The Misunderstood Benzodiazepines: Why They Are Not the Enemy in the Fight Against Anxiety

Benzodiazepines have long been a subject of debate in the medical community. Often demonized and seen as a last resort, these medications play a vital role in managing anxiety. Doctors, for good reason, are cautious about prescribing them, especially in the face of the opioid epidemic. However, it's crucial to understand the nuances and benefits of benzodiazepines and why they should not be the first to fall in the crosshairs of the fight against anxiety.

The Opioid Epidemic and Benzodiazepines

The opioid epidemic has been a significant concern in many nations, leading to strict regulations around the prescription and use of opioids. In Oregon, for instance, if you are on pain medication, you are unlikely to receive a script for a benzodiazepine. This caution is understandable given the high risk of fatal interactions between opioids and benzodiazepines, which can lead to respiratory depression and death.

The Irony of Medicine

Despite the legitimate concerns over opioids, the very same doctors who are wary of benzodiazepines are often quite liberal with prescribing other medications with significant side effects. For example, drugs like Abilify (aripiprazole) are commonly prescribed as adjunct treatments for depression. Aripiprazole carries a high risk of causing an irreversible condition known as Tardive dyskinesia, characterized by uncontrollable movements and involuntary twitching. Yet, doctors continue to prescribe this medication without significant commercial or ethical qualms.

This irony highlights a broader issue in the medical community: a lack of balanced judgment when it comes to prescribing medications. While benzodiazepines are often vilified for potential addiction, other drugs with similar side effects are prescribed with little scrutiny. This inconsistency is concerning, as patients need to understand the risks associated with all medications, not just those perceived as evil.

Insights from a Significant Study

A study conducted by a doctor from MIT in 2014 sheds light on the mischaracterization of benzodiazepines. According to Dr. Farrow, benzodiazepines do not cause the classical form of addiction. While withdrawal symptoms can occur, benzodiazepines do not lead to the same level of compulsive use as substances like ethanol (alcohol) or barbiturates. Ethanol and barbiturates are classically addictive due to their ability to produce significant euphoria, whereas benzodiazepines have a minimal euphoric effect.

Dr. Farrow highlights that patients who appear to be dependent on benzodiazepines often have a clear understanding of their use and can control their intake. This is comparable to individuals with type I diabetes who may be heavily dependent on insulin without being addicted to it. The key difference lies in the brain's wiring: alcohol and drug addiction involves rewiring that can be detected through brain imaging techniques like PET scans and fMRI.

This study suggests that the blanket demonization of benzodiazepines is misplaced. While withdrawal is a serious issue, it is not indicative of the same level of compulsive use as is seen with substances like ethanol and cocaine. Doctors need to reassess their attitudes towards these medications and consider the benefits they provide in managing anxiety and other conditions.

Conclusion

While benzodiazepines should be used with caution, especially in the context of the opioid epidemic, they are not the enemy in the fight against anxiety. The medical community must address the irony of prescribing life-saving medications like benzodiazepines with caution while simultaneously prescribing other drugs with significant risks. Patients deserve clear, evidence-based information about their treatment options, and doctors should reassess their biases to provide the best possible care.

The understanding and proper use of benzodiazepines can significantly improve the quality of life for many individuals suffering from anxiety. By addressing the myths and misconceptions surrounding these medications, we can better support those in need.