In a single year, more than 16 million prescriptions for Xanax were dispensed to treat anxiety and panic disorders. Klonopin and Ativan prescriptions added up to 14.7 and 10.5 million, respectively. As for Valium, the number was only a little shy of 5 million, and it was mainly written for anxiety and alcohol withdrawal. So, […] The post What Is the Safest Benzo for Anxiety? appeared first on Garden State Treatment Center.
In a single year, more than 16 million prescriptions for Xanax were dispensed to treat anxiety and panic disorders. Klonopin and Ativan prescriptions added up to 14.7 and 10.5 million, respectively.
As for Valium, the number was only a little shy of 5 million, and it was mainly written for anxiety and alcohol withdrawal.
So, all these benzos can be (and are often) used as anxiolytics, but which should you use? What is the safest benzo for anxiety?
There are no hard and fast rules, and it’s hard to say that one benzo is inherently better than the others without knowing the risk factors and case specifics. Your psychiatrist will consider a bunch of factors before deciding on a suitable medication.
In the meantime, let’s learn more about these drugs’ safety profile, risks, and more.
Benzos: Overview and General Safety Info
At one point, barbiturates were the dominant sedative-hypnotic. By the 1960s, scientists had discovered chlordiazepoxide, the first benzodiazepine ever.
Soon enough, benzodiazepines (BZDs or simply benzos) were among the most widely prescribed drugs in the world. They were used as sleeping aids, muscle relaxants, sedatives, anti-convulsants, and more.
The reason they became this popular was actually their safety. BZDs were considered safer than barbiturates. Of course, this popularity dropped over time as people started realizing how addictive benzos can be.
Today, benzos aren’t the first-line medications for anxiety disorders. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are both the treatment of choice for generalized anxiety disorders.
BZDs are now mostly used for short-term management of anxiety.
5 Possible Risks of Using Benzos to Treat Anxiety
Let’s take a closer look at the addiction potential and the other issues that make benzos risky:
1. Addiction and Misuse Potential
Unfortunately, all drugs in the class are habit-forming and have the potential for misuse. Reports estimate that around 17% of the people taking a benzo are abusing it. This can mean using without a prescription, taking higher doses, or taking more doses than necessary.
Long-term use of benzodiazepines could cause physical dependence, which is when your body adapts to the drug and can no longer function properly without it.
2. Toxicity and Overdoses
Benzos work by increasing GABA neurotransmitters in the brain, which calm and slow down the central nervous system. In normal doses, this effect can tune down the intensity of anxiety and panic attacks. So, while overdosing on a prescription benzo is possible, it’s unlikely.
The risk becomes bigger if:
- You’re taking more than what’s prescribed.
- You have alcohol or other drugs (mainly opioids) in your system.
In fact, over 80% of fatal benzo ODs involve opioids.
But even marijuana intake can interfere with benzos. For some people, it’ll cancel out the effect of the drugs and worsen the symptoms of anxiety. As a result, they might be tempted to take an extra pill or two.
3. Withdrawal Symptoms
Another risk that scares people away from using benzos is withdrawal. Since they cause physical dependence, the drugs can also put your body in withdrawal if you try to stop abruptly.
Long-acting benzos are considered a bit safer because they’re less likely to trigger the symptoms.
4. Impairment and Accidents
Because BZDs can slow down nerve signals (and thus, reflexes), they could be particularly dangerous for drivers. They can lead to drowsiness and affect a person’s ability to drive or operate heavy machinery.
The risk is usually highest when the person first starts using the anxiolytics.
5. Potential Harm to Fetuses
Some benzos have a category D rating from the FDA. This means they could be used by pregnant women if a physician decides that the benefit outweighs the risk.
Other benzos, however, fall in the category X. These are always contraindicated during pregnancy. Think flurazepam (Dalmane), Temazepam (Restoril), and triazolam (Halcion).
3 Factors That Affect the Safety of a Benzo Treatment
Healthcare professionals need to know about previous and/or current substance abuse issues. They should also be aware of your up-to-date medication list.
Here are three more aspects that go into consideration:
1. Benzo Potency
Benzos vary in potency. So, what is considered a “safe” dose changes from one drug to another.
For instance, an oral dose of 0.25–0.5 mg of clonazepam (Rivotril and Klonopin) is more or less equivalent to about 15–30 mg of flurazepam.
2. Benzo Duration of Action
Lorazepam (Ativan) and alprazolam (Xanax) both have short half-lives and don’t stay in your system very long. They’re called short-acting benzodiazepines, and they’re more commonly used as sleeping aids.
Generally speaking, these drugs have a high misuse potential. But lorazepam still causes fewer withdrawal symptoms and has a lower potential for abuse than alprazolam. That’s because it has a slightly more prolonged effect.
Your psychiatry provider might opt for an even slower-acting benzo when prescribing an anti-anxiety medication that you’ll use long-term.
3. Patient’s Age
Older people can be particularly sensitive to the side effects of benzodiazepines. They’re more likely to get confused and lose coordination.
Additionally, as we age, our livers may become less effective in metabolizing certain drugs. So, a physician might prefer benzos that don’t rely on liver function.
Lorazepam, for instance, is considered a safe choice for patients with hepatic impairment.
Common Benzos: Clonazepam vs. Lorazepam vs. Alprazolam
Clonazepam is a long-acting benzodiazepine with a half-life of 30–40 hours. It’s mainly used to treat seizures, but can also be helpful in cases of panic disorder.
One study compared it to alprazolam and lorazepam and found that there wasn’t much difference in the anxiety assessment scales. There was, however, a difference in the incidence of side effects. Clonazepam caused the least adverse reactions, followed by lorazepam.
It’s also worth noting that while clonazepam is safe to use with contraceptives, lorazepam should be used with caution. It won’t affect the contraceptive, but it might be less effective in managing anxiety symptoms.
7 Tips for Safer Benzo Use in Anxiety Cases
Besides clonazepam and lorazepam, several BZDs can be safely used to manage anxiety. A lot of the safety aspect falls on how you use the drug.
Here are seven tips that can make your benzo use less risky:
1. Don’t Mix Drugs
The number one safety tip is to never mix your prescribed benzos with illicit substances.
Even if you’ve already experimented with the substance and know that your body can handle it, you won’t be able to predict how it’ll interact with the benzo.
2. Stick to a Low Dose If Possible
Odds are, your psychiatrist will start you off on a low dose for short-term treatment. They might even prescribe BDZs for use as needed rather than a fixed daily dose. Your best bet is to stick to their instructions and not take more than what’s prescribed.
Remember that the goal is relief from anxiety, not total sedation. If you’re not getting enough relief, talk to your psychiatrist about increasing the dose gradually.
3. Journal Your Intake
If you’re worried about the addiction potential, consider keeping a journal. You’ll write down every dose you take and how effective it was in reducing anxiety and panic attacks.
This way, you, along with your psychiatrist, can go over the intake frequency and spot early signs of misuse.
4. Set a Longer-Term Plan
The benzos might work well in the short term, but you still need to consider what you’re going to do in the long run. It’s always better to learn to process your anxiety and regulate your nervous system.
Here are some options to consider:
- Try using talking therapies, like cognitive behavioral therapy (CBT). It can help with social anxiety disorder and substance use disorders.
- Make lifestyle changes that are generally good for your mental health (exercising, getting enough sleep, avoiding burnout, etc.).
- Look into other treatment options, like SSRI antidepressants. Nonselective beta-blockers are originally blood pressure medications, but can help with anxiety as well.
- Join a support group.
5. Be Honest With Healthcare Professionals
Your psychiatrist is here to care for you. They won’t judge. If you have a history of substance abuse, don’t hesitate to disclose that in therapy.
In fact, it’s good to be honest with all your healthcare professionals. After all, you don’t want an ER doctor to prescribe something that’ll interact with your anxiolytic.
6. Don’t Quit Cold Turkey
Quitting abruptly can be hard on some people, and the anxiety might come rushing back.
Before you stop using the benzo, talk to your doctor. They’ll likely recommend a dose taper.
7. Be Mindful of Other People’s Sobriety
It’s great that you’re concerned about your safety. However, you might also want to be mindful of others.
Benzos are controlled substances known for their recreational use. So, if you have friends, coworkers, or family members with a history of substance abuse, think twice before leaving your prescription drugs out in the open. They might be tempted to grab a couple of pills and relapse.
Get Help With Your Dual Diagnosis Today
It’s not uncommon for people to suffer from mental health issues, like anxiety, along with an ongoing substance use issue. This is what healthcare professionals in the addiction treatment field call a dual diagnosis.
Unfortunately, using a benzo to control your anxiety in this case can feel like a slippery slope.
If you think you might suffer from a dual diagnosis, don’t hesitate to speak with our associates today and learn more about your treatment options.
The post What Is the Safest Benzo for Anxiety? appeared first on Garden State Treatment Center.
