Platinum Magazine, April 2005
John R. Cook, Ph.D.
Registered Psychologist

Recent high profile drug recalls by the major pharmaceuticals, such as that of the arthritis medication Vioxx by Merk in September 2004, and government warnings like the June 2004 advisory from Health Canada, associating the newer SSRI antidepressants with increased risk of suicide, have shaken consumer confidence. Well they should! The regulatory process governing the safe use of prescription medication in our country appears to be seriously flawed. One of the reasons for this is that the drug companies have been allowed to become the gatekeepers of information about their own products. They fund the bulk of drug research, and carefully control the way results are disseminated through company-sponsored grand rounds and conferences. This taints both the regulatory process and physician education. Accordingly, my advice to the drug-consuming public is: User beware!

Nowhere is it more important to heed this advice than in the use of a major class of anti-anxiety drugs called benzodiazepines. These products are marketed under trade names such as Xanax (alprazolam), Rivotril (clonazepam), Valium (diazepam), Ativan (lorazepam), and Serax (oxazepam). In addition to being prescribed as a tranquillizer for stress and anxiety, these drugs are also used as hypnotics to promote sleep, as muscle relaxants, and as premedication before surgery. They work by depressing the activity of the central nervous system, and so their major effect is sedation. However, other side effects from regular use can include loss of balance, confusion, memory impairment, anger and depression.

Although not recommended on a regular or intermittent basis for more than 2 to 4 weeks, benzodiazepines are frequently prescribed for much longer, particularly to women. The greatest risk of long term use is dependence; the body comes to depend on the drug both physically and psychologically for normal function. The patient starts to experience symptoms of withdrawal between doses, and has to take progressively larger doses to achieve the same initial effect. Eventually, regardless of the original reason for taking the drug, the patient is taking the drug primarily to prevent withdrawal. Withdrawal symptoms usually includes a more severe version of whatever the drug was intended to treat: anxiety, agitation, sleeplessness, and muscle pain, in addition to perceptual disturbances, muscle twitches and stomach upset.

If you or a loved one wish to come off of your benzodiazepine medication, consult your physician about using the Ashton protocol as described in the Ashton Manual on the College of Physicians and Surgeons of BC Website. An easier to read, more fully downloadable version of the manual is available on my Lonely Links Website.

The Ashton protocol calls for the substitution of an equally strong dose of a weaker, longer lasting benzodiazepine called Valium. The dose of Valium is then gradually tapered over a period of several months. The good news is: this protocol really works. The bad news is: some of your withdrawal symptoms may persist up to a year or more after you stop taking the drug. I will be talking about cognitive behavioural therapy - a safe alternative to benzodiazepine medication for the treatment of anxiety - next month.