Posted by Elizabeth on March 12, 2002, at 20:31:58
In reply to Re: benzodiazEpines, posted by gilbert on March 9, 2002, at 17:19:11
> There are huge amounts of data clinical and standard pyschiactric practice that would say otherwise then your statement above....
I should have been more specific. Some clinical practitioners may have the impression that benzo tolerance is common. And in fact, it is, if the benzo is being used for *insomnia* (not anxiety). I think it's a bad idea to get in the habit of taking benzos for insomnia. But anyway, an opinion is not necessarily right just because it's held by some psychiatrists. Physicians can be vulnerable to being influenced by their emotions, by propaganda, etc., just like the rest of us can.
I was referring to data derived from well-designed, rigorous clinical research. This research is described in articles that I've read and/or that are cited in standard textbooks in relevant fields. I'm not going to make a claim based solely on what a psychiatrist (or a few of them) believes; that's what is called an "appeal to authority" and is very often misleading. You know four psychiatrists who think benzos should never be used long-term? I know plenty (definitely more than four) who do use them long term with success. It is true that patients who are abusing benzos tend to have to increase the dose a lot. Patients who take benzos for anxiety seldom abuse them, though. As I've said before, it's important for a pdoc to keep a close eye on a patient with a drug abuse history if it becomes necessary to treat such a patient with benzos.
Anyway, I prefer to look at the facts themselves in forming my own opinion, rather than let the "experts" (those I know, or those you know) tell me what opinion to have. I think everyone here is aware that doctors sometimes get things wrong.
It's important to realize that the drug monographs in the PDR are put together by pharmaceutical companies, not disinterested academics or clinicians. The drug companies tend to make conservative recommendations in order to cover their own butts.
But anyway, the product monographs say not to use *sleeping pills* more than a couple weeks. Insomnia is not an anxiety disorder. People who take benzos as sedative-hypnotics for too long will most likely start needing to raise the dose at some point.
In contrast, if you read the Xanax monograph, you'll find that it's well accepted that people with anxiety disorders require longer treatment than just a month or so. "Demonstrations of the effectiveness of XANAX by systematic clinical study are limited to four months duration for anxiety disorder [GAD] and four to ten weeks for panic disorder; however, patients with panic disorder have been treated on an open basis for up to eight months without apparent loss of benefit." This doesn't sound to me like a recommendation against long-term treatment. (Note: this is from the 1999 PDR.)
I'm out of town and don't have Schatzberg & Nemeroff's psychiatry text here, but they go into the subject in some depth. I think I've probaly cited them in the past.
> I would say your statement that "all the credible sources" is from a personal bias rather than a scientific point of view
I think you should be more careful before making accusations of bias. That's not a very nice thing to say.
Some people do abuse prescribed benzos, and these people often take much more than the prescribed dose. (Most anxiety disordered patients taking benzos do *not* abuse them; those who do are almost unfailingly people who also abuse other drugs.) Every now and then a person taking a benzodiazepine for anxiety, and not abusing it, may nonetheless become tolerant to the drug's anxiolytic effects, but the available evidence clearly shows that this is exceptional.
-elizabeth
p.s. I'm not sure what you mean by "the DMV." (Where I come from, that's the Division of Motor Vehicles.) If you mean "DSM-IV," that's a set of diagnostic guidelines, *not* prescription information.
poster:Elizabeth
thread:96969
URL: http://www.dr-bob.org/babble/20020307/msgs/97695.html