Bennzodiazepines include Xanax (Alprazolam), Klonopin (Clonazepam), Valium (Diazepam), Serax (Oxazepam), and so many more. They are great anxiety medications known to quickly calm someone down. But we need to take a serious look at benzodiazepine treatment and usage in our nation.
Why?
Ah, the famous question why. The reason is because chronic prescriptions of benzodiazepines lead to a dependence that we quite frankly don't know what or why such profound withdrawal symptoms happen? After a mere two weeks of taking a benzodiazepine daily, one is likely to feel withdrawal symptoms. After just months, one is likely to develop a withdrawal syndrome that takes months to cure.So what are we doing about it? Are we wrong?
These fundamental questions are critical if we want to improve our health care in this nation. Firstly, we have seen an increase in benzodiazepine prescriptions by over 300% in the past decade. Among veterans at a VA Hospital, nearly 60% are prescribed a regimen of benzodiazepines.Benzodiazepines are meant to be taken as needed for prevention of a panic attack. If this were how all patients used or all doctor's prescribed, we would have no problem with the usage of benzodiazepines as a relatively safe way to calm one down.
But sadly, doctor's often (unknowingly, to be fair) prescribe benzodiazepines as a regimen for a long term, without understanding the side effects of getting off.
What are these side effects?
Firstly, I am prescribed benzodiazepines and have been for over five years. I have tried to taper, including under a doctor's supervision (thrice) and had six seizures. Benzo withdrawals are pure hell. I can't begin to explain what happens. You get aches and pains, hallucinate, pupils so dilated you appear you are on crack, Hypertension, Irritable Bowel Syndrome, Nerve Damage, and diagnoses you feel are real but come back negative. Check out this one forum where they are discussed. Guys, there have been hundreds of noted side effects and science just can't explain it.The real problem is adequate tapering, or lack thereof.
IF YOU HAVE BEEN ON BENZODIAZEPINES AS A REGIMEN FOR OVER A YEAR, DO NOT EVER THINK OF COLD TURKEY OR GETTING OFF IN A MATTER OF DAYS OR EVEN WEEKS. ALWAYS SEEK A DOCTOR'S ADVICE BUT STUDY YOURSELF SOME INFORMATION FIRSTLY.eg. The common American approach to tapering one is by switching them to Klonopin or Clonazepam. This is a grave mistake as it is one of the more dangerous benzos. In fact, were I to taper, I would switch my Clonazepam to Alprazolam for a few weeks and then taper long term.
THE MOST PROFOUND METHOD OF TAPERING IS KNOWN AS THE ASHTON MANUAL.
What is that?
Dr. Heather Ashton of the UK is a notable researcher in benzodiazepine chemical dependence and abuse. She is one of the few doctor's to open a clinic to help taper people off of benzodiazepines. Using money from a few university grants and generous donations, she has studied the effects of benzodiazepine withdrawal syndrome and its profound effects on society.Benzodiazepines are not really old. And not many people know their dangers. The vast majority of people prescribed benzodiazepines are told to only take it as needed, and they do so; therefore, the drug is of absolutely no harm to them but rather extremely helpful.
HOWEVER, many doctor's prescribe it as a regimen and due to relatively recently light on withdrawing from benzo's, doctor's have just chosen to keep patients on them. In fact, Yale University recently came out with an article suggesting the DSM make changes to benzodiazepines, by 1. No longer prescribing regimens unless excruciating circumstances and after two antidepressants have been tried in conjunction, 2. When prescribing, for an as-needed basis only with smaller doses, and a smaller quantity. Eg. you get a script of 30. Sure, you just might take one a day because your definition of anxiety has changed because now your excellent sleep is a must, lest you panic. And 3. For those who are already on benzodiazepine regimens, keep them on it! Only increase the dosage minimally when absolutely necessary. Whether or not the therapeutic effects remain, it is like a diabetic with insulin. Your body needs it.
The Sole Greatest Changes We Can Make
a. Doctor's need to acknowledge the dangers of writing regimens and should therefore not do so unless one is on a regimen. IF THEY ARE, they need to stay on it for an extended period.
b. Doctor's need to practice a very slow, gradual taper by those wishing to get off. The Ashton Manual is the ideal method to get one off. The Klonopin method of tapering in the United States and for a time Canada has been an utter failed.
b1. Doctor Heather Ashton suggests that a very long taper be implemented. In fact, while I cited her online book, her newer edition says to make cuts every 2-4 weeks, not 1-2. Ideally, people should be prescribed Diazepam (Valium) and initiate a slow, listen-to-your-body technique.
eg. You are taking 6mg Xanax daily and have been for years. This equals 120mg of Valium. (While different per benzo, 10mg of Valium = .5mg of Xanax.) You should switch to Valium because
1. Valium has a much longer half-life. Contrary to Xanax's 8-12 hours, Valium can stay in your system for over 200 hours, helping to alleviate negative systems.
2. Valium comes in way different strengths. 2, 5, and 10mg, all which are incredibly small compared to other benzo's. (Eg. 1mg Xanax=20mg Valium, 1mg Ativan=10mg Valium, etc.) With Valium, you are able to get to the lowest of the low.
3. Since your dosing can substantially change, you have the opportunity to make very slow cuts, giving your body time to adjust. You can't do this with Xanax. After 12 hours, you are in danger. If you go from 2mg to 1.5mg overnight, expect major complications. Your body must take incredibly small cuts.
4. Valium has two active properties, giving you anxiety relief and long-term maintenance to prevent seizures and horrible withdrawal symptoms.
c. Doctor's need to re-evaluate the popular benzodiazepines prescribed. IF prescribed as needed, I see no harm in benzodiazepines. I think it is an error in judgement to prescribe 30 tabs a month, and I do not think .5mg of Alprazolam is really necessary as a starting dose when studies have shown lower doses being just as effective, BUT THE MEDICAL COMMUNITY IS LARGELY IGNORING THE SAFEST BENZO.... TRIAZOLAM!!!! Triazolam is a very, very short acting benzodiazepine, with such a short half-life the chances of getting dependent are near impossible. This is the purpose of benzodiazepines... To quickly eleviate a panic attack. Not to prolong 12 hours of glorious laziness, or 20 hours... But to quickly stop it in its tracks. Triazolam is one of the safest benzo's because its half-life is so short it's nearly impossible to become hooked. Yet it gets rid of that gut, blink of an eye panic attack that you had.
Do not get me wrong. This medication is generally indicated to put someone to sleep (though not keep one asleep) but it has the same properties as most other benzo's, and would be ideal.
d. Doctor's should listen to patients who have been prescribed benzo's as a regimen and not scrutinize, deny their validity, etc. Most of us, including me, are victims. I was given a regimen to take the first time I had a panic attack worthy of going to an urgent care. I didn't refill the script and had a seizure. I had never tried one until then and I was reluctant.
I want to eventually get off of benzodiazepines. But timing, place, patience, and practice are all critical. Also, doctor's are not dumb. They are rather seldom faced with tapering people who are chemically dependent to benzo's because most people aren't given as a regimen. Doctor's have long followed the Klonopin-taper method that has failed miserably. Therefore, we need to inform doctor's when we want to get off that we want to take it slow, and we shouldn't throw a book in their face... But we should maybe bring some literature, and scientific literature, and we should definitely bring literature from across the Atlantic (The US has yet to give a grant to a University for a mega-study on benzodiazepines and had it not been for donations, the UK wouldn't have had the data gathered today which has been the forefront of what we know.)
e. We have to stop blaming doctor's for lacking the education of addiction/dependence prevention when it is medical schools that lack the course materials in doing such. This is indicative and seen with antibiotics, ibuprofen, etc. It is proven that medical schools spend very little time on techniques to help chemically dependent patients.
What should we tell our doctors if we want to taper?
- We ask that we be switched to Diazepam and have frequent appointments/communication with doctors
- We ask to be referred to a therapist
- We ask the doctor to please be mindful of our situations and let us control our bodies. We cannot/should not commit to an exact taper plan that says "50 day taper" and stick to it to the dot. No. We may need to updose, we may need to wait a bit longer before decreasing our doses, or we may be lucky enough to speed it up.
- We ask the doctor to constantly monitor our pulse and heart-rate shall we need to be put on anti-seizure medications (eg. Trileptol is a good one; Gabapentin is known to help with withdrawals and to an extent seizures but not too effective with seizures. I personally discourage it as I've met people hooked on it after getting off benzo's but that's between you and your doctor.)
- We ask that shall we feel the need to reinstate, the doctor accepts such, but at first tries to simply increase our dose while being lower than the original. (eg. I was on 6mg. I am on 40mg diazepam. Maybe put me on 3mg, not back to 6!)
- We ask that shall our anxiety be so debilitating that we cannot function, a specialist or a doctor knowledgeable on the pharmacology of other medications may put us on, but we ask for acute purpose only.
- We ask the doctor to ultimately let us decide our benzodiazepine's fate, as we are victims, while respecting their urge to taper us.
- We ask for patience, possible alternative anxiety medications (hydroxyzine is a great one; antihistamine known to be better than the benzo Bromazepam. Buspirone never helped me but it could help you. Paxil is monumental in helping with anxiety though that I do not encourage SSRI replacements over benzo's.)
Lastly:
- We ask for open communication, and understanding. That we may have been short and rushed to the doctor out of fear that we would have a seizure. But this doesn't mean we are drug seeking or abusing.
- So we should consent to a quantifiable drug test at any time.
- We ask that shall we need to get on disability, the doctor can assist.
I am on a tipping point on whether or not I want to taper. But just know these facts.
AND DON'T FORGET TO CHECK OUT THE ASHTON MANUAL! REMEMBER, YOU CAN STABILIZE FOR HOWEVER LONG IT TAKES FOR YOUR NEXT DECREASE IN DOSE, AND YOU CAN INCREASE IF NEEDED, AND YOU NEED TO LISTEN TO YOUR BODY ALWAYS. :)
http://www.benzo.org.uk/manual/
Ashton Manual ^
Chapter II - A good how-to
Chapter IIb - A good conversion guide from one benzo to another.
Chapter III - Benzo symptoms from withdrawal, including protracted
Chapter I - How benzo's affect the body.
Best of luck to you if you are considering coming off. It is very noble of you and I hope to one day as well. Weigh your pros and cons. Any time you make a cut, take time to see that your body is able to operate machinery. Be open to your doctor, whether you abused or misused or were a victim. Take your time always. Always. Always. Study alternative medications shall you feel you need.
BONNE CHANCE!
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