What are anti-anxiety medications?
Anti-anxiety medications are those medications that primarily fall into the category of benzodiazepines, or benzodiazepine equivalents. These medications have been very useful and have also carried some baggage around because of their (so called) touted addictive potential. What are some of these medications? A few, but not all are: Alprazolam (Xanax), Clonazepam (Klonipin), Diazepam (Valium), Chlordiazepoxide (Librium) and other short acting anti-anxiety medications. Librium for example has been used to detox individuals from physical symptoms of withdrawal from addictive medications. Medications have long been used to decrease stress and anxiety. Yes, we as humans have been conditioned to be fearful and not only be fearful but we have learned “fear” is implied to be bad. Hence, the necessity to calm or relax an individual into a functioning state. Fear many times induces anxiety, anxiety leads to real physiological and psychological symptoms. We all would like to function at our best, however this becomes difficult when experiencing moderate to severe anxiety.
How do anti-anxiety medications work?
The first anti-anxiety medication was Valium. It came upon the market around 1963, however long before Valium we had many natural products that actually calmed the individual. They have fallen to the way side over the years, mainly because they are not fast acting enough and do not have the highest efficacy rate. Valerian root, one of the most popular herbs has been used for centuries. Studies are minimal and the validity of these studies are weak due to decreased sample size. There is anecdotal evidence that it has helped with sleep disturbances and mild anxiety. This author has tried Valerian root capsules for sleep and did not notice a dramatic improvement. Like many herbs clinicians struggle with appropriate dosage, titration of the dosage and excretion rates of herbs that are not well studied.
Anti-anxiety medications work by controlling the excitability in the brain. For the purpose of this article we will not get involved in the specific pharmacological dynamics of the medication. It is important to note that all have slightly different mechanisms of action. Some will take effect quicker than others, some will be excreted faster than others, and some have a higher abuse potential and addictive potential. It is VERY IMPORTANT we draw a distinction between abuse and addiction. All of those who abuse medication are not necessarily addicted, however all addicted have abused. Temazepam (Restoril) a moderate hypnotic appears to have the highest addictive and abuse potential than other anti-anxiety medications. It has a very short half life. We do know that pharmaceuticals like cocaine, and other drugs that have a short half life, (which is the amount of time half of the drug is excreted from the system) are highly abused.
Are Benzodiazepines addictive?
Any substance that alters the mental status of an animal, human being or organism that increases pleasure, decreases anxiety, increases appetite or sexual pleasure has the potential to be addictive. There are many factors that play into a drug being addictive. Health care professional often make the mistake of stereotyping patients based on race, dress, location, as well as the health care professionals personal background. Restoril has a high addictive potential because it has a quick peak for efficacy and a quick half life. Xanax on the other hand has built a quick reputation for being addictive when in reality it is much less addictive than the majority of other anti-anxiety medications. Our previous experience taints us from being objective and when confronted many get defensive, hence minimal learned behavior. When I worked in an emergency department in the south Bronx I also fell pray to the patient population desperately wanting a refill on their Valium, Librium, Vicodin and any other medication that would alter their senses. One could point the finger at every patient that wanted a refill and I promise you be correct about addiction ninety percent of the time. It is the ten percent that we should be embarrassed about. So, over the last thirty-five plus years in medicine I can say I have learned. Xanax for example is NOT the most addicting anti-anxiety medication out there. The success I have seen using Xanax appropriately clearly out weighs the negative experiences I have seen.
Remember the attribution theory. We all carry our previous experiences, the good and the bad into the future. We draw conclusions, make comments and often embarrass ourselves based on our pre-conceived ideas. It is the very pre-conceived ideas that we carry as health care providers that directly effect our treatment if we are not aware. A recent study that reinforces there must be an addictive personality and the conditions must be right before addiction occurs was just released.
Journal of Clinical Psychopharmacology. 2011 Apr 19. Pfeiffer PN, Ganoczy D, Zivin K, Valenstein. ” Benzodiazepines and Adequacy of Initial Antidepressant Treatment of Depression.”
In this study 43,915 patients were studied. This is a large patient population which was followed. The patients were followed for one year. The purpose of this study was to help compliance with patients taking anti-depressants, The majority of anti-depressants do not start to alleviate symptoms until they have been on board for about three to four weeks. In this study the patients were given Xanax at the same time and found it actually increased their compliance with their medication. The interesting finding for this examiner was NOT what the study was looking at but at addiction rates. Out of the almost 44,000 patients who took Xanax the rate of addiction was 0.7%. Let me repeat that, out of 44,000 patients less than one percent were addicted to Xanax after one year. Addiction was defined as any physiologic or psychological need for more medication as well as evaluating and controlling for tolerance. The need to have the dose increased.
Through studies, time and experience we become clinically responsible and objective. We do not become objective by becoming passionate because we saw ten addicts walk through an emergency department demanding Xanax, or demanding Vicodin and then we generalize their behavior to others who take the same medication for a very real problem.
To treat patients well, we must treat ourselves well. That means clinicians need to look at what they own and become responsible. Rumors lead to distortions, and distortions lead to more non-medical individuals falsly accusing health care providers. Yes there are individuals addicted to Xanax, Vicodin and other narcotics. It is the vast, vast minority that are truly addicted. Think about that when you go out Friday night and order that beer, make your toast and think about your brain cell death, liver involvement while your pancreas tries to swim away with it’s integrity.