Anxiety Shorts: The Potential Pitfalls of Benzodiazepines

There is a class of drug called benzodiazepines, but they are commonly referred to as “benzos.” They are a very effective and rapid acting anti-anxiety pill. However, the research shows you should try to avoid using them in anxiety treatment.

An example of a benzo is called Xanax. They are often used in treatment for panic disorder in particular, so I’m going to focus on that. Here’s a classic example of their use:

Jill starts having a sudden surge of increased heart rate, she is hyperventilating, sweating, and shaking. She thinks she is either dying or going crazy. It came out of nowhere. She acts quickly and manages to get to the ER. They confirm that she is not having a heart attack, and give her a benzodiazepine to reduce her anxiety.

This is fine, but what should happen next if this continues to be a problem is the person should receive cognitive-behavioral therapy. What often happens instead is the person receives an ongoing prescription for a benzodiazepine to manage their anxiety

What’s the Problem with That?!

To begin with, we are really good with treating panic disorder when we use interoceptive exposures , so why would we manage anxiety with drugs when we can successfully treat it for good? Interoceptive exposures focus on creating the physical sensations associated with panic.

This view is supported by the most comprehensive review of the literature, which was done by the National Institute for Health and Care Excellence. They state that cognitive-behavioral therapy should be the first line treatment and that benzodiazepines should not be used beyond 2-4 weeks. More than this, they also note that long-term use of a benzodiazepine is not efficacious

There Are Other Downsides

Beyond this, I’ll tell you what happens with long-term use of benzodiazepines. There are 3 problems:

1) Tolerance:

The same dose of benzo becomes less effective over time. Thus more and more is needed to get the same effect.

2) Physical Dependence:

The body becomes used to having the benzo, and when you try to stop it you can experience “rebound anxiety” which is an increase in the symptoms the drug was designed to treat.

3) Psychological Dependence:

This is one we can see a lot. Basically, a person can become dependent on having the benzodiazepine with them at all times. Doing things without the drug present becomes very anxiety-provoking in case they happen to have a panic attack.

The Effect On Treatment

For panic disorder, treatment should quickly involve removal of benzodiazepines, and move to exposure treatment. If a person tries to do exposure treatment but keeps their benzodiazepine, it can interfere with treatment because it can be considered a “safety behavior.” The analogy I like to use is that to learn to properly ride a bike you have to take off the training wheels.

Hopefully you understand from reading this what benzodiazepines are used for and their potential impact upon treatment for panic disorder. I’ll write in more depth soon about the different types of exposures that can be done for this issue.

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