Should Valium be presribed for anxiety?

[Anon54]

Last yr i had all the benzos i wanted. thn i got cut off .. now ive been lookin for a dr who will precribe valium. i want 50 5mg pills a month. thats not to much to ask. anyway no one will fuckin precribe it. this is in australia btw.

So most drs I go to wont precriobe valium for long-term. they say it is to addictive & is not worth it in the long run.
what is your opinion. should valium be presribed as treatment for anxiey for long-term treatment?

My opinion is yes it it should but u should only receive a certain amount a month. not enough to take every day or get a dangerous tolerance too.


Ive had to add this edit to my post. When im talking about valium im sort of refering to all benzos. not just valium. Should any benzo be precribed for anxiety. or is it a bad idea because of potential addiction?

 

[ryand123]

I agree with you. Im in the US and quite a few doctors are more than happy to give you all the xanax you want. And personally i think that valium is alot less physically addicting (dont get me wrong valium is addictive) than xanax. They made Xanax to get people off Valium because Xanax "wasn't addictive". And now the whole country is filled with bartards (sorry to all you guys that like Xanax im not trying to talk crap!) who need it to live normally. Now i know that everybody was on Valium when it came out, but it is IMO alot safer drug than Xanax.

 

[Apostacious]

Actually, ryand, valium/diazepam is much more problematic of a benzo to take PRN (or as needed), due to the long half-life of its active metabolite. In other words, you may get away with taking xanax/alprazolam once every two to three days for several months without developing a physical dependence, but there is a good chance that you cannot get away with such a dosing schedule with diazepam. The difference in metabolic half-lives between alprazolam and diazepam are basically night and day. Alprazolam's metabolic half-life is 10-15 hours, while diazepam's half-life is 20-100 and its active metabolite (nordazepam) is 36-250. Therefore even if you regularly take two to three days off from diazepam, you are still at great risk of developing a benzodiazepine dependency, because even after 72 hours, the main active metabolite has only undergone two half-lives. Generally, it is accepted that a drug is typically "out of your system"/inactive after four to eight half-lives. Yet, if you regularly took two to three days off from dosing alprazolam, you would be at a very low risk of developing a dependency, because even the high-end metabolic half-life would have reached the fourth half-life clearance with regularity. However, if you are taking high doses of alprazolam on said schedule, the half-life clearance level goes up proportionally.

 

[laCster]

whatever the case may be, i would definitely not go in asking for valium. you have to let the Dr come to his/her own conclusion. i have had this happen to me multiple times. i would go in faking anxiety symptoms, depression, ect.. and some would prescribed benzos and some would prescribe SSRI's. luckily, most of my doctor shopping has been a success and i didn't take many trials before i was able to find the right one who decided on his own to prescribe me benzos/lyrica.

 

[ryand123]

But wouldnt the shorter half-life of alprazolam cause withdrawls to set if faster? I could be wrong, but im intrested in this.

 

[Muddle]

perhaps situational anxiety or presentation anxiety not daily anxiety or social.
Most drs will try to shove ssris/maois down your throat even for panic disorder, trust me I know. Been there done that
dont go in asking for benzos they will think you are a drug seeker right of the bat and all of that mess.


I cant really give an informational opinion (no degree, only my own research) [although I have personal experience] as to wether or not valium should be used for long term but most doctors will consider it a bad idea. Benzo withdrawels are hell and if you dont taper you will be physically dependent on them even if you arent mentally.

But best of luck

 

[laCster]

pregabalin(lyrica) is another option, it is a quite effective anxiolytic . when taken daily at a steady rate, pregabalin's anxiolytic properties definitely showed their true nature. lyrica's "feeling" is similar to alprazolam imo.

 

[K'd-OUT-in-AZ]

"Most" all doctors are against prescribing benzodiazepines for long term use and I believe they should. I was hooked on Klonopin for 11 years and let me tell you, benzodiazepine addiction is no joke. Going without it for just a day creates all kind of anxiety problems much worse than it was before you started taking them. And this gets worse the longer your hooked. Then after spending 3-8 months tapering, when your completely off of them the psychological withdrawals hit you very hard with extreme cravings & terrible anxiety. If you don't spend months tapering you'll have to deal with the physical withdrawals which are very harsh on your body.

But on the other hand, I think benzodiazepines are very helpful when taken "as-needed" or at least like every few days when you really feel stressed out or when you feel panic starting to take over. When taken like this they are very useful. My current doctor won't prescribe it anymore because I tried so hard getting off it and doesn't want me going through it again. So I'm going to see a new doctor and tell him...the rest of this will be a doctor shopping technique and I know that's against the rules so I won't continue on.

 

[Apostacious]

But wouldnt the shorter half-life of alprazolam cause withdrawls to set if faster? I could be wrong, but im intrested in this.

In order for withdrawals to begin in the first place, a physical dependency is needed (it normally takes anywhere from one to four (or more) weeks of daily, or frequent use for physical dependency to set in). If one isn't physically dependent on benzos, aplrazolam or another short half-life benzo on an as needed basis with a maximum dosage frequency of one dose every three days is recommended. Yet, if one is already physically dependent, then yes, diazepam is highly recommended as a maintenance drug, and for titration due to the slow, steady elimination half-life.

 

[Pegasus]

Actually, ryand, valium/diazepam is much more problematic of a benzo to take PRN (or as needed), due to the long half-life of its active metabolite. In other words, you may get away with taking xanax/alprazolam once every two to three days for several months without developing a physical dependence, but there is a good chance that you cannot get away with such a dosing schedule with diazepam. The difference in metabolic half-lives between alprazolam and diazepam are basically night and day. Alprazolam's metabolic half-life is 10-15 hours, while diazepam's half-life is 20-100 and its active metabolite (nordazepam) is 36-250. Therefore even if you regularly take two to three days off from diazepam, you are still at great risk of developing a benzodiazepine dependency, because even after 72 hours, the main active metabolite has only undergone two half-lives. Generally, it is accepted that a drug is typically "out of your system"/inactive after four to eight half-lives. Yet, if you regularly took two to three days off from dosing alprazolam, you would be at a very low risk of developing a dependency, because even the high-end metabolic half-life would have reached the fourth half-life clearance with regularity. However, if you are taking high doses of alprazolam on said schedule, the half-life clearance level goes up proportionally.

I hate to argue with you (you're such a cool guy), but alprazolam and others with short half-lifes are shown to build dependency very quickly compared to other benzos with longer half-lifes.

Physical dependence on benzodiazepines: differences within the class.
Wolf B, Griffiths RR.
Source

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract

Concern about physical dependence seems to be the major limiting factor in the long-term treatment with benzodiazepines (BZD). The severity of the withdrawal syndrome is determined by multiple factors, e.g. dose, duration of use, frequency of dose interval, mode of discontinuation, the pharmacologic characteristics of the BZD, personality and previous or concurrent use of cross-dependent drugs and/or alcohol. There is evidence that BZD with a short elimination half-life cause a more severe withdrawal syndrome than those with a long elimination half-life. Besides pharmacokinetic properties, pharmacodynamic factors such as potency may also covary with the liability of a BZD to induce physical dependence. There is an increasing body of literature indicating that quickly eliminated, high potency BZD such as alprazolam and lorazepam may be more likely to cause severe withdrawal reactions than slowly eliminated compounds such as diazepam or less potent derivatives such as oxazepam. Alprazolam seems to play an exceptional role, insofar as relatively soon after its introduction to the market a number of case reports of withdrawal psychoses, seizures and intense rebound anxiety were published. Data reviewed from the literature correspond well with the results of interviews conducted with 31 clinicians across the United States with experience in detoxifying patients dependent on BZD, 84% of these physicians mentioning alprazolam as especially problematic with respect to the intensity and/or duration of the withdrawal syndrome.

There's another article which I wish I had access to, but here's a blurb about it from Wikipedia:
"In a 1983 study of patients that had taken long-acting benzodiazepines, e.g., clorazepate, for extended periods, the medications were stopped abruptly under double-blind conditions (that is, patients were receiving either placebo or the same drug they had been taking). Only 5% of patients that had been taking the drug for less than 8 months demonstrated withdrawal symptoms, but 43% of those that had been taking them for more than 8 months did, whereas, with alprazolam - a short-acting benzodiazepine - taken for 8 weeks, 35% of patients experienced significant rebound anxiety. To some degree, these older benzodiazepines are self-tapering."

Eight MONTHS for clorazepate vs eight weeks for alprazolam to have similar dependence ratios. Pretty astounding IMO.


OT- I think that for a benzo, diazepam is a pretty good choice. However, in general, benzos for anxiety are a poor choice.

 

[Korn3x]

i think benzos can work very well for panic attacks or for anxiety that pops up on the occasion. as for being prescribed them for everyday usage for the treatment of anxiety, that's sort of a gray area. my mom is prescribed xanax, but she's only prescribed 0.25mg pills, and only takes them on an as needed basis. it takes her a couple months before she actually needs a refill.

as far as the everyday treatment of anxiety, i know cases where it's done good and bad. one of my friend's mom's takes massive amounts of benzos every day, because she has been on them for such a long time. while she seems to be managing, you wonder what her mental state will be like when she's much older. it's a gray area, but personally i think if you're experiencing anxiety every day (and not just on occasion) other options should be tried first before resorting to benzos, as they will lead to a dead end eventually.

sometimes if i'm having some anxiety, what i really need is a good run or other form of strenuous exercise. exercise does wonders for both mental and physical health, and has much more of an impact on people's well-being than most believe.

 

[SpunkySkunk347]

I agree with you. Im in the US and quite a few doctors are more than happy to give you all the xanax you want. And personally i think that valium is alot less physically addicting (dont get me wrong valium is addictive) than xanax. They made Xanax to get people off Valium because Xanax "wasn't addictive". And now the whole country is filled with bartards (sorry to all you guys that like Xanax im not trying to talk crap!) who need it to live normally. Now i know that everybody was on Valium when it came out, but it is IMO alot safer drug than Xanax.

I totally agree with you. Xanax blows Valium out of the water.
Diazepam and alprazolam are the only two benzos I would consider as potentially euphoric, with the latter taking the lead by far.

Lorazepam is too goofy (shit gets goofy on ativan) and clonazepam is too mellow (you can swallow like 10 of them and not really notice any blatant benzodiazepine sensation, although you definitely experience the amnesia and sedation)

 

[brimz 2.0]

15 years of benzo addiction is telling me no they should not be prescribed for anxiety .
Only as a worst case scenario and even then at a low dose and for no longer than 2 weeks.

 

[pally pete]

I hate to argue with you (you're such a cool guy), but alprazolam and others with short half-lifes are shown to build dependency very quickly compared to other benzos with longer half-lifes.



There's another article which I wish I had access to, but here's a blurb about it from Wikipedia:
"In a 1983 study of patients that had taken long-acting benzodiazepines, e.g., clorazepate, for extended periods, the medications were stopped abruptly under double-blind conditions (that is, patients were receiving either placebo or the same drug they had been taking). Only 5% of patients that had been taking the drug for less than 8 months demonstrated withdrawal symptoms, but 43% of those that had been taking them for more than 8 months did, whereas, with alprazolam - a short-acting benzodiazepine - taken for 8 weeks, 35% of patients experienced significant rebound anxiety. To some degree, these older benzodiazepines are self-tapering."

Eight MONTHS for clorazepate vs eight weeks for alprazolam to have similar dependence ratios. Pretty astounding IMO.


OT- I think that for a benzo, diazepam is a pretty good choice. However, in general, benzos for anxiety are a poor choice.

I had one week of heavy Alprazolam use back in April and i suffered some severe withdrawal symptoms!

Sweats,insomnia,terrible anxiety,nausea,loss of appetite,hallucinations (including closed eye visuals and audio hallucinations) amongst other things.

For this reason i will keep away from Alprazolam even though it can be a great 'situation' benzo,although i do realise that my misuse had some effects on the withdrawal symptoms i experienced.

As for the OP's question...i believe long term benzo uses causes more harm than good.

 

[Apostacious]

I hate to argue with you (you're such a cool guy), but alprazolam and others with short half-lifes are shown to build dependency very quickly compared to other benzos with longer half-lifes.



There's another article which I wish I had access to, but here's a blurb about it from Wikipedia:
"In a 1983 study of patients that had taken long-acting benzodiazepines, e.g., clorazepate, for extended periods, the medications were stopped abruptly under double-blind conditions (that is, patients were receiving either placebo or the same drug they had been taking). Only 5% of patients that had been taking the drug for less than 8 months demonstrated withdrawal symptoms, but 43% of those that had been taking them for more than 8 months did, whereas, with alprazolam - a short-acting benzodiazepine - taken for 8 weeks, 35% of patients experienced significant rebound anxiety. To some degree, these older benzodiazepines are self-tapering."

Eight MONTHS for clorazepate vs eight weeks for alprazolam to have similar dependence ratios. Pretty astounding IMO.


OT- I think that for a benzo, diazepam is a pretty good choice. However, in general, benzos for anxiety are a poor choice.

Ah, its all good, I share the same respect for you. I agree with you that alprazolam tends to build a nasty dependency, very quickly. But, if one avoids any sort of daily dosing (even three days in a row can develop dependency with alprazolam if it is "round the clock" administration) with alprazolam and adheres to a strict one dose for one day, and three days off after the dose, then dependency should almost certainly be avoided. But, my main point is that diazepam is a horrible choice for an "as needed" benzo, if one is attempting to avoid a dependency and mitigate panic attacks.

 

[effie]

To the OP - 50 5mg pills is easily enough to get you hooked... I think the only responsible way for a doctor to prescribe benzos is either prescribe a small amount each month, not enough to use every day, for "emergency" situations, OR if someone is stable on a low dose and doesn't appear to be building tolerance, to continue that dose, OR to help someone taper safely and as comfotably as possible. I have friends tapering, and it doesn't sound fun in the slightest.

Everyone is different and we can't say what is best for you over an internet forum. We can advise, talk from personal experience, but ultimately you need to have a honest discussion with your doctor about why you want diazepam and what the consequences would be, and what the alternatives are for your personal situation.

edit: Pegasus, that is very interesting reading, thank you. However I must say I do agree with Apostacious that diazepam is a very bad choice for "as and when". You want something short acting and anxiolytic, that can kick in fast and not leave you groggy all day. Lorazepam would be my personal choice, I think.. but again, everyone reacts differently to benzos and have their own preferences, so this would be for a doctor to decide in discussion with you OP, depending on what specific situations you need it for and your own personal history.

As for long term treatment of anxiety, I am a massive CBT advocate, although it is hard work, takes a long time and isn't for everyone.. but it can give you lifelong techniques to bring your anxiety
under control

 

[Cane2theLeft]

^ huge +1 on CBT here (and everything else above as well).

People often just want a quick fix and while it feels great to have that anxiety disappear for a few hours, it's not a solution. As has been said, overuse can produce a myriad of problems themselves worse than the initial anxiety.

Free-floating prescriptions of daily benzodiazepines is quite likely to exacerbate the situation if used over a long period so I always encourage people to use them as sparingly as possible. The most sustainable approaches seek to address the root of the problem as well as teach coping mechanisms that don't rely on GABAa agonism. A lot of people don't have access to great mental health care or (if in the US) can't afford it but there are always ways you can address it such as finding websites with suggestions how to mitigate/cope with anxiety, picking up CBT workbooks, etc.

 

[effie]

^ completely agree Cane. There are a couple of really good books, but I can't remember the titles right now - will get back to you if they come to me! They were recommended by my CBT practitioner.

There are a couple of websites out there too that my psychiatrist recommended -

Living Life to the Full and MoodGym

They are both developed by psychiatrists. I've only tried MoodGym, which I found quite irritating and over-simplifying/over-generalising at first but actually turned out to be very good if you can get past the start. It's a good way to learn about the principles behind CBT and try to start using the techniques if you can't see a CBT practitioner, anyway

 

[Pegasus]

I thought I quoted another study about intermittent alprazolam use and rebound effects... No need to dig it up, but I do encourage anyone looking at the short-acting benzos to be extremely cautious.

 

[ryand123]

^ completely agree Cane. There are a couple of really good books, but I can't remember the titles right now - will get back to you if they come to me! They were recommended by my CBT practitioner.

There are a couple of websites out there too that my psychiatrist recommended -

Living Life to the Full and MoodGym

They are both developed by psychiatrists. I've only tried MoodGym, which I found quite irritating and over-simplifying/over-generalising at first but actually turned out to be very good if you can get past the start. It's a good way to learn about the principles behind CBT and try to start using the techniques if you can't see a CBT practitioner, anyway

I would like to add another book that might be helpful. Its from a scientific standpoint, it explains how anixety works in the brain and gives you quite a few coping strategies. "Change Your Brain, Change Your Life" By: Dr. Daniel Amen