It is very important to note that benzoiazepines are often given as a regimen to patients suffering from chronic anxiety even in light of growing skepticism. Benzodiazepine prescriptions as a percentage have significantly decreased and are widely cautioned by the FDA and ill-advised to give as a regimen by the Surgeon General. Over the years we have seen many practices ban prescribing benzodiazepines altogether. The growing worries over benzo's lie in their addicting nature and withdrawal symptoms which are profoundly similar to a very strong case of Somnolence. Despite the limited studies on tapering methods that widely relay the need for a very long-term weaning of the drug in small increments, the American method of taper is still using Klonopin in a relatively short term.
Currently in the United States, despite efforts to seriously criticize psychiatric practices, benzodiazepines are accepted among the majority of medical practitioners if prescribed in a very limited, as needed bases. Most benzodiazepine prescriptions are not meant to be taken as a regimen, and there is a rapidly growing amount of doctors who are ceasing prescribing benzoiazepines altogether due to its withdrawal symptoms.
However, it is false to believe most psychiatrists or medical practitioners give regimens out as a widespread and accepted method, which is commonly believed by the general public. While many doctors indeed still prescribe regimens, it is not the first choice and withdrawal symptoms are unknown to the one prescribing. Doctors who write regiments will often not have to encounter tapering a patient because they allow the patient to stay on the dosage, especially for pallutive care.
Prescribing benzodiazepines for an as-needed basis only and not a regimen should be accepted by the medical community and become the norm for all practices. Right now, there is no consensus and the DSM-V does not prohibit a regimen, the military largely gives regimens to patients, yet there are some psychiatric emergency units that won't even carry them for emergencies.
The reason many doctors are pushing away from prescribing habits altogether is due to the growing number of studies and patients seen with withdrawal symptoms, something not recognized before. However, the mistake in this practice is an over generalization and distrust that patients will take their medications as indicated. Benzo's are great anxiolytics and more effective than SSRI's/SNRI's. A regimen is problematic and in light of data, is unethical to initiate.
Many patients who have been prescribed a regimen of benzodiazepines are stuck in a bind now; their new doctors may not prescribe or may require a taper that is ill-advised to the knowledge of those who have gone through one.
What do we do then?
Cutting to the chase:
Instead of providing you with more history or explain how benzo's work, who gives them the most, etc, all you need to know is this: Benzodiazepines are a group of anxiolytic drugs, meaning they are drugs to treat anxiety. From Generalized Anxiety Disorder to Panic Disorder, Benzo's have been a go-to drug since the late 60's. Doctor's prescribe benzo's in usually one of two ways; many doctors will write a regimen script if an antidepressant has failed, or they give it as an as-needed medication that should only be taken in the time of a huge panic attack or really bad anxiety. Many are scared of flights and will be prescribed just a few to take before their flights. Before procedures benzos are often given. And for those who stress a lot, a bottle of Xanax is usually not far.
There is not a problem with taking as needed and doing such shall not cease as there is no evidence of harmful causes due to it. However, doctors often give prescriptions of doses higher than needed and give a quantity of 30. By giving 30 tablets, one may be inclined to take the benzo daily and quickly redefine what anxiety means to them if they find it helps so much. Therefore, doctor's should a) give less than a quantity of 30 as a means to ensure the patient knows it's not a daily med, b) will start patients on lower doses c) will evaluate what type of benzo they give. Doctor's should not write benzodiazepines as a regimen anymore unless extreme circumstances call for it and mental health practitioners should have better literature, including in the DSM, defining appropriate benzo use. Those on a regimen now have been put in a position they did not expect nor their doctor. Having such elongated withdrawal symptoms is a shocker and unseen by many. For patients on a regimen, doctor's should have no limitation or legislation requiring them to get off but should rather focus on keeping the dose the same with only minimal increases through ones lifetime. A taper should not be forced because the patients often would be forced to undergo a quality of life for several years incredibly hard and even dangerous. So long as those on a regimen can stay, doctor's should not be subject to punishments unless they neglected information to the patients. Patients were victims of a pill but knowledge of its potential dangers has been available and one cannot put sole blame on the doctor for the lack of knowledge. Benzodiazepine Withdrawal Syndrome should be recognized and benzo regimens should be a thing of the past. But benzodiazepines are widely effective in treating excruciating situational anxiety that is the exception. This situational anxiety should be complicated to the extent that it affects ones quality of life.
Sum:
- Patients already on a regimen have the right to stay on it shall they wish so long as the doctor keeps the dose steady and seldom increases it
- Regimens should not be allowed anymore
- Greater study into tapering methods needs to be evaluated
- Benzo's as an as-needed medicine are okay but to ensure patients know their boundaries, it is essential that a) quantity is very few and b) dosage is smaller.
- We have to find something safer because while benzo's work great, the threat it imposes on people who may be forced off immediately can be devastating and unethical.
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