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  1. This class of drugs, which includes Xanax and Valium, helps control anxiety and panic attacks. A recent study found 1 in 20 adults received a prescription for benzodiazepines in 2008. By Kirstin Fawcett Feb. 19, 2015 | 10:28 a.m. EST+ More The mere thought of climbing into a car sends Jenn Waterman spiraling into a state of agitation and fear. Waterman, a 30-year-old freelance book editor who lives in Arapaho, North Carolina, survived two near-fatal car accidents as a teenager. Since then, she’s battled post-traumatic stress disorder and panic attacks. Waterman has visited a therapist, and she regularly takes Zoloft, a medication that treats depression, anxiety and other conditions. But the only thing that truly quells her nerves before sliding into a vehicle’s passenger seat, she says, is Valium. “I notice that once I go ahead and take it, I feel so much better – like I can finally relax,” she says. “Sometimes that makes all the difference in the world.” Valium is a medication that’s part of a larger class of drugs called benzodiazepines. Benzodiazepines are commonly prescribed for anxiety and agitation. They can also be used for insomnia, seizures and alcohol withdrawal. Some types of benzodiazepines are instantly recognizable; Ativan and Xanax, for example, have infiltrated popular culture and are now colloquially considered “quick fixes” for everything from poor sleep to panic disorders. But other forms include – but aren’t limited to – the drugs Klonopin and Valium. Benzodiazepines are some of the most common medications in the world; a recent study sponsored by the National Institutes of Health found that about 1 in 20 adults received a prescription for them in 2008. They’re extremely effective for patients like Waterman, who have crippling anxiety. Unlike medications like selective-serotonin reuptake inhibitors, which take several weeks to reach full efficacy, benzodiazepines work almost immediately. They can also be good for treating chronic anxiety in patients who have adverse reactions to SSRIs and similar medicines. The drawbacks? Benzodiazepines can be habit-forming. And they carry a host of dangerous side effects – including impaired cognition and mobility in older individuals, and potentially life-threatening withdrawal symptoms in people with severe addictions. A study sponsored by the National Institute of Mental Health recently linked long-term use of benzodiazepines to a heightened risk for Alzheimer’s disease. And data from the Centers for Disease Control and Prevention showed that benzodiazepines, along with opioid pain relievers, are the prescription drugs most often responsible for emergency department visits and drug-related deaths. So are benzodiazepines helpful or dangerous? Like most pharmaceutical drugs, experts say, they’re a mixed bag. Despite studies suggesting that physicians over-prescribe them, even those in the medical community tend to disagree on whether the benefits of benzodiazepines outweigh the risks. For every doctor who writes a prescription for Xanax, there’s another who refuses to do so, says Jerrold Rosenbaum, chief of psychiatry at Massachusetts General Hospital. “It’s amazing how polarizing the conversation gets,” Rosenbaum says. "There is a constituency that views [benzodiazepines] as evil and harmful; they tend to come out of the substance use disorder community. They’re not perfect drugs, but they do work for conditions for which nothing else [is as effective].” Benzodiazepines can be safe for short-term use. “Benzodiazapines are very effective, particularly in the short term, for the treatment of acute anxiety and insomnia,” says Larissa Mooney, an assistant professor of psychiatry and director of the Addiction Medicine Clinic at the University of California-Los Angeles. “They calm people down, and they help people fall asleep and stay asleep.” Most doctors say benzodiazepines should not be prescribed for more than a few weeks. The body slowly builds up a dependency to the pills, which can be averted by not taking them for an extended duration. Patients should also make sure to follow their doctor's dosage instructions, and to slowly taper off the medication instead of stopping cold turkey. In some cases, though, long-term use of benzodiazepines can be acceptable, Mooney says. “There are a subset of people who seem to respond very well to long-term benzodiazepines,” she says. “They may be maintained on a low dose and never need anything higher – meaning they don’t develop a tolerance. They may be intolerant to other classes of medications. And it seems to augment their treatment for anxiety.” All of the above are true for Waterman, who has sporadically taken Valium over the years. She sticks to a low dosage, goes periods of time without taking the medicine and says she’s never felt any physical side effects. She’s also had bad reactions to other antianxiety drugs; Valium is the only medicine she’s taken that hasn't produced physical side effects. And while Zoloft helps her anxiety, Valium is more effective at halting her nightmares and panic attacks. Benzodiazepines are not a cure-all. Many people with panic disorder or acute anxiety use benzodiazepines as a first-line method of treatment until they’re able to find another coping mechanism. But they might also have underlying issues that contribute to their anxiety, Rosenbaum says. These problems might be best addressed by tackling life stressors, taking an antidepressant that helps with anxiety or trying cognitive-behavioral therapy. Certain people should not take benzodiazepines – or they should take extra precautions. People with a history of alcoholism or drug addiction are advised against taking benzodiazepines. Similarly, elderly people face an increased risk of falls, cognitive disturbance, sleep apnea and a potentially heightened chance of dementia, says Charles Reynolds, a professor of geriatric psychiatry at the University of Pittsburgh School of Medicine. However, he says, certain factors that often appear with aging – for instance, bereavement, insomnia and low-grade depression complicated by anxiety – mean benzodiazepines “do have a place in the management of emotional distress in older adults.” In these cases, he says their best bet is a short-acting benzodiazepine prescribed for a limited duration. And it goes without saying, he adds, that anyone taking benzodiazepines should avoid depressants such as alcohol or opioids. Doctors should carefully monitor patients’ use of benzodiazepines. “In most cases of benzodiazepine dependence, addiction begins with a legitimate prescription,” says Tiffany Jones-Rouse, a licensed social worker and substance abuse counselor based in the Baltimore-District of Columbia metro area. “Folks seek intervention for a variety of conditions, from muscle spasms to chronic anxiety disorders, and they're often issued a prescription for Xanax, Valium, Klonazepam, Ativan or another tranquilizer.” These drugs, she says, can be beneficial for people who have never demonstrated drug or alcohol dependence. In this case, their dosage should always be time-limited and closely monitored by a physician who addresses the potential for addiction. The problem, Jones-Rouse says, is that while many physicians impose prescription time limits and address the risks and side effects, others might not. Over time, a patient will sometimes develop a tolerance toward the benzodiazepines. Their negative symptoms will return, and they will either request a larger dosage from their doctors, buy the medicine illegally or turn to another substance, like alcohol. In certain cases, Jones-Rouse adds, people don't recognize that they're dependent until they make the decision to stop taking the medication. They’ll quickly find that they experience uncomfortable withdrawal symptoms such as mood swings, agitation and irritability, and changes in appetite and sleep patterns, among others. In worst-case scenarios, unmonitored benzodiazepine withdrawal can lead to stroke, seizures and heart attacks. And benzodiazepines, when combined with other drugs, can result in overdose and death. It's possible to safely withdraw from benzodiazepines, even after extended use or abuse. According to Jones-Rouse, hospitals and treatment programs provide medical monitoring for the detoxification phase. Therapists, social workers and psychologists trained in dealing with substance abuse can provide longer-term psychological care. And public support programs such as the 12-step programs Narcotics Anonymous and Chemically Dependents Anonymous provide a social support network that aids in recovery. SOURCE: Lloyd Sederer is medical director of the New York State Office of Mental Health, adjunct professor at Columbia University’s Mailman School of Public Health and medical editor for Mental Health for the Huffington Post. Follow him @askdrlloyd and visit his website www.askdrlloyd.com. The opinions expressed here are his own However, experts say most physicians agree on the following guidelines – independent of whether or not they themselves prescribe benzodiazepines.
  2. Hi Folks, I have been feeling a really desperate need to get a few thing down on paper on out for other people to view, people who aren't my wife and aren't going to charge me $135 am hour to tell me cognitive therapy is the answer to everything. Overall, I would say I have a good life, I am married, have a house, have had the same job for 12 years. But I have a lot of skeletons in my closet. When I was a preteen, I was a very sensitive guy, and such i got picked on a lot. I would come home crying every other day from getting picked on at at school. When I reached junior high, I found a group of people who accepted me (kind of), as long as I did drugs with them. I quickly found that a life constantly doped up on anything was better then any reality. I was using an illegal drug, drinking, taking any pill I could get my hands on, Anything to escape reality, cause reality just sucked for me. That went on for about 6 months,, and then I had a bad experience with an illegal drug, and that sparked my genetic disposition to Panic Disorder. I'm not talking just the shortness off breath type panic disorder, I am talking about the type of panic that made me hallucinate an lose bowel control. Good times. So my parents put me in rehab, and I saw a Pysche who put me on 1mg of xanax at the age of 13. The Xanax worked great for dealing with my panic, but he did nothing for helping me though me issues. We played chess. I am now 32, and finally weaned off the xanax at age 31. Now am battling serious issues of self worth, panic, and addition again. I started having really bad panic attacks again, so my GP put me on Klonopin. Now I am battling shaking this crap. I am typing this message on 60mg of valium just to keep the shakes at bay. My wife and I are trying to have a child, and I can't perform. It makes me feel comletly worthless. I want to be a father so bad it hurts. My job is completely dead end and I did not finish my college degree. Each day leaves a grey cloud potential unemployment over my head. I don't know how much more of this I or my wife can take. I am looking for a sympathetic ear. I just need someone t talk to. My wife is a chemical dependency counselor, inconveniently - so when I try and talk to her about this stuff the counselor mode comes on and flips all this crap right back on me. I would appreciate anyone willing to take the time to talk to me more. Jeff
  3. For those who remember me, I hope some of you recover and happier! I became a part of my depression and it lives in me. To be able to bear the pain, I developed addiction to prescription med... My mother caught me, we went to 2 specialits, the first one was horrible, said I am hopeless, need hospitalization and ECT. The second became my dear and wonderful psychiatrist, who also happens to be an expert in CBT treatment. I struggle with the addiction...because none med helps and this one does. He wants me off anti depressants totally...slowly. and wants to replace it with intense therapy. I am so tired of life. I try to be optimistic...no doubt, CBT teaches me that...but life is a long and painful road for me.
  4. <blockquote> <i>"A leaf fluttered in through the window this morning, as if supported by the rays of the sun, a bird settled on the fire escape, joy in the task of coffee, joy accompanied me as I walked."</i> Anais Nin </blockquote> This is scary, I haven't written openly and honestly in many years and I really need to start doing so again. I feel like everything that was important to me was left behind years ago and I've just sort of wrapped myself up in the security of being invisible and not really existing outside of my head. It's time for me to take action and begin taking steps in my life to actually recreate myself. I lost my father this year and honestly, I don't want to die alone and scared of the world and trapped in my addictions like he did. I don't want to forget how blue the sky is and how much the smell of the autumn air makes my heart coo and purr and squeal. I've been numb and asleep and just holding on tight to my pain and fear and anger for so long that the process of opening my eyes and my heart terrifies me. I'm tired of feeling ashamed of my life. I'm tired of punishing myself with excess and imbalance and I <strike>need to</strike> am taking steps to heal myself. I'm going to call my therapist in the morning and begin seeing him again even though I'm ashamed of the fact that I've allowed some of my "numbing" behaviors to return to my life. I <strike>can't</strike> won't allow that all or nothing sort of 12 step mentality to rule my life; I'm not drinking or doing drugs (and haven't since 1992)but I still struggle with my need to escape through various means (food, tv, books, morpgs etc) and I honestly believe that I can gain balance if I can just find focus and structure with these things. I've recently realized that I need to change my entire mental relationship with food in order to regain my health. I need to stop thinking of unhealthy foods as rewards and adapt to thinking of healthy, nourishing food and physical activity as "treats" to myself. <span style="font-weight:bold;">10 Acts of Self-Love: (for this week)</span> <bl> <li>Dress, brush teeth, do hair every morning</li> <li>Walk for pleasure with my dog daily</li> <li>Spend 15 minutes of household cleaning daily</li> <li>Write openly and honestly daily</li> <li>Call my therapist and set up an appointment</li> <li>Take the time to prepare 3 healthy meals and 2 healthy snacks daily</li> <li>Create something</li> <li>Assemble my new desk and blinds</li> <li>Do laundry</li> <li>Spend 30 minutes each day organising one of the lower floor rooms</li> </bl> Many of these sound so simple but as someone who suffers from extreme chemical depression even dressing seems like an insurmountable task on my really rough days. <object width="640" height="385"><param name="movie" value="http://www.youtube.com/watch?v=qqZZlL0l5Uk?fs=1&hl=en_US">'>http://www.youtube.com/watch?v=qqZZlL0l5Uk?fs=1&hl=en_US"> </param> <param name="allowFullScreen" value="true"> </param> <param name="allowscriptaccess" value="always"> </param> <embed src="http://www.youtube.com/watch?v=qqZZlL0l5Uk?fs=1&hl=en_US" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="640" height="385"></embed></object>
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