I attended a powerpoint presentation recently, given by a nationally renowned psychiatrist, who provided an excellent overview of modern day psychiatry in America. It was quite disturbing to learn that the most widely prescribed psychiatric drug is Xanax. More bad news is the Center for Disease Control and Prevention (CDC) reporting a sharp increase in fatal overdoses of prescription drugs. In fact, if you look at the top fifteen most prescribed psychotropic drugs, you will find Ativan (at #3), Valium (#8) and Klonopin on the list as well. If your regular doctor is prescribing them, they can’t be all that bad, right?
The History of Benzodiazepines
Many of you reading this article may not know that all four medications are classified as “minor tranquilizers” and are from the same family of drugs, called benzodiazepines. The first “benzo” sold in America was Librium in 1960, followed quickly by Valium, which was the number one prescribed psych med for most of the 1970′s and is still high on the list. When Xanax became available in 1981, it was marketed as the best drug for panic attacks. Certainly Pfizer did a great job of marketing, making Xanax the big winner–the most popular psychiatric drug in America–but is this really the best treatment for anxiety?
Some of you who are reading this article may currently be taking one of these drugs as prescribed by your doctor. I am a psychotherapist, not a doctor, and I am not offering medical advice here. Rather, I am offering information so that you, as a consumer or interested family member, can have more facts at your disposal. Unfortunately, hugely expensive, clever commercials flash onto our screens daily, touting one promising drug or another for various psychiatric conditions. Given how debilitating anxiety can be, it is no wonder that we reach for something, anything, to fix it.
Without going deeply into the chemical composition of benzodiazepines (such information is readily available on line), they offer short-term sedation, muscle relaxation, seizure prevention, and anxiety reduction. Xanax (also known as alprazolam) and Ativan (lorazepam) are short-acting, usually providing temporary relief in 15-30 minutes. Klonopin (clonazepan) and Valium (diazepam) are longer-acting. In general, benzodiazepines are safe and effective in the short term when used as prescribed. What is highly controversial is their long-term use for anxiety disorders, and whether or not they should be the first line of attack for the anxiety that often accompanies depression.
For people who can’t get on an airplane without breaking into a cold sweat, the use of this form of medication is a life-saver. One of my clients (who had not taken any drugs) recently told me that one of the flight attendants told her she should take Valium next time because she was making everyone on the airplane nervous. Medications like this are used routinely for surgical procedures where the doctor wants the patient awake but not anxious. After a traumatic event or loss, the use of short-term anti-anxiety agents can be the only way some people can get any sleep. These are just a few of the appropriate uses of these medications.
There is a dark side to this story. First, all benzodiazepines are addictive and have the potential to be abused. They are known by street names like zannie bars, school buses, white ladders, totem poles, tonka toys, and zanners. They can lead to a physical and/or psychological dependence. If dependence develops, it can be extremely difficult for a person to stop using the medication because withdrawal symptoms may occur. Typical withdrawal symptoms include sleep disturbances, irritability, increased nervousness, and muscle cramps. If someone has been abusing them at high doses, the withdrawal effects could include psychosis, epileptic-type seizures, coma, or even death.
From the reports of doctors working in rehab facilities and from the self-report of dozens of clients I have seen, they say it can be more difficult to get off of benzo’s than to detox from heroin. They wished someone had warned them before they began long-term use of these meds. There are some excellent resources if think you might be addicted and you want to know more about this topic. That being said, never stop taking any psychiatric medication suddenly or without the supervision of your doctor.
Another important fact is that when Xanax is combined with alcohol or many other drugs, its effects are magnified. We all know the dangers that come with drinking and driving, or other ways that drugs can impair judgment. Given that the benzo’s can affect physical coordination, they can be particularly dangerous for the elderly. They can also interfere with memory–I have worked with college kids who have suffered blackouts from the mixing of alcohol and benzo’s.
Third–and perhaps most importantly–there are other effective treatments out there for panic attacks, and these treatments are not dangerous or addictive. Panic attacks and other anxiety disorders are usually treated successfully with psychotherapy and when medication is needed, with safer, non-addictive antidepressants. Another important component of good treatment is the education of both the patient and significant others. The cure of panic disorder involves the sufferer understanding that the panic attack itself, although horribly uncomfortable and frightening, is not fatal and will ultimately end.
In order to recover completely, the panicking person must remain in the phobic situation long enough for the panic attack to lessen on its own. Learning that you can face a feared event–and conquer your fear–is a turning point. If instead, you simply pop a pill, you might think that only the pill will bring relief rather than learning effective strategies for self-soothing and breathing through the discomfort.
Studies have shown that Americans report higher levels of anxiety than most anywhere in the world. Can that really be true? We are certainly not the only nation that is overwhelmed with problems. In fact, we have more wealth and resources than most. So why have we become a nation with millions of Americans being tranquilized artificially? Is it possible that we have begun to confuse real cases of anxiety–a painful diagnosable disorder–with the normal, inevitable pain of being human?