Fig. 1. Pills & the US (Fast, 2018)
Anxiety Disorder Treatment: Issues with Long-Term Benzodiazepine Use
KISMET MOHAMMED HON 450 MEDAILLE COLLEGE
Presentation Outline Introduction History of Benzodiazepines Antithesis Dangers of Benzodiazepines Cognitive Behavioral Therapy as an Alternative Combination Treatment Conclusion
Introduction u
u
u
Anxiety disorders are the most common mental disorder for adults (National Institute of Mental Health, 2017).
Fig. 2. Psychotherapy Clipart (Vector, n.d.)
First-Line Treatments for Anxiety Disorders: u
Benzodiazepines
u
Psychotherapy (e.g. Cognitive Behavioral Therapy)Therapy)
Benzodiazepines are controversial u
Linked to many problems such as addiction, withdrawal issues, etc. when used for long periods (Bystritsky et al, 2013).
Fig. 3. Prescription (“Pill Bottle Clipart,� n.d.)
Thesis Statement & Importance
In order to minimize risks, benzodiazepines should: Only ever be prescribed in short-term doses. Be used in combination with an evidence-based psychotherapy (such as cognitive behavioral therapy). Never be prescribed for periods longer than four weeks.
Section I: History of Benzodiazepines
Fig. 4. Vintage Ad (“Serax,” n.d.)
Section I: History of Benzodiazepines 1950s
• Benzodiazepines are discovered by chemist Leo Sternbach (Tone, 2008).
1960s
• Initially the drug was met with praise
1970s
• Addiction issues become more noticeable
1980s
• FDA begins to place restrictions (Guina & Merrill, 2018).
1990s-Present
• Continue to be frequently prescribed • Increased research on alternative treatments (Guina & Merrill, 2018).
Fig. 5. Leo Sternbach (Oransky, 2005)
Section II: Antithesis/Counterargument 1.) Panic Disorder Relief • Other medications do not have the same guaranteed effectiveness for alleviating panic attacks (Susman & Klee, 2005). 2.) Cost-Efficient • Benzodiazepine prescriptions are not as costly as psychotherapy sessions (Conan, 2012). 3.) Convenient • Unlike other medications and psychotherapy, benzodiazepines are quick and can reduce anxiety within minutes (Neves et al., 2019).
Section III: Dangers of Benzodiazepine Use
Physical Dependence
• The body can become reliant on benzodiazepines within just a few weeks of taking them. • Makes it difficult to discontinue the drug
Withdrawal
• Occur once the body has become dependent on benzodiazepines • When discontinuing the drug, patient may experience headaches, nausea, and increased anxiety/panic attacks.
Addiction/ Misuse
• The powerful effects of the drug can make it easy to get addicted to. • Can lead to major distress and further worsen anxiety.
Cognitive & Motor Effects
• Long-term use has been linked to memory and concentration impairments. • For older patients, there is an increased risk of motor problems.
(APA, 1990; Longo & Johnson, 2000; Weber & Duchemin, 2018).
Fig. 6. Withdrawal Diagram (“Benzodiazepine Addiction and Abuse,” 2019 )
Section IV: Cognitive Behavioral Therapy Cognitive behavioral therapy is a successful form of psychotherapy. Focuses on the relationship between anxious thoughts, feelings, and behaviors. Patient actively works to address negative thinking patterns in order to form new positive ones. Emphasizes coping skills and confronting fears directly.
Fig. 7. CBT Model Example ( “What is Cognitive Behavioral Therapy, � n.d.)
CBT combined with short-term benzodiazepine prescription
Section V: Combination Treatment
Medication can help ease patients’ anxiety in first weeks of therapy
After 1-2 weeks, the patient is able to safely discontinue medication while continuing therapy sessions.
CBT combined with long-term benzodiazepine prescription
Risks of dependency can form and counteract benefits of CBT
Can lead to a decreased motivation to continue CBT
Conclusion The risks of long-term benzodiazepine use significantly outweighs the benefits.
Cognitive behavioral therapy should be much more encouraged for anxiety treatment.
More awareness must be spread on the risks of benzodiazepines.
Future research should look at enhancing psychotherapy options and understanding anxiety disorders better.
Reflection Abnormal psychology is an important subject area within my major My Major:
Psychology The field of abnormal psychology looks at understanding mental disorders and researching treatments.
Career Goal:
Clinical Psychologist
Clinical psychologists seek to help treat mental disorders (typically with psychotherapy).
References American Psychiatric Association. (1990). Benzodiazepine dependence, toxicity, and abuse: A task force report. Washington, DC: Author. Ashton, H. (1994). Guidelines for the rational use of benzodiazepines. Drugs 48, 25–40. “Benzodiazepine Addiction and Abuse” (2019). Withdrawal diagram [Image file]. Retrieved from https://www.ukat.co.uk/benzodiazepines/ Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current diagnosis and treatment of anxiety disorders. P & T: A Peer-Reviewed Journal for Formulary Management, 38(1), 30–57. Conan, N. (Host). (2012, Oct. 22). Psychiatrists shift focus to drugs, not talk therapy. [Radio broadcast episode]. Retrieved from https://www.npr.org/2012/10/22/163409863/psychiat- rists-shift-focus-to-drugs-not-talk-therapy Dryden, W., & Branch, R. (2012). The CBT handbook. Los Angeles, CA: Sage Publications. Fast, J. (2018). Pills & the U.S. [Image file]. Retrieved from https://www.healthyplace.com/bipolar-disorder/bipolartreatment/optimizing-and-stopping-bipolar-medications-gsd. Guina, J., & Merrill, B. (2018). Benzodiazepines I: Upping the care on downers: The evidence of risks, benefits and alternatives. Journal of Clinical Medicine, 7(2), 17. Longo, L. P., & Johnson, B. (2000). Addiction: Part I. Benzodiazepines-side effects, abuse risk and alternatives. American Family Physician, 61(7), 2121. National Institute of Mental Health. (2017). Prevalence of any anxiety disorder among adults.The National Institute of Mental Health Information Resource Center. Retrieved from https://www.nimh.nih.gov/health/statistics/any- anxiety-disorder.shtml
References (Continued) Neves, I.T., Oliveira, J.S.S., Fernandes, M.C.C., Santos, O.R., & Maria, V.A.J. (2019). Physicians’ beliefs and attitudes about benzodiazepines: A cross-sectional study. BMC Family Practice, 20, 71. Oransky, I. (2005). Leo Sternbach [Image file]. Retrieved from https://www.thelancet.com/journals/lancet/article/PIIS01406736(05)67588-5/fulltext#figures Otto, M. W., McHugh, R. K., & Kantak, K. M. (2010). Combined pharmacotherapy and cognitive-behavioral therapy for anxiety disorders: Medication effects, glucocorticoids, and attenuated treatment outcomes. Clinical Psychology: Science and Practice, 17(2), 91-103. “Pill bottle clipart” (n.d.) Prescription clipart [Image file]. Retrieved from http://clipart-library.com/pill-bottle-cliparts.html “Serax”(n.d.). Vintage ad [Image file]. Retrieved from https://w-bad.org/vintageads/ Spiegel, D. A. & Bruce, T. J. (1997). Benzodiazepines and exposure-based cognitive behavioral therapies for panic disorder: Conclusions from combined treatment trials. American Journal of Psychiatry, 154(6), 773-779. Susman, J., & Klee, B. (2005). The role of high-potency benzodiazepines in the treatment of panic disorder. Primary Care Companion to the Journal of Clinical Psychiatry, 7(1), 5–11. Tone, A. (2008). The age of anxiety: A history of America’s turbulent affair with tranquilizers. New York, NY: Basic Books. Vector, C. (n.d.). Psychotherapy clipart [Image file]. Retrieved from https://www.gograph.com/clipart/psychotherapy-conceptillustration-gg105348671.html Weber, S. & Duchemin, A. (2018). Benzodiazepines: Sensible prescribing in light of the risks. Current Psychiatry, 17(2), 22-27. “What is cognitive behavioral therapy” (n.d.). CBT model example [Image file]. Retrieved from https://breathe-uk.com/what-iscognitive-behavioural-therapy-and-what-happens-in-cbt-sessions/