Glad this comments line is still open. And thank you NYT's for featuring my previous comment.
Will just state again: where is the help, from within the medical (prescribing) community, to help people who are trapped by having taken these meds for a long time, and now are getting older, and are trapped in a parallel nightmare and will find them to be a real health hazard in other ways?
Don't those prescribers owe their patients some type of support and assistance, for instance, with setting up and monitoring a safe taper system?
Going it alone seems to set the stage for disaster. And fundamentally a dereliction of their sworn oath.
22
And stop with the lumping all people over 65 into the one-size-fits-all elderly category. I've had generalized anxiety since birth and have had to live through cycles of the treatment de jour. Went through the talk therapy back in the day where you lie on the couch and they try to root out the non-existent cause, antidepressants, SSRIs, CBT. The only thing that works for me are those "nasty" benzodiazepines. I never take them every day, I take them as they used to be prescribed 30 years ago - as required. Unfortunately now I'm supposed to be cured of this illness the moment I reach 65 because all seniors are one and the same. My mother is over 90 and I inherited my disorder from her. She still doesn't have any dementia, she's never fallen and has had no consequences of taking these drugs "as required" for 60 years. Nothing but a good, decent quality of life. Enough already.
26
I was able to replace Ambien with 2-4 mg Tizanidine before bed (non-narcotic muscle relaxant), I'd be interested if anyone else has experience with this medication.
4
This is not an I am better than you comment, but I have been meditating on Headspace for over a year now and it really helps with anxiety and stress. I also may take one miligram of melatonin if I have additional stress and it really helps. I hope these two suggestions can help others. My doctor told me you cannot get addicted to melatonin.
7
You cannot become addicted, and I know several people for whom it has been a great help. However, it can have drug interactions and disease interactions and people should talk to their physicians before taking it on a regular basis.
5
What is Headspace?
1
A separate study needs to be done on the elderly who have more medical problems and lack of a support system. They can't just shape up and not take meds for anxiety, sleeplessness or whatever when they are suffering on a daily basis.
13
As a geriatrician, I have cared for people who suffered negative outcomes both while taking them and while attempting to discontinue them. The risk of falls, delirium, and cognitive decline are real for those taking benzos, particularly as they grow older. I understand that some people started these drugs for disabling anxiety or panic disorder. However, now in their 80s, 90s or beyond they can't remember why they were started and tapering may bring its own risks. There a geriatrics saying which I learned in training: "there is no pill for every ill." Unfortunately, the faith in pharmaceuticals in our culture can be inappropriately intense.
21
The article is not representative of the clinical/scientific literature. The comments might best be described as the anecdote wars. What is clear is that it would be good to have effective anxiolytics that do not cause physical dependence. It is also clear (but not addressed adequately in the article) that untreated anxiety disorders cause enormous suffering and early-onset ones can shorten the life span by many years- best estimates are 10-20 years. There is almost no good data on post-withdrawl syndromes being medication effects vs relapse. I am no fan of big pharma, but the numbers being thrown around by experts and publicly available "big data" are enough to have big pharma drooling at the thought of developing a patentable new molecular entity not Schedule 4, 3 or 2 (not subject to abuse) anxiolytic as effective as benzos.
4
Whatever drug is manufactured to relieve the effects of anxiety is going to cause more anxiety once the drug wears off. What comes down must go back up. I can't imagine a drug that would relieve anxiety and not have a rebound effect. I think all pills do have a rebound effect. If there would be such a drug without any rebound whatsoever, it would be amazing. But I still wouldn't take it.
5
Well that's great Delia, so I guess you just recommend people suffer.
8
Riverrunner, I think what Delia is recommending is that we not repeat the mistakes of the past. Drugs such as Xanax were initially hailed as being "safer" than Valium (aka Mother's Little Helper). Clearly that did not turn out to be the case.
2
Benzodiazepines down-regulate the GABA-A receptors, up-regulate the Glutatmate receptors, clog up the Voltage Gated Calcium Channels (VGCCs), throw off the HPA Thyroid Axis, damage the Limbic System of the brain and most of the time cause Adrenal Fatigue, which complicates the HPA Thyroid Axis dysregulation. You need not take my word for it, there are plenty of research papers available on the Internet which will all lead you to the same conclusion.. Other systems are impacted, but this what the bulk of Benzo Withdrawal Syndrome is and why nobody can really figure it out.. Feel free to contact me. Thank you. P.S. Do not give benzo victims fluoroquinolones. quinolones or progesterone as it causes more damage. Look that one up as well, the info is out there.
18
You are absolutely right, Paul. I wish I would have understood all that before I took Ativan. There are posts from people riddled with all the symptoms you list. The autonomic system is profoundly affected, too.
6
Thank you Paul. Benzodiazepines are dangerous drugs and, in my opinion need to be more tightly controlled.
I was on a "low" dose (.5 mg 2 times a day as needed) for four years. It nearly killed me, and even 17 months off of it, I still suffer from neuromuscular side effects, agoraphobia, gastrointestinal issues, and rebound anxiety. I habituated to a low dose quickly, and then used alcohol more and more. From the benzo forums I've been on, this is not uncommon. My doctor never explained that benzodiazepines and alcohol work on the same GABA receptors, and that drinking while on benzos is dangerous. Some of the damage done to my body can't be undone.
I've found cognitive behavioral therapy and meditation to be helpful in dealing with my anxiety disorder.
7
This is such a criminal epidemic. Having to read an article like this makes me even angrier. The elderly do not have the strength to cope with the side effects of a benzodiazepine let alone tolerance with drawl. I have been brain injured from 7 years due to a benzodiazepine. I have been tapering since mid 2015. I have spent two years of my life in bed and homebound trying to wean myself off this drug with absolutely no help from my doctor. Diabolical symptoms physically and mentally that I have sustained nobody in the whole world not even the worst criminal deserves this. Would've been easier to get electrocuted all at one shot or burned at the stake. I've been gutting it out just to survive and make it through another day. Like my other bands the Warriors, we will keep fighting until we heal and then we will make so much noise that we will blow the roof off this benzodiazepine epidemic.
17
I have two clients who use benzos to help them sleep and they CANNOT get off them. It's a problem, as they are both falls risks, but their doctors aren't too eager to find solutions.
I have also found that doctors are now prescribing either Gabapentin (which I think has horrible side effects) or seraquel to help with sleeping... to stay away from the benzos.
9
Read the Ashton Manual free online and also join benzo groups on Facebook.. There is one called "Benzo and "GABA Drug" Use and Recovery Experiences" which already has doctors, RNs LPNs, med students, etc talking to us about our experiences and learning how to safely withdrawal clients.. Make up a profile if necessary.. We're okay with that.. Thanks
12
Interesting and important article, but I want to make the author and others aware that VA actually stands for Veterans Affairs not Veterans Administration as it is called multiple times in this article. If you're going to un-abbreviate something, please know what it stands for (US Department of Veterans Affairs and its local subsets). Thanks!
8
You can take away my alprazolam when you can pry it from my cold dead fingers.
16
Regarding the EMPOWER trial, which was cited in the article and led by the Canadian geriatrician Dr. Cara Tannenbaum: the link is not provided for the 21-page booklet to empower patients to taper their sedative-hypnotics/benzodiazepines (only the study itself). The link to the booklet is a very useful resource for seniors. It would be great to add it to the article. Here is the link to the brochure: http://www.criugm.qc.ca/fichier/pdf/BENZOeng.pdf
4
The overwhelming majority of older people use these drugs without problems. They are extraordinarily helpful in addressing many issues that can destroy the quality of life experienced as we age.
We really do not need a passel of younger “nanny doctors” tut tutting that we elders are having entirely too much fun and should not be taking drugs because - well, just because it is unseemly and some small number of people will have adverse reactions.
If doctors would do their jobs and monitor the patients to whom they give these drugs, fewer people would be taking inappropriate doses.
26
Cecilia, have you actually read the comments? All of your assertions are refuted there, by people with lived experience--people who take "appropriate doses" as prescribed. While this article may happen to fall in a series geared toward the older years, the problems cited in it related to benzodiazepines know no age boundaries.
18
Have you read the comments? Have you looked at statistics? No, people taking four and five Xanax a day and more are not taking an appropriate dose.
The overwhelming percentage of older people who take these drugs take them safely and derive a great deal of benefit from them. People who cannot or will not take them safety need to be monitored by their physicians and should avoid taking them.
The quality of life of the elderly is too important to dismiss by saying no one should have access to these drugs.
26
The assertion there are people taking 4 and 5 Xanax a day in the comments and that's where the problems are is just simply not true. Nor is "nobody should have access to these drugs" said in the article. Talking about a drug having problems, which this class of drugs does, is completely appropriate. I wish they did discuss statistics more. The APA Task Force on benzodiazepine dependence found 40-80% have dependence and withdrawal from discontinuing this mediation. Additionally, about 1 in 6 go on to be disabled by the drug while on, during and even after coming off. I agree, the quality of life for the elderly is important, and having all the information when starting and stopping a drug is critical to retain quality of life. If patients are not getting good information, then it is imperative to ensure they do.
6
Too many people jump to anti-depressants, etc. when they should be finding the root of the problem. Physicians are too quick to write prescriptions. As a senor I would not want to be on drugs unless absolutely necessary for my health. People age and become diabetic, hypertensive, have cholesterol, thyroid and other issues. Your liver can only metabolize so many drugs. Americans like to remain oblivious to the damage they are doing to their bodies as they are only interested in the now and not the future and the long term problems with all of these ingested drugs.
9
The root of the problem is aging. You can’t pretty it up.
17
If the negative comments are not backed up by reliable scientific studies (as one commenter says she was told by her doctor), it is because those in a position to do studies have refused to conduct them. No studies EXIST on the long-term effects of benzos, or on the effects of withdrawing from them.
Those of us who are living with those withdrawal effects, and painstakingly titrating our dose reductions, and supporting one another in the process, would welcome with open arms some reliable scientific studies. We want to know what percentage of those who take benzos are likely to suffer as we do and why, whether as the result of tolerance while taking the drug or during the course of withdrawal from it. We want to know how to prevent that from happening, because a sheer glance at any online support group will speak to tens of thousands of unacknowledged cases.
And, more than anything, we would welcome with gratitude any real scientific help in getting us off these drugs safely, as we (the vast majority of whom have taken the drug only as prescribed, as good patients, never raising our doses unless told to) are not only summarily dismissed by the scientific community, but more often than not left to fend for ourselves.
31
Yes, I wholeheartedly agree, Lina! Most of the clinical studies are done in the earlier stages of benzo use, when things seem to be going well. And there is so much bias in them that one wonders if a clinical study is ever done WITHOUT bias.
The medical community tells people to get off these drugs much too quickly, causing devastating effects on the nervous system. They don't realize, out of ignorance, what havoc they're wreaking. The pharmacists aren't much better.
An overhaul of the entire system concerning benzos, as it stands now, is desperately needed.
14
I have chronic anxiety related to my bipolar condition. I have taken Ativan for 30 years. I am aware that I am addicted, though at a very low dosage level (1 mg). I am aware of other mild side effects. But what is left out from this article is that severe anxiety is a life-threatening condition and nothing treats the condition like benzodiazepines. These drugs work for countless Americans and they save lives. Those with bipolar illness commit suicide at a high rate. Ativan keeps me, and many others, from anxiety levels that could make the numbers of suicides mushroom. When drugs are tremendously helpful for many and harmful for some, it is wrong to ignore their positive contribution and to only speak of the negatives.
50
That is why we need informed consent. You have chosen to take benzos, knowing that they cause problems. Others knew nothing about them and trusted their doctors to give them good advice. They are stuck in an endless loop of terrible symptoms that seem never-ending. Without researching on my own (since I chose to listen to my doctor), I would never have known that the incapacitating symptoms I was going through was from the Ativan.
For you, the drugs may be fine. For others, not.
13
Hi, I'm a reporter working on a project about benzos. I was wondering if you would be open to talking with me about your experiences.
I WANT to talk, too! I have been trying for 2 years to recover from > 8 years of benzos taking less than prescribed!!
3
We are becoming a nation of addicts thanks to a medical profession that believes that pills are the solution to every ache, every pain and every emotional problem.
I have had a rough menopause and it will never occur to me to pop any of these mind altering substances. It is called life, you move on, you deal with it. I have found that meditation is a great help and so is exercise.
10
I and other non-MD professionals, especially those of us with a background in addiction counseling, have known about the severe addiction caused by benzos, for years. I'm glad the Times finally wrote about this widespread problem. --Anne Rettenberg LCSW
11
It's not an addiction, Anne. You've got to realize that. Almost all of us took the drugs as prescribed. Benzos, especially the fast-acting ones, foster dependency quickly because of their half-life.
Addiction puts the onus on the patient. It relegates us to labels. Iatrogenic dependence is the phrase that needs to be used. We were following our doctor's orders. We weren't using them illegally or downing a whole bunch at one time. There is a distinction, and it must be made.
19
There is no shame in having an addiction. It's a disease.
1
Physiological dependence is NOT "addiction" Anne. The brain makes adaptations to the benzodiazepine and when the drug is taken away, the brain/CNS no longer functions normally. Most of us took the drug as prescribed by the doctor, sometimes less. Most of us never craved the drug, never upped the dose, were never drug-seeking. I often took less than prescribed because who wants to be on pills? I stayed on them and thought it was difficult to come off because I was told by the doctor that the "anxiety" I felt when I stopped meant I “needed” them. I didn’t know that what I was feeling was withdrawal. I still have pills left over from tapering because I am too upset at the pharmacy (who also never warned me) to return them calmly and don't want to flush them down the toilet. I have no desire to take them.
Calling iatrogenic dependence an "addiction" is incorrect and not helpful to understanding the insidious nature of these drugs, how they hijack the brain unbeknownst to the person taking them and it is a disservice to your patients when you cannot understand the distinction. It is insulting to anyone to be called an addict when they are not one. Otherwise, no, there is no shame in it.
12
And the NYTimes strikes again.
No drugs for anyone. Ever.
'Cause drugs are, you know - bad!
Big Pharma!!
10
Ian, instead of just sneering, why don't you read through all of the reader comments here, many of which document how benzos have destroyed readers' lives.
13
Medical Marijuana.
End of story.
13
At this time I am unable to collect my thoughts well enough to say anything more than benzodiazepines hurt me.
15
Reading this article, one of several I’ve read lately, about benzo's - terrify and worry me about the safety of these drugs and the knowledge of my doctor. A sleep specialist (MD) prescribed two benzo’s; Clonazepam and Temazepam after my sleep study showed restless leg syndrome and nocturnal leg jerking. These are to be taken an hour apart before bedtime. I’m over 70 and have been taking them for over a year. I asked the doctor recently about the safety of these drugs and he said they are safe when taken as directed and that the negative comments are not backed up by reliable scientific studies. But as I said, I’m worried now and afraid to take them. I will look in to titration from them and think seriously about getting off both of them. They work well, I have never upped the dosage and have no obvious side effects. But I’m worried.
7
Where you would be in trouble would be if you needed a knee replacement or broke your hip and they put you on the usual Percocet as the pain medicine and you are on those two benzodiazepines.
3
Restless leg syndrome is extremely uncomfortable for people and lack of sleep is dangerous. I highly recommend you seek medical support if you’re going to go off of two benzodiazepines you have been on for years. There is an Anxiety medicine that is not a benzo and is highly effective and safe called Buspar. I don’t know why this is not used more.
4
I tried the Buspar you are talking about. It gave me terrible migraine headaches. One reason to avoid Buspar.
1
"Drug problems are deeply stigmatized." Ya think? Exhibit A: this article. Maybe anti-anxiety drugs and insomnia medications have become so widely prescribed to older people in recent years because (a) there are more older people, and (b) they need the medications. The aging brain goes through many changes, and insomnia is one of them. Is this a problem? Only if the person can't get medication. Benzodiazepines are old, cheap, and overall have a good safety profile; they are far less likely to result in fatal overdose or other serious adverse events than the barbituates common in the 1950s.
13
Ah, the 60 year old 'benzo slogan', aka marketing ploy of They're less likely to kill you than barbituates which makes them safe. Perhaps some more current research would be in order. A simple google search will give you 60,000 or so documents listing the serious adverse effects of benzodiazepine use and the common life-threatening withdrawal from them. Emergency dept. physicians would be good sources as well, they see 80,000 people suffering from those rare and unlikely serious adverse events each year in the U.S. Public Health England began a full investigation into them last month, the Scottish Parliament has followed, Massachusetts is hearing a bill right now. That "good safety profile" is no more.
6
"Life-threatening withdrawal"... so don't withdraw. It is the push to take people off the medications that is killing them. The stigma is killing them. The War on Drugs 2.0 is killing them. The benzodizepines themselves address a very real medical need in the elderly, insomnia and anxiety. And how many non-withdrawal ER visits are due to combining with opioids or other meds, as was recently noted in another Times article?
5
PL, just read all the comments here with people's personal stories. Benzos have destroyed many people's lives. Both people trying to withdraw from them and people whose lives were destroyed before they got any chance to think about withdrawing from them.
10
Next, we'll be trying to wean diabetics off their dependence on insulin. Really, the bias against any medication to relieve pain and anxiety has reached Prohibition proportions. If benzodiazepines are that widely prescribed, the vast majority of people taking them are not falling, not increasing their doses, not sleepwalking through their days, not walking into walls, not abusing them. If that happened in most cases, we'd be witnessing a zombie apocalypse. No, the concern isn't about falling or overdosing, its the moralizing judgement against people who can't buck up and will their stress away.
24
PL, Benzos are not insulin and insomniacs are not diabetics. That a stupid analogy invented by the medical establishment and then parroted out by all of them like members of a cult.
There's no moralizing about people "bucking up". It's not the patients fault if the medical establishment cannot cure them safely and reliably. That's the medical establishment's fault. Who here has blamed the victims?
10
Really hope there is one or more follow-ups on US detox programs on this topic.
The warnings have been sounded over the last several years, but where is the help?
It seems hopeless -- senseless? -- and downright dangerous to try to taper or get off completely ... as it appears to be an interminably long process with only pain and debilitation all along the way.
What a terrible trap to be in ... and from this comments section, it seems there are a lot of trapped people out there.
Praying for all affected for a breakthrough that offers some reprieve from what seems a constant waking (and sleeping) nightmare.
9
Most alcohol and drug treatment programs will not even accept patients who need to withdraw from benzos unless it's from relatively small doses. It takes too long and presents a risk of serious complications and liability. And insurers probably would not cover it. Opiod or alcohol addiction they will treat. Benz addiction they will not.
6
Oh, yes, they do. But the results are poor. The person is usually left in a wrecked state, probably worse off than before detox.
3
Detox is a very, very bad idea. To be taken off the drugs and to be put on other drugs causes the central nervous system to go crazy. It simply SHOULD NOT be done.
Sensible tapering can take place. Yes, it can take years. But it's better to be functional and able to drive, interact with people, not be agoraphobic, and be able to work and to function in society as a real member than a crippled mess in your bedroom, afraid to turn on the light or have any music playing because of extreme sensitivity, being afraid to step outside the bedroom door. I wish I had gone slowly now. But it's too late.
5
Recent reports say that clinical use of psylocibin (the magic in magic mushrooms) can end depression and anxiety among people, even making them feel spiritually uplifted, and deeply connected with the world.
Perhaps the effect of psylocibin on the prisoners of Big Pharma should be studied.
7
Benzodiazepine and alcohol are probably the most dangerous substances to withdraw from. Even if its done gradually Benzo withdrawal is one of the most painful substances to withdraw from. Unknown to many Benzo detox takes considerably longer and is much more uncomfortable than heroin withdrawal. Ask Stevie Nicks (who came off Klonopin) how bad it can be. Benzo withdrawal brings with it not only insomnia and anxiety (which ironically is what they are prescribed for) but also depression, agitation, hypertension, muscle aches, extreme fatigue. The depression is resistant to antidepressant medication. Its literally a nightmare process and sometimes requires hospitalization.
16
Perhaps someone should pass that info on to doctors; they seem to know nothing about it. Mine sure didn’t, and the results were catastrophic.
12
It is not just benzos that are a problem for older folk. I am currently severely disabled from lamotrigine and seroquel which were prescribed by a neurologist/psychiatrist who continued to urge me to take them. I reported numerous falls - at this point I have had over one hundred. He ignored the falls,
16
Why is no one seriously studying the issue of post-menopausal insomnia in women? Sexism? Sleep difficulties after menopause are rampant and the best that medicine has to offer is "sleep hygiene" (or CBTi, which is not widely available) -- truly is insulting as most (educated) women tried sleep hygiene long ago and found little relief. Older women who are active and busy and often still working can not afford, and should not have to tolerate, chronic sleepless nights. We take benzos, or similar, in order to maintain some quality of life. If men were having this problem, would it get more attention?
31
Postmenopausal... yes, insomnia, yet another medical problem caused by estrogen deprivation. Havent there been enough studies showing that the natural healthy state for women requires estrogen? Abdominal fat distribution, increased LDL cholesterol, osteoporosis, dementia, heart disease -- all are preventable if estrogen levels are maintained. Instead, women are prescribed a pharmacopea of workaround drugs with their own dangerous side effects. Menopause itself is treated as nothing more than hot flashes that women are expected to tough their way through. Medicine has extended life expectancy beyond 50, but somehow the cessation of a key hormone at that age is now overlooked: estrogen is no longer replaced, thanks to the narrow, misplaced, focus on its effect on breast tissue, based on a poorly designed, decade-old study that has since been largely discredited. Like the persistence of the "fat is bad" notion from the 1970s, the rap against estrogen has been slow to change, to the great detriment of women's health.
6
I totally agree with anonymous. Why is there no help.
4
There are some things that help, such as going to bed earlier, and accepting the idea of a two-stage sleep. I am writing this at 2am and will soon go back to bed for my second sleep of the night. Anything you ingest to help you sleep messes up the sleep stages and makes the problem worse.
6
For those looking online for the Canadian informational brochure, which includes a 21-week tapering schedule for benzos and z-drugs, here is a link:
http://www.criugm.qc.ca/fichier/pdf/BENZOeng.pdf
The initial study showed that 27 percent of patients, many of them long-term users, were able to discontinue the drug within six months using this tool, compared to five percent of a control group. Another 11 percent were able to reduce their doses. The brochure advises proceeding under the supervision of a doctor or pharmacist.
3
Ms. Spahn, I guess you haven't had personal experience with becoming dependent on a benzodiazepine. The 18 week tapering schedule in the recommended Canadian brochure is totally inadequate for people who have been taking benzodiazepines for more than just insomnia. This schedule of halving a daily dose would throw many into severe, screaming withdrawals. A 27% success rate, for people who presumably want to reduce the medication, is not very good. I would suggest that people who are looking for tapering plans google the Ashton Method, developed in England by a trailblazing woman who ran a clinic to help people off these drugs. Her success rate is much higher.
14
Take no drugs like these unless you would die without them, or nearly die. It is not like say insulin which you have to have. Pain and mental meds are very dangerous, don't use them.
11
I have witnessed benzos kill over 50 people, usually due to suicide. Not because of reemerging mental disorders, but due to the devastating, crippling tolerance withdrawal, withdrawal, and Benzodiazepine Withdrawal Syndrome which slams into some attempting to stop benzo use, or recover from being prescribed. I'm speaking of lawyers, doctors, nurses, Veterans, law enforcement officers, chefs, BioChem engineers, etc.. All dead. Gone. Destroyed. Left in their wake are the many thousands who avoided suicide, but are left completely disabled due to taking a medication prescribed to them by the doctor they trusted. I, too, am a Benzo Victim. I learned by fate in 2012 when my latest doctor fired me as a patient as I insisted I be taken off of Klonopin. His words? "I will not be responsible for what is going to happen if you attempt to get off this medication." I joined online Benzo Support Groups a few hours later. I studied for 2 1/2 years before starting my taper which is now in it's 40th month. Currently at 0.0063mg of Klonopin using a compound liquid. I am mentally and physically disabled with the worst Hell coming once I am completely off. Stop this Madness. Benzo Buddies on the Internet has over 40k members, all in the same Hell. This is not rare. This is not acceptable. This is killing and maiming patients who were never warned or afforded Informed Consent. In Canada and the UK victims can sue. We, in the U.S., cannot and have been abandoned. Please Help
21
Paul, I understand. I have been to the depths of despair. No one can imagine such terror unless they've been through it. And it seems to never end. Some people give up. This affects every facet of one's being, and yet no one "gets it" unless they've been through it. We're relegated to labels such as mentally unstable and "anxious." If they only knew.
I agree that we in the U.S. have been abandoned. But there are websites (Benzo Case Japan and Benzodiazepine Information Coalition) that one can research through and get help. It's unfortunate that the very doctors who are prescribing these drugs remain in the dark or refuse to acknowledge the terrible problems.
Congratulations on slow tapering! I wish you the best!
5
So true, Paul, all of it.
And I commend you for tapering off on your own very carefully!!
2
I find your post particularly moving, Paul, because my most horrific side effect of getting off of a very small dose of Xanax (1.5 mg PER WEEK) was periodic bouts of suicidal depression. And I was a happy, non-depressed person before this, put on Xanax initially by a doctor who thought he was being kind in making my trip to China for my son's wedding a little easier.
Now, whenever I read in the news that someone committed suicide or went off the wall, my first thought is, "What was he on? What was he trying to NOT be on?" I've been particularly frustrated that all the New York Times articles about PTSDiand suicide in vets, the connection is never made between these bleakest of mental states and what happens to person's brain when they come off of these drugs.
People need to know what these drugs can do.
Hang in there. Just stay alive. But only people who've been through this can understand how what an appalling assignment that can be.
Linda Crew
www.lindacrew.com
3
I took SSRIs for 25 years. The only time I felt anything was when I forgot to take my pills. If I forgot my pills the next day was like a triple hangover.
I took 2 migs of Ativan for about five years. Last year I decided I had had enough. It took a year but I’m clean for a month now. I sleep like crap so I smoke a little pot at night. Does the same thing as the SSRIs and Atavan as far as I’m concerned. I’m gonna start walking for exercise when the weather warms up a bit more. That’s what I know.
14
SSRIs are handed out like candy and they can have devastating effects. A friend of mine from the gym disappeared for a few years after a hip implant. The next time I saw him he had probably almost doubled his body weight, and in a very unsettling and unusual type of way. This was not normal obesity, which in men, tends to start in the gut. He had massive flaps hanging from his arms. And he looked awful. Before, he barely had an ounce of fat on his body and walked 3 to 4 miles per day. SSRIs also come with warnings to not stop taking them abruptly. It seems to me there are few drugs that are safe to take long term, and they all have side effects. But regarding bezos or opioids, when were speaking of elderly people, if these drugs improve their lives by their own estimation, why don't we let them live the way they choose for the few years they have remaining?
2
I keep waiting for the article announcing the wonderful, and completely safe, substitutes for opioids for pain, and now, benzodiazepines for anxiety. What? There are no wonderful, safe substitutes? The unhelpful advice accompanying the urgent warnings say we should try exercise, meditation, various unavailable or expensive therapies, or better yet, just accept a life with pain and anxiety.
These alarmist articles consistently conflate the problems and issues of criminal DRUG ADDICTS, with the legitimate health issues of old, sick people. A significant proportion of old people suffer pain associated with normal aging, for which they DESERVE pain relief. Ditto for depression or anxiety. These are not the people overdosing and dying.
Read the article in today's NYT about palliative care and how the demonization of opioids is making it difficult for doctors who serve dying patients.
16
I take strong issue with your description of this article as "alarmist." I am an ordinary, now elderly person currently tapering off of a dosage of .5 mg of klonopin prescribed for me for anxiety years ago. Describing it as the worst nightmare imaginable doesn't begin to tell the tale. These medications are not effective forever, and when they lose their effectiveness, whether it be weeks or years, they can cause an extreme version of the very symptom they were prescribed to alleviate: horrible, unrelenting anxiety. And that is not the only symptom tapering off of them, or remaining on them without continually increasing the dosage, causes. A few of the ones I am experiencing are depression, crippling nerve pain, fatigue, depersonalization, derealization, fear, tinnitus, sleeplessness, and extreme sensitivity to sensory stimuli. This is a real and devastating health crisis for many, many thousands of other ordinary people of ALL ages in our country and around the world.
13
people 'deserve' solutions for their pain and anxiety that are not worse than the original problem that they are trying to alleviate.
12
Drug addiction is also a legitimate medical problem, and drug addicts also DESERVE help and relief. You speak as if "the people overdosing and dying" are just throw-aways.
3
Based on evidence, cognitive behavioral therapy is the most efficacious and safest treatment for insomnia disorder. But in practice, it is generally unavailable. Why? Because it is a psychological intervention. Which U.S. healthcare does not provide standard access to. Why? Because those trained to deliver it, like those who largely created it, are psychologists. The remedy? Integration of psychology & medicine.
16
I wonder if that technique is on the internet?
1
Yes, there are lots of ways to teach yourself CBT. Look first for the book "Feeling Good", by Dr.Robert Burns. A very good guide to CBT.
2
If this "evidence" is the same as the rigorous tests new drugs and medical treatments have to undergo, and the results are as you claim, I would think insurers would be happy to make CBT available. Psychologists may help some people and provide other useful services, but to the best of my knowledge they have never cured anybody of anything.
I’ve been on benzodiazepines for 14 years and have changed my dosage twice in that period. I have multiple sclerosis, insomnia and anxiety. With the medication I get a good night’s sleep and am a relatively pleasant person. I’m 50 and have no signs of cognitive decline. Without them—I’m a nightmare to be around. They were prescribed by my neurologist who is picking the lesser of 2 evils—chronic insomnia carries its own health risks and lack of sleep/anxiety can cause MS to flare up. Do I like that I have to take them? No. Will I continue to take them? Yes. This article overlooks the complex physical and mental health issues many people face. The N.Y. Times can do better.
51
I'm stockpiling mine for that time when I've had enough, medicine can't help me, and I can move on so they can unplug the damn machine. Dr. Jack was a hero!
8
My mother has taken Ativan for sleep for forty years. She's leveled off at 2mg because the doctor won't let her have any more than that. The idea of trying to "wean" her off her drug at 92 looms as impossible as flying by flapping my arms. She knows the risks, so I say...not my problem.
6
I don't understand why, at 92, the doctor wouldn't just want to make your mother comfortable in whatever way he/she could. Weaning someone that old from Ativan is too serious of a matter. This is where I definitely would draw the line.
19
What would be the point at age 92?
6
I believe I said exactly that.
People are different and react differently to drugs. Consider all the generalizations and hearsay evidence iin this hysterical article and the ones on the "opioid epidemic." Prohibition was a failure and so will this present campaign. Scaring patients and doctors into the idea that everyone, no matter what their condition, is at risk from these drugs will do more harm than good.
12
Great article. My grandmother (84) has been taking Ativan for years and complains of memory and other cognitive issues. Her prescriber has even expressed to her that he's not totally comfortable prescribing it anymore, and yet he continues to do so against his better judgment.
Also, this is not just a problem for the elderly. I took Klonopin as prescribed for a single month in 2014 at 26 years old and tapering off of it was the most harrowing experience of my life. It took close to a year to feel remotely functional and I still have neurological and cognitive issues that I can't be sure aren't some lasting, unresolved damage. It is the greatest regret of my life and thousands of other people of all ages are going through the same thing; it's not hard to find their accounts on Youtube and various support groups. The NYT should do a piece about this as well.
29
Dr Humphreys is labeled a "researcher" but not labeled a psychologist. In truth, he is both. So? Evidence suggests cognitive behavioral therapy, a psychological intervention, is more effective and safer than medication but is also rarely available. Why? Because it is delivered and was largely created by psychologists (e.g., Meichenbaum, 1977). Nationally there are nearly 3x as many licensed psychologists as there are psychiatrists (107k vs 40k). They nevertheless remain poorly integrated into standard health care. So? Unless we start calling things as they are, "psychopharmacology" will remain in place to protect medicine's hierarchy, psychiatry in particular, & pharmaceutical profits more broadly. But as you and many others point out, it will not protect patients.
All doctors know disciplinary turf can be deadly.
8
Sadly, many or most psychologists are not well acquainted with cognitive behavioral therapy. It should be made a priority in training clinical psychologists.
As for psychiatrists, they often show disregard for psychologists and any non-drug intervention. Their whole goal is to bully their patients into taking dangerous drugs such as SSRIs (more so than benzos).
What a tragedy.
6
I have been exposed to cognitive behavioral therapy in an alcohol inpatient program. I still don't even know what it is. It made absolutely no sense to me. Is that because the "therapists" didn't know what they were doing, or because there really is "no there there?" Have there really been serious and reliable studies of this technique, whatever it is? To me all it seemed like was snake oil. Before you dismiss that, keep in mind that, to the best of my knowledge, no psychologist has ever "cured" anybody of anything.
3
Bob, I have not heard of it being used for alcoholism, if that is what it was used for in that program, so I don't know about that. But certainly it has been studied for mental health issues like anxiety, depression, PTSD, OCD, ...
The skill/knowledge of the "therapists" definitely matters.
If it made "absolutely no sense to you", that's a bad sign. Unless your state at the time made it difficult to make sense of anything. (If that was the case, it'd be hard to use too.) Actually, even things that don't work will probably "make some sense" in the sense of being possible or plausible. e.g. some old-fashioned Freudian stuff that's out of favor nowadays.
1
Three industries benefit from pushing pharmaceuticals: the pharmaceutical industry itself, which has successfully sold the public on the idea that mental illness is nothing more than a “chemical imbalance”; allopathic medicine, which is well suited to a prescribing model as a means of addressing patient concerns; and the health insurance industry, which seems happy to pay for unlimited pills but is obstructionist toward other treatment models such as psychotherapy that are based on interpersonal relationships and which require work on the part of the patient. Pharmaceuticals have their place but there are big gaps in our knowledge of how these chemical treatments work and unforeseen consequences of using them long term, or stopping them after long-term use. The brain is not the simplistic cartoon one sees in ads.
18
You are right, Mary Ellen, about the fairy tale of "chemical imbalance". That is just something the medical establishment made up on zero evidence. We don't know what a "chemical balance" would be for a "normal" brain. We cannot even measure these things and even if we could would not know what they mean.
But this wild "chemical imbalance" claim is used mainly for other drugs, I think, not benzos.
Then the medical practitioners all start parroting like members of a cult stuff about those other drugs being "the same as insulin for diabetes". They're not insulin for diabetes. That's a terrible analogy.
And they never warn about all of the risks and side-effects.
9
"They're not insulin for diabetes. That's a terrible analogy."
Why? are they not (the same as ) 'insulin for diabetes?"
Why? is it a "terrible analogy?"
Please explain.
1
Ian, for starters, please scroll up and read the comments of me & babymf, CA, both below (in reply to) Paul Chomiak's comment.
There are just far more differences than similarities. We understand insulin and its role in the body. We understand the pancreas and what it's supposed to do.
We don't understand the brain at the chemical level. And benzos, etc. are certainly not a normal part of the body produced by the body. Normally, when medicos pull out the insulin/diabetes tale, they also talk about "chemical imbalances" in the brain. We don't know what a "chemical balance" is in a "well-functioning" brain. We cannot even measure brain chemistry.
The flaws in the analogy go on and on. As I said, please also scroll up & read the other comment on this.
5
Many years ago, after I stopped drinking, I suffered massive anxiety and panic attacks, so bad that my teeth chattered. I took 3 mg. of Klonopin, which was my standard dose for several years. When I changed psychiatrists, my new one wanted me to stop taking it. I was extremely resistant, but I did agree to lower the dose to 2 mg. My next psychiatrist (I've had to change frequently because of Medicare) didn't think it was a problem, but I decided to taper off some more, down to 1 mg. I have some minor brain damage that already causes cognitive problems and balance issues, and more than one doctor had told me the Klonopin was making it worse. That psychiatrist retired. My latest psychiatrist isn't particularly interested in my treatment. However, I lowered the dose to .5 mg, now to .25 mg. I'm hoping to wean off of it in the next month. It has to be a time where I'm okay with insomnia and nausea. I'm taking other medications, so I don't want to start with a non-benzo anxiety drug before I know how my health is without Klonopin.
I'm extremely lucky that I was an alcoholic before I started meds. I dislike being dependent on anything. This process has taken several years, as advised by this article.
14
Elisa, why does Medicare force you to change psychiatrists so often?
The minor brain damage, do you mean that was caused by the drugs or something else?
I am guessing that many psychiatrists don’t accept Medicare.
3
Since the dawn of time, we humans have used various substances to alter our consciousness. If you have an ailment (anxiety, pain, the generalized heebie-jeebies) it is natural to want to feel better and function normally. Come off your high horse and have some compassion. Tomorrow it could be you.
18
The article talks about persuading patients to not use these drugs for long periods, but patients need prescriptions from doctors to obtain these drugs.
The language of the article is telling in other ways: it talks about the use of the drugs among older adults, and about people taking them for years, rather than the use of the drugs by doctors, or about doctors prescribing them for years.
The problem is doctors, pharmaceutical companies, and insurance companies that prefer drugs to therapy or other alternatives, not patients.
26
Being on benzos is like playing the roulette wheel with your health. It is simply NOT KNOWN who will suffer terribly and who won't. I think that is one of the most dangerous aspects of benzos. You're taking a chance by taking it long-term, meaning over two weeks. You can't depend on doctors to lead you down the correct path because the medical community has been extremely slow to understand these pills. This has continued for decades! I would wager a bet that often people don't know that they have symptoms because they're often buried beneath polypharmacy. In other words, a person visits the doctor for insomnia, a very common withdrawal symptom of benzos. They're given a drug. This goes on and on for whatever ails the patient. But the underlying problem has been the benzos.
It's important to do your own research on this. Doctors won't, most likely, present the facts to you. After all, they're the ones who prescribed the drug and they've mostly turned their backs on the negative consequences.
11
Similar to issues with steroid I was prescribed for my poison ivy....tapering.
“You never, ever recommend that someone stop cold turkey,” Dr. Maust said. That can bring withdrawal symptoms that include nausea, chills, anxiety, even delirium. “You taper down very gradually.”
1
Weren't you prescribed steroids in a taper-pack? i.e., 6 pills the first day, 5 the next day, etc. I have used them this way several times for eczema and there was always a built-in taper. Unfortunately, even with a taper, there is often a rebound effect.
1
"Despite warnings from experts, older people are using
more anti-anxiety and sleep medications..."
Hmmm. And just who is facilitating this behavior??? This sub-headline makes it sound as if the "older people" are ignoring the "warnings from experts" and rushing out and getting those pills! There's a middle-person here. The doc. The gatekeeper. The wielder of the mighty prescription pad.
This is especially pertinent when the population involved is 65+. People raised in a time long gone, when the Doctor was seen as all knowing, all wise, with time to listen and consider before acting.
26
A most interesting article. For many years I was dependent on Immovane /zopiclone as a result of a workplace discrimination incident. For Canadian readers of this article, I would recommend a treatment program available through Pharmacy.ca of Toronto. In essence, it is a blinded tapered withdrawal program and can be prescribed through medical specialists. Not all family doctors are aware of it. I found it to be a great help
2
Maybe I missed something... Where can one obtain the advisory booklet on tapering off these drugs over a 21week period? I’d like to try. I take both clonazepam and zolpidem at bedtime (and have for many years). I know going cold turkey would be very hard, but at age 67, after reading this, I think staying on them might be too risky. Thanks.
4
Where do you obtain the advisory booklet for tapering off the drugs? There isn't any! I have contacted both the drug manufacturers, and addiction specialists,and they really don't have a realistic protocol, considering the terrible withdrawal syndrome. Unfortunately, the best thing you can do is look at the Facebook groups for benzo tapering, they have more realistic tapering programs than what you will get from a medical professional. The biggest problem is that dosages made by the pharmaceutical companies are not made small enough, or able to split in small enough pieces to get off safely. Hopefully, at some point they will be mandated to provide tapering size doses for people who are trying to get off these drugs.
There's The Ashton Manual www.benzo.org.uk/manual as one resource
5
You can go on BenzoBuddies. They have people who are doing different kinds of tapering methods and micro-tapers, titrations. There are many in your shoes, wondering the same thing.
I would caution you to go very slowly at first to see how you do. Some people can handle a faster taper and some people simply can't. A 21-week taper period would be way too fast for some people.
8
I have to push back a little. My mother has had terrible anxiety and depression starting in her mid 80s, and no doctor would do anything to help her. They all just shrugged and said, well that’s what happens when you get old.
I wish one of them had given her a happy pill to lighten her load a little. I don’t fear “addiction” this late in life. I do fear the day after day of weeping and despair.
Maybe legal pot is the answer.
41
Anti-anxiety meds, used alone, will make anxiety worse unless it is coupled with a SSRI. CBT, hypnosis and/or acupuncture should help alleviate anxiety so that a person may eventually taper off the medications. Do not self-medicate on alcohol or smoking. There is no quick fix but there is hope with persistence and support and moving (i.e. swimming like a reader mentioned). Great article!
3
Yeah! Swimming. THAT'S the ticket!
1
To control your anxiety and deal with the side effects, and for fun, take swimming lessons and swim hard and every day at the same approximate time. It's likely more affordable than medication and psychologists, has no side effects, and 'swimming friends are the best friends.'
13
I have used Xanax sparingly for years. It has helped tremendously to quell debilitating obsessive thought patterns. There is a place for such drugs. Unfortunately so many people fail to use them appropriately.
13
Susan, it's not that they fail to use them correctly, it's just that their systems are different from yours. Xanax is very short-acting. Someone else in your shoes would have developed tolerance long ago. You sound as if you're one of the lucky ones. It has nothing to do with failing to use them correctly. Maybe you metabolize them differently from other people. We don't know why someone in your shoes would be suffering greatly and you aren't.
5
Oh, yes, Xanax works wonderfully well. That's the trouble with it. I would have considered my use of it sparing too. What a shock to go off and find the gates of hell wide open before me. I had no idea that some of the symptoms I'd been dealing with--intrusive thoughts of suicide, weird chest clamping episodes, and even my first in my life panic attack, were actually interdose withdrawal symptoms. I'm well and happy and sleep through the night now, so glad I stumbled onto my cure for myself: getting off Xanax.
Linda Crew
Corvallis, Oregon
www.lindacrew.com
5
After reading an article in the NYT in 2014 (https://www.nytimes.com/2014/09/14/opinion/sunday/should-we-all-take-a-b..., I started taking lithium orotate to address chronic low-level anxiety. It's OTC and safe and I've been so grateful many times for this low-cost and highly benign supplement. It restores for me the sense of "at peace with the world" that I recall from childhood, and I sleep like a baby, regardless to what's happening in my life. It's not addictive, it's beneficial at many levels; only side effect is moderate dry mouth. It's neutral as to pain.
I associated lithium with bipolar treatment and was wary.
But we're talking a trace element amount, something like 1/50th of what is prescribed for bipolar. So tiny there's no worries about longterm use, etc. I find 1/2 the recommended dose works wonders for me, and take 1/2 a tab before sleep every night.
My alternative meds doc tells me he finds that some people don't experience much benefit from LO, but that a percentage are tremendously benefitted. This supplement is so cheap and so non-damaging that I think it's worth a try for everyone to see if you're in the lucky category. There's no downside and the upside potential is huge. Read comments by users on Amazon for lots of personal testimonies.
3
My wife has incurable, metastatic breast cancer. I'm her primary caregiver. Is this a stressful situation? Does it cause anxiety? I eat healthy, exercise vigorously and regularly, meditate as best I can and see a therapist. I also take an antidepressant and a little Ativan. Try it without the meds and see how far you get. You can do it, of course, but it's not about you.
31
Terry, your story is heartbreakingly familiar to people on the Benzobuddies.org board. People who were prescribed "a little something to help" while they coped with what seemed like the more serious issues of a family member. Then these poor souls spiral downward on their own, and looking back, so wished they'd not accepted this pharmaceutical help. It's not about whether you deserve all the help you can get, it's that these drugs so often lead to your own downfall. I'm so sorry about your wife.
Linda Crew
Corvallis, Oregon
www.lindacrew.com
5
When I was 7 months off 4 years of klonopin use, my husband suffered a spinal cord injury rendering him a tetraplegic. He's been in the hospital for almost 9 months and hasn't recovered any function. I am his caregiver and will be when he comes home. I'm anxious and depressed, but I will not again go through the the damage done by benzos. I exercise, eat well, meditate, and see a qualified cognitive behavioral therapist. So, I do know what it's like to go through unbelievable stress unmedicated, and it can be done.
1
I started benzos when I was 13 years old having panic attacks in school. I followed the doctor’s direction and when the panic attacks abated I stopped taking Valium. This was in the 70s.
Fifteen years ago I was diagnosed with an auto immune disease with no cure but immense pain. Prior to that label, I was taking a benzo because the anxiety of not knowing what I had (misdiagnosed for ten years), caused panic attacks. I’ve been on and off benzos for more that thirty years. I’ve been on opioids for ten years. No one ever said don’t combine them. No one ever said how to stop taking these drugs. It was here handed to me and a get better comment.
I’ve tried withdrawal from both at different times. I was unsuccessful as the brain craves the medicines and causes all types of harrowing feelings when it doesn’t have the medicine. Interesting fact is my family won’t have anything to do with me, along with some long time friends, as they think I’m an addict. LOL. I take my medicines according to the directions. I see both pain doctor and psychiatrist monthly. Until there is another method, besides death or comma, I will continue my medicines. They keep me functioning. It’s sad that educated people such as my family, doesn’t get why I take these medicines. I guess they would rather see me in bed squirming from the auto immune disease’s immense pain and laying in hiding under the blankets due to my anxiety. Sadly I don’t think I’m the only one I this situation.
27
You give the perfect reason to eradicate the word addiction once and for all. People are dependent on a certain drug, not addicted to it.
Thank you for writing down your story.
14
hear, hear Maria Bierens.
the "addiction" label obfuscates the real problem we're facing, which is tolerance. the desire among many in the benzo community is to get off these drugs asap.
9
Add some refer and I could better deal with this miserable president and chaos.
7
I use pot now. used to use Oxycontin and benzos. Marijuana is a wonderful drug if you use it correctly.
Also suboxone saved my life when I was addicted to Oxycontin. That drug is a lifesaver and I wish it didn't cost me $300/month even though I had a gold level Obama care plan I was paying $400/month for.
3
Reading the comments is so frustrating.
Users of these drugs--which impair/sedate and affect cognition--literally seem unable to comprehend that the drugs are not helping them.
They can't comprehend this because the drugs impair their brains.
They can't comprehend that the reason they feel so bad when they aren't taking the drugs is because they're addicted and experiencing withdrawal.
They can't comprehend that low doses (like .5mg) are low because the drug is so potent. With impaired cognition, they think .5mg is no big deal.
I personally don't care how drugged up people want to be as long as they don't ever get behind the wheel of a car.
Paula Span is trying to help, but good luck with that. It's like trying to pry poisoned candy out of the hands of toddlers.
9
And it's frustrating on the other side, because some people don't seem to comprehend that there's a REASON people seek relief from anguish, pain, and debilitating symptoms. Everyone saying "Well, goodness, just don't take these bad drugs" seems to not understand that things were pretty bad BEFORE the person started taking (insert name of evil drug), and none of the "Well, just don't take them then, stupid" replies seem to show any compassion for the suffering. Your post amounts to, "Told you so."
27
Physical pain, trouble sleeping, depression are symptoms. Each may have a dozen different underlying conditions. It is not surprising a pill for all does not work, not to mention a pill that targets the symptom without probing the specific underlying conditions.
5
Many years ago a kind physician prescribed 2 meds: Desyrel aka Trazodone and an anti depressant called Efexor, generic Venlafaxine. My dosages of both have increased but they are non-problematic as far as addiction goes. I have nights when I have trouble getting to sleep. My meds are not a panacea. Because of my severe neck pain, the same wonderful physician prescribed cyclobenzaprine. When I have a crisis I take it more frequently but, I can use it as a sleep aid as it makes one sleepy if that's necessary. I am 71 and I've always had careful and wonderful physicians. I want Adderal for my ADD but my doctor won't give it to me! I do have ADD that has been a livelong curse but, at my age, she's put her foot down!
4
And you think if we had the incomes of experts we wouldn't sleep more easily? Really. we are tired of having to battle the experts to get some relief. They caution the general practitioners against prescribing palliative medications because a patient whose life expectancy is not even a year may become dependant? Small children who are unrelated are cautious. Is it because we look like we have a serious communicable disease?
So now the do-gooders are out to help us leave this earth sooner no matter how we feel.
See you in the after life.
9
Hasn’t the number of people over 65 risen a great deal in the time period for which an increase in benzo-related deaths is reported? A jump in number doesn’t say much unless the respective numbers of deaths are reported as percentages.
6
This article cites percentages and the percentages cited indicate an increase over time.
2
As MS Span writes, zolpidem (the most popular sleeping pill) is part of the opioid problem. The risk of overdose deaths is 4 times as high among those also prescribed zolpidem with an opioid. However, the FDA has not added a "black box" warning about opioid risks to the zolpidem prescribing information, nor has it warned about the very high mortality risks associated with zolpidem. There are over a hundred rather new studies about the risks of zolpidem and other sleeping pills. For detailed information, please see
http://dx.doi.org/10.12688/f1000research.8729.2
Daniel F. Kripke, M.D.
13
There are so many alternatives to starting down the benzo cul de sac.
It is a pity maybe a shame more HCPs aren't aware of or schooled in them. Looking at illiopsoas tension， gut flora issues and metabolic toxicity are the avenues of exploration most likely to yield long～lasting results. Acupuncture can be quite helpful as well. And finally，there are several fantastic Chinese or hybrid Chinese～modern herbology formulas that work well once the drug dependence issue has been resolved.
2
I read about any drug before I take them, but continue to drink a couple of glasses of wine at night against medical advice to limit to one glass. Benzos fry your brain, moderate wine simply relaxes. Why are we steered away from a medicinal food toward a drug. Is the pharm industry more powerful than the wine lobby? Call me crazy.
6
It's good to stay away from Benzos. I agree with you on that. Surely you can moderate the amount of wine, however, to more like 2 glasses a night?
I am getting awfully tired and very frightened about all the hysteria about opioids. Most of us in chronic pain don't abuse them and are not addicted. What is going to happen to those of us in chronic, severe pain when we are denied pain relief? All of the holier than thou types would be singing a different tune if they were in my boat.
52
Everything you say is contrary to the evidence. The evidence doesn't support the use of opioids for chronic pain. I have heard very few addicts admit to an addiction. I could give you a dozen suggestions starting with a mental health evaluation but find most people addicted to opioids are content continuing to use.
4
We're elderly because we managed to survive. If we are not a bother, don't concern yourself. We can decide how to live or not.
36
You are free to decide. You are free to make healthful decisions or dangerous harmful decisions.
12
But there is no law preventing you from putting the gun to our heads because we may have made a "dangerous harmful decision." Dangerous tp you? If not, whose business is it to determine the reasonable cause of death was "not natural"?
Sometimes I just don't go out because I am more comfortable in my gracious space. So far, I have been able to fend off those who would invade my space so as to create the illusion that they are justifying their own existences. and for whose benefit do they exist? The certainty of death is not nearly as frightful as life for some.
5
Yes but if you are on Medicare we all pay for your healthcare and the consequences of your bad choices. We get to comment.
5
This is another article that again, invites ignorant readers to inaccurately exchange the terms anxiety attacks with panic attacks. They are not the same at all. It is a very frustrating misconception that leads most, even those who work for EMS and most doctors to respond incorrectly to those having a panic attack. Anxiety attacks are very different. Panic attacks mimics different diseases. When someone is having a panic attack, they feel incomprehensibly ill. No medication will help. It is hard to tell if one is having a panic attack or is really sick. They usually last 20 minutes, strike unexpectedly, and the symptoms are not always the same. Anxiety is not the same at all, it is easily identified, and it is ongoing, unlike panic attacks. Stop insulting those of us who suffer from it and who are constantly misunderstood because not even doctors know much about panic disorder.
7
My mother is 87, suffering with a fractured pelvis and restless leg syndrome. The doctors and the nurse practitioner wanted to treat the pain with steroids and Tylenol and the restless leg ( that kept her up all night ). She gets to pay for all the over prescribing the other doctors and nurses have done and for three weeks they left in her pain. I finally threatened to sue the hospital if they didn't help her and they capitulated. She has opioids when the pain is insurmountable and medicine to help her sleep. Finally! We fired the doctor and the nurse practitioner and finally she is getting the care she needs and is beginning to recover. Our new care doctors are finnaly treating the patient. This hysterical bs the Times like's to promote hurts people. My mother worked out twice a day and was in better shape than most soccer moms. This new conservative approach won't work any better for patients, perhaps worse if nurses and doctors take the time to get to know their patients and stop treatment by the numbers..
53
Many physicians are incapable of individualizing. They just follow algorithms. Sad. Sorry your mother had to suffer needlessly and thank you for your reporting this.
16
I was prescribed trazadone, an older pre-Prozac anti-depressant as a sleep aid. It works. No next day drowsiness. I recommend trying it.
8
Does it make you sort of shaky on your feet in the morning? Foggy headed?
tried it as I am a chronic insomniac. Unfortunately, it didn't work for me. I've been on ambien for far too long but it's not that effective anymore and I don't want to increase the dosage. I can't seem to find the solution and know or have read about the potential connection between dementia and ambien. I am trying to stop taking ambien but it's so hard. wish I knew where to turn and what to do.
3
Not really, but it can cause orthostatic hypotension, when your blood pressure drops suddenly as you get up. That would be an issue with the elderly.
1
While I would wager that a majority of new physicians are aware of the problems with benzodiazepines and are reluctant to prescribe them for outpatient use, many are still unaware of the downsides associated with other sleeping medications in older adults. The nonbenzodiazepine sedative-hypnotics ("Z-drugs" inclduing Zolpidem, Zaleplon, Eszopeclone) can increase risk of falls and delirium in adults over 65. Even over-the-counter drugs that people use for sleep (Benadryl, Tylenol PM, Nyquil, other allergy medicines that produce drowsiness) have high anticholinergic effects that can increase risk of delirium and worsen memory and cognition if taken regularly in older adults. The best treatments for insomnia are good sleep hygiene and cognitive behavioral therapy targeted for insomnia. However, if sleep hygiene does not reduce the insomnia and CBT is not available, then melatonin, ramelteon, or trazadone are better medicines than over-the-counter sleeping aids that contain diphenhydramine (the active agent in Benadryl). The American Geriatrics Society publishes a list of medications to avoid in older adults, called the Beers Criteria; thankfully more and more physicians are knowledgeable about the Beers Criteria now that our population ages.
7
Thank you for mentioning drugs that contain diphenhydramine (the active agent in Benadryl). This drug is ubiquitous and is in countless over the counter meds. And the majority of consumers have no idea about the dangers--"anticholinergic effects that can increase risk of delirium and worsen memory and cognition if taken regularly in older adults." Alzheimers' stats rose with the use/over use of this drug. But this goes unreported among the obsession with opioid painkillers and benzos.
Taking choline supplements can help counteract some of the very real damage; many people are also already deficient in this essential brain nutrient.
5
Unrelated to ALL of these drugs is the fact that many older adults don't sleep well because they have sleep apnea, and might also need supplemental oxygen to get a good night's rest.
3
Supplemental oxygen is rarely prescribed for sleep apnea although you are correct, it is under-diagnosed.
1
Anyone tried a nice fat doobie? -or an indica pill for those who don't like smoke? Well at least for those of us who live in a marijuana legal state.
25
"Numbers from the Centers for Disease Control and Prevention tell the story: In 1999, it tallied just 63 benzodiazepine-related deaths among those aged 65 and older. Almost 29 percent also involved an opioid. By 2015, benzo deaths in that age group had jumped to 431, with more than two-thirds involving an opioid. (Benzo-related deaths in all age groups totaled 8,791.)
Look at the numbers. Ask why this article was written as an admonition for older Americans. Consider the concept of sensationalism ... and watch what Rx combinations you might consider taking. Then wonder again why NYT chose to target older American as higher risk folks.
14
I am unsure why some people feel they must be put “in charge” if you will, making sure people conform to their why of thinking, because, by God, they are right. How many of you wake at 3 AM, maybe feeling you are unable to breath, visited by all your dead relatives and literally shaking in fear?
To you that never have experienced a panic attack I say, lucky you. But, until you do, please don’t mandate what medication a person may or may not use that helps them deal with this crushing debilitating illness.
While people need education on what they take, you should not lose your right to use a medication that helps you just because you reach a certain age. It’s rule number 65, “Opps, I see you
are 65, no more angyolytics because you are old and may pass out. Of course we have nothing else for you to take that is completely safe, so go home and suffer in silence”.
Really???? Age doesn’t necessarily make you stupid but it sure makes people think you are. I have used Alprazolam 0.5 mg about 5 times a month for severe anxiety for several years, never passed out, never needed to increase the dose, all it does is help when I need it.
Now a constant fight when I need a refill. Talk about going overboard! I have just decided to get some meds in Mexico, a lot less hassle, and still cheap and I won’t have to deal with the “Elderly people are stupid” crowd who know everything about everything but go back to “Just Say No” even with nothing offered to help you.
Sad 4 America
43
Perhaps 90% of the elderly should not be on these drugs but 10% do benefit with minimal risk. It is the physician's responsibility to sort this out and not to blindly follow guidelines as if they are infallible and apply to everyone instead of to most.
10
In some jurisdictions guidelines are hard rules that threaten docs's licences...i.e. computerized rx records. Or why patients needing pain meds and relaxants are tossed into the street to purchase chinese fentanyl. Rumor has it that every opiod rx is followed by a query letter from the powers that be in some jurisdictions.
2
If you are at or beyond age 65, the medical industry, regardless of provider, looks at you as a liability that will eventually co$t them $ignificantly. It is far easier to prescribe pills than work with us (indeed, I am well beyond 65) to improve our lives by way of therapies - mental & physical.
Until the medical industry executive decision makers looks beyond their quarterly P&L statements and their vesting stock options valuation, more and more 'oldies' in need of good medical care will be sent off with a promise, a prescription and a pat on the head with kind words 'be well old thing'.
13
In and out of office quickly so I can document in computer in such a way as to maximize billing while avoiding fraud. This takes away time from patients. But oh well, Americans accept this.
4
Thank you for telling it like it is!
3
I developed extreme anxiety after a series of major life changes. All my anxiety centered centered around dying and not being around for my two young kids. I refused my doc's offer of meds and instead focused on diet (eat to live) and exercise, meditation, and chamomile tea when it starts to get overwhelming. I've lost 30 lbs, eliminated prediabetes and high blood pressure, and have all kinds of energy to be there for the challenges of parenting. When my anxiety builds up again, I drink chamomile and hit up the local zen center if possible. My doc doesn't even know what chamomile is, even though there are clinical studies showing its efficacy on reducing anxiety.
26
God bless you and your family. Melatonin can help with sleep also.
1
At 68, just finished almost seven months of every pain management injection in the bag for chronic spinal pain. Now on daily dose of moderate opioid for daily pain while new MRI awaiting review of neurosurgeon. Had major disc fusion surgery five years ago. The pain has worsened depression, anxiety and insomnia - thus on benzos, too. The pain has taken away my life. The benzos help manage the day to day living and provide some sense of hope.
Know all about how insurance wants to use cheap opioids and won’t cover more expensive alternatives. Also know about MD pill mills and growing abuse.
Clearly there is no easy answer but no regulation will stop a person who wants to break the law. Don’t make it nearly in possible for those of us in pain to get help.
30
I agree with you. The view in the article and many comments is a blanket condemnation of benzos. Sometimes they do a lot of good, just as opioids do. Life is complicated, and answers are not easy, no matter how polemicists would like it otherwise.
28
I truly understand the frustration of people taking these meds with all of the recent press regarding these drugs. I had a terrible anxiety and sleep issues at menopause and thought for many years that Ativan was a miracle for me until I reached tolerance, and then it became my worst nightmare for many years. Running from doctor to doctor with other heath issues and rebound anxiety from tolerance withdrawal. Because the anxiety would go away after I would take another pill, I assumed it was the underlying problem and didn't understand what the drug was actually doing. People who assume they have these addictive substance "under control," are not understanding how it impairs your judgement even when you think it isn't. You will have a ball and chain for the rest of your life, or the withdrawal could be the worst experience you will ever go through. After taking me seven years to get off all of this crap I no longer have anxiety or sleep issues. However, I have a host of other problems from down regulated GABA that I don't know will ever go away after over two years off. Ultimately it's up to you, but I wish someone had sat me down and told me what these drugs were going to do me. I have few regrets in my life, but taking Ativan is one of them. I have to live like a recluse now due to head trauma I had from blackouts that the drug caused. We need to look at what the undying cause of our anxiety is instead reaching for a pill every time we have a problem.
18
“ . . but I wish someone had sat me down and told me what these drugs were going to do to me.” But that’s just it, Merry. THEY DON’T KNOW.
4
You're right......they don't know. That is why I'm doing this: www.FollowYourBlissFoundation
Our organization has seen an incredible increase in traffic over the last 6 months. People are sick, and they are looking for answers they aren't getting from their doctors. We educate and help the public understand the problems we are up against with 90 million people on this drug worldwide. Mainstream medicine has trained us to pop pills and not how to deal with our human emotions. We're not allowed to have emotions anymore without needing a label so they can prescribe a pill. Man did I learn the hard way.
2
I don't see a quiet drug problem at all because I don't see how occasional use of a benzo or pain pillar for chronic conditions lead one to become an addict. Seriously, there is a difference between addictive behavior and responsible use. It's the medical profession that can no longer make the distinction. The problem actually started with them doing the overprescribing. I have taken opioids for osteoarthritis and facial neuralgia occasionally years ago and never became an addict. But for the past 5 years, I've had to suck it up because now the mantra is live with it. But I have been accused of being a drug addict just because I talk about pain when asked. So I stopped going. Why take another MRI or x-Ray when the treatment is the same which is to say nothing. I'm fed up and in pain.
25
99/100 people use opiates and never become dependent or addicted. The other 1% suffer tremendously and their lives may be forever changed for the worse, or they may end up dead. A good deal for society? Depends on which side of hte coin you live. But you gotta see both sides to get the whole picture.
9
Opioids are not the preferred treatments for either of your conditions. Osteoarthritis is better treated with NSAIDs and trigeminal neuralgia is better treated with carbamazepine. I am not your doctor but I would not begrudge your physicians for not giving you medicines that are third or fourth line treatment for your conditions.
But what if you can’t take NSAID’s? As you must know they are extremely hard on our digestive system and can cause ulcers and GI bleeds. People with history of such should not take NSAIDs. Always exceptions to the rules.
Opioids have always ranked higher in pain relief until recently. Hysterics now have produced a study ranking OTC pain reliever over opioids. To each their own because the different ways our body utilized drugs. They also tell me Excedrin Migraine takes migraine pain away. LOL on that one. Maxalt other hand works extremely well on pain and photophobia.
7
I became horribly dependent on klonapin for sleep and anxiety and the withdrawal, totally mismanaged by a treatment center, nearly killed me and did long term harm. But, and this is a big but, the suggestion that non drug treatments can be effective for severe insomnia is a cop-out, just plain BS. Sleep hygiene and CBT nibble around the edges of sleep, and this may be enough for mild issues, but a drop in the bucket for major problems. It is kinda sad that the NYT keeps pushing this stuff on the vulnerable and unsuspecting public. This is an arena where medicine has been remarkably impotent.
25
Thank you for your comment. I suffer with insomnia and keep asking my psychiatrist what alternative is out there for me after he reluctantly fills out a prescription for ambien. He warns me that it can impair my memory. He tells me that it may be linked to dementia and not to take it every day. But when I tell him that my lack of sleep impairs my day to day functioning, he says that while he'll give me a script, there's nothing else he can do for me. I am at my wit's end, cause I follow sleep hygiene protocol and know that CBT "nibbles" but is not a true solution. Why is this issue which affects so much of our population not being effectively addressed?
7
The Ambien has ruined your sleep hygiene.
It's not surprising that you now can't sleep without it.
The Ambien is the problem, not the solution. It puts users in a vicious cycle.
2
People with severe insomnia are seriously sick, but doctors either don't believe this of just don't have anything to offer. Other drugs are out there that can be used with much lower potential for dependence, although some have side effects of their own--I would list them, but then the Times would probably not publish the note. I now get by fine on a combination of really low dose Seroquel and melatonin. Important to keep the seroquel really low to avoid bad side effects. Docs will say no, bad drug--yes, at higher doses, where it acts as an antipsychotic, not at 25 mg. Sleep medicine is "stone knives and bear skins". I feel your pain.
4
A major issue here of the people defending benzos is that they don't know they are EXACERBATING THE REASONS THEY TAKE THEM. Yes, that is unbelievable! Simply ask the many, many thousands of us for whom it took years to figure that out. A good place to start is the online, victim created community "Benzo Buddies" which as 38k members.
Or
You can look at the research. Here's some. You're going to want to pay special attention to the Pharma funded Marks study whose longterm results were obscured in the original journal abstracts.
https://www.benzoinfo.com/2017/01/07/upjohn-study-shows-xanax-alprazolam...
Ashton, H. (1987). “Benzodiazepine Withdrawal: Outcome in 50 Patients”. British Journal of Addiction
Burke, K. et al. (1995). Medical Service Use by Patients before and after Detoxification from Benzodiazepine Dependence.
Crowe, S. et al. (2017). The Residual Medium and Long-term Cognitive Effects of Benzodiazepine Use: An Updated Meta-analysis.
Fixen, A. Ridge, D. (2017). Stories of Hell and Healing: Internet Users’ Construction of Benzodiazepine Distress and Withdrawal.
Marks, I. (1993). Alprazolam and Exposure Alone and Combined in Panic Disorder with Agoraphobia: a controlled Study in London and Toronto. British Journal of Psychiatry.
There's much more but I'm getting cut off by the word limit.
I'll give a million dollars to anyone who can provide solid research which supports longterm use.
16
Before you start taking any drug, do some serious reading. It's your only body. Act accordingly.
8
Sometimes the long term effects of a medication become known too late--reference Nexium, a medication that was widely prescribed in the 90's, which has been found to be almost impossible to stop because it causes a physical change to your stomach lining (proton pump inhibitors turn out to lead to the production of more proton pumps, leaving you with more proton pumps than you started out with before you started taking the medication). The current Rx on OTC labels recommends taking Nexium for no more than 14 days. Curiously, these OTC 14-day bottles are provided in packs of three . . .
10
when you can't sleep due to pain issues from old age, financial issues, personal loss, it all adds up, burdens that even a young adult has trouble dealing with. S0.... what else can society expect. Just wait until the Republicans cut Social Security and Medicare. What's needed are safer sleep and anti-anxiety meds. If developed though, the drug companies will be charging an arm and a leg for them; even more financial strain will follow. Time for more socialistic policies, like price freezes on drugs, wage freezes on medical professionals, and corporate executives.
17
Thank you for mentioning this and the future cutbacks which I believe will happen no matter what unless as you point out there are socialistic policies with regard to pharmaceuticals and medical care. I am an insomniac who wrestles with sleep issues every day know that ambien is not the answer but feel trapped because there's no other solution and know that I'm in a vicious cycle. Best responses I've come across are from people in Oregon and Vermont. You live in progressive states and if there's any improvement in our system, I believe it will come from people in your states.
7
our bodies make many chemicals that would be illegal to sell without a prescription . people need to be modified to fall in line with DEA and federal laws
2
Ha! My father in law just passed away at age 95 . He usually had a stiff gin martini or two at happy hour, then his sleeping pill, and a couple of vicodins for his pain before bed. He lived for 20 years with a urostomy. He could drink me under the table! And why not? For two years after his urostomy ar age 72 we thought he was going to commit suicide. His demise had nothing to do with his alcohol or drugs, or his prior bladder cancer for that matter. I took ativan .5 every night for two years for esophageal spasm, it was the only thing that helped. It eventually went away, I stopped the ativan without problem. I think anti anxiety drugs can be titrated and an informed patient can use them prn instead of every 6 hours like they prescribe. That is a big part of the problem. Some of the responses here indicate that is just what people do. I think us older folks are entirely capable of managing this and each case is a little different. My fear is they are going to reschedule these drugs now to schedule 3 just like they did with hydrocodone, then you wont be able to get it at all anymore.
14
So what happened to him that he got worse, and then got better? I don’t understand your narrative
2
This is yet another precise example of why the overall approach to 'health' by Western medicine, is repulsive. Everything is a bandaid solution, with most doctors never considering or wanting to understand WHY someone has a particular ailment in the first place. They never want to dig deep, ask questions, suggest lifestyle changes, etc. It's always just 'here's a prescription'. Positively disgusting. Thank god we now have the internet, where we can do our own research and be our own advocates. Clearly, many doctors are not our advocates, but rather, are those of big pharma.
11
This is ageism and sexism. I use Ambien for insomnia and have done so for years. I have never increased my dosage and soon will have to go to Tijuana or the dark web to get a prescription because of this hoopla concerning opioids. I have had insomnia since I was a child. Do these researchers really think I have not tried everything to get a night's sleep in the last 50 years?!
I came of age during the Sixties and managed to not become an addict. I don't drink or smoke. I will not be denied a good night's sleep because people are overdosing on fentanyl or pain killers. I am in the later part of my life and I am not going to be in pain or be awake all night.
Researchers, put that laser focus on deaths from alcohol, guns or real addiction and leave us alone. You know that saying, "the kids are alright" well, the "older" people are alright.
By the way my husband can walk into any doctor's office and get anything he wants, but oh those older women, we really have to keep an eye on them.
Meanwhile the side affects of all the drugs that doctor's want "older " people to take are staggering. Let's talk about that.
53
Spot on comment! Especially the " old women" who are, you know, "crazy." But the old geezers, not so much.
12
My sleep issues are mostly solved by: using clothes pins every night to put up black out sheets over my bedroom windows, turning on a small fan as a white noise machine, keeping my thermostat (for A/C) at 74 degrees at night, not eating anything after 7pm - or more than a few sips of water, using a small amount of melatonin at bedtime on occasion, having the head of my bed elevated 6-7 inches for GERD, sleeping on my left side for GERD, putting a thick gel foam pad on my bed so I won't slip down so much, avoiding monosodium glutamate (in canned soups, etc.) and caffeine after early afternoon and more. Also following endocrinologist's bloodwork schedule so that I don't become hyperthyroid.
1
Write an article about the drastic drop in overdoses among the elderly after they legislate assisted society. These articles about reducing the deaths in the elderly due to benzos, guns, opioids, lack of basic needs etc are running from the truth. People want to die for many truths in our sick neglectful society. If you want our elderly to think carefully about their end of life choices, then make their needs not met by a maze of Heath insurance nightmares and high costs, make their lives affordable, make them welcomed in your community, appreciate their lives and allow them to die humanly.
15
This article is misleading. I have been taking Klonopin for many years with zero problems. I never needed to keep increasing my dose. Cognitive therapy was not effective in reducing my chronic anxiety. I also take Effexor for depression. I am getting sick and tired of all this fear mongering against benzodiazepines. The media is obsessed with people's drug use. It sells.
24
It's all well and good for you then, but what about the people who suffer such bad withdrawals that they cannot work, communicate with people, drive a car, even get out the door because they develop agoraphobia? Some are beset with such bad nerve pain that they can barely do anything. Some are bedridden. Some cannot parent well. Losing everything just because they tried to get off a drug that was causing damage. I couldn't even read the computer because I had such bad vertigo spells. I couldn't even walk far because I was too dizzy.
We need informed consent. We need to be recognized so that others don't fall into the same trap. We need to be recognized by doctors, for one thing. They usually say that in one month, symptoms are gone. But that is a lie. It's all about the nerves. And nerves take a very long time to heal. Sure, there are people who don't go through any withdrawals. I would have loved to have been one of those. But I was not lucky by a long shot. And I'm sick of hiding from my doctors for fear of being rebuffed.
4
Try "Free and Easy Wanderer" teapills (Xiao Yao Wan) before you turn to drugs which might pose serious addiction and side-effect problems.
This Chinese herbal remedy makes me feel like a normal person, able to get through each day and take what comes.
The Plum Flower brand is safe, reliable, and effective. Check out the Amazon reviews of "Plum Flower Economy Size - Free and Easy Wanderer - Xiao Yao Wan"
(Do not confuse this remedy with "Free & Easy Wanderer Plus".)
alice,
The product you recommended has fillers. One of the fillers is talcum, which is carcinogenic.
2
This may not be a solution for many, but to cut my anxiety, I more than halved my coffee consumption, boosted herbal tea consumption started taking melatonin for better sleep, and exercised. I also worked to sleep longer and took up meditation.
This is not a panacea but most if not all these activities do not require regular checkups on the kidneys and liver-which most modern drugs do. The side effects of modern drugs terrify me. I also do nutritional supplements because whatever I spend on them is part of my food budget.
oh, and for those dire situations, I insist on valium, not any of the newer slower antianxiety meds that build up in your system. Everyone says that valium is highly addictive but I love it because it is fast acting and, for me at least, easy to stop. Helps that I do not have an addictive personality.
Bottom line, get to know your own body and environment. No one knows it better than you. I truly applaud everyone in the article working to get off modern antianxiety and antipain meds. I can't imagine how hard it is.
5
Valium is highly addictive precisely because it is fast acting. The slower benzodiazepines have reduced risk of addition because the "speed" at which drugs take effect tends to determine the "high" a person experiences with the drug.
LB: You seem to think the elderly take valium to get "high." Nothing could be further from the truth for this old-timer, who takes it occasionally to get to SLEEP, not "high."
5
Valium is one of the slowest-acting benzos there are. In my experience, reading many posts from sufferers, some people are able to go many years on Valium without problems. Ativan and Xanas are very fast-acting. Usually, at some point, a person will realize there is something wrong when taking these drugs. Again, it varies with each person. With Ativan, I was dependent very quickly.
I never experienced any high from the drugs. There are some who do, but they're in the minority.
There ought to be a genetics test someone can take to find out how quickly one metabolizes these drugs because no one wants to experience the type of withdrawal you can have from them.
1
Ok. Here is another situation where genetic testing would be helpful for many patients. Each patient may have differing levels of enzymes necessary to metabolize certain benzos. DNA can be a generally accurate indicator of these enzymes. So, a patient may produce enzymes such that he or she metabolizes klonopin in such a way that a .5 mg dose is really more like a 1 mg dose. If you give that patient even a .5 dose of klonopin, they will struggle to quit using it, even after a short time (although it can be done). Unfortunately, the testing is very expensive, and I doubt insurance reimbursement would ever cover it for a benzo alone. Maybe some practitioners could shed some light on that subject. As far as I know, patients are never asked upfront whether they would like to have this testing. It generally comes only after the fail on a course of SSRI/SNRI, antipscyhotics, or mood stabilizers.
3
I only read a few of the comments,so I may have missed this. However, it is astonishing to have an article about problems with abuse of medications that does not mention the pharmacuetical companies. It is no accident that car and drug ads dominate TV. These are two of the major money makers in US society and both have discovered that advertising pays. Curious that we dont allow hard alcohol ads on TV, considering it a moral issue, but drugs are fine. the pharamceutical companies have also invested heavily in physicians to convince them that abuse of pain or anxiety medications is not a big problem. Why is there no control of this societal scourge? Could it be the massive contributions these companies provide to politicians. That also happened with tobacco, but eventually public awareness started to overcome the political cash pipeline. Could that happen with drugs?
7
There are more than enough hard alcohol ads on television. There's Jim Beam, rum, Crown Royal, Jack Black, a variety of vodkas . . . sweet cocktails in cans . . . I'd choose marijuana if I had to. I don't drink or smoke but who knows what I'd do without Ambien? Prescription drugs can do as much harm as good. So can water.
We should be allowed to make informed decisions regarding what we choose to take for health issues that affect the quality of our lives.
2
Glenda, Good correction of my note that hard liquor ads are actually allowed on TV. My bad, I guess I need to watch more TV. I still disagree with your view that avoiding the nanny state and allowing us to make informed decisions about what to take is the correct way. It is very clear that the deliberate misinformation of the pharmaceutical houses on issues such as pain relief, drug treatment of ADHD and statins for avoiding heart disease are very effective, some say by deluding a minimally informed public. I get it that you feel Ambien is not in this class, although there are certainly some drug avoidance people who would disagree.https://www.theatlantic.com/health/archive/2013/06/ambien-the-good-the-b.... The issue is definitely whether federal agencies like FDA should help guide public choices or if they should leave us all on our own against the relentless barrage of ads.
https://www.nytimes.com/2017/12/24/business/media/prescription-drugs-adv...
As others have pointed out, most, if not all, prescriptions have side effects. Why are they singling out this type now? People are depending on relief from deliberating symptoms. Sure, there are people addicted to anything or most anything, but leave the rest of us alone will you. I've successfully used Lorazepam for a decade and that is because it does as is prescribed. I don't abuse it. That is the key. Why not write weekly articles about the hazards of addictive drugs such as alcohol and tobacco?
10
You are incorrect in thinking that someone must be addicted to benzos. There are very few who are taking these drugs who are addicts, and most are using them "as prescribed."
GABA is a very important neurotransmitter, that brings calm to the body, that benzos "hijack" in order to create the calm that is so prevalent in benzos. This creates an upset in the delicate balance of the nervous system and causes glutamate (an excitatory neurotransmitter) to flood the system when a person becomes dependent on benzos, which often happens, especially when using Ativan and Xanax. That is why people feel more anxious as time goes on. It has NOTHING to do with addiction.
You are probably one of those who can go for years on the same dose. Lucky you. But there are many who would go through horrific withdrawals in your shoes.
8
I became a doctor because I truly wanted to help others life happier, healthier, safer lives. I certainly didn't expect to serve as a glorified, if licensed, drug dealer. Following the exhortations of TV advertisements, patients seem to believe they can direct me to prescribe whatever they want; and while no one has ever requested Lipitor or Prilosec by name, I'm inundated with demands for Xanax, Selexin, Ambien, Adderall, OxyContin.
Anxiety and insomnia are two disorders that respond well, if not immediately, to therapeutic and lifestyle interventions. Unfortunately, drugs are a lot cheaper and thus beloved by "healthcare administrators" and the suits at insurance companies. I spend far too much time working to mitigate the ravages of addiction in my patients to cavalierly expose anyone else to such misery.
There's been an explosion (spurned by the contraction in opioid prescribing) in new patients asking for benzos or benzo-combos. In our practice, we NEVER prescribe Xanax (a highly problematic drug with impressive street value,) prescribe only small quantities of benzos only for infrequent, as needed use, and never prescribe combos or co-administer with relaxants or stimulants. Our safe prescribing policies have met with vociferous blowback, but for patients who are willing, we'll taper them off these addictive drugs, even if it takes a year and referrals to multiple ancillary services. It's the right way to practice and promotes healthier long-term outcomes.
24
My spouse was able to withdraw from the fairly high dose of Ativan he was taking with the guidance of our HMO’s chemical dependency program doctors. They substituted Clorazepate, a longer acting drug, which he then withdrew from. They also added Gabapentin to his treatment to suppress the withdrawal.The withdrawal took 2-3 months and we now can’t remember too many ill effects. At the end, he concluded that the anxiety he had been feeling daily was from frequent withdrawals from Ativan in between pills. He is in his 70s and on quite a few other drugs for pain and heart problems, so it was a relief to be off the Ativan. I’m surprised not to read more about this method.
8
I'm nearly 67. For the past four or five years, I've used valium to combat occasional insomnia. At most, I use it two to three times a week and usually take it at half the prescribed dose. There are many weeks when I don't need to take it at all.
But when I do need a valium to get to sleep, it's a life saver. Waking up stone cold at 3:00 in the morning and unable to get back to sleep is a debilitating experience, especially if you have appointments or other things that need to be addressed later in the day. Similarly, laying in bed for hours on end trying to get to sleep is torturous. It not only lessens your productivity the following day, but it can also throw off your circadian rhythm for days or weeks on end, and leave you vulnerable to various infections due to your suppressed immune system.
Like many commenters here, I resent the medical community's and government's growing hysteria and overgeneralizations concerning opioid and now benzodiazepine use. This year, I could not find a single doctor willing to prescribe a codeine-based cough medicine for me despite my bronchitis and the hacking cough that kept me up most of the night. I also know several older people who were either not prescribed or were under-prescribed effective opioid-based painkillers after surgical procedures.
Enough is enough. Most government officials and younger Americans view older Americans as useless drains on the economy. Why not just write us the prescriptions and get rid of us humanely?
35
My friend was only able to use Excedrin extra strength after her root canal. Too painful for words.
4
I have found ibuprofen very useful after all sorts of dental surgery. In past, doctors often prescribed opiate pain kilers, but I didn't like how I felt when I took them, so doc said decent alternative would be 2 or 3 200 mg. ibuprofen instead (so a 400 or 600 mg. dose). Haven't had any pain problems with that -- I find most severe dental pain is just in 12-24 hours following surgery and after that can reduce dosage.
I had emergency surgery & insertion of pins for open fracture of a thumb last fall. I checked out of hospital w/prescription for percocet, which I was to alternate with prescribed 600 mg ibuprofen tablets. DIdn't need such high dose of ibprofen after a couple of days, so stopped it and substituted 2-200 mg. of my own tablets, and tapering down to 200 mg. doses. Still have a big bottle of those 600 mg. doses they prescribed, as well as some unused percocet. I have to be careful with the ibuprofen as it seems to induce acid reflux if taken over a period of months and then I have to go on a course of prilosec, which happened this winter after all the ibuprofen I took last fall.
3
You can’t generalize like that. I’ve had dental surgery twice in my life, first time I was in severe pain and most definitely needed opioids, second time around I didn’t even need ibuprofen.
2
Being on benzos has been a nightmare. The "calm" I was receiving from them has certainly been futile compared to the extreme symptoms. In fact, they are still going on to this day, four years after ending my taper.
I would caution anyone to go slowly in weaning themselves off. I cold turkeyed .5 mg. Ativan. Though doctors ignorantly call that a "low dose," it is not in terms of the damage it can cause the nervous system. I then was put on Klonopin, which I would not suggest to anyone.
Unfortunately, no one knows who will suffer greatly and who will escape unscathed. These drugs should only be taken short-term, meaning days. I don't believe in the four-week rule. I knew someone who only took Ativan for 21 days, and she was suffering for at least a year.
Those who have suffered a great deal lose their homes, livelihoods, friends, finances, their very souls. They become crippled in every way.
This is a very seductive class of drugs. It draws you in. You feel as if you're completely calm. But it can turn on you in no time. No doctor told me anything about its dangers. My sister said she hoped I wouldn't be addicted, but I knew I was nothing like an addict, so I didn't heed the warning. I didn't know anything about GABA or glutamate either. I certainly do now!
Nerves take a long time to heal. I wish there were a test that definitively showed who should NOT take these pills. The suffering has been unbearable.
11
Can you clarify what the damage to the nervous system is of a .5 mg dose of ativan. A lot of people here are mentioning that, permanent brain damage, etc., but isn't clear to me what that is. Are you experiencing that? How does it affect you in your daily life?
2
I have had cognitive problems resulting from the benzos. I couldn't read, be on the Internet for long because it would be overwhelming. The brain becomes very confused. Reading, which I love, became a chore.
I developed agoraphobia, light and smell sensitivity, heard things that weren't there, saw things that weren't there. I looked in the mirror and could not recognize myself. Walking around, it felt as if I were in a movie. Nothing seemed real.
All that is gone. It just takes time for the brain to heal. It is as if there's been a brain injury. I don't feel that this is permanent, though. It just takes time to right itself. Some heal much quicker than others. However, I'm feeling MUCH better cognitively than a few years ago.
6
Back in the '70's, I took my mother to task for taking a sleeping pill every night. Suggested she asked her doctor about it. She did and he said "So you take a sleeping pill every night, so what?!" She lived until the ago of 89 and suffered no ill affects from the pills. Mind clear as a bill until she died. How p.c. we've all become.
21
This is called an anecdote - one person's story. Although interesting, it has nothing whatsoever to contribute to a scientific approach to medication management. Benzos are highly addictive, do nothing to address root causes, and create a great deal of suffering for patients when they are improperly prescribed. Using science to make decisions isn't PC.
4
The issue has precisely nothing to do with pc.
1
Anecdotal evidence is the worst kind.
1
I've been on many benzos. Was on three when I-was working for extreme anxiety no amount of CBT or bedtime hygiene could help. Now, retired, I am on one to which I am habituated. In a similar way I-am habituated to 5 mg paroxetine. Both are nearly impossible to wean off. I get brain fog, extreme runny nose, insomnia, wild mood swings, among other symptoms, only after three weeks off of the paroxetime (which is at half of the smallest tab). I have extremely vivid nightmares, in addition, and night sweats three weeks after I stop the lorazepam. My psychopharmacologist advises me to continue with both. No Dr. I have found in N. VA can wean me off of them.
6
Oh, a couple more here:
https://withdrawal.theinnercompass.org/
www.survivingantidepressants.org
1
J, as long as you can get enough pills from your doctor, you can taper on your own. Many of us have been in the same situation. I did a slow, self-guided taper with no medical support. Here are some good resources:
Heather Ashton Manual (for tapering): https://www.benzo.org.uk/manual/
Support forum: www.benzobuddies.org
Benzodiazepine Information Coalition: www.benzoinfo.com
More comprehensive info: www.benzo.org.uk
1
J: paroxetine (aka paxil) rivals benzos in their difficulty of withdrawal.
it took me 3 tries to get off that drug: finally successful after using liquid
and an eyedropper and decreased by a tiny bit every night.
2
I just turned 70. I’ve been taking 0.5 mg of alprazolam on an as-needed basis for over 20 years. In an average week, I take four pills. I have had decades of cognitive behavioral therapy, have taken almost every anti-depressant out there, and I exercise, but none of these approaches has provided relief from the overwhelming anxiety that I sometimes feel. Over all these years, I have not had to increase the dose of alprazolam. Sometimes a week will go by when I don’t take it at all. However, on those occasions when my anxiety feels like I’m on the verge of going mad, that 0.5 mg alprazolam pill is a life saver.
This article paints benzo use with a broad brush. I know there are many cases where benzos should not be prescribed, but for me, when anxiety starts snowballing and taking over my life, alprazolam provides relief. Alprazolam doesn’t turn me into some kind of zombie. I read complex literature, solve problems, and am able to stay focus and concentrated when I need to.
When I feel overtaken by anxiety, alprazolam restores the equilibrium that makes me able to function. Sometimes the mere knowledge that the alprazolam is available if I need it is enough to calm me down.
41
The fact that the knowledge that you can take it can calm you down points to the poorer of our minds. You're reaping a placebo type of benefit.
I'm not trying to convince you to do anything differently. I've battled boys of depression and anxiety so I have a great deal of sympathy and empathy for what you go through.
1
I don't view this as a placebo effect. If my anxiety is not severe, than it is a comfort to me that if it does get worse, I have the option to take a pill so that I don't have to go through the terror of a full-blown panic attack.
9
God, I hate auto-correct. AI has a long way to go before it poses a threat to humanity. In the meantime, I have to stick to posting comments with a real keyboard.
1
Benzodiazepine addiction, morbidity and mortality are not limited to the elderly, as illustrated by Tom Petty’s recent death. The stated cause of death was opiate overdose, but he was also taking alprazolam and temazepam. It is possible his use of the benzos, combined with the opiates, contributed to his death.
We talk about the scourge of opiates in this country and overlook the similar problem of benzodiazepine addiction. Opiates and benzodiazepines beautifully treat symptoms, but once accustomed to them it’s hard to find anything that works nearly as well.
Opiates and benzos are both addicting, physically and emotionally. Accompanying addiction is withdrawal for those who abruptly stop the medication or cut down the dose. While overdosing on opiates is deadlier, withdrawal from benzodiazepines is the more urgent medical emergency and can also kill you. Combined use compounds the dangers exponentially.
Doctors eager to treat anxiety and insomnia do so with benzodiazepines too often, and risk creating new problems for their patients.
4
What annoys me is the generalizations in an article like this that ALL people over the age of 65 should never receive anti-anxiety or sleep meds like Ambien because of the risks they pose to SOME older people. Physicians prescribe boatloads of meds with terrible side effects for problems like, AF, hypertension, , high cholesterol, prostate problems, ED, GI issues, etc. I never see an article about how elderly people shouldn't receive heart medications because some elderly patients faint or fall as a result of the meds. I think physicians would say "Well heart problems are SERIOUS and can be life threatening, so the risks are worth it." I can tell you, chronic insomnia and/or anxiety is a terrible problem for many elderly, it decreases the quality of life and causes depression and weight gain among other things. I'd happily sign a waiver accepting the risks associated with Ambien and Xanax so that doctors would give me a reasonable amount to make my life better. Shouldn't it be MY decision?
63
But in many cases doctors don’t specify, or even understand, the risks. I think that’s the complaint. Hard to disagree.
6
The article never said that no one over a certain age should not receive these drugs. How you read that is being me.
It simply points out the real risks associated with their use and (correctly) suggests that they are over-prescribed. As are almost all medications meant to treat emotional and psychological issues.
5
It should always be your decision; it's your funeral too.
5
"Improved sleep hygiene" - tell that to elderly people that have chronic pain as well as daily anxiety about not being able to afford to live to whatever age "their time" is up and the ugly direction of this country. Education about medication dosage and use may help but these are likely not the people dying from heroin and fentanyl. Elderly people have many years of experience dealing with life challenges. Recommending "improved sleep hygiene" ? I'm sure elderly people are well aware of recommended sleep habits. It's just hard to do when you are in pain and your mind just won't shut down.
43
I wish I could get the millenials upstairs to improve their "sleep hygiene" -- i.e., not stay up till the wee hours, then stalk around their uncarpeted bedrooms in high heels before throwing shoes on floor with bang -- then I wouldn't need to do anything to improve my "sleep hygiene."
I am fed up with what AARP doesn't do with us and would love to find out whatever happened to the "Grey Panthers" of olden days. Does anybody know?
2
they died
2
Oh goody, another article bashing the use of benzodiazepines and their terrible side effects. All drugs have side effects. Let's talk about blood pressure drugs that are commonly prescribed to the over 65 set. HCTZ can cause dizziness. Amlodipine (a calcium channel blocker) can cause chronic constipation and will keep you awake if you take it at night. Ace inhibitors can give you a nasty hacking cough.
Oh, then there are statins. They can cause severe liver damage. If you don't have that side effect then you may just have debilitating muscle pain and weakness.
35
At 69 years old waking up in the middle of the night and not being able to get back to sleep without reading for an hour or two is torture. You see when I wake up at 2 or 3 am and start thinking about anything it leads to thinking about everything. I've been taking Temazapam for about 6 months and now I'm good for 6 1/2 to 7 hours of uninterrupted sleep. I feel much better when I wake up and am more productive during the day. Seniors are inundated with articles about how bad sleep deprivation is for us so what's an old guy like me to do? Take sleep rehabilitation classes? Wean myself off the pills and go back to waking up in the middle of the night and reliving how I may have screwed up when I was younger or worse yet worry about not having enough money to get me to the finish line? I'm sticking with the pills because at my age I don't really care about the addiction part of the equation. I want to feel good for my remaining years and if a good nights sleep does it for me I'll live with the addiction.
68
I recognize and agree with much of what you say, but let me tell you that my addiction to klonapin for sleep very nearly killed me. Look up the story of Lindsey Buckingham, famous singer, for another similar history. Recommend virtually ANY other sleep med rather than benzos--low dose Seroquel, trazodone, doxepin, melatonin, hydroxyzine. Best bet is a combo of really low doses of more than one of these, that is how I survive now. ANYTHING but benzos. That said, of course some people can take benzos for extended periods of time without problems. You might be lucky. But it is Russian Roulette.
10
Most of us with chronic insomnia have tried everything you say. It's much easier to NOT depend on a controlled substance for sleep. It'd be much easier to take an OTC sleep aid. But if they don't work, you're still left with the problem of not sleeping. Trazodone actually made me MORE awake. Those of us with chronic insomnia depend on those sleep drugs, mine is Ambien. I've taken it for years, with no ill effects...but I do fall asleep upon taking it, and get 6 hours of sleep that I would have to fight for, and only do in two hour shifts...so, no thank you. I'm fine with my Ambien...and my sleep.
15
Smoke a joint. You'll feel better and not put those at risk of so many debilitating side effects.
1
Amazing...
Adequate sleep probably the single most therapeutic self-care - up there with weight control...
But, in your usual self-righteous way, you sound subtle alarm...
Yet - you advocate for...
> Marijuana legalization...
*ttps://www.nytimes.com/interactive/2014/07/27/opinion/sunday/high-time-marijuana-legalization.html
> Facilitation of continued heroin addiction...
*ttps://www.nytimes.com/2017/08/18/opinion/overdose-naloxone-opioids-trump.html
Perhaps you should spend more time getting mid-life adults "weaned" off of these two "pharmas", along with alcohol and opioids...
Or getting diabetics weaned off insulin (by losing weight) vs proceeding to (highly lucrative for the providers, while bankrupting Medicare) dialysis-for-life...
Recurring theme across US health care seems to be higher-priced more labor-intensive intervention vs real prevention - which'd be greatly facilitated by widespread genomic sequencing and whole-body imaging...
For clarity, glad to take on anybody who wants to argue against these, citing "false positives", "privacy" and other such faux-barriers to progress...
Analogous contrast - today, an airliner can disappear out of the sky, and be lost for months...Yet - people can track anyone anywhere within cellphone range or carry an auto-on distress beacon, for when out of range...
PS - looking at technology trends, a whole genome sequencing AND a whole body (3 Tesla) scan will soon cost less than the typical price for a colonoscopy...
3
Ever care for an elderly parent?
Amazed that they don’t know what they are taking.
Amazed that the doctors don’t know all the drugs they are being prescribed.
Enter in Hospice, which is another form of medicated euthanasia.
We don’t have healthcare, we have managed death care.
4
Hospice is a blessing for terminally ill patients and their families. Ask anyone who has used hospice care and you'll understand how ill-advised your comment is.
10
Dear fellow readers,
I apologize if I offend anyone, but whenever I read articles like this one, I always think, this author needs to talk to me about my mother, My mother is 90, and has been, for years and years and years, simultaneously taking on a daily basis, two different antidepressants, large doses of Ativan, and Ambien before bed. She does not get - and has never gotten - any exercise, has always had terrible eating habits, and despite all the medication, she has always been an unhappy and miserable person. To top it all off, despite all I just wrote, my mother does not have any chronic or life-threatening medical problems. So, go figure.
9
Gee, drugs that improve quality of life for seniors -- alcohol, Xanax, Valium -- what are the risks thirty years down the road? A happy 97 year old with an addiction problem? Now where's my bottle of gin?
34
now that marijuana is legal in my state (california), both my wife and my 95 year old mother and father use marijuana tinctures for sleep and neuropathy. as do tens of thousands of others all up and down the pacific coast.
risk of overdose? risk of addiction? drugs that turn on you? not their drugs. this must be an article about big pharma.
13
Can you please tell me what tincture, dose, etc. can be used to enhance sleep? Thanks.
5
The upcoming Canadian marijuana legalization...if the cons.in our Senate will stop their self righteous obstructionism....has no provision for edibles for the foreseeable future. Very shortsighted in my opinion. It is illegal to smoke in so many settings...edibles make way more sense.
1
Unfortunately, elderly in nursing homes become guinea pigs for the theory is that there is a medicine for every ailment. A friend had recently gone blind and her sister's neurologist told her she was having hallucinations resulting from what he called Charles Bonnet Syndrome, yet the nursing home began a strong series of anti-psychotic medications. Several of those meds had serious drug interactions with all the other pills she was taking. It took our subsequent research on Charles Bonnet Syndrome to get the nursing home to stop the medications.
10
in many nursing homes these drugs are given in order to make people easier to manage
4
And something you should always research when looking at nursing or rehab faciities for you or a friend or family member is its reputation on medications. I'll never forget when I was looking at rehab places for my late mother 12 years ago and called a local nonprofit that advocates and collects comments on such facilities in my area -- when I mentioned one place I'd looked at they said "well the medical director there DOES have a reputation for over medication." They also had quite a few patients crammed in some rooms (lots of triples). Guess the medications helped them manage their "population."
3
I had the opposite experience when a family member was in a nursing home, and I considered the facility itself to be about average in quality. They were constantly looking at titrating, reducing, dropping medications that the doctor thought were unnecessary or no longer needed. They were very careful with pain meds.
2
Wow,my thoughts about benzodiazepines are that for certain major mental illnesses and end of life care,they are immensely useful,but for anxiety disorders or insomnia,they are excruciatingly dangerous drugs. As a retired RN who worked primarily in psychiatric settings and chemical dependency, I have cared for far too many who were iatrogenically over prescribed and ultimately addicted to these very nasty drugs.I have seen first hand how sensitive seniors are to the downside of benzos.
More than once we had elderly patients involuntarily committed to our locked psychiatric wards who were floridly psychotic only to discover them to be prescribed both benzos and opiates and often multiples of different forms of these drugs. Xanax perhaps because the dosages seem tiny compared to Valium is especially prone to overprescribing and abuse.It is also one of the most difficult from which to detox.As it is metabolized, it steps down into its component parts of less complex but still psychoactive drugs as the liver works to remove it.For example it passes into its less chemically complex forms of Ativan, librium(often given in ERs for alcohol detox to prevent DTs),klonopin and Valium.These drugs especially Valium and Ativan are also used to treat the seizures of alcohol withdrawal and also severe epileptic seizures.They can be lifesaving in these emergency situations.BUT in those who have taken them long term, stopping suddenly can result in seizures.I list them as my allergies.
25
Gotta love it. The experts are warning older people from using the anti-anxiety and sleep meds but how on earth do you think the older people get the meds? From experts of course. They can't be purchased over the counter.
As a side note, this is another reason marijuana should be legalized. It really helps with sleep & anxiety and is far safer than many of the legal meds currently sold.
19
Why do you presume that marijuana is "far safer" than "legal meds"? It is addictive and alters the mood. I don't see how you think it is any different than other drugs.
2
There is a shortage of psychiatrists, psychologists, couselors and social workers in our communities, and the ones we do have are underpaid for the years and money it takes to achieve their skills.
As long as drugs are more readily available than clinicians, these drugs will continue to be a terrible burden on our communities. You can thank your employers, governments and insurance companies for the lack of funding.
10
Not to mention the fact that many of them -- especially psychiatrists -- do not participate in Medicare so you have to pay out of pocket if you want to see them.
6
Another problem here is that we can be "elderly" for forty years (or even more, who knows?) I always wonder what "65 and over" really means, but it probably means that any research did not discriminate between 60s, 70s, 80s, 90s, 100s.
16
The real source of prescription drug problems is Physicians! They Do Not know their patients and do not spend the time it requires to monitor their care. Visits are short and hurried. The doctor spends most of the time typing, not listening. The only thing they can offer is a pill or a test or more pills. Medicine doesn't treat the source of a health issue but looks for a work-around or a drug that for unknown reason masks the symptoms. Annual exams, with the hope of maintaining health, have become especially worthless. With dwindling funds for research True cures will not be found. The $$ is in pills and the volume of doctor visits & tests.
29
There is some truth to this. This is what is happening in the doctor's office: 1) Physicians, especially those of a bygone era, fought but lost the battle to NOT have to enter electronic medical records. Medicare required it. So hospital systems and other insurances require it. (Notice that the clinic puts a computer in the room, so this data entry required of the physicians is being done during YOUR appointment. Doctors actually hate it. Also, Typing 101 is not taught in med school.) Now you have metrics and the high-paid-data-entry-physicians are judged by their metrics, not by their ability to listen to patients and take care of them. It's insane. 2) The other issue is whether doctors understand the pharmacology of these drugs. Many do. Many do not. So yes, physicians really can add to this problem, and a pill is easier when the patient wants immediate relief. Therapeutic counseling is the way to go with these types of conditions but patients usually decline counseling. 3) The third problem is the patient. It's very difficult to wean patients off of drugs that can make them feel better. They want relief, and the overwhelming information from friends and internet implies that their doctor is negligent if they don't treat with a readily available pill, regardless of the adverse effects.
What is the solution? Retrain doctors, educate patients, and for heaven's sake, stop making doctors type into some fancy data system and let them talk to their patients again!
11
1) Physicians didn’t take typing 101 in med school? How did they get through college without typing? Never wrote any papers in college? Please.
2) Physicians don’t understand the pharmacology of the meds they’re prescribing? Not okay- if true they need to give up their license until they educate theirselves on what they are doing.
5
I think this is especially a problem with GPs, internists, etc. which is all many elderly see. Many people do not live where there are psychiatrists or where they can get to a psychiatrist, and even if they do have access to a psychiatrist, he or she probably doesn't participate in Medicare, so seeing him or her could involve paying $300 or more out of pocket.
3
I had sleep difficulty for several years. After reading Mathew Walker,s book "Why We Sleep" the TV was removed from the bedroom and I went on a schedule for my sleep. I meditated and used an Alexa Dot to play soothing music. Now five months have passed and I feel better than I have in years. The only cost was the price of the book. There is a reason that they use sleep deprivation as torture. You don!t have to torture yourself.
11
Works for mild problems, not more severe problems.
5
Thanks for the recommendation.
Concern about people having negative temporary, or more permanent, experiences with meds prescribed for a range of feelings ( anxiety, panic, depression) and behaviors (sleeplessness) associated with their types, levels, and qualities of their well being is legitimate.To note that they have a "drug problem" is both misleading and inaccurate.We have been seeding and harvesting a culture which has rooted the belief that there is a solution for every human problem for a very long time.One needs to just try hard enough! And modern science has permitted us to live the myth that there is a chemical solution for whatever ails us.Even when we may not be able to adequately express and describe whatever IT is. Or when IT happens less. More, or most, frequently.There is no "magic bullet;" pharmacological, or not.Notwithstanding Big Pharm's promises.There can be, and are, daily challenges to experienced states of well being, wellness, and quality of life on so many levels."Pills," whatever their structure, action(s) and associated "experiences," are not an effective antidote for the outcomes of discriminated against age, identity; gender, ethnicity, etc.Nor functioning in a survival mode.While living longer.Feeling existentially alone.With insufficient personal resources.And inequitably shared available, and accessible, external resources so necessary for good enough daily living. "Pills," designed to affect targeted systems, cannot and do not replace a PERSON's coming to terms with...
4
I was prescribed Ativan over 20 years ago for muscle spasms. It worked well for that, however over the years while taking it I developed new symptoms like panic attacks, tachycardia, digestive problems and a number of other conditions which were actually indicating that when the dosage wore off I was in withdrawal. The physicians that I went to for help wanted to either up my dosage, or add other medications to control my new symptoms. I do not want to be tied to this drug anymore, so I am slowly tapering off of it. The hell that I have been going through the past six months is indescribable, and something I would never have anticipated I would be doing at the age of 62. Like Ms. Falstein, I have had to taper at incrementally small rates, and it is going to take me at least another year to finish.Oten, even reducing 1/4 of a pill at a time is too much, producing horrendous symptoms. This is why people like Ms. Falstein and myself are resorting to DIY methods like liquid titration and cutting and weighing pills on a jewelry scale. The pharmaceutical companies need to to provide smaller incremental dosages for people to assist in getting off them safely. I believe there are going to be a lot of lawsuits regarding benzodiazepines in the coming years.
32
Would also be helpful if pharmaceutical companies didn't provide dosage guidelines that are actually 2 or 3 times what many people need. Many GPs, lacking experience with these drugs, go by these guidelines and grossly overprescribe.
2
Victoria-keep going (slowly) and you'll make it.
1 mg of Ativan = 10 mgs of Valium. just keep cutting that 1 mg.
2
Drugs may be the only relief for some people, but as mentioned earlier there are other methods that occasionally can yield results. I am 64 and was having panic and anxiety attacks over the previous 12 months. After a trip to urgent care related to a panic attack, I was prescribed a tranquilizer that allowed me to sleep. However this approach was not addressing the problem, and had side effects.
My physician strongly encouraged anxiety management coaching as a first alternative. As mentioned in other posts, this type therapy is typically not covered by insurance, and takes effort and time to work. The process also initially interrupted daily routines. I am fortunate that I have an understanding associates, and only work part-time with a flexible schedule. The approach uses methods to become sensitive to the onset and techniques to reduce the anxiety level before it spirals out of control. While it has been a very effective methodology, I still have a tranquilizer as a back-up.
11
This is the key. Insurance covers drugs. Coaching and counseling are very expensive and not covered. Finding a competent clinician can be challenging. And doctors feel they’ve failed if you leave without a prescription for something.
3
If you ever go on Medicare you confront an entirely different situation: either the treatment isn't covered, or it is covered but nobody who provides it is willing to be a Medicare provider.
A low-cost alternative is looking into whether any senior centers in your area offer classes in stress management, meditation, etc. Some near me do (though I haven't been to any).
3
Anxiety management coaching does not work for panic disorder which is totally different from anxiety. Panic disorder is much worse and one can get panic attacks even when having a good time. Stop already using panic attacks for what is just anxiety. They are two different conditions.
4
This article is dead on. I've spent thousands of hours researching this as I'm the main caregiver for my mother with Parkinson's. For years her sleep doctor had her on klonopin (she has REM Behavioral Disorder from the Parkinson's). In 2015 her neurologist increased her Lyrica for pain from 50mg to 300mg. She almost immediately started having problems, so a sub for her primary took her off Lyrica cold turkey...which caused major withdrawal symptoms...which caused confusion and dizziness...which caused her to stop her clonazepam because she said it made her dizzy at night...which caused even more withdrawals, hospitalization, and putting her on ativan. Soon after that, she was referred to a pain clinic for her back problems, put on various pain medicines that caused hallucinations, finally settling on oxycodone with the least side effects. By the time we got a new neurologist to tell us she shouldn't be on ativan, it was months later and she was dependent on them. We've been weaning her off ever since, now using water titration. She was on 3.5mg a day 3 years ago. Now we're at 1.6mg a day. What's worse is she fell and hurt her back again in January. So they give you meds to help your back pain, which make you confused and dizzy, which makes you fall and hurt yourself again, which makes them want to give you more pain medicine. What kind of sense does that make?
8
I'll turn sixty-nine this month and have had my share of aches, pains and certainly trouble sleeping at night.
The day they legalized recreational cannabis in Colorado, I got a vape pen, edibles and THC oil cartridges. I vape a small amount before bed, and sleep well on a regular basis. Its odorless, neat, and simple to use. Theres no fear of overdose. With knee replacement and other typical afflictions, I'm offered opiods from doctors and dentists, dermatologists and more. Except for a few days after major surgery, I avoid them.
I'm not proselytizing for Cannabis, but for some of the ailments that produce the handwringing in this article, I simply want to offer that there's a cheap, simple
alternative available for adults, that works with tested results.
When Jeff Sessions and some state legislatures come out of the wilderness, I hope you can get a better night's sleep.
145
Substituting one drug for another cannot be a solution.
4
substituting a less harmful drug is a good idea.
2
Sanctimonious twaddle.
3
It should be noted that a one month (1mg twice a day or 60 pills) supply of alprazalom cost between fifty cents and $2.00 making it one of the few drugs that many seniors can afford.
14
Opioid use by older Americans is blamed for “fatal overdoses — which are a comparatively tiny number given the size of the older population.” Sleeping medications (benzodiazepine) can lead to “falls and fractures... drowsiness and fatigue” and may “have a negative effect on memory and other cognitive function.”
Most physicians are relatively young and have yet to experience the unique joys of aging: chronic pain, difficulty sleeping and resulting mental fatigue and depression. We know what the doctors and scientists think – how about asking what an aging population would prefer. Our options are a relatively pain-free life and a decent night's sleep with the small amount of risk that brings versus living with chronic pain and trying to function on four to five hours of sleep per night.
Perhaps the classic “cranky old geezer” – denied pain relief and sleep -- is cranky for a good reason. We aren't getting any younger and prettier, and we understand the majority of our lives are behind us. Perhaps we are less concerned about when we will die and more focused on spending what time we have in less pain and discomfort.
240
Thank you. You have pointed out the reality that most authors - but thankfully not yet all doctors - are missing when considering the risks. Options are few, our lives are challenging in ways incomprehensible to the young, and the pressure is on physicians to withdraw what little relief can be had. Cognitive therapy at hundreds of dollars a month and a five year withdrawal plan (in some cases longer than our actuarial lives) so the DEA or Board of Medicine doesn't get on the doc's case?? I too would like to see the focus turned to what we would prefer and what we are willing to accept as risk for diminished pain during our days, and a night of reasonable rest.
24
That a story based on a tiny sliver of the “aging population” amidst the National handwringing over the opioid crisis is published as dire warning is so misleading as to border on the comical. Kris hits the nail on the head. Heading into my sixties having had my share of bumps and bruises, I have watched a boatload of thirty something physicians cut off dozens of patients who had been just fine wth long term proper use of sleep medication, not because of their concerns for their patients, but for their fear of being enmeshed in the next witch hunt. So it goes with the opioid crisis. With all evidence pointing to the conclusion that cutting off prescriptions for opioid users overwhelmingly leads to heroin, we choose to treat the symptom rather than the disease. One great thing about being 60 is that I’ve been around long enough to know how this story ends.
11
here we go again ..it is always "old women" who need to discipline themselves with some new age quackism about "sleep hygiene." My Ambien is low dosage at night and allows me to enjoy my days. I am 75 and know how to go to sleep....
Yes, Dr. I know not to watch tv and not to have bright lights on and OH YES ...I remembered to brush my teeth. The condescension is stupefying.
lectured
27
This is not just a problem for the elderly. These drugs will become a problem for most anyone who uses them. Saying they "turn" on you is true --it is just a matter of when. If you read the package insert it clearly states they're NOT to be used for periods beyond 2 to 3 weeks.
I became dependent on ativan while sick with Crohn's disease. At first ativan seemed like a dream come true. It worked so well to control my anxiety. But just a few months later my anxiety was threw the roof. 1000 times worse then the original problem. The drug turned paradoxical and I was trapped on it. I went from doctor to doctor trying to figure out what was wrong with me. I suspected it was the drug but no one believed it. Also no one knew how to safely taper me off. I almost died and I will spare you the details of that. I became delusional and psychotic and ended up in the hospital. Once a benzo goes off all bets are off. Miraculously, I recovered but it took almost 2 years as the withdrawal syndrome can be very long and made non-functional for a while. I share this to spare anyone else the pain I endured. Maybe benzos are ok to take before surgery or for flying but never continuously. And please don't go cold turkey off these drugs if you're on them. They need to be very slowly weaned.
14
Curious to know how many mgs. a day you took at your "peak."
2 mg max. I was only on it for 4 months first time and came off with few problems. Second time about 7 months and was a totally different story.
1
These comments are such a comfort to me and I hope they move me to action. My psychiatrist suggested Vyvanse for Binge Eating Disorder. I am on that plus antidepressants plus a small dosage of Ativan when needed. I want OUT and I don't even know where to start!
2
Hi Julianne,
A few resources for you, if you're interested:
www.benzoinfo.com
https://withdrawal.theinnercompass.org/
www.survivingantidepressants.org
4
What is missing is that many older people have trouble sleeping, whether caused by pain, restless legs and twitching, worry, and so on. Getting only 5 to 6 hours of sleep may be as bad long-term as some drugs. Perhaps oral marijuana should be made more easily available.
32
Older people do not necessarily need 8 hours of sleep. But since many are irrationally convinced they do, they end up hooked on these drugs.
3
It's not up to you to decide what amount of sleep older people 'necessarily need'. Everyone has individual needs. If I feel tired and irritable after 4 or 5 hours, then I obviously need more sleep. Getting 'hooked' on a good night's sleep isn't a bad thing, and it's 'irrational' to suggest that it is.
7
and i am sure you have not found a way to tell how much sleep any given person needs
Taking pills when you cannot sleep or wake up in the middle of the night? How stupid, when one bottle of Guinness Extra Stout will do the trick, whether you take it at bedtime or at 2 am (with a slice of heavily-buttered bread).
9
Must be allergic to any and all beers. I throw it up as soon as it hits my stomach.
Damn, will have to stick with Xanax. BTW, w/o I sleep 3-4 hours at best. Exhausted.
My mom (an alcoholic) was unbelievably prescribed Klonopin in her 70s for anxiety/tremors. Shortly after she started it, she fell and broke her neck. Luckily her neck has healed, but it's amazing to me that a Dr. would do something so stupid.
9
" it's amazing to me that a Dr. would do something so stupid."
Mike, unfortunately doctors will continue to do that because they are never held responsible for their actions.
6
If doctors are never responsible for they're actions, why do they have to invest in millions of dollars of malpractice insurance? When patients beg for quick fix pills, now with the threat of poor "customer ratings" on the internet, doctors are naturally going to attempt to provide their patients relief from suffering using inmperfect but sometimes helpful methods.
3
Carrie, are you a doctor? If you are, I really hope you are more grown-up than to give patients "quick fix pills" just because they "beg" for them.
Do you grudge doctors having to take out insurance? All sorts of people take out insurance for all sorts of things that may or may not happen. It's just part of the cost of life, or in this case the cost of doing business. It's just a small fraction of what they earn, and it has the effect of making them not responsible for their actions, which is the opposite of what you're claiming.
I know people who have died as a result of medical malpractice and nothing happened to those doctors who killed them. There are other stories like this by other readers in these comments. Please read them. Being responsible for their actions would mean being deregistered at the very least, and possibly put in jail if their actions warrant it.
1
Wwe are a sick nation. We overmedicate our children, and our elederly. Let's see how this will pan out in 20 years.
6
Those chirpy perky baby docs can pry my benzos from my cold dead fingers.
27
PLEASE DO NOT THINK THIS IS A PROBLEM JUST FOR THE ELDERLY.
THIS A PROBLEM THAT FACES EVERYONE WHO ARE PRESCRIBED BENZOS. IF AT ALL POSSIBLE, AVOID THEM. THE WITHDRAWL FROM THEM CAN TAKE YEARS AND IS AGONIZING. SOME PEOPLE CAN NEVER GET OFF OF THEM. COLD TURKEY CAN KILL, DUE TO UNSTOPPABLE MUSCLE SPASMS AND CONVULSIONS. I WISH THE NYT HAD EXPANDED THE SCOPE OF THIS ARTICLE TO INCLUDE EVERYONE. READ THE COMMENTS. THEY ARE A REVELATION !!!!!!!!!!!!
9
I could not ignore your post, as the urgency of it speaks perhaps to personal experience. I have spent more than 35 years dealing with addicts personally and professionally after surviving my own journey through alcohol and drug addiction. I spent several of those years working at a treatment facility that included a non-medical detox unit, i.e. closely monitored cold turkey.
Withdrawal from many drugs can be a protracted struggle that continues well beyond the nightmarish early days. Although it is a miserable slog through physical and psychic pain, and can reveal or intensify existing health problems, the withdrawal process itself is not life-threatening, with two exceptions.
Those two exceptions are alcohol and benzodiazepines.
There is not enough room here to describe the misery I have experienced and witnessed, or to expound on the many reasons I believe have led so many in our society to a state of life-threatening drug dependence in the search for a life that seems worth living. However, there is room to say this:
If you believe you or someone you care about may be dependent on any drug, GET PROFESSIONAL HELP form a certified addiction specialist or facility. It may be a matter of life and death.
2
Very likely marijuana would solve 80% of these problems. Too bad the laws make it almost impossible to even research this.
26
The problem is that for some (many?) people improved sleep hygiene and congnitive behaviour therapy dont work. Between a rock and a hard place.
20
Has anyone told the pharmaceutical companies about these problems? Maybe they would stop incentivizing the prescription writing. And maybe doctors will doctor, amirite? Amirite?
1
The pharmaceutical companies are making millions off of these benzos. They KNOW the dangers of these drugs, but are motivated by greed. Upjohn funded a Xanax study in the 1980s, but unfortunately downplayed or dismissed the long-term side effects that affected more than half of the patients who took the drug.
The Xanax study was criticized by an international team of eleven psychiatrists and two psychologists in a two-page letter in the July 1989 Archives of General Psychiatry. The letter argues that “this trial poses problems for the long-term efficacy of alprazolam [Xanax] because 1) its superiority vs. placebo seems to decrease by week 8, and 2) it has severe discontinuation problems.” The authors also stated that it was “biased” to conclude that the drug was effective “based solely on short-term partial gains” (Marks et al).
So, let me spell it out: Upjohn KNEW that their magic pills can create neurological impairment and worsen quality of life in every way, and even though concerned psychiatrists called them out that it was unprofessional to only report Xanax’s short-term benefits, Upjohn duped the public (including the Federal Drug Administration and the National Institutes of Mental Health) into believing the medication is an effective and safe treatment for panic disorder. Read Robert Whitaker's book Anatomy of an Epidemic--it is an eye-opener.
3
Andrew, your point is correct.
As long as it makes huge amounts of money for Big Pharma and doctors, they will never want to hear about these problems and change, however many lives are destroyed.
3
The above comment is an excerpt from my book--
1
It is such a welcome sight to finally see an article in a major newspaper about the dangers of benzodiazepines. So much media attention is devoted to the opioid epidemic, but there is another underreported epidemic--the millions injured because of benzodiazepines--that is also destroying lives.
I took a benzodiazepine (clonazepam) as prescribed, never abused it, and went through a hellish 27-month period of tapering and recovering from the damage the drug wreaked on my brain and body. Unfortunately, my story is very common; there are thousands of us all over the world who are going through this disabling experience.
Since the medical community is largely ignorant about just how insidious benzodiazepine withdrawal syndrome is, the benzo-injured look to one another for help tapering these medications and coping with the unbelievably tortuous symptoms. I believe there is a story here for someone brave enough to write it--a story about the incredible community of benzo survivors who do everything to help one another. We find the language of addiction (which patient-blames) to be insulting because we took our medications as prescribed and never abused them. Most of us were prescribed these medications when we were at our most vulnerable because of traumatic events in our lives, and we trusted our doctors. I ended up writing a book about this; let me know if I can be of any help for further articles on this topic.
41
We (me and my doctor peers in our practice) recommend a long titration off Klonopin/clonazepam, decreasing by 0.25mg daily per month. When the patient has used 0.25mg daily for at least 4 weeks, we recommend decreasing to 0.25mg every other day for at least 4 weeks before trying to stop, but some patients then decrease to 0.25mg every 3 days before trying to stop.
There is so much in the medical literature on how to start and continue medications, and precious little on how to get patients off meds. I might be a doctor, but inevitably I'm a patient, too, and I want to know why Big Pharma isn't made to be equally responsible for understanding how patients can stop medications. Would you happily take a drug if you knew in advance you'd be need to take it forever to avoid devastating withdrawal phenomena or need a year to wean off? If intolerable, protracted discontinuation syndromes were more fully evaluated, fewer drugs might win FDA approval.
8
hey ninteen-
thats an insanely fast taper rate. .25 mg of K = 5 mgs of V equivalent.
go on Klonopin yourself for several months and then try tapering
off at that speed.
3
Many elderly people, myself included, find kratom to be a good substitute for these prescription drugs. It's made from the leaves of a tree in Southeast Asia, and provides similar relief to a mild opioid, although it is not an opioid. I use it to control the symptoms of severe restless leg syndrome, but others are using it for PTSD, anxiety disorders, and chronic pain. It does not make one high, does not suppress breathing, and has no effect on one's ability to function. Sadly, the FDA is trying hard to ban it, perhaps because it is cutting into the profits of the drug companies.
10
I have a lifelong sleep problem which had been treated with trazodone and Sonata for the last 20 years. After surgery for lumbar stenosis, I was started on low dose Vicodin which improved my sleep enormously, apparently because it alleviates the severe restless leg syndrome which is part of my insomnia.
With news about the possible contribution to dementia of the z-drugs, and because I started to experience late night dizziness, I tapered off the Sonata last year. It now takes longer to get to sleep, and I smoke a bit more 'medicinal' marijuana as a nightcap than before. Cognitive Behavioral Therapy has helped, too. Now I am tapering off the weed, but given the long history of insomnia, my sleep is deteriorating further. In spite of the current opioid hysteria, I am unwilling to give up my 5 mg of Vicodin, as it helps so much with the restless legs which wake me every few minutes in its absence. Some degree of drug dependence is preferable to being in a permanent zombie state from chronic lack of seep.
24
"Benzos ARE alcohol." That's what a nurse practitioner friend of mine always says. They operate in the same part of the brain and in much the same way. So, all the issues related to alcohol use are mimicked by Benzos...including dependence, impairment, tolerance, overuse...and death. Stay away. Learn instead: mindfulness, meditation, melatonin, exercise, less food at dinnertime and patience.
7
Dependence on benzos is probably more rampant than what patients and physicians think. It is hard to convince a close relative or friend who had been using it for many years since their own physicians haven’t addressed the problem.
9
I’m shocked how easy it is to get Benzos from Drs in AZ.
1
Bet you are not over 65 years of age. If over 65, you almost have to head for Mexico.
1
What seems very strange is that -- when I was in my 20's I knew that benzodiazapines were addictive, and that a certain type of omnivorous drug user would hunt doctors who would prescribe them freely ( and everyone in town knew which doctor was the oca Dr. Feel Good) We're talking 45 years ago! So what gives? There are good reasonable uses of the drugs; none involve long term prescriptions.
7
Some forms of chronic pain can only be treated successfully with opioids. The current hysteria over long-term use of narcotic pain relievers is due to poorly compiled and skewed statistics that directly contribute to costly drug "recovery" programs, health insurance companies and private prison investors.
Unless suicide by chronic pain patients is considered beneficial, I'd argue that opiate prescriptions need to be carefully considered on a case-by-case basis rather than condemned in a sweeping statement.
14
I just spent the last two weeks doing my own Clonazapan study- watching my 87 year old mother go through serious withdrawal from going off this drug 'cold turkey'. By the grace of God I was able to figure out what was happening to her. After 20 years of taking the drug for "night terrors" and thinking of it as her sleeping pill, Mom stopped taking her Clonazapan after being prescribed Percoset for severe sciatic and back pain. She was rightfully concerned about combining the two meds. After 10 days of increasingly severe withdrawal symptoms that we initially attributed to the Percoset, including delusions, hallucinations, itching, sweating, etc. I stumbled onto the fact that she had stopped taking the Clonazapan and a call to a Nurse Practitioner family friend confirmed her symptoms were withdrawal from the Benzo drug. Mom went back on it immediately and was feeling better within two days. I am amazed at her ability to weather this harrowing experience. Now the task of weaning her awaits.
33
My heart goes out to you and your mother. She is so fortunate to have you looking out for her. Slow and steady is the way to go with a taper plan...and your mom should dictate the pace of the taper so she is as comfortable as possible. It is not easy, but it is possible. Your faith is God will help! God bless you.
4
I meant to say "your faith IN God will help."
1
Clonazapan aka Klonopin is in a class by itself as far as being extremely physically difficult to withdraw from. This is a known fact. It should not be prescribed.
3
In case it helps, my sleep cocktail, which is working quite well (but not perfectly,) is 3mg Melatonin, 500mg Valerian, 25mg Trazadone. I'm a pretty healthy man, 74. After looking over the BEERs, none seem to be listed, though I'm wary of the Trazadone. I've only been on this for a few months, here's hoping it lasts!
2
As someone who has suffered from a severe anxiety disorder my whole life, I can say that for long term relief, benzos are not the way to go. lf you need to take a medication daily (and not sporadically or for a specific situation), you need to be on a control medication such as an antidepressant that does not have the addictive qualities of benzos. The body also doesn't tend to acclimate to antidepressants, so once you find your dosage rarely is there a change needed.
I was basically unable to function my anxiety was so extreme, yet with cognitive behavioral therapy and a daily antidepressant, I an basically anxiety free. The only time I ever took a benzo was when on a long flight to Australia. My psychiatrist won't even prescribe them to me (not that I have asked), excepting the Australia flight because I voiced concerns about having a panic attack halfway across the Pacific. Even then, I was only prescribed a few pills.
22
Panic attacks are NOT anxiety attacks. This kind of ignorant comment is very infuriating and insulting to those who do have panic disorder, a condition that is truly terrifying and that antidepressants and therapy cannot help at all.
3
Misinformation here. Some anti depressants are quite hard to stop. Paxil is notorious.
7
I used to take all the prescriptions suggested by my doctor, and take the ones prescribed for the side effects. It was a constant struggle to maintain a balance between functionality and physical and mental pain.
After addiction treatment, and cognitive therapy, I only take a low dose blood pressure medication.
9
I know many people who have similar adverse effects from Neurontin/Gabapentin. Long term use, on prescription dosages, results in severe problems for many people, one in my family.
There is also a Facebook group for people relating their experience with usage, and with the long, long taper. The medical community has virtually no help to offer for withdrawal. The manufacturers did not carry out any long term studies, and have no detox protocol to offer.
The local drug addiction treatment centers refuse to help, since usage is not classified as addiction. So people are left to their own with zero help from the medical community. Left to pursue alternative solutions on their own.
And often the prescription for Xanax or Ativan is given as a way to calm down the anxiety and panic attacks and to help with sleep. So an additional addiction is layered on top of the gabapentin problem.
10
I was given gabapentin to ease withdrawal from klonopin. Gabapentin is an anti seizure drug prescribed off label for anxiety. As soon as I read about it, I wanted to wean off it. I believe it's delayed my recovery from klonopin withdrawal. Another over prescribed drug.
2
A serious problem for elderly patients is that reliance on these drugs often causes reductions in physical activity. Long-term reliance produces irreversible muscle loss and bone deterioration.
It would be better for an older person experiencing anxiety to engage in repeated bouts of physical exercise and meditation than to start a regime of regular use of deadly drugs.
18
Thank you for highlighting this almost silent problem which carries significant risk to frail, elderly individuals. The public, and the medical profession, certainly need to be educated about the serious consequences of inappropriate and overprescribing of benzodiazepines. For more information about potentially inappropriate medications for the elderly, consult the Beers Criteria published by the American Geriatrics Society.
9
And what if you're elderly but not frail. Or is everyone over 65 automatically now considered frail?
1
Stop searching for grievance.
I’m wondering about the patient info sheet that is enclosed with every prescription med. I’m not blaming these people who have suffered, as the medical personnel could certainly do better. However, I’ve found that reading the enclosed info about each medication is very helpful. For example, I recently had a prescription which the dr said to use for “2-4 weeks”, but the enclosure clearly and emphatically stated the med should be used no longer than 2 weeks. Also, there is a lot of info online at reputable sites such as the Mayo Clinic site. Knowledge is power.
21
This article reflects the sorry state of medicine today when these harmful drugs appear to be prescribed routinely by many doctors on a long-term basis without appropriate monitoring. What also appears to be missing in these practices is patient informed consent by the provider as to the known dangerous side-effects of these drugs, especially when mixed with other drugs or alcohol. Patients should not have to research this on their own on the internet. Unfortunately, we live in a pharmaceutical culture that promotes drugs as the only remedy for every ailment or condition.
14
There would be no quiet drug problem among seniors if more of them inhaled "medicinal" marijuana. And if they grew their own that would provide the extra benefit of exercise. I am 82 and still growing.
28
I will be 84 next October and hope that marijuana is legal in my state when my arthritis gets "unbearable" (I think I still have a few good years).
2
Inhaled? Edibles so much easier.
I'm 73 years old, healthy a a horse. My sleep problems began with menopause, which is when I discovered the world of the insomniac- an hour of restlessness until falling asleep and then wide awake at 4:30, for a total of maybe 4.5 hours of sleep. I was constantly fatigued and cotton headed all day. Every doctor I asked for any kind of sleep med gave me the sleep hygiene lecture. No caffeine, plenty of fresh air and exercise, same bedtime every night, no electronics, etc etc. So I used OTC stuff like Benedryl and melatonin, not great but better than nothing. Finally I described my sleep problems to a nurse practitioner who gave me a script for Ambien. My world changed. I took it almost every night for months, then was able to take it every other night. I still, 10 years later, take it once in a while, when traveling, or if I am upset or worried about something and know I won't be able to fall asleep.
I no longer get my Ambien from MY doctor, I get it from younger friends and family who share their supply. No medical doctor will ever prescribe Ambien or Xanax to someone as "elderly" as I am, I suspect because they fear liability if I fall and break a hip. I know lots and lots of older people who get their supply just as I do, and sometimes money changes hands, or friends who visit foreign countries with fewer restrictions will being back a supply.
149
Susan, I am in your age group and now in SE Asia in a country very harsh of drug use for any purpose. In the US, I used Ambien irregularly to adjust my insomnia, over here, I use a med called Esilogan but I do not like it but it works to get me back to sleep. I was taking a .5mg that was a 1mg split in half, worked fine for sleep but left a mild headache. Then they stopped making/selling the 1 mg and now sell only the 2mg so I weaned myself, going cold turkey.
Lately though, I have irregularly taken the drug but wonder what I will face when I return to the US soon. VA hospitals will not give me Ambien anymore, I did not know about the ban on Ambien for seniors. I am really a robust person, exercise like mad so slipping is not even in the picture. The garbage that VA does give is useless.
I will NOT use marijuana, have always frowned on all but the most ubiquitous OTC drugs and never a recreational item. NEVER!
4
Susan: if they give you the "sleep hygiene lecture"....why don't you follow it, instead preferring to take OTC drugs or meds you obtain illegally?
Sleep hygiene is real and it DOES HELP.
Also: there is cognitive behavioral therapy you can use in conjunction with good sleep hygiene! and I wonder if this started with menopause, if you went "cold turkey" or used hormones?
In either case...by age 65 or retirement and surely by 73, you don't have to drag into a job each day. So being sleepy is not the end of the world. You can exercise, meditate, do yoga, etc. and take NAPS.
I have personally noted a lot of folks with sleep problems drink way too much coffee, and are IMHO addicted to caffeine but absolutely refuse to give it up.
2
I am ready to be cut down by your readers.
I have been a physician for many years and I can tell you that benzodiazepines are a disaster and I can rarely think of ANY of my patients where they are indicated.
Your writer mentioned side effects from rapid cessation but seizures are also a serious risk if there is not a gradual withdrawal.
Unfortunately, alcohol, benzodiazepines and opioids are commonly used with often little regard for the serious risk of respiratory depression.
Thank you for your article which may increase awareness of benzodiazepines.
Personally, I believe it is time for more discussions on alcohol and give it the respect that it deserves.
47
jp, the vast majority of reader stories in these comments support your point that benzos are a disaster.
5
Thank you for this article; this information needs to spread far and wide. It is extremely important to reach out to those who have no idea what's wrong with them while taking their meds exactly as prescribed. I wasted thousands of dollars over several years on doctors and treatments; attempts to fix me when no one knew what was wrong and no one could figure it out. People are not expecting their medicine to turn on them. People are not expecting to be treated like addicts and people are not expecting their lives to be turned completely upside down from a half milligram of medicine prescribed by their trusted doctor. I certainly did not expect to become completely broken and debilitated for years. It was the benzodiazepine.
19
Sigh... so-called "modern" medicine has fallen into a DEEP hole in many countries. The emphasis has shifted from prevention and common-sense lifestyle changes such as excellent nutrition, more exercise and fresh air, spending more time in "green spaces" outdoors, getting out of the house, making more friends and doing things like volunteer work that foster closer ties to community and give folks a sense of "belonging" and being wanted, needed and doing something for others, building nourishing relationships, etc... most doctors don't even mention these to many of their clients who could most benefit from them!! Its drugs, drugs and more drugs, with surgery sometimes thrown in for good measure. SOOOOO many lives have been wasted, shortened or made miserable by drugs which are simply not necessary. Many medical schools don't even have adequate courses on nutrition, lifestyle choices and their effect on health, and on the intricate relationships between mental, social, emotional and physical well being. I;m only 62 myself so know little to nothing about being "elderly", but i DO know that i'll never take any drugs except as a last resort, excluding a few things like antibiotics, which are difficult to avoid when the need arises. We should be educating our children, AND our populace at large, in sensible and practical ways to attain then MAINTAIN robust health as long as possible, with a focus on prevention rather than predominantly treating symptoms.
18
In addition to the side effects, these drugs impair anyone who takes them.
Of course the person taking them refuses to believe they are impaired, but everyone around them can tell.
If you're taking one of these drugs, you ought to get a life sentence if you're ever caught driving a car.
5
oh yes, ....a life sentence will definitely fix this problem.
18
I'm not interested in fixing a grown adult's voluntary decision to impair themselves; I'm interested in preventing them from killing innocent people.
If it takes a life sentence to keep them off the roads, so be it. Nobody makes them take the drugs.
4
Many patients refuse to take safer medications for sleep or anxiety and want a quick fix to their problems. They ask for (or demand) benzodiazepines. Others have been on them for years and refuse to taper and stop despite warnings about side effects. Put those obstacles into a brief office visit with 5-10 other chronic medical problems to fix and add in patient satisfaction scores...is it any wonder there are so many people taking these meds?...
12
Yes, we are conditioned to want a quick fix, but doctors can say no to prescribing benzos. For those who are on already on them, doctors need to offer incredible patience and reassurance that it is possible to taper and heal. Our medical system is horribly broken. But a little compassion, understanding, and knowledge go a long way. I had to fly halfway across the country to find a doctor who was sympathetic and who supported my slow taper plan. I could not find a benzo-aware doctor in the DC area; they all wanted to taper me too fast. Just some food for thought. If you are a physician, please read the Ashton Manual if you haven't already.
2
I was given a benzodiazepine to "calm me" when diagnosed with thyroid problems. There was so little patient education that I didn't even know what a benzo was, or that I was taking one, until eight months later. When I began having adverse effects after 7 or 8 weeks and told my doctor, the dose was raised. Multiple doctors, several emergency dept. visits, and hearing "it can't be the med, you're taking it exactly as prescribed", led me to stop the benzo on my own. This constant denial nearly cost me my life. The only medical assistance offered was more psych meds, which I declined. I could have never imagined the hell that is benzodiazepine withdrawal. Two years later I'm around 75% healed, still hoping the severe cognitive impairment will improve. Dealing with the fall-out, the impact this 'benzo sickness' has had on every aspect of my life, will never be over.
I was/am a mid-fifties woman with a common thyroid issue, hardly considered elderly, and previously very healthy. I applaud you for writing what I hope to be the first of many articles on the dangers surrounding benzos. Please consider reaching out to the patients commenting here, the amount of dedicated research we have all done on the subject could be very helpful. Thank you for your excellent article.
30
Venlafaxine 300 mg/day for 15 years. The only thing I know is that if I missed a dosage it was like I was half dead. In fifteen years I never knew if those pills made me feel better. I weened my self off for in year. I’m done.
Atavan 1-2 mg/day for 10 years. Miss a dose, no sleep. I weened myself off for in year. I’m done. I wanted to turn 65 and get my Medicare and be off prescription drugs. I’m enjoying my retirement smoking pot.
23
I was prescribed Xanax, then Klonapin, almost 30 years ago for panic attacks. I’ve always taken them as directed. Doctor after doctor prescribed them without hesitation. I became dependent. I’ve tried tapering slowly - twice - under doctor supervision, but the withdrawal was too painful and difficult. I have to take these drugs for the rest of my life, because there is no alternative. I still suffer withdrawal symptoms and rebound anxiety. I have an increased risk for dementia and other problems mentioned in the article as I age. Benzos are a problem. Doctors need to learn to prescribe them properly - for no longer than four weeks at the lowest effective dose. Patients beware!
20
Your situation mirrors mine almost to a "t". At 64 years of age, this article sort of scares me.
1
I was prescribed Ativan by my doctor for 10 years. I started at .5 mg and by the end was up to 4 mg a day. Not only did my anxiety get progressively worse during this time, I also started experiencing brain fog, depression, loss of emotions, muscle aches and other odd symptoms.
26 months now after taking my last dose, I’ve gone through absolute hell, and I’m still suffering. Doctors say this is all in my head and it’s not possible I could still be affected by he drug. They say “it’s out of my system”, so then why are there more than 4,000 others in my Facebook Benzo support group still suffering too after many months and years?
I always took as prescribed, and it enrages me that doctors put it back on me and others and claim that we’re dependent, addicts, or just mentally unstable.
Without a doubt, I would be a much healthier, happier person today without them.
I hope and pray someday I will feel normal again, whatever that is. Thank you for covering this important topic. It’s a lonely place to be and I feel somewhere vindicated.
71
Describes my situation perfectly. Four and a half years of my life in effect wasted by taking a drug, Valium, as prescribed, originally following back surgery as a “muscle relaxant,” then, incredibly, continued to help with my original reaction to it. My doctor, to this day and notwithstanding all the documentation I’ve presented, insists protracted withdrawal difficulties are impossible. It’s scandalous, infuriating, and means you’re on your own when you try to deal with it. The medical community is completely unhelpful and occasionally downright hostile.
9
Jessica's experience is very relatable to mine. I originally took Klonopin for a bout of insomnia and anxiety a few years ago. It worked quite well for the first 2 or 3 weeks, but then began to work less and less and ultimately my anxiety got worse being on the drug. After trying to get off the drug a few months later on my own, I was unable to function due to severe fatigue that I had not experienced prior. I realized I was stuck on a drug that no longer helped but getting off the drug was hell. Ultimately an older doctor helped me and many other patients gradually taper off these drugs over the course of many months using a compounded liquid prep of the drug. Sadly, this doctor died a couple of months ago with no one to take his place. I owe my life to him. Hopefully, medicine will begin to recognize that severe and protracted withdrawal from benzodiazepines can happen in a number of folks.
14
ironic isn't it Stephen? we have to take the poison to get off the poison.
and ever so carefully. i wish you luck and courage.
9
Please bear in mind that 1 mg of klonopin is equal to 20 mgs of Valium.
If faced with taking 20 mgs of a benzo wouldn't you be more daunted then
ingesting "1" mg of Klonopin even though they are the same strength.
This is one of the reasons that these "newer" benzos so freely accepted by
patients.
14
Thank you Jaf. People should be warned about this.
3
I just recently kicked a 9 year opioid addiction.. I was injured in the military in 2010 and was immediately prescribed 30 mgs of oxycodone, 3x per day, and Xanax 1mg 3x per day/as needed... This is over prescribing at its finest, after a 15 minute appointment, out of which I’m not even sure the Dr. understood what happened to me, I walked out with a prescription for some serious drugs.. Following orders and assuming that a Dr. would be looking out for my well being, I fell into the trap.. Long story short, it took 9 years to kick both drugs and move on... My major concern is the fallacy that there is help out there for those with no insurance, or the poor.. (The people really affected by addictions) There isn’t help for anyone who wants it, or even needs it.. I called the VA for over a week pleading with them to get me somewhere to detox... I finally had to break and go to the Emergency Room and tell them that if they didn’t help, I was going to shoot myself... This isn’t acceptable... I desperately reached for help, to no avail... Will I be labeled a crazy? Maybe, but I have my life back after almost 10 years of life on a timer, it’s like an invisible prison, you wall yourself in... Thank you for bringing light to these issues, but we’ve got a long way to go to get this right..
62
Good for you, RG. Health is weath.. Iyengar yoga has helped me stay healthy inside and out. Good Luck!
8
The sad fact is that there's no help for this issue even for people who CAN afford it. Ultimately, everybody here is pretty much on their own. Psychologically it would be nice to have some docs who knew what was what holding our hands, but they are too busy being in denial about the damage caused by the very drugs they've prescribed.
I would have happily paid out of pocket for somebody to help me, but nobody could or would.
4
Hysterical flavor of the day. Painting with a broad brush. You don't speak for me. Alprazolam is a miracle drug as far as I'm concerned. Been on it 20 years. Never have increased my dosage. I am able to function - to work - be productive. Do not preach to me. I would find this article silly but for the fact that its fervent misguided message may keep some from using a drug that has been of tremendous help to me and may in fact help them too.
97
Mark, have you considered the possibility you are the one being hysterical? Paula Span did not claim to "speak for [you]". She did not quote you in her article. You're lucky if everything worked fine for you. But read all the other comments here. These drugs have destroyed people's lives.
4
Agreed. It's been a lifesaver for me.
2
I am sincerely glad you haven’t had any trouble as a result of these drugs, but I assure you that for the percentage of those of us who do, the central nervous system damage is completely devastating and total hell on earth. I was on benzodiazepines, as prescribed, for only a few months (for sleep and as an anticonvulsant), and have now been completely off of them for over three years, and I still suffer debilitating symptoms. There is new research that demonstrates that some people are genetically predisposed to be poor metabolizers of pharmaceuticals, and that such people tend to be in the high-risk category when it comes to complications. This is likely the problem that causes benzodiazepines to be so problematic for some people (like me), and yet seemingly not problematic at all for others (like you). Here’s hoping that there will someday be a test that will help prescribers determine which people are more likely to be helped and which are more likely to be harmed by various medications. That way, people like you can reap the benefits of such medications, while minimizing the suffering of others who are more likely to be harmed by them.
10
In April 2004, the coroner failed to request an autopsy in spite of the fact I showed him two empty pill bottles. Within a period of about two weeks, my friend had taken a two month's supply of diazepam and lorazepam. Her doctor knew she was suicidal, too, since she had tried to take her life with an overdose of insulin just before Christmas, yet prescribed the second med after she claimed the first med was not working. How many more deaths result from overdose when a man can claim the death was from other causes and get the doctor-on-call to sign off?
10
I also found that the pharmacist filled the second prescription without question. My friend was daily ingesting a cocktail of around 15 medications, including haloperidol and risperdol. The Haldol was initially prescribed at too high a dose and she was exhibiting signs of tardive dyskenesia, which I noticed and reported to the doctor. More recently, another friend in a nursing home needed me to be a 'watchdog' over all the meds she was taking. We need to be wary.
4
If the medicos are not held accountable even when their actions lead to death, what hope is there?
4
I still believe my friend died from an overdose of 'benzos'. Accordingly, the data on related deaths is not given its full importance. The statistics should also include cases like that of my friend and, therefore, represents a much greater problem.
2
Absolutely the most devastating scourge to blanket the over 55 crowd over the last decade, the best anxiety killer was, is, and will always be exercise----it sedates, inspires, motivates, repairs, and restores! Couple this magical concoction to a reasonable diet and a wee bit of restraint, the results are astounding!
Nothing too dramatic here or new news, the very nature of every pharmo- based cure stated in this article begins and ends with decreased effectiveness---therefore, you need more stuff because the old dosage fails to deliver, within three months, you are hooked. These revelations are dated, yet very applicable.
I would encourage any reader here to resist following anybody's medical direction here on titration, dosage, or decreasing effectiveness---plenty of published material from the Cleveland Clinic, Hopkins, the Mayo Clinic, and the NIH. Following these anonymous spigots of medical advice is as foolhardy as the drugs themselves.....do your own research.
4
While I agree exercise, diet, and a healthy lifestyle absolutely play a role in reducing anxiety, for those of us who have true anxiety disorders, this is a physical condition that sometimes does require the use of medication. Just like exercise, diet, and a healthy lifestyle can be enough for some people to be able to control their diabetes, others have to take insulin as well.
I will say though I don't think benzos are the way to go for most people with an anxiety disorder (there may be a few exceptions.) Generally, antidepressants are the way to go.
8
And what precisely are you supposed to do if you're already doing a brisk walk walk of 3-5 miles a day, go to the gym 3 or 4 times a week, don't drink, do stretching exercises/yoga, and still have difficulty getting sound, restorative sleep?
5
I am an elderly alcoholic with decades of sobriety and avoid drugs like those described in this article. I use Cognitive Behavior Therapy and have found it exceedingly helpful in the long run for better sleep and reduced anxiety.
12
Thank you so much for this important article and JF for telling your story. I was first prescribed Ativan 1mg by a GP. When I cold-turkeyed, symptoms were misunderstood and I was sent to a psychiatrist where I was misdiagnosed and given more drugs, including clonazepam (Klonopin) 0.5mg, “one or two at bedtime”. I took them as prescribed, often less, not every night, for nearly 20 years.
I was led to believe these drugs were safe, that they could be taken long-term and they could just be stopped. I had no idea how powerful they were or the harm they’d caused. In retrospect, I see that, but for a short period of time, I became increasingly unwell. Benzodiazepines and z-drugs are insidious. They hijack the normal function of the brain, so every system in the body is affected. I learned the truth online and it was a stunning revelation. I tapered for 15 months, with no medical guidance or support. In fact I was told benzo withdrawal did not exist and I live in a “world class city”. I am 66 months post-taper and I am still recovering from CNS/brain damage. The mental and physical suffering has been inhumane and unimaginable. And the lack of knowledge in the medical community and public has only added insult to injury. Physical dependence can happen even with low dose, short-term and/or sporadic use. I wish I’d been warned.
18
The Ativan was initially prescribed for IBS. When I discovered I had Celiac disease and felt much improved on a gluten-free diet, I decided to come off the benzos. That's when I entered Hell on Earth.
11
Can you give a bit more detail on the nature of brain damage you have suffered. Would help in recognizing these problems in others?
1
It is challenging even writing this because I now have trouble with organization and planning. Fear, anxiety and looping thinking doesn’t help. I have paranoia, anger beyond justifiable, depression, agoraphobia. I was a practicing artist, but unable to be creative now. Insomnia comes and goes. These were not pre-existing problems for me. I gained 35lbs on benzos and lost 50 while tapering, most I have not gained back. Being in “fight or flight” much of the time burns calories. I have olfactory hallucinations. I had light sensitivity. I still have some sound sensitivity. My right eyelid droops some days.
I have pain, weakness and rigidity in most of my body, including my gut. I never had pain before benzos. I have severe GI problems now that are far beyond the IBS I once had. Many of my muscles feel short and tight, despite stretching and walking. Everything that was relaxed by the benzo is now the opposite.
Some of these symptoms were present to an extent while on benzos but came on with a vengeance during my taper. They are less acute now, but come in waves, that are often crippling and I am unable to have a life yet. I believe I will heal once all GABA receptors (calming) have up-regulated. There are trillions of them, all over the body. Most are in the gut. It just takes time, more for some than others, due to I believe genetics and because going off and on benzos, like I did, is known to make each subsequent withdrawal more difficult.
2
HELLO!
Medicinal Marijuana.
Oral tablets. Two versions:
- one for daytime
- one for nighttime/sleep
5mg or 10mg.
12 hour Extended Release form available.
Ready for market distribution in standardized doses from heavily regulated producers, and at affordable price points.
Minimal side effects, but could include reduced blood pressure and smiling.
Marijuana has been vilified in the Unites States for decades, yet its track record for misuse/overuse is minuscule compared to the many risks from the rampant use of 'benzos', other prescribed drugs and alcohol. Offering this alternative -- legally -- gives the consumer more choice at a lower cost. Where and Why is this not an obvious option across the United States?
....and until now I had not even mentioned the job and tax opportunities!
15
We used to think oxycontin was a reasonable drug to give people for long term pain.
Substituting ONE DRUG for ANOTHER DRUG is never going to be the solution.
Getting high is not a substitute for getting well.
4
Thank you for exposing the dangers of benzos. I took Klonopin for 17 years and it took me 19 agonizing months to get off of it using a liquid titration taper.
The official prescribing guidelines for benzos is for 2-4 weeks, not months or years! I would still be on Klonopin today if I hadn't initiated getting off of it. And when I mentioned to my doctor I wanted to get off of it he said "okay, we'll taper a third, a third, a third". I knew that that was ridiculous and would have put me into horrible withdrawal (because I had tried cutting a third and it was hellish!)
The tone of the article seems to put most of the blame on the patient for "overuse and abuse". Statements like "despite warnings...." and "persuading older people that there are other methods [for dealing with anxiety] has proved an uphill fight". I can assure you that patients are not being adequately warned. Not once in the 17 years I took Klonopin was I warned by a healthcare provider, including both my psychiatrist and my PCP.
in my opinion, the law for benzos should be changed in at least two ways: 1) Adequate written informed consent should be required prior to prescription, and 2) they should not be permitted to be prescribed for longer than 2-4 weeks. Doctors are woefully under educated in this area as relates to the prescribing guidelines, the damage they cause, and the extreme difficulty in getting off of them.
THANK YOU VERY MUCH for this article exposing the dangers of benzodiazepines!!
29
I heartily agree, Ken. Informed consent is essential.
Had I taken "street drugs" I'd have been off in 2 weeks.
8
Thank you NYT for bringing attention to this matter. It’s just not the elderly. It happened to me too. I still have neurological damage from benzos after taking them as prescribed. I was cold turkey’d by a doctor in the VA because the drugs literally turned on me and I became suicidal overnight during my tapering off process. Please do more articles like this one. I came off opiates 11 years ago and it was a walk in the park compared to benzos. I wouldn’t wish my suffering of withdrawal effects on my worst enemy.
11
I was on a low dose of Xanax for years, prescribed by a psychiatrist who said I needed them "for life" (his words). They turned on me eventually, and I had to wean myself off. This took me about a year. There was no help offered and no real guidelines out there so I white knuckled it.
These are short-term (think two to three weeks) drugs, tops. Not meant for long term use. Use at your own risk.
10
About 12 years ago, we had to have my mother-in-law involuntarily committed because of her use of Ambien, Xanax, Oxycodone, valium and Percocet. She had a chronically failed back, anxiety, depression and difficulty sleeping. She didn't speak to us for two years after the 72 hour hold which led to 28 day detox. I could have sent my girls, then 3 and 5, to college on the street value of what was in her apartment. At 75, she was doc shopping for pills. Thank you for this. So many families don't know how this can happen and how devastating it can be.
9
Most of all: SHAME ON HER DOCTORS! anyone 75 is on Medicare, which is excellent SINGLE PAYER insurance as all liberals fondly desire for the rest of us. So why was this permitted? why did her doctors not keep records and share information?
Of course, though it is hard to believe -- even a 75 year old can be "doc shopping for pills" and have a very addictive personality.
2
After experiencing anxiety attacks in my 20's I began a regimen of talk therapy and 1970's tranquilizers. None of this worked and I became increasingly housebound. In the early 1980's I was given Xanax. It was like a miracle. I still became anxious, but I now had an effective tool to reduce the anxiety. Thanks to this single drug, I had a productive career and am a happily retired grandparent. I still get anxious and I still take Alprazolam (the generic for Xanax). Although I am in my 60's, I can still work the NYT's Sunday Crossword puzzle in 30 minutes. Yes, it would be great to be anxiety free and not need any medicines, but, after 40+ years of anxiety, I really don't see that happening. Certainly people who drink or use contraindicated drugs should not take this medication, but to deny it to people it has helped is not acceptable. Frankly, I'd probably turn to other drugs or alcohol, which would be much worse.
40
This is a really well done article. Thank you.
I followed my doctor's instructions, exactly, while taking prescribed benzos (prescribed in combination with opiods) for 12+ years, until I was paralyzed and almost died. The description of "acid in the veins" is, sadly, apt. Ultimately, the suffering caused by the myriad damages from my #MedicalObedience was beyond cruel and inhumane. At 4+ years on the free side of all meds, I am SO grateful to be SO much better!!
11
Yes, Lisa. Blind #MedicalObedience is a killer.
I'm sorry to hear of your paralysis and near death, but glad you survived and got much better.
1
Taking Klonopin daily as prescribed has ruined my life, stolen my career, health, on and on. After a 16 month brutal taper, I am still disabled and suffering two years since my last dose. There are no words to describe the horrors of withdrawal from these pills.
19
These drugs, like many others, have potential to cause harm. The conditions they treat, particularly insomnia, have the potential to cause harm and also to degrade quality of life. An elderly person who hasn't slept well for several days is not going to be fully functional and risks falling, accidents, etc. That person may very well be safer using zolpidem or lorazepam. A person in constant pain from arthritis may very well decide that a considerable risk from a drug that controls that pain is well worth it. It's a balancing test.
9
From failing to do my yoga exercises for months, my 74-yer-old body painfully locked up with muscle pain. Luckily here in Guatemala where I live, I encountered a wonderful Brazilian physical therapist who makes home visits, and with his treatment, massage and specific exercises, the pain is going away and I feel good again. Why don't more US doctors refer patients to physical therapists instead of passing out pills?
11
Perhaps because insurers in the United States cover pills but limit coverage for physical therapy and medical massage.
11
Ann Cameron: the treatments in Guatemala are likely crazy cheap because you have a high level of AMERICAN income in a very poor third world country.
What would someone pay IN THE USA to have a wonderful physical therapist come to your home twice a week and give you not just therapy but massages and TLC? Several hundred dollars PER SESSION!!!
No insurance is going to pay for that, and such treatment is only available to the very rich.
4
Last year exactly at this time, I was nearly overdosing on a daily basis on my prescriptions of klonopin, Valium, oxycontin, and oxycodone (in addition to other psychiatric and pain medications, like gabapentin and cymbalta and Prozac). I was suicidal, so I’d “not remember” how many I took of each prescription or how often during the day. I never took more than my allotted monthly number of pills. Doctor with 20 experience in my field here. I know pharmacology. I know the particular dangers of benzos and opioids. I took them as prescribed anyway.
I was given these drugs for the reasons most people are: anxiety, depression, pain. Scripts were always refilled, no questions asked. I truly believed I was in so much psychic and physical pain that they were necessary. I didn’t make the connection (and neither did my doctors) that the more drugs I took, the worse I got. In the end the choice was simple: get off the drugs or die. So I went to rehab.
If you want to experience a particular type of hell, be a patient with the as-yet poorly characterized and medically misunderstood phenomenon of severe benzodiazepine withdrawal reaction and be cold turkeyed at an expensive, reputable rehab. If you didn’t want to die before, you sure will after that.
I now spend my time researching. Trying to find patterns in data and anecdotes and information to explain why the disconnect is so profound that even doctors who prescribe the medications themselves become entrapped.
43
Thank you for sharing. I hope your expertise and research can help us fuel change.
3
Please also research gabapentin/neurontin for adverse effects and severe withdrawal agony. The medical community has seen fit to ignore or wash their hands of the problem. Withdrawal threatens profits, and therefore is ignored.
1
You are a DOCTOR and you did not realize there was something horribly wrong with taking DAILY klonopoin, valium, oxycontin and oxycodone, PLUS gabaprentin, cmblata and prozac????
There is no medical condition that would justify using all of these DAILY and nearly overdosing. Is it possible you were given whatever you wanted by colleagues because they thought a DOCTOR would be more responsible and knowledgable about mixing such heavy drugs?
2
Physician Assistant here. Took benzodiazepines as prescribed for work stress. Began to develop what I know now was tolerance withdrawal. Psychiatrist prescriber denied it was possible, but I had done my research and knew it was the benzos. My family noticed drastic changes in my moods and personality. I had developed severe suicidal depression, chronic diarrhea, rashes, persistent anxiety and agoraphobia (all supported in the expert literature as being due to benzo tolerance).
The withdrawal syndrome is horrific and has become protracted, lasting 5 years and 3 months to date. I have been so ill I am on disability and cannot work, requiring much assistance from family. My symptoms include, but are not limited to persistent and chronic muscle rigidity, nerve pain, numbness, dizziness, a sensation of being "on a boat," anxiety, paranoia, depression, apathy, anhedonia, memory loss, cognition problems, inability to focus or multitask, depersonalization/derealization, etc.
I have been met with pure ignorance from the majority of medical professionals I did see while desperate for help and validation. I have, however, since consulted a forensic psychiatrist for many years who knows this withdrawal syndrome is very real and very debilitating.
It's important to note that I had none of these issues prior to taking these prescribed benzodiazepines. Buyer beware. Taking benzodiazepines exactly as prescribed has catapulted me into a hell I couldn't have dreamed existed.
50
How sad that it takes a FORENSIC psychiatrist to understand what his/her medical peers don't.
2
One thing that isn't clear to me from this article or other articles on this subject in the Times is how much of these drugs people are/were taking. Jessica Falstein says she was taking multiple drugs. How many multiple drugs? With opiods we hear of people who were prescribed them for pain, then started taking them all the time, then started taking even more than that all the time and stealing to get enough of them. So was Ms Falstein taking them just days,just nights, or days and nights and what kind of dosages was she taking Was she taking what was prescribed or more than what was prescribed? And was the prescription from a GP or from a psychiatrist who knew something about drugs? Are the anti-anxiety meds bad for everyone in even tiny doses or is the point that people start taking ever larger doses and mix them with other drugs, as opiod addicts do?
4
ellienyc, patients, especially the elderly, are often prescribed an increasing cocktail of drugs because drug 2 is needed to combat the side-effects of drug 1, drug 3 to combat the side-effects of drug 2, and so on.
2
Low doses are a red flag that the drug is potent.
These drugs impair people and are linked to dementia. They're unsafe at any dose for more than a day or two.
The point of the article is that many people don't realize this.
3
John: when I took over the care of a 91 year old aunt, I found she was on 14 different medications. It was not just costly and confusing for her -- she had early stage dementia -- but I suspected strongly the drugs were interacting in a negative way.
Among other things, she took laxatives because some of the drugs were constipating -- then she got diarrhea from the laxatives, so they put her on anti-diarrheal drugs. Not short term -- forever.
Once she got prescribed a drug, even in the hospital, it was continued indefinitely. She took allergy drugs for allergies I could not determine who had diagnosed or when -- inhalers and pills and shots -- after getting her out of her filthy, dust-covered apartment, we determined she had a DUST allergy that nobody even considered. In a clean environment she needed no allergy meds at all.
Once off all drugs....the stomach problems and sleep problems ended -- there were no more allergies or runny noses -- she slept normally without the Klonopin she'd been taking FOR YEARS.
Her only ongoing problem was mild hypertension of 130/85, which her doctor and I agreed was debatable as needing drug treatment in a 91 year old with dementia. I would have given her the BP meds anyhow, but the Assisted Living facility charged $700 a month EXTRA for "medication administration" even if there was one pill or even VITAMINS -- so I stopped all drugs entirely for her.
She lived another 3 years, with no problems and died a natural death.
2
In 1996 I was prescribed klonipin first for anxiety but it wasn't very helpful for that, but since I thought I found it helpful for sleep the doctor said at least it's helpful for that and that it was often prescribed for sleep, (always taken as directed). By 2006 I was so cognitively and memory impaired, plus serious anxiety and depression, I had to go on disability. Lost my job, house everything! Even then doctors didn't know benzodiazepine tolerance and major side effects were the culprit. By in 2011 the nasty physical effects hit. I went from easily being able to walk 6 miles to struggling to walk 1 mile with serious muscle weakness, pain, very fast heart rate, heart palps. I searched online and found the answer at: benzo.org.uk . It turns out millions around the world have become physically dependent, injured. Many have been lost to suicide because of the horrendous symptoms benzos can cause. Others have died from seizures and other health complications caused by cold turkey removal of the drug.
I used the Ashton manual to taper for 15 months. Now 57 months post taper I am still very much disabled with severe cognitive and memory problems, severe fatigue. I'm better with better physical abilities now and the total hell tapering was is mostly passed.
14
The issues I’ve seen with these drugs in my family have involved alcohol. What they tell the Doctor rarely includes the truth about their drinking.
10
How much of this is due to real anxiety the elderly face? And the fact that it's easier to get a drug than it is to deal with the real source of the problems? Yes, there are plenty of people with anxiety disorders but it's hard to get health insurance to cover the therapy that could help them deal with it. Insurance will cover drugs but not meeting with a therapist on a regular basis.
There's a lot to be anxious about in America, no matter how old you are. And nothing is being done to alleviate the very real anxieties people are facing: how to pay for health care, keep a job, keep a place to live, pay off loans for education, pay for kids college educations, save for retirement, care for elderly parents, etc. The real wonder in America is that more of us aren't addicted to pain killers and other drugs.
22
I guess I'm fortunate. I have been prescribed every type of benzodiazepine, and every time, I cannot follow the prescription, because within 2 days, I become suicidal. It's a not-especially-common side effect. I'm not suicidal any other time - only when I have tried to take any anxiety medications in the benzo family. I'd rather be frantically anxious and utterly unable to sleep than suicidal. So now, when I see a new doctor - which happens with some regularity, as my career takes me to live in new places every few years - I just write that I cannot take benzos, ever.
6
Patients in the US expect a pill for everything. They expect to feel happy and pain-free all the time. Doctors succumb to the pressure from patients to prescribe dangerous drugs. Another doctor may already have done so under a different name. A recent study showed that OTC painkillers worked as well as opioids without the addiction. Doctors should take the lead and not endanger patients which drugs which can cause confusion, loss of balance, addiction and more problems down the road.
8
I actually do think people have a right to freedom from debilitating pain (not to be confused with general "aches & pains" of old age).
But nobody can expect to feel 100% happy all of the time. It's not the normal human condition. I think part of our problem is media -- which our ancestors did not have to contend with -- everything from TV to movies to social media, that present the lives of very affluent people or celebrities, all of whom seem to be giddy with happiness 24/7 and engaged in endless "fun" activities -- with no hard work, downtime, mild depression or general sadness ever.
We compare our drab ordinary lives to this, and feel awful -- jealous, anxious, deprived, lonely, sad. But the images and ideals are not realistic and they make most people feel WORSE about EVERYTHING.
3
Benzodiazepine medications are extremely dangerous. Here in the U.K. Public Health England are conducting a review into the dangers of prescribed drug dependency. Professor Heather Ashton wrote the Ashton manuals that are an invaluable resource. Physical dependency on benzodiazepines can happen even on a lose dose and more often than not has nothing to do with misuse at all. In the U.K. there are specialist centre for benzodiazepine related disability. But not enough. We are campaigning for a 24/7 helpline. Some people need 24/7 care for many months and sometimes years. In severe cases people need Zimmer frames and wheelchairs. Benzo related disability is absolutely horrific. Well done to the NYT for this coverage.
12
This article is my story at age 71. 16 years on Xanax with extreme difficulty tapering off. My advice? Only for temporary, emergency use.
20
Curious to know the dosage you took and how many times a day.
4
Don't remember dose, but it was relatively small; maybe 1 mg 3 times per day. It was the length of time that hurt me. Really do believe I have damage to my central nervous system, but symptoms (dizziness) could be result of ageing too. A few months without any now and I am managing.
1
This is a very real problem for all the reasons in the story. As a geriatrician, I am often asked to evaluate older patients for complaints of memory loss. If they are on a benzodiazepine, my first recommendation is that they taper the medicine off. But patients - and often their families too - are frequently very resistant, even after I've explained how potentially damaging these drugs can be to their cognitive function. Many times patients can't even explain why or how they were started on the medicine. These are useful drugs for limited indications (e.g., anxiety in dying patients), but are too often overprescribed.
63
I took a "low" dose of Klonopin as prescribed for around 4-5 yrs. I tapered off in a month. My CNS was so damaged henceforth that the next 3.5 years of my life were truly a waking nightmare: a never ending feeling of terror, sleeping 2-3 hrs a night, muscle spasms, nonstop nausea, hallucinations, cognitive impairment, rage, severe depression.. Amazingly, I was met with complete rejection by the medical community. Thank God benzo victims are beginning to unite online. There are SO many of us, many are still unaware the drugs are their problem. This is a true scandal far surpassing the Thalidimide scandal of the 1960's. Please, NYTs continue to run with this!
24
Want to see more frightening stories? Check benzobuddies.org
4
Overprescribing and misuse of benzos may indeed be a problem, but to suggest that this problem surpasses the thalidomide catastrophe of the 1960's is both hyperbolic and completely insensitive to the thousands of people who have faced lifelong disabilities due to thalidomide. Comparing apples to oranges does not strengthen your argument.
8
A "low dose" of Xanax for me for 16 years; still dealing with what I feel are the aftereffects, dizziness mostly, although that could also be a function of age.
I've never taken anxiety medications but have recently developed intense anxiety over having involved dental procedures, probably because I've had to have so many of them. My primary physician has declined to prescribe for me any short-acting anxiety medication such as Ativan because I'm in my 70s and he says it isn't safe for the elderly. And so at my last 2 1/2 hour dental procedure, I had a full blown anxiety attack the whole time with racing pounding heart and high blood pressure. My heart continued to race for hours afterward and my chest ached for two days. How can this be better for my health than taking a short acting anxiety medication and have my husband drive me to the appointments? Oh yes, my dentist tried nitrous oxide but I'm one of the rare ones for whom it had no perceivable effect. Maybe prescribing an anti-anxiety medication would actually be helpful for certain elderly people in certain situations. I don't think it's fair to give blanket warnings that it's always a bad medication for us.
174
There's a difference between using these meds for "performance angst" (including dental work, public speaking, air travel, etc.) And treating long term anxiety with them. I'd ask my dentist for an rx if my primary was reluctant just on the basis of age. For me, a half-mil.of lorazepam is every bit as essential at Novacain to surviving a dental procedure. The problem with your primary may also be the HMO protocol which may be tying his hands. Plus, of course, a bit of ageism. Which this article also suffers from.
26
I would agree to the use of a benzo in your specific case, for a limited time.
6
On a recent prostate biopsy ONE Valium, an hour before, was very helpful; that's it, though...ONE.
10
3 week taper in Jan/ Feb-2013 by my neurologist ,and first year I was able to go visit people ,just mild walking difficulties,second year somewhat more difficult and shoulder and back muscles were contracting quite a bit, along with severe head pressure ,third year it was all I could do to get thru a supermarket holding on to a shopping cart once a week ,and I passed out momentarily in the check out line ,forth year could barely get to my bathroom and needed assistance to get to my doctor ! Also felt like I was going crazy and going to pass out and convulsions picked up to 3-10 times a week ! Year 5 still getting worse as standing is so hard,I limit it to once or twice a day !( I have been living 24/7 in my recliner since I stopped the 8mg daily of lorazapam! ) Also I was 75 when I stopped my Benzo and now I am 79,but most say that doesn't impede the healing.
7
3 weeks seems much too fast to taper from an 8 mg dose. Check benzobuddies.org.
1
For anxiety, which often is linked to depression, we may try one x 1000 micrograms (1 mg) of Vitamin B12 daily, plus three x 5mg (three x 5000 micrograms) daily of oral high dose folate aka folic acid. Both are cheap and safe. Both can be bought usually without a prescription, therefore.
Search for:
Megafol 5 mg Folic Acid Tablets 100 ($4.99 to $5.49);
Nature's Own B12 1000 mcg 120 Tablets; (or Nature's Own Activated Methyl B12 60 Tablets)
Daily dose and duration of treatment seem to be crucial. Low dose folate supplementation is reported to have little or no effect. Dose must be high strength folate (5 mg) taken three times a day. And one needs to follow the daily folate and B12 regimen for at least thirty days.
(NB, Megafol 0.5mg Folic Acid 100 Tablets are also available. Don't bother with these. They're just one tenth the strength of the 5 mg folate tablets. The former don't seem to have any effect on anxiety, agitation and irritability. It seems one MUST take three high dose 5 mg folate tablets a day for thirty days to notice any improvement)
1. Treatment of depression: time to consider folic acid and vitamin B12 http://journals.sagepub.com/doi/abs/10.1177/0269881105048899
2. 'L-Methylfolate as Adjunctive Therapy for SSRI-Resistant Major Depression: Results of Two Randomized, Double-Blind, Parallel-Sequential Trials' https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2012.11071114
4
Of course, doesn’t have to be any particular brand of B12 or folate.
2
While I would not negate the effects of good nutrition -- good sleep hygiene -- stress reduction -- relaxation techniques (like meditation, yoga, etc.) and exercise -- there is no one vitamin or supplement that is a cure, just like there is no one drug that is a cure.
Some of what is bothering people here -- especially the elderly -- is just LIFE. The fear of growing old, poor health, lack of income, isolation from family or friends -- the ongoing deterioration of one's body as you age -- impending death. There is no cure for the human condition that exists in a bottle.
3
Why the hell do they prescribe these drugs for long-term (anything over a week) use?
10
Because some people have debilitating anxiety that prevents them from functioning and these drugs alleviate it. Why do they prescribe insulin for diabetics?
11
Antidepressants work better long term for anxiety in most people. Generally there is no reason to be prescribing benzos long term.
3
Because the things that might help people long term are costly interventions -- years of psychotherapy, talk therapy, cognitive behavioral therapy -- they don't work predictably or on every person. But they are more likely to result in a permanent cure, without drugs.
BTW: this also goes for true pain management programs. They take a long time, involve cognitive and physical therapy and participation by the patient and are expensive! so it is far easier for most doctors to say "here, take a opioid drug and shut the pain off instantly with no effort".
2
The article is unbalance.These drugs exist for a reason.
old people suffer more depression and insomnia. Cognitive therapies do not work well with this group, simply because they are more mentality fixed.
Physicians prescribe them for the quality of life. Are there any statics concerning how life was more enjoyable after taking them.
Many States even pass legislation to restricted physician. it is not surprising,Considered that the legislators are not suffering these diseases . But they are going to be old just like everyone will die.
it is political correct to condemn them. It makes people think it is bad to take them. For many cases, " detoxification" in old people is very debilitation.
the struggling deviate most patient form other meaningful things.
These drugs can induce dependence. So are anti-hypertensives and anti- diabetes. Patient take them for life.
There is always complications. Auto accidents killed a lot of people.
7
jcyang, how is this "politically correct"? Have you read the victims' stories in these comments?
What do you think auto accidents have to do with this topic? Do you think that if someone dies in an auto accident, it's okay for someone to die from taking benzos?
1
jcyang: neither blood pressure meds nor diabetes meds (metformin, insulin, etc.) cause dependence. In fact, most people DO NOT LIKE taking them, and the real problem is getting patients to comply with doctors orders.
Nobody gets high from BP meds or metformin, and most people would be overjoyed to STOP taking those drugs!
2
I was prescribed benzos after daily panic attacks left me unable to function. I would wake at two a.m. unable to get my breath, my heart raced while adrenaline pumped through my body. It was terrifying, but without any reason for why. This would go on for hours, affecting me throughout the day. I was unable to drive, go into public places, partake in life. First I was given extended release 12 hour Xanax, but within two weeks I developed 'rebound' anxiety - my body reacting to the withdrawal of Xanax by creating the same symptoms which caused me to take the medication. In between each dose I was so drugged I slept all day. Finally another doctor helped me get off the medication, putting me on antidepressants to help with this anxiety symptoms. Years later I still consider this one of the worst periods of my life.
25
I haven't taken Xanax in years, but I keep a few pills (less than 6) on hand in case of a panic attack. I had them in my 30s, and they were awful beyond imagining, so you have my sympathy.
They worked in an amazing way for me, literally turning the symptoms off like a light switch in about 30-40 minutes. They relieved incredible suffering, plus the FEAR of having more panic attacks -- a fear almost as bad as the panic attacks themselves.
However, I never took them daily or got dependent on them. I think most doctors here are way overprescribing a drug that should be used only when needed, and not daily.
1
I think this article is very timely and does a great job of explaining the dangers of these drugs in the elderly population. These drugs are dangerous at all ages but present specific risks for seniors. I am tapering off a benzo myself and it has been an awful experience. I now co-direct a nonprofit Benzodiazepine Information Coalition www.benzoinfo.com which raises awareness about the dangers of benzos because I believe patients have the right to adequate informed consent about the drugs they are taking. This article does also point out that cold turkey is dangerous and enforces the need for a slow taper. Our organization has seen way too many horror stories of seniors who were forcibly cold turkeyed off their long term benzo simply because they were 65. This is cruel and inhumane given that withdrawal symptoms can be severe, not to mention dangerous as abrupt cessation can also result in seizures and death.
9
The hysteria concerning opioids has given the author a step onto the trendy bandwagon. She pretends to advocate for the elderly, yet time and time again she writes of the dangers of sleep and anxiety medications, with the underlying assumption that seniors are fuzzy minded and unable to weigh risks and benefits.
First it was Ambien and the “z-drugs”, now it’s benzodiazepines. Note the large number of comments. This article will be read by everyone and will provoke strong feelings. Physicians have become punching bags in the comments, another unfortunate trend.
Common sense dictates that these medications be used with caution. Ms Span apparently believes that elders lack common sense; that they will drive while using them, escalate their use and not check in with their physician.
I agree that maybe 1 out of 10 will misuse pain and anxiety medications, but I advocate for the 9 who will not. I’d also like to reiterate that not all people over 65 are demented and in need of younger people’s advice.
108
This is not about elderly people being too fuzzy headed to take the drugs "properly". Many people were instructed by their physician to take these drugs every day, for years, thus increasing the risk of dependence. This is about the physicians, and the pharmaceutical companies who encouraged this type of prescribing. Younger people are just as vulnerable to this horror.
9
Are you a physician? You seem more concerned about physicians being criticized than about the health of vulnerable people. Surely the wellbeing of the elderly is all that matters.
Elderly people are not all demented, but even more than younger people they are vulnerable to being bullied by their carers and physicians.
5
Well said.
4
It is simply incompetent psychopharmacology to prescribe benzodiazepines as maintenance drugs for anxiety, panic or insomnia.
It could be recognized as malpractice.
These medications are not cures, they manage acute symptoms- ideally for a brief time. Other treatments are necessary for the long run.
Patients are impatient but ultimately follow careless prescribing by MDs.
Benzos lose effiucacy as a patient develops a tolerance. Dosage creeps up. The down-regulation of GABA systems is plausibly depresso-genic. It can impair cognitive functions.
Medicated sleep is not quality sleep. Being unconscious through sedation is not restorative. The brain needs real sleep cycles, useful 'architecture' to keep neurochemisttry humming.
Fragmented sleep may be an intractable feature of aging, but alcohol & Xanax are toxic 'solutions,'
Short term solace from suffering is compassionate. Long term bad medicating is shameful, shallow and causes iatrogenic (needless) woe.
22
This exact same thing happened to me. I followed my prescription exactly as prescribed and ended up sick for years tapering off the drugs. Was not warned this was even possible beforehand.
13
Klonopin was prescribed for me, with no warnings, for 19 years. It took me 6 months to taper off the 1 mg a day dose. I completed the taper in 2012. I have been free of any benzodiazepine for almost 6 years. I am still having disabling withdrawal at age of 72. It is believed that I have permanent damage to the brain and CNS.
11
I am so glad melatonin works for me. My sleep has been poor all my adult life and I tried ambien, lunesta, and sonata they all worked for a bit, but not very long and lunesta left me with a nasty taste in my mouth too. Valerian worked longer, but still failed eventually. Melatonin has worked for years and my only side effect is vivid dreams. One of my kids gets nightmares from melatonin, though, so that is something to be aware of if you try it.
I also cut my five milligram tablets in half, five is more than needed, though it doesn't affect me badly.
2
I have taken these very sporadically for years, less than 60 low dose pills a year. I use them fpr anxiety when I fly and for sleep when I am on vacation with my loudly snoring husband. Very occasionally I have used them for other episodes of anxiety, never more than one a day and never for more than 3 days or so. I have experienced no bad side effects yet, I'm 69. I would be very leery of taking these more often, so limit myself to the amount I take now.
I find them very helpful and would resent being told I can no longer get a prescription. There is a lot of truth to what some other commentators have said, somehow people think all of us seniors need their protection.
160
You are taking them as they are intended -- as needed, sporadically. Although, if you are older, you could still be at higher risk for adverse effects from those sporadic doses because the body does not metabolize the drugs the same as age progresses. The greater danger, however, is chronic daily use, for which these drugs are not intended but are prescribed for regardless of the multitude of professional guidelines which advice against doing so.
14
I agree. I also take a low dose benzo once or twice a week at bedtime for chronic insomnia. It helps.
These articles by Paula Span never include a discussion of dosage.
7
Me too - exactly that, except that my doc prescribes 30 low dose pills a year. (They have a long, long shelf life so I keep a stash.) I use them to help sleep on planes, to get through the worst night of a cold, and for other rare times when I really want a good night's sleep but can't get it. We all need to educate our young docs on evaluating individual cases. In the meantime on a related matter contrariwise, I'm looking for other OTC meds such as decongestants that aren't automatically "Maximum Dose" since as we age we need less: looking into pediatric doses. (Also buy smaller apples, oranges and bananas.)
2
Compounding and causing a lot of this problem is the lack of continuity of care ethic that is the foundation of good medical practice. Patients keeping their own health providers are rare these day, as the managed care model of medicine has overtaken the traditional model and people are shuffled from provider to provider almost at random. The provider no longer talks face to face with you, instead reading from a computer screen, and gives you 15 minutes. Basically the provider has only a flashing picture of your medical needs. Yes, overdosing is a problem and so is underprescribing. Hard to tell when this is a very common time frame.
16
Some Jimi Hendrix music might help.
1
While the science is far from settled, many patients use marijuana for both sleep issues and anxiety (among others). Marijuana is far safer than the benzo drugs. There needs to be further study to support the vast amount of anecdotal evidence for the use marijuana for such conditions. And in the meantime, broad legalization will allow the wider use of this safer and perhaps more effective alternative.
14
The solution to drug addiction is never going to be "switching to another type of drug". Some people posting here, rhapsodizing over their pot usage, admit to being users for FIFTY YEARS. That's not pain control -- that's an addictive personality who has found their drug of choice.
3
As usual, many commenting here want to distance themselves from the clueless folks who are abusing benzos and becoming addicted. They see themselves as separate, as people who legitimately NEED and deserve these drugs.
The question people should be asking themselves, however, is not "Am I an addict?" It's "Are these drugs I'm taking helping or hurting me?" The answer is, they're probably hurting you, even if you don't know it.
I had to go through a wicked withdrawal from Oxycodone after knee replacement surgery at the age of 61. When I still wasn't getting well 8 months later, I realized I needed to ditch the small dose of Xanax I had occasionally been taking for sleep for five years. It turned out the Xanax--a benzo--had been doing a number on my brain and body I hadn't even realized, and the difficulty of getting off much greater than with opioid pain meds.
It's been five-and-a-half years since my last crumb of Xanax, and I'm finally fully recovered. Since I was already a published author (Children of the River, Random House 1989 and still in print) I decided to write a memoir to give other nice ladies such as myself a heads up. Your doctors won't worry about you becoming an addict, so you better worry about yourself!
Accidental Addict: a True Story of Pain and Healing....also Marriage, Real Estate, and Cowboy Dancing.
Linda Crew
www.lindacrew.com
16
I wonder if we should also not start looking at the efficacy of knee replacement surgery in almost everyone, as all I read about is the awful pain that requires heavy duty opioids for long periods of time (and sometimes, forever). Is a surgery intended to give people more functionality WORKING if it gives them lifelong intense pain requiring opioids for the rest of their lives?
2
Truly a consideration, particularly when used with opiates and/or with dementia and dementia-like cognitive deterioration. The big BUT here is how do you ensure adequate quality sleep and, where indicated, how do you manage pain? “Alternative treatments like cognitive behavioral therapy and improved sleep hygiene can be as effective for insomnia[...]” - this may not work for the majority of those who are habituated or whose insomnia has been well-managed by this category of drug. An uphill battle on many fronts.
6
Elderly patients who are prescribed "benzos" should be required to engage in non-drug anxiolytic activities such as mindfulness meditation, yoga, tai-chi and age-appropriate exercises in general. The best time to make positive changes in one's life is when the positive effects of drugs like benodiazepines are having their maximum effect. That way, when the pill's effects are wearing off, the benefits of positive life style changes are kicking in, making weaning from benzos easier.
8
Many of us out here are sick and tired of being denied the medications we need because a small proportion of the population have problems with them, including abuse of the drugs and overdoses, usually due to their own stupidity.
In terms of weaning people off these drugs, I have talked to many people about it and I haven't met anyone who was weaned off their pain killers or benzos. Most doctors summarily cut people off and let the chips fall where they may.
I have constant pain from various sources and choose to smoke marijuana instead of taking opioids. Last year I was drug tested, and because of the marijuana, I was immediately cut off of my anti-depressants, Xanax and Ambien. Since then I get about 4 hours sleep a night, constantly have a feeling of impending doom and can barely function. The only thing that keeps me from completely flying apart is my marijuana smoking.
I have found that too many doctors are uncaring and incompetent, and the law is most definitely an ass.
156
Ambient and Xanax are NOT anti-depressants.
3
Sarita, I know that. I guess my writing wasn't very clear. My antidepressant was Zoloft.
3
Which entity did that "drug enforcement" on you?
There are folks who abuse these drugs and those who really need them. These reports always leave the latter out of the picture and that is very unfair. My mother suffered from the terrible pain of rheumatoid arthritis for the last 31 years of her life. All they would give her was aspirin then finally ibuprofen became available and they gave her that in mass quantities. The pain would lessen for a while and then come back and she'd have to suffer until the next dose. Eventually the relief was minimal.She did not drive or drink alcohol. I wish they would have given her opioids to ease her pain. She had a terribly painful condition. Would it have been so bad if she had become addicted to something that would have allowed her to at least have less pain? There are folks who need these drugs and take them responsibly. Living with intense pain is horrible. Let's think about those people too.
205
Except that opioids don't work well for rheumatoid arthritis pain. And something you and most of the other comments overlook regarding both opioids and benzos is that extended use of either can actually lower the pain threshold making the pain worse. This doesn't occur suddenly but is a gradual thing and what happens is that they get prescribed higher and higher doses of medications that make things worse.
9
Believe me I understand that it is a vicious circle in many cases but can you imagine what it may be like to live in pain and progressive deformity for 30 years. I would much prefer to at least occasionally be able to take something that would alleviate such horrible pain. I know she would have become addicted. I know she would have needed more of the substance if she took it too regularly. The point I'm trying to make is that there are people for whom society needs to have some compassion and understand that addiction or at least dependence is more than justified. There should be no stigma in those cases and certainly not form the medical profession.
21
Some years ago, my family doc stupidly prescribed a benzodiazepine "off label" to help me quit drinking, and I became almost hopelessly addicted to the "cure." It took me years to get off the addiction treadmill - finally quitting the benzos was far harder than giving up the booze.
Any addiction doc would say that was a huge mistake, but primary care physicians have taken to prescribing this class of drugs almost mindlessly for any number of ailments because, as the article illustrates, they make for initially very happy patients.
Like opioids, this stuff is literal dynamite, and the medical profession needs to understand that.
10
Another jumping on the bandwagon story about the evils of drugs. Stop judging. This type of anti-drug hysteria is so damaging to the majority who use drugs responsibly.
66
Many of us commenting have taken the medication exactly as prescribed and are now having debilitating symptoms.
7
As Tim said, many commenting have taken the drugs exactly as prescribed and have had their lives destroyed. No on is judging the victims. They are judging Big Pharma and the medical establishment that aids them.
2
"Judge not lest ye..."
And yes these articles foster hysteria largely because they are read carelessly: see NYT Replies.
They are, however, informative and give us valuable information to use when we are often isolated from the informal discussions we used to have when we were younger. Rx ads on the TV are not a substitute and, your doctor like some cited in these comments may not have the knowledge of geriatric medicine that you need. Among the friends of my earlier life were many physicians. Some were thoughtful men and women who respected t-he body of knowledge available in their time and understood how much they didn't know - and proceeded with caution. Some of them experienced the horror of making a mistake even so. Some of them were not so thoughtful. Each of us needs to know, has the responsibility to know as much about our own health needs as possible, as well as about the state of current medical thinking and practice.
The NYT publishes news about current medical thinking and practice, and makes me aware of what I need to know. I always take another person to my medical appointments - including dental, eye, and hearing appointments - to help remember what is said and done and, especially, to ask questions that don't occur to me. I always try to have some idea of what I am and am not willing to do or take and refuse to proceed unless I have satisfied myself that it's a good plan for me.
I've got more good advice but only 43 words left...
L&B&L
Thank you so much for writing this. This is a REAL problem. My mother started taking Klonopin right around the same time as Ms. Falstein, still takes it, and it has been a very bad thing for our family. She is not the person she once was. She passes out at strange times (babysitting....), is prone to alternate vagueness and fits of rage, and forgets lots of stuff. She has violently attacked me for suggesting that she reconsider her prescription drug use - like, frightening, addict behavior, ready to throw me under the bus if that will keep her on her Kpins. This has been the cause of significant family conflict, and is now a significant worry for all of us as she gets older. It was absolutely unnecessary. She never had anxiety disorder - just docs in the early 1990s seem to have been in love with the Klonopin for middle-aged women. Her one attempt to wean herself down was hideously miserable. I fear that she may end up in a medical situation where she gets cold-turkeyed - which would be disastrous.
60
I am soon to be 68 and never had a problem with sleeping or leg cramps, dry eyes and mouth, nor dizziness until I was prescribed statins and blood pressure meds along with an anti platelet forming drug after having two stents placed. I take a 5mg ambien now and then for sleep. But my go to drug of choice is cannabis for the cramps and it also helps with sleep. After 50 years of using cannabis I can say that I don't appear to have any side effects. It's also very relaxing and fun to share with my girlfriend.
12
Ah, geez, another scare article about another class of drugs. How about some real analysis of why people are in so much pain and anxiety? Could it have to do with the constant state of war, violence, and frequent threats to daily living?
177
Tom, you're n the mark. The Grannies for Peace Brigade is full of old people with arthritis, tachycardia, asthma, and all the other problems of old age. But they understand the direct and indirect consequences of violence and injustice. So these old folks get out and take action. We hobble to the local high schools and hand out leaflets about planning for life after high school to avoid going into the military. We have anti-military actions on military holidays like Memorial Day. Getting out and taking action really helps control lots of the symptoms. And some of these elderly take action in spite of much physical pain!
9
You really think that taking medications are going to do anything for those problems?
1
YesYesYes! And from living so long in a society that is felt as more complex and threatening than most can manage.
Getting through each day for a Crown*, is a long slow slog of being inadequate to its demands or opportunities. It is for me, at 91, in excellent health, living in a pleasant retirement community, with adequate income and a present family. I think that covers all the basic needs. But! and ! I live in a rural town with very limited transportation and no longer drive; it is necessary to ask my family for or order special transportation for the elderly and disabled to market or keep health appointments and, more important, meet a friend, go to the library, buy a newspaper and have a cup of coffee. I live in a community but it's rural and that is because it is less expensive to house us there rather than in the town. When I look out my window at any time of day I see the same thing; it's a nice view but static: small buildings that hold our apartments, the road that connects them, trees. Not much changes: birds fly intermittently, more rarely a deer or flock of turkeys or a squirrel, or the trees sway if there is a breeze, an auto or delivery truck now and then. And I like looking out my window and observing the minute changes that do occur. What I'm saying is that it is easy to become bored, to become wrapped up in loneliness and fear, better known these days as anxiety, to feel useless and fatigued and like doing nothing.
*Crone of either gender.
L&B&L
3
The fact is that most doctors don’t understand the sleep mechanism in the brain and that each person may respond differently. Many people can not tolerate melatonin, otc sleep medications, etc. and benzodiazepines work best at small doses. Please stop generalizing patients - it does them a disservice. Lack of sleep can kill people, increase anxiety and suicide rates. This is not a small problem problem for those of us who have it.
133
But benzos actually disrupt sleep architecture so they end up making sleep problems worse.
Why would you take medications that exacerbate a problem? If you had hypertension would you want to take a medication for it that actually raises your blood pressure?
3
A person desperate for sleep will take something that helps him or her sleep. I know whereof I speak. There's a reason sleep deprivation is used as torture. People who are not in the position of needing relief are not able to understand those who are. Making theoretical arguments and warnings about a drug to someone in terrible pain is cruel.
11
I have taken a small dose of ativan at night for years to help get a good night's sleep. My sleep problems are better, not worse, with this.
Last year, after I heard about problems with benzos and old folks like me, I went to the manufacturer's website to see what the recommended dosage was, esp. for someone like me who takes it at night. It was 2-3 times as much as my doctor prescribed.
10
I think we are to swayed by anecdotal stories of a small % of people who have issues with the drugs they are taking. Opiod addiction and overdose (on prescription drugs) is very low. Some people who become addicted have had past issues with addictive substances (and hopefully we are starting to see addictive substances don't exist without an addictive personality (and another note is that the addictive personality is a continuum that we are all on, and subject to in different circumstances (stress, anxiety, etc)). Anyway, is complex. I have a family member who had a depressive/anxiety episode and is on Zanax and anti-depressives. Hopefully, when it is appropriate, he will be able to function without them. For now, thank god they exist and are available. He would not be here now without them.....(don't ask me how I know that, it is too painful).
19
Experts state that anywhere between 30-80% of people who take benzodiazepines for longer than six months will experience withdrawal -- the severity of withdrawal varies from person to person (it may be due to a concept called 'kindling': https://en.wikipedia.org/wiki/Kindling_(sedative%E2%80%93hypnotic_withdr...
You lack a basic understanding of the difference between physical dependence and addiction. Physical dependence is the body's adaptation to the presence of the drug. Addiction is a behavior of abuse. You can be physically dependent to a benzodiazepine without any abuse behavior at all, just by taking as your doctor prescribed. This has nothing to do with an "addictive personality". https://www.drugabuse.gov/publications/principles-drug-addiction-treatme...
26
Studies have shown that as many as 25% of people without any history of addiction or substance abuse who are prescribed opioids for chronic pain become addicted to them. Perhaps you consider that low.
3
Since most people are not prescribed opioids, the fact that 25% of those that are may become addicted to them does not make his statement incorrect.
2
One other point. Although both benzos and opioids are sedating, they both can interfere with normal sleep architecture so that use of them can actually worsen sleep, not improve in it.
7
First of all there is nothing new about concerns about the overuse of benzodiazepines. I and other physicians have written about this for years. In fact, this column could have been written 20 years ago as we have known everything in it for at least that long.
As to the use of benzos with opioids, something else we have known for 20 years. It is that use of benzodiazepines actually reduces the analgesic effects of opioids. That physicians not only continue to prescribe both but have done so at increasing rates just demonstrates how many docs don't know enough about these meds to prescribe them properly due to inadequate education.
Finally, it isn't true that benzos and the "z-drugs" are the same. The former are addicting in every sense of the word and, unlike with the opioids, withdrawal from them can be life threatening if the person goes cold turkey (I'd be willing to bet that if you polled your readers, most would think withdrawal from opioids is more dangerous). The Z-drugs can cause oversedation and are only meant for brief use but don't carry the same addiction risk as the benzos.
12
Actually, the Z-drugs cause physical dependence and withdrawal syndromes as well and must be slowly tapered (see schedule 12), often by using a benzodiazepine: https://benzo.org.uk/manual/bzsched.htm
Addiction and physical dependence are not synonymous.
8
You are mostly on the mark, except for the statement "that physicians not only continue to prescribe both....). In many cases, different doctors are prescribing the benzos and the opiods. Polypharmacy is particularly prevalent in the elderly because they are usually seeing several doctors for different issues, and there is no coordination between them. I saw this with my own father, where I had to try to keep an eye on what he was getting and make the different doctors aware of his other prescriptions. Physicians tend to be pretty resistant to non-physicians (I am a PhD) trying to get them to stop a med or coordinate with a doctor in another specialty.
9
Scientist,
If it were only a case of poor communication between physicians that would be bad enough but studies have shown that in many cases the same physicians are prescribing both classes of drugs which indicates they don't know what they are doing
4
In my province, Ontario, folks over 65 get their benzos et al for free - score one for big pharma.
10
Sounds like more elder bashing to me. I guess we are just too stupid and old to know not to take benzos with opioids, unlike the younger crowd who are dying in huge numbers. Maybe when you get older you should have the right to do whatever gets you through your life. Hey we have lived longer than most of the drug salesman and doctors.
202
Tell me about it! I just turned 65 a mere month ago & have already experienced the attitude that I'm a mush-brained senior who can't read an RX label or be able to discriminate about appropriate use of drugs.
32
I disagree. The problems described are endemic to the medical industry as a whole. A prescription is the quick and easy way out. Don't attempt to get at the deep roots of anxiety. Don't attempt CB or other non-drug therapies. Just write a prescription and send them on their way. Indeed, the only evidence of ageism I see here is the ignorance many doctors seem to have of the special needs of their older patients.
1
If you want the right to do whatever gets you through life, stop asking for special perks due to your age.
2
Informative articles like this are one of the reasons I subscribe to NYT.
4
Informative comments too!
4
I believe Ms. Span has written a similar article that implied that people over 65 do not have the intellectual ability to handle ambien (which I take). Insurance companies have used these articles to exclude coverage for these drugs to men and women over age 65. This saves the insurance companies a lot of money. In the past before AARP, automobile insurance companies used to charge people over 65 a higher premium for coverage, because all people over 65 are poor drivers, just as all people over 65 can't properly manage their prescriptions. On the contrary I recommend that ambien be banned for anyone not retired under age 65. They might be driving to work over medicated, unlike the retired senior having tea, watching the Today show.
95
I take a low dose of Klonopin (after weaning off another medication) for restless leg syndrome, which started about five years ago. Without it, I average only 2 or 3 hours of sleep a night. In my mid-fifties, the onset of menopause isn't helping my sleep either. My doctor requires me to check in every three months to discuss the effects of the medication, because it is a controlled substance, and has warned me that if it stops working I will have to taper off it as well before restarting treatment with it or a different medication. Do you think I'll be a safer driver dozing off at the wheel from lack of sleep, just because some people over medicate and some doctors prescribe medication without checking what their patients may already be taking?
10
The term,psychopharmacologist,is false and misleading. There is no such entity. There is no licensure, standards of practice or occupation as psychopharmacologist. It refers to prescribers who refer to themselves as that in order to obscure the fact that they restrict their practices to lucrative money making and time limited drug prescribing without the concomitant responsibility of monitoring for drug effects, adverse ones along with the desired ones, performing adequate physical assessments and practicing medicine with the patient's overarching benefit in mind.
Please, New York Times, expose the ruse of "psychopharmacology" and physicians posing as "psychopharmacologists" and stop using them as legitimate terms.
12
The Times might also stop referring to psychiatrists as "shrinks" a perjorative term. I don't recall it referring to anesthesiologists as "gas passers" or cardiac surgeons as "chest crackers." Why then the anti-psychiatry term?
13
Dear Ms. Span,
You didn't use the term and I didn't say you did, but if you're interested I can cite you many instances when your Times' colleagues have used it. And if you're unaware of this, apparently you don't read The Times very much.
2
"Gas passers." "Chest crackers." A bit longwinded compared with "shrink", but otherwise not a bad first attempt, Steve. Maybe we should try using these terms.
Cannabis. It totally helps anxiety, increases appetite and used regularly for insomnia. Also, when using cannabis there's never a feeling of being lonely. It's perfect for the elderly. And you can't overdose or become an addict. Get with it people!
119
@Mr. Slater: Ah, but you left out the part where underlying paranoid schizophrenia can be activated by cannabis use, as I saw happen to a close family member who ended up committing suicide.
13
Mr. Slater you hit the nail on the head. Thank goodness prohibition has ended in parts of the country. This one simple plant! I am no longer an addict of alcohol or opiods. I stopped taking anxiety and sleep medication I had been on for 30 years. I don't get addictive cravings and I feel great every morning!!! 50 yrs old. Been taking HUGE amounts of aspirin and ibuprofen for years, and.... No need anymore!
I have effectively broken my chains with big Pharma and rely less on insurance!
7
Proud smoker for 50 years. It worked for me.
3
The medical system is not equipped for the necessary individualization in the roulette game of legal drug dealing/addiction, nor are individuals equipped to deal with the drug marketing and naive trust in the profession. A temporary relief of any symptom is often followed by chemical adjustments in the body that make the drug no longer effective - and the PCP then recommending going off the drug with little knowledge of how to titrate off slowly. Then more side effects kick in.
Cannabis is a great alternative to synthetic drugs for sleep aid; edibles being the easiest for those who don't want to smoke. The use of psilocybin mushrooms is also being researched relative to anxiety and depression, since most current anti-depressants have little effect.
Not a bad idea for the elderly to start some exercise, increase endorphins, meditation, and look back to some of the early (abruptly stopped at the time) research on drugs from the 60's, which the MAPS Foundation out of San Francisco is busy doing.
NYU and John Hopkins are doing research, as well as the Realm of Caring in Colorado Springs which focuses on cannabis. The DEA needs to be revisiting their relationship to Purdue Pharma and the others that make daily news and effect lives negatively daily as well.
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I keep hoping to hear research results on the use of psylocybin as a sort of first line offense/defense for chronic and acute depression ( and for PTSD). A Dr. I see for depression thinks it offers a lot of hope for long lasting freedom from depression w/o having to use medications long term ( life-term) which does relieve depression for many, but with side effects.
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I wonder whether it is different in other countries.
Perhaps there are some cultures/nations that provide a better support for elders and there is less dependence on drugs.
(It might also be true for younger people.)
I suspect our nation is disease focused with little effort to encourage or facilitate the “good life” for our citizens.
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Wow!-a scare article in the NYT about benzos. Please look at the recent medical literature on benzodiazepines; it appears that antidepressants have been over-sold as a substitute and benzos are now being considered as first-line. Right, be really, really careful with benzodiazepines and opioids are taken together. If you take an older patient off benzos, what do you propose to give them instead for their anxiety? CBT? There have been so many studies that show that while people do become tolerant of some of the effects of benzos, the benzos maintain their ability to quiet anxiety. As to dizziness, nothing causes dizziness like anxiety. The main problem with benzos is that they are very inexpensive (ca. 10 cents a tablet) and the pharmaceutical industry would much rather you were dosed a second-generation antipsychotic, which cost $30 a tablet and poses the risk of stroke, diabetes, etc.
http://hughes12.com/The-Bias-Against-Benzos.php
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Yes, you are right that pharma would rather you be on a more expensive drug, but that does not mean that benzodiazepines are safe to take for more than 2-4 weeks. You wrongly assume that tolerance to the other effects is painless just because the anxiolytic effects might continue a bit longer -- they are not. Dizziness is not the only issue either -- you fail to consider falls, delirium, dementia, psychiatric manifestations of tolerance, memory loss, aggression, muscle spasticity, and withdrawal syndromes which can often be severe and/or life-threatening, etc.
In response to your posted article, there are others you might want to check out: https://www.youtube.com/watch?v=WUK64RcSDj8&t=138s
https://www.psychologytoday.com/blog/saving-normal/201607/yes-benzos-are...
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It's doctors who put elderly patients on these drugs, and it needs to stop. When my mother went into a nursing home, she was understandably depressed and sad initially. It was a big adjustment, of course. The doctor started her right away on an antidepressant. I was furious. Then, I found out that most of the patients were taking them. They make it easier for staff to deal with the patients. I moved my mother soon after to another nursing facility, where I refused to allow her to be put on the drugs. After a few months, my mother made a few friends and adjusted to her new life. She continued to have some periods of depression, but that was normal, in my view. She knew she was nearing the end of her life and naturally, she was sad and sometimes anxious about it. Who wouldn't be? But, the care she got was gentle and understanding. The doctors who hand out those drugs to the elderly should be disciplined, and their licenses revoked.
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Excuse me but as the article was about benzodiazepines, I don't see how your discussion of antidepressants was a relevant issue. And if you want to compare benzos to antidepressants, it's an easy one as the former are addicting and withdrawal from them can be life threatening and the antidepressants are neither.
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Actually, the good folks at Cochrane have proved otherwise, Steve:
https://www.ncbi.nlm.nih.gov/pubmed/21992148
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Excuse me, Steve. I guess I'm not as smart as you are. Sorry I confused "benzos" with antidepressants. My point was that these kinds of drugs (and hold on to your hat, Steve, while I refer to anti-anxiety and antidepressants in the same sentence) are handed out in nursing homes to make patients easier for staff to deal with. Who wants a bunch of old people being sad and depressed and anxious because they have outlived friends and family, and many are alone and know that the next step is death? Easier to have them all complacent and calm and in their happy places. We need more understanding and compassion for the elderly. Trying to address their needs with drugs doesn't help.
OK, Steve, go ahead and patronize me again.
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Benzos are fantastic for hospice and dying patients, therefore we do not want to ban the use in the elderly. It is important to tell the rest of the population that benzos can increase the death rate and dementia risk. Sometimes folks would rather not be in withdrawal for however many years of life they have left and elect to continue them. I think the critical first step is not prescribing them for daily use in the first place for anyone with a life expectancy > 1 year.
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I'm glad to see this article. Several years ago a doctor prescribed 25mg of amytriptylene to help me sleep. "Any side effects?" I asked. "No, maybe dry mouth." No warnings at all. It was soon clear that 25 mg was way too much. So I eventually got it down to 5 mg a night, taken 4-5 nights a week. A year or so later, sleep felt heavy, so I stopped taking it, assuming ending such a low dose wouldn't register much difference. A week later, I came down with nausea, chills, such fatigue I absolutely couldn't even get out of bed. Only a few days later did I connect what I thought was an oncoming flu to discontinuing even such a small dose. A Google search into "side-effects of amytriptylene" showed in a box every one of my symptoms, and testimonials of people who suffered for months from withdrawal. My doctor should have warned me about the dangers of stopping even a small dose. I will never forget what those weeks of withdrawal felt like. Wise up, doctors! Take a few minutes to explain what you're giving people who trust you.
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The doctor should have been prescribing amitriptyline for sleep problems in the first place.
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I left out the "not". It should have read the physicians should not have been prescribing amitriptyline for sleep problems.
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I think that one general problem is that dosing of most meds - is done as if every adult were the same: age, sex, size, health and despite other meds being taken (including OTC and prescribed meds). Some times even before I got "older," I reacted more strongly than average for some drugs, to the extent of taking a child's dose of say, an allergy medicine, and finding it sufficient. I suspect that the older you get, the slower the metabolism, and the greater the risk that something will also remain in your system longer. Or perhaps the enzymes or liver function are not as effective in clearing toxins. When there is a lack of specific information about differences in effects on older folk, it makes sense to act as if this is probably the case.
AND - we so do need more geriatrically trained physicians.
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The problem with these studies is that they promote one size fits all thinking. It is happening with people with pain and prescription of opioids. Patients are being weaned of pain medication who never abused it and need it for unrelenting pain. It is the same with Benzos. There are people who don't abuse them, have never upped the dosage, and know not to mix them with Alcohol or Opioids. I'm one of them. Let's finally deeply look at each individual patient, and prescribe accordingly.
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Thank you; very well written. Some patients need benzos to function, let's not stigmatize their medical condition nor scare them.
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The problem is that there are no studies demonstrating the benefits of extended use of either opioids or benzos with the exception of using the latter for true anxiety disorders (this does not mean the person is just feeling anxious, it means they have diagnosable disorder that is preventing them from functioning and I can assure only very small minority of people prescribed benzos have one of these).
Doctors can either practice medicine based on true science and research or based on anecdotes. You decide which you would prefer.
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The majority of people who wind up in trouble with benzodiazepines take them exactly as directed for longer than 2-4 weeks. Not abusing them is not insulation against their damage. In fact, people who do abuse them might fare better in regards to becoming physically dependent than people who take them as directed, because abuse is sometimes sporadic and not daily, whereas they are often prescribed for chronic, daily use. Daily use long-term is what results in tolerance, tolerance withdrawal, interdose withdrawal, physical dependence, and subsequent withdrawal syndromes. Abuse, of course, is more dangerous because of risk of overdose, especially in combination with other drugs/polypharmacy. Also, most of the escalating dosages are done by the prescriber in patients who are on long-term benzodiazepines as prescribed. They increase the dose because they're "treating" tolerance withdrawal. The problem with that is, you can only chase that dragon so long until you're tolerant to the higher dose -- then what?
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I wonder why doctors don't prescribe mindfulness based stress reduction (MBSR) first instead of immediately leaping to medication? It can be quite effective for anxiety and chronic pain.
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Although single professional guideline on the treatment of sleep problems recommends trying psychologically based therapies first before going on to medications (and not the benzodiazepines), I can give you two answers to your question:
1. Most physicians receive at best minimal training in the psychologically based therapies and so don't even know about them and because they don't do them aren't going to paid to do them.
2. Sadly, many patients think that if they aren't prescribed medications for a problem, they aren't getting the best treatment and will be dissatisfied with the doctor. This is true about sleep medications, pain medications, and antibiotics which is why doctors prescribe them for viruses for which they have no benefits.
Doctors find it far easier to give patients what they want and not what is in the patients' best interest.
3
they do.
Well written and don't forget alcohol.
Although we are successful with things like campaigns against drunk driving and AA chapters but it is still a problem including with seniors, but with drugs we went in the opposite direction.
We expanded our de facto criminal health care system and added another crime to it, legal drug pusher resulting in the current disaster.
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Thank you so much for this wonderful article.
Nothing but respect and admiration for Ms Falstein. She truly is an inspiration.
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Maria Bierens in Holland, nothing but respect and admiration for you as well, my sweet love and partner for life. You've educated yourself way beyond the "call of duty" in all things benzo all to understand my plight.
You've been with me for over two years in this struggle and always by my side.
I only wish this article had included what an important role you've played in my life.
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Great article.
Thirty years ago I had trauma related emotional problems that really shut down my ability to sleep or work. I was told that, in effect, Big Pharma was my friend.
That led to many years of nightmarish struggle to recover, not just from the trauma, but from the legal drug addictions. At the time there was no help available to wean myself off the drugs, in fact, was strongly discouraged from even trying. Now I read of massive problems with dementia and other long term side effects.
We consumers of Big Pharma products need a vital and loud consumer agency protecting us from them and those doctors who more than anything, seem to work like the drug dealer down the street (metaphorically speaking) who only exists to sell drugs and create addicts.
Hugh Massengill, Eugene Oregon
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As to that 30 years ago. At that time I was doing my pain management fellowship and many of the patients we admitted to our inpatient program were taking benzos and even then we knew we needed to get them off of them and we did so safely. It is not true that there was no one around who knew how to safely discontinue those drugs at that time. Perhaps your physicians didn't but it just meant you were going to docs who didn't understand the drugs they were prescribing.
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Delve deeper into this medical concern and one might see it as symptomatic of many other medical issues: limited research into the role of gaba and its neurotransmitter related system that underlies why benzodiazepines are effective, almost no research into cannabis as a possible substitute for benzodiazepines, primary care not trained on weaning patients off benzodiazepines, and an inadequate communication structure between patient and doctor. Chronic medical issues require frequent and accessible communication that can not be accomplished by either once every six weeks office visits or use of a tech assistant as a phone contact go between. Cognitive behavioral therapy is very expensive, highly communication dependent, and may not be silver bullet so often cited in mass media.
Last, physicians have little accountability other than fear of a malpractice law suit. My elderly mother took a benzodiazepine for over 20 years as a sleep aid. When it stopped being effective her locally esteemed physician instructed her to stop cold turkey. Cardiac stress shortly occurred and she had a defibrillator implanted. By her own request she returned to nightly use of the same benzodiazepine and over the next year her cardiac issues subsided to the point that it was no longer evident that the defibrillator was necessary. Where was the equivalent of a trip wire to keep treatment from reliance on a cold turkey protocol? Peer review? Access to an ongoing clearing house of treatment results?
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William Phillips, cognitive behavioral therapy needs a properly trained psychologist and, as you say, isn't a silver bullet. But at the very least it does not have the harmful side-effects and dangers that these drugs have. As for being expensive, maybe, but not more expensive than the same amount of time spent at the physician or psychiatrist, while they just randomly try different drugs or doses on you.
5