What we’ve said about Benzodiazepines

“I do think they are basically a mood stabilizer. They function to reduce the excitability of the brain. It's just that they're a full shutdown medication, and it's not good for those reasons. But when you see catatonia, you should probably be using it”

“the Ben... benzos role is for patients with an acute decompensation that I don't have a concern about addictive risk for the patient”

“I just really hate anything that causes withdrawal and physiological dependence for patients. I think it's an awful thing to do to somebody when there are other options, you know, um, Will I never give it? No. I remember when I was in medical school, I saw a patient who just presented for a regular medical catch up checkup”

“what I mean is that you've done a... at least minimally adequate psychiatric evaluation to reach a diagnosis and that there's a medical indication to prescribe that benzodiazepine for that diagnosis in the long term”

“It's basically a brain off switch, essentially. So that's the problem. That's not treatment. That's suppression. And that can be useful in some situations”

“they are symptomatic treatments that create habits, build tolerance, and stop working. They're not fundamental treatments of the underlying condition, so much as they are that they're drugs that help people feel better temporarily”

“99% of the time you're They're not really true. Treating the anxiety disorder when you use a benzodiazepine, a Z drug, or alcohol. Frankly, all about the same in terms of their use with different levels of tolerability for different people”

“too many drawbacks, memory issues, learning problems, slows your progress. Progress in psychotherapy and healing from psychiatric disorders. Addictive. Did I already say addictive? Withdrawal problems. Tolerance, too”

“Yes, benzodiazepine and alcohol withdrawal is medically dangerous, right? People can, you know, delirium, they can have life-threatening seizures as a result of withdrawal”

“benzodiazepines decrease the efficacy of therapy. And I feel like that's, it really decreases the ability to learn new information. So for anxiety, the treatment for anxiety is avoiding avoidance”

“anxiety can be interpreted as an activation right as a higher level of sort of psychological energy. And if you decrease it, remove it, or suppress it entirely as you would using a benzodiazepine, that will slow or stop motivation itself”

“We should be avoiding benzodiazepines. And that's because there's an absence of clear benefit. It could worsen the PTSD. And the big problem is it impairs learning in therapy”

“by the way i don't mean benzos or prms i don't use those okay it has to be other things that globally lower the level of neuroticism anxiety”

“Benzos are, I don't see any independent efficacy in depression, even though they're being given a lot. Some people like to give a benzo early on to help with the anxiety. Amphetamines. But then, yes, some people like to give a benzo or set of hypnotic early on in the initiation of SSRI”

“So yes, I don't do the classical thing of benzos with the first couple weeks of the SRI. I don't do that. If they want a PRN, they need a PRN for some reason, I still encourage against it. I'm not going to not use it if the clinical situation is right for it. I'll use gabapentin or hydroxyzine”

“I think that what you're referring to can just as easily be accomplished by high dose hydroxyzine, low dose trazodone, gabapentin at higher doses, you know, Mirtazapine if you have to”

“I'm always willing to give a sleeper on the first visit. And the reason is because I never really ever prescribe addictive potential withdrawal potential sleepers on the first visit or the second visit or the third or whatever”

“Don't use the short acting ones because that's going to make the possibility of forming addictive behavior worse. Personally, I would either do clonfin or valium”

“we're going to talk about the plan to see how we can reduce or stop the dosage over a period of time that's equivalent to the total time that they've been on the benzodiazepine or two years if they've been longer than two years. That's my general rule. It's not evidence-based”

“especially when someone has been on longstanding benzos. We have basically induced iatrogenically as physicians. We have doomed them to a state of physiological change that may be permanent. They just have to be on those benzos. OK, it's not a good thing”

“there was like a recent big study that showed that there's a higher mortality in patients who discontinued long-term benzos. So it's, you know, there is genuine risks in tapering patients off of benzos. And those need to be genuinely considered”

“if people come off a benzodiazepine, they tend to have greater self-confidence, better concentration, less depression, and all that's from clinical observational studies. That correlates with what we see on the PET scan, which is that the brain is healthier six or 12 months after coming off of benzodiazepine”

“I take them not as trying to manipulate me, not as trying to get this drug. I take them as an innocent person who heard that Xanax is helpful for anxiety and calmly lay out my reasoning as to why I don't think it'll be helpful long term and why we won't be going that route”

“I will want to confirm in some fashion that they have been getting the controlled substance on my state record. I think every state now has a record of controlled substance prescriptions that you can look at”

“You should not, even under the urgency of apparent medical withdrawal, agree to be the stopover in a series of doctors that a patient is going to for urgent benzodiazepine prescriptions”

“You need to commit today to treatment with me and we need to commit to a with a tapering plan, basically a withdrawal plan that is medically safe”

“let's pick a date together in the next few weeks where we can get you to a medical detox center. And I'm going to give enough medication to last until then”

“we all have access to this controlled substance record. And so if I see this happening and you don't come back, then I'm going to know that you're not really agreeing with me about how we're supposed to treat this”

“Usually, it devolves into yelling and firing. way before that, you know, and it's what you do. And then you just essentially don't prescribe it”

“You have to explain to the patient, like, I'm hurting you if I were to prescribe these things long term. I'm preventing you from getting better”

“You're going to be on a controlled substance that causes addiction, withdrawal, executive functioning problems, memory problems, sedation, and it probably slows your ability to improve yourself in the psychotherapy as well. And I might be happy to give this to you, but I can't say that if you have to change doctors”

“A certain personality type that tends to have an anxiety disorder is probably the lowest risk for addiction habituation with benzodiazepines. It's the medication hater. It's the person who does have strong placebo effect and negative emotional relationship with medications, right”