Why Doctors Hate Benzos (It’s Not Why You Think)
I know, the benzo you take works wonders. You instantaneously feel relaxed when it kicks in. It’s the only thing that actually works that well. And that’s exactly why psychiatrists hate it and how the medication will actually prolong and exacerbate your symptoms.
Record scratch. What? You just said it works!
It does work to reduce your anxiety immediately. But it also reinforces problematic patterns your anxiety disorder uses to stay alive.
Here’s how your anxiety works. Let’s take panic disorder as an example. It’s not the only anxiety disorder and it’s not the only one with panic attacks as potential symptoms but the disorder’s features include experiencing panic attacks and fear of having panic attacks to the point that people change their behaviors in hopes of avoiding a panic attack or escaping once it’s happened.
Keywords: avoidance & escape
When someone is prescribed a benzo, they usually have described panic attack symptoms such as racing heart, labored breath, sweating, fear they are dying. They often present to the ER thinking they are having a heart attack because they really feel like they are dying. If you have ever felt that level of panic you know it’s very difficult to rationally talk yourself out of it. They are referred out and in many places, like here in Traverse City, a family physician will be prescribing the medication instead of a specialist, since there are so few available psychiatrists.
What’s the problem? You have a panic attack, you take the med, presto, you can function.
Absolutely right, normally this is how a benzo works and it works very well at calming you down quickly. The problem is that it reinforces the avoidance and escape strategies that keep your panic disorder alive.
Almost all people I know with anxiety disorders or phobias see an increase in the intensity of their anxiety within a few months of starting a benzo. They also usually need to increase their dose at this point. Paradoxically, they feel they need the medication even more because their anxiety is so intense, without realizing that their dependence on benzos is the driving force.
Many people prescribed benzos have been given the substance abuse lecture. It’s true, benzos are easy to abuse, people naturally build up a tolerance to their effects. They are also incredibly dangerous to mix with alcohol and could kill you. This is often the lecture people hear, that often folks become dependent and abuse it. But even if you always take it as a prescribed, even if you never mix it with alcohol, even if you never intentionally take more than you should – the drug can still impede treatment of an anxiety disorder.
Treatment for anxiety disorders and phobias is usually a form of exposure therapy. In a safe place you are exposed to the thing that totally freaks you out. Over time, you habituate, or basically get used to it instead of having a horrible panic attack. It’s not a fun process but it works. There are ways to help exposure therapy be more effective but this is the gist.
If the benzo calms you down you’ve effectively escaped or avoided the thing a therapist wants you to approach and sit with. It means you can’t habituate and will need the benzo to calm down. And pretty soon, your anxiety will increase and so will the dose of the benzo. At some point, you will not be able to safely increase the dose.
This is the general rule. I have met folks with complex PTSD or other disorders where every other med has failed. Given the nature of trauma exposure treatment it can be a long process. Benzos can be helpful, it’s just really important that your therapist be attuned to how the med is helping or hurting.