There is something to be said about the fact that antidepressants and tranquilizers just do not mix well together when prescribed to the same patient. Surely, it seems like such a good idea at first. Prescribe an anti-depressant such as an SSRI as a 1st line of pharmaceutical treatment and then prescribe some sot of a benzodiazepine tranquilizer for bad anxiety/panic attacks/insomnia/nightmares. Sounds like a winner, right?
Sadly, benzodiazepines can worsen pre-existing depression, as Styron correctly noted. Having read Darkness Visible in its entirety, I do recall that the first tranquilizer Styron was prescribed was Ativan, not Halcion. Somewhere along the lines, Styron receives a change from an already short-to-intermediate acting Ativan to an even shorter acting Halcion that can be even more problematic than Ativan. The author of this article correctly notes that Dalmane was given to Styron at the hospital to stop Halcion, but Dalmane is also a benzodiazepine tranquilizer, and not an antihistamine, as the author suggests. As cold turkey from any long term benzo use is not recommended under any circumstances, it makes sense that Styron was given a much longer lasting Dalmane in place of the short-acting Halcion, which has such a ridiculously short half-life that it may be impossible to taper off of directly. It’s no wonder Styron was so angry at the FDA about allowing this particular drug.
But going back to my original theme, I have myself exeprienced much agitated depression from benzodiazepine tolerance and withdrawal syndrome, and it is actually that this syndrome, when severe enough, will make a patient generally unable to tolerate an antidepressant that might have been tolerated prior to commencing the use of benzodiazepine. Now, if a psychiatrist insists on a patient taking the antidepressant, then the patient faces a dilemma of either a) not taking the antidepressant at all and pretending that they do, b) taking it in much smaller dosages, as the ability to tolerate it is further reduced, or c) allowing the doctor to add another CNS depressant type medication to be able to tolerate the anti-depressant or d) increase the dose of the prescribed benzo to counter the antidepressant’s side effects, risking even more problems with benzodiazepines and even more central nervous system instability, which may in the end cause the patient to be labeled “treatment-resistant”.
Nowadays, whenever I see the words “treatment resistant”, I always can’t help but wonder if benzodiazepine is/was a part of their medication regimen.
Thank you. I have really enjoyed the article, but I do have to disagree that dangers of benzo withdrawal are well known to the public. Yes, they may be well-known to psychiatric patients who take them, but there is very little out there outside of benzo survivor communities that communicates some of the less obvious issues yet just as equally disabling outcomes from them. Not many people in general public have even heard of the Ashton manual and generally have no concept of how benzos really work, other than that they initially seem to treat the conditions they are prescribed for.
Also, a lot of benzo patients have or had taken other psychiatric drugs: mood stabilizers, antidepressants, beta blockers, antihistamines, antipsychotics, etc.
Before I was prescribed a benzodiazepine, I was just one of those antidepressant users who was told that I should never really go off of them, but needed to stay on a maintenance dose (typically 1/2 of the normal dose) to prevent a recurrence of another depressive episode. That’s what had been drilled into my head many, many times.
I like the article, too, but I wish that it could also talk about challenges of people being severely harmed by prescribed benzodiazepine tranquilizers and the brave souls who are trying to become free of these chemicals while enduring the suffering that is incredibly horrific. No, these people are not zombies. They feel such strong emotions through the process of reaching towards living a chemical-free life, yet an outside observer (often a doctor) just looks at them as just a “bit depressed” and a “bit agitated”. I wish the doctors actually listened and understood that people can feel so horribly overstimulated on the inside from the med withdrawal, while appearing more calm on the outside. The inner world can be far more searing and volcanic than any doctor or a psychiatrist is even mentally capable of imagining.
I was both on SSRI’s and benzos, and benzos by far win the 1st prize for the nastiest withdrawal of any prescribed drug on this planet. It is the most misunderstood, the most misprescribed and the most incorrectly tapered drug class out there. Benzodiazepine dependence is the most complex and life-destroying iatrogenic dependence of all Rx drugs used in mental health. If people want to take them, they can take them, but I am not getting fooled by those soul-sucking, brain-disabling,
health-damaging “medicines” ever again. Also, Klonopin and Ativan are disgusting drugs. They are both valium on steroids. Good luck withdrawing from each.
The article fails to acknowledge that benzodiazepines (especially the high potency ones) can bring about tolerance, physical dependence and many side effects in a very short-time, regardless of how they are prescribed. It’s more about understanding their mechanism of action than anything else. If one understands the effect they have on the brain and body as a powerful GABA catalyst, it is obvious that these medications are meant for emergency use only. A lot of people being prescribed these medications on daily basis and instructed to take multiple times a day are most likely already iatrogenically-dependent on them. If they are not, they will soon be. Such every day “prophylactic” treatment of treating underlying condition before it occurs leads to physiological dependence very quickly. Then, we have perfect patients who never take an extra pill, yet, they have become enslaved to their prescription and are dependent on that next refill in order to keep functioning, not to get sick or worse. So, the “take every day, clearly spelled out prescriptions” only make sense if the prescription is very time limited (several days), or if the patient is already iatrogenically dependent and/or being tapered down.
Other than that, in new benzo users, as-needed prescribing, not without its pitfalls is probably the safest way to go. Basically, try to prescribe the lowest dose for as needed use and warn the patient that this is a sub-optimal treatment of anxiety/panic/insomnia, etc., as well as offer safer alternatives (therapy, other medications, etc.). Also warn the patient of likelihood of physical dependence and potential inability to stop taking these meds with the result of worsening health and side-effects.
Flying while on lorazepam, ambien, and dominal is just crazy. Isn’t dominal in the same medication class as Thorazine??? Also, I don’t think a pilot should be ever prescribed benzodiazepines or z-drugs. These are unsafe even when driving a car, let alone flying….
Suddenly, we’re on this antidepressant crusade, while forgetting how much more dangerous those GABAergic drugs are….
Bruce Hornsby – The way it is
Standing in line marking time–
Waiting for the welfare dime
‘Cause they can’t buy a job
The man in the silk suit hurries by
As he catches the poor old ladies’ eyes
Just for fun he says “Get a job”
That’s just the way it is
Some things will never change
That’s just the way it is
But don’t you believe them
They say hey little boy you can’t go
Where the others go
‘Cause you don’t look like they do
Said hey old man how can you stand
To think that way
Did you really think about it
Before you made the rules
He said, Son
That’s just the way it is
Some things will never change
That’s just the way it is
But don’t you believe them
Well they passed a law in ’64
To give those who ain’t got a little more
But it only goes so far
Because the law another’s mind
When all it sees at the hiring time
Is the line on the color bar
That’s just the way it is
Some things will never change
That’s just the way it is
But don’t you believe them
Thanks for all your efforts, Laura. I found myself dependent on benzodiazepines, and in a hellish withdrawal what some doctors wouldn’t think of as a very high dose. Yet, here I am, nearly housebound, exhausted, with daily panic attacks, and horrible looping thoughts. It feels like it’ll never end. Most of the doctors I’ve seen never acknowledged this is a withdrawal, and once who did, would have put my health at risk with their crazy rapid taper. Things look, hopeless and bleak and every day is a challenge. Dealing with stressful events in life feels like climbing Mt. Everest. I’ve had some predisposition to feeling anxious and mildly depressed throughout my life, but those feelings were bliss and happiness, considering what I am dealing with now. I didn’t even know this sort of reality existed until late last year when I was misdiagnosed with other illnesses. I am keeping myself from going to ER, psych wards or detox center, because they have no idea how to deal with benzo dependence.
There is something to be said about the fact that antidepressants and tranquilizers just do not mix well together when prescribed to the same patient. Surely, it seems like such a good idea at first. Prescribe an anti-depressant such as an SSRI as a 1st line of pharmaceutical treatment and then prescribe some sot of a benzodiazepine tranquilizer for bad anxiety/panic attacks/insomnia/nightmares. Sounds like a winner, right?
Sadly, benzodiazepines can worsen pre-existing depression, as Styron correctly noted. Having read Darkness Visible in its entirety, I do recall that the first tranquilizer Styron was prescribed was Ativan, not Halcion. Somewhere along the lines, Styron receives a change from an already short-to-intermediate acting Ativan to an even shorter acting Halcion that can be even more problematic than Ativan. The author of this article correctly notes that Dalmane was given to Styron at the hospital to stop Halcion, but Dalmane is also a benzodiazepine tranquilizer, and not an antihistamine, as the author suggests. As cold turkey from any long term benzo use is not recommended under any circumstances, it makes sense that Styron was given a much longer lasting Dalmane in place of the short-acting Halcion, which has such a ridiculously short half-life that it may be impossible to taper off of directly. It’s no wonder Styron was so angry at the FDA about allowing this particular drug.
But going back to my original theme, I have myself exeprienced much agitated depression from benzodiazepine tolerance and withdrawal syndrome, and it is actually that this syndrome, when severe enough, will make a patient generally unable to tolerate an antidepressant that might have been tolerated prior to commencing the use of benzodiazepine. Now, if a psychiatrist insists on a patient taking the antidepressant, then the patient faces a dilemma of either a) not taking the antidepressant at all and pretending that they do, b) taking it in much smaller dosages, as the ability to tolerate it is further reduced, or c) allowing the doctor to add another CNS depressant type medication to be able to tolerate the anti-depressant or d) increase the dose of the prescribed benzo to counter the antidepressant’s side effects, risking even more problems with benzodiazepines and even more central nervous system instability, which may in the end cause the patient to be labeled “treatment-resistant”.
Nowadays, whenever I see the words “treatment resistant”, I always can’t help but wonder if benzodiazepine is/was a part of their medication regimen.
Thank you. I have really enjoyed the article, but I do have to disagree that dangers of benzo withdrawal are well known to the public. Yes, they may be well-known to psychiatric patients who take them, but there is very little out there outside of benzo survivor communities that communicates some of the less obvious issues yet just as equally disabling outcomes from them. Not many people in general public have even heard of the Ashton manual and generally have no concept of how benzos really work, other than that they initially seem to treat the conditions they are prescribed for.
Also, a lot of benzo patients have or had taken other psychiatric drugs: mood stabilizers, antidepressants, beta blockers, antihistamines, antipsychotics, etc.
Before I was prescribed a benzodiazepine, I was just one of those antidepressant users who was told that I should never really go off of them, but needed to stay on a maintenance dose (typically 1/2 of the normal dose) to prevent a recurrence of another depressive episode. That’s what had been drilled into my head many, many times.
I like the article, too, but I wish that it could also talk about challenges of people being severely harmed by prescribed benzodiazepine tranquilizers and the brave souls who are trying to become free of these chemicals while enduring the suffering that is incredibly horrific. No, these people are not zombies. They feel such strong emotions through the process of reaching towards living a chemical-free life, yet an outside observer (often a doctor) just looks at them as just a “bit depressed” and a “bit agitated”. I wish the doctors actually listened and understood that people can feel so horribly overstimulated on the inside from the med withdrawal, while appearing more calm on the outside. The inner world can be far more searing and volcanic than any doctor or a psychiatrist is even mentally capable of imagining.
I was both on SSRI’s and benzos, and benzos by far win the 1st prize for the nastiest withdrawal of any prescribed drug on this planet. It is the most misunderstood, the most misprescribed and the most incorrectly tapered drug class out there. Benzodiazepine dependence is the most complex and life-destroying iatrogenic dependence of all Rx drugs used in mental health. If people want to take them, they can take them, but I am not getting fooled by those soul-sucking, brain-disabling,
health-damaging “medicines” ever again. Also, Klonopin and Ativan are disgusting drugs. They are both valium on steroids. Good luck withdrawing from each.
The article fails to acknowledge that benzodiazepines (especially the high potency ones) can bring about tolerance, physical dependence and many side effects in a very short-time, regardless of how they are prescribed. It’s more about understanding their mechanism of action than anything else. If one understands the effect they have on the brain and body as a powerful GABA catalyst, it is obvious that these medications are meant for emergency use only. A lot of people being prescribed these medications on daily basis and instructed to take multiple times a day are most likely already iatrogenically-dependent on them. If they are not, they will soon be. Such every day “prophylactic” treatment of treating underlying condition before it occurs leads to physiological dependence very quickly. Then, we have perfect patients who never take an extra pill, yet, they have become enslaved to their prescription and are dependent on that next refill in order to keep functioning, not to get sick or worse. So, the “take every day, clearly spelled out prescriptions” only make sense if the prescription is very time limited (several days), or if the patient is already iatrogenically dependent and/or being tapered down.
Other than that, in new benzo users, as-needed prescribing, not without its pitfalls is probably the safest way to go. Basically, try to prescribe the lowest dose for as needed use and warn the patient that this is a sub-optimal treatment of anxiety/panic/insomnia, etc., as well as offer safer alternatives (therapy, other medications, etc.). Also warn the patient of likelihood of physical dependence and potential inability to stop taking these meds with the result of worsening health and side-effects.
Flying while on lorazepam, ambien, and dominal is just crazy. Isn’t dominal in the same medication class as Thorazine??? Also, I don’t think a pilot should be ever prescribed benzodiazepines or z-drugs. These are unsafe even when driving a car, let alone flying….
Suddenly, we’re on this antidepressant crusade, while forgetting how much more dangerous those GABAergic drugs are….
Bruce Hornsby – The way it is
Standing in line marking time–
Waiting for the welfare dime
‘Cause they can’t buy a job
The man in the silk suit hurries by
As he catches the poor old ladies’ eyes
Just for fun he says “Get a job”
That’s just the way it is
Some things will never change
That’s just the way it is
But don’t you believe them
They say hey little boy you can’t go
Where the others go
‘Cause you don’t look like they do
Said hey old man how can you stand
To think that way
Did you really think about it
Before you made the rules
He said, Son
That’s just the way it is
Some things will never change
That’s just the way it is
But don’t you believe them
Well they passed a law in ’64
To give those who ain’t got a little more
But it only goes so far
Because the law another’s mind
When all it sees at the hiring time
Is the line on the color bar
That’s just the way it is
Some things will never change
That’s just the way it is
But don’t you believe them
Thanks for all your efforts, Laura. I found myself dependent on benzodiazepines, and in a hellish withdrawal what some doctors wouldn’t think of as a very high dose. Yet, here I am, nearly housebound, exhausted, with daily panic attacks, and horrible looping thoughts. It feels like it’ll never end. Most of the doctors I’ve seen never acknowledged this is a withdrawal, and once who did, would have put my health at risk with their crazy rapid taper. Things look, hopeless and bleak and every day is a challenge. Dealing with stressful events in life feels like climbing Mt. Everest. I’ve had some predisposition to feeling anxious and mildly depressed throughout my life, but those feelings were bliss and happiness, considering what I am dealing with now. I didn’t even know this sort of reality existed until late last year when I was misdiagnosed with other illnesses. I am keeping myself from going to ER, psych wards or detox center, because they have no idea how to deal with benzo dependence.