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Benzos and Other Drugs
I rarely prescribe benzodiazepines, a chemical class of central nervous system depressants like alprazolam (Xanax), diazepam (Valium) and clonazepam (Klonopin) for purely psychiatric indications at all, and when I do I discontinue them as soon as possible. Physicians often compare benzos to other chronic prescribing in arguing against stopping them, but I believe those comparisons suffer from numerous flaws.
The key arguments against chronic benzo use:
- Safer alternative treatments exist, including psychotherapy.
- We cannot tell the patient still benefits from them without stopping the drug.
- Discontinuation causes a reprise of the discomfort that led to the first prescription creating the illusion that the patient needs to continue.
Risks of benzos:
- Impaired driving and other motor skills.
- Impaired judgement.
- Interaction with alcohol and other drugs.
- Mood depression.
- Overdose potential.
Let me compare and contrast with drugs that may warrant long term use. Parameters to consider:
- Therapeutic effect
- Abstinence syndrome
- Time to loss of therapeutic effect
- Symptoms treated
- Availability of alternative treatments.
- No effective alternative for treating opiate addiction may exist.
- Pain management led to the first use of opiates. Discontinuation of an opiate does not produce pain. It produces an entirely different syndrome.
- It may take weeks for return of the original target symptom.
- The discontinuation syndrome bears no resemblance to the target symptoms/illness.
- Risks of long term use pale by comparison to those of benzos.
- Diabetes does not resolve spontaneously.
- Symptoms of diabetes recur almost immediately after discontinuation.
- Insulin has no separate abstinence syndrome.
- They have no abstinence syndrome.
- Discontinuation in itself does not lead to pregnancy.
- You do not discontinue them just because you have not gotten pregnant (yet).
I have yet to find a valid comparison that might support chronic use of benzos.