drug rep???

    • Suzi Q 38

      I agree. I did not like Neurontin and/or Lyrica.
      I was given #270 of the neurontin 100 mg, and #270 or Lyrica 25mg. I was told to try one or the other and see which one I liked., 3 times a day.
      I had been complaining about numbness and cold in both hands and feet, plus a numb sunburned feeling on the top of my rear posterior.
      I realized after a few days, that while the numb feeling was better, I was very sleepy all day. Also, I gained 5 pounds in 2 weeks easily while on the drug. Furthermore, I stopped taking the drugs because I realized that while they helped my symptoms they were masking the “root” of my severe problem. It was spinal stenosis in my C-spine which was making my limbs weak and causing permanent paralysis.
      I told the neurologist and gastroenterologist that I was through taking these meds until they could figure out what was wrong with me.

      You haven’t lived until you have witnessed a true addict demanding their addictive drug from their pharmacist.
      I saw one once, and It changed my idea of what drug was truly needed to manage my care.

    • MinhNguyen

      The anti-epileptic drug Lyrica is owned by the same big pharma that owns anti-epileptic drug Neurontin… There was one big-ass settlement involving pushing Neurontin on doctors for inappropriate, unapproved uses. Some have called Neurontin “the late-20th century’s most successful snake oil”, it was prescribed so enthusiastically and for so many things it was ultimately shown to be useless for. So is Lyrica approved for anxiety the way benzodiazepines are?

      Lyrica is only FDA approved for the treatment of
      (a) Diabetic peripheral neuropathy
      (b) Epilepsy
      (c) Fibromyalgia
      (d) Postherpetic neuralgia

      Use as an anxiolytic would seem to be off-label. Is it the new flavor-of-the-month for “treating” anxiety because of its great track record, or because of “enthusiastic” marketing? If it’s so great for anxiety, why isn’t it approved for that, the way benzodiazepines (which are suddenly drawing headlines pronouncing “We Must Stop Prescribing Benzodiazepines For Anxiety!”) are? Any coincidence that there’s really no money to be made in benzodiazepines these days, since they’re mostly all off-patent and cheap as chips?

      • MinhNguyen

        See also in Wikipedia, “List of off-label promotion pharmaceutical settlements”, for details of the 2004 fraud case regarding Neurontin ($430 million settlement) and the 2009 case involving Lyrica (a $2.3 billion settlement with the Department of Justice to resolve criminal charges and civil claims under the False Claims Act).

  • querywoman

    The most prescribed drug in the US is Lipitor, or generic atorvastatin, for high cholesterol, a doctor-defined illness. Valium was once the best-selling drug in America.
    A young family doctor told me recently that the only thing that has really been proven to lower cholesterol is diet.
    Why does the American medical profession dislike treating illnesses with symptoms? I’ve had to go to the emergency room several times with illnesses with symptoms, for which I had complained to doctors in their offices already and been ignored, having the doctors push preventive medicine on me like blood pressure, cancer, and cholesterol screening on me.
    A psychiatrist told me once that Buspar didn’t seem to be addicting. My mother told me that a doctor had told her the same thing about 35 years ago about Valium.
    My mother, in her infinite wisdom, said if Betty Ford had kept her mouth shut, then it wouldn’t be so hard to get Valium.
    When I see that the top-selling medicine in the US is for something with symptoms, then I will know that American medical priorities have changed. I do take levothyroxine, a perennially well-prescribed drug for a symptomatic illness. I got a little over $100 in the Synthroid class action suit, too. In the right dose, it’s a relatively safe drug, not like Accutane.

    • Mike C.

      Your family physician was mistaken, there are numerous journal articles showing the efficacy of statins, not to mention most cholesterol is produced by the body not diet which is heavily influenced by genetics. So in many cases diet will have little affect on cholesterol levels. Because it is a genetic factor there is no way to treat the illness totally, so in order to contain the disease symptoms must be treated as well. A simple google scholar search will show you this. Secondly, patients are often non-compliant so sometimes we have to offer them the choice of a drugs which also kills them in a different way to prolong their more immediate death from something else, but ultimately the patient gets to choose their own care.

      • querywoman

        I don’t automatically believe any doctor! He would say you are wrong. I can google and find results either way. One has to decide for oneself.
        Niacin is cheaper than statins. So why don’t docs use it more frequently for high cholesterol? I still have a very serious problem with a statin being the best selling drug in this company.
        Since I am diabetic, I assume that I have a tendency to high cholesterol. However, about 2 years ago, my cholesterol was high, but my T4 levels were low.
        After a very slight increase levothyroxine, my cholesterol went down.
        My brother, a noncompliant diabetic who died too soon, but after years of complications, took niacin for his cholesterol.
        My father’s mother had died early of pellagra. My brother used to have what looked like horrid acne with lesions, and also had serious diarrhea since his early 20s, did quite well on niacin. Diarrhea, mental illness, and skin problems are symptoms of niacin deficiency. His skin cleared nicely on niacin, without the scarring of acne.
        My grandma probably did not have enough niacin in her diet, but he did. There is a form of niacin deficiency/absorption problem that can occur even when a diet has adequate niacin. If it’s inherited, and there is no test for it, that explains why she was the only one in the family who got pellagra.
        I have a different set of problems than my brother, and have an endo with whom I am an excellent match. I am also more compliant than him. I will fire a doctor and get another if I must. This is my SIXTH endocrinologist, and he is top notch!
        Asthma drug, Advair, is one of the top 10 selling drugs. I think a stomach upset drug was another one in the top 10 for a symptomatic illness.

        • Mike C.

          Naicin has numerous side affects and people are non-complaint with them.. I can list off choices your doctor should give as well, but I was addressing the specific example here. I am surprised any of you even see doctors since you all seem to disbelieve them so much.

          • querywoman

            Mike C, dya think I believe statins don’t have numerous side effects??? Do you take symptomatic illnesses seriously in your patients as well as BP & cholesterol. Tell me, I don’t know you!
            My daddy said his brother died too early by stopping Warfarin, cause the bro’s wife wanted him off that “rat poison.” Daddy knew what Warfarin is, but kept taking it!
            TRIVIA: niacin worked for my bro. He liked to tell people that he had something else wrong besides diabetes, the pellagra that his grandma had. He’d take niacin, but not much else. Don’t most diabetics have something else wrong?
            FYI, I don’t think, I KNOW that I am smarter than most doctors! Unlike my brother, though, I see them all the time. I have plenty of meds that I take on a daily basis, so I DO have a use for doctors. When I pay a doc, I want some med to make me feel better!
            Had to go through a bunch of docs to get to the good ones. Mine like having a compliant patient who researches and stays on top of her own issues.
            Another thing, Mike, I was a public welfare worker for years. My clients thought the public health doctors would fix them! Nope, it’s up to the patient to fix him or herself! Most doctors, unless they are surgeons, give advice! You write a special note on a piece of paper and hope the patient will take the note to a pharmacy and get the medicine and take it!!! That’s a pipe dream with a lot of patients! Haven’t you heard that a diabetic fixes him or herself, by taking meds, etc?

          • Mike C.

            First off anyone who says they are smarter than anyone else is probably the dumbest person in the group, because if you have to justify what you are saying without logic but rather telling people you’re smarter, than you are a D!@# fool. Niacin has the worst tolerates profile of all the drugs, I know because patients tell me, I could give you hundreds of examples but obviously that trumps the one case of your brother. Your other evidence is the stories of people who needed a social worker, so obviously they are the most learned, disciplined and honest individuals around. I don’t really understand your diabetic comment but I have never heard of a diabetic with type one that can regrow their pancreas, whereas one with type two could easily cure themselves with lifestyle changes. But I guess those are the details doctors know and other people just think they know.

          • querywoman

            Not smarter than everyone else, but MOST doctors that I have seen. Can you read?
            It isn’t very bright to not address the issue of costly new drugs coming out every few years, waning and waxing in popularity.
            I never said my brother regrew his pancreas. He was in DENIAL about his diabetes. The only illness which he would accept and discuss was the possible niacin uptake problem.
            Why shouldn’t I ask if it worked for him and is so cheap, why isn’t it used more? I have not researched that issue much.
            The niacin seemed to work for my brother’s cholesterol and his skin problem. He may well have an inherited form of niacin uptake problem! That he could talk about and accept. He would not accept that his pancreas grew defectively. Over 10 years, he had three amputations, and still would not take his meds. After the last amputation, he had a stroke and several heart attacks and lived almost 2 1/2 years in a nursing home.
            Anyone else would have been dead sooner! I saw noncompliant diabetics die soon the years I spent in social work.
            You should try harder. I think we are on the same track! I am a compliant diabetic. a type II. I have managed to get off insulin totally with Victoza. I also take Amaryl (new) and metformin (on it for years!
            Type II cannot always be cured with lifestyle changes,. Furthermore, there are many types of diabetes, and Type I and II are loose categories.
            You originally jumped and told me the family doctor who told me only diet had really been proven to lower cholesterol. He was young, bright, and competent. You instantly dismissed him as WRONG! I do not consider it smart to not consider alternatives. I can read evidence both ways.
            My current dermatologist and endocrinologist have extremely good relationships with me and mutual respect! These doctors are open-minded. I KNOW that each one will gladly discuss the constant development of new costly drugs and coercion to make patients take them with me.
            I have been researching cholesterol and see a lot of statin-bashing, usually by nuts like Mercola.
            I also know that hypothyroidism is related to cholesterol. Maybe the family doc was slightly wrong! I say you are
            I rely on history a lot. I will soon research statins in China.
            I mentioned in another post that I fired an endocrinologist who once socked it my insurance company for $780 for office visits! Did I hate him? Heck no, Ioved him. He amused me, and I told him so. Plus, he got me feeling good enough to go to law school for a while. I didn’t finish, but it was fun while it lasted. I was a tad older and had high blood sugar and needed to go on insulin the whole year. I had a lot of bad luck, like car breakdowns.

            I prefer the law of the land as a defining force. And the government and laws will address the tendency of doctors to want so many patients on costly new drugs all the time!

          • Mike C.

            anyone else… not everyone else… can you read?
            Don’t worry, I read no further, your arguments are so convoluted and your grammar is about as poor as they come, that it is no longer worth trying to decipher. Furthermore, it is obvious you are not comprehending what I have written as illustrated out above.

          • querywoman

            I’m through with you also! Maybe I should not waste my fingers! Your reading comprehension is questionable, also I never said I hoped my med board would fire a doctor! Where did you get that?
            I fire my own doctors!
            I don’t go to close-minded docs! I fire them promptly!
            You amused me with your obtuse nature. Hee! Typical, “Trust me, I’m a doctor.” I just researched that phrase!
            Good luck!

          • Guest

            So why don’t you write a blog post, “STOP PRESCRIBING INSULIN FOR TYPE TWO DIABETES”? Just tell all of those lazy sods to eff off and stop eating so many donuts?

            Why is it only anxiety sufferers you to whom who insist, “don’t you dare ask me for relief of your symptoms – go away and heal thyself”?

          • Mike C.

            I never commented on anxiety and benzos… the conversation has been about statins. The mere assumption of an argument never made, makes you look foolish.

          • querywoman

            Dear Mystery Guest, so glad you jumped in! His prior responses are Xactly why I jumped in with my, “I don’t think, I knew, I am smarter than most doctors!’
            He had steadfastly take one view: excess cholesterol is bad, and statins are great!
            I had an intuition that he might actually be flexible, but I couldn’t get out of him.. You have!
            Thyroid pills might have once bee a fad, but they have stood the test of time. Prescribed statins have not!
            Guest, I do not directly use the word, “stupid” against another poster in any post. But I will use the term, “smart,” for you!
            Go for it!
            Mike C. has read many of my posts and also yours! This is good Perhaps eventually he will start thinking.
            I don’t fortune tell. Not sure yet if a patient will sue doctors and drug companies for statin side effects! Maybe someone already has!

          • querywoman

            Mystery guest, I clicked on “Respond” on your comment again, since I won’t click it on Dr. Mike C’s response to you.
            The article here is about anxiety and benzos. I threw in that doctors are addicted to prescribing. I already had asked him if her took anxiety and pain seriously (something to that effect.) He doesn’t like my grammar, but he finally responded partially here here.
            I’m full of myself and my problems and have had umpteen problems with doctors! That’s right, I am responsible for my own health, not them. I moved on to better docs, and am doing so much better.
            I’m not a benzo freak, but I got past myself enough to rant here about benzos not being that bad while BP and cholesterol meds, the in-vogue ad nauseum, meds are faddish and have side effects! How unselfish of me!
            What a dolt I am! He’s read me! That’s an accomplishment!

      • querywoman

        In truth, why should I believe one doctor and several articles instead of another doctor and several other articles?
        I have known all my life that pap smears and mammorgrams were overdone and very profitable. I have lived long enough to see some others agree with me.

        • Mike C.

          yet cervical cancer deaths have been reduced by two thirds, get pap smears are crazy.

          • querywoman

            The ACOG no longer recommends annual pap smears. Other industrialized countries never did them as much, but still have reduced deaths. In the end, one must decide for oneself.
            I remain appalled that the best selling US drug is a statin!

          • Mike C.

            Because Americans have high cholesterol? I guess I’ll simply stop treating my patients. Thank you for bringing this to my attention.

          • querywoman

            Ha! Ha! I know you are not gong to stop treating cholesterol! But it remains a doctor-defined illness! Do you treat anxiety and pain?

          • Mike C.

            I treat whatever the patient needs within my scope and what I feel comfortable with based upon what the patient has told me and what they agree to.

          • querywoman

            Dr. Mike C, it appears to me that you are not getting one of my main points: statins are new drugs, and the risks are not fully known. Prescribing fads have come back to bite doctor’s b(__)tts time after time!
            Valium was once a wonder drug.
            LIke most of us, you are a product of your times!

          • Mike C.

            Statins have been used for centuries by the Chinese and were first used as a pharmaceutical in 1984 so I am not sure what is so new about them.. but okay… keep perpetuating false statements.

          • querywoman

            I am neither a doctor nor a biologist and do not know the history of statins. How am I making false statements? Statin prescribed drugs are new!
            The contemporary American medical and pharmaceutical professions repeat a cycle of developing and selling costly new drugs. It takes a while to learn side effects.
            Don’t you know a lot more about alcohol and opium than statins?

          • Mike C.

            Okay more tangents… not sure what EtOH and opium have to do with statins. I don’t consider a drug approved by the FDA for 28 years to be new especially when it’s been used for centuries as previously noted. When comparing survivability rates they are usually 1 year, 5 year, 10 year etc… so since the first statin was approved there has been ample time to make a comparison. I have now said the same thing twice, both times saying it is a new drug, which is not true as i have now pointed out twice… just because you keep saying it doesn’t make it real.

          • Guest

            It IS new that you’ve started prescribing statins to completely asymptomatic patients. The vast majority (75%) of patients you prescribe them to didn’t have coronary artery disease in the first place!

          • Mike C.

            Once again, you’re making assumptions about what I prescribe and to whom and singling out one specific group of individuals to fight your argument when I made no claims about that specific demographic, but merely countered a broad statement with an equally broad statement.

          • querywoman

            Oh Guest, he thinks I am close-minded and thick, when I discuss many viewpoints. His attitude is he is right no matter what! I won’t respond to him – he doesn’t want to me. I will respond to you!

          • Guest

            It’s a fad. Just like Lyrica is. Just like Neurontin was. Just like SSRIs are. Doctors have no trouble prescribing expensive yet ineffective drugs with heavy side effects to people who don’t need them anyway. It’s only where the drugs actually help their patients where they start to balk about getting out the prescription pad.

          • querywoman

            DEAR GUEST! A voice of common sense. I knew there were some. Dr. Mike C seems to have, “Trust me, I’m a doctor syndrome,” and won’t discuss fads.
            In all my popping off her, I have not pointed out that BP and cholesterol meds offer a doc reasonable chance of success and have tests to measure significant changes.
            When it comes to anxiety, depression, and pain, they have only our WORDS upon which to rely!
            Alcohol and opium are not fads!

          • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

            If you are in a monogamous relationship and aren’t exposed to HPV then you are at low risk of cervical cancer……that is if you can trust your husband to not fool around behind your back.

          • Mike C.

            doesn’t change the fact that with the introduction of pap smears numerous deaths related to cervical cancer have been prevented…

          • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

            Then why did my ob/gyn give me 4 paps when I’m in a monogamous relationship (married 28 years) over a 3 year period and they were all negative???? These were during followup visits for a benign dermoid cyst surgery he had done previously…….seems like overkill to me…..he was also testing for gonorrhea, syphilis and HPV. ALL NEGATIVE!

          • Mike C.

            Sorry this post will be some tough love.
            1. Your little story is very insignificant in reality.
            2. Regardless of what you are doing now, does not necessarily mean what you were doing 30 years prior isn’t relevant, after all cancer doesn’t suddenly appear overnight.
            3. If you were uncomfortable with receiving more paps, then why didn’t you do the adult thing and simply tell your doctor you were no longer going to have them done.
            4. If you had gonorrhea, syphilis or HPV via any previous partners, or your husband was cheating on you, wouldn’t you want to know? Once again many of these infections are dormant for many years, if you didn’t care then why did you allow your doctor to perform the test?

            You are complaining about your personal experience, which has nothing to do with the reality of pap smears and their benefit to hundreds of thousands of other women. You are also complaining about your doctor, when at any point you could have simply said no. Are you a child that has no power over your life?

      • Guest

        Is there any proof that lowering a patient’s cholesterol levels via the use of statins actually makes them live longer?

        • Mike C.

          Nothing is 100%, but there was a American Journal of cardiology article showing that statins significantly reduces coronary artery disease raising life expectancy.

          • Guest

            Three fourths of the prescriptions that are written for statins are for primary prevention. In other words, doctors are prescribing Crestor, Lipitor and simvastatin to healthy people who have no symptoms. These are people who may have “risk factors” for developing heart disease, but who are otherwise doing pretty well.

            Is it logical for physicians to prescribe statins to healthy people in the hope that such drugs will extend their lives? If doctors truly believe in “evidence-based medicine,” the answer has to be no. A recent analysis of 11 clinical trials involving over 65,000 people produced no evidence that statins saved lives (Archives of Internal Medicine, June 28, 2010).

            Even though there is no good evidence that statins prolong life when prescribed for primary prevention, there is no doubt that these medications do cause side effects. Muscle pain and weakness are the most common complaints, but some people also report cognitive problems (memory and thinking not quite right), peripheral neuropathy and elevated blood sugar. There is even a report that statins are linked to cataracts (BMJ, May 20, 2010).

          • Mike C.

            You’re cherry picking your data, the meta analysis was for “intermediate to high-risk individuals without a history
            of CVD” what about patients with a history of CVD, what about catching it early with patients with no apparent CVD? Not to mention the P value is ridiculous.

            As the case with all drugs, you’re trading demons, the choice is ultimately the patient’s, lower quality of life vs longer life.

          • Guest

            If you’re going to drug otherwise healthy patients with statins, giving them a lower quality of life in exchange for what you believe (but is not proven out in evidence) will be a longer life, and “the choice is ultimately the patient’s”, why not let anxiety sufferers choose a higher quality of life vs. what you believe (but is not proven out in evidence) will be a shorter life?

            And it wasn’t “my” evidence or “my” data, it was peer-reviewed studies published in the Archives of Internal Medicine and the BMJ.

            If you’ve got studies showing that the 75% of patients with no signs of heart disease to whom you are prescribing statins anyway, “just in case”, are actually living longer because of it, go ahead and cite it.

          • Mike C.

            We learn statistics to weigh the risk to benefits. Every drug is poison, used with merely the intent to prevent the greater danger from reducing the overall mortality. It was the data you used to make your argument, so in this context it was yours. Ultimately any treatment is the patient’s choice.

            I have no problem prescribing Benzos for anxiety, I never said otherwise, I merely responding to the blanket statement made about statins.

            And I am sorry I cannot find a paper asking for the specific requirements, although once again, I never made claims about those specific individuals, I merely said that statins have been shown to work in opposition of the other commentators claims that they do not work, this is evident in studies such as the MRC/BHF Heart Protection Study and numerous articles in the American Journal of Cardiology as I already mentioned before.

            I find it hard to believe that you are thinking objectively if you are putting words in my mouth. This illustrates and unwillingness to change your perception to meet reality and makes this a another pointless argument.

          • querywoman

            Guest, I love you. When he responds, he admits he does prescribe benzos. I never go that info from him.

          • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

            My cholesterol is 199, would you prescribe a statin? Just wondering……I would not want to take any statin drugs while going through a horrendous menopause with hypothyroidism and possible fibromyalgia symptoms…….I would think the statin would worsen the fibro symptoms of muscle pain……My father died 30 years ago in his early 50′s of M.I. No autopsy was done……he wasn’t obese and he was moderately active. There is no way I would take a statin, I would lose weight if my cholesterol shoots up from my other medical condition (hypothyroidism).

  • Mika

    ——————————————————

    “The arrest reports in my local newspaper attest to the problem of the illicit sell [SIC] of benzodiazepine in my area.”

    ——————————————————-

    Um, maybe because it’s a medication that actually works (unlike the useless antidepressants you push on people), but because you’ve decided to puritanically exercise the power your government-granted monopoly on drugs gives you and deny suffering patients any legal access to it, you’ve pushed them onto the black market?

    After all, the AMA were huge supporters of the Volstead Act (prohibition) back in the day. The Protestant misery-index is strong in thee.

    Just a thought.

    • CMcGH

      Keep it a thought.
      There’s no government conspiracy here – medical professionals are too busy to entertain notions like this

      • J.M.

        No, not a “government conspiracy”. You don’t read very well. Just
        still more “unintended consequences” from power-tripping medicos USING
        the monopoly the government has granted them to deny people medications
        which actually help, and in so doing creating an illegal black market in
        the product, and then gasping like startled goldfish over the fact that
        the sufferers they’ve driven away are now being arrested for seeking
        relief the only way left to them.

        We might have thought you’d
        have learned about unintended consequences and such through your
        adventures in helping to get alcohol banned.

    • disqus_XpaeflETHK

      Good to hear from a rep from the Benzo addicted community..

    • Mike C.

      Just a thought, but perhaps it’s because they can be very dangerous and those medicos actually don’t want to see you worse off on the drugs… but I guess if we over prescribe were money hungry and if we under prescribe were heartless… no science involved.

      • Guest

        Lots of drugs that you all over-prescribe “can be very dangerous”, but you do it anyway. Lyrica for anxiety is not only more expensive and has lots of side effects itself, it’s not even approved for that use. And Seroquel? For anxiety, depression and anxiety? That has no side effects, RIGHT? lol
        And look at all the other drugs with dangerous side effects you push. It’s not about patient safety, that’s for sure. It’s just about swallowing whatever that month’s pharma reps tell you, and of course getting a kick out of playing “gatekeeper”.

        • Mike C.

          Once again, you prove my point. I am a “gatekeeper” because my butts on the line if something happens to a patient to whom I mis-prescribe. Don’t blame me for that blame the state attorney general. As for reps, I don’t even talk to them, as if I want to sit their and get lectured by some kid who got all his knowledge from a few courses taught by his company. If you think we all get kick-backs then wow, you’re still living in the 90′s. Why would I risk a quarter a million dollar a year job for a couple thousand from drug companies. Not to mention patients always have the right to refuse or ask for alternative treatments, which many do not even making it worth the time to prescribe. If you are not getting adequate treatment from your doctor you have both the right to see another physician or tell that physician that he is not treating your properly based upon your know experience. If he still refuses to treat you the way you expect, than report him to the state medical board. You’re living the victims life, take some personal responsibility… or better yet become a doctor since you know so much and perhaps you’d know what you are talking about.

          • querywoman

            Mike, some do and some don’t! I don’t guess you let the drug pushers sell you up, but some docs do! And state medical boards don’t do squat for the patients! Only thing I ever found was fire a doc, and move on!

          • Mike C.

            One, medical boards don’t fire physicians… they can remove their license, but more likely they will fine the the physician. Over 5 million was collected in fines in the US. So the reality is not consistent with your statement.

            Secondly, if you leave and the physician bills an insurer for services not rendered, he’s committing fraud. You can notify your insurance and they will charge back the physician and you can once again notify the SBME.

            I don’t know how you can reason any doctor would fight you of a couple dollars while risking their license or a much greater fine. Regardless of what you claim, it doesn’t make sense.

          • querywoman

            Mike C, how long have you been practicing? To what payment system are you accustomed?

            Texas never fined any doctor that I reported! I am not aware of them fining doctors!
            When I had private insurance, I went to an endocrinologist twice. On a phone call to his nurse, she hung up on me while I was lamenting my childlessness and upset me into tears.
            Neither the doctor nor she ever apologized!
            He got two $15 copayments out of me and $780 from private ijnsurance. I called the insurance company and ask them if t they could not pay him. They said no, since services had been provided.
            After I went on Mcare, I had a bad visit with a skin doc from the start. I told him that if he was not going to believe me, I would just walk out. He said, “There’s the door.”
            That was fine with me! I walked and he did not bill Medicare.

          • Mike C.

            You seem to have a lot of problems with physicians, yet the common thread seems to be yourself. I think it is time to look in the mirror. I cannot argue your anecdotal logic. Why would an insurance company pay for services not performed? This does not make sense. Insurance companies do not like paying even when services were performed. I can merely provide sound logic and the facts that are readily available at various medical board sites. If you do not wish to believe and check those facts then you will never be able to alter your reality making this a pointless argument.

      • querywoman

        So, Mike, is it better to buy marijuana on the corner if one can’t get legal Valium? I heard hydrocodone goes for $10 a pill, but mine aren’t for sale!

  • buzzkillerjsmith

    I inherited a Xanax practice in 1989. My predecessor, a nice guy but maybe a bit too nice, had 20 or so anxious pts on Xanax. This med has a very short half-life and is quite habit forming. The previous doc knew he had let the genie out of the bottle with these pts but he could in no way get it back in the bottle so he left. No fool.

    I fell to me to try to get some control back. I put pts on contracts, had them make frequent office visits, tried to switch to less nasty benzos like Ativan, tried complete tapers. Sometimes it worked, sometimes not. Benzos are great for short-term anxiety but not for long term, and boy do they depress people. Many of these pts had dedicated their lives to taking Xanax. Very sad, lives involuted.

    Some pts got mad when they couldn’t get their meds no questions asked and they found a new doc. I was not generally heartbroken.

    It took me 2 years to clean things up and was a lot of work. My pts were then getting better medical care.

    We did not use SSRIs for anxiety disorders in the old days, not did we use CBT. These are much much better treatments and I now do not prescribe chronic benzos without consultation from a psychiatrist that I respect, not from any old drug-pushin’ doc.

    • CMcGH

      I am in a similar position, having inherited a psychiatric practice that sounds similar to your primary care practice. The previous psychiatrist prescribed lots of Xanax, Clonazepam and Lorazepam, at dangerously high doses.
      I refused to prescribe them without a clearly defined “exit strategy”.. sometimes this discontinuation process took 6-9 months. Some patients got mad and left, but 90% stayed. Two years into it, I can say that those who stayed are happier and healthier… not just because of the medications (non-benzodiazepine) that I prescribe, but because they have also connected with skilled therapists, and have made significant lifestyle changes that support overall health and wellness.
      Kudos to you for staying true to the needs of your patients, and consulting with a psychiatrist you trust. We need more PCP’s who will do this… collaborative care always benefits everyone.

      • Suzi Q 38

        You are a good doctor, getting to the “root” of the problem, instead of just giving the lonely child “candy”
        to make h/her happy.

    • Suzi Q 38

      Good, Doc. If you look into the personal lives of these patients, past and present, they have a sad story or stories to tell.
      They need to talk as well as take their less addicting meds.

  • querywoman

    Seroquel, a very heavily sedating antipsychotic, is among the 10 top selling drugs in American. I saw something recently about college students being prescribed antipsychotics for insomnia when all they needed was a simple tranquillizer!
    I am well aware of the risk of addiction. I take hydrocodone very rarely for serious skin lesion-related pain. I ask for more every year and a half or two. It does help.
    I use public transportation. A couple of nights ago, a guy on the bus told me he’d been to the emergency room and got about 25 hydrocodone, that he didn’t really need. I said I had a very small amount. He asked me, “Do you sell them too?” I told him I don’t sell them, and then he denied it, but went on to say he had sold them a time or two. I hear this stuff all the time. I really shouldn’t mention my hydrocodone.
    Doctors don’t want to prescribe mild tranquilizers or narcotics. They don’t want to prescribe antibiotics (am familiar with drug resistance!) But they dish out anticholesterol and antihypertensive meds like the candy they despise!
    I want to see some real studies about the side effects of their favorite drugs. Antipsychotics have a strong risk of tardive diskensia (I don’t care if it’s mispelled.)
    When I see that the top-selling drug in the US if for a patient-defined illness with real symptoms, I’ll know that American medical care has changed.
    Here’s food for thought: old men father large broods of children in Africa and the Arab world. The average elderly American man does not have the energy to chase a young woman! Why? Are all the American elderly men on BP meds that kill their desire?????

  • querywoman

    About anxiety, when I was younger, the real problem was I had to live with my ever-anxious mother who pushed all her anxieties off on me! She didn’t want me to get out of her sight!
    It’s a lot cheaper to give people drugs for anxiety than to do real, costly social work to help them change their living situations!

    • querywoman

      My own parents were a combo of many very fine qualities and also some very bad ones. Mama always popped a few tranks or antidepressants, but she wasn’t an addict. Daddy ridiculed that, but years later he got on them himself.
      I’m not like Michael Jackson blaming my parents forever!
      But yeah, pills did help me quote with Mama some. Once when I was in college, I asked my family doc for some sleep med. He gave me a few Dalmane and told me to be sure and tell my mother (worried about suicide.)

      I told her, and she wanted of my pills!

      Years later she got some Valium from the same doc, using her line, “If Betty Ford has just kept her mouth shut, etc.” She was surprised when he wrote him up. He said she could have them if she really wanted it. She just took them as needed. Before she died, both she and my younger brother were using Restoril for sleep. They used the same NP.
      My younger brother is another story entirely. He doesn’t talk to me at all! In the past, he has had anxiety attacks so bad that this blood pressure can go to 250/170. Yes, he gets BP meds and goes for regular care.

  • querywoman

    One can always find someone to back up their opinion. I found the site of a psychiatrist who thinks like me.
    The kevinmd site doesn’t seem to like html links. If you care, google this article, “Antipsychotics Are For Psychosis, Not Insomnia,” by David M. Allen, MD. He discusses the relative safety of benzos. He’d rather be addicted to benzos than insulin!
    Yeah, if he were diabetic, he’d welcome the insulin. I got off insulin with Victoza, so now I am addicted to Victoza.
    Tell a doctor you want to stop the anticholesterol and antihypertension meds, and watch him or her squawk!

    • querywoman

      Dr. David M. Allen is so full of common sense it hurts! He talks about how the pharmaceutical companies manufacturing the costly new psych drugs put out stuff bashing the benzos when then went generic! He likes to put patients on antidepressants plus a benzo!
      He also talks about CCS, “Crappy Childhood Syndrome,” as a major cause of anxiety that responds to therapy.
      He says the benzo withdrawal process is eased by Tegretol, but that the anxiety symptoms usually return withou the benzos! Golly gee!
      Do benzo freaks cause car accidents? Probably, like a bunch of other cr@p. My biggest fear these days in cell phone drivers, including my local bus drivers!

    • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

      I thought that insulin was a hormone…….?

      • querywoman

        Yes, insulin is a hormone. What I am talking about, and so is Dr. Allen, is that stopping insulin is bad too! We’re nitpicking over the definition of “addiction.”
        If he need insulin, he’d be glad to have it, but sorry he had diabetes.

  • Guest

    It’s been estimated by NAMI that around 30% of people with mental health issues are not helped either by therapy or antidepressants. You can trash benzos all you want – I know for a fact many physicians get kickbacks for newer meds and benzos are ancient. Most antidepressants are more harmful as they can make people suicidal or homicidal, cause liver damage, or renal failure. I’m an anomaly. I get upset when my benzo is demonized because it has proven results as an antidepressant and PTSD treatment. Some of us are living stable, healthy, productive lives because of benzos, not in spite of them.

    • Suzi Q 38

      THankfully, I neve never tried the benzos, or any other antidepressant.

      • querywoman

        Suzi Q, benzos are what’s considered a tranquilizer, not an antidepressant.

        • Suzi Q 38

          Yes, I typed to fast.
          Thanks. Also, I only promoted a few old antidepressants and a neuroleptic for Schizophrenia (Navane).

          That was many moons ago…..

  • maryhirzel

    Anxiety: Orthomolecular Diagnosis and Treatment [Paperback]
    -Jonathan Prousky (Author), Abram Hoffer (Introduction)

  • Joe Williams

    Physicians getting kickbacks is always comical.
    As a psychiatrist I beg of you to do as the author is suggesting here. I am the medical director of an outpatient mental health clinic at a hospital. My situation affords me to see the end result of benzo overuse and over-prescribing all too frequently. I see many who still feel anxious and don’t function because of it, yet swear that their medicine helps them.
    The way that I tend to approach the issue is not from the angle of addiction however. Addiction no matter how you phrase it invariably ends up being a ‘moral’ argument between the prescriber and the patient. “I think you are addicted” vs “You calling me an addict? I don’t misuse my meds! Why don’t you trust me?!” Whether you are correct or not, it is all too often an advisarial exchange. I instead prefer to discuss the biologic profile of the medication when taken too often. There is no question that for acute anxiety there is nothing better than a benzo in most cases, hence their appeal. When in comes to chronic anxiety however, their biologic profile is prone to failure to contain anxiety. Whether I can expect the anxiety to be chronic in nature is therefore a main consideration that I have. If I can expect it to be chronic and daily, a benzo just cannot and should not be a first choice as it does not make sense from a bio,logic perspective. Additionally, they also erode the ability to tolerate stress over time. I suggest taking the route of educating about the biology behind them. That is the domain of the prescriber in terms of expertise. Even if I believe they are an obvious abuser I take this route as opposed to focusing on whether I can or should be able to trust them.
    I hope this helps or at least was tolerable to read.

    • querywoman

      Using diagnoses like, “anxiety” or “depression,” as catchall terms are also dangerous. I always get nervous and frightened from noise and other stimuli. It worsened and took me years to get the best existing diagnostic term: Asperger’s Sydrome, from a psychiatrist.
      I mentioned it later to a family doc, who said Catapres or clonidine was effective for it. He nearly broke his arm writing it up. The psychiatrist did not know about this medicine.
      I have taken clonidine 3x daily for over 10 years, and it greatly reduces my stimuli response and naturally helps calm me. The clonidine has significantly changed my life but I still have autistic stimuli responses.
      “Depression” is, sadly, a dump word for a lot of illnesses that doctors don’t understand. Even in the actual psychiatric terminology, there are many different diagnoses than just “depression.”

    • Peter J. Stanton

      What evidence do you have that long term alprazolam reduces the body’s ability to tolerate stress? Anxiety causes major cortisol release and is damaging to the body. Now that we know the mechanism of this drug it makes perfect sense. The precise mechanism was not known when the drug came out and worked where Valium had failed. Blocking the attacks reduces all of the stress hormone levels. BTW if I am dependant but the drug works who cares? Any long term use of Benzos or narcotics will cause a patient to build up a tolerance and then level off as I have at 2.5 mg/day. So what? It’s called management. You know that Dr Joe.

  • Patricia

    Thing is, anti-depressants don’t work for everybody; neither does therapy. Many times a doctor cannot tease apart what is actually wrong with someone who is presenting as anxious or depressed. Prescribing an anti-psychotic for insomnia is a bit overkill (and pretty wrong in my opinion). And benzos are sometimes the only thing that works for some people. Why should those people have to be subject to this withholding and gate-keeping?

    • Guest

      “Why should those people have to be subject to this withholding and gate-keeping?”

      So that doctors can congratulate themselves in blog post after blog post for their “bravery” in denying patients the drugs that would improve their quality of life.

      Have a swing around any of the med-blogs and observe how many doctors get off on sending pain &/or anxiety sufferers away without relief, and then congratulate each other for their “bravery” in denying help to these marginalized and already-disempowered classes of citizens.

      It’s a power trip.

      • Patricia

        I agree; I have commented before on the disparaging of “drug seekers”. I am not saying they don’t exist and it must be hard to discern who is who; but what about people who need these drugs for quality of life? The huge push towards the use of anti-psychotics and anti-depressants to deal with anxiety and sleep problems is more than disturbing. The side effects are terrible and possibly life threatening. So why give seroquel for sleep (which is an anti psychotic that causes large weight gain and terrible grogginess) instead of Ativan? For sleep and anxiety?

        All this just increases the infantilization of the patient and the distance between practitioner and patient.

  • Peter J. Stanton

    I have had anxiety for 21 yrs. Specifically, “panic disorder”. I tried the drugless route first and it did not work including talking therapy. While I was still working I felt as though I was walking on eggshells all the time. Finally I tried Xanax. Xanax attaches itself to the GABA receptors in the brain. Those receptors tell the nerve cells in the “fear center” of the brain, NOT to fire. Long story short: I have been taking 2.5 mg of Xanax (generic Alprazolam) for 21 yrs and not only does it block any attacks, I have zero side effects. Now my well meaning doc who is a psychiatrist, was concerned and also said ” We really should wean you off the Xanax”. I replied ” Since there are no known side effects from taking the dose I now take and it works why should I stop”? She replied: You have a point.
    I have no cognitive decline, memory loss, liver problems, coordination issues but I have a drug that works. OTOH: SSRIs like Paxil and Zoloft do NOT raise GABA levels much but raise serotonin levels. This neurotransmitter is more of a buffer and mood elevator. While it may raise the threshold for having a full blown attack it does not calm down the general anxiety in between attacks. I am a health provider and a science professor and have been able to objectively see the effects of all of these drugs on myself and others. My advice to MDs would be to NOT feel “Holier Than Thou” because you are not handing our benzos like candy. Evaluate the patient. If you don’t know the difference between panic disorder, phobias and generalized anxiety disorder and an addict who wants to party ( and most of your FPs do not) then refer to a psychiatrist. For appropriately evaluated patients Xanax IS indeed an effective short and long term solution for many patients. Don’t take them off the drug because YOU feel uncomfortable.
    Peter J. Stanton DC, MS, DABCO

    • Joe Williams

      Good results with SSRI’s do actually lower the anxiety between attacks. You are not describing having had a good result obviously.
      I also agree with you that for someone in your situation who is working and functioning, taking you off of a medicantion just because the prescriber is uncomfortable is not the best course of action.
      I always hesitate to discuss things on internet forums because it is impossible to foresee/address every possible objection/situation without writing a novel. I do feel it is important though to emphasize that there are too many people who end up on benzodiazepines without much forethought. There are too many candyman type prescribers still. And most importantly, too many people who are not functioning at all and end up not only suffering as they were before the drug, but also addicted.
      As for drugs/benzos reducing stress tolerance, the literature is there. The question is always of quantity. To use an extreme example, one Xanax per month certainly won’t reduce your stress tolerance. Taking it multiple times per day with no initiative to avoid stress where possible on the part of the patient is another issue. The vast majority of the time (but not in every case) people don’t understand this and expect that the medicine will always work or that the next higher dosage will be safe enough.
      Don’t read any of what I have written and assume that I don’t ever prescribe benzos. There have been many situations where I have and still do.

      • Guest

        So you disagree with the title of this piece, the stern commandment to “STOP PRESCRIBING BENZODIAZEPINES FOR ANXIETY!”? (but DO prescribe Lyrica instead, which has not been approved for treatment of anxiety and whose manufacturers have already been busted once for inappropriately pushing off-label uses of this drug, which JUST HAPPENS to be a lot more expensive than benzos…..?

      • RenegadeRN

        As a former charge nurse in a chemical dependancy/ psych ( duel diagnosis) unit, I was extremely concerned about the over use of benzos.
        I have had a young lady come to the desk at 6:30 AM, eyes still half shut, asking for a PRN benzo because ” I feel anxious” OMG! Really? You aren’t even awake!

        Patients ask for( demand) them and psychiatrists seem to freely hand them out. I have seem addicts sent home with a new addiction to benzodiazipines. Very disturbing.

        What about utilizing substances such as 5- HTP or GABA to help the body naturally boost deficient neurotransmitters? What about diet manipulation to the same end?

  • Santa Diego

    I don’t disagree, but I think there is a role for these meds. 15 years ago, one of my kids developed a serious, chronic illness. I couldn’t sleep or concentrate well enough to work safely.

    • Joe Williams

      I don’t disagree with what you have said here at all. Certainly there is a role for these meds and a couple times per week is not close to being a problematic quantity that would induce the process of tolerance. What you are describing is using a benzodiazepine in it’s optimal role which is not daily. Daily use is not always a problem either but too often their prescription and use is done without this degree of thought.

    • querywoman

      UR a doc and take an occasional benzo once or twice a week? Good 4U!

    • usvietnamvet

      It’s a shame you weren’t able to learn to meditate. It is one of the most effective methods I’ve tried for PTSD. It’s a good idea to try learning it when things are going well so it’s there when needed. They’re also finding that Tai Chi is extremely effective with many illnesses including psychological disorder. I also found acupuncture effective. They say that Medicare could save millions if they used these alternative methods.

      • querywoman

        I have done a lot of yoga and undid a lot of computer repetitive stress injury with it.. There are many natural ways to help.

  • sparklingsoul

    I took Ativan for 10 years due to Prozac side effects. I started Prozac (after trying all the other SSRIs, Buspar, etc.) for depression and anxiety and immediately developed severe insomnia, so my psychiatrist prescribed Ambien. I took that for several years, until it stopped working, then moved on to Ativan.
    Prozac stopped working about a year after I started taking it. It destroyed my libido, resulting in me being childless and single at age 45. I also found it so addictive (i.e. unbearable withdrawal) that it took me five years to wean off 20 mg. Within two months of stopping Prozac, I started weaning off the Ativan and discontinued its regular use within a year. Currently I take Ativan once or twice a month when my anxiety really flares up.
    Secondary moral of the story: Not only are SSRIs addictive (although the medical community will never admit it), they come with debilitating side effects that can mess up your life.
    Primary moral of the study: The judicious, monitored use of benzos is an effective way to treat severe anxiety. If a primary care physician doesn’t have time to closely monitor its use the patient should be referred to a psychiatrist.

    • querywoman

      An Ativan once or twice a month! Sounds safe to me! I can go weeks or months without needing a hydrocodone. But sometimes I get very painful skin lesions as it goes through a peeling-down process!
      My nurse nags me to take the hydrocodone when I need it. I stockpile it. I also hate the feeling after two or three days. But it really helps! I recently got a new script, which should last me a year or more, and will try to take it more!

      • usvietnamvet

        If you take the medication regularly many of the “side-effects” go away. One of the problems with pain is that many people take pain meds way past the point they should have taken them. It’s like pouring a glass of water on a huge fire. Opioids are much more effective when taken before the pain gets too bad. There is also evidence that our nerves learn pain if not treated.

        • querywoman

          Absolutely! I am a very lite user of hydrocodone. I stockpile, thinking maybe I’ll get a headache, etc. And I hate the goofy feeling.
          I recently went through a horrid spell with my skin. I went my dermatologist. We discuss itching a lot, but not my pain. He could see my serious pain. He gave me a new prescription for hydrocodone, which I haven’t even used. I took my old pills.
          After a few days on the hydrocodone, my pain began to ease, and I became more able to take care of myself and do my treatments. After about 5 days, and I could not take whole pills 3x a day, I was so goofy I place my hand too hard down on a restaurant table and knocked hot food on my friend.
          Since then, and it’s only been about a month, I have taken an occasional hydrocodone for light pain in chronic lesions that I live with, and have for years. It helps!
          As a very light user, I do need it occasionally. I am trying to take it more, since it really helps me function. My dermatologist will do an annual refill easily. His nurse said they could only do 30 days, and I told her it will last me a year.
          Have any new meds ever really replaced opium derivatives?

  • sparklingsoul

    Let me add that I’m in the unique position of being a licensed therapist who is also a drug rep. I’ve sold two drugs that have since been taken off the market. A blockbuster hypertension drug that I sold (along with its entire class of antihypertensives) is being investigated by the FDA for potentially causing cancer. Another drug that I sold had a new black-box warning added to the prescribing information each year. I’ve had the unfortunate experience of watching antipsychotics being sold off-label for depression 10 years ago, and now on-label for depression (talk about swatting a fly with a mallet).
    Every drug comes with adverse events. The best psychiatric drug for the patient is the one with the greatest benefit and fewest side effects, and this varies from patient to patient. The only people qualified to decide which drug that is are the psychiatrist and the patient, or the primary-care physician (if she/he has enough time to spend with the patient) and the patient.

    • querywoman

      Glad you posted. Blood pressure drugs are not harmless! What was that pain drug that has recently gone on and off the market?

      Benzos get such a bad rap! Seroquel might cause diabetes!
      The new extra strong, expensive antipsychotics should not be pushed for mild anxiety and depression!
      The older a drug is, the more we know about it. Alcohol and opium are the best examples! We know more about Valium than Prozac and Seroquel.

      • sparklingsoul

        I completely agree…the older the drug the more we know about it. I sell an old drug now, and doctors are all confident about its safety profile.

        • querywoman

          Such commonsense, Sparklingsoul! I have a friend who died of the very nasty ALS/Lou Gehrig’s. You know most meds are futile for that. He had a PhD in a hard science. He told me once that his doc wanted to put him on lithium. I pointed out to him that lithium had been around for years, and docs should be more familiar with it.
          Before his diagnosis, he had taken that newer pain med for a sports injury that has been taken on and off the market. He said he liked it. Not linking that to ALS, just commenting.
          I’m doing great on Victoza instead of insulin. Sometimes I fear it might be taking off the market like other drugs, but I’m soaring on it now!

          • querywoman

            Vioxx – I think that was his pain med.

          • usvietnamvet

            Vioxx was not a pain medication. It was an anti-inflammatory medication. I wish drug companies would stop labeling these types of medication as pain meds. .

          • querywoman

            Glad you jumped in, usvietnamvet! There are many drugs used for other types of pain, like Elavil for pain, etc. Don’t know much about vioxx, but apparently it was a kick@ss med.

  • querywoman

    I wrote about my clonidine reducing my autistic responses to stimuli and thereby, anxiety. Clonidine has a rebound effect on blood pressure. The family doc 1st prescribed it 2x daily and told me to take my BP midday.
    I got high midday BP’s due to the rebound effect, so we added a midday pill.
    If I were to stop the clonidine, I would get very high blood pressure quickly due to the rebound effect! But the docs want me to stay on clonidine 4ever. So do I.
    Is that not a withdrawal symptom?

  • querywoman

    An even better answer for docs to alleviate both anxiety and depression: help the patient get out of the job that’s killing him or her, that job that provides the salary and insurance money that pays you! Then help the patient during the transition time, refer to social services if necessary, perhaps send to vocational rehab, or encourage patient to apply for SS disability!
    But, since most docs work 80 hours a week, they can’t even cure themselves of overwork!

    • usvietnamvet

      Many alternative methods are more effective then drugs in helping people deal with a wide variety of psychological issues. Meditation can help you cope with a job that you’re not happy with. Growing up I was told that you didn’t have to like what you did and I’ve always worked. when I worked at jobs I hated I simply found joy in other aspects of my life. I think our expectation that our jobs have to be fulfilling is a bad thing to be teaching children. A job is something you do so you can afford to live. Even though I had plenty of jobs that weren’t very fulfilling I always found something positive about the job.

      • querywoman

        A reason I make a post like this is to remind doctors that jobs cause many health problems, while giving them their best-paying patients.
        Doctors need to realize this, and often need to find appropriate treatments for job-related health issues.

  • margolioth770

    Stress-related anxiety symptoms are in-fact under-reported. And the reality is that Family-Care physicians are on the front-line. I was one of 3 psychiatrists running a multi-cultured outpatient anxiety clinic at SUNY Downstate, Brooklyn. If anything Benzo’s are under-prescribed. Notwithstanding the value of the SSRI’s, and presynaptic Gabaminergic enhancers like valproate and lamotragine, nothing has yet been shown to be as effective as the Benzodiazepines in rapidly switching down an overactivated Sympathetic Nervous System.
    As far as abuse and dependence is concerned, for that minority group one has to communicate and caution patients about this risk. An attempt should be made to shift to longer -acting Benzo’s in patients with chronic anxiety.
    What concerns me is that physicians are not prescribing Benzo’s because of Big-Brother regulations. I think that’s more a result of conditioning. If you can demonstrate that you are within guidelines of safe practice standards Benzo’s
    are effective, inexpensive, and relatively non-toxic. Buspar is a placebo, and “stress kills”.

  • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

    I was given Zoloft for my GAD and panic attacks and it did not help so I weaned off it after 6 months. I had brain zaps while weaning off. I was stable taking .5 mg 1x ad day of xanax for 8 years till I started going through menopause. Now I might have Fibromyalgia along with anxiety.

    • querywoman

      Su, you seem to be currently experiencing a lot of those vague. hard to treat symptoms. I hope you find some effective treatments soon.
      In your trip to get these treated, have doctors demanded that you take blood pressure or cholesterol meds and do cancer screening? Preventive medicine when patients need real symptomatic treatment has been my major rant here!

      • http://www.facebook.com/people/Su-Camarrari/100000583910954 Su Camarrari

        No they haven’t demanded I take BP meds, my BP is in the normal range and my cholesterol is 199. There is no way they could justify prescribing those meds to me when my bloodwork all falls in the Normal range. I also had a cardiac workup and everything was normal except for my TSH level which went to 5.88 (H). I was just retested after taking Armour thyroid for 2 months and am awaiting results. They also tested antibodies to see if Hashimoto’s thyroiditis is involved. Ever since I started menopause I have all kinds of crazy neurological symptoms, neuropathy, etc……I had an MRI of the brain which was negative for MS. This has been going on for 3 years. I currently take between 1 – 2 mgs of xanax for anxiety. I used to only take .5 mg of xanax and wanted to taper off when the menopause symptoms hit me hard (like a Mack truck). My doctor didn’t want to give me Prempro due to my history of dvt during a pregnancy 20 years ago. I don’t have typical menopause symptoms (hot flashes) I have atypical symptoms of dizziness, off balance and muscle pain, also “jelly legs”. It’s a nightmare. I don’t know why this happened…..it’s ruined my life. I thought I had MS, still not sure if I do but my neuro said I probably didn’t have it since I passed the neurological tests they gave me and my MRI was negative……now I am wondering if it’s due to fibro…….I am very confused and sad. Could the low dose of benzos I had been taking have caused this to happen?? I also was given a benzo 20 years ago after I had a baby I had severe panic attacks, I believe my thyroid was acting up after the pregnancy approximately 9 months after giving birth. I only took it for one month….the panic attacks gradually subsided…….they came back about 10 years later during the perimenopause period I believe. Went through menopause 9 years later and the panic attacks got much worse……

        • querywoman

          I am not a doctor. Any kind of body disharmony can contribute strange pains, anxiety, etc.
          Yes, menstrual symptoms and menopause strongly related to thyroid problems. Sadly, most docs, including Ob/gyns and endos, usually dismiss it as psychological. If the thyroid tests look normal to them, then you have a mental problem.
          Your TSH is way out of range! Did you GP do a T3 or T4 as well? I just did lab work for my endocrinologist, and he requested TSH and T4.
          I think you do need to see an endocrinologist with that kind of TSH.
          I started on a medicine called clonidine, a blood pressure med, for a form of high functioning autism just before I stopped menstruating. Sometimes it is used for menopause. I have never had a single symptom of menopause.
          Clonidine has to be used carefully in nonhypertensives.
          I am just saying there are other meds that may help you, not necessarily mine. It’s hard even to find a good endocrinologist.
          GOOD LUCK!

          • usvietnamvet

            Many vague psychological and physical sx’s can be treated effectively with acupuncture and yoga. These are at least things that do no harm so should be tried. I was suffering from GERD and started both acupuncture and yoga which helped but what helped the most was drinking vinegar which increased the acid content in my stomach and stopped the GERD.

          • querywoman

            Or tai chi, or some other things. I undid a lot of computer repetitive stress injury with yoga, which none of my doctors suggested.
            I knew the answer in my own heart.

            I do hope Su finds something that works for her soon!

        • querywoman

          Su, it’s very difficult with most drugs to trace side effects back to them. The PDR and the info online has a staggering amount of side effects listed for almost every drug. When they do a drug study, they write down all symptoms people report.
          You have to talk to the people who prescribe certain drugs regularly to learn about the real side effects.
          I got diarrhea and real stomach “gripes” on Zoloft. I knew it was a drug reaction because I had had a similar problem with a large dose of iron pills. It felt exactly the same! Gripes!
          My mother had had stomach problems and had seen a proctologist. She had been on Zoloft a long time, and no one ever asked her about that.
          After I went off Zoloft, so did she. Her tummy trouble resolved. She went on Celexa like me.
          I don’t know much about neurology disorders and fibromyalgia. Unfortunately, a lot of pain is nonspecific, like many of your other problems. I had a long battle to get adequate treatment for many of my own problems. Good luck!

Most Popular