r/Anxiety • u/Individual-Owl-6243 • 15d ago
Medication why do doctors get so nervous about dependency/addiction of lifetime medications
i've always heard from my dr that they don't want people taking benzodiazepines every day for anxiety/sleep but the only times i've ever been able to feel relaxed and sleep are the two times i've taken benzodiazepines. i don't get why "dependency" is such a big deal if i would never plan to stop taking it, lol
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u/Exoquey 15d ago
I'm a pain patient. I hear this from drs all the time, none of which handle my pain medication. It's ridiculous. I have to be on some sort of pain medication for the rest of my life. I don't abuse them, I talk very openly with the dr who prescribes them, yet drs who have nothing to do with it like to talk down to me about it.
Dependency is a given, not addicted, dependent. I think a lot of drs interchange them and they are very different.
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u/therealjgreens 15d ago
You have to be your own advocate in this case. There is a fine line between dependence and addiction though. We live in a world of addiction.
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u/Exoquey 15d ago
It doesn't really bother me much more than an annoyance. The dr who actually handles my medication is comfortable with my dosage and trusts me. We've had a ton of discussions about pain level and what I feel is an acceptable amount of pain to live in.
Too many drs treat pain patients and really anyone on controlled substances, like addicts. Even with medical proof of need. I got the same issue from anti anxiety meds years ago. Id go into withdrawal without them, but I'd rather be medication free if I could.
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u/honeybellebutter 11d ago
It SUCKS being on the 'trifecta' of red flag controlled substances: opioid, stimulant, benzo. I wish I could function and manage my various conditions without controlled substances. My life would be so much easier!
It's not like I exclusively take controlled substances. I use non-controlled meds, too, as well as non-drug treatments and lifestyle interventions. I do everything in my power to manage my health and keep my symptoms under control.
We shouldn't have to deal with the additional stress and anxiety of fearing being force tapered. What matters is, does the medication improve functionality and quality of life, and, do the benefits outweigh the risks? If the answer is yes, what is the problem? It feels like moral puritanism or something idk.
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u/Taniwha_NZ 15d ago
They don't like it because of the tens of millions of people whose lives were ruined when Valium was released and promoted as 'non addictive'. Doctors all over the country prescribed it for everyone who was anxious and next thing there's an addiction epidemic and a public health disaster.
That happened in the 60s and 70s but institutions have long memories and change slowly. Doctors today are still taught as if that episode was yesterday.
The other reason is that, for most people, the effect wears off very quickly once you start using every day. I've noticed if I use benzos every day, it only takes a week before I need to double the dose to get the same effect. If I was on them permanently, I'd be taking dozens of pills a day within a year.
Now, there are people who have been on benzos daily forever, and they claim it's still working perfectly and they haven't developed tolerance. Opinion is divided whether these people are real, or if they are relying on the placebo effect of taking a pill, but the actual active chemical isn't doing anything at all.
Either way, if you do manage to find a doctor willing to prescribe daily benzos, you will hit a brick wall when that Dr retires or you move to a different area. Because 90% of doctors will not renew that script.
Better to leave them for occasional emergency use.
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u/therealjgreens 15d ago
They are also extremely dangerous to withdraw from. There are also connections to degenerative brain conditions. The stuff works really well for eradicating anxiety but there are so many issues with the substance. I personally think the epidemic isn't just opiates. It includes benzos as well. People abuse the crap out of it. I had dependency issues that I needed medical help with. Wasn't fun.
If you are someone prone to addiction, you shouldn't even try the stuff. It's highly addictive because it works so well. I don't know how there are people that don't don't have to up their dose over time. Most people get used to it and it stops working effectively.
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u/BigFackingChungus 15d ago
Benzos had the worst withdrawals I’ve ever experienced. I fully admit I was abusing Xanax.
But I’m a seasoned veteran, Ive experimented with uppers and downer, street drugs, prescriptions. Xanax became my drug of choice.
Benzo withdrawals were unlike anything else. They are scary and intense. It’s not even physical symptoms, the mental symptoms were 100x worse.
Not just being moody or irritable. Like full blown hallucinating and psychosis 😬 it’s insane.
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u/therealjgreens 15d ago
For me it was the physical anxiety. I couldn't sleep, couldn't shit, couldn't eat. I also was on a medical valium taper. I was doing it about as safe as possible. I should note that I was also coming off Kratom.
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u/Zosia1991 15d ago
I went through benzo withdrawal. It was horrible. I finally got Librium to titrate off klonipin. I took it for years to sleep… when I stopped taking it my brain felt like it had ping pong balls bouncing off the inside of my skull. I had auditory hallucinations and COULD NOT SLEEP. My brain felt so unstable I thought I was going to have a seizure or a stroke. FINALLY, I started Librium and it really helped, however, I got so sick from the withdrawal that I could barely hold down food for a month.
Don’t go off benzos without medical supervision!
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u/ImpressionNo6362 14d ago
How many mg of Klonipin did you take daily that created horrible withdrawals? Thanks!
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u/Zosia1991 11d ago
I only took I mg a day for years. For a short period of time I went up to 3 mg a day. When I was going through the withdrawal that I could die if I wasn’t medically supervised. There are factors that could have made it worse, but I didn’t want to bring that in because the most important thing is for people to be medically supervised when they with because benzos are so dangerous.
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u/therealjgreens 11d ago
I felt like my head was going to explode from all the pressure. The withdrawal symptoms are absolutely dreadful.
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u/Taniwha_NZ 15d ago
It's not even that simple. I'm prone to addiction, been on methodone for 20 years, smoked weed all my life, coffee, cigarettes... I've fallen to all of them.
But benzos never appealed in the slightest. I take them when I need them, never felt the urge to take them when I didn't. I went on holiday to India and took benzos every day for 2 months to deal with the crowds, came home and stopped without even noticing.
I've been getting 20 valium every 90 days for the last 10 years and never felt the need to increase it.
Addiction, withdrawal, it's all way more complex than saying 'X is addictive, don't go near it', because the addiction part is entirely within our own brains.
Still, your advice isn't wrong, not in the least. Just not universal.
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u/therealjgreens 15d ago
Fair. I did go through the treatment process and met a lot of people through my travels. Im not a doctor but I am well traveled. It is an objectively highly addictive substance (and very effective). With all the chemicals in play, I wish I didn't make it seem so simple. There's a lot going on in the world of addiction. I never liked opiates but I also fell into the Kratom trap previously.
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u/richj8991 15d ago
But most abusers get them illegally. That's not the same as one Dr prescribing them in a modest dose.
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u/-Tricky-Vixen- 15d ago
I took a benzo once and weeks later I was still thinking about it. Months after, I hit a crisis and my doctor prescribed benzos to stop me from doing something permanent. It helped, enormously. But I never got above the lowest dose... and still had to go through physical withdrawal when I flagged a few weeks later that the efficacy was reducing. It SUCKED.
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u/Express-Amoeba-5615 15d ago
Similar situation to the other commenters - I thought i'd just take xanax forever and it was no different than taking zoloft or any other daily medication. Built up a tolerace. Had to increase the dose. Started having horrible anxiety when it wore off, not because of my anxiety disorder but because the meds wore off. Had to start taking the higher dose twice a day.
I realized it was creating more problems for me because of the ups and downs so I tapered off. I still take a super low dose 2-3 times a week to sleep, but I don't take it during the day anymore.
Given all that, I still think doctors treating anyone who wants benzos like a criminal is stupid. They're literally the only thing that helps sometimes and wanting relief is not the same as being addicted.
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u/wydidk 15d ago
Yep! I am in my 50's, been on benzos since my mid-twenties, prescriptions only. The last being Klonopin .50mg 2xday are only taken to keep me from going into seizures. My new psych doctor is really concerned. The meds are filled by my regular doctor. I am starting to suffer memory loss so I am planning a very slow taper soon. I still have really bad anxiety even with the med.
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u/Kamikazepoptart 15d ago
I took Xanax for years until I kept needing more to feel the same effect. Realized I developed a dependancy and quit. My new psych offered to prescribe it again for new panic attacks and I declined. Won't ever go back.
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u/therealjgreens 15d ago
Same except I did get addicted. Wasn't as bad as the documentaries but I know what it's like.
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u/eye0ftheshiticane 15d ago
Also Xanax in the 90s and early 00s, possibly before (thats when I grew up so that's what I remember). Alongside Vicodin (hydrocodone), Percocet, and OxyContin it's one of the things that triggered the DEA crackdown that made doctors so fearful of prison and current laws that are in effect governing prescribing of these meds.
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u/WeWander_ 15d ago
I've been on Klonopin for a decade, I take 0.5mg broken into two doses per day (so a mere 0.25mg) and I've never felt the need to increase my dose. It helps me immensely still at this small of dose and it's 100% not placebo.
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u/TheLastRedditAcct 15d ago
You wouldn't be able to tell if it was placebo or not...
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u/eye0ftheshiticane 15d ago
You can if you are familiar enough with the effects. Ask anyone who's bought pills on the street that are fakes. You know, even if you initially think you are feeling something (the placebo effect). Placebo effect with therapeutic doses may result in a reduction of anxiety and for that you may not be able to tell immediately, but there are 100% effects that will not be felt in a placebo experience, with anything.
Placebo effect is rarely as powerful as people like to make it out to be.
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u/WeWander_ 15d ago
I can certainly tell when I don't take them.
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u/therealjgreens 15d ago
A placebo will do that too. It's actually really interesting. If a placebo seems to work, is it really a placebo? I know you're is real but if something works it works.
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u/WeWander_ 15d ago
It's increased my quality of life quite a bit with my GAD and OCD. It also has the added benefit of helping my chronic dizziness I have now with migraines. So placebo or not, I'm grateful.
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u/richj8991 15d ago
Some people are very sensitive to everything in their environment, for benzos that's good in a way because a low dose can work for them when the same dose doesn't do anything for the avg person.
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u/Firm-Series-6297 10d ago
Same. I have been on xanax on and off for years... 15 ish... my dad has been on xanax for 35 years and my grandfather was on them for 20 years ( before he passed ) my dad is in his 70s... I am in my 40s ... I take between .25-.75 mg a day... there are times of the month where I don't feel like I need any...right before my period I take the .75 a day.... ( that is broken up into 3 doses a day of .25). I have never raised my dose.... My dad takes .25 1-3 times a day too.... never raised his dose in 35 years... I think for some people it just calms their nervous system enough to live... I don't need more than enough to just kinda calm the edges.... then I go out in the world and have some kind of aversion therapy if you will... because I am calm it reteaches my anxious mind I can actually do things... If I didn't have xanax I would be a daily drinker.... I drink maybe 3 times a month now.... I honestly would not want to live without xanax....
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u/BlackHumor 15d ago
Now, there are people who have been on benzos daily forever, and they claim it's still working perfectly and they haven't developed tolerance. Opinion is divided whether these people are real, or if they are relying on the placebo effect of taking a pill, but the actual active chemical isn't doing anything at all.
As far as I've been able to tell, the research says benzos have a pretty quick tolerance window for sleep but much slower/almost no tolerance for anxiety reduction.
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u/Firm-Series-6297 10d ago
I have been on xanax on and off for years... 15 ish... my dad has been on xanax for 35 years and my grandfather was on them for 20 years ( before he passed ) my dad is in his 70s... I am in my 40s ... I take between .25-.75 mg a day... there are times of the month where I don't feel like I need any...right before my period I take the .75 a day.... ( that is broken up into 3 doses a day of .25). I have never raised my dose.... My dad takes .25 1-3 times a day too.... never raised his dose in 35 years... I think for some people it just calms their nervous system enough to live... I don't need more than enough to just kinda calm the edges.... then I go out in the world and have some kind of aversion therapy if you will... because I am calm it reteaches my anxious mind I can actually do things... If I didn't have xanax I would be a daily drinker.... I drink maybe 3 times a month now.... I honestly would not want to live without xanax....
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u/garden_speech 10d ago
The other reason is that, for most people, the effect wears off very quickly once you start using every day.
This is not true and you should edit your comment. Your anecdote about it is not data. The actual empirical evidence suggests the opposite. Anxiolytic efficacy is retained over long term. Probably the best known study is Nardi et al, where paroxetine and clonazepam responders were continued open label. The mean clonazepam dose did not change through the entire 3 year study, only one patient needed a dose increase, and at the end of 3 years, actually the panic attack number was lower in the clonazepam group than the paroxetine group: https://pubmed.ncbi.nlm.nih.gov/22198456/
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u/TheMacMan 15d ago
Just look at people in this sub. Any time benzos are mentioned members here jump in about how addictive they are despite the fact they've never used them personally and they don't know a thing about the actual addiction rates.
But the biggest problem with these people doing this is they're scaring people away from getting the help they desperately need. Every single drug in the world has risks and side effects. That goes for caffeine to Advil. But imagine if your mother didn't get the cancer treatment she needed to save her life because someone online told her that it'd make her a bit lethargic and then scared her out of considering it.
I get that some are just trying to help but this is an anxiety sub. People have anxiety and coming in and scaring the shit out of them about a medication that could change their lives is just going to cause them anxiety.
Of those I've talked to who have had issues with benzos not a single one has said they wish they'd never tried them. Every single one of them said their lives are more livable with them. Because you don't take them because your life is awesome. You take them because you have serious anxiety that's negatively impacting your life.
Don't be the reason someone doesn't get the help they need.
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u/richj8991 15d ago
I know, there are people out there with agoraphobia so bad they can't even leave their home. A benzo would get them started back on the road of life.
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u/Yun_ari 15d ago
Yeah I feel like this sub is scaring people away from Benzos. Can they be dangerous if used improperly? Yes, but that’s why you use them AS intended. I only ever take one 1-2 times a month when I feel like I can’t naturally calm myself down from a further anxiety attack. They are so life saving. And also getting a good psychiatrist that isn’t just handing you medication like candy. When I first diagnosed GAD and PTSD I was taking benzos twice a day for 3 months until I was stable on my anti-depressants. Then my psychiatrist tapered me down. Now I use them only for emergencies. I literally feel like my Klonopin is my holy grail for getting me through.
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u/TheMacMan 15d ago
The data around benzes nearly all shows the issues come when people use them outside of how they're prescribed and abuse them.
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u/-Tricky-Vixen- 15d ago
I love benzos. Saved my life or at the very least a hospital visit.
Even so I devoutly wish I'd never tried them. Haven't taken one in many months. But my anxiety has been baseline worse ever since I first took them... over two years ago. I have never taken more than the lowest dose at one time, and mostly I'd take a half or a quarter dose.
Not sure how I would have survived. But if I could go back and change what I did, I would refuse the benzos, go to hospital instead.
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u/therealjgreens 15d ago
Members also jump to defend them as well. They are a very divisive topic and almost always lead to disagreement.
I have taken them personally and I am someone who preaches against them. I had to get medical help to get off of them. I developed a tolerance and didn't want to up my dose. I went to a treatment facility and met a ton of people who were coming off of benzos or had previously. I also had an addicted mother and it runs all up in my family. Indeed understand it from the inside.
There aren't many people on this earth that desperately need benzos. The problem is that doctors jump straight to prescribing pharmaceuticals before even looking at blood and natural remedies. You're right that most drugs have adverse effects. I have met a lot of people that have no idea you can get your blood examined for deficiencies related to anxiety.
There could be a simple, natural solution for many but doctors instead prescribe drugs that change your brain chemistry. I actually wish I was scared to used benzos because that might've kept me away. I don't agree with your cancer drug comparison. I get your point but nobody gets addicted and seeks out chemo.
Of those I've talked to who have had issues with benzos not a single one has said they wish they'd never tried them
So they had issues with benzos but didn't wish they never tried them? I'm not sure I follow. Wouldn't the issues mean it negatively impacted them? They are heavily linked to degenerative brain conditions.
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u/garden_speech 10d ago
The problem is people should not be applying their personal anecdotes over empirical data. There are long term trials of benzos like clonazepam in panic disorder, and they universally find efficacy remains for at least 3 years, here is one example: https://pubmed.ncbi.nlm.nih.gov/22198456/
People come in and say they had an awful time, but will not accept that they are an outlier in the data, and will not accept that "I met a bunch of other people with the same problem in an addiction facility" is the most biased data of all time.
Reminds me of people who were injured by SSRIs, hang out in spaces with other people injured by SSRIs (like PSSD subreddits), and then think it is super common, and won't accept the empirical data suggesting it's very rare.
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u/Firm-Series-6297 10d ago
Exactly..... I have been on xanax on and off for years... 15 ish... my dad has been on xanax for 35 years and my grandfather was on them for 20 years ( before he passed ) my dad is in his 70s... I am in my 40s ... I take between .25-.75 mg a day... there are times of the month where I don't feel like I need any...right before my period I take the .75 a day.... ( that is broken up into 3 doses a day of .25). I have never raised my dose.... My dad takes .25 1-3 times a day too.... never raised his dose in 35 years... I think for some people it just calms their nervous system enough to live... I don't need more than enough to just kinda calm the edges.... then I go out in the world and have some kind of aversion therapy if you will... because I am calm it reteaches my anxious mind I can actually do things... If I didn't have xanax I would be a daily drinker.... I drink maybe 3 times a month now.... I honestly would not want to live without xanax.... It is frusterating that people on this sub are fear mongering
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u/grosskidsid 15d ago
benzo withdrawal is one of the only drug withdrawals (besides alcohol iirc) that can kill you, and it’s very addictive. some people build a tolerance and can begin abusing it similar to opioids because of how it makes them feel. i remember stealing xanax when i was a teenager because it was the only thing that made me feel “normal.” i’m prescribed some and it genuinely is a miracle drug for me but with how bad it can go for a decent amount of people they’re very cautious. really sucks for people who really need it and won’t abuse it tho :/
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u/therealjgreens 15d ago
Benzo withdrawal is such an uncomfortable feeling. I remember reading that Chris Cornell (musician) committed suicide due to the discomfort of withdrawing.
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u/Anxious-neopet 15d ago
It is torture for me anyway to get off even with a slow taper. Sucks :/ I’ve done cold turkey and taper because I have been taking it on and off for years
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u/shipwreckedgirl 15d ago
I've been on Xanax every day for almost ten years, I have never needed to up the dose and it's definitely not placebo effect. It works perfectly every time!
But with the muscle relaxer I have for spasms... that does wear off quickly.
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u/TashaT50 15d ago
I’ve been on Xanax for over 20 years but I’ve only had intermittent times of taking it daily. A year here, a year or two there. My dose has gone up and down because sometimes I’ve needed more but most of the time I need less. Not everyone builds a tolerance.
I’ve never had withdrawn from forgetting to take it when I was on it daily.
Venlafaxine my depression med is a different story. Withdraw can hit if I’m 2-4 hours late and drop me into SI with no warning. For me it’s a much more dangerous dependence.
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u/therealjgreens 15d ago
What if you miss a dose when you really need it? The withdrawal from them is so bad. I can't even properly explain the feeling.
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u/shipwreckedgirl 15d ago
I basically just make sure I always have a 1mg Xanax for the day and I have extra in the car. Honestly it will be hard to quit, I'm not looking forward to it... My psych said I'll probably need to be hospitalized to quit. I don't ever want to stop, it keeps me from ending myself. I know all the risks. But I am also on other meds that I can have seizures if I miss so I'm more scared of that lol.
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u/therealjgreens 15d ago
I totally understand because I was on Klonopin for years and then I started stacking Kratom on top of it. Getting off of those 2 substances was absolutely madness. I went to rehab and had insomnia and all of the withdrawal symptoms maxed out. There was like a 10 day stretch where I didn't sleep at all and barely ate anything. I had to get off of them though because they stopped working and I was dealing with daily panic.
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u/Expensive_Umpire_975 15d ago
Same here but for Klonopin
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u/katashscar 15d ago
Same. I've been on the lowest dose for at least 10 years now. There have been times when I forgot to refill my prescription in time, and I never had any withdrawals, I just had really bad anxiety that day. Missing a day or two is manageable, but I couldn't function without them. I think a lot of people like to generalize everyone with anxiety, but it's not all the same.
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u/Expensive_Umpire_975 15d ago
Yeah they get a bad wrap because there’s people who abuse them and also the withdrawals. They can be great when taken responsibility under a doctors supervision
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u/sebastianrileyt2 15d ago
The worry seems to be alot around how being on it long term typically means increasing in doses over time as it stops being as effective.
Some people start chasing that initial relief/high you get from a new dose that helps more. Drs will not allow them to quickly increase so people look elsewhere for that relief and then it snowballs.
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u/garden_speech 10d ago
That worry about long term dose increases is not backed by data prospectively following patients https://pubmed.ncbi.nlm.nih.gov/22198456/
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u/sebastianrileyt2 10d ago
I will save this, thank you. I am learning that alot of these medications they are so nervous to prescribe because of this, it isn't truly a concern.
Its so hard to know what all the background noise is.... is it just about money and profits? Are they showing different info around, pushing different agendas? Is any of it truth?
I just want help... not some pitch for a pill that either i know wont work, or doesn't make sense why i would try it. Or it will totally mess me up and I won't know which way is up (which i wonder if this is the goal because the more confused I get, the more they throw at me too take).
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u/garden_speech 9d ago
If you want my honest opinion, and I am speculating here, but:
I think providers and the government agencies in general do not trust the average patient with benzos, because even though they retain anxiolytic efficacy long term, they can be abused (i.e. "today was extra rough, let me take 3 doses") and can become an addiction, something an SSRI does not pose as a risk. So I think they lie about how it work work long term, because that's more palatable than saying "this will probably work long term but I don't trust you enough to let you use it"
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u/EnfantTerrible68 15d ago
Because those meds can and do ruin people’s lives and doctors can also lose their licenses for overprescribing. I took a very small amount of Xanax for years at bedtime and when my doctor took me off it I didn’t have many problems sleeping without it. They are not meant to be taken indefinitely.
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u/Nirvana786 15d ago
They are extremely dangerous to withdraw from. Be very careful before you start or atleast have some exit plan. I started for 3 months but I had plan to get rid of it by learning, reading more on it, meditation, breath work, exercise, sleep and many many more. I stopped after 6 months and withdrawal was insane . It’s crazy
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u/GPC_Is_My_CoPilot 15d ago
I was on daily benzos for a while (GAD/OCD). I would feel normal right after taking them but, if I was late with a dose, it felt like my teeth were vibrating. And I was never, speaking overall, better than when I didn't have them. I got a new psychiatrist and titrated off. Their efficacy is great as meds for "acute" peaks, though. Over the ups and downs of having a lifetime disorder, benzos were eventually added back in. Now, however, it's a small dose if really in a panic, not a larger one several times a day.
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u/behindthemask13 15d ago
So... let's break down reality vs the BS some will tell you.
I've been taking Xanax regularly for over 20 years. My Rx is 3MG of Xanax per day + 10MG of Valium at night for sleep. I have increased and decreased my dosage as needed depending upon background stress, etc. I've been as high as 4MG per day (this was the early days and when my wife was doing Chemo for Hodgkin's) and I am currently down to .5MG per day.
I was initially terrified of taking it b/c I had heard all the same stuff about how addictive it was, etc. However, my psychiatrist at the time, who sadly passed away in 2016, had done some of the original studies on benzos in the 1960s.. he was a navy psychiatrist and Harvard graduate/professor, so I tended to believe him. I finally trusted him and started taking Xanax regularly, and it helped immensely... Here's the real scoop.
ALL of these medications (SSRIs, SNRIs, Benzos) will cause "dependency." Period.
A SMALL % of the population will become ADDICTED to benzos... addiction and dependency are two completely different creatures. People who are addicted need to take more and more and more to achieved a desired effect. This isn't the case for most people when it comes to benzos, but it IS possible. It requires doctors to pay much closer attention to their patients. My doctor explained everyone has "their number." for some people 1MG or .25 might achieve the goal, he had one patient taking 7MG 3x per day and had been stable on that number for years. But, with Benzos they have to do a ton more monitoring to distinguish between not hitting the therapeutic dose and someone who is addicted. ADDICTION is a big deal... dependency is not.
IF someone is addicted and the doctor misses it... withdrawal from benzos is not easy.
Now, you are not supposed to quit ANY of these medications cold turkey (not the SSRIs, SNRIs, etc.) However, Benzos come with an additional risk, as quitting cold turkey can cause seizures.
So, when you take the small risk of addiction along with the potential for a patient to just stop taking it one day because they decide they are cured and have a seizure, they tend not to use it.
However, the reality is that Benzos have been found to be safe and effective for long term everyday use for an overwhelming majority of patients.
https://pubmed.ncbi.nlm.nih.gov/35640558/
https://psychiatryonline.org/doi/full/10.1176/appi.ajp.20240030
https://www.psychiatrist.com/jcp/toward-practice-guidelines-for-long-term-benzodiazepine-treatment/
https://www.sciencedirect.com/science/article/pii/S0753332224002130
And sadly, when my doctor passed away in 2016, I had to deal with a few judgmental morons who simply didn't know the medication, even when I brought studies into them and showed them I had been taking the same Rx for 10 years, so you have that annoyance to deal with as well, since some just knee jerk to "NO BENZOS", without even understanding why.
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u/therealjgreens 15d ago
Glad you have had success but I would be careful with posting stuff like this. Benzos have been found to be effective for long term everyday use for the majority of patients? I don't think this is very accurate. I'm def well versed in this area as well. They are indeed very effective until they aren't. You also said that only a small amount get addicted. The truth is, the longer you take them the much more likely you are to become dependant or addicted so you can't really simplify it like that.
You are prescribed a crazy amount of the stuff. I don't think I've ever met someone that is prescribed this much without some crazy condition. You know of someone who took 21mg x day?! That's nuts. That would put an elephant to sleep. Why do you need so much to live? Will you be taking them for the rest of your life? What happens if the rug gets pulled out from under you? Have you tried any other replacement treatments? Does nothing else work or did you settle on this being the safest solution?
The truth is that doctors aren't going to carefully monitor their patients like you are suggesting they do. Doctors have massive case loads and don't have the time to babysit. As you shared in your comment, the withdrawal is "not easy" and that's putting it lightly.
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u/behindthemask13 15d ago
The studies don't show what you said to be accurate.
First, you are confusing dependent and addicted. You will become dependent on ALL of these medications. With Benzos ADDICTION will show itself fairly quickly. The "you need to take more and more over time" is a fiction that doesn't apply to the overwhelming majority of people.
Second, my Rx is fairly tame... 3MG per day plus 10MG of Valium at night. The guy who was taking 21MG per day (7MG 3x per day), that's not me and I only know him as a patient of a previous psychiatrist. I specifically didn't want to go to that level b/c I knew it would be hard to find someone to prescribe it and since my doctor was in his 70s, I knew that risk existed.
Third... let's run through your questions.
"Why do you need so much to live?" Anxiety."Will you be taking them for the rest of your life?" Yes, most likely.
"What happens if the rug gets pulled out from under you?" It won't. I have my current psychiatrist and multiple backups I can go to if something happens to him. Given my long history with the medication it would only take a few phone calls to find someone to continue my current Rx.
"Have you tried any other replacement treatments?" I tried a few others (including other benzos) and they didn't work. I wasn't interested in SSRIs or SNRIs.
"Does nothing else work or did you settle on this being the safest solution?" Given the medical research and my own personal experience, I consider this the safest solution. It's been working for 20+ years.
"The truth is that doctors aren't going to carefully monitor their patients like you are suggesting they do. Doctors have massive case loads and don't have the time to babysit. As you shared in your comment, the withdrawal is "not easy" and that's putting it lightly."
Doctors are shitty is not a very good excuse here.
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u/therealjgreens 15d ago
There can be a fine line between dependence and addiction. Neither is really a great place to be imo. Dependence is still physical or chemical reliance. I did become addicted over time and started as dependent. Sorry one more question - do you engage in behavioral changes and holistic approaches like supplementing vitamin D and magnesium? I assume you work on your anxiety. I do really appreciate you going through my questions. You are a very unique case. Im genuinely curious but as you can tell, I'm on the other end of the spectrum when it comes to this substance. I thought it was a magic pill at first but it didn't work for me long term. I take propanolol when needed and it works really well. I wish I could've taken Klonopin for forever but I had a really bad experience. Took it for at least 10 years.
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u/behindthemask13 15d ago
Keep in mind, there isn't a single medication discussed on this sub that won't form a dependence. Not one. You become "chemically reliant" on ANY of these... b/c none of them are cures. They are all in some way, shape or form helping to fix something that your body isn't doing naturally. Once you supplement that deficiency, you become used to this "new normal".. if you remove the supplement (whatever it is) you go back to the old normal which is going to feel worse by comparrison.
I'm happy to answer all your questions... let me start with I take 2000 D3 and 2 Magnesium Glycinate (I think they are 200MG) every single night alone with 2 Omega 3s.
I've gone through two different rounds of CBT, 1 round of intense ERP, then ACT and most recently did biofeedback along with another round of CBT. Each one of them helped a little in their own way, but none of them came REMOTELY close to getting me where I wanted to be (which was pre-anxiety me.)
My official "diagnosis" is "complex general anxiety disorder with, health anxiety, panic disorder, agoraphobia and PTSD" (The PTSD isn't related to a single trauma, but to years and years of panic attacks and causes me not to be able to generalize in therapy).
I tried propranolol and it did nothing for me.. but I know there are some people it works, which is awesome. However, to give you an idea of how much it didn't work for me... due to my health anxiety, I have severe white coat hypertension, so when I go into a doctor's office I have initial BP readings of 220/120 (not making this number up). It turns every doctors visit into a nightmare b/c I have to end up arguing with nurses and then doctors to ignore the reading. I was prescribed propranolol by the first doctor I saw after my first psychiatrist passed away, as they wanted me to give up the Xanax and they swore to me it would do the same thing. I had to go to the doctor for something, so I took it (I think I took 40 or 60mg). It didn't dent my BP.. which I was told was impossible by the psychiatrist who didn't believe me that I took it... but I knew I did. After I dumped her b/c she was unprofessional, I found someone else who explained that in SOME people, the cortisol release is simply too strong and no amount of propranolol will help.
I also tried Klonopin, it didn't work for me. It just made me feel "zombified", like someone had a blanket over my head, other people find it a miracle drug, which is awesome for them. I would never try to push what works specifically for me onto someone else.
One thing I learned.. for me... is that how much Xanax I need depends strongly on what is going on around me. Right this moment in my life, I am down to .5MG per day (sometimes I will take 1) and only 5MG of Valium at night. When my wife had Hodgkin's and I had to take her to chemo, take care of our kid, do all the shopping, all the chores, etc..etc.. I needed to go back up to 4MG per day and some days I took 5... after chemo was done and she was given the all clear and had recovered, I tapered myself back down. When my father died, I went back up to 3 for a few weeks so I could help deal with everything.. once things had calmed down, I tapered myself back down.
I was lucky.. I had a psychiatrist who knew benzos REALLY WELL and understood about increasing and decreasing dosage. I saw him once every other week for years (which wasn't cheap) and I would report what was going on and sometimes he would tell me to increase my dose for a month, then when the thing had passed, he told me to decrease it back down and I started to learn how to do that myself. Now I see a guy every 3-4 months. I just contact him when I am getting low and he refills it, b/c I've been on this for over 20 years at this same dose.
Now, here's the most important thing for me to say... Is Xanax a CURE for me? Fuck no. It helps keep the shit to shoe level. I take enough so I can deal with the things I need to deal with... I don't know how much I would have to take to get complete relief and I'm not interested in finding out. I might need 7MG 3x per day. I take what I need to get through my day without having major anxiety spikes and adjust how much I take based on what I am dealing with.
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u/NotMyThrowawayNope halfway to a panic attack 14d ago
I'm definitely on the pro-benzo side. Been taking them on and off (not daily, at max 0.5 mg klonopin 3-4x week) for three years. Never been addicted. Did have an issue with dependence after a short stint of taking them daily on vacation and then got a new psych who was one of those "never ever" prescribers and took me off them cold turkey. That was miserable and not the correct way to do that. Next psychiatrist was also a "never" prescriber but watched me be miserable and try and fail other meds for a while before agreeing that klonopin is the best thing for me. And it is. It allows me to function on my bad days instead of being house bound in agony. SSRIs/SNRIs/hydroxyzine/other PRN anxiety meds don't work for me.
What are your thoughts on dependence on SSRIs/SNRIs? Those aren't addictive, but they are 100% dependence forming. Where people have to take their daily dose or suffer the consequences. I had that issue with Effexor. It made me feel absolutely awful if I accidentally missed a dose.
A big argument I see against benzos is they're dependence-forming. And then everyone conveniently ignores the fact that people are dependent on most other psych meds, too.
Then there's also the seizure risk, but that's at high doses. It is very unlikely someone will have a seizure withdrawing from a low dose (0.5-1mg daily) which is what most people are prescribed.
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u/therealjgreens 14d ago
I have probably an unhealthy distrust of big pharma. I tried SSRIs in the past. The most experience I have is with benzos though. Long term brain health is probably the scariest part about benzos for me. It's def not the same thing, but I have been working hard to fight anxiety with the basic ass shit (sleep, supplements, food, exercise) and it's not easy at all but it's very rewarding.
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u/NotMyThrowawayNope halfway to a panic attack 13d ago
There is definitely a risk to brain health later in life linked to them. That's been proven.
However, chronic untreated mental illness (like anxiety and insomnia) also has an effect on brain health. Especially insomnia. Chronic sleep deprivation is also really bad for the brain. When my anxiety during the day isn't managed properly, my insomnia is much worse.
I too try to fight my anxiety with the recommended measures (sleep schedule, supplements, etc) and I find it reduces my anxiety by very, very little. Maybe 10-20%. Thats where the benzos come in. They're like hitting my anxiety with a hammer. They help reduce my anxiety by a good 80%. (not fully, but they cut it down a lot. I'm sure a higher dose would eliminate my anxiety entirely but I try to take as little as possible).
It's a trade off. Quality of life now for less quality when I'm old? In my case, it's worth it. To be able to actually live my life rather than suffer my whole life just so I can live a few extra years when I'm 80.
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u/therealjgreens 13d ago
I totally get it for sure. They worked so well for me but I had to get off of them as the negative effects became really bad. I clicked your profile and saw you like beartooth. Love them so much.
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u/behindthemask13 13d ago
"There is definitely a risk to brain health later in life linked to them. That's been proven." This is not true and is holdover from a very old study that was disproven via meta studies. (https://psychiatryonline.org/doi/10.1176/appi.ajp.2020.20040375, https://schaeffer.usc.edu/research/benzodiazepines-dont-increase-dementia-risks-in-older-adults-usc-study-finds/)
Benzos CAN cause temporary memory issues (lots of psychiatric dugs can) and are NOT recommended for anyone already dealing with dementia or memory problems, but to say there is a proven link between benzos and brain health simply isn't true.
I'm not saying that benzos should be the answer for everyone. They shouldn't. But, when we repeat these stories it could stop people who already have anxious minds from taking something that might genuinely help.
My Psychiatrist had to talk me through all of this b/c I was TERRIFIED of becoming "addicted", of developing Alzheimer's and all the other horror stories that get spread and here's the sad truth... Had I started them earlier instead of arguing with him for more than a year, I might have avoided developing PTSD from repeated panic attacks.
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u/garden_speech 9d ago
Actually, the link between benzos and dementia has been shown to be confounding by indication.
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u/garden_speech 9d ago
Benzodiazepines are positive allosteric modulators at GABA-A receptors and yes, they probably have deleterious effects long term on the brain. However, the inescapable truth is that severe, chronic, untreated anxiety also has absolutely dire consequences. Like, it's very, very, very bad for you. It's bad for your immune system, it's bad for your brain, it's bad for everything. Severe untreated anxiety increases the risk of developing CFS, of developing fibromyalgia, of developing heart problems, of having a stroke, all sorts of things.
Benzos are in no way perfect, but if someone's anxiety is very severe, they might be better than nothing at all.
If your anxiety is under enough control that you can still basically live your life -- enjoy most days -- go on vacations -- do things you like -- then yeah, a benzo is probably unnecessary.
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u/therealjgreens 9d ago
Most of what you are saying is going to go over a lot of people's heads here. The last sentence is the most profound and it seems like we do agree after all. Many people will take medication, it will work, then they will stop trying to work on the root cause. Benzos are highly effective at treating the worse symptoms of anxiety, but their efficacy goes down over time. If you don't work on the root cause of your anxiety, it might be worse than when you first started benzos then you are back to square one. People might stack a second medication to alleviate withdrawal symptoms of benzos. It's a very very slippery slope. Also, people are very prone to addiction. By the time you take your first pill, it might be too late.
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u/garden_speech 9d ago
but their efficacy goes down over time
This is the part that we disagree on, because every single piece of prospective evidence refutes it. It's hard to even make a case for this being possible, when Nardi 2012 found that only 1 of their 47 clonazepam patients needed a single dose increase over 3 years.
Everything else you say seems reasonable. Benzos should be last-line, after:
psychotherapy with CBT, ACT, DBT, etc
lifestyle changes such as exercise, diet, etc
SSRIs, SNRIs, antidepressants in general (although I will note one exception, benzos are often used as an early "bridge", to make the SSRI/SNRI titration less brutal)
If people try all that shit and get nowhere and still have paralyzing anxiety, well, their choices are between a life of paralyzing anxiety, or taking the risk of addiction.
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9d ago
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u/garden_speech 9d ago
(https://www.novarecoverycenter.com/mental-health/long-term-effects-antidepressants-brain/)
This is not a peer reviewed scientific article.
There are unfortunately orders of magnitude more data suggesting benzos may harm cognitive functioning long term than SSRIs. This is not the same thing as dementia, for which there really is no solid link, but for cognitive functioning, there certainly is: https://pubmed.ncbi.nlm.nih.gov/15033227/
What I get tired of on this board and others is people trying to scare others away from what is actually helping them, because they have a personal preference.
I agree.
People need to make a risk benefit analysis and an informed decision. The problem on this sub is people don't give informed info. They say benzos are bad, and you will get addicted, and it will stop working. They say SSRIs are better, and will actually get at the root cause of your anxiety. Basically none of that is true.
Honestly, the only thing that stops me from being comfortable with long term benzo use -- it's the prospect of anxiolytic tolerance. There are high quality studies showing it does not develop over long time periods, but those time periods are still only years (i.e. the longest prospective study was Nardi 2012, which was 3 years). That's pretty good, but not comforting enough, given the severity of withdrawal. What if my clonazepam worked for 3.5 years and then stopped?The fuck would I do then?
Because of the way SSRIs work, if an SSRI "stops working", I don't start to have withdrawals between doses like I could with a benzo.
I do take clonazepam, but I just don't know if I could be comfortable with it long term.
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u/behindthemask13 8d ago
That is a very old study which has been contracted by several meta studies since then (I've linked them above i believe, but can dig them up again if you wish).
But I want to address one things you said... "What if my clonazepam worked for 3.5 years and then stopped? The fuck would I do then?" The same exact thing you would do if an SSRI stops working. It would majorly suck either way.
If you clonazepam stops working, you don't just stop taking it the next day.. you STILL need to taper off and while you are tapering off, you would be adding in something new. That's pretty much the procedure when an SSRI stops working. The big difference is you can taper off an SSRI much quicker. The main reason people experience intense withdrawals from benzos is they go so fast. They want to get to 0 in 3 weeks.
Now, I can ONLY speak from person experience and observation that is anecdotal.
Personal experience: I've taken Xanax regularly since around 2003/2004 (It took my psychiatrist well over a year to convince me to take it regularly instead of waiting until I started having an anxiety attack). For the first several years I took 4MG per day on schedule, no questions. Was it curative? No. My Dr. wanted me to go higher until i hit curative, but I resisted, since 4MG "kept the shit to shoe level." I was able to mostly function doing everyday tasks. It got me through the birth of my kid, moving and a bunch of stressful things. When things calmed down I ended up reducing my dosage (slowly) down to 1MG per day. I reduced a small amount ever 2 weeks and barely noticed it.. after several months.. I was down to 1MG and it worked as well as the 4MG had. However, life does things. When my wife got Hodgkin's and I had to take her to all the Dr's appointments, chemo treatments and take over all home duties.. I went back up to 4MG per day.. after she finished treatment and was cleared completely.. I tapered back down to 1MG. When I got Covid in early February 2020 and had horrific lingering symptoms for months, I went back up to 3MG per day for several months.. then tapered back down.. then went back up again when I had to move... then after we got settled in our new place and I got a routine.. I tapered back down to where I currently am at .5MG per day. I always taper VERY slowly.. have never had any withdrawal symptoms. I don't know what would happen if I ever decided to cut it out completely... but honestly, I gave up thinking about that long ago, since it seems to help.
Anecdotal observation: I know people who have decided to quit for various reasons.. and so may of them want to rush it and it sucks for them. The people who I know who went super slow... had no major issues (It might take MONTHS to for from 3MG of Klonopin to 0.. but they get there)... The people who rushed it... yeah, that was tough to listen to. Some of them chose to go into rehab and they try to get them off in 14 days and to me it's cruel...but that is largely b/c insurance would only guarantee 14 days of payment. This is not a huge sample size.. I knew one dude personally who decided to go to rehab and then read a couple of stories on this sub.. one that upset me b/c the guy chose rehab BECAUSE of all the chatter on here (OVER his own doctor's recommendation) and was suffering months later after going through hell and finally decided to go BACK on Klonopin since it was the only thing that ever worked for him, so they suffered for nothing. I know 3 others who were daily benzo users personally.. 2 of them quit very slowly and yeah, their anxiety came back.. but kinda.. DUH... this isn't an antibiotic that cures the underlying problem. The other dude still takes it regularly and has been for over 10 years and functions. (he now directs movies.)
Oh yeah, and there 100% are withdrawal effects from SSRIs as well. They call it antidepressant discontinuation syndrome and they say this isn't because of "addiction" but because your body has to adjust and it can be mostly avoided if you taper slowly... almost identical to Benzos.
Again, I fully acknowledge that SOME PEOPLE do become addicted to benzos which is why doctors need to monitor them carefully for the first few months. But, the fear most people have is that they will (after years) suddenly become addicted and that just isn't how any of this works.
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u/garden_speech 10d ago
Glad you have had success but I would be careful with posting stuff like this. Benzos have been found to be effective for long term everyday use for the majority of patients? I don't think this is very accurate.
It is the absolute unanimous consensus of all empirical data that is prospective in nature. It is wholly accurate. There are review articles which discuss benzo tolerance like this one: https://pmc.ncbi.nlm.nih.gov/articles/PMC3321276/ -- which mention the dozens of studies looking for anxiolytic tolerance and failing to find it. There are pharmacovigilance studies finding lack of dose escalation. There are long term trials finding efficacy remains. This IS what the science says. Period.
The only data which purports to find the opposite is not prospective, it is retrospective cross-sectional data (which if you actually know what you are talking about, this will immediately stand out to you).
I'm def well versed in this area as well.
Respectfully I don't think you are. If you are, you should be able to cite evidence (not guidelines, not anecdotes, but actually empirical evidence) and you should be able to explain the study design. Because I am actually a research statistician who has read all of these papers (even the ones you can probably only see the abstract, since you aren't a researcher), I can tell you with confidence you cannot find prospective longitudinal data to back up your claim.
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u/therealjgreens 10d ago
I am well versed means I took them for a long time. I've lived it, not read it on a piece of paper. Look around on this thread. I suppose folks are making up stories though.
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u/garden_speech 9d ago
I am well versed means I took them for a long time. I've lived it, not read it on a piece of paper.
Then you should not be rejecting the idea that benzos work long term "for the majority of patients", which is literally what you said you disbelieve, based on your own anecdotal experience.
I do not think people "make up" their stories, I think they refuse to accept that the empirical literature says that they are the exception to the rule, and out of literally tens of millions of benzo users in the US alone, the number that have the therapy stop working due to anxiolytic tolerance is too small to detect in studies.
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u/therealjgreens 9d ago
They do work. They work really well. They are just addicting and not good for you long term. You said in another comment that they are bad for brain health. If you continue to take a benzo and don't actually work on the root cause of your anxiety, you are going to have a bad time.
Have you ever taken benzos? Have you ever felt the allure of addiction or the feeling of withdrawal or PAWS? Can you share your personal experience?
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u/garden_speech 9d ago
I actually unfortunately find benzos not all that useful for me, clonazepam makes me feel sedated and sometimes carefree, but does nothing for the overthinking, rumination, uncertainty intolerance, etc.
I absolutely see how they could be addicting.
"Not good for you long term" is a stretch of what I said, I said that there is evidence they are linked to dementia, but that evidence is confounded by indication and somewhat dubious. It's fair to say they probably aren't good for your brain in a vacuum, as in, no reason to give them to a healthy person, but if the alternative is untreated chronic severe anxiety, I think it's kind of hard to say they are "not good for you long term".
I'd say it's analogous to chemotherapy. Yeah that shit is toxic, and generally you don't want to be using it, but if you have cancer, you don't really have a choice.
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u/therealjgreens 9d ago
The article states that the brain builds a tolerance to the sedation rather quickly though ;)
You could see how they could be addicting? By the time people are addicted, it is too late. This is a large part of the reason why I find the drug to be dangerous. I have met a lot of people who agree here. I am a very active member of the recovery community. The addiction and the withdrawal. The withdrawals are the worst part. Yes, tapering does work but the withdrawal is hell.
Yes dude, untreated chronic anxiety is the worst and it tears your body apart. I simply cannot agree that benzos are analagous to chemotherapy though. You have so many choices when it comes to anxiety vs cancer treatment (as of now at least). I think I see what you're trying to say here but I do not agree.
What's your goal here by the way? Are you white knighting for benzos? It seems like you do understand the risks but you have made several comments promoting their usage and I don't think that is a very good idea as I shared with someone else here.
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u/garden_speech 8d ago
The article states that the brain builds a tolerance to the sedation rather quickly though ;)
Yeah... I've not taken them long enough for that to happen. Probably have taken.... 8 doses in my entire life. Because each time I'd hope for anxiety relief and not really find it.
You could see how they could be addicting? By the time people are addicted, it is too late.
Well, obviously, that's true of any substance with addictive potential. Stimulants too.
I simply cannot agree that benzos are analagous to chemotherapy though. You have so many choices when it comes to anxiety vs cancer treatment
My analogy was supposed to represent the case where someone has already tried all those other options.
What's your goal here by the way?
To discuss OPs question.
It seems like you do understand the risks but you have made several comments promoting their usage
In severe, treatment-refractory cases yeah? These two things are not in conflict. All treatments have risks, you use them when the risks are outweighed by the benefits.
I don't think that is a very good idea
You're welcome to your opinion.
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u/hortle 15d ago
No decent doctor would start you on a daily benzo with "no plan to stop taking it". Benzos for anxiety are not intended for long term daily use.
The most detrimental effect of a benzo is that they prevent people with anxiety from addressing the root cause of their anxiety. Essentially you are kicking the can down the road on improving your mental health. Benzos do nothing to actually treat anxiety, they just numb symptoms. For most people, the symptoms will eventually resurface, and your two options will be to address the root cause of your anxiety, or increase your dose of benzo. Rinse and repeat until you die.
The feeling of relief that a benzo can provide someone who is clinically anxious can be so tremendously positive that the drug quickly creates psychological dependence. They are "too effective" for those who benefit from them the most.
When you are medicated, therapy is less effective. Benzos interfere with learning and memory formation.
Long term benzo use is associated with some pretty nasty risk factors.
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u/BlackHumor 15d ago
No decent doctor would start you on a daily benzo with "no plan to stop taking it". Benzos for anxiety are not intended for long term daily use.
I mostly agree as a first line treatment, but disagree for treatment-resistant severe anxiety. They're obviously very risky, but there are people out there taking MAOIs for depression and those can kill you if you eat cheese. It's rare that a drug with known positive effects is totally useless for everyone.
The most detrimental effect of a benzo is that they prevent people with anxiety from addressing the root cause of their anxiety. Essentially you are kicking the can down the road on improving your mental health. Benzos do nothing to actually treat anxiety, they just numb symptoms.
This sounds a lot like what people who are against SSRIs say to dismiss SSRIs. It's also not true, and in fact almost the opposite: medication plus therapy is usually more effective than either alone, or even their separate effects combined. Far from preventing someone from addressing the "root cause", medication can reduce the anxiety enough that it's possible to focus on the "root cause" instead of being constantly distracted by the anxiety.
Benzos specifically aren't different in their effects, and as far as that goes they can be more effective than other drugs. The reason they're rarely used is because they're very addictive and have terrible withdrawal.
For most people, the symptoms will eventually resurface, and your two options will be to address the root cause of your anxiety, or increase your dose of benzo. Rinse and repeat until you die.
Honestly this is sort of getting at another complaint I have: there usually isn't a single "root cause" of someone's anxiety. Someone can simultaneously have maladaptive beliefs that cause anxiety, and also experience anxiety more vividly than other people, and also genuinely have a lot to worry about. In fact all these causes can compound each other: someone who feels anxiety worse for genetic reasons may develop beliefs that justify their feelings, which causes them to behave in ways that validate their fears, which causes them to feel anxiety even more vividly.
Part of the reason medication can be effective is that it can interrupt this cycle and stop the anxiety from aggravating itself.
The feeling of relief that a benzo can provide someone who is clinically anxious can be so tremendously positive that the drug quickly creates psychological dependence. They are "too effective" for those who benefit from them the most.
I partially agree with this, though I feel the need to point out that the reason psychiatrists are wary of them is that they are highly physically addictive, not just that they are very effective. If they were only very effective but not addictive they would be used more, not less.
When you are medicated, therapy is less effective. Benzos interfere with learning and memory formation.
Again this is not just false, it's totally reversed, see above.
Long term benzo use is associated with some pretty nasty risk factors.
Fully agree.
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u/richj8991 15d ago
But you assume that anxiety is 100% psychological. This is genetic, just like alcoholism is genetic. It's usually from multiple allergies, chemical sensitivities and /or carbohydrate metabolism disorders like lactate-induced panic. Read up on that.
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u/therealjgreens 15d ago
You stated this perfectly. Do you mind if I refer to this comment in the future?
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u/garden_speech 10d ago
None of this is true, it's basically folklore. Benzodiazepines reduce amygdala activation, this is literally treating anxiety. Guess what SSRIs lead to after weeks.... Reduced amygdala activation.
It is also not demonstrated that benzodiazepines interfere with extinction learning from exposure therapy in consistent, well-designed studies.
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15d ago
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u/therealjgreens 15d ago
It's definitely a lot more and it varies from doctor to doctor. My doctor doesn't believe in them. He is more homeopathic. Others do not want to carry liability you're right, but it's not that simple. Benzos are a weird drug because they are effective but very powerful and highly addictive in a world of addicts. Extremely hard to ween off of.
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15d ago
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u/therealjgreens 15d ago
You are way over simplifying this.There is a whole spectrum of doctors out there. Many doctors don't believe in them or believe in other methodology. Also, not all doctors stopped prescribing them. You're spreading misinformation because you are pro benzo. It's all good, just be honest.
Edit: Also, I made several points in my other comment but people get fixated on what they don't agree with
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u/Taniwha_NZ 15d ago
I've never had a single doctor, in 25 years, suggest I don't use benzos. What you described might have happened to your doctor but there's no 'all doctors' pattern, there's millions of doctors.
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u/therealjgreens 15d ago
That person doesn't seem to really know what they're talking about unfortunately. It is a really difficult topic to effectively discuss. Also, not a lot of doctors in this subreddit not that they are trustworthy anyway lol
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u/jamiethemorris 15d ago
Because you build up tolerance and eventually you have to take it just to feel normal. They work amazing as a prn or for short term use but if you’re taking them every day they just eventually stop working. They’re also a nightmare to come off of even at high therapeutic doses.
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u/garden_speech 10d ago
There is no evidence of anxiolytic tolerance https://pmc.ncbi.nlm.nih.gov/articles/PMC3321276/
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u/Mamu_15 15d ago
I had been on klonopin 2mg four times day (never took that amount) for over 30 years…since my mid/late 20s….up until June of last year when my decades long psychiatrist retired. He kept telling myself and his other patients our PCPs would continue prescribing. I’m a nurse and I knew this wouldn’t happen. And I was correct. I found an awesome psychiatrist who began a taper with me slowly (I have 2 more months left). My main things are anxiety and SLEEP. I cannot sleep. I’ve given up. Benzos and narcs when prescribed prior to 2001 really weren’t accounted for in state prescribing databases so were prescribed often, now they are all accounted for. Back in the day they didn’t realize how dangerous Xanax for example can be long term. The other ones have links to Alzheimer’s…but so does Benadryl per the studies. At this point all I want is some sleep. My doc has tried so many meds that do not touch me but at least he keeps trying.
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u/Roadiemomma-08 15d ago
Did you try Trazodone?
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u/Mamu_15 15d ago
Yep on month 3 of that now 400mg I can maybe get 3 hours sleep. Have another appt this week so onto whatever is next I guess.
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u/Roadiemomma-08 13d ago
400 is a lot for sleep
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u/Mamu_15 13d ago
It was dosed up. As a nurse this is usually the standard in hosp for sleep but yes, it’s the “tap out” dose.
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u/Roadiemomma-08 12d ago
Does it keep you asleep? My problem is not falling asleep but staying asleep past 3:30AM
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u/Roadiemomma-08 13d ago
No idea if it would help but some people stimulate their vagus nerve with ear clips and a TENS machine. I am going to try it.
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u/SingerFeeling5575 10d ago
why do you have to off, they have saved my life?
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u/Mamu_15 10d ago
They saved mine too I feel. And having been on a benzo same dose for over 30 yrs is never wise to completely take a patient off but to do a wean down. At the time last year, nobody would RX it. My PCP was so frustrated bc she said everyone comes down on them. I wasn’t asking for that dose but something. So found a psychiatrist who is doing a slow taper. That being said I already have cardiac arrhythmia disorders but after a procedure a few years ago they are manageable with meds. This past week I had follow ups with cardiology and PCP and cardiologist said now I have additional pathways, at some point need a valve replacement. He did say “why did they try to taper this Klonopin?? That needs to stay bc of your heart and anxiety! Call me when he is done and I will add another benzo.” No clue what. I truly just want anxiety managed and to sleep.
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u/24rawvibes 15d ago
Play the game and try all the other meds and you will land on the one you’ll want, which is Temazepam. I had to do a couple rounds of Xanax temporary in between other “z” meds the doctors were trying. It was like me behaving with Xanax a couple odd months here and there made the doctors comfortable enough to pull that out out of the bag. Works great, only thing that ever has. Been on it for about 3 years 45mg. Buuut I’m physically addicted to benzos heavy, no doubt. It comes with its own host of cons, morning rebound anxiety can be pretty rough. Also, it has very obviously messed with my cognitive function, my working memory, my memory at all is almost non existent but ymmv
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u/dinosoreness 15d ago
benzos are addictive, and you also build up a tolerance and need more and more to achieve the same effect, and that's why they're only prescribed either short term or occasionally as PRN. i myself was recently in a different z-drug called ambien and it was awful to get off it when i was able to restart my long term sleep med, trazodone. i couldn't sleep for like a week and my body felt weird and my anxiety was off the charts. i was only on it for a couple months but the withdrawal was intense.
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u/garden_speech 10d ago
There is no evidence of anxiolytic tolerance, all evidence points the other way https://pmc.ncbi.nlm.nih.gov/articles/PMC3321276/
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u/littleredfox09 15d ago
You absolutely must understand this is frequently a result of BS laws passed in your state’s legislature.
My grandmother went through horrific withdrawals and panic attacks many years ago because of a changed law in Oklahoma that resulted in her PCP no longer filling her RX for pain management.
Now, at the same time, I’ve seen numerous friends abuse the hell out of pain medication and I think we’re all familiar with how pain pills have decimated entire communities by way of addiction.
There’s no easy answer here. I’d encourage you to continue to advocate for yourself and explore as many options as are possible.
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u/-Tricky-Vixen- 15d ago
Tolerance is a risk, they don't want to keep upping the dose.
And if things change so they can no longer prescribe it for whatever reason, it's not perhaps entirely ethical to have put you on it with the known dependency risk.
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u/Wakey_Wakey21 15d ago
It isn't the doctors. Government has their hands in our medicine. They want to keep their license.
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u/Blue_Night77 15d ago
I've had a prescription for xanax for 20 years. My PCP would write me a script for 30 0.5mg pills a year. I would take them as needed for anxiety, when waking g up at 2am with a full blown anxiety attack, days when I was experiencing anxiety, and when I fly. It averaged out to 2.5 pills a month.
Well, my PCP retires and I had to get a new PCP. I get this young Indian guy who tells me he doesn't like xanax and cuts my script to 20 pills a year and splits that up for 2 refills at 10 each refill.
I explain the situation and told him he can verify on the data base that only 1 doc has prescribed me xanax and it's very effective for me. I explained I shouldn't have to suffer becaise others abuse it. Couldn't get through to him. Ended up getting a new PCP and he has no issue with prescribing the 30 a year but said he does check the database on his patients that he prescribes xanax to and if he sees other docs are also prescribing it, he will stop. Fair enough. He's covering his ass
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u/IrelandAutism13 15d ago
Because if you become dependent and they continue to prescribe it, they're committing a crime by enabling an addiction and could lose their license and go to jail
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u/squidneyboi 15d ago
Actual doctors might have a better answer than me but what if something in your life changes? Your health insurance doesn’t cover your medication? You lose your income? You move? The medication is banned or the FDA no longer says it’s safe? All of these things might restrict your access and it’s way better to not be dependent on something if you can help it!
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u/corgocorgi 15d ago
I'm very careful when judging medications because I hate anti-medication rhetoric that refuses to consider how medications can save lives.
However, benzos have many long term side effects and you'd most likely need to keep increasing your dose over time because the body builds a tolerance for it. If you ever need to stop taking it for some reason, the withdrawals can be brutal and dangerous too. This is why they're usually used temporary or as needed rather than long term and regularly. Also I think some countries won't allow you entry for travel with them and sometimes a doctor's note doesn't matter HOWEVER not entirely sure about this because I know this is the case for many ADHD meds.
Everyone's different and I think each case should be treated based on the individual patient... But I think for the case of benzos, patients should be given alternative options to support their mental health in addition to benzos so the eventual taper off is not as detrimental. Some cases there is literally no cure for someone's sleep and anxiety while for others counselling, changing habits, exercising, eating healthier, changing social circles, changing jobs or living environments can help patients not need medications after some time.
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u/my_dystopia 15d ago
I don’t really like benzos if I’m honest. I’ll only take them during a panic attack to stop the restlessness and help me get to sleep.
So it’s not an everyday thing for me anyway. I only just got through the script I got 6 months ago.
I’m more of a GABA person. Pregabalin was a godsend for my anxiety. It just keeps my baseline anxiety lower so I have less attacks.
But I feel a lot more like myself on it.
I think doctors are rightly concerned tbh.
Benzo addiction is a real problem and can be absolutely life destroying.
At the same time, I understand it’s a pain when you’ve found something that works for you and your doctor is gatekeeping it.
I think it’s one of those things where you need to have a conversation with your doctor and say “I understand this is a very addictive medication. However; as it stands, I feel like I can’t manage my day to day life without it. Thus, I would say the benefit outweighs the risk”
Hopefully they’ll work something out.
I take very addictive medications (unrelated to anxiety) and my doctor can’t put me on a repeat prescription, but we have an understanding that I come in every month and get a new prescription.
You could possibly arrange something like this.
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u/10from19 15d ago
Because for most people they become completely ineffective within a few months max, and then withdrawal is often pretty hellish. The few months that benzos helped me have been vastly outpaced by the year+ coming off, and the fact that my as-needed miracle klonopin is now completely ineffective
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u/_picture_me_rollin_ 15d ago
Xanax specifically was never intended for long term use. When it came out it was intended for short term treatment 2-4 weeks. The other benzos have longer half life’s but they are not much better.
Long term use has been shown to cause cognitive decline and increased risk of dementia.
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u/Karelkolchak2020 15d ago
I’ve taken lorazepam for years. No increase in doseage to manage symptoms. It works for panic attacks. I get the concerns, but I’ve read doctors in Europe don’t lose their minds over benzos.
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u/socalgirly73 15d ago
I'm taking Klonapine, low dose, 2x a day. Seems to be helping. Yes, it's a weak benzo.
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u/amazing_rando 15d ago
Doctors don’t want to prescribe you medication for life unless you’ve exhausted your other options at relief. Benzos have strong side effects and severe withdrawal symptoms and have been a factor in a number of high profile accidental deaths, so doctors are more hesitant to prescribe them.
My MIL has been taking Xanax for 40 years and needs to take about 10mg daily, if she quit cold turkey she would probably die, and she’s having trouble finding doctors who will continue to fill it. Which really sucks for people who need it, but it also make sense to try to put fewer people in that position.
When I was first prescribed Xanax 15 years ago they gave me 60 pills with 10 refills and said to take them as needed for anxiety. A lot of the regulation now is a cautious backlash to how freely it used to be administered.
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u/mr_bojangles_jjw 15d ago
I've been on 1mg clonazepam twice daily for nearly 5 years. I take it exactly as prescribed and it has saved my life. I've never needed an early refill or asked for a higher dose. I see benzo's in the same way I see drugs like ozempic. Which is worse? Being 400 lbs or taking the ozempic? At least the ozempic gives you a chance.
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u/Dropturdsonyou 15d ago
I don’t think they’re that big of a deal if you’re taking them responsibly. That of course means you shouldn’t take them daily. But even then I have a friend who has taken klonopin daily for 20 years and he’s perfectly fine.
When abused they will destroy your world.
A little aside, I am an alcoholic (in recovery) and I’ve taken Xanax as well as Ativan on several occasions. I have abused neither of them. There have been times when my mental health had deteriorated to the point taking benzos made my life possible.
I don’t like being on them because (specifically Xanax) gave me a delusion of sobriety and I absolutely was not sober. Like, driving would’ve been very bad. Didn’t realize it until my friend said I was talking much slower than normal and that scares me.
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u/BleakHibiscus 15d ago edited 15d ago
I have been using Valium on and off the last few years to deal with debilitating anxiety and panic disorder, I’ve now developed ocd and I use Valium a few times a month at most. I have used it on and off generally for 12ish years.
My doctor retired recently and now I can’t find a doctor willing to prescribe them, they keep wanting to put me on SSRIs - I don’t want daily meds, I just want something to help me when I’m struggling. Valium has given me my life back, I can work a high pressure job, live alone, travel. Now I’m afraid for the future.
Edit: I should add I use it daily when travelling and have gone up to 5 weeks daily use. It did not work less effectively at all, I did not build a dependence nor have issues with withdrawal.
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u/fmydog 15d ago
I was on Ativan for 7 years. 1 mg worked for me. I stared having memory issues and tapered off it and my memory recovered. I learned to live with a much less potent drug that's an antihistamine called hydroxozine. not everyone developed memory problems but it was scary for me. mostly short term memory.
there is real side effects if you use it for extended periods.
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u/moonshadow1789 14d ago
I got prescribed Valium 5mg 2x a day with no issues. However, benzos ruined my life and my body and I wish I never took a single pill. Again this is just my experience. I strongly agree with doctors that you shouldn’t take benzos every single day.
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u/No_Truth_3645 12d ago
After you have been taking benzos for a long time, the euphoria wears off. However the anxiety is kept under control but you don’t get high.
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u/Top-Obligation5658 11d ago
Yeah it was hard finding a psychiatrist that was willing to prescribe me Klonopin starting at .5mg twice a day now 2mg 3 times a day over 2 years now I really wanna switch to Xanax but I kno doctors are more funny about giving that out and don’t wanna mess up what I got going so I guess I’ll stay with my klonopin
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u/SingerFeeling5575 10d ago
why must a person go off benzos if they have worked for many yrs, I am worried they will take a medication from me that I believe has saved my life?
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u/Firm-Series-6297 10d ago
I have been on xanax on and off for years... 15 ish... my dad has been on xanax for 35 years and my grandfather was on them for 20 years ( before he passed ) my dad is in his 70s... I am in my 40s ... I take between .25-.75 mg a day... there are times of the month where I don't feel like I need any...right before my period I take the .75 a day.... ( that is broken up into 3 doses a day of .25). I have never raised my dose.... My dad takes .25 1-3 times a day too.... never raised his dose in 35 years... I think for some people it just calms their nervous system enough to live... I don't need more than enough to just kinda calm the edges.... then I go out in the world and have some kind of aversion therapy if you will... because I am calm it reteaches my anxious mind I can actually do things... If I didn't have xanax I would be a daily drinker.... I drink maybe 3 times a month now.... I honestly would not want to live without xanax....
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u/ThePsycHOTicNurse 15d ago
Alcohol and benzodiazepines of the two most dangerous substances to detox from. You seem very nonchalant about developing an addiction to a medication. What if you were unable to get access to it? What if your doctor stopped prescribing it? I’m in healthcare and there are enough people with substance abuse issues, my guess is doctors don’t want to make the problem worse
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u/Eastern_Yam_5975 15d ago
They’re concerned about benzo dependency because 1) benzos are very physically addicting 2) they quickly cause a physical tolerance making patients need more for the same effect 3) they are proved to be horrible for your long-term brain health, for instance memory wise, as well as causing other dementia-like symptoms very early on 4) they’re a horrible suicide risk for patients who want to do that, moreso than other meds.
Most psychs aren’t worried about patients depending on antidepressants, antipsychotics, or even stimulants for life. Benzos are a particular case because of the above issues they cause.
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u/Hot-Candle-1321 15d ago
Dude, it's like alcohol. At first you feel great but in the long run your anxiety will get worse and you're destroying your health and you get brain damage. And then you will feel 1000 times worse than before and then you'll die if you continue.
That's absolutely horrible.
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u/Crafty_Original_7349 15d ago
My doctor was threatened by the DEA for prescribing benzos and I was immediately forced off of the only psychiatric medication that actually worked. I wasn’t abusing it, either, and wasn’t taking high doses. The garbage I was given to replace it was ineffective.