A blessing and a curse.
The biggest problem with benzos is that they work. At least at first. If you need to quickly resolve symptoms of anxiety, or more appropriately, panic, benzodiazepines are absolutely effective. The problem is in how they do it. Benzos decrease your brain’s ability to re-wire itself, what we call neuroplasticity. That means that all of the coping mechanisms you’re learning in therapy, the incremental exposure to things that make you anxious… all of that gets slowed WAY down. If your brain has a chemical floating around that slows down, or even halts the rewiring process, the old connections from stimulus to anxiety are stuck. All the therapy in the world can’t fix the root of the anxiety. The research tells us that there is no difference in anxiety between SSRI/SNRI users and benzodiazepine users at 8 weeks, but the benzo group is hooked on a pill that withdrawal from isn’t just uncomfortable, it can be deadly. 18% will have dependence at 6 months and a further 21% will have developed tolerance.
So, do we use them? Yeah, but judiciously. Benzos shouldn’t be first, second, or even third line meds. They shouldn’t be prescribed in sufficient quantity to allow for daily dosing. They should require regular check-ins, regular monitoring of the additional prescriptions, and monitoring for misuse. There’s a lot of patient education that should go into those prescriptions as well.
With the system being as it is, we’ve inherited a lot of patients on long term benzodiazepines. Our goal is always to safely taper them to less than daily dosing with an eye toward discontinuation if possible. We’ve got a fair bit of experience with it.