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Prescribing with Care

Your Adult ADHD and Mood Disorders Psychiatrist in San Antonio, TX

  • Writer's pictureJeffery M Benzick, MD, PA

Policy on Anxiety (benzodiazepine) and Sleep (Z-drug) Medications

Long-term use of benzodiazepines and tranquilizers in the Z-class (Ambien, Sonata, Lunesta) can be risky due to their potential for dependency, addiction, impaired alertness and coordination. Misuse and diversion are also concerns.

These medications are controlled substances subject to definite standards of clinical and ethical care as well as laws. Prescription policy for such in this practice bears reiteration. They can be especially problematic when combined with pain medications or muscle relaxants. Furthermore, because they are widespread and easy to find in the community, they may be diverted and frequently present in the mix of narcotic overdose. For some public health and law enforcement agencies, this approaches a public health hazard.

While these tranquilizing medications are effective agents for the immediate relief of acute anxiety, in most cases, they should only be used short term. Contraindications would include past or current misuse of benzodiazepines and other dependency-producing substances such as alcohol, cannabis, narcotic pain meds, stimulants, barbiturates, and various street drugs. Also, any history of illegal activity (convicted or not) connected with use of such.

What we’ve learned is that the best treatment for anxiety is to learn coping skills to deal with the uncomfortable emotion. Medications like benzodiazepines just cover it up and become the coping strategy.

Many patients want to continue these long term out of fear of withdrawal, or fear of insomnia, or psychological craving. Research shows even patients who have taken these medications for years--even decades--can safely taper down on their dose. The time required can be individualized, and, as many of us have already discussed, might take months or even years. We might even decide that an inpatient detox program is needed for closer monitoring.

I am committed to learning more about functional/integrative options to assist with the management of anxiety, and have found these incredibly helpful.

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