Tag Archives: Epilepsy

Benzodiazepine Use: Benefits and Risks

A few days ago, I was sent an E-mail requesting I post an infographic on my blog about the dangers of benzodiazepines. The infographic was created by a dual diagnosis recovery center for people with a mental illness and co-occurring addiction. Because it is very much focused on the U.S. situation, I cannot repost the infographic here without further comment. I don’t do that anyway. Instead, I’m also sharing my knowledge of and experience with benzodiazepines, their benefits and risks.

The Hidden Dangers of Benzos
All rights reserved. Attribution: first posted on DualDiagnosis.Org

Benzodiazepines are a class of tranquilizing medications, among which are diazepam (Valium) and lorazepam (Ativan). While they can legally be prescribed for a range of conditions – insomnia, anxiety, panic attacks, seizures, etc. -, the Dutch insurance system limits coverage for benzodiazepines to four conditions:

  • Maintenance treatment of epilepsy or as-needed treatment of an epileptic seizure.

  • Treatment of anxiety disorders, when treatment with at least two antidepressants has failed.

  • Treatment of multiple psychiatric conditions that require use of high doses of benzodiazepines.

  • Palliative sedation during end-of-life care.

Physicians who prescribe benzodiazepines for these conditions, need to add the code B2 to the prescription.

I have used benzodiazepines on several occasions. First, in 2006, I was prescribed a benzodiazepine sleeping pill. It was at the time still covered, but no longer would under the current insurance regulations. However, from 2007 on, I’ve used several benzodiazepines for PRN use for irritability. Whether this falls under the multiple psychiatric conditions rule, I do not know, since I am in an institution so medications are covered anyway.

In 2010, I was on Ativan daily for three months. I was on a moderate dose of 3mg/day. After these three months, I told my psychiatrist I felt I no longer needed the Ativan. He changed the prescription to as-needed and I quit taking the benzodiazepine cold turkey. That truly wasn’t a wise choice. A few days from quitting, I was trembling and shaking. At first, I thought it was the antidepressant I’d started taking three weeks prior, but I eventually realized I was probably experiencing Ativan withdrawal. I spoke to my psychiatrist, who put me on a taper schedule that took several months. Ultimately, I spent almost as long trying to taper the Ativan as I’d been on it.

I honestly never found relief from benzodiazepines. Usually, I slept for a few hours then was irritable again. Then again, it seems that with irritability, the goal is to knock you out, not to really make you feel better. I also learned recently that benzodiazepines should really not be prescribed to people with borderline personality disorder, as the anti-anxiety effect causes borderline patients to be disinhibited and potentially become aggressive. I don’t think I ever experienced this myself.

I tend to develop tolerance to benzodiazepines really quickly. With the sleeping pill I took in 2006, I was given ten tablets that I used up over a six-week period. No daily use at all. Still, the last few pills didn’t really work at all. Please realize that, if you got used to one benzodiazepine, you’ll likely develop tolerance to the next pretty soon too. In November and December of 2007, I was on three different benzodiazepines, with about ten benzo-free days in early December. The first, I got used to within five days but kept taking for a month anyway. Then I had the ten days when I was off benzos – but on a stronger tranquilizer that is really an antipsychotic. Then I started taking nitrazepam (Mogadon), one of the more expensive benzos out there. It worked for about two weeks, but I did use the neuroleptic as adjuvant treatment. By the time I’d gotten used to the Mogadon, my doctor thought it would be time for something other than a benzo, but the psychiatrist disagreed and put me on diazepam. That didn’t work and I quit all tranquilizers at the end of December.

I have not been on any benzodiazepines for about a year now. I took Ativan as-needed until the summer of 2013, but it hardly worked so I now take promethazine (Phenergan), a low-potency neuroleptic. I do not want to be on benzos anytime soon again. Then again, I don’t suffer from epilepsy or a significant anxiety disorder and my irritability is kept relatively under control by a daily antipsychotic and PRN Phenergan.

When I ran the above infographic by some fellow bloggers to determine whether it was genuine, some people told me they did great on benzos. If you’ve suffered from severe anxiety for a time and antidepressants have not worked, I can totally see why you’d try benzodiazepines. If you have epilepsy, something has got to drag you out of a seizure. Therefore, even though I have personally not had luck with benzos, I don’t want to say that benzodiazepines are necessarily bad. I like the Dutch insurance policy, making sure that people won’t reach for benzos too soon but those who need them, can get them.

What’s in a Name?: Autism Subtyping in DSM-5

Recently, there appeared an article in the Journal of Autism and Developmental Disorders on why autism should be taken apart. I have not read the article yet – going to do so after I’ve had a good night’s sleep -, but I have read Harold Doherty’s comments on it. They follow the usual autism awareness rhetoric: my child is not like autistic advocates and therefore autism must be taken apart. And oh by the way, the DSM-5 is bad for calling the entire spectrum by the same name.

Let’s focus on that last bit. I own a copy of the DSM-5, and in the criteria for autism spectrum disorder, there are specifiers for:

  • With/without accompanying intellectual impairment.

  • With/without accompanying language impairment.

  • Associated with a known medical or genetic condition.

  • Associated with another neurodevelopmental, behavioral or mental disorder.

Furthermore, most people in the autism community know this, but there are three severity levels with coding of severity on each of the two symptom domains: social communicative impairments and repetitive behaviors.

Let’s contrast this with the DM-IV, which people like for its distinciton between Asperger’s Syndrome and autistic disorder. Anyone who has a communicative impairment, which could be just being unable to hold a conversation, and meets the criteria for Asperge’rs, could be labeled with autistic disorder. In fact, many of the autistic advocates Doherty and others disagree with, have an autistic disorder diagnosis. In terms of severity, also, the DSM-IV is pretty rigid in its focus: you only get the GAF scale, which determines a patient’s global level of functioning. I have a GAF score of 40, which means severe impairment in severeal areas of functioning. It is not stated whether this severe impairment is due to my autism or my borderline personality disorder or even due to the many labels I have on axis III (general medical conditions) and IV (psychosocial functioning).

I am not against subtyping of autism. In fact, I completely see how intellectual disability, language impairmetn, associated medical conditons such as epilepsy, etc., make a huge difference in an autistic person’s functioning. What I am completely against is the dichotomous taking apart of autism that Doherty etc. so often advocaate, where you eithr have Asperger’s (ie. social ineptness) or you have low-fuctioning, severe, classic autism. This dichotomy means that people who have severe impairments in self-care skills but, say, an IQ above 70 and no language impairmetns, are denied services on the basis of being merely socially inept. I don’t need to go into the consequences of this.