benzos arent all that bad - Social Anxiety Forum
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post #1 of 45 (permalink) Old 02-11-2006, 01:33 PM Thread Starter
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benzos arent all that bad


a serious problem for some panic attack sufferers is a loss of self confidence, causing them to want to stay at home and never go out.
some SA sufferers have panic attacks and some dont

any benzo, that is valium type med is very helpful, the sufferer can fortify themselves with an adequate dose before going out and take some more tablets with them in case more are unexpectedly needed, they work fastest if disolved under the tongue
its a great pity, IMO, that many docs now refuse to prescribe these benzo meds art all, panic attack sufferers shouldnt be penalised because drug addicts who have run out of illegal drugs, also chase after these meds to tide them over

benzos allow people seriously disabled by panic attacks or fear of panic attacks, to get out, do things, visit friends, etc and thus get back some self confidence
remember that life is short and time passes quickly
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post #2 of 45 (permalink) Old 02-11-2006, 01:48 PM
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It's because some benzos (Xanax) are addictive -- that's why psychiatrists (who know what they'rd doing) are hesitant to prescribe them, especially in someone who might get hooked.
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Quote:
Originally Posted by LittleZion
It's because some benzos (Xanax) are addictive -- that's why psychiatrists (who know what they'rd doing) are hesitant to prescribe them, especially in someone who might get hooked.
There is that nasty word "addictive" again. I'm again forced to point out that benzos can cause dependency, especially when used regularly in high doses. Benzo addiction is a true rarity.

You also say "some benzos (Xanax) are addictive". Only some? Is Xanax some special one that stands out from all the rest? Can you point us to any study that shows certain benzos to be any more "addictive" than other benzos?

The DEA classifies benzos as a Schedule IV controlled substance. That's the lowest level of controlled drug and it means that even the DEA deems them to have only limited potential for abuse and dependency. More "addictive" drugs would be put in Schedule III (Vicodin, for example), or Schedule II (morphine, for example).

We know that alcoholism is often a comorbid condition with SA, as the SA sufferer seeks to self-medicate. Now if a doctor fails to provide an anxiety patient with the benzos they need, what are they supposed to do to find relief? I guess they then have to go with the only drug they can legally obtain: alcohol. By not giving out benzos, some people are driven to drink, which hardly strikes me as a better alternative.

So, would you rather have them taking Xanax or drinking vodka to clam down? Which strikes you as the safer alternative?
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post #4 of 45 (permalink) Old 02-11-2006, 04:00 PM
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Quote:
Originally Posted by UltraShy
Quote:
Originally Posted by LittleZion
It's because some benzos (Xanax) are addictive -- that's why psychiatrists (who know what they'rd doing) are hesitant to prescribe them, especially in someone who might get hooked.
There is that nasty word "addictive" again. I'm again forced to point out that benzos can cause dependency, especially when used regularly in high doses. Benzo addiction is a true rarity.
I know a lot of CD pros who'd disagree with that. You're entitled to your opinion, of course.

Quote:
You also say "some benzos (Xanax) are addictive". Only some? [snip] ... any more "addictive" than other benzos?
Most of them, actually, but some are more addictive than others, of course. You sound pretty defensive about the subject.

Quote:
So, would you rather have them taking Xanax or drinking vodka to clam down? Which strikes you as the safer alternative
?

Straw man, I'm guessing.

Look, I'm just repeating common clinical wisdom.

edit: rewording to make it a little less harsh, sorry.
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post #5 of 45 (permalink) Old 02-11-2006, 04:12 PM
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Quote:
Originally Posted by LittleZion
Quote:
Originally Posted by UltraShy
There is that nasty word "addictive" again. I'm again forced to point out that benzos can cause dependency, especially when used regularly in high doses. Benzo addiction is a true rarity.
I know a fine psychiatrist, psychologist, and addictionologist, in a leading CD treatment center, who would laugh at that statement.
Certainly no bias there. If he's an addiction specialist, could it be that he tends to meet lots of addicts in his practice, giving him a biased view of the world?

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So, would you rather have them taking Xanax or drinking vodka to clam down? Which strikes you as the safer alternative?
Quote:
Straw man. Nice try.
It's hardly a straw man argument. Years ago I met this guy on an anxiety forum. He was afraid to take benzos because they were "addictive", but he had no problem drinking a couple liters of whiskey every weekend. Would he have needed such massive amounts of booze if he'd been properly medicated?
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post #6 of 45 (permalink) Old 02-11-2006, 04:18 PM
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Sorry about the late edits, I didn't know you were on.

Is the addictionologist biased? I don't think so. He's one of the most balanced guys I know. And the psychiatrist has decades of experience in the CD field, and she's very suspicious of benzo's. Most doctors aren't, though. Some hand them out like candy.

Re. the alcohol thing, granted, being dependent on Xanax is better than being dependent on alcohol.
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post #7 of 45 (permalink) Old 02-11-2006, 04:26 PM
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Quote:
Originally Posted by LittleZion
It's because some benzos (Xanax) are addictive -- that's why psychiatrists (who know what they'rd doing) are hesitant to prescribe them, especially in someone who might get hooked.
There is some debate but here's a few (there are many more) journal reviews/articles that would likely not agree with the use of "addiction" wrt benzos in anxiety patients. This includes one review (see second abstract) representing the opinion of "a representative panel of 73 internationally recognized experts in the pharmacotherapy of anxiety and depressive disorders."

---------------
J Clin Psychiatry. 2005;66 Suppl 2:28-33.

Benzodiazepine use, abuse, and dependence.
O'brien CP.

Although benzodiazepines are invaluable in the treatment of anxiety disorders, they have some potential for abuse and may cause dependence or addiction. It is important to distinguish between addiction to and normal physical dependence on benzodiazepines. Intentional abusers of benzodiazepines usually have other substance abuse problems. Benzodiazepines are usually a secondary drug of abuse-used mainly to augment the high received from another drug or to offset the adverse effects of other drugs. Few cases of addiction arise from legitimate use of benzodiazepines. Pharmacologic dependence, a predictable and natural adaptation of a body system long accustomed to the presence of a drug, may occur in patients taking therapeutic doses of benzodiazepines. However, this dependence, which generally manifests itself in withdrawal symptoms upon the abrupt discontinuation of the medication, may be controlled and ended through dose tapering, medication switching, and/or medication augmentation. Due to the chronic nature of anxiety, long-term low-dose benzodiazepine treatment may be necessary for some patients; this continuation of treatment should not be considered abuse or addiction.

The full article can be found at:

http://www.psychiatrist.com/supplenet/v ... 6s0205.pdf


-----------------
J Clin Psychopharmacol. 1999 Dec;19(6 Suppl 2):23S-29S.

International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: IV. Therapeutic dose dependence and abuse liability of benzodiazepines in the long-term treatment of anxiety disorders.

Uhlenhuth EH, Balter MB, Ban TA, Yang K.

Despite decades of relevant basic and clinical research, active debate continues about the appropriate extent and duration of benzodiazepine use in the treatment of anxiety and related disorders. The primary basis of the controversy seems to be concern among clinicians, regulators, and the public about the dependence potential and the abuse liability of benzodiazepines. This article reports systematically elicited judgments on these issues by a representative panel of 73 internationally recognized experts in the pharmacotherapy of anxiety and depressive disorders, a panel which was constituted by a multistage process of peer nomination. The criterion for inclusion at each stage was the nomination by at least two peers as one of the "professionally most respected physicians of the world with extensive experience and knowledge in the pharmacotherapy of anxiety and depressive disorders." Sixty-six respondents (90%) completed a comprehensive questionnaire covering a wide range of topics relevant to the therapeutic use of benzodiazepines and other medications that might be used for the same purposes. Overall, the expert panel judged that benzodiazepines pose a higher risk of dependence and abuse than most potential substitutes but a lower risk than older sedatives and recognized drugs of abuse. There was little consensus about the relative risk of dependence and abuse among the benzodiazepines. Differences between benzodiazepines with shorter and longer half-lives in inducing withdrawal symptoms are much less clear during tapered than during abrupt discontinuation. There was little agreement about the most important factors contributing to withdrawal symptoms and failure to discontinue benzodiazepines. The pharmacologic properties of the medication may be the most important contributors to withdrawal symptoms. In contrast, the clinical characteristics of the patient may be the most important contributors to failure to discontinue medication. The experts' judgment seems to support the widespread use of benzodiazepines for the treatment of bona fide anxiety disorders, even over long periods. The experts generally viewed dependence and abuse liability as clinical issues amenable to appropriate management, as for other adverse events related to therapy. However, more definitive clinical research on the remaining controversial issues is urgently needed to promote optimal patient care.

--------------------
J Psychiatr Res. 1990;24 Suppl 2:81-90.

A practical approach to benzodiazepine discontinuation.

DuPont RL.

Non-medical use of benzodiazepines is rare among patients with anxiety disorders. Numerous studies have found that non-medical use, or abuse, of benzodiazepines occurs usually among patients with histories of alcohol and drug abuse--those who use those drugs to get "high". This article distinguishes between medical and non-medical use of benzodiazepines in clinical practice, and offers practical approaches to discontinuation of benzodiazepine treatment for both medical and non-medical users of those medicines. The major barrier to clear thinking about the abuse of benzodiazepines is the confusion of "addiction" and "withdrawal". Addiction means high, unstable dosing outside medical and social boundaries for "recreational" purposes, loss of control over use, and continued use despite clear evidence of harm. Alcoholism and heroin addiction are typical examples of addiction (Kalant, 1989). In contrast, withdrawal is a pharmacological consequence of discontinuation of a substance on which a person has become dependent. Many drug-addicted people have only minor withdrawal symptoms when they stop drug use. Many medical patients, with no evidence of addiction, have withdrawal symptoms when they stop treatment, especially when they stop abruptly (e.g. surgical patients using narcotic analgesics and epileptics using benzodiazepines or barbiturates in their treatment). Addiction to benzodiazepines, in the sense of loss of control over use and continued despite harm, is virtually limited to people with pre-existing drug or alcohol abuse, while withdrawal symptoms after prolonged daily use are common among medical users of benzodiazepines. The serious nature of both drug abuse and anxiety disorders is not emphasized sufficiently during medical school or in the professional literature. The distress and disability from which both groups of patients and their families suffer is profound. Fortunately, both drug abuse and anxiety patients receive tremendous benefit from successful treatments, both pharmacological and nonpharmacological (DuPont, 1986a; DuPont, 1984). This article discusses the use of benzodiazepines in two distinct populations--drug abusers and patients with anxiety disorders--and helps clinicians distinguish between the use of benzodiazepines in the two groups. The central distinction made in this article is reflected in the common use of the words "drugs" and "medicines". The former term often denotes non-medical substance use, while the latter term refers to traditional pharmacotherapy.
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post #8 of 45 (permalink) Old 02-11-2006, 04:27 PM
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Quote:
Originally Posted by LittleZion
Is the addictionologist biased? I don't think so. He's one of the most balanced guys I know. And the psychiatrist has decades of experience in the CD field, and she's very suspicious of benzo's. Most doctors aren't, though. Some hand them out like candy.
And there are doctors with equally impressive credentials who think benzos are safe & effective meds vital in the treatment of anxiety & panic disorders. There is no universal agreement on the issue.

If you don't use benzos, then you're basically stuck with SSRIs, which have significant side effects (sexual problems in particular) that make them unacceptable to many patients and SSRIs also fail to work in plenty of patients (I'd be one of those patients).

As for docs who hand out benzos like candy, can you provide their names & phone numbers as many members of this forum would love to meet them. This may have been true in 1976, but in 2006 it takes a crowbar to pry a benzo script out of their grip in many cases.
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post #9 of 45 (permalink) Old 02-11-2006, 04:47 PM
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Scrotacles, it was hard to take those citations too seriously, since the first one began, in the first sentence, by saying, "Benzodiazepines ... may cause dependence or addiction." (And just in case there's any misunderstanding, I'm well aware of the distinction between dependence and addiction.)

It's good to hear you say that physicians no longer overprescribe benzos. I'm sure the numbers have dropped dramatically in the last 5 or 10 years.

You say, "If you don't use benzos, you're stuck with SSRIs." Actually, you're stuck with working on the issues in therapy, which is what most people with SA would greatly prefer to avoid (myself included).

In the clinical world, it's not hard to find someone who's been on Xanax for 10 years without every learning the first thing about coping with anxiety. Whether you call that "dependence" or "addiction" is almost secondary. It's a problem rooted in avoidance of the real issues and over-reliance on anti-anxiety medication to solve the problem (which it doesn't).

p.s. And before you say I want to ban benzos, I hasten to add that benzos are safely and effectively prescribed all the time. You just have to have a doctor who knows what they're doing.
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Originally Posted by LittleZion
Scrotacles, I couldn't take your research citations seriously since the first one began by refuting your point, in the very first sentence. "Benzodiazepines ... may cause dependence or addiction."
And water may cause death by drowning.

You should have kept reading a few more lines to find this gem:

Quote:
Few cases of addiction arise from legitimate use of benzodiazepines.
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post #11 of 45 (permalink) Old 02-11-2006, 06:13 PM
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Interesting discussion. I would kind of agree with arthur, and also with LittleZion. I think benzos are effective and underprescribed, and are tremendously safe. But I don't think they help with the core deficits that I (and many others) suffer from: low self-esteem, mistrust, ingrained maladaptive coping mechanisms. And avoidance.

I have little to no social "anxiety" anymore, even without my Valium, but I have a tremendously hard time believing that I could ever be likeable or that I even want to form relationships and be a functional member of society. I usually shuffle those problems under the larger heading of my "depression". I wish benzos - I wish anything - could take care of that. But it's not going to be fixed in the long-term with anything but exposure and therapy. I'm still waiting for GSK to make a pill that gives me the ability to make friends.

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post #12 of 45 (permalink) Old 02-11-2006, 06:55 PM
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Quote:
Originally Posted by LittleZion
Scrotacles, it was hard to take those citations too seriously, since the first one began, in the first sentence, by saying, "Benzodiazepines ... may cause dependence or addiction."
There are no inconsistencies. It may cause dependency in anxiety patients but abuse/addiction in such individuals is rare...at least that's the opinion of some experts. On the other hand, some benzos (particularly valium) may be abused by poly-drug users. Abuse/addiction in this latter group does not imply abuse/addiction in the former group.

The point is that REASONS FOR USE can greatly affect the degree to which abuse/addiction occurs. The same thing can be said even with other drugs with arguably higher addiction potential...like opiates.

Wrt CBT, I agree with you that it should always be tried...but CBT works in about 50% of patients (and the relative benefit is debatable). If you look at research done by psychotherapists, benefits in patients for whom it works, seem large. If you look at research done by psychopharmacologists, benefits seem relatively small. Moreover, even with CBT/psychotherapy, long-term commitment/practice is required or relapse occurs. At least that's what my psychotherapist told me.
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post #13 of 45 (permalink) Old 02-11-2006, 09:27 PM
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It's a problem rooted in avoidance of the real issues and over-reliance on anti-anxiety medication to solve the problem (which it doesn't).
What real issues? What is the problem? Do you know what causes anxiety disorders? If you do you could probably get a scientific award or something. Anxiety disorders are chronic conditions and the chance of curing them are slim to none. No medication will cure them. Therapy won't cure them. You can simply control the anxiety through medication or therapy or whatever else.

About benzo addiction, if you use them like your supposed to, you won't get addicted. If you use them to get a high, then you could get addicted, but that applies to addicts, not to anxiety patients. If you're taking them for anxiety and then have to stop for some reason, it is dependency. The same thing happens with ssri's. Does that make them addictive?
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post #14 of 45 (permalink) Old 02-11-2006, 10:21 PM
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Benzos are great for SA period. Docs who underprescribe benzos to SA patients pushing SSRI's instead really tick me off. It is their job to know this stuff and I feel many psychiatrists don't even understand SA very well despite the "Dr" in front of their name otherwise they wouldn't be pushing zoloft and other worthless drugs for social anxiety.

Xanax addiction???? Man I have much much bigger worries in life than the very remote chance I'll get addicted to xanax. People with SA are suffering and to deny or try benzos as a last resort type drug really ticks me off. Would you deny painkillers to someone in extreme pain? Not only that but SA destroys you in so many ways that the treatment should be aggressive as by the time people seek treatment usually they have been suffering for many years.

Do docs get kickbacks from drug companies to push the ssri's or what?

My Easy Button: Xanax + Bud Light
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post #15 of 45 (permalink) Old 02-12-2006, 07:24 AM
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Quote:
Originally Posted by workman
Quote:
It's a problem rooted in avoidance of the real issues and over-reliance on anti-anxiety medication to solve the problem (which it doesn't).
What real issues? What is the problem? Do you know what causes anxiety disorders? If you do you could probably get a scientific award or something. Anxiety disorders are chronic conditions and the chance of curing them are slim to none. No medication will cure them. Therapy won't cure them. You can simply control the anxiety through medication or therapy or whatever else.
There are tons of literature about the various causes (some real, some just conjectured) of anxiety disorders. There's no one single cause. It's genetic, it's environment. As far as the environment/learning piece, there are so many different causes there it would take a lifetime to spell them all out. As for parallels in the themes of people with SA, you can look at what people on this board talk about all the time -- lack of social self-confidence, lack of social skill/experience, sense of inadequacy, being hypercritical of oneself, negative expectations about one's own performance and others' reactions, chronic patterns of avoidance, etc. That's some of what I was referring to.

I'm not sure what your criteria for "cure" is, but there are plenty of people who have overcome a variety of anxiety disorders.
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post #16 of 45 (permalink) Old 02-12-2006, 08:47 AM
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Quote:
Originally Posted by Scrotacles
Wrt CBT, I agree with you that it should always be tried...but CBT works in about 50% of patients (and the relative benefit is debatable). If you look at research done by psychotherapists, benefits in patients for whom it works, seem large. If you look at research done by psychopharmacologists, benefits seem relatively small. Moreover, even with CBT/psychotherapy, long-term commitment/practice is required or relapse occurs. At least that's what my psychotherapist told me.
This is lower than what I have typically heard. For example:

Social Anxiety Disorder: A Common, Underrecognized Mental Disorder
TIMOTHY J. BRUCE, PH.D., and SY ATEZAZ SAEED, M.D.
University of Illinois College of Medicine at Peoria, Peoria, Illinois
(Am Fam Physician 1999;60:2311-22.)
http://www.aafp.org/afp/991115ap/2311.html

... Approximately 20 controlled studies have examined various components of behavioral and cognitive behavioral interventions for social phobia. Results indicate that cognitive behavioral therapy involving exposure and focusing on changing phobic thinking can benefit as many as 75 percent of patients. Evidence suggests that treatment gains made during cognitive behavioral therapy generally endure after treatment is discontinued. Initial comparative data show that relapse rates after discontinuation of cognitive behavioral therapy are significantly less (range: zero to 17 percent) than those following discontinuation of effective pharmacotherapy (~50 percent). Taken together, the study data support the use of cognitive behavioral therapy as a first-line consideration in the treatment of social phobia. Whether the common clinical practice of combining pharmacotherapy and cognitive behavioral therapy provides any benefit over either modality alone or for specific subgroups (e.g., the severely symptomatic) awaits direct study.


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post #17 of 45 (permalink) Old 02-12-2006, 12:54 PM
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aloha.

though i haven't posted in a while, this is (another) one of those threads that just compels me two put in my two cents -- my experience.

anxiety runs on both sides of my family. it wasn't severely triggered until external events a few years ago but it was extremely severe. literally, i could barely stop crying, or take a deep breath, or eat. i couldn't leave the house alone. forget about working outside the home or just about anything else.

benzos were an absolute miracle. they helped me function enough to do all those things above plus, most importantly, get to therapy.

i am now barely SA or PTSD, and i rarely panic. i'm still a bit OCD but i think another med would help with that.

after finding the right benzo for me (valium) i've tapered from 30mg to 15. i'm continuing therapy and tapering until the rough edges are smoothed out and/or i'm on a med that will better address the OCD.

but my point is i was a complete an utter basketcase, a sobbing shaking frightened creature on the floor, growing cysts all over my abdomen.

now i socialize, exercise daily, and i'm even returning to work tomorrow!!!

though therapy (mostly EMDR and bioenergetics) did most of the "healing", there's no way in the world i could have made it there without benzos. in fact i'd probably be dead.

fwiw my doc sees more dependency and side effect issues with ssris than with benzos but really, whatever it took to help me function in the world, that's what i thank my life for. i'm glad i'm tapering but even if i were on it forever i'd take that over my pre-benzo life. as has been said again and again, to deny this tool is like denying painkillers to someone with other kinds of suffering. and preaching about it won't help anyone, even the rare person who is truly addicted (i kicked nicotine after 30 years but at least then i had good evidence as to why i should.)

every day i wake up not freaking out i thank my wise doctor who knows i don't abuse benzos. every time my family sees me smile and take another step they do the same. there is no comparing my easy taper to my previous wanting-to-die feeling of mental illness. please, have compassion for those who are suffering.

aloha.


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post #18 of 45 (permalink) Old 02-12-2006, 01:04 PM
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i wish i had a doctor who knew the depths of despair anxiety could send a person into. I've been on many, many medications and there are only three drug classes that calm my severe anxiety/agoraphobia: opiates, benzodiazepines, and alcohol. I'm very tired of read about how dangerous benzodiazepines are considering how much life completely and utterly sucks when you must face never-ending anxiety. If I had had better treatment years ago I would most likely be in a better position now.


and please, give me a list of these doctors that overprescribe benzos. .5mg every other day doesn't cut it for me and i've been in this *****ed up mental health system since I was 11 or 12 and have been met with nothing but ignorance on the part of doctors, nurses and therapists.

so please, please, please, do not try to save me from the horrible addicts life I am going to face should I choose to take a xanax or valium.


//bitter
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post #19 of 45 (permalink) Old 02-12-2006, 01:50 PM
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I agree with lei. It's helpful for those with severe anxiety. Imo, the ultimate goal should be learning new ways of dealing with things, which is what a lot of (ok, some) people on anti-anxiety meds avoid.

Here's an example from personal experience. Not long ago, I talked with a high-level professional man, 40 years old, who had been on benzos (Klonopin, Xanax) since he was 9, for anxiety. What bothered me about this situation was, the guy knew absolutely nothing about why he was anxious, the thoughts or behaviors that accompanied his anxiety, or coping strategies. After 30 years of "treatment," he knew next to squat about dealing with his anxiety. All he did was take Xanax or Klonopin regularly (in increasing dosage over the many years), and then forget about it.
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post #20 of 45 (permalink) Old 02-12-2006, 02:06 PM
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Lots of interesting opinions:

Based on my experiences:

Although my anxieties now as 32 years old are not bad as it was when I was in my teens. During my teens, my anxiety was so bad that I literally was afraid that my anxiety would suffocate me. It was literally a "minute to minute" struggle for me... To say the least, it was pure hell....

Now at age of 32... I don't have that extreme anxiety (thank god) but my symptoms still persist and still persist... only medication can really reduce my symptoms to the point of "near normal" or sometimes "normal" levels

I have had tried therapy twice (and am on one right now)... in my opinion CBT is not really helpful to me because I think I have chemical imbalance in my brain that was triggered by traumatic events in my teens.

There are times when I am in social situations where I KNOW there aren't ANY reasons to be nervous.... When there are group of my friends that I am really comfortable with.. yet my body/mind go "anxious" for no reason... That's when I know it's just the damn chemical imbalance.....

Good Example:

I say to myself, "I will have great time going to meet my friends at a club".... "I'll dance with my friends", etc... (remember, that's CBT therapy).. then when I am at a club with my friends, I just go anxious... so for me CBT doesn't work....it's the chemical imbalance...I just realized that I don't avoid going to social events because I don't have any issues with meeting people. I'm not scared of meeting people at all, but the issue is when I am AT the social situations, my body/mind goes overboard.

For lot of us, we do have depression/anxiety that runs in our families

If doctors think benzo are dangerous, then they BETTER get their *** in researching for finding better medications for rest of us!!!!!

I know how all of you are feeling.. really I do... right now my anxiety/depression is "stabilized" due to Klonopin and Zoloft... but it can pop up at anytime...

So to summarize everything, I agree that benzos are not bad... same for AD'S but medicine field need to get their "****" together and develop something better for those who have chemical imbalance. CBT is great for those who only have psychological issues that affect SAs...

dx: SAD/GAD and (self-diagnosed) mild depression
rx: Effexor XR and Klonopin
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