My understanding is benzos were seen as a safer alternative to barbituates, which were easy to OD on while benzos are not.
However benzos can be highly addictive, I’ve heard several stories of people having withdrawal symptoms that literally lasted years when they quit taking benzos. Supposedly benzos can be anxiogenic over the long term.
I get the impression they aren’t prescribed much for GAD and other medicines are preferred for general anxiety, but as far as acute anxiety does anything work as well as benzos or have doctors moved away from prescribing them for acute anxiety too? I’ve had acute anxiety and had good luck with antihistamines, but I doubt they are anywhere near as powerful as benzos.
Basically, are doctors becoming wary of using benzos for chronic or acute anxiety, and if so are there alternatives for acute anxiety?
It is “safer” in the sense that it is a longer-acting drug than xanax. Longer-acting means fewer doses. Fewer doses, in theory, should lead to fewer over-doses (I say in theory because I have no idea what the real-world statistics are).
Many doctors don’t like giving them in my personal experience and for good reason. I had a hard time getting a prescription for them several years ago (several different versions) and it was a mistake to even start them. I didn’t become fully addicted but it was very difficult to stop once I started just because the withdrawal made me sick when I tried. I should have known better because my own grandfather died suddenly and unexpectedly from benzodiazepine withdrawal at age 55. I will never touch any version of it again because the benefits don’t last very long and the risk is too high for me.
There are other drug treatments for acute and chronic anxiety. I had much better luck with a beta blocker (propranolol) and I am a little mystified why it isn’t a first-line defense because it works really well, is generally safe and is non-addictive. It simply blocks much of the body’s malfunctioning fight or flight response so you don’t ever get overly anxious in the first place. It doesn’t make you high or interfere with mental function either. It is baffling why doctors don’t try something like that first instead of going straight to things like benzodiazepines that are basically the same as alcohol in pill form.
I work in a community mental health agency. Not only do we rarely start them on new patients, we’re working on weaning patients that have been on them for years off. I work in an area with a very high occurrence of opioid overdoses, and benzos can hasten an overdose.
Ideally, you would treat the underlying cause of the anxiety both chemically (preferably with SSRIs or SSNRIs) and with therapy. When we see people on intake, we attempt to make this prescribing practice clear, as well as the rationale behind it.
I know you’ve had good luck with propranolol for your anxiety. I’ve tried metoprolol and wasn’t too impressed by it, but metoprolol is cardioselective while propranolol is not, maybe that is why I didn’t see much benefit.
However I have used beta blockers to help with acute anxiety like a panic attack. That is more what I’m wondering. I know there are a ton of drugs that can help with chronic anxiety that lower daily anxiety and help prevent panic attacks. But what if you need something immediately? Your anxiety is acting up, or you have a panic attack? Other than benzos (and antihistamines) are there any options?
I think Patton Oswalt’s wife died from combining opiates with xanax.
My question though is does anything else really work for acute anxiety like an anxiety attack or if you are having a bad day for whatever reason and anxiety is acting up? Benzos are more for that, but they are starting to be seen as so dangerous that even using them an a PRN drug isn’t something some doctors will do.
What options are there for intense acute anxiety other than benzos and antihistamines?
Why lump them together? I think antihistamines are an option other than benzos. My gf deals with fairly severe anxiety and panic attacks. She has had surprisingly good results with antihistamines.
Therapy is the best long-term solution for acute anxiety, in my biased opinion (as a therapist). I recommend learning mindfulness and relaxation techniques. I personally like guided meditation. I’ve had panic attacks in the past, and they’ve always subsided on their own eventually, even if it was not as quick as I like. However, it’s not something I’ve lived with on a daily basis, so take that with a grain of salt.
There’s also some value in the “Xanax in the pocket” theory. Some clients do not want an entire prescription of Xanax (or other benzo), just one or two. Just having them available prevents panic attacks.
I think there are certain subsets of patients that benzos are ok for, but more and more often doctors feel the risk outweighs the benefits, so almost no one gets them. I’ve always doubted the efficacy of antihistamines (i.e. Vistaril), but I have clients that swear by it. As a plus, your allergies are better too!
Antihistamines can be pretty effective. I’ve even had good luck with something as small as half a benadryl tablet (12mg). The only problem is it takes a while to be absorbed and take effect.
The H1 histamine receptor seems to play a role in anxiety, so antihistamines can have an anti-anxiety effect.
Thanks for the info. I read over both of the links. I think the cynical part of my really thought the sedation was all the anxiety relief that came from antihistamines. Now I have been educated and will be able to explain this much better to my clients!
The curve in the actual article shows a fairly steady increase in both numbers of individuals prescribed to and amount prescribed up through 2013 as most recent data.
So according to the actual available data, no, it seems that doctors are not moving away so much, at least through 2013. Maybe it’s changed direction some over the past three years? Could be or could be not.
I was just prescribed Restoril due to having trouble staying asleep for more than three hours. After reading about it I decided to stick with my OTC antihistamine sleep meds.
Benzos are very dangerous. It has nothing to do with the presence or absence of the drug in your body. They do damage to the nervous system over time, and some taper over the course of years to get off them, and only then go for years hoping to heal.
This is a recent item on this and on why Drs “don’t believe” people who are suffering.
Also all psychoactive drugs may have a discontinuation experience that can lead to other drugs and Drs are only happy when they are prescribing. it all depends on the individual response to these things. There is no prediction…
These days benzos are getting a bad name, and Drs will try to avoid them. But try to find a Dr who will admit it was the benzo that destroyed someones life. Drs are caught up in their own web. You’re on your own, basically.
One alternative for anxiety is gabapentin. But you need to be very cautious in using any drug. Whatever you take you will have to come off of.
Long-time readers of the Dope will probably remember my personal benzo (Klonopin to be specific) horror story. I used it for anxiety; got addicted at a very low dosage after several months; horrific withdrawal that took me about 16 months, and even after that I didn’t feel quite right for another year or two. I spent 8 months living with relatives and another 8 months in a board-and-care home, and thinking at the time that I might be there the rest of my life.
I am now on Medicare with a major HMO. They won’t prescribe benzos. I’m told that Medicare forbids it now.
Benzos may be safe and effective for serious but short-term anxiety spells, like if you have a final exam coming up. But for long-term chronic anxiety, they are counterproductive and just end up making things worse. I don’t believe I’ve ever read or heard any convincing arguments that any other drugs are any more effective.
One Doper in another thread (I think it was Wesley Clark?) claimed good results with normal doses of diphenhydramine (Benadryl), but I’ve generally read that it usually takes much greater doses to be effective for anxiety.
