Medications most commonly used to treat anxiety disorders are the benzodiazepine class of minor tranquilizers. The classification of “minor” tranquilizer is a reference to the psychiatric illness they have been FDA approved to treat and have no correlation to their potency or effect.

Minor tranquilizers of the benzodiazepine family are used to treat anxiety, phobias, stress illness, insomnia, muscle spasm and some forms of seizure disorder, all considered minor psychiatric illness. The major tranquilizers (Thorazine, Mellaril etc.) are used to treat major psychiatric illness of psychosis and schizophrenia.

The immediate therapeutic benefits and symptom improvement are seductive to the prescribing physician and anxiety sufferer alike. Anxiety disorders are extremely aversive in their affect. Being part of the continuum of the natural, primal flight-or flight response of the central nervous system, those affected are driven to seek escape by the most primitive portions of the brain. This drive makes it difficult to make an objective decision in spite of the harm and dangers of tranquilizer use.

Before making a decision to begin chemotherapy for anxiety reduction it is important for the patient to be fully informed of the risk-to-benefit profile of the medications. Benzodiazapines were approved only for short-term therapy. The Physicians Desk Reference indicates their use for a maximum of four months and many of the pharmacologists who developed the medications advocate a maximum of 4 to 7 days continuous usage. This short-term recommendation is to prevent the intense addiction caused by tranquilizers.

Many large-scale clinical trials have not found therapeutic effects after two to four months. In the case of benzodiazepine sleeping medications they may loose their desired effect in days.

In spite of their enormous popularity and the billions of dollars of profit they generate, (for several years they have been the number one medication prescribed in the U.S.A.) it is apparent they provide diminishing benefit to the long-term anxiety disorder patient.

METHOD OF ACTION

The full complex actions of the benzodiazepine tranquilizer are currently beyond the understanding of neuroscientists. The Physicians Desk Reference lists their exact method of action as “unknown.”

What is known is that they work in conjunction with a neurotransmitter, gamma-amino butyric acid (GABA). Neurotransmitters are the messengers that move between nerve cells (neurons) allowing them to communicate. They are divided into excitory (excites the cell) and inhibitory (calms the nerve cell). GABA is one the primary inhibitory neurotransmitters that occurs in over 40% of all neurons. This accounts for the broad range of freighting symptoms when the medication is stopped.

When GABA is plentiful or activated we feel calm and serene. When other neurotransmitters are activated like norepinephrine we feel agitated, anxious, panicked and ready for action. Tranquilizers increase the potency of GABA naturally occurring in our brains, which in turn tones down the nerve signals between neurons.

Each nerve ending is covered with thousands to millions of channels or pores that allow these neurotransmitters to move to the next nerve cell and carry on the “action” message or the lack of activity we call relaxations. For simple illustration tranquilizers bind or plug many of these openings. They also help GABA plug the holes it occupies even tighter. With less “action” messages being sent the nervous system calms down and we feel the world is safe.

Our brain recognizes that less GABA is needed and reduces production. It also becomes lazy when alarms sound that would normally trigger additional GABA needs…these needs have been chemically filled by the benzodiazepine medication. The body has an innate intelligence called homeostasis. This means it is always trying to return to what it perceives as center or normal. It senses that the nerve endings contained perhaps 1,000 channels prior to medication (this number is used for illustration they in fact number into the hundreds of thousands). The tranquilizer has blocked 500. The drive for homeostasis directs the neurons to create 500 additional channels. We now have 1,500.

This phenomenon is called tolerance, the body becoming adjusted to a given effect and requires more to have the previous anxiety reducing or therapeutic action ( you may remember when initially taking the medication you were tired or sleepy but the symptoms lifted in several days – this is tolerance building ). Addiction is the psychological component of drug seeking behavior which is usually not present with anxiety patients. Tolerance is often mislabeled addiction when referring to the state of the body being unable to perform normal functions without the medication.

Tranquilizers are intensely tolerance building ( physically addicting ). Some medications we may take for years and will never need increased dosages. Tranquilizer tolerance in some individuals increases on a daily basis while others can remain on the medication for months before problems begin. Alcohol should never be used as it decreases time for tolerance to build and increases negative neurological changes.

While the nerve cells may have started with 1,000 channels at the beginning of medication, after time they will have created hundreds of thousands of extra channels. When we reduce dosage or have achieved tolerance, these extra channels come unplugged and allow increased neural transmission and excitement because you are always building tolerance. Patients often believe that they are having a resumption or increase in their previous symptoms while on the medication when in fact they are experiencing withdrawal symptoms and neurological disease brought on by the medication. Anxiety patients probably have functional irregularities in their brain GABA systems. This may be caused from reversible stress induced neurochemical changes dating back to childhood or from biological abnormalities. In the search for small comfort it is cruel to provide temporary relief of anxiety at the expense of a long term negative outcome. Psychiatric medications do not heal any disorder. Symptomatic relief must be weighed against the undesirable effects and informed decisions made. Benzodiazepines further disorganize normal brain activity in building tolerance with the result that we mortgage tomorrow’s happiness for today’s temporary relief.

WITHDRAWAL SYNDROME

When we have reached a level of tolerance to a given dose ( this can happen to susceptible individuals with one dose ) or we reduce our level of medication, the additional nerve channels become unblocked ( remember tolerance has created millions of additional channels for nerve impulses to flow ) and the opposing nerve cells become excited with increased neurotransmitter flow. If this were not sufficiently disruptive the brain has replaced its endogenous ( inner ) GABA production on hold because of the tranquilizer mimicking GABA. Rampant uncontrolled “action” signals fire and neurological chaos ensues. Anxiety up to 10 times previous levels, sweating, trembling, hallucinations and over 250 disabling symptoms documented by the FDA are possible ( see partial list on last page ). Whether in months or years, everyone will reach an exponential tolerance increase and will have to discontinue medication.

Extensive research has shown use of tranquilizers for 30 days will produce withdrawal symptoms in approximately 40% of patients. Use for 120 days raises the percentage to 60%. Over 6 months 75% and over one year nearly 100%. This is highly variable as patients have taken medication for years without withdrawal and documented cases of one week on medication precipitated months of withdrawal.

Withdrawal can be divided into three classifications:

* Mild - very few symptoms, normal functioning.
* Moderate – many of the listed symptoms, functioning severely restricted.
* Severe – extreme dysfunction, seizures, symptoms of major mental and neurological illness.

Statistically those long term users ( over 6 months ) can expect 20% in the mild classification, 60% in the moderate and 10 to 20% in the severe withdrawal syndrome class. While most readers anticipate their inclusion in the best 20% mild withdrawal, we gain perspective if we visualize a loaded five shot revolver with four bullets and one empty chamber. We would have a 20% chance of landing on the empty chamber and surviving. These are not good odds for any medical decision.

Unfortunately only abstinence and time can return the nerve cells to normal. Some medications have shown limited relief but are extremely potent, dangerous medications that have only very limited safety margins. This withdrawal time can be a Satanic hell…

Everyone who has experienced severe withdrawal would gladly trade hourly panic attacks for withdrawal and the healing time can be quite protracted. It must also be stressed that some individuals have only mild symptoms and the level of discomfort is not predictable.

When we think of withdrawal we often envision the heroin addict vomiting, sweating and writhing in bed for two to three days. His drug tolerance has not changed the physical characteristic of the brain in the same way tranquilizers do and his recovery is short. Because tranquilizers change the structure of the neuron, and nerves are the slowest tissue in the body to heal, withdrawal may require several weeks to 3 to 5 years for the majority of symptom relief. Sub-clinical symptoms may persist for years. The good news: the tolerance will drop, the brain will regain control and many people who have been through difficult withdrawal report that they no longer have any anxiety or panic

We are unsure whether the severe withdrawal has caused biochemical changes in the neurons rendering them permanently less sensitive or that by comparison to the horrors of withdrawal anxiety holds no power> It must be stresses that this anticipated positive outcome is only after the withdrawal is completely healed and in those with the moderate to severe symptoms.

REASONS TO DISCONTINUE MEDICATION

WARNING: Do NOT suddenly stop taking medication.

It is apparent that there is little wisdom in continuing a medication that will not heal anxiety or any of it’s manifestations, will provide symptomatic relief only as long as tolerance is not increased, cycles of higher dosages of medication are required and globally disorganizes a brain struggling to normalize under the impact of chemical complications. Each dose sets up a rebound which decreases our brain ability to cope with chemical induced anxiety. Many times what we mistake for our symptoms returning or becoming worse…even after one pill…is the medications delay damage.

Everyone who contemplates using a benzodiazepine medication should read all 17 FDA approved benzodiazepine listings in the Physicians Desk Reference. Because of their chemical similarity any one of the medications has the potential to cause all of the listed reactions. While these adverse reactions number into the dozens as admitted by the pharmaceutical companies the FDA has recorded over 1,000 different troubling and dangerous reactions in their adverse reaction documents that the drug companies are not required to list.

Whether you are aware of it or not you are always intoxicated while you are taking a tranquilizer. Even one dose may impair you for up to three days. Medications have an action in the body called “half life” or the amount of time it requires ½ of the medication to leave your body. Many of the benzodiazapines have long half lives up to 4+ days. It takes four to five lives to eliminate the medication entirely from a single dose. One pill can take up to twenty days to be eliminated from the body. Persons who have liver disease (alcohol use), are obese, in poor health or are over 45 may have greatly increased times of elimination.

If you are taking medication on a daily basis you increase blood levels to a “steady state.” This is when the amount you take each day is matched by the amount lost through half life elimination. A 5 milligram dosage taken every day may result in steady state blood levels of 25 mg or higher. While patients often congratulate themselves on their low intake of medication their nervous system is reacting and building tolerance to a much higher level. Many medical emergencies are the result of the multiplication factors from the increased blood levels and long elimination times from the body.

It is impossible to explore all the dangerous, and at times even life threatening effects these chemicals have on our physiology. It is well researched and documented that they do not heal, they postpone the day of reckoning for learning other healing possibilities and the potential for painful neurological damage increases with each dose.

One analogy that may be used is that of a flat tire incident. You are driving down the freeway and have a flat tire – decision. You can get out in all the difficult conditions along a freeway, unlock the trunk, remove the spare tire and jack and be acutely miserable. You may also decide to drive on the flat tire in hopes of reaching a service station so someone else can do the unpleasant work. When you arrive at the station the attendant informs you that you now have a ruined tire, rim, brake drum and suspension system. The result of a decision. The short term relief has presented us with a larger, costlier long term problem.

Tranquilizer use prevents us from making life changes, gaining knowledge on coping with the disorder, and affects our bodies ability to return to normal function. At some future point we will have to deal with our disorder. If we have chosen to “drive on the flat” we will be forced to deal with a chemical illness which is often many times worse than any anxiety disorder.

STOPPING THE MEDICATION

Do not stop taking the medication abruptly. You may have seizures with long term damage.

Because the tranquilizers have been restricting nerve activity and we have no way of predicting how much effect it has had on each individual you must stop taking the medication by reducing the dose over a period of days to several weeks.

It is extremely important that you have support in this process. You are not alone, each year 1.5 million people become addicted to Xanax alone. For many years these were the most often prescribed medication in the U.S. and overseas prescriptions numbers were even higher. The National Institute of Mental Health has estimated that up to 10 million people are presently addicted to benzodiazapines and many more who use alcohol are cross addicted to both drugs (remember alcohol increases the addiction / tolerance to tranquilizers).

You can do a simple test to see if you are tolerant (addicted) to benzodiazapines. If you have been on a steady dose for several weeks, stop taking one half of your daily dose (unless you are taking them for seizures). On the short acting medications like Xanax and Ativan you will experience symptoms from the withdrawal list within two or three days. Longer acting medications like Valium and Tranxene may take two or three weeks. These drugs are stored in our fat cells and in unusual cases it has taken over one month for addiction symptoms to appear.

If you experience withdrawal symptoms you can be sure that the medication has caused changes in the neuronal structure of the brain. Most people became frightened when they realize that with only half of their medication gone they can become so ill, what will happen when the other half is gone. While fear may be present it is a time for self-care and resolve to not let your brain become any more debilitated.

When the other half is gone (and only then) you will finally begin to heal. This may be very difficult or it may be just slightly uncomfortable. The higher the dose and the longer you expose your nerve cells to the chemicals the more certain the probability of a severe withdrawal. It is important to simplify your life to allow time for recovery. You will not be in control of this process as it progresses at it’s own predetermined rate. Do not take any additional medication doses, do not use alcohol or barbiturates or other drugs active on the central nervous systems (coffee, cigarettes, cold medications, sugar, chocolate, diet pills, many herbal remedies, pain pills, etc.) that will slow recovery or send you back to the beginning.

As you begin to withdraw it is imperative you become an informed advocate for your self. Most physicians will misinterpret your withdrawal symptoms as re-emerging previous anxiety. It is not If he/she is unable to understand the unusual sequelae (range) of symptoms you will be mis-diagnosed and treated for other disorders. Realize you are in withdrawal, read the symptom list (even if all of your symptoms are not on the list it is probably withdrawal), and do not fall into the additional trap of mis-diagnosis and medication. Physicians do not like difficult patients and benzodiazepine patients can be difficult.

Unknowingly Robert Frost coined a phrase that is most appropriate to benzodiazepine withdrawal, “The best way out is through.” Many of the physicians who assist us in the downward spiral of medical addiction. Most of them are compassionate and concerned. They are mis-educated by the pharmaceutical industry that in their rush for profits are often short sighted. Life has many pitfalls. We must all become informed medical consumers, protect ourselves from main steam mis-information and share this information with others struggling for answers.

Benzodiazepine Tranquilizer Withdrawal Symptoms (Partial list) ANXIETY
AGITATION
RAGE
IRRITABILITY
INSOMNIA
FATIGUE
HEADACHE
MUSCLE ACHES
MUSCLE SPASMS
TREMOR
SWEATING
CONENTRATION LACK
SEIZURES
NAUSEA
DEPRESSION
PSYCHOTIC BEHAVIOR
ABNORMAL PERCEPTION
BURNING SENSATIONS
BLURRED VISION
GASTROINTESTIONAL DISORDERS
ANGER
FEELING LIKE GOING CRAZY
INSENSITIVITY TO: SOUND, TOUCH, LIGHT, TASTE, MOVEMENT
HALLUCINATIONS
PARANOIA
INCREASED PANIC
IMPAIRED MEMORY
DEPERSONALISATION
DEREALISATION
VOMITING
INCOORDINATION
FLU-LIKE-SYMPTOMS
WEAKNESS
NIGHTMARES
MORBID THOUGHTS
HEART PALPITTATIONS
THOUGHT DISTORTIONS
RACING THOUGHTS
PARAESTHESIAE
DIZZINESS
GRINDING TEETH
DYSPHORIA
CHILLS
SUICIDAL FEELINGS
VIOLENT BEHAVIOR
FEELINGS OF COMING APART
IMPAIRED IMMUNE SYSTEM
NEUROPATHY
TINNITUS
DELUSIONS
MALAISE
RANDOM PAIN

Prepared for the National Center For Tranquilizer Information by *Rik* All material copyright protected. Request permission to reprint or additional information to: National Center For Tranquilizer Information, 67-715 Medano, Cathedral City, CA 92234 (619) 322-4545