Benzodiazepines: Miracle Drugs?

The first benzodiazepine – chlordiazepoxide – became available, from Hoffman-La Roche, in 1960, under the brand name Librium.  It was soon followed by:

diazepam (Valium) 1963;
nitrazepam (Mogadon) and oxazepam (Serax) in 1965;
temazepam (Restoril) 1969;
clorazepate (Tranxene) 1972;
flurazepam (Dalmane) 1973;
clonazepam (Klonopin) 1975;
lorazepam (Ativan) in 1977; and
alprazolam (Xanax) in 1981;
etc.

Benzodiazepines are categorized as sedative/hypnotics, which means that they have a relaxing, generally pleasant, sleep-inducing effect, and were embraced promptly by psychiatry for the “treatment” of anxiety, tension, worry, sleeplessness, etc.

In this respect, the benzodiazepines largely replaced the earlier barbiturates, which had received a great deal of negative publicity because of their much publicized role in lethal overdoses, both accidental and intentional.

. . . . . . . . . . . . . . . .

Initially, there was a good measure of skepticism among the general public with regards to benzos, and indeed, with regards to psychotropic drugs generally.  The dominant philosophy in those days was that transient, drug-induced states of consciousness were not only ineffective in addressing human problems, but were also dangerous. There were still lingering traces in the collective memory of the laudanum travesty, and, of course, there were daily reminders of the dangers of “drowning one’s sorrows” in alcohol.

But pharma-psychiatry systematically, deliberately, and self-servingly undermined this skepticism.  Pharma’s motivation in this regard is clear:  to make money.  Psychiatry’s motivation is more difficult to understand because the history, as is often the case, is largely forgotten.  At present, psychiatrists have come to be accepted as “real doctors” by the medical profession generally, and by the general public.  But in 1960, it would not be an exaggeration to say that they were considered something of a laughing stock among medical practitioners, and were regarded with bemused tolerance by the general public.

For these reasons, psychiatrists were highly motivated to accept something that would enhance their status, and create an appearance of medical authenticity.

Meanwhile, pharma was looking for ways to market their products.  It was a match – to mangle the usual phrase – made in Hell.  Psychiatrists – desperate for status and assurance, and smarting under the negative publicity of the barbiturate debacle – succumbed readily to pharma’s unctuous flattery and cajolery, and linked themselves whole-heartedly to the industry’s efforts to undermine the healthy skepticism of the general public, and incidentally, of a great many real doctors.

And the package sold like hot cakes.

By 1977, according to Wikipedia, “…benzodiazepines were globally the most prescribed medications.”  Sales dipped briefly in the late 70’s after their classification in the US as a Schedule IV drug, but benzos remained generally popular, and today, the drugs continue to grow in popularity.  According to IMS Health, a total of 76.7 million prescriptions for benzodiazepines were written in the US in 2005.  By 2009, that figure had risen to 87.9 million – an increase of 14.6%.  During the same period, the US population had gone from 295.52 million to 306.77 million, an increase of only 3.8%.

. . . . . . . . . . . . . . . . 

So what we have here is a success story.  Pharma sells billions of dollars worth of drugs, psychiatry takes its “rightful” place in the ranks of bona fide medical specialties, and vast numbers of people receive safe and effective “treatment” for “real” illnesses such as generalized anxiety disorder, social anxiety disorder, agoraphobia, etc…

So what’s the problem?  Well, there are lots of problems.

Firstly, the products, despite the long-insisted pharma-psychiatry hype, are addictive – a fact which is now well-known and need not be labored here.  Check the website Beyond Meds, or search Google for benzodiazepine addiction/dependence.

Secondly, it began to be clear early on, that the drugs did indeed have some serious adverse effects.  These included:  drowsiness and falls; skill impairment/traffic accidents; disinhibition/aggression; memory problems; etc.

Thirdly, more evidence of adverse effects emerges almost every year.  Most recently, it has been reported that benzodiazepine use is associated with an increased incidence of homicide and dementia.

HOMICIDE

In June 2015, Tiihonen et al published a study from Finland on the link between homicide and various drugs.  They found that the risk ratio for current use of benzodiazepines was 1.45, with a 95% confidence interval of 1.17-1.81.  In other words, current benzo users were about 45% more likely to commit a homicide than comparable non-users.

“Benzodiazepine…use was linked with a higher risk of homicidal offending, and the findings remained highly significant even after correction for multiple comparisons.”

DEMENTIA

In May 2015, Zhon et al published a meta-analysis from China which explored the association between long-term benzodiazepine use and the risk of developing dementia.  A meta-analysis is a study which combines the results of previous studies on the same topic.  Zhon et al combined the findings from six studies, involving a total of 45,391 participants, including 11,891 individuals with dementia, and found:

“Compared with never users, pooled adjusted risk ratios (RRs) for dementia were 1.49 (95% confidence interval (CI) 1.30–1.72) for ever users, 1.55 (95% CI 1.31–1.83) for recent users, and 1.55 (95% CI 1.17–2.03) for past users. The risk of dementia increased by 22% for every additional 20 defined daily dose per year (RR, 1.22, 95%CI 1.18–1.25). When we restricted our meta-analyses to unadjusted RRs, all initial significant associations persisted.”

And concluded:

“On the basis of either unadjusted or adjusted risk estimates, our study consistently indicates that long-term benzodiazepine use is associated with an increased risk of dementia.”

The authors point out that associations of this sort do not necessarily prove causality.  However, given the known neurotoxic effects of these products, a causative link seems likely.

Zhon et al conducted three separate investigations:  ever use vs. never use; recent use vs. never use; and past use vs. never use.  In all three cases, the association between benzo use and dementia was clear and substantial, which prompted the authors to write:

“…our findings regarding recent and past use of benzodiazepines may provide an important implication that stopping use of benzodiazepines cannot significantly reduce the risk of developing dementia.”

In other words, the damage is already done.  People who have used benzos in the past are at increased risk of developing dementia even if they haven’t used the drugs recently.

DISCUSSION

So there it is.  Pharma invents a dangerous drug, and with the enthusiastic help of psychiatry, markets it as “safe and effective” in the “treatment” of anxiety, which psychiatry has obligingly, conveniently, (and incidentally, fraudulently) transformed into an illness.

The reality is that anxiety is not an illness, but is, rather, the normal human response to anxiety-provoking situations.  And in our brave modern world, there is no end of anxiety-provoking situations.

Personally, I have not experienced a great deal of anxiety in my life, but I will readily acknowledge that in recent years, I have experienced a fair measure of anxiety while driving or riding in fast-moving, congested traffic.  My concerns in this regard are exacerbated when I notice the very large number of other drivers who are speaking on their cell phones (and even texting!) as they careen blithely through the narrow lanes of potential carnage.

I have resolved this problem by the simple expedient – and this is not Einsteinian stuff – of avoiding fast-moving, congested traffic!  The notion that a person could or should dissipate anxiety of this sort (or any sort) by ingesting a downer drug is a special kind of inanity found only in psychiatry.

And fast-moving, congested traffic is only one of the many anxiety-provoking situations in modern life.  Here are a few others:

Persistent inability to make financial ends meet
Not having medical insurance
Being concerned about losing one’s job
Driving an unreliable car
Living in tornado/hurricane areas
Being troubled by painful/distressing memories
Getting into the “right” school
Getting one’s children into the right school
Competing for college placement
Involvement in competitive sports
Living in big cities
Choosing the “right” food
Socializing with members of the opposite sex
Decision-making generally in everyday life
Concern about child-rearing
Worry about exposure to everyday toxins
Dealing with new job/city/people
Poor health
Feeling overwhelmed by the demands of one’s job
Having a chronically sick child
Caring for an aging parent
Involvement in a stressful relationship
Caring for an ailing partner
Tension surrounding the sale/purchase of a home
Fluctuations in the stock market
Forest fires
Noisy neighbors
Street violence
Floods
Drought
Blocked septic systems
Earthquakes
Failure to conceive
Unplanned pregnancy
Threat of domestic violence
Having little or no social/family support
Being alienated from one’s family
Etc., etc., etc…

I recognize, of course, that avoiding fast-moving, congested traffic is a great deal easier than dealing with most of the anxiety-provoking situations in the above list. But the general principles are the same.

Anxieties are normal.  In fact, they are adaptive.  They encourage us to be alert and ready for action, and also to take corrective actions with regards to the anxiety-provoking situations.  Extreme anxiety is the normal and adaptive response to extreme situations.

During my career as a psychologist, every client who came to me in extreme distress or anxiety was living in circumstances that were extremely distressful or anxiety-provoking.  Helping the individual ameliorate the distressing circumstances invariably ameliorated the feelings of distress.

Psychiatrists don’t see this obvious fact, or if they do, they ignore it, because they are conditioned by their training and by the exigencies of reimbursement, to pretend that the problem is – to quote the DSM phrase – “in the individual”.  The problem is fraudulently presented as an illness, because psychiatrists need illnesses to legitimize their drug-pushing, and for their continued survival as a profession.

Benzos “work” on these anxieties essentially by switching off neuronal activity.  Benzo users don’t feel anxiety, because the pills have impaired their ability to feel anxious.  To put it plainly, people who use benzos on a regular basis to dissipate anxiety are chronically intoxicated to the point of blissful apathy, all the while incurring an array of risks which often are far more serious than the initial problem.  (Some people, of course, use benzos to avoid withdrawals, but that’s a whole other issue.)

And psychiatrists actually have promoted, and continue to promote, the notion that this constitutes treating an illness!  It is noteworthy that at a time when real doctors are developing an increased recognition and respect for the body’s natural resources, warning systems, and defense mechanisms, psychiatry is going in the opposite direction.  All psychiatric drugs – including benzos – operate, not by correcting an abnormal state, but rather by suppressing/distorting normal function and creating a pathological state.  Chronic benzo intoxication is a pathological state.

Modern life offers unprecedented comforts and conveniences, but, in exchange, exacts a huge toll in terms of tension and anxiety.  The notion of dissipating these anxieties with neurotoxic, addictive drugs isn’t just ill-conceived, dangerous, and disempowering; it’s a dehumanizing obscenity.

  • Sweet63

    “The risk of dementia increased by 22% for every additional 20 defined daily dose per year”

    I’m not sure what this means. What is defined daily dose? We talking about the 3mg some people take per day?

    Could it be that the same people who tend to develop dementia also tend to be indiscriminate in drug use, prescribed or otherwise, or less questioning of authority? I’ve never understood how someone could take these kinds of dosages every day for years.

  • Rob Bishop

    These “anxiety-provoking situations” are fear… critical for adrenaline surge when being chased by a tiger, but a crippling cognitive reaction when unchallenged. CBT is effective for disputing irrational thoughts and negative thinking that create fear. We can neutralize our fear without drugs. Even a fear of death is irrational, since we all know we will die.

  • aemaroney

    I recently went off clonazepam after years of naive use. I stepped down the dose over a 45 day period. I had not felt “woozy” from this drug, therefore thinking it was safe to use. I now feel better than I have in years. Years ago I was diagnosed with major depressive disorder and clon. was added to my daily scripts about 10 years ago. Because I found this info on benzos I knew I could no longer take them. Thank you for bringing this information to the general public who have trusted Psy’s with their current mental health. Now I am in a wait and see mode for dementia & my future mental health.

  • M.

    The list of “anxiety-provoking situations” is interesting, because it highlights how criticism of psychiatry is a social justice issue. Financial insecurity, lack of social support, street violence… these problems are often beyond one’s individual control.

    But psychiatry steps in and says, “the problem is with your brain and we can help!” It’s frustrating. The pill pushers obscure real problems and depoliticize suffering. How are we supposed to fix societal problems if everyone believes they’re merely suffering from brain diseases?

  • all too easy

    The general public is provided a full description of this drug in the packaging label.

    How many of those taking this and other powerful CNS drugs drink alcohol simultaneously?

  • Rob Bishop

    Interesting point. But in a world of financial security and zero violence, the mind would still create anxiety. Our desire for “security” (of any sort) is suffering we inflict on ourselves. Much (most?) of life is not within our control, and resisting this fact can, and does, cause people significant mental and emotional turbulence.

  • all too easy

    “The problem is fraudulently presented as an illness, because psychiatrists need illnesses to legitimize their drug-pushing, and for their continued survival as a profession…” Old Phil

    Phil takes great pleasure in accusing others of committing horrible crimes, always from the safety of not being specific. Name a doctor who is pushing drugs, Phil. She should be in prison.

    “Benzos “work” on these anxieties essentially by switching off neuronal activity. Benzo users don’t feel anxiety, because the pills have impaired their ability to feel anxious.” Big Phil

    How does a drug switch off neuronal activity? When did neuronal activity equal feeling anxiety?

  • Phil_Hickey

    Sweet63,

    Thanks for coming in.

    The “defined daily dose” in this study is “the assumed average maintenance dose per day for a drug used for its main vindication in adults.” Obviously the milligrams would differ from one drug to the next. Defined daily dose is often abbreviated as DDD.

    I agree that the phrase you quoted isn’t entirely clear, but I believe it means that people taking 385 (365 + 20) DDD’s per year have a 22% greater risk of developing dementia than people who take 365 DDD per year.

    The post was published published on MIA as well as here. There’s a very interesting discussion string that discusses, among other things, the way
    people get caught in this particular web.

    Best wishes.

  • Phil_Hickey

    Rob,

    Thanks for coming in. We can indeed neutralize our fears without drugs. This is something that previous generations knew well, but has been systematically suppressed by pharma-psychiatry.

    Best wishes.

  • Phil_Hickey

    aemaroney,

    Thanks for coming in. I hope things go well for you. Stopping benzos abruptly can be dangerous, so please be careful, and get some good advice/support.

  • Phil_Hickey

    M,

    Good question! I suppose the answer is: to keep exposing the hoax for what it is – a destructive, disempowering fiction carefully built and maintained to promote the interests of pharma-psychiatry.

  • M.

    Yeah, that’s my thinking too. I’m glad you’re here arguing against the nonsense.

    I think psychiatry’s fictions serve more than just the drug companies and psychiatrists themselves though. If they were the only ones to benefit, I don’t think the profession would have nearly so much power. Often, we see pharma-psychiatry serving the interests of the powerful against the relatively powerless.

    Thus:
    “Difficult” elderly people in nursing homes are given antipsychotics, “problem” children get Ritalin, stressed housewives, tranquilizers (the first time I saw this old ad, I was gobsmacked), 60’s civil rights protesters were diagnosed with schizophrenia…

    Really, I think one of the reasons the drugs and myths are so widespread is that they help maintain the status quo.

  • Phil_Hickey

    M,

    I agree. The ad is appalling. I’ve seen similar in the old
    psychiatric journals in library stacks.

    Best wishes.

  • catG

    While I agree with you, Dr. Hickey, and believe the desire for profit both monetary and recognition driven have created a cycle of dependency on pharmaceuticals, I respectfully disagree that all anxiety is born of a reaction to real, current anxiety provoking situations. You speculate that your anxiety driving in congested, fast moving traffic is a reaction to the observation of cell phone usage and the subsequent ‘logical’ avoidance reaction to what you assume will be irresponsible drivers. However, pre cell phone development, many senior citizen drivers, felt the same anxiety. Clearly, I can always recall seniors driving, excessively slowly, gripping the wheel, in the slow lane of traffic. I speculate they, too, were anxious and it had more to do with the degeneration of their ability to respond quickly to fast moving traffic and nothing to do with cell phone usage. In this case, anxiety was created as a reaction to the actual situation of slower brain reaction time or dimmed vision and this does support your conclusion that real situations (even in terms of internal biology) cause anxiety.
    However, I disagree that anxiety is always related to real time situations. While the original anxiety reaction is most likely due to a real life situation like one that you name (e.g. not having health insurance, dealing with a new job, floods), much anxiety is generated, over and over, by dysfunctional neuropathways created by the original real anxiety producing situation. In other words, long term anxiety producing situations can leave a person with anxiety even when the anxiety producing situation is gone. The person can no longer ‘shut down’ the feeling of anxiety and it can occur ‘out of the blue’ in situations that are basically unrelated to the original anxiety situation. In my opinion, at least half of all anxiety is created this way and is not adaptive. This kind of anxiety may be beyond the control of the individual and varying types of treatment required. In extreme cases, after much consideration, short term use of benzodiazepines may be able to break the cycle of anxiety but only when used under supervision and with the addition of other therapies.
    I agree that 95 percent of the use of benzodiazepines (and many other pharmaceuticals) is unnecessary or based on unreliable statistics. However, in certain cases, in very limited amounts, it can provide relief, and even be a tool to assist ‘cure’ for unremitting anxiety of the kind I described above.

  • Ana Maria De La Guardia

    This philip hickey Is the most stupid person i have ever known

  • Ana Maria De La Guardia

    This philip hickey Doesnt know anything about mental health

  • Ana Maria De La Guardia

    This philip hickey is an ignorant dont believe everything the internet tells you

  • Ana Maria De La Guardia

    This philip hickey Is a scam

  • Ana Maria De La Guardia

    This philip hickey Has no idea what hes talking about

  • Rob Bishop

    There’s a huge community of scientists and highly educated professionals that agree depression, anxiety, ADHD, PTSD, addiction, and other mental challenges are not mental illness. There’s no scientific evidence these mental conditions are rooted in chemical imbalances, genetics, or biological defects. Millions of people are “diagnosed” without blood tests or brain scans… just conversation and arbitrary checklists. Three times I’ve been told by different doctors I need serotonin re-uptake inhibitor, after only a brief conversation. Don’t you find that crazy?

  • Ana Maria De La Guardia

    Tell that to the nurses when i was put on a ward and hearing voices and thought that i was going to change the world and gad amazing mood swings and lost concienceness and lost my memory and was aggresive and would allusinate that everyone in front of me was masturbating. And would not be lucid and had not idea were i was for 15 days untill my doctor rescued me a brout me back to reality. Tell tham to them in your 15 questions dumbasss

  • Ana Maria De La Guardia

    Yeah, that phil is a dumbass!

  • Ana Maria De La Guardia

    Helllo??? Roobb??? Anssweers?? Right non because u dont have any. U dont know anything. Youve never beenn there so u should not be speaking about the subject anyway

  • Ana Maria De La Guardia

    The internet is full of crap bigotry and bullshit and this website proves it

  • Ana Maria De La Guardia

    This is time were the first amendment should be ashamed of itself

  • Rob Bishop

    Your negative hostile name calling shows you’ve not learned how to control your emotions. I hope you explore the true root of your anger, pain, and suffering, and find peace some day.