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Study, Jan/18: Benzos--Upping the Care on Downers/Risks, Benefits, Alternatives


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The full title of this American study is "Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives".

 

THIS IS EXCELLENT! There's so much here that validates the negative effects of long-term use of benzodiazepines. As I read through it, I kept saying, "Yes!" With more than 100 references, it's clearly well-researched and supported. Ashton's 2005 study is article #1 of the 108 references, by the way.

 

Table 2 features the lengthy list of CNS effects caused by benzos, many of which overlap with symptoms of other disorders. So interesting to see it listed that way!

 

I can't summarize the highlights right now, but suffice to say, this one is highly recommended. Read it. Print it out. Share it with medical professionals as evidence that these meds play havoc with the central nervous system.

 

http://www.mdpi.com/2077-0383/7/2/17/htm 

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You're welcome! I'd love to hear your thoughts when read it, Terry. I know it's rather dense, but it's worth it.

 

This is the part about adverse effects, and it includes Table 2, which I mentioned above:

 

Adverse Effects

BZDs are linked to a variety of adverse effects, whether used long-term, short-term, or as needed. While BZDs would be ideal anxiolytics if they could selectively inhibit the hyperactive amygdala (implicated in anxiety), because GABA receptors are widely distributed throughout the CNS, BZDs indiscriminately target the entire brain. This is particularly problematic for those areas of the brain that are already hypoactive in anxiety disorders, such as the PFC (implicated in mood dysregulation including depression and anxiety, behavioral dysregulation including disinhibition and irritability, and cognitive dysfunction including inattention and cognitive processing of risk/stress/trauma) and hippocampus (implicated in amnestic effects and inhibited fear extinction). However, global CNS inhibition also leads to adverse effects via every area of the brain including motor, sensory, speech, and respiratory impairments [19,58,74,85]. Table 2 attempts to summarize an exhaustive list of cognitive, emotional, behavioral, perceptual and physical adverse effects from BZDs [1,3,4,8,11,15,24,31,59,74,78,79,80,83,87,88,89,90,91].

 

NB. "PFC" is the prefrontal cortex, I believe.

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This seems to be what we've been looking for, for a very long time. I'm excited by the article. Excellent part that you chose to stress, Lapis!! Yes, I will certainly read it. I also want to make a copy and send to my NP. This really ought to be sent to all doctors!!!
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What an "NP", Terry?

 

As far as highlights go, there are many. There's a part where the authors distinguish between dependence and addiction, which speaks to issues we've discussed around here quite a bit. Also, the explanations of how benzos actually worsen rather than improve conditions such as anxiety and insomnia are absolutely essential reading for all doctors. As well, the discussions of tolerance and adverse effects, the fact that benzos are contraindicated for PTSD and many other disorders that they're routinely prescribed for, the fact that there are serious risks if they're combined with other CNS depressants.....It's all in there!

 

Here's the part about physical dependence. Check out the percentage of people that become physically dependent on benzodiazepines: 58-100%!

 

Physical dependence is the presence of tolerance and/or withdrawal. Of those prescribed therapeutic doses of BZDs long-term, 58–100% inadvertently become physically dependent (therapeutic dose dependence) [1,12]. Iatrogenic dependence is more likely to occur with high doses and/or short acting BZDs, but can occur with any BZD prescription [1,26,31]. As tolerance develops, some patients are able to persuade providers to increase their dose (prescribed high-dose dependence). Even patients who recognize the long-term ineffectiveness of BZDs often continue to take them to stave off withdrawal symptoms, which are often mistaken for baseline anxiety [1]. With increased usage, tolerance and the potential for withdrawal worsen. Both BZD tolerance and withdrawal can be explained by the chronic desensitization of GABA receptors and sensitization of glutamate receptors. Considering that low GABA receptor sensitivity and hyperactive glutamate are implicated in anxiety [1,97], this would imply that chronic BZD use could actually exacerbate the pathophysiology of anxiety rather than improves it.

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Nurse practitioner.

 

This is something that ought to be seen in the Benzo Information Coalition, Benzo Case Japan, and any other site that covers benzos!! It's that important!!!

 

And also Mad In America.

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Thanks, Lapis. I sent the link to my NP (nurse practioner) -- the one who prescribed benzos for me, may she rot in the Hot Pace. Maybe she will read it . . . at least the Adverse Effects section and the one on Tolerance.

 

Maybe she will get a clue and prescribe these more sparingly?? At least not for as long as the 9 years that she prescribed benzos for me. Grrr.

 

Katz

 

 

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Good for you, Oregonkatz!

 

I do hope the medical professionals will take the time to read this article. If they're prescribing benzos, they need to know this information. And they need to discuss it with any patient for whom they want to prescribe benzos BEFORE making the prescription. It's called "informed consent", something that most of us were never given the opportunity to experience.

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Here's another key quote:

 

Even in the conditions for which BZDs have proven efficacy—PD, GAD, SAD and insomnia—there is no evidence of long-term efficacy.

 

Aside from PD, GAD, SAD and insomnia, no other mental disorders have an evidence-basis for BZDs. To the contrary, PTSD [31,36,44,58] and phobias [59] have evidence of ineffectiveness or even harm. Biological explanations for BZD-induced anxiety include discontinuation symptoms (i.e., withdrawal or rebound symptoms resulting from GABA receptor desensitization and glutamate receptor sensitization) and/or worsening of underlying anxiety pathophysiology (e.g., disrupting normal hypothalamic-pituitary-adrenal [HPA] axis stress responses, and inhibiting serotonin regulation) [58]. BZDs have demonstrated the ability to interfere with fear extinction [17,23,39], which is critical for the improvement of anxiety and is likely why BZDs have been found to increase fear conditioning with phobias [59] and to have fear-sensitizing effects in response to stress [23,60,61]. For many, BZDs—especially when used long-term—actually worsen anxiety.

 

BZD treatment for PTSD is particularly concerning because BZDs have no known preventative value for PTSD and may actually increase the risk of developing PTSD 2–5 times among those with trauma; BZD side effects overlap with several PTSD core symptoms (e.g., avoidance, negative mood, inattention, amnesia, recklessness, irritability); PTSD is commonly comorbid with conditions that are contraindicated for BZDs (e.g., SUD, traumatic brain injury [TBI], depression); and BZDs can inhibit trauma-focused psychotherapy by promoting avoidance of exposure, numbing trauma-related emotions, and inhibiting of cognitive processing (all of which is necessary for recovery) [3,58,62,63,64,65].

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On the subject of tolerance:

 

A major disadvantage with BZDs is that tolerance to their therapeutic effects develop relatively quickly while many adverse effects persist. Tolerance develops to hypnotic effects within days to weeks, to myorelaxant effects within weeks, to anticonvulsant effects within weeks to months, and to anxiolytic effects within months [1,8,83,96]. This explains why patients commonly increase dosage over time and many eventually take more than one type of BZD after the first loses effectiveness [1,3,4,73,79]. While therapeutic effects are subject to tolerance, adverse effects often are not, with cognitive, depressogenic, and disinhibiting effects typically persisting long-term when present and increasing in risk if doses are increased in response to therapeutic tolerance [8]. Because tolerance to brain stem depressant effects develop more slowly than tolerance to sedating effects, patients may take more BZDs to achieve desired effects (e.g., hypnotic, anxiolytic or even euphoria in recreational abusers) which may cause sudden respiratory depression, hypotension and/or death [3].

 

BZD tolerance develops as the result of long-term alterations of the intraneural gene expression and function of GABA receptors, likely including downregulation of BZD binding sites on GABA-A receptors (similar to alcohol), uncoupling of the allosteric linkage of the BZD-GABA receptor complex, and changes in receptor subunit turnover [1,4,8,83,96]. Chronic BZD-induced enhancement of GABA also likely results in a compensatory sensitization of excitatory systems (including glutamate) [1,97].

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I think all of this is excellent for us, Lapis!! I do feel, however, that slow tapering off by medical personnel is of utmost importance, too. I wonder if those receiving this information will have the idea that they should get people off the drug as quickly as possible, not realizing how detrimental to the CNS that is.
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Hi Terry,

There's a companion article to this one, but I haven't put it up yet. I'm still making my way through it. It's directed at physicians, and it focuses on what to do with transfer patients who are already on benzodiazepines. There's information about tapering in that one.

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Good to see this Lapis! It is comprehensive and I'm impressed that it originates from departments of psychiatry, put together by two young psychiatrists (I looked them up).  It is slow, but there is hope for the future...  What would be really helpful now is a study that proves that recovery from benzodiazepine damage can take many years for some, due to no fault of their/our own.
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Hi Everyone,

I've just posted the companion article by the same authors, which looks at the next steps, i.e. getting people off benzos. I'm on the fence about it and will re-read it. For now, I've put it up, and I'm hoping everyone will have a look and weigh in.

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Hi Terry,

There's a companion article to this one, but I haven't put it up yet. I'm still making my way through it. It's directed at physicians, and it focuses on what to do with transfer patients who are already on benzodiazepines. There's information about tapering in that one.

 

Thank you for posting such important articles!!! Well, I'll read it. I'd certainly like to know about doctors and tapering. Judging from what I've heard doctors tell me, I don't have a good feeling. But I'll keep an open mind, anyway.

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Yes, there's quite a bit that's good in this other article too. I'm re-reading it and posting parts that might be of interest, but it's definitely worth reading all the way through. I had someone print it out for me, since I find it easier to read on the printed page.

 

 

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