Anxiety Medications Can Lead to Even More Worries

Stan Starr, a 54-year-old financial consultant, goes to 12-step meetings not because of addiction to street drugs or alcohol, but because of the pills he was prescribed years ago by his psychiatrist for anxiety.

Five years ago, he couldn’t sleep at night, his heart raced, he experienced wrenching stomach pains, and he felt as if his skin was crawling off his bones—he was in the midst of a two-and-a-half-year battle to withdraw from the Klonopin he was taking for his anxiety symptoms. “I went through sheer living hell,” he said of the withdrawal. “I didn’t know if I was going to make it.”

Katie Balestra, special to the Washington Post, tells Starr’s story in her article on benzodiazepines, drugs that are often prescribed to treat anxiety, panic attacks, and sleep disorders, explaining that they were originally pushed as a safer alternative to barbiturates. But health professionals and consumers are reporting that drugs like Xanax, Ativan, Valium, and Klonopin can lead to physical dependence, often resulting in severe withdrawal symptoms.

In 2008, 85 million prescriptions were filled for the top 20 benzodiazepines, an increase of 10 million since 2004, according to IMS Health, a health-care information company based in Norwalk, Connecticut. Those receiving the prescriptions in 2004 included 66,000 veterans suffering from post-traumatic stress disorder, according to a study by the Department of Veterans Affairs physicians last year. Worldwide revenue for Xanax rose to $350 million last year, up nearly 50 percent from 2003, according to pharmaceutical company Pfizer’s financial reports.

While some people herald the benefits of benzodiazepines, others say they are over-prescribed and can come with serious side effects. Some patients become tolerant to the drugs, so they take higher and higher doses to achieve the same effect. This can lead to physical and psychological dependence.

Stephanie Licata, a Harvard Medical School behavioral pharmacologist who studies benzodiazepines, explained that the drugs tell your brain to slow down, creating a calming effect. In some people, this can lead to memory loss and impaired motor skills.

John Steinberg, a physician and former medical director of the chemical dependency program at the Greater Baltimore Medical Center, estimates that 10 to 20 percent of those taking benzodiazepines for extended periods will have problems with dose escalation and physical dependence. “For a serious side effect, that’s a fairly large, significant number,” he said. “It is, after all, a devastating and debilitating adverse effect for those who experience it.”

Long-term use can also affect one’s mental state, according to Heather Ashton, a professor of clinical psychopharmacology at Newcastle University in England, who has studied the drugs since the early 1980s. In 2004, the Britih government made an effort to limit prolonged use of the drugs, advising doctors that the drugs should be prescribed only for short periods.

Withdrawing from benzodiazepines can be similar to withdrawing from heroin—abrupt withdrawal can result in hallucinations, seizures, and even death. Stan Starr started taking the drugs in 1996 after experiencing anxiety about his pending divorce. After he starting taking Klonopin, his anxiety started to disappear.

Six years later, he saw a new psychiatrist who said he needed to get off the drugs because he had become addicted. Shortly after, he decided to taper off the drug. He felt withdrawal symptoms immediately and took and extended leave from work. “It was ripping me apart inside,” he said.

After taking his last pill in 2002, Starr could not sleep for more than a few hours at a time, had a racing heartbeat, and experienced night sweats. Sometimes he couldn’t tell if he was speaking clearly and completely withdrew from his family and friends. After two and a half years, he started being able to sleep for a full eight hours.

Some doctors say that the vast majority of their patients do just fine on the drugs, however. Robert DuPont, former director of the National Institute on Drug Abuse, who has written several books on addiction and anxiety, said the drugs are widely successful in treating panic and anxiety. He said that 90 percent of his patients have no difficulty taking the medicine, and those with problems are most likely to be people who’ve had issues with addiction in the past.

“The typical patient that I see with anxiety is taking [benzodiazepines] well within the green-light zone,” he said. Addiction is an entirely different issue, having to do with a person “essentially falling in love with a chemical high,” he said. “For those people, they’re booze in the form of a pill.”

Some physicians recommend that people experiencing anxiety and panic attacks look to other options before turning to the drugs. According to Jerilyn Ross, the director of the Ross Center for Anxiety and Related Disorders in Washington, cognitive behavioral therapy is one of the most effective ways to treat anxiety and panic disorders.