Wednesday, October 10, 2007

More On Everyone's Favorite Medication: Xanax

First, check out Roy's post below from earlier today; he tells us how to cure alcoholism! Click Here.
[I do nothing of the kind, don't listen to her.]

So the New York Times has a health blog, and if you ask me, today it's trying to be Shrink Rap. In today's Post, For Some Bereaved, Pain Pills Without End,
the unnamed author talks about the ease with which physicians ( primary care docs) prescribe benzodiazepines for acute grief, the ease with which they refill these scripts-- often for years at a time--, the ease with which these patients become addicted and suffer from side effects:

Powerful benzodiazepines such as Xanax, Valium and Ativan are widely overused in older patients, many experts fear, leading to serious health worries, including sleep troubles, cognitive difficulties, car crashes and falls. Yet doctors in the survey seemed willing to offer unlimited amounts of these addictive drugs to help patients cope with death.

The study is small-- it consists of 33 primary care docs in Philadelphia, and interviews with 50 older patients who've taken benzodiazepines for years: 20% said they began taking benzodiazepines during a period of grieving. Want details? Read the original article HERE.

As always, the reader comments are as enlightening as the blog post itself (ah, that's true here at Shrink Rap as well).

Interesting stuff, but I guess I think the sample here is so small as to be useless. Half the docs said they'd prescribed benzos for grief (so at least 16.5 primary care docs) and 10 patients started chronic benzodiapine use after a death. I'm not surprised, I'm not commenting on anyone's practice, I guess I just don't like the tone of the blog post which somehow paints the docs as ignorant, perhaps lazy, may be even negligent or sinister.

Finally, please note that I stole my "grief" graphic from a Red Sox blog:


Anonymous said...

We had an intervention for my in-law after the death of spouse. Turned out that "heavy drinking" was (and had been) a great deal more than that. Once the spouse was gone then in-law couldn't function.

Part of that was going through the pill drawers. Oh my, there were plenty. I never thought about playing the grieving spouse card, but thinking about it it seems like a winner.

The hospital we used said they have whole groups full of blue-haired rehabers.

None of them thought they had a problem because it was "just" something the Dr. prescribed.

Alison Cummins said...

The doctors quoted in the article and commenting on the blog present a dilemma of anxious patients who are probably too frail to be taking benzodiazepenes.

How do you best help this population? It's common for people to become more anxious as they age for whatever reason - whether it's loss of autonomy that's causing the anxiety, or whether it's just a brain that's wearing out just like the joints and heart.

I imagine that ideally one would treat anxious old people just like anyone else and prescribe relaxation techniques, sleep hygeine and exercise.

But what do you do if these approaches are insufficient?

NeoNurseChic said...

Thought benzos were to be avoided in older folks. Whenever my grandmothers have been in the hospital for procedures, surgeries, or prescribed meds for various outpatient conditions, I am always very leery of any talk of benzos, and have made active attempts to get my parents to watch this closely and get it stopped ASAP.

I guess my paranoia comes from sitting one-to-one with an older gentleman who was delirious about 80% of the time, which was a sudden change after receiving benzos. When my grandmother had her gallbladder removed, she actually received a diagnosis of alzheimers due to the state she was in at the time. Turns out, this was in part due to the fentanyl patch combined with the presentation of sepsis in the elderly. The day of the surgery, I was on the phone with my dad several times asking him to make sure she didn't receive benzos.

But then, if these things are started in mid-life when someone is going through the grief process and then is picked up as "not such a good idea" some 30 odd years later, it is a much harder habit to break...

Seems like physician's caseloads are so heavy at times that some things get lost in the shuffle. (Pertaining to several prescriptions being written for benzos and renewed time after time without even reevaluating the need...) I'm not pointing fingers or making a general statement - just seems like another area of the health care system that needs revamping.

Take care,
Carrie :)

Anonymous said...

Several years on benzos. No question that I am physically dependant on them. To dull anxiety or numb grief, some doctors are very willing to continue precribing them and as a patient I will share responsibilty for continuing to take them even though the main reason to take them is to keep the withdrawal symptoms at bay. In the short term they do help but after a time they actually create the anxiety and then you have a problem. I am not sure if my doctor is lazy but I don't think they want to admit that there is this dependance thing going on even though that is something they should know. They don't want to hear about it really, not sure why, and I have stopped bringing it up because by now I figure I would have to go into rehab to get off them (more than one) and I am afraid of that. But maybe I should ask for the topamax if it helps "cure" drinking since that is the only way to get the effect out of the benzo anymore. The doctor knows this too. Maybe they are just lazy.

Anonymous said...

I left my first comment before reading the article. The article said nothing new. Several elderly relatives of mine started benzos back when their spouses died and took them until the day they died and watched the clock to see if they could take another pill yet.
The thing that really got me was one of the later comments from a psychologist who stated that in 30 years of practice she had never seen a patient addicted to tranquilizers. She may be correct to say that addiction is tough to define but she should have the sense to know that dependance, physical and psychological happens all the time with tranquilizers and that is why they are not great for long term use for anyone. Not saying they do not have their place because they do but they are not a good drug to be maintiane don becasue the only thing they maintain is continued use and escalating doses. So she doesn't have to call it addiction but she says who cares if people are addicted? Since she has never seen an addcited person in all her 30 years of practice what would she know about it. She is trying to say that addiction doesn't exist or that she is an animal psychologist and no dog or cat or monkey she has ever seen has been addicted to tranquilizers. I recently read that some people who have had gastric bypass surgery to lose weight tranfer their addiction from food to drugs or shopping or gambling. Is it addiction or an OCD type behavior? Anybody know? If I got off benzos would I start to overeat and gain a ton of weight or transfer to another addiction?
That is one scary psychologist.

DrivingMissMolly said...

Taking benzos is the new stigma.


DrivingMissMolly said...

Doc never called in a refill to my clonazepam so I was off it one week. I decided to stop taking it. Unforch, I started shaking all day again with the killer anxiety.

Tried relaxation Cds, bubble baths and even bought a $200+ Stress-Eraser.

Don't assume we want to stay on these drugs and aren't trying other things. I also take alprazolam. I DON'T want to be depended on a shrink to prescribe for me. This was justified by no one approving my refill while doc went on vacay.


Anonymous said...

I have a question:

First a bit of info: I have been on and off almost every benzodiazepine there is over the past few years. When I am taken off the medication I get so anxious I cannot sleep, I have massive anxiety attacks that go on and on, I have panic attacks, so I start drinking to calm my anxiety, which works for a few weeks, until I start drinking 6-9 drinks/day, then I start having withdrawal anxiety the next day.

So my psychiatrist helps me stop drinking with a benzo, which I'm okay with at low dose for a while, then I become anxious again and I increase dose again and again, until I have a problem with that and the process of coming off them starts. Then I start drinking and (you get the picture).

I have had times where I am able to get off everything for an extended period, but I have to live with so much anxiety almost everyday when I do this. Eventually the anxiety, mixed with chronic and severe depression, gets the better of me and I start alcohol again, then benzos, then alcohol then...

My question: What can I do or what else can I take to stop having all this anxiety?
Anxious Anon

Anonymous said...

Anxious Anon - I have seen many people helped greatly by taking themselves to AA.

It's not fast, and it's not easy, but it works for a lot of people -- many of them with other psych problems.

It's also pretty cheap and you get to hear some interesting stories and jokes.

Anonymous said...

Thanks for the reply Anonomous. I have thought of AA, but I do not feel comfortable with the concept of a "higher power".

While I recognize I have a problem when I drink, I do not think I have a drinking problem. I think I have an anxiety problem that always precipitates self-medicating with alcohol.

As taking benzos to help with alcohol wothdrawal just keeps my vicious cycle of alcohol, benzos, withdrawal anxiety, anxiety, alcohol etc. going, I guess my question really is what other activities and/or medications are used to treat anxiety other than benzodiazepines
Anxious Anon

Anonymous said...

anonymous-I understand what you are saying about a Higher Power.

My HP was AA for a long time.

You owe yourself to at least investigate.

My thoughts are with you.

Anonymous said...

What I want to know is, why is it that so many journalists feel compelled to refer to psychotropic medication as "powerful"? The adjective is completely meaningless in such a context.

I guess it is just "powerful" journalism.

Anonymous said...

Benzos, especially Xanax, are wonder drugs for inducing a state which can only be described as comfortably numb.

I see nothing wrong wtih it. I think there is an obsession with psychiatrists and their insistence that patients deal with things. Well, what if you aren't ready to deal with things? What if dealing with things makes you even crazier? Isn't allowing the patient time to be ready to receive help elementary?