Posted by sukarno on December 15, 2010, at 12:30:18
In reply to Re: Do antidepressants induce chronicity? » ed_uk2010, posted by sigismund on December 4, 2010, at 14:49:32
The theory that BZDs can "cause" agoraphobia is, in my opinion, without any scientific merit. In addition, an abstract I read states that unmedicated PD patients have 20% less GABA activity than controls.
Agoraphobia is considered to be a complication of panic disorder that is not treated well enough with either pharmacotherapy or CBT, etc, according to the psychiatrists I've spoken with and the official information on panic disorder that I've read throughout the years.
Many people take BZDs for anxiety but because some develop agoraphobia later on does not prove causation in my opinion.
Doses of BZDs required to achieve remission in panic disorder are much higher than those needed for generalized anxiety disorder or other anxiety disorders. Unfortunately, many physicians and psychiatrists do not prescribe doses sufficient to achieve remission.
If alprazolam (Xanax) is prescribed at all for panic disorder, unfortunately it is prescribed in sub-therapeutic doses (0.250.5mg once or twice a day or as PRN) which could lead patients to believe the medication is not effective. It should be prescribed in a low dose on a TID or QID schedule and then increased slowly until the panic attacks resolve (in the clinical trials, doses of 56mg/day were used in the treatment of panic disorder).
BZDs in general make me much more social, less fearful and less inhibited, even after 20 years of nonstop use. This is good as I feel comfortable approaching people I don't know and initiating conversation. Prior to BZDs in the 1980s I was introverted and a nervous wreck. There would be no way I would talk to strangers or hang out in public places back then.
I firmly believe that benzodiazepines are under-utilized in our society. Despite being placed in Schedule IV of the Controlled Substances Act in the United States, I feel they are prescribed less often than drugs in Schedule II and III, which makes absolutely no sense whatsoever unless doctors actually believe that ADHD or chronic pain is worse than panic disorder or that anxiety is "all in the head" or "not serious enough" to warrant medication.
I've actually met a psychiatrist who said "you only need to change the way you think" to conquer panic disorder and depression. Oh really? Would they say that to someone with ADHD or chronic pain? How about someone with angina? Cancer? Diabetes?
Schedule IV medications have far less abuse potential than drugs in Schedules II and III, but it is easier to get methylphenidate, amphetamines and other psychostimulants, and opiates/opioids than BZDs. For example, there are pain clinics and pdocs who specialize in ADHD, but I've never heard of a panic disorder clinic. We badly need a special clinic of our own though.
As a doctor in the US state of Mississippi once told me in 2001, "The state medical board here is very backwards in their thinking. Unfortunately they believe doctors should only prescribe BZDs to patients on their death bed."
Strangely, many doctors are more accepting of cannabis (Schedule I), a drug with high abuse potential, than BZDs. I have a friend in Nevada who told me that doctors are recommending cannabis there even for "headache".
Even when cannabis was in the dark days of absolute prohibition my psychiatrists would sometimes just giggle when I mentioned my experience with cannabis when I was younger. They thought it was a benign drug, which it probably is, but it is abused much more often than any other illicit substance. I thought that abuse liability is the determining factor in whether or not to prescribe a psychotropic substance. Schedule IV drugs have less abuse liability than those in more strict schedules.
That said, I support medical cannabis, but it is much more abused than prescription drugs.
Rx: alprazolam 1mg QID, famotidine 20mg BID, cetirizine 5mg BID, GNC Ultra Mega Gold vitamin supplement BID
Dx: panic disorder with agoraphobia, chronic depression, probable PTSD
poster:sukarno
thread:972394
URL: http://www.dr-bob.org/babble/20101203/msgs/973631.html