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  1. #1

    Some Concerns About Abuse of Benzodiazepines Unwarranted

    Some Concerns About Abuse of Benzodiazepines Unwarranted
    Clinical Psychiatry News
    Volume 34, Issue 3, Page 31 (March 2006)

    by Linda Little

    ALBUQUERQUE — Prescribing practices for treating anxiety disorders are shifting from benzodiazepines to antidepressants—partly because of increasing concern about dependence and cognitive impairment with benzodiazepines as well as their potential for abuse. However, much of the concern is unwarranted, Dr. Carl Salzman said at a psychiatric symposium sponsored by the University of New Mexico.

    Physicians must determine the risk vs. benefit for each drug class, said Dr. Salzman, who is affiliated with the Beth Israel Deaconess Medical Center and the Massachusetts Mental Health Center in Boston.

    Benzodiazepines may be abused, as well as cause memory impairment and dependence with chronic use, but nearly all abuse is limited to substance abusers. Long-term therapeutic use does not lead to dose escalation, and memory impairment is mild, reversible, and does not occur in everyone.

    Antidepressants are useful for anxiety spectrum disorders and mixed anxiety-depressive states but do not act rapidly. Serotonergic antidepressants commonly produce sexual dysfunction and blunted affect, and are associated with withdrawal symptoms when abruptly discontinued, said Dr. Salzman, also a professor of psychiatry at Harvard University in Boston.

    Overall, benzodiazepines are safer than antidepressants. They do not impair cardiac function, alter hepatic enzymes, or lower seizure threshold. Thus, Dr. Salzman believes benzodiazepines should still be first-line treatment for anxiety. For patients who must choose between mild dependence vs. loss or reduced sexual function, benzodiazepines trump antidepressants.
    Attached Files Attached Files

  2. #2

    Re: Some Concerns About Abuse of Benzodiazepines Unwarranted

    I like this article a lot.
    For patients who must choose between mild dependence vs. loss or reduced sexual function, benzodiazepines trump antidepressants
    .

    I have never, and I mean NEVER been able to find an SSRI that did not cause me total sexual dysfunction...and I tried a lot of them through my teenage years. The sexual side effects weren't even the only side effects I got. Those SSRIs were just a horrible experience for me, and yet, when my anxiety becomes an issue doctors will only consider SSRIs. It is very frusterating. Benzodiazapines work so much better for me with no side effects...yet they are so much harder to get than SSRIs, even though the doctors straight up tell me that I will get the sexual dysfuntion from all of them (I've been told this by two different psychiatrists). They also never eased the anxiety one bit. When I tell them this they just look at me like...well, SSRIs are the only option, take it or leave it. And of course, my husband is adamitely against my taking SSRIs for obvious reasons.

    It's very hard to keep hearing how great these SSRIs are...it makes me feel like some kind of freak for not being able to use them.

    What about Buspar? Do you know anything about that medication? Isn't it supposed to be different in some way than all the rest of them?

  3. #3

    Re: Some Concerns About Abuse of Benzodiazepines Unwarranted

    Yes. Buspar is an anti-anxiety medication that is neither a benzodiazepine nor an SSRI:

    http://www.rxlist.com/cgi/generic/buspir.htm

    BuSpar® (buspirone hydrochloride tablets, USP) is an antianxiety agent that is not chemically or pharmacologically related to the ben-zodiazepines, barbiturates, or other sedative/anxiolytic drugs.

    The more commonly observed untoward events associated with the use of buspirone HCl not seen at an equivalent incidence among placebo-treated patients include dizziness, nausea, headache, nervousness, lightheadedness, and excitement.
    Sexual dysfunction is rare wirth Buspar but there are some medical conditions that would not be compatible. Ask your doctor for more information.

  4. #4

    Re: Some Concerns About Abuse of Benzodiazepines Unwarranted

    Oh interesting. I did ask that psychiatrist that I (mistakenly) went to and he didn't want to prescribe me anything w/o me agreeing to this treatment contract. Anyway, all he said about Buspar was that he didn't usually prescribe it and wasn't really familiar with it. He then said that I could get that from my regular doctor if that's what I wanted. My regular doctor is a very nice woman but she is not going to know these medical condition and details like that, trust me on this.
    Why won't anyone talk about Buspar? Is it just not used anymore or what? It's the strangest thing. It's starting to feel like a conspiracy (not really).

    I will try that weblink-it is not working right now. Maybe there will be some top secret info there.

    I mean, it sounds promising. I'd like to be more relaxed....

  5. #5

    Re: Some Concerns About Abuse of Benzodiazepines Unwarranted

    I'm not sure why it's not used more. Possibly side-effects (the dizziness and nausea don't sound like a lot of fun)? Or maybe the manufacturer isn't as aggressive in marketing it to doctors...

  6. #6

    Re: Some Concerns About Abuse of Benzodiazepines Unwarranted

    Or maybe the manufacturer isn't as aggressive in marketing it to doctors...
    I bet you're right. So much of pharmeceuticals is marketing it's really sickening. I have a relative who is a saleswoman and she just recently had to stop taking doctors to basketball games in order to convince them to prescribe a certain diabetes medication. She had to stop because it became illegal.

    Anyway...so you do not know anyone that has ever taken them and nobody on this forum is taking Buspar? I am increasingly interested in Buspar now. I took it once as a child and hardly remember it (which is a good sign I think).

    If it is 1)no sexual side effects 2)non addictive 3)specifically for anxiety instead of depression....what is not to love?

    nausea and dizziness sound dealable....but I don't remember any side effects...of course I was only probably 10-12 years old. I remember I had to take three pills per day.

    Dr. Baxter, what are the medical conditions that Buspar conflicts with? Or maybe it doesn't matter because come to think of it, I don't have any (notable) medical conditions...I only have imaginary medical conditions.

    Maybe I should look into it, my jangled nerves could use a rest.

  7. #7

    Re: Some Concerns About Abuse of Benzodiazepines Unwarranted

    Possible concerns related to buspirone's binding to dopamine receptors: Because buspirone can bind to central dopamine receptors, a question has been raised about its potential to cause acute and chronic changes in dopamine-mediated neurological function (e.g., dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia). Clinical experience in controlled trials has failed to identify any significant neuroleptic-like activity; however, a syndrome of restlessness, appearing shortly after initiation of treatment, has been reported in some small fraction of buspirone-treated patients.
    http://www.rxlist.com/cgi/generic/buspir_wcp.htm
    What does this mean to you? It sound like there could be serious side effects, doesn't it?

  8. #8

    Re: Some Concerns About Abuse of Benzodiazepines Unwarranted

    so you do not know anyone that has ever taken them and nobody on this forum is taking Buspar?
    One client. He didn't react well but he really hasn't reacted well to any medications - he seems to be unusually sensitive and what some psychopharmacologists term a "rapid metabolizer".

    As for the quote about side-effects, the crucial part is this:

    Clinical experience in controlled trials has failed to identify any significant neuroleptic-like activity
    In other words, the action of the medication raised some questions but research to date has failed to provide any evidence to support those concerns.

  9. #9

    Re: Some Concerns About Abuse of Benzodiazepines Unwarranted

    Thank you for all that information. Your client sounds just like me. I don't react well to any medication. I've just had to accept that there isn't going to be an anxiety medication for me.

    Thank you for clarifying that quote for me. It sounded safe but dangerous at the same time. When I read the words tardive dyskinesia it sent chills down my spine. If I take a medication that has that as a possible side effect-I WILL get that side effect...and when it is neurological damage, that is really scary and I wouldn't even want to go there, you know?

    Maybe Buspar could maybe be an option though if you really don't think that is a side effect....whenever I speak to a doctor about this there is basically no solution. They are always surprised about the side effects that I get. I get the ones that are really rare.

    It is scary to take them though, remembering how sick and scared they made me.

    Benzos, on the other hand, have been the only medication that has ever worked for me and only had drowsiness as a side effect-and the drowsiness is not that bad anymore.

    I think that people are being overly cautious with these benzos and that is causing people who could really benefit from them to suffer unneededly.

    Thanks for helping me wtih that Buspar thing Dr. B...that is much more than I've got out of any doctor that I've ever mentioned them too...even that psychiatrist.

  10. #10

    Re: Some Concerns About Abuse of Benzodiazepines Unwarranted

    I do agree with you and the writer of the article - I think there is an unwarranted stigma to the use of low dose modern benzodiazepines and I also think that for some people there really isn't anything else that works nearly as well - and for some nothing else that works at all.

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