Posted by Elizabeth on December 4, 1999, at 9:10:23
In reply to Re: social anxiety - benzos - to Rick, posted by Jane on December 3, 1999, at 16:32:38
> rick, while i think that benzos with long half lives provide a "buffer" of safety against addiction, as you have read previously everyone is different, and i think most doctors are aware that regardless of benzos, these still contain the potential for addiction and this may be why it is not often mentioned as often as first line therapy.
For the record, I asked my therapist once what drug(s) he would consider as first-line treatments for panic disorder (not social phobia, but treatments are similar). He said either Klonopin or an SSRI would be his choice.
People with anxiety disorders are very sensitive to the side effects of antidepressants, so sometimes if they don't have depression also, there is a compelling reason to use a benzo instead.
> keep in mind too, that many times people suffering from anxiety require long term therapy and benzos in the long term are often associated with dependence and withdrawal syndrome.
(sigh) IMHO the problem is that many doctors aren't familiar with the proper way to discontinue a benzo...or worse, assume that any patient who has withdrawal symptoms must be "addicted" or abusing the benzo. I'm sure that all the people here who had withdrawal symptoms upon discontinuing Paxil, Effexor, etc. would be rather offended if their doctors had treated them like drug addicts or suggested that the withdrawal was their fault and they just had to suffer through it. Benzos have to be tapered very slowly, much more so than antidepressants. Doctors need to be aware of this. IMHO a good procedure is: (1) determine that it actually is time to stop taking the benzo; make sure the patient *consents* to the change (2) decrease by a small amount (e.g., 0.25mg/day of alprazolam) (3) continue decreasing *as tolerated* (if once a week is too often, do it once every 2 weeks, etc.); go more slowly when close to zero.
> another factor is the interaction of benzos with alcohol. how often do you think people suffering from anxiety "self-medicate" by drinking a bit to relax? if they continually drink while taking benzos, they can be in serious risk for injury or accident if they're active because of the potentiating effect of benzos on alcohol effects.
If someone is abusing alcohol, that's a special case. However, you should realize that benzos are a major part of the treatment for alcohol withdrawal! If someone truly has just been "self-medicating" with alcohol, benzos should serve as a safer, more effective substitute, and the person should no longer need alcohol.
Also of course it is not safe to assume that anyone with an anxiety disorder is an alcoholic! (I hardly ever drink, for example.)
> so i think collectively these factors make benzo less than stellar a choice in treating anxiety disorders for most individuals who are active and need to work during the day.
Huh? Anybody who is going to work drunk has a serious alcohol problem that needs to be addressed. This goes beyond having an anxiety disorder.
> of course there are exceptions to the rule, but exceptions are in minority.
The above is your opinion -- what you base it on is not clear. But here's a fact: anxiety patients almost never abuse prescribed benzodiazepines.
poster:Elizabeth
thread:15816
URL: http://www.dr-bob.org/babble/19991123/msgs/16184.html