Benzodiazepines (like Ativan) - More Harm Than Good? Addiction?
Benzodiazepines are a class of medication that's used for three things. Primarily it's seizure prevention or stopping seizures once they've started, then they're used for anxiety, and also used sometimes for withdrawal symptoms. When you're coming off of alcohol or coming off some other addictive substance, sometimes these are used to help ease that transition.
Types of Benzodiazepines
Okay, so what medications are benzos? And I bet you've heard of a lot of these. One that's very common is Ativan, also known as Lorazepam by its generic name. Another one is Xanax, which is known as Alprazolam. Another one that has a longer life, so it stays in your system longer is known as Klonopin or Clonazepam. And then another one you've probably heard of, Valium, is diazepam. One other very common one, it's known as Restoral. The generic name is known as Temazepam.
What's the deal with benzos?
They've been around for a long time. They are very effective at treating seizures, and they're also quite effective at taking away anxiety. They work through the GABA transmission in the brain and throughout the nerves.
Why I'm talking about them today is because they are often overused, especially in a clinical setting. These medications are quite addictive. Over time, you have to have more and more to get the same effect. They're very difficult to get off of, and a lot of people end up going into rehab and because they just can't get off of these medications. So they really are not a long term solution for those with anxiety disorders.
In fact, they may do more harm in the long term than they do good. Benzos are linked to different long term side effects such as memory loss, confusion and difficulty thinking clearly, difficulty sleeping, disturbing dreams, personality change, and changes in emotional responses. They can actually increase your anxiety over time. And they are also linked to irritability, paranoia and aggression. These medications, they've been used a lot for a long time because they've been around a long time. For a while it's all we had for anxiety disorders. Doctors used to prescribe them like candy, and they were everywhere.
What To Use Instead
I'm not here to just present problems to you. I want to show you what some of the solutions are. Now, there's a lot of options that you can go to before you need to go to benzodiazepines for anxiety disorders. One which I talk about in another video I'll link here, is hydroxyzine. Hydroxyzine is an antihistamine and it's very effective for treating anxiety symptoms. It is also non addictive and is something that you can use in the long term, not to mention it will help with your allergies.
Another option that you can try before going to Benzos is Gabapentin. Gabapentin has shown in studies over and over again that it can treat anxiety symptoms. Now, I was on Gabapentin for a while and it didn't help me, I didn't notice any effects from it. But there are many out there who have great results from Gabapentin, so it's something that you can try.
Another medication, Lyrica, works very much the same as Gabapentin has also been shown in studies to help with anxiety. Lyrica actually has some slight potential for addiction. It's less so than the benzodiazepine class. It's not quite as addictive. It's something that you may want to go to before the benzos.
Another whole class of medications that you could try are the beta blockers. Another class besides that are all the antidepressants. There are three or four different classes of antidepressants that are effective for anxiety, and you can try those.
Talk To Your Prescriber
So there are lots of options here. I just want people to know and understand that benzodiazepines are not a good solution in the long term for anxiety disorders. They usually lead to more problems. They lead to addiction, and they lead to all those really bad long term side effects that I mentioned before.
Talk with your doctor about some of these other options to go to before you go to benzodiazepines.
Sometimes doctors are quick to go to benzos, so you tell them, “Hey, I want to try something that's non-addictive and is a long-term solution for me before going to benzos.”
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Auvelity - 2022's New Antidepressant Medication
Auvelity (dextromethorphan/bupropion) For Depression
Auvelity is a medication newly released on the market in August of 2022. It is a combination of two common medications. It is dextromethorphan, which is used in a lot of cough medicines. The other active ingredient is bupropion which is an antidepressant and smoking cessation agent. The two are combined to create a greater antidepressant effect.
Dextromethorphan Mechanism of Action
The interesting thing about this medication is that it is the first time that dextromethorphan has been used to treat depression. Dextromethorphan has been used recreationally to create a “high.” It was this “high” combined with the increased popularity of Ketamine's use for depression that led to the increased interest in dextromethorphan. Dextromethorphan and Ketamine both act as an antagonist (blocker) of the NMDA receptor. Blockade of the NMDA receptor is what is believed to create the antidepressant effects from Ketamine. Dextromethorphan takes advantage of this mechanism of action without ketamine's side effects.
Benefits of Dextromethorphan vs Ketamine
Ketamine has a lot of drawbacks to it. It must be administered through an IV and can have some major side effects. Some of the side effects of Ketamine include amnesia, psychosis, visual distortions, and confusion. The side effect profile of dextromethorphan is vastly superior in comparison. Dextromethorphan is not a controlled substance unlike Ketamine. Ketamine is a schedule III-controlled substance. This puts Ketamine as having a higher addictive potential than drugs like Xanax or Tramadol.
Bupropion Mechanism of Action
Bupropion acts as Norepinephrine-Dopamine Reuptake Inhibitor. It increases the levels of dopamine and norepinephrine in the synaptic cleft. The synaptic cleft is the space between two neurons. The level of chemicals in this space is what determines mood and other functions of the body. Bupropion has been specifically shown to help with conditions like Seasonal Affective Disorder and Major Depressive Disorder. It does not help with anxiety disorders and may make them worse.
Auvelity Side Effects
Side effects of dextromethorphan/bupropion include:
- dizziness
- headache
- diarrhea
- somnolence
- dry mouth
- sexual dysfunction, and
- hyperhidrosis (Excess sweating)
The Anxious Resistance Take on the New Antidepressant
Auvelity is an interesting medication. The combination of bupropion with dextromethorphan shows greater effectiveness than bupropion alone. Using the NMDA receptor actions of dextromethorphan may increase the benefits of this medication. It is a novel mechanism that only a few drugs currently used to treat depression take advantage of. It is worth asking the question of why a formulation of dextromethorphan alone is not available. The potential of dextromethorphan alone should justify its use in this manner. Using bupropion with dextromethorphan is a bit of a mystery. Combination therapies are common in the psychiatric space, however this one does not seem to make a lot of sense. It may hold potential benefits over other medications by using the mechanism in dextromethorphan. Though I believe there would have been more benefit in developing a dextromethorphan formulation for depression without the bupropion combination.
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