Benzodiazepines for Anxiety Disorders | Dr. Jeffrey Knuppel
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- Опубліковано 22 лип 2024
- Benzodiazepines are an effective yet controversial treatment for anxiety and panic. In this video, I combine what I've learned about treating patients with anxiety disorders for many years (with benzodiazepines and other medications) with what research says about benzodiazepines (also known as "benzos") for the treatment of anxiety disorders. This class of medication includes medications such as alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin, Rivotril), diazepam (Valium), and others. In this video, I review how benzodiazepines work, how they are similar to and different from each other, what we know about what they are most effective at treating, and the possible side effects. I also discuss the "benzodiazepine conflict" that arises between patients and prescribers because these medications can provide immediate anxiety relief for many people yet carry risks that must be considered as well. Finally, I discuss why many prescribers are hesitant to prescribe alprazolam in particular.
I'm Dr. Jeff Knuppel, a psychiatrist (M.D.) with over 20 years of practice experience. I'm a licensed healthcare professional (physician) in Wisconsin, USA. My goal is to create helpful and interesting videos about mental health and self-improvement. If these topics interest you, please subscribe so that you don't miss any new videos when they are released. Thank you!
DISCLAIMER: This channel is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on or linked to from this channel is at the user’s own risk. Please consult your healthcare professional before making any changes in your treatment. I do not respond to requests for medical advice, either as comments/questions on this channel or as direct messages to me.
What's your experience been with benzodiazepines and anxiety? Share your thoughts below! 👇
Honestly I would love to do an interview with you
Will you interview me but I would love to do that because I have things to say that would probably help the world of benzo withdrawal. Being as where it is now I don't have to tell you you already know how it's going with that
Sent me crazy for 3.5 years when I stopped.
You are the only freaking person explaining this that well, because I've had panic disorder since I was nine years old, I have Trauma from seeing the first Tower get hit on 9/11, waking up literally 5 minutes after falling asleep hearing that Bang from the tower getting hit, it keeps me up all night sometimes for days, and constant panic, and it's PTSD . On top of that I can't even leave my freaking house, I have severe severe severe panic disorder, I used to throw up before getting on roller coasters, I used to throw up on Christmas day, I still do to this day throw up at times because of nervousness, my doctor today I saw her after waiting 3 months for this appointment, she insists on getting me on an anti-psychotic, I've already been on that one as well and others, along with every single SSRI and snri along with beta blockers which beta blockers actually landed me in the hospital because my brain is so hypersensitive to anxiety that it can tell the difference between low blood pressure and actual Panic anxiety, so she just insisted on going the SSRI route and tell me straight up you don't remember what the effects were when you were on the ssris, I said how are you going to tell me I don't remember if they worked or not. I was like I was on them for extended periods not just a month not just a week, years at a time, and at the same time I don't remember anything? I'm like they don't work for me, I said I'm depressed because I have panic disorder, I can't do anything at the age I am at now, I can't progress the way I want to, I start panicking when I leave the freaking house and I'm not even agoraphobic, my heart just starts to race and I get panicky and I have to go back in the house, but I know that if I had something as a safety blanket in case the Panic started, it could work almost like a placebo where I feel I would not have to actually take them, or as much I mean. I don't want to take them every day, no not at all I understand the pharmacokinetics of benzos, but at the same time to treat every patient the same, insisting they take what they've taken already, and then on top of that I don't know who the genius was that came out and said everybody needs to get off their benzodiazepines right now and these moronic people in this world decided to agree with it and say hey we all need to do this and start suing our doctors, it's like do you guys not remember why you got on them? You're ruining it for the people that actually need them and on top of it, people that are abusing benzos make it harder as well, it's just not fair and this whole world is Twisted I'm glad you posted this because you make a lot of logical sense, I'm at a stand still right now and it's honestly driving me freaking nuts😢
Thanks for your comment. I sincerely wish you the best. It sounds pretty intense and distressing.
@@JeffreyKnuppelMD yeah she is pretty much trying to get me on a cocktail of ssris and antipsychotics and I am not doing that. It's not working it never has and I'm not going to submit my brain to another fluctuation that will cause rebound issues in the future. Of course we're looked at as people seeking out benzos but I don't even drink I don't like feeling drunk, if I ever do take a benzo it's given by a family member a certain amount maybe six or seven of them like stashed away for an emergency but I take the bare minimum, 0.5 of a clonazepam before bed or even a 0.25, I never raise my dose, but at the same time the doctors now are feeling like they're going to lose their licenses because of the fear-mongering going around and the World against benzos now, which in my opinion is making the healing process worse for people because in these groups people are saying, while some people say they didn't have many symptoms when they were tapering or even cold turkey, I even know my own mother was on 1 mg of Alprazolam for 32 years she stopped cold turkey had no withdrawal symptoms, I know other people and I've seen people that abused benzos that were tapered off quickly within 2 weeks and healed within a month after with no protracted symptoms. Entire jail / rehab where people abuse these benzos and get off rapidly, tend to not go back because they submit nor do they give in to the fear-mongering. A lot of these patients nowadays have never felt withdrawal before so it comes off as absolutely insane to them, whereas drug addicts or recovering addicts have been through opiate withdrawal, they can take pain so they can taper off rapidly. But in these groups there are people that say they didn't have any symptoms and they are bashed for saying that thank you, people say you're a liar you have never been on a benzo and all of this nonsense and I'm like how are you guys going to tell these people this? It's like if they don't suffer what you suffer they are liars? There are close to 9 billion humans on Earth and genetically / biologically / neurobiology not everybody is the same. And to expect that everybody is the same it's causing this Mass hysteria nowadays. And people are not healing because their brains are creating symptoms or mimicking symptoms that they read from other people and that is the problem in my opinion
These meds should not be prescribed for anxiety. MAYBE if severe trauma occured, and then only for a week or 2. You will be worse off after quitting these meds.
Thank you for sharing your expertise.
You’re welcome! Thank you for watching.
Great video on Clonazepam.
Thanks! I’m glad you liked it.
Here's a good book on this topic: The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs (The Maudsley Prescribing Guidelines Series) 1st Edition.
Wish you were my psychiatrist. Since Covid, hard to get an appointment with any psychiatrist. I've suffered from GAD, Panic and mood swings for most of my adult life. Some days I can cycle thru feelings of feeling relatively normal and then severe anxiety / panic several times. Really the only thing that has ever helped was Clonazepam but having an addictive personality (alcohol abuse when younger), I try to take it sparingly and then mostly at bed time. I probably average 0.5 mg a couple times a week but sometimes go a few weeks without. But one thing I've noticed is, it's supposed to have a half life of something like 12 hours but when I take it during the day which isn't often, I would say, it takes a good hour to have an effect and then after maybe four or five hours it starts to wear off, I wonder why that is? Wish it lasted the whole day. I recently tried buspirone which helped a little but increased my dizziness as well as tinnitus. Now trying Gabapentin, not doing a thing.
Excellent video and well explained. I wouldn’t take them again too many problems
Thank you!
Explained very well. Thanks Doc!
My pleasure! I’m glad it was helpful.
I’ve been on the same benzo for close to 20 years now. One time I ran out and forgot to fill it, it was crazy my mood went from happy to sad, I could not sleep I got 1 hour in 2 days, and I would get really warm then freezing cold. Finally I found out I was without it and went back on it.
That's a great example of why people who take benzos regularly for many years shouldn't stop them abruptly (I realize you did this unknowingly).
I have been on 1mg/day as needed for several years. They are still effective. I have never run out, I actually have a surplus. I also take Gabapentin. The combination works. I have been through the gamut of SSRIs and atypical anti psychotics. I work in IT. Amazingly, I can function well.
Thank you for the video.
I have refractory GAD and Agoraphobia.
I have been on Diazepam for approximately 6 years, BUT, not daily. PRN only, which usually is 1-2 per week, and sometimes I’ll go for a few weeks without using it.
It is moderately helpful and I tolerate it perfectly.
I think benzodiazepines certainly have their place, but they need to be used appropriately, based on each individuals circumstances.
Thanks for sharing that. I’m glad you found something that works for you. I 100% agree with your conclusion.
I'm glad that there's a MD that has a more open mindedness about the use of small dose benzodiazepines, some doctors made you feel so guilty about wanting it for severe anxiety.
Don’t do it!!
28 years ago I had anxiety, panic, especially in crowds. I saw a psychiatrist who prescribed clonazepam for 3 months and did exposure therapy to crowded places. As far as Xanax, I know about 30 people who are addicted. The best euphoria is from Valium, imo
Thanks for sharing. I hope the treatment you received years ago has helped you.
thankyou for this when used correctly they really do help. What do you say about the doctors that are refusing patients Benzos? Also could you please do a video on anxious patients starting new anti depressants please. It's very scary. I have to start a new one as my old one is making me sick in the stomach 😢
Thanks for your comment. I tried to explain in the video the dilemma doctors face about prescribing benzos as it’s not always an easy call, but as I mentioned, always and never are not usually the right answers in medicine including when it comes to benzos. I appreciate your video suggestion. Best wishes with your medication transition!
Are you familiar with Maoi’s? Would love a video on them!
There aren’t many videos on UA-cam about them!
I am currently on Tranlycypromine.
Yes I’m familiar with MAOIs. They’re not prescribed often today, but they’re very effective for some people. Thanks for your suggestion.
Thank you for the video. I was prescribed Prozac and gabapentin and clonazepam as needed. I only take Prozac and clonazepam, I am honestly scared to try gabapentin. My psych doesn't know. My panic disorder is daily and I been trying to find a proper solution without messing my brain any further.
i get panic attacks daily
You’re welcome. I’m sorry to hear you’re having panic attacks daily despite taking Prozac and clonazepam. Obviously this is something you should talk through with your prescriber, but if you’re still having them daily, it doesn’t sound like what you’re on is working very well and may need to be adjusted or changed. I certainly wouldn’t be satisfied with that result. As far as the gabapentin goes, I made a video recently about pregabalin and gabapentin for anxiety that might help you information-wise about the gabapentin, but whether or not gabapentin is likely to help you, your psychiatrist is in a better position to discuss that with you since they know you. If you haven’t already, you may want to discuss with them psychotherapy (it really does help panic) and exercise. Meds certainly aren’t the only option, but I know from experience that some people can get more “traction” with the non-medication approaches if they’re doing at least somewhat better from meds first if they’ve got moderate to severe panic disorder (since people with panic disorder are often terrified to do anything because they fear having more panic attacks).
@@JeffreyKnuppelMD thank you for the response, I will talk to my psych about this!
Thank you for the video. Now I have more anxiety
And also, somebody can fall off the road after taking the seroquel, they can fall off the road while taking other non-narcotic or any type of mine altering substances, they can still have that same exact effect and I think it's overlooked, everybody always and I'm not talking about you or saying you said the wrong thing you're actually saying everything correctly, but at the same time people that truly need these medications as a safety blanket at the most or the least, these doctors nowadays it's so obvious that they are just not prescribing them because of the reasons like the benzo Holocaust we are in now, that's why they are not prescribing I'm not because these patients don't need them, it's just insane so somebody has to suffer and then develop a heart condition and then I have to go through extensive care in their life because their panic disorder was not taken care of properly😢
I would love you’re opinion on my case please. 🙏🏻.
I have had pop a Nic disorder for over 20 years now. I barely drink alcohol nowadays. O can live my normal daily life with no anxiety and my panic and irrational thinking anticipatory anxiety only comes when I have to do something more out of my comfort zone. Such as long travels, shopping centres and Iv completely avoided flying for years so have missed many family holidays down to being too scared of getting in a plane and not being in control at all or able to get back to my safe place if I need too. Iv tried many ssri and currently take 20mg escitalopram which I have recently reduced to 10mg as daily im fine. I was out of comfort zone the other day and freaking out so I had a pint of lager, not recommended I know, but when you get like that u just need an out, and it did I had a great day and my thoughts were not on anxiety at all which was awesome. I was thinking if I had a benzo in these rare occasions or if I were to brave going on a holiday I could take them, fit not daily.
While I can't give individual medical advice, I can tell you that a common use case for a benzodiazepine is to have it available as-needed with the intention of taking it infrequently (as you mentioned) along with an SSRI (like the escitalopram you're on) or SNRI which is taken every day. So, yes, what you asked about is a good strategy for many people. Only you and your doctor/prescriber can figure what's right for you, though.
@@JeffreyKnuppelMDcan I take benzos while on fluoxetine? Im hoping I get them prescribed for me so I can actually be around a lot of people
I am the patient C example. Tried many different medications and had to taper them off because of side effects / no effect for my severe social anxiety. Yet I am still scared to approach my doctor with the idea of benzos, it looks like to me it has a super bad reputation due to all abuse with it.
Thanks for sharing that. That’s gotta be a tough spot to be in. You could let your doctor know that you’ve done some more research on treatments and wondered whether a benzo might help. It’s best to just be honest that you’re hesitant to even bring up the topic because you don’t want to seen as drug seeking but feel desperate to get relief. This could at least start a conversation with them about the topic. The other thing to keep in mind is that cognitive behavioral therapy is very effective. Personally my experience in treating patients with anxiety disorders with medications has been that social anxiety is one of the more difficult types of anxiety to treat. I hope you find something that works for you.
I've been on clonazepam 2mg for 4 consecutive months... How long wil tapering take?
I just answered your question about this for another video here -- you said you're using it every 2-3 days. How long it takes to taper off a benzo depends to some degree on the person taking it, but if you're taking 2 mg/day every 2-3 days and have only been on it for 4 months, my best guess is that you can get off it over a few weeks. Please be sure to work with your prescriber in doing this.
At least a year
Look into flotation therapy
I've had my prescription for years and I've never abused them.. A 30 day perscription would last me like 4 months. Only took half a pill of a low dose when needed.. I realize it's a bandaid and you really need a therapist to get at the root cause of the anxiety and fears and work from there but I'm thankful that I have them for rough times. Like when my mom passed last year and I had to plan everything... There good if you respect them and only take as needed. Dr should prescribe them like my Dr 1 refill for a 6 month period. That's 60 pills for 6 months..That way you don't get addicted to them....I see nothing wrong with that..
That makes perfect sense -- I'm glad to see it's working for you. I agree with your comments about benzos. Thank you for your comment.
See I would get my clonazepam from somebody I know, and yes they are prescribed to her, but I never went above 0.5, even when I figured they weren't working as well, I just didn't increase my dose I had to do the rest of it as self work in my mind, like if I said hey I can't fall asleep tonight that well the 0.5 isn't working as well so I'm going to have to do my own mindfulness with it and eventually I would fall asleep, but at the same time, I just refuse to raise my dose. I never felt the need to keep going up and up and up and up
What is the shortest time to be on Benzo for GAD
There isn't really a shortest time period, but I'll just say that in some situations such as when someone with an anxiety disorder also is going through a particularly stressful life situation, a few weeks may be helpful. The challenge with treating GAD for such a short time period, though, is that it's often a longstanding problem, and without any other treatment such as therapy, the anxiety is likely to come back.
Crore Thanks @@JeffreyKnuppelMD
You’re welcome!
Isn't there a place for this class of drugs in bipolar disorder? Antipsychotics seem much worse so far as antimuscarinic effects, which most likely does lead to dementia. SSRIs and SNRIs are not an option for many due to mood instability. In my personal experience, withdrawal from antipsychotics is just as bad as benzos. I've often wondered if the anti-benzo stance of the past decade is a moral panic of sorts. Those with bipolar who are stable on lithium for example don't have many good choices for anxiety. Even anticonvulsants that can help have major cognitive side effects that for many make day-to-day life difficult. Can we really say quetiapine is safer than clonazepam?
Benzodiazepines definitely have a role in some patients with bipolar disorder although I do believe that increased caution about prescribing them in recent years is legitimate. I agree that antipsychotics are definitely not benign drugs - you mentioned Seroquel - I see this overprescribed frequently. With the newer antipsychotics, the metabolic side effects are often overlooked. As I mention in many of my videos, care must always be individualized as each person is different. The side effects of these meds are frustrating to me as a psychiatrist, too. Thanks for your comment.
I switched psychiatrist was doing fine on ativan for sleep and val for panic now i have been diagnosed with cancer can't sleep burn off the ativan with the bad anxiety panic shaking cant calm down and he says lets try another ssri i been on and snri and old time doxepin,elvil most others ,and never overused they even checked in the cures db no problems i mean i have cancer and may not make it but i do know i wont even get into the ent drs office to talk if i cant sleep and iam in panic already and now make my remaining days the worst
I’m so sorry to hear about your situation. It sounds enormously stressful to say the least. I hope you can work with your doctor to find something that helps, and I hope they’ll listen to you and work with you collaboratively.
I have been on Xanax for several years and it works well for me
I’m glad to hear you found something that works for you, thanks for sharing.
Look up benzo withdrawal and Akathisia
Diazepam made my anxiety worse ,made me severely agitated and aggressive
Thanks for sharing your experience with diazepam.
Akathesia
Not sure what that is
What about all the doctors that just do not want to prescribe Benzos any longer, especially the younger doctors. You older guys are going to retire one of these days. Then what? This needs to be addressed pronto.
I explained in the video why, in my opinion, doctors are more cautious about prescribing benzos now than they were 10-20 years ago, but I wasn't aware of a particular trend among younger doctors who don't ever prescribe benzos. What has your experience been regarding this? I'm curious.
@@JeffreyKnuppelMDGeneral consensus among the benzo recovery forums is that doctors are no longer willing to prescribe Benzos beyond 2 or 3 weeks if at all and usually only in conjunction with an antidepressant or antipsychotic prescription which are being used now in lieu of a Benzo. The few weeks are to help with the usually terrible symptoms that come with starting an antidepressant. Abruptly stopping a benzo script is becoming more common as older doctors retire and younger ones take their place. I’m 71 and had to turn to the online forums when my physchiatrist of 25 years abandoned me because I hit tolerance and my benzo was no longer effective. He did not want to deal with withdrawal in the correct way and it took months to find another doctor. I finally found an older doctor willing to switch me over from Xanax to Valium per the Ashton Manual. General consensus is that older doctors are more willing to prescribe for longer periods of time and almost no doctors know how to taper correctly. Physchiatrists are seriously trying to tell their benzo patients to go to rehab which would be the worst medical advice ever given by a doctor who took an oath to first do no harm.
What about the hundreds of thousands of people worldwide, including myself, who suffers from benzodiazepine induced neurological dysfunction? Years of living in hell after getting off because the body have problems or can’t regulates the gaba a receptors back to normal. This can happen to people even on low-dose and on short term use. And before you go to the conclusion of “recreational use” and addiction only 0,2% of those who get harmed by benzo meet the criteria for abuse and 99,8% took the benzo as prescribed according to “the psychologist magazine “. Even the FDA updated their warnings last year. Please update yourself before lecturing people about this dangerous medication.
Thanks for explaining this.
@@TsStonechronic stress and anxiety can cause way more issues neurologically. Why are u taking them if they cause issues? Take them once or twice a week. Like how we're supposed to ration sugar
Please people don’t take these pills eat healthy and exercise and yoga don’t go the pill route if you can help it
I 100% agree that lifestyle and non-medication approaches are best if they work for a person. However, some people also need medication to function and be well (I think I explained this well in the video).
I fully concur that benzo’s can be extremely helpful for some people. I took Clonazepam daily for about 5 or 6 years and it helped me out a lot. And eventually I decided to slowly wean myself off it, and I didn’t experience any kind of withdrawal symptoms at all. Of course, this isn’t everyone’s experience and I admit that they can cause bad withdrawal issues for people that are more predisposed that way. But the solutions to that are never far away. Either stay on them so withdrawal doesn’t happen, or taper off them very slowly. That way even if there are some withdrawal symptoms, they won’t be any worse than coming off your average antidepressant
Thanks for sharing your experience.
That’s really assuring I’ve been on klonopin for almost 7 years it was the only thing to make me feel somewhat normal with high anxiety , dpdr ext
I only take .5 and I had a bad anxiety setback here recently and take .5 2x a day which is what is prescribed but I’ll taper down ima. Couple weeks back to .5 a day good to know it’s not all horror stories ❤
There are no guarantees with any of this. I tapered off of 25mg of Temazepam over 1 year and continue to suffer 6 years on. My story is repeated hundreds of thousands of times over. Maybe more.
@@THXx1138 Temazepam is short acting so 1 year seems to short for withdrawal. I took about 3 years to withdraw from diazepam which is very long acting. If you are withdrawing and getting withdrawal symptoms then you should go back to the dose before and go more slowly. If you had withdrawal symptoms it honestly is because you rushed the process
@@THXx1138Much more.
Benzo's destroid my life 😢
same here, absolutely horrible medication. they shouldn't even be called medicine.
Why? I'm trying to get my hands on some. I use to take codeine. I can't wait to try them bc anxiety and chronic stress is way worse than any pill I could take
You can but they are highly addictive, they will make you worse off during and after use, way worse. I strongly suggest healthy alternatives. Dr. Peter Joseph Witt Doering on youtube makes a lot of content on the topic of the dangers of benzodiazepines. " I can't wait to try them bc anxiety and chronic stress is way worse than any pill I could take" you say this with truth, but you haven't experienced the absolute horrors of benzo withdrawals. Good luck on your healing journey.
The worst drug in the planet.
Valium works yo relax my scoliosis and helps me stop bring anxious do I can focus to work. If I take more than 5mg at once I’ll feel drowsy and need to sleep. I have never gotten high from Valium. It’s useful and it seems to scare doctors to death (similar to prescribing morphine 😂). It’s a good drug. I am limited to 50 every 6 months only. I self regulate. Luckily I have a very good doctor.
Don't do it