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bonkers for benzos

getting to know the benzos
last week, i blogged about psychiatric medications that are rarely (or, if you're in canada, never) prescribed, despite evidence that they are effective. as a counterpoint, i thought i'd write about a category of drugs that i find to be frighteningly over-prescribed: benzodiazepines. these are the drugs that are most likely to be handed out if you go to your doctor to complain of anxiety, stress, sleeplessness, recurrent headaches, generalised pain... well, put it this way: there are a lot of things that are likely to get you a prescription for benzos.

librium, the original benzo, was discovered in 1955, but was originally thought a disappointment. however, further testing and refinement resulted in a marketable drug, first made available in 1960. despite some concerns over the poorly-understood long-term effects of the drug and the potential for abuse, benzodiazepines were a marked improvement over their predecessors, the barbiturates (which, i discovered today, is a word i've been misspelling and mispronouncing my entire life). barbiturates had been the go-to medication to basically cure anything resembling a state of stress or even wakefulness for the first half of the century, but it was widely known that they were prone to abuse and that the stressed patients who took them had a tendency to use them for suicide. plus, of course, there were a number of soldiers in world war ii who were given "goofballs" to help depress their respiratory system, making it easier to work in the subtropical conditions of the south pacific (and probably making it a heck of a lot less stressful to risk their necks at war). the drugs seemed reasonably effective, but it unfortunately lead to a lot of pill-popping zombies coming home from the war, who were either forced into lengthy rehabilitation, or who continued as they were, leading to a widespread problem with barbiturate abuse in the post-war years. compared to that record, these spiffy new benzo drugs seemed like a good deal.




as occasionally happens, the launch of this new wonder drug caused a bit of a stampede. everyone had something that could be cured by a benzodiazepine. most will be familiar with the rolling stones' ode to the "mother's little helper"- an improvement on librium called diazepam, aka valium. and the more the drugs were used, the more data on the potential pitfalls emerged.

while certainly less problematic than their precursors, benzos are addictive and withdrawal can be extremely difficult. although not approved for long-term use (because of their addictive potential), many people do continue to use them (and doctors continue to prescribe them) on the understanding that they are to be taken only on an "as-needed" basis. there is limited data on the prevalence of benzo abuse, it is known to exist and, while it is rarely a drug used as a "first choice" it is often abused by patients who are already abusing alcohol (one of the indications for benzos is in managing symptoms associated with alcohol withdrawal) or other drugs. and in the long term, there is evidence (although it falls short of proof) that benzos can start to cause things like anxiety, depression and insomnia (which sort of defeats the purpose of taking them, most of the time) and so-called "paradoxical reactions", meaning they make you tense, aggressive and, as an added bonus, more likely to end a party making out with your best friend and wearing a lampshade on your head, since they can cause "lowered inhibitions". what's worse is that benzos work as anxiolytics (anti-panic meds), because they slow your brain down, which makes them cause something whimsically termed "cognitive impairment". in layman's terms, the more you use them, the more likely the chances that they'll leave you as stupid as a bag of hammers.

interestingly enough, the trend in development has not been towards combating the side effects of these drugs, but in making them stronger. the current market king, ativan, is exponentially more powerful than its antecedents valium and clonazepam (which is still used to sedate psychotic patients, so it's not like it's children's aspirin or anything). and ativan is routinely doled out to people for stress and sleeping problems- often without further investigation. (note: ativan is not approved for therapy lasting longer than 8 weeks in the u.s. or 4 weeks in the u.k., but that doesn't mean there aren't ways to get around the rules...)

chemical structure of a benzodiazepine
at the top of the benzo pyramid are drugs like xanax- termed the most frequently abused benzo in the united states- and halcion, which is powerful enough as a hypnotic drug that it's only use is as a sleep aid. their powerful effects and potential for abuse don't stop doctors from doling them out- xanax as a first line treatment for panic attacks and halcion as an anti-jet lag drug for frequent travelers.

as you've probably guessed, i'm not a huge fan of benzos. i find that they are moderately effective as  pain relievers for my chronic neck and upper back pain, if only for the fact that they are much more easily expelled from the body than the cocktail of non-steroidal anti-inflammatories (mostly naproxen) and muscle relaxants, so they don't leave me with that nice "zombie head" feeling the next day. (that said, they're also not really as effective, so it's a trade-off.) as for panic attacks, i find them completely useless. i had xanax prescribed to me as a first-line med to control severe anxiety attacks and found that they had the charming effect of completely sedating me physically, while having no effect mentally. so i was panicking and paralysed.

given my own experience, i'm surprised that benzodiazepines aren't used more often as pain medication. yes, they're addictive, but pretty much all pain meds are, whereas there are better options for the management of anxiety disorders. both valium and the lesser known oxazepam are lower-intensity benzos that still help muscles relax.

another interesting purpose to which they might be applied hinges on a promising, but so far unproven medical theory. one of the lesser-known properties of benzos is that they are actually effective anti-convulsants, effective enough that they are often used for the management of epilepsy in animals. they are used for epilepsy in humans as adjunct therapy, useful in the relief of seizures in progress, but are ineffective as monotherapy (i.e., by themselves). however, some scientists have posited the idea that migraines may actually be a mild form of epilepsy. no one has ever been able to prove the link, but no one has any other viable theories as to what causes migraines either. in fact, despite being a fairly common condition, migraines are poorly understood and the treatments available for them- usually harsh drugs developed for other purposes- are hit-and-miss at best. in this case, it would seem that it would at least warrant clinical studies to see if benzos showed promise as migraine therapy. as far as i know, none are being conducted.

if you've been prescribed benzodiazepines, or if you are considering them as therapy, here are some resources for you to do your own research. please keep in mind that a) this is not an exhaustive list; b) i'm not a medical professional and have no training in medicine or pharmacology; c) chances are you aren't an expert either; and d) not all conditions require medication, so you should discuss any additions, adjustments and/ or changes of meds, as well as other options that might be available to you, with a medical professional.

list of benzodiazepines with comparative dosage chart
info sheets for xanax, ativan, valium and clonazepam
an article on xanax abuse and addiction- sadly short on stats, sorry
an article on ativan abuse and addiction- comes from narconon
interesting piece on the effectiveness of the natural remedy kava- produced by the association of natural medicine pharmacists

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