The first benzodiazepine – chlordiazepoxide – became available, from Hoffman-La Roche, in 1960, under the brand name Librium. It was soon followed by:
- diazepam (Valium) 1963;
- nitrazepam (Mogadon) and oxazepam (Serax) in 1965;
- temazepam (Restoril) 1969;
- clorazepate (Tranxene) 1972;
- flurazepam (Dalmane) 1973;
- clonazepam (Klonopin) 1975;
- lorazepam (Ativan) in 1977; and
- alprazolam (Xanax) in 1981;
Benzodiazepines are categorized as sedative/hypnotics, which means that they have a relaxing, generally pleasant, sleep-inducing effect, and were embraced promptly by psychiatry for the “treatment” of anxiety, tension, worry, sleeplessness, etc.
In this respect, the benzodiazepines largely replaced the earlier barbiturates, which had received a great deal of negative publicity because of their much-publicized role in lethal overdoses, both accidental and intentional.
. . . . .
Initially, there was a good measure of skepticism among the general public with regards to benzos, and indeed, with regards to psychotropic drugs generally. The dominant philosophy in those days was that transient, drug-induced states of consciousness were not only ineffective in addressing human problems, but were also dangerous. There were still lingering traces in the collective memory of the laudanum travesty, and, of course, there were daily reminders of the dangers of “drowning one’s sorrows” in alcohol.
But pharma-psychiatry systematically, deliberately, and self-servingly undermined this skepticism. Pharma’s motivation in this regard is clear: to make money. Psychiatry’s motivation is more difficult to understand because the history, as is often the case, is largely forgotten. At present, psychiatrists have come to be accepted as “real doctors” by the medical profession generally, and by the general public. But in 1960, it would not be an exaggeration to say that they were considered something of a laughing stock among medical practitioners, and were regarded with bemused tolerance by the general public.
For these reasons, psychiatrists were highly motivated to accept something that would enhance their status, and create an appearance of medical authenticity.
Meanwhile, pharma was looking for ways to market their products. It was a match – to mangle the usual phrase – made in Hell. Psychiatrists – desperate for status and assurance, and smarting under the negative publicity of the barbiturate debacle – succumbed readily to pharma’s unctuous flattery and cajolery, and linked themselves whole-heartedly to the industry’s efforts to undermine the healthy skepticism of the general public, and incidentally, of a great many real doctors.
And the package sold like hot cakes.
By 1977, according to Wikipedia, “…benzodiazepines were globally the most prescribed medications.” Sales dipped briefly in the late 70’s after their classification in the US as a Schedule IV drug, but benzos remained generally popular, and today, the drugs continue to grow in popularity. According to IMS Health, a total of 76.7 million prescriptions for benzodiazepines were written in the US in 2005. By 2009, that figure had risen to 87.9 million – an increase of 14.6%. During the same period, the US population had gone from 295.52 million to 306.77 million, an increase of only 3.8%.
. . . . .
So what we have here is a success story. Pharma sells billions of dollars worth of drugs, psychiatry takes its “rightful” place in the ranks of bona fide medical specialties, and vast numbers of people receive safe and effective “treatment” for “real” illnesses such as generalized anxiety disorder, social anxiety disorder, agoraphobia, etc…
So what’s the problem? Well, there are lots of problems.
Firstly, the products, despite the long-insisted pharma-psychiatry hype, are addictive – a fact which is now well-known and need not be labored here. Check the website Beyond Meds, or search Google for benzodiazepine addiction/dependence.
Secondly, it began to be clear early on, that the drugs did indeed have some serious adverse effects. These included: drowsiness and falls; skill impairment/traffic accidents; disinhibition/aggression; memory problems; etc.
Thirdly, more evidence of adverse effects emerges almost every year. Most recently, it has been reported that benzodiazepine use is associated with an increased incidence of homicide and dementia.
In June 2015, Tiihonen et al published a study from Finland on the link between homicide and various drugs. They found that the risk ratio for current use of benzodiazepines was 1.45, with a 95% confidence interval of 1.17-1.81. In other words, current benzo users were about 45% more likely to commit a homicide than comparable non-users.
“Benzodiazepine…use was linked with a higher risk of homicidal offending, and the ﬁndings remained highly signiﬁcant even after correction for multiple comparisons.”
In May 2015, Zhon et al published a meta-analysis from China which explored the association between long-term benzodiazepine use and the risk of developing dementia. A meta-analysis is a study which combines the results of previous studies on the same topic. Zhon et al combined the findings from six studies, involving a total of 45,391 participants, including 11,891 individuals with dementia, and found:
“Compared with never users, pooled adjusted risk ratios (RRs) for dementia were 1.49 (95% confidence interval (CI) 1.30–1.72) for ever users, 1.55 (95% CI 1.31–1.83) for recent users, and 1.55 (95% CI 1.17–2.03) for past users. The risk of dementia increased by 22% for every additional 20 defined daily dose per year (RR, 1.22, 95%CI 1.18–1.25). When we restricted our meta-analyses to unadjusted RRs, all initial significant associations persisted.”
“On the basis of either unadjusted or adjusted risk estimates, our study consistently indicates that long-term benzodiazepine use is associated with an increased risk of dementia.”
The authors point out that associations of this sort do not necessarily prove causality. However, given the known neurotoxic effects of these products, a causative link seems likely.
Zhon et al conducted three separate investigations: ever use vs. never use; recent use vs. never use; and past use vs. never use. In all three cases, the association between benzo use and dementia was clear and substantial, which prompted the authors to write:
“…our findings regarding recent and past use of benzodiazepines may provide an important implication that stopping use of benzodiazepines cannot significantly reduce the risk of developing dementia.”
In other words, the damage is already done. People who have used benzos in the past are at increased risk of developing dementia even if they haven’t used the drugs recently.
So there it is. Pharma invents a dangerous drug, and with the enthusiastic help of psychiatry, markets it as “safe and effective” in the “treatment” of anxiety, which psychiatry has obligingly, conveniently, (and incidentally, fraudulently) transformed into an illness.
The reality is that anxiety is not an illness, but is, rather, the normal human response to anxiety-provoking situations. And in our brave modern world, there is no end of anxiety-provoking situations.
Personally, I have not experienced a great deal of anxiety in my life, but I will readily acknowledge that in recent years, I have experienced a fair measure of anxiety while driving or riding in fast-moving, congested traffic. My concerns in this regard are exacerbated when I notice the very large number of other drivers who are speaking on their cell phones (and even texting!) as they careen blithely through the narrow lanes of potential carnage.
I have resolved this problem by the simple expedient – and this is not Einsteinian stuff – of avoiding fast-moving, congested traffic! The notion that a person could or should dissipate anxiety of this sort (or any sort) by ingesting a downer drug is a special kind of inanity found only in psychiatry.
And fast-moving, congested traffic is only one of the many anxiety-provoking situations in modern life. Here are a few others:
- Persistent inability to make financial ends meet
- Not having medical insurance
- Being concerned about losing one’s job
- Driving an unreliable car
- Living in tornado/hurricane areas
- Being troubled by painful/distressing memories
- Getting into the “right” school
- Getting one’s children into the right school
- Competing for college placement
- Involvement in competitive sports
- Living in big cities
- Choosing the “right” food
- Socializing with members of the opposite sex
- Decision-making generally in everyday life
- Concern about child-rearing
- Worry about exposure to everyday toxins
- Dealing with new job/city/people
- Poor health
- Feeling overwhelmed by the demands of one’s job
- Having a chronically sick child
- Caring for an aging parent
- Involvement in a stressful relationship
- Caring for an ailing partner
- Tension surrounding the sale/purchase of a home
- Fluctuations in the stock market
- Forest fires
- Noisy neighbors
- Street violence
- Blocked septic systems
- Failure to conceive
- Unplanned pregnancy
- Threat of domestic violence
- Having little or no social/family support
- Being alienated from one’s family
- Etc., etc., etc…
I recognize, of course, that avoiding fast-moving, congested traffic is a great deal easier than dealing with most of the anxiety-provoking situations in the above list. But the general principles are the same.
Anxieties are normal. In fact, they are adaptive. They encourage us to be alert and ready for action, and also to take corrective actions with regards to the anxiety-provoking situations. Extreme anxiety is the normal and adaptive response to extreme situations.
During my career as a psychologist, every client who came to me in extreme distress or anxiety was living in circumstances that were extremely distressful or anxiety-provoking. Helping the individual ameliorate the distressing circumstances invariably ameliorated the feelings of distress.
Psychiatrists don’t see this obvious fact, or if they do, they ignore it, because they are conditioned by their training and by the exigencies of reimbursement, to pretend that the problem is – to quote the DSM phrase – “in the individual”. The problem is fraudulently presented as an illness, because psychiatrists need illnesses to legitimize their drug-pushing, and for their continued survival as a profession.
Benzos “work” on these anxieties essentially by switching off neuronal activity. Benzo users don’t feel anxiety, because the pills have impaired their ability to feel anxious. To put it plainly, people who use benzos on a regular basis to dissipate anxiety are chronically intoxicated to the point of blissful apathy, all the while incurring an array of risks which often are far more serious than the initial problem. (Some people, of course, use benzos to avoid withdrawals, but that’s a whole other issue.)
And psychiatrists actually have promoted, and continue to promote, the notion that this constitutes treating an illness! It is noteworthy that at a time when real doctors are developing an increased recognition and respect for the body’s natural resources, warning systems, and defense mechanisms, psychiatry is going in the opposite direction. All psychiatric drugs – including benzos – operate, not by correcting an abnormal state, but rather by suppressing/distorting normal function and creating a pathological state. Chronic benzo intoxication is a pathological state.
Modern life offers unprecedented comforts and conveniences, but, in exchange, exacts a huge toll in terms of tension and anxiety. The notion of dissipating these anxieties with neurotoxic, addictive drugs isn’t just ill-conceived, dangerous, and disempowering; it’s a dehumanizing obscenity.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.