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Long-term benzodiazepine use causes synapse loss and cognitive deficits in mice

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bjornsing11 minutes ago

Benzodiazepines seem to have extremely different long term effects in humans depending on genetics and/or personality (or at least so it seems to me).

For example I’ve taken (prescribed) oxazepam and/or diazepam in significant doses every 6/12 hours for 3+ months, and then just suddenly stopped. Never felt the slightest urge to take the diazepam I had left in my bathroom cabinet.

But I’ve heard stories of people becoming severely addicted after consuming less than 10% of that total dosage.

So “your mileage may vary” as they say, and better safe than sorry.

shepardrtc13 hours ago

I was prescribed benzos because of sleeping issues, but I was also taking phenibut at the same time. After about 3 weeks of using large doses of the benzos every night, I stopped taking them, but a year later I still feel pangs of withdrawal sometimes when I get stressed. It took me another 4 months to get off the phenibut and a month or so after that before my sleep returned to normal. There were months where I maybe got an hour or two of sleep a night. If I got stressed, I simply wouldn't sleep at all. I once went three days without sleep. The torment of that combined with the withdrawal from the drugs showed me what hell was like. I tell everyone to never take benzos for any reasons. I don't care how safe the doctors say they are; they aren't. Period. There are repercussions - as this study shows - and they will not help the underlying cause of your issues. Treat the cause, not the symptoms.

yodsanklai12 hours ago

> I tell everyone to never take benzos for any reasons

You can't generalise your experience. Everybody is different and that's the doctor's job to assess whether the benefits outweigh the cost, considering the patient and their problems.

Personally, I've been taking benzos very occasionally for 20 years (never more than a few days at a time) and they helped me overcome difficult times. Never had the slightest addiction or side effects.

> Treat the cause, not the symptoms.

Easier said than done

headsoup41 minutes ago

> easier said than done

Yes but easier comes with a greater cost.

This is widely true for broader society where we are all busy taking the convenient solution over the harder, proper way, because screw long-term.

Sometimes, you have to realise that what pharma companies list as 'side effects' are not that at all, they're effects. Think about that.

Broken_Hippo22 minutes ago

Yes but easier comes with a greater cost.

It isn't like we are choosing easier because we are lazy. The reason it is easier to say is because with a lot of diseases and afflictions, we simply do not know the cause or do not know how to treat it. And honestly, it is Much better to treat symptoms than to treat nothing at all. Heck, sometimes it might mean death - like in the case of diabetes - or more suffering and disability - like with MS.

It isn't just because we are taking the convenient solution, in other words, and I find it disingenuous not to remember that we have a lot of holes in our medical knowledge and to realize that our imperfect knowledge leads to much of this.

And redefining side effects isn't really helpful. Sure, the medicine causes them, but it isn't like any researcher or doctor is trying to make you have unwanted effects. They are there because we don't yet know how to do the treatment without unwanted effects, and we still do it because sometimes those are better than the disease.

I don't think "big pharma" is innocent, mind you, but it doesn't help anyone to focus on conspiracy theories when you could be looking at things that actually happen and including other organizations that allow the abuse to continue (for profit medicine, for example).

pirate78711 hours ago

My family was addicted to benzos by a quack doctor who hands them out like candy. He has many seniors on it long term for "anxiety" and though seniors are at particular risk and are not supposed to use more than 6 months.

r3trohack3r11 hours ago

I got to see this side of American medicine while in high school. My great aunt unofficially overdosed on a cocktail of drugs prescribed by a group of loosely coordinating doctors.

When she passed, her cocktail included 12 prescriptions. One of her doctors had prescribed her medication to lower her blood pressure while another had her on medication to raise it.

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shaky-carrousel20 minutes ago
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kayodelycaon10 hours ago
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pkaye10 hours ago
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nootropicat10 hours ago
donthellbanme10 hours ago
jnovek10 hours ago

Same here. Occasional clonazepam use for panic attacks which are secondary to post-traumatic stress disorder.

Never even the tiniest sign of dependence. Sometimes I go months between uses.

I am also a chronic pain patient and I worry that benzos are going to get the opioid treatment.

There was a period in the mid to late 2010s where patients who depended on opioids for any sort of quality of life were taken off of their medication without any sort of alternative. It’s something that people love to gloss over when they talk about the opioid crisis, but if you knew someone personally who went through that, you know that we collectively subjected those people to torture.

risho9 hours ago

long term constant exposure to opioids will literally begin cause the pain they purport to solve. If you give a perfectly healthy person with no pain at all opioids for long enough they will be indistinguishable from a person who has an actual chronic pain issue.

people should only ever take opioids VERY TEMPORARILY to get through surgeries or other such things. Opioids are not for long term pain management.

Same thing with benzos and anxiety.

ridgeguy8 hours ago

Not correct, at least for some opioids.

Nearly all opioids present the hazard of dose escalation over time to maintain their efficacy. Hence the dose escalation commonly seen with morphine, oxycontin, etc.

Most opioids, in addition to interacting with mu-opioid receptors (the mechanism of pain relief), also activate NMDA receptors, which enhance pain sensitivity. So for most opioids, there's an adverse dynamic in which analgesic activity competes with nociceptive activity, leading to dose escalation.

Methadone is one of two opioids that don't activate the NMDA receptor system. (The other is dextromethorphan, the OTC cough suppressant.) Methadone has been used very successfully to treat chronic pain, and does not exhibit dose escalation issues. Methadone has slow kinetics and does depress respiration, so when putting patients on it, dosages should be titrated slowly to avoid hazardous or fatal events. This is easily managed in ordinary clinical practice.

A close family member has been treated with methadone for chronic refractory migraines for >20 years. She transitioned to methadone from morphine SR after experiencing the classic need for increased dose. With methadone, she's had no dose escalation, no impairment due to psychotropic effects...it's simply given her a life to live.

sva_11 hours ago

I have friend who was at nursing school, and she'd get them prescribed for the few occasions where she had to do a presentation, as she would get extremely nervous. She never took them after. Maybe she could've addressed the issue differently, but it worked for her, and she never got hooked. But milage varies, and so on. She also told me that at the hospital, benzos are readily available and they kinda hand then out like candy to manage patients (there doesn't seem to be any rigorous bookkeeping about them).

I also tried a few many years ago, but they didn't really do anything for me. I think they only work if you got anxiety or something, so some underlying issue which -if chronic- is probably not a good fit. Never had any cravings since.

nordiazepam9 hours ago

> I think they only work if you got anxiety or something

Probably something to that. I didn't feel much at the prescribed dose. Being curious and foolish, I took 3x. Did feel that. Socially effusive. Good sleep. There was a physical aspect. A warm glow, muscles that felt relaxed rather than stiff. Like waking up in warm sun after a particularly good night's sleep.

People without anxiety, who aren't literally and metaphorically tense, probably get far less of that. But that's what it does for a really anxious person like me, especially with a bit too much. So of course I did it again the next day.

You quickly come to long for, or believe that you're just better off, in that state all the time. But there is tolerance. It stops working like that at the same dose after a few days in my experience. So, take more. I was in big trouble within a month. That's the psychological addiction in my experience, the strong desire or preference for being in that state, emotionally.

I couldn't stop. No physical consequences but intolerable withdrawal mostly of rebound anxiety and insomnia. I eventually got off them with a very long taper. ~5 months with the dose adjusted weekly. No significant physical withdrawal. At the right dose of a long-lasting benzodiazepine, I felt like before I had started taking them, more or less. I did have to learn to deal with the psychological need to be more disinhibited than normal. If I could do that, and not escalate doses, getting off would be possible. It was, and I haven't taken any since the last dose of the taper. I think about that state and sometimes I do long for aspects of it, but they're not really cravings anymore. Only get those for nicotine.

kayodelycaon11 hours ago

I’ve reacted differently to different benzos. One did nothing. Another triggered one hell of a mood swing (I’m bipolar). Finally settled on Klonopin, which has a long half-life. It seems to be less.. harsh?

Psychoactive medications are fun…

sva_11 hours ago

I really only ever tried the ones with a short halflife personally.

Now that I think of it, a benzo actually did help me once, when I got my wisdom teeth removed. Made me a bit more calm about it. But it was fairly tolerable overall anyways.

kevinmchugh6 hours ago

I've been told that benzos are a good option for someone anxious about flying. They make the flight tolerable and help the person feel comfortable flying in the future. They may only need to learn that there's nothing to fear in flying, and benzos can help them learn that.

I trust the person who told me that, but have heard a lot of benzo horror stories.

(I'm not afraid of flying)

dymax785 hours ago

Unfortunately, I’m one of those individuals illogically terrified of flying. A small dose of a benzo (in my case, Ativan), makes the flight bearable.

mikepurvis11 hours ago

This whole discussion is making me feel better than ever for choosing cannabis edibles (legal in Canada) to address stress-induced insomnia and other sleep issues for which the root cause was not something I was in a position to immediately address.

I take it a few times a week as needed, small doses (2-5mg) and I feel that I am in control of it and could go off any time.

ta98810 hours ago

The thing with most addictions is that as long as you are taking a substance and don't try to stop you feel that you are in control. As long as you have not tried to stop you will never know

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mikepurvis9 hours ago
ipaddr8 hours ago

Doctor's job is to quickly find a solution in the 10 minute appointment that insurance will cover optimizing for higher pay. A doctor runs a business.

If you have been taking benzos for 20 years you might have an addiction. Parent poster was talking about cravings a year later.

NoSorryCannot7 hours ago

Most doctors don't run a business.

bogomipz6 hours ago

Private practices in the US have been declining for decades. Most Doctors today are employed by a hospital or other provider network. This trend has only accelerated since the pandemic as well. As a result of this Doctors have had no choice but to run their practices as a business. This is why they now require you to have a credit card on file, why there's cancellation fees, and why you don't actually see the Doctor until almost an hour after your appointment. They are simply triple and quadruple-booked. They can not choose their volume. This trend has been well-documented. See:

https://www.ama-assn.org/press-center/press-releases/ama-ana...

https://www.healthcarefinancenews.com/news/nearly-70-us-phys...

https://www.webmd.com/health-insurance/news/20210527/more-an...

outoftheabyss10 hours ago

Agreed, I have pretty bad social anxiety with hypervigilance. Taking on average 3 5mg (occasionally a 10mg dose) tablets a week when needed for presentations or meetings with more weight allows me to keep my job.

Even such a small dose I feel restores a sense of normality that I haven't experienced in over 10 years without them, I'm able to rationalise what I want to say, conversation flows, I feel in control. With all that said, I've been doing this for a while and have never come close to addiction and no noticeable side effects. I continue to work on the underlying causes but without them I would be much worse off.

cj10 hours ago

For performance anxiety, try asking a doctor for propranolol.

Propranolol blocks the physical symptoms of anxiety. It stops your hear rate and blood pressure from rising. It stops those uncomfortable adrenaline rushes. It stops stress-induced trembling / shaking.

It's completely safe, any doctor will happily prescribe it, it's not addicting, and unlike benzos, it doesn't affect your cognition.

outoftheabyss10 hours ago

Thanks but I've tried beta blockers and a couple of SSRIs and diazepam is the only thing that touches my anxiety. When I walk in public the vigilance to perceived threat is is what I would expect walking through 1980s Beirut, it's a primitive fear response that manifests through symptoms that are more mental than physical in nature - heart rate and sweating in particular are issues but seem to me to be at the bottom of the chain.

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AlecSchueler10 hours ago
o1044936611 hours ago

Yeah, I've been diagnosed with chronic insomnia and benzos are the only thing that can reliably put me to sleep if I desperately need them. I reserve them for emergency situations, but just knowing I have them as an option is comforting.

ada198111 hours ago

I think literally everything from learning to play tic tac toe to quantum computing is easier said than done…

It’s harder to clear trauma, teach emotional regulation and to build a life that is healthy, yes. And, it’s a path worth walking down.

jlmorton12 hours ago

It's much the same with chronic alcohol usage, and a very similar pathway. Both alcohol and benzodiazepines bind to GABA receptors, and through several difference mechanisms (desensitization, downregulation through gene expression, degradation), these receptors become less sensitive.

GABA receptors are critical to sleep. After prolonged usage of alcohol, or benzos, sleep often becomes impossible without an ever-larger dosage.

These sleeping difficulties sometimes persist for quite a while, and sleep disturbances are one of the primary causes of relapse in alcoholics. People learn that alcohol helps them to fall asleep. Even if the quality of sleep is poor, it's substantially better than no sleep at all, as anyone who has gone through what you did surely knows.

bsimpson12 hours ago

Someone close to me has long been addicted to both alcohol and Ambien (sleeping pills).

I'd never considered that alcohol could trigger the need for Ambien. I'd presumed it was a lifestyle thing for someone who was used to being out all night.

phenthrowAway12 hours ago

To anyone curious about phenibut:

Don't. Just don't. Please.

Just a few weeks of usage can cause dependence. It is notorious for causing compulsive redosing. Withdrawal can make you unable to sleep for days, with lingering effects like panic attacks and anhedonia for weeks and weeks. Withdrawal from larger quantities can cause auditory and visual hallucinations and seizures and can even KILL you. Avoiding serious symptoms requires an excruciating taper that can take months. The effects of long term abuse are poorly understood.

"But it's totally legal, and with responsible dosing can be a potent nootropic. I'm not a drug addict, I'm a biohacker. I'm not after a high."

Yeah, That was my thinking too, and in hindsight that was immensely stupid. Please just look at r/quittingphenibut before doing anything.

Be kind to your GABA receptors.

capitalsigma12 hours ago

I take phenibut about 1x/week, I have been for about 2 years now. I think it's generally pretty OK for me, though I've started to worry that it impacts my memory a touch, at the edges.

Do not take drugs every day. For real. I don't want to victim-blame but it is wild that you expected to be able to be able to take drugs daily for weeks without withdrawals. As a rule of thumb, unless you intend to be on it forever (e.g. caffeine), you should never take anything more than maybe 2 days out of 7 in the week. Psychoactive drugs are not like aspirin, where you dabble a bit as necessary.

Phenibut is serious stuff. Nobody would say "I had only been drinking a pint of vodka every day for a few weeks before I realized I might have to deal with withdrawals."

radu_floricica3 hours ago

This is why we can't have nice things.

I'm sorry, but you fucked up, with the focus being on "you". Phenibut is notorious for building tolerance fast, and having bad withdrawal.

I really really dislike it when people try dangerous things in obviously wrong ways, then act like it's society's fault that they were available. No, it's not. I've tried a lot of things over the years, and I've been properly paranoid with most of them. I'm extremely creative with treating my insomnia but guess what: I have two doctors I check with. I don't care when they laugh at me (like when I told them I'm taking 1/60 mirtazapine pill), or when they shrug. I keep checking for the moments when they say "no, that's a really bad idea", and I keep doing that even if they keep saying nothing for 10 years at a time. Because even one "no, that's stupid" makes it worth it.

c7DJTLrn12 hours ago

Well that's frightening. I tried it out recently and didn't really feel anything that would get me hooked on it but maybe that's naive.

mckirk11 hours ago

My advice: Don't underestimate the substance, but also don't give too much importance to stories of people that overdid it and had a terrible time. People have been using Phenibut for long periods of time without getting dependent -- provided they space out the "Phenibut days" enough. Of course that requires some self-knowledge: If you are the kind of person who would have trouble keeping it to "not more than twice a week maximum (ideally not more than once a week) at reasonable dosages", then Phenibut can easily turn into a slippery slope to physical dependence, with horrible withdrawals.

If you know yourself enough not to overdo it, it's not _that_ terrible a thing; though your individual response to it will of course vary, which is where the "self-knowledge" comes in again.

shepardrtc12 hours ago

Phenibut is horrific and should be banned. I thought I could control it, but I couldn't.

sshine11 hours ago

I tried it once years ago.

Amazingly potent. I considered finding applications for it, but alas, I had no use for it.

Seems like a WW2 drug like amphetamines: Sure works wonders if you’re patching up people, going through horrors like a breeze. But it ain’t a peace-time nootropic with minimal downside.

nostrebored9 hours ago

Never more than two non consecutive days in a week — this isn’t a mystery.

s530011 hours ago

Because you have no self control a substance should be banned.

Cool world that would be to live in.

infamouscow10 hours ago

These drugs chemically change the brain, so your brain might fall into a state where you lose control.

Drugs often get pulled decades after being approved, usually because the safety studies were not expansive enough to give a complete picture of the danger. For example: Varenicline.

heavyset_go12 hours ago

I've heard of people going through withdrawals after just a single week of use. Nuts that it's sold as a supplement at all.

Interestingly enough, a suspected GABA prodrug that supposedly passes the blood-brain barrier called picamilon has been banned by the FDA, yet phenibut is still on shelves.

SemanticStrengh12 hours ago

picamilon is banned? That's dumb, soon they will ban l-theanine and taurine? I really don't think you can get addicted to picamillon like phen or benz

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kayodelycaon11 hours ago
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heavyset_go12 hours ago
opportune11 hours ago

Did you tell your doctor you were taking phenibut when they prescribed you benzos? It seems like something you definitely shouldn't mix.

I completely agree that benzos are bad news unless you truly need them. In my relatively uneducated opinion, I don't think they should be a first-line treatment and it's kind of a joke that they're considered schedule 4 (at least compared to things that are schedule 2 - I don't think really anything should be "scheduled"). Benzos and other gaba-ergics may not be as pleasurable as other drugs, but they're very addicting and have the most harmful withdrawal process of any class of drugs.

Phenibut and the prevalence of RC benzos (which aren't subject to the federal analogue act since benzos are schedule 4) are another phenomenon. I think people underestimate the risks of this stuff due to how easy it is to get them - especially phenibut which is sold in a lot of more "legit" websites.

TearsInTheRain8 hours ago

They are considered a first line treatment because they are fast acting whereas other anxiety medications like SSRIs can take weeks to start working.

opportune7 hours ago

That makes complete sense for something like panic attacks. I guess I’m thinking more of GAD - I don’t know if they’re formally first line treatments but I know it’s definitely possible to get started with a long-acting benzo

duvara3 hours ago

Just putting this in here. If you are suffering from insomnia, one possible alternative is to look into CBTI (cognitive behavioral therapy for insomnia). Its one of the only clinically proven non-drug-related treatments for insomnia. If you are struggling, google it and try to find a CBTI counselor to help. Don't try it on your own - its quite challenging. It literally saved my life a few years ago.

erichmond9 hours ago

First, I want to acknowledge your situation so I don't want to belittle what you went through in any way, but I had a catastrophic series of events happen in my life almost 9 years ago, and Xanax was literally a life saver for me.

Taking the Xanax allowed to me relax enough to do the work to figure out how to relax naturally. Before the Xanax I was having crippling panic attacks 24/7.

My only point is, you're a data point of one, I'm a data point of one we both had very different experiences. I don't tell people to take, or not to take benzos when they ask me, I just give my objective experience and let them make their own decision.

loeg11 hours ago

> I tell everyone to never take benzos for any reasons. I don't care how safe the doctors say they are; they aren't. Period.

Do you ever wonder if maybe something about your situation might be different from most other people prescribed benzos? For example, the concurrent phenibut use.

noduerme3 hours ago

I don't think they're meant to be taken that way.

I've had the same bottle of Xanax around for 5 years. It's more like a "break the glass in case of emergency" type thing. Usually reserved for going to funerals or weddings of people I hate, when I can't tie my tie because I'm in a cold sweat. As the kind of alcoholic who never turns down a drink, it surprises me how strongly I don't want to touch diazepam, how little inclination I've ever had to take it recreationally, even though I enjoy it and know it can provide short-term comfort. On a lot of occasions, having the bottle in my pocket just in case has been enough.

Then again, that might be because of how strongly it reacts with alcohol, which is a given in most situations where I'd break out the Xanax...

raylad5 hours ago

Somewhat germane:

https://pubmed.ncbi.nlm.nih.gov/22371848/

Conclusions: Receiving hypnotic prescriptions was associated with greater than threefold increased hazards of death even when prescribed <18 pills/year. This association held in separate analyses for several commonly used hypnotics and for newer shorter-acting drugs. Control of selective prescription of hypnotics for patients in poor health did not explain the observed excess mortality.

SemanticStrengh12 hours ago

there can be legitimate uses for acute exceptional benzo use for e.g. panic attacks but yeah for anxiety or sleep they are a slippery slope that ruin lives. As I said in my other comment, there exist effective, saner solutions.

cameronh9012 hours ago

I have a small pack of prescribed diazepam in my backpack in case I have a panic attack. Haven't used any of them so far, but just having them there makes me a lot less anxious.

azinman212 hours ago

That’s a classic strategy. I had a brief period of panic attacks that benzos really helped with that helped me gradually have less and less. I don’t particular like the feeling of the benzo, luckily, so it wasn’t appealing to take outside of acute need. My doctor did seem to want to monitor refills and asks me how often I take them (almost never now), so he was aware of the dependence issue. I do carry one around just in case, and very rarely, do in fact need it.

throwaway2332411 hours ago

Same here with klonopin/clonazepam . I take .5mg max which is generally the starting dose, and very, very sparingly - like .5mg every few months max.

Benzos can absolutely decimate anxiety reliably - and half of my panic is the fear of not being able to control a panic attack (thus the self-feedback loop into panic). The amount I take only takes the edge off which is all I need, just knowing I have it is such a massive help at preventing panic attacks it's crazy.

shepardrtc12 hours ago

My eventual treatment for my underlying anxiety was Lexapro. It's worked wonders. I can't say enough good things about it - as long as you stick with it. Old SSRI's are terrible, but newer ones work like they're supposed to. At least in my opinion.

SemanticStrengh12 hours ago

SSRIs do not work for everyone. It's good that they work great for you.

johnisgood5 hours ago

There were times when I abused them. I had a pretty bad withdrawal that gave me a seizure. Now I take them to give me munchies. For that of course I must not take it for longer than 2 weeks. My depression and anxiety is treated in a different way. Benzodiazepines messes with my memory and cognition. Lorazepam seems to be the worst on memory, for me. Useful for dental appointments though.

matheusmoreira10 hours ago

> I tell everyone to never take benzos for any reasons.

You tell people having a panic attack not to take a sublingual benzodiazepine?

EricMausler4 hours ago

>There were months where I maybe got an hour or two of sleep a night.

I feel like this is very easy to gloss over while reading, but in actuality is quite an intense experience to have gone through. This would drive me actually insane, I don't know how to coped with it

TearsInTheRain8 hours ago

Was your use monitored by a doctor? It doesn't sound like it. Klonopin was very helpful for me to pull me out of an episode of severe anxiety and constant extreme panic attacks. It was a bridge med until the SSRIs kicked in. My dose was never that high and I wound off them slowly after two months. Stopping abruptly after 3 weeks sounds like a bad idea. Im very grateful for that drug.

RGamma12 hours ago

Doctors prescribe benzos for sleep issues and tell you they are safe? Do you live in the US?

shepardrtc12 hours ago

Yes. Some doctors do; some don't. My new doctor was horrified when I told her what I was prescribed. She's young, and she said the first thing they say in medical school nowadays is, "Benzos are bad." My first doctor was much older and clearly from a different era of medical school.

jolux12 hours ago

My doctor is young and gave me a limited prescription for ten doses of lorazepam while I was adjusting to duloxetine, which often exacerbates anxiety in the first couple weeks. I was experiencing regular panic attacks before starting so he wanted to be sure they didn't become disabling. Benzos are safe when the amount and duration are carefully controlled. The problem is chronic usage, which is more or less contraindicated these days.

SemanticStrengh12 hours ago

is that a question? Benzos are not safe despite what many doctor believe. I'm in EU.

oboes11 hours ago

In my opinion doctors underestimate the danger of benzos. They also often don't know that there is a black market for benzos (like there is for any other drug). Patients will be able to find benzos if they look for them even if they don't have a prescription.

I had a friend who wanted to stop smoking cannabis and got alprazolam prescribed for that by his doctor (it was in EU). In my opinion it would be better to stick to cannabis than switch to Xanax.

I myself tried talking with my family doctor about my benzo addiction. I was addicted to etizolam, a RC benzo popular at the time. He seemed not to believe me that it was possible to get benzos without a prescription, and told me that I was wrong and couldn't have a benzo addiction.

RGamma12 hours ago

Weird this can happen in the EU to be honest.

In Germany these things are really difficult to come by for these minor reasons (it's probably different for the critically ill but I wouldn't know).

Briefly, doctors have to have special permissions to prescribe potentially addictive or mentally altering substances and it's only with a special, bureaucratic kind of prescription ("BtM-Rezept").

That's why I always wonder how this can happen so casually. If I'd ask my GP for benzos for sleep problems I'd most certainly not get them even if he'd be allowed to prescribe them and reckless prescription in this case could lose him his license.

whimsicalism12 hours ago

they're saying they wouldn't be so easily prescribed in the US

SemanticStrengh12 hours ago

is that a joke? I'd be very surprised if doctors were'nt abusing benzo prescriptions for GAD

JimBlackwood10 hours ago

I think it’s dangerous to say you should never take benzos. People and their mental states are different.

For people with anxiety and panic attacks, benzo’s are literal lifesavers.

77pt7712 hours ago

Of the common legal drugs, benzos are by far the most dangerous to quit.

And you get addicted in like a week.

Be very careful.

bsimpson12 hours ago

There was a tea bar in my neighborhood that would put kratom in one of the teas.

It didn't make me feel particularly euphoric, but I did find myself craving it the next day. Shit is fucking weird and scary.

entropie12 hours ago

> Of the common legal drugs, benzos are by far the most dangerous to quit.

Not sure if that's right. Alcohol withdraw can actually kill you.

ikiris11 hours ago

They're the same withdrawal... Benzos are just far more potent, so the dependence can happen MUCH faster, in like days.

kevin_thibedeau12 hours ago

By the time you've developed alcohol dependence you've most likely gained more than a few comorbidities. That doesn't happen in a week.

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hirvi746 hours ago
hibern812 hours ago

Benzo withdrawal can as well.

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entropie12 hours ago
tinyhouse12 hours ago

I took it for two months for sleep and had no issues quitting it besides a few nights of taking longer to fall asleep.

jotm12 hours ago

Wow, 1. who tf gave you phenibut before gabapentin/pregabalin? Phenibut is notoriously hard to quit. It takes at least a few weeks of gradual tapering down. 2. Together with a benzodiazepine? Wew, lad. Should've also taken a few shots of vodka before sleep for the insanity trifecta.

Edit: sorry, I always assume other people have access to medication. I don't so I shouldn't have laughed.

Yeah, so there are a few gabapentinoids/gabaergics out there, and they can help a lot.

But please read everything you can before deciding on something.

Just a couple of pages of Phenibut experiences have convinced me to not try it because there are better alternatives with fewer side effects.

Fargoan12 hours ago

He probably gave himself phenibut. It's not a prescription drug. You can just buy it online.

SemanticStrengh12 hours ago

it's less frequent but people can get addicted to pregabalin too.

jotm10 hours ago

I mean, a lot if not most drugs are addictive - if not physically, then mentally. It's all down to whether it helps you more than it harms you.

Hell, I can make the same argument about exercise - is it worth the risk of physical injury, something that most people don't even consider? I'd say yes, the beneficial effects outweigh the negative ones.

I've used gabapentinoids (and am using a gabaergic right now) to great positive effects. The downsides are there but they are minor. On that note, I have been using alphaPVP for ADHD management and am happy to report it is nowhere near as scary as the media makes it out to be. A shorter lasting version of methylphenidate, basically, and better than cocaine for the purpose.

Gabapentin and pregabalin withdrawal can be scary at first, but once you know the effects and learn to taper off, they're rather harmless. In fact, the biggest danger is in not being able to buy them because the medical system won't allow it, leaving you to quit cold turkey. Second biggest danger is from the police (illegal to possess without a prescription).

I have not tried any benzodiazepines or phenibut, but I'd bet they can be managed pretty well.

throwaway2332411 hours ago
robwwilliams8 hours ago

Caution: While this is a cool study in Nature Neuroscience, almost all facets of this work are based on a single fully inbred strain of mouse—-C57BL/6J. This strain also happens to have a major mutation in the GABRA2 gene that reduces expression about 2X relative to almost all other strains of mice. GABRA2 is one of the most important receptors involved in inhibitory responses in CNS and benzodiazepine responses.

This same strain also has a well known splice variant mutation in a key mitochondrial gene, NNT, that modulates both mitochondrial and macrophage function. The microglial mentioned in this paper are a special class of macrophages that reside in the CNS.

Given these comments, when the authors refer to “wild type” (WT) mice, remember these are anything but true wild type mice. Fully inbred strains always carry numerous homozygous recessive and dominant mutations (several hundred each) that often affect CNS, immune systems, and mitochondrial functions.

The results may well hold up in other strains, but I would not count on it. Do benzodiazepines affect all humans uniformly?

Would studies of other strains or types have been practical? Yes. The Thy1-GFP and Thy1-YFP lines can be crossed to make F1 hybrids. This particular transgene is also available on at least one other strain of mouse (DBA/2J).

Unfortunately, most reviewers at Nature Neuroscience are not geneticists ;-) They are typically strong molecular neurobiologists who are used to reductionist methods. They are perfectly content with submission to Nature journals that are based entirely on with N=1 mouse genome—almost always the mutant C57BL/6J inbred strain.

In my own work I try to avoid this N=1 trap. (But I have also failed ;-)

Generality and robustness of results (see quote below) should ideally be established across two or more diverse genomes before making broad claims of relevance to other species, including od course to humans.

The quote:

“We have demonstrated that microglia in WT mice alter their morphology and functions upon diazepam treatment and cease to do so in Tspo−/− mice.”

SemanticStrengh12 hours ago

The world of medecine is degenerate. Sustainable, non addictive and non neurotoxic anxiolytics exists: the #1 being opipramol the sigmaergic. emoxypine (which btw cure hangover) and guanfacine are worth mentioning. Maybe beta blockers to some extent. NMDA antagonists such as memantine have side effects but are not neurotoxic to my knowledge and there are milder ones such as mg-lthreonate. afobazole is interesting but its pharmacology is too weird to be sure. Etifoxine is revolutionnary, it double axon length growth rate so ironically a great cure to benzo neurodamage. its acts on the mitochondria benzodiazepine receptor. It's unclear to me wether it is subject to a tolerance effect and if so if it is lower. Also etifoxine can interact badly with other drugs on the liver. Note that there exists ultra-atypical mechanisms, such as inositol megadose or tofisopam but they are not firstline.

So yeah, basically opipramol and guanfacine should be what humans take as first line. Glycine is a nice obvious augmentation (kinda absurd that people forget about the second inhibitor neurotransmitter in the brain, especially since the effect feel nice and doesn't really lead to tolerance). if you have benzo neurodamage, take magnesium lthreonate which is a very potent synaptotrophic.

also fun fact: the benzo cartel was so strong it was the most prescribed drug in the world, all classes, in the 70s

sph12 hours ago

I have a hard time believing that while the current status quo is suboptimal, there's some little known compounds that are, as you say, revolutionary and with little side effects. Pharmacological research is a constantly moving target, there is no scientific nor economic reason that a supposedly "perfect" remedy remains unknown. Sounds too much like thinly veiled conspiracy, or perhaps they're not as perfect as you're suggesting.

That said, it's not my area of competence, so if you know _why_ opipramol and guanfacine are ignored compared to benzos and other anxiolytic, you should probably explain that.

EDIT: re: guanfacine, I know it's a second-line treatment for ADHD, it was previously used to treat hypertension, but this is the first time I hear it might be applicable as an anxiolytic. It does certainly have side effects, though not as bad as being neurodegenerative like benzodiazepines.

https://en.wikipedia.org/wiki/Guanfacine

PragmaticPulp9 hours ago

> I have a hard time believing that while the current status quo is suboptimal, there's some little known compounds that are, as you say, revolutionary and with little side effects.

Your suspicions are correct. The parent comment is an example of a trend among people who know just enough about pharmacology to be dangerous: Exaggerating the benefits of less popular medications while demonizing mainstream medications. Add a dose of conspiracy theory ("pharmaceutical industrial complex") and it's a recipe for contrarian exaggeration.

The parent comment strangely missed the actual mainstream, effective treatments for anxiety: SSRIs and Buspirone are widely used for long-term anxiety treatment with significant success. They’re not perfect and you can find horror stories if you search the Internet long enough, but people tend to get fooled into thinking mainstream medications are worse than obscure ones because mainstream medications will naturally have a higher absolute number of negative reviews online than rarely-prescribed medications.

In practice, it would be rare for a doctor in the United States to prescribes benzos as a first-line and long-term treatment for chronic anxiety. They are prescribed for panic attacks and short-term anxiety (e.g. a difficult court case with an end date) but SSRIs are the mainstream treatment.

loceng8 hours ago

You should probably read about the pharmaceutical industrial complex to balance out your wildly biased and one-sided, unbalanced perspective.

Are you honestly going to claim that the many multi-billion dollar pharmaceutical industry doesn't have a financial incentive to lead people toward 1) daily use medications that gives the industry a monthly recurring revenue stream, 2) where many people on them long-term because many of them have severe withdrawal symptoms so they are very hard to get off of?

And then something like 80% of ad revenue of mainstream media in the US comes from the pharma industry - so how do you suppose that influences what news and narratives are shared or allowed to be shared to the majority of a population on the mainstream-mass media channels?

You conveniently also forgot to mention that SSRIs, for example, actually increase the rate of suicide (along with suicidal ideation) - so you're more likely to kill yourself if you take them then if you didn't take them; that is from their clinical trials. It's the elephant in the room that's been mostly suppressed from conversation for some reason, somehow - probably in large part look at my previous paragraph for one mechanism used.

Are you also claiming then you know "more than just enough about pharmacology" in order to give a more credible response? Or are you perhaps arrogant thinking you're more competent to respond - but perhaps instead you're just indoctrinated into a biased perspective? Do you work in the medical profession, perhaps even one that prescribe medications? Consumers are bombarded by propaganda, and professionals even more so.

In reality you probably don't actually have any idea what level of knowledge nor experience the person you're responding to, saying that their response is dangerous.

Reality is more complex than you're currently aware of.

PragmaticPulp8 hours ago

> Are you honestly going to claim that the many multi-billion dollar pharmaceutical industry doesn't have a financial incentive to lead people toward...

Benzodiazepine patents expired long ago. Same with most SSRIs.

If you're suggesting that pharma execs are conspiring to get rich by selling people their $4/month generic Prozac prescriptions, then I don't know what to tell you. I suspect your thinking is motivated more by narratives and conspiracy theories than facts and figures.

> You conveniently also forgot to mention that SSRIs, for example, actually increase the rate of suicide (along with suicidal ideation) - so you're more likely to kill yourself if you take them then if you didn't take them; that is from their clinical trials.

You have NO idea what you're talking about and you're spreading harmful misinformation. The black box suicide warning is for the startup period and is a rare side effect. SSRIs have a net reduction in suicidal ideation.

The patient population who has been prescribed SSRIs is more likely to be associated with suicidal ideation than the general public because SSRIs are prescribed to depressed patients, not the general public.

> Reality is more complex than you're currently aware of.

I'm very confident in my knowledge of these subjects and it's clear from your posts that you've been consuming some alternative medicine propaganda. I hope everyone reading this can see that you're pushing alternative medicine concepts mixed with conspiracy theories, not actual research.

makeitdouble10 hours ago

On the inertia and the gap between what the research/newest drugs and what is prescribed day to day: it is very real.

And there’s tons of reasons for that, ranging from:

- doctors that cling to the treatment they know to work (“the devil you know”)

- sheer lack of knowledge (not their speciality so they’re not up to date by a long shot)

- waiting for a few more years to have long term real world data

- pharma companies effectively bribing them by any means so they don’t look elsewhere

loceng8 hours ago

- propaganda put out by competing pharma companies to smear newer medications or create distrust of them

- pharma companies who spend more to get the lion's share of ad time keep their brand at the forefront of consumers, consumers then ask for those medications and then don't know about alternatives because they've been drowned out

- arguably some of most effective drugs have been illegal the past 40+ years as part of the "war on drugs" (did pharma industry help make those illegal?): marijuana, psilocybin/DMT, MDMA, and even cocaine will knock people out of a depression - where it could be taken weekly or less (arguably potentially more addictive than other medications, but SSRIs with severe withdrawal symptom is arguably equivalent to addiction, the aversion to the withdrawal symptoms) - but pharma can't patent any of those, so they can't gain exclusive rights to a brand they advertise to manipulate people to buy or trust their brand over something else (so patented drugs can captured more revenue and have more profit to pay more for ad time to drown out cheaper, more effective competitors).

- etc.

gavinray11 hours ago

I have personal experience with Guanfacine (and Clonidine), beta blockers (Propanolol/Labetalol), Etifoxine, Phenibut, and a myriad of benzos.

Long history of RX for anxiety disorders, which I eventually tapered off of and quit due to dependence.

Can attest to Etifoxine being effective without side effects, guanfacine and clonidine being mildly effective. Beta blockers never did much for me but YMMV.

ineedasername9 hours ago

After all of those, what did you settle on for managing anxiety long term? Was it the Etifoxine?

retrac12 hours ago

Anecdotally, I can attest to the surprising efficacy of alpha blockers. I have used prazosin as a sleep aid for the last decade, a few times a month.

There were some limited studies that suggest it is effective in helping sleep quality in people with nightmares and PTSD. Now, I don't have PTSD, but I do have a mind that will not shut off at night, running in useless circles that jolt me back awake. It does nothing for the racing mind, but my body's physiological reaction to my emotional state is lessened. I physically relax, quite literally in smooth muscle activation terms, and apparently that lets me get to sleep.

Beta blockers are probably a bit more heavy duty, but they do appear to be quite effective at treating performance-related anxieties from another small study. Shakes? Chills? Dizziness and blood pressure spikes? From the discussion I had with my psychiatrist, I think the working hypothesis is that treating the physical symptoms of anxiety is an effective intervention here, as the discomforting experiences that the initial anxiety triggers, creates a feedback cycle. (Oh god, now I'm sweating and flushed, everyone's gonna notice...!)

cameronh9012 hours ago

Propranolol is very commonly prescribed for anxiety in the UK. I take it as needed and it works wonders, but it does make me a bit lethargic. It doesn't completely eliminate the low level anxiety but it stops it ending up in a viscous panic cycle.

ineedasername9 hours ago

To me it seems like it helps with some of the physical symptoms of anxiety, but not so much the anxiety itself. So, it's efficacy depends a lot on the pathology of a specific individual's anxiety. For many people the physical symptoms of anxiety become self reinforcing, and short circuiting them can stop the anxiety. For folks whose anxiety takes a different path it may still be slightly effective but not quite as much.

matheusmoreira11 hours ago

Widely used for anxiety in my country as well but not an optimal choice due to the cardiovascular effects. As you noted, it can cause fatigue.

+1
SemanticStrengh11 hours ago
kayodelycaon12 hours ago

High blood pressure and anxiety can both cause similar symptoms. Tightness in the chest, for example. Your body tends to mistake one for the other.

Treating high-blood pressure with an ACE inhibitor (which does not treat anxiety) can reduce anxiety simply by relieving symptoms that feel like anxiety.

Beta blockers have the nice effect of directly treating both anxiety and high blood pressure.

SemanticStrengh12 hours ago

Good to hear! Glycine 3 gram before sleep can be useful as a combination. it relaxes the body too and relaxe the mind also. There are interesting studies showing positive effects on sleep and no tolerance.

magnesium l threonate before sleep, the lthreonate variant penetarte the brain far more than regular magnesium, and it acts as a mild NMDA antagonist, which means it decrease maximal excitation. it is also a great synaptotrophic.

voldacar56 minutes ago

> the lthreonate variant penetarte the brain far more than regular magnesium

How is this possible? Don't the magnesium ions fully dissociate once they come in contact with water, so that there's just free floating Mg+ and threonate?

gavinray11 hours ago

Etifoxine can be purchased from other countries and has studies showing comparable effects to classic benzodiazepines for acute panic attacks, but without being addictive.

Personal experience, it doesn't have noticeable psychoactive effects like benzos do but does block stress response + panic.

https://en.wikipedia.org/wiki/Etifoxine

nickstinemates23 minutes ago

remedies and compounds that work widely have a name: medicine.

blantonl12 hours ago

also fun fact: the benzo cartel was so strong it was the most prescribed drug in the world, all classes, in the 70s

"Mother's little helper" was a term coined during the 60s and 70s (Diazepam - aka Valium)

m_a_g10 hours ago

I've been seeing your comments on HN and you seem very well-read. Is there a drug/supplement stack you recommend or use? I've seen you recommend magnesium l-threonate and skq1 several times and I was wondering if there are more drugs/supplements that are worth mentioning.

ineedasername9 hours ago

Not sure what the parent post would recommend, but l-theanine is supposedly well tolerated and moderately effective as an anxiolytic. Annecdotal personal experience supports this.

rhexs12 hours ago

Emoxypine doesn't seem to have any English studies, or has incredibly few. So it may or may not be useful, but I sure as heck can't tell.

SemanticStrengh12 hours ago

here's 438 studies for you https://pubmed.ncbi.nlm.nih.gov/?term=Emoxypine&sort=date the marketing name is mexidol. Emoxypine is a wonder drug for health, it is one of the most potent superoxide antioxidant and has an incredible range of body protective effetcs see e.g. https://en.wikipedia.org/wiki/Emoxypine#Mechanism_of_action

look at the pictures and admire the amount of saved brain volume https://www.researchgate.net/publication/221738761_Evaluatio...

rhexs12 hours ago

Interesting. What's the quality of Russian medical research versus western? What journals are considered prestigious? (Not trying to troll -- I honestly have no idea and can't judge it accurately).

PragmaticPulp8 hours ago

> What's the quality of Russian medical research versus western?

Generally speaking - not great. There are some interesting Russian compounds out there that seem to do something, but they always fall way short of the miraculous effects shown in old Russian studies.

Old Russian pharmaceuticals have actually been a gold mine for supplement sellers in the past two decades because they're basically unregulated pharmaceuticals that can be marketed in the United States and other countries while pointing customers to questionable Russian studies to promote them.

If you browse Nootropics forums, you can find scores of people who tried the various compounds. Few people seem to continue any of them for very long either due to lack of primary effects or growing side effects. As I said, the Russian studies paint a very optimistic picture of the drugs.

Look at it this way: If any of these old compounds were really miracle drugs, the big pharmaceutical companies would be rushing to get them to market in the United States with some creative patented exclusivity. But none of them have taken any of these compounds past the early research phases. Similar story in other countries.

Some potentially interesting compounds, but you have to take the studies with a huge grain of salt.

+1
SemanticStrengh12 hours ago
bin_bash10 hours ago

don't forget buspirone!

SemanticStrengh10 hours ago

buspirone works great, when it works.. which is for what ? 20% of the population?

ldjkfkdsjnv13 hours ago

The reality is many drugs have long term effects, we just can't see them yet. But if you are close to someone who is a user, over the long run you will notice differences. Sometimes its just that they don't have the same spark. Regardless, 100 years down the line we will look back in horror at the state of pharmaceutical drugs. All it takes is going to a doctor, saying you have anxiety, and the doctor pops out a script. His "medical degree" and insurance demands that he "treats" his patient.

openknot13 hours ago

>"But if you are close to someone who is a user, over the long run you will notice differences. Sometimes its just that they don't have the same spark."

The loss of a spark can happen regardless of drug use. Work in an unsupportive environment over a long period of time, a breakup, or the failure to achieve a long-sought goal can cause a person to change over time. In addition, the underlying condition that the medication is treating may cause the effect, which could have been worse had the medication not been prescribed.

It's plausible that medications may have understudied long-term effects, but there are too many confounding causes to attribute a behavioral change to long-term medication use.

mikercampbell12 hours ago

As someone who has had a long time relationship with Xanax, it quite literally saved my life. I was prescribed it for chronic nausea, and was 40lbs below my ideal weight.

I've never been tempted to take any more than my prescribed dose, and so it's been a "healthy" relationship, but I'm working to discontinue my prescription for reasons other than this article.

Not to be one of those "well, I use it and I'm fine and aren't tempted", on the contrary - I understand fully why people would feel the tugs of addiction.

It's hard because I know I have an uphill battle to go. I use therapy and have seen benefits from psychedelics and medicinal cannabis, but it's literally a "pick your poison" battle.

But also, it's hard to have a spark when you're not able to live a normal life without assistance.

But in hindsight, I can see that this route has had it's costs and I'm excited to see who I am independent of it.

ZanyProgrammer13 hours ago

The reality is that many doctors these days will not prescribe large amounts of benzos, certainly not just willy nilly.

ldjkfkdsjnv13 hours ago

I'm not just talking about benzos, but also anti psychotics, amphetamines, statins, and basically the whole gamut. My brother is a pharmacist, and is constantly shocked by the prescriptions that healthy people bring in to get filled. The medical field has been unjustly given too much prestige.

cwzwarich13 hours ago

> My brother is a pharmacist, and is constantly shocked by the prescriptions that healthy people bring in to get filled.

While I definitely agree with your general point, how does your brother know that they’re healthy or don’t need to take the medication? I’ve never had any discussion with a pharmacist (in the US or Canada) where I’ve revealed this information.

wickoff13 hours ago

15-ish years ago, when I was twenty, I was foolish enough to see a psychiatrist. I walked away with a prescription for an SSRI, a typical antipsychotic, a mood stabilizer and some Xanax to take as needed.

What I really needed was my father not being dead when it mattered.

+2
ldjkfkdsjnv13 hours ago
opportune12 hours ago

If they're healthy, couldn't that be because of the medicine?

A lot of people have conditions that medicine treats so well you wouldn't even know they had a condition at all.

I know many people who have taken antipsychotics, amphetamines, and statins for decades and it was perfectly fine for them. I also personally know some judgmental pharmacists too. All I'll say is, there's a reason pharmacists and doctors are distinct professions.

matheusmoreira11 hours ago

> If they're healthy, couldn't that be because of the medicine?

It's very likely. This actually has to be explained to a lot of people with chronic diseases like hypertension and type 2 diabetes. Way too many of them just stop taking their medication after their condition improves.

cycomanic12 hours ago

I believe blaming this on doctors only is way to easy. I believe many people demand medication when they go to the doctor. If they go because of a cold they don't accept being told to rest for a week, but demand antibiotics, if they feel depressed they don't want to be told to exercise, but want a quick medication etc.. I definitely see this since coming to Sweden, where it's difficult for doctors to prescribe antibiotics and lots of expats complain that they went to the doctor and were told to rest for a week. They feel they are not taken seriously if they don't get medication (that is not to say that there are no problems with how healthcare is done here, but restrictive prescriptions of antibiotics is not one of them).

hombre_fatal10 hours ago

I'm sure you can find examples of failings on all sides, but doctors are the ones that pull the trigger.

When I got an amphetamine prescription in uni (like everyone else), I felt like I was lucky to have a doctor that started me off on the lowest dose.

Everyone I knew was on a much higher dose than me just starting out. People would get a dual prescription of XR capsules + IR tabs when they need a bump. Then when they couldn't sleep, the doc would just add another pill to the mix. And not just a mild one, but an extreme one like Seroquel.

Your doctor just isn't a specialist, and certainly not someone specializing in you and your specific ailments despite what we seem to pretend in these threads. Best strategy is to be informed and meet them in the middle.

cstejerean13 hours ago

And how does he know they are healthy?

+1
anonymoushn13 hours ago
ZanyProgrammer13 hours ago

Your brother is not a clinician, definitely not those people's clinician.

anonymoushn13 hours ago

antipsychotics are horrifying. do therapeutic doses of stimulants cause problems other than heart disease over the long term?

maleldil12 hours ago

Antipsychotics are terrifying, but I'd rather deal with the physical side-effects than the disorder, and they're pretty effective at treating that.

matheusmoreira11 hours ago

Depends on how you define "problem". Amphetamines may cause a lot of side effects: lower appetite, agitation, insomnia, irritability, bruxism... The list goes on. Whether these risks are acceptable or not is an individualized choice. Some side effects may even be beneficial: lower appetite for weight loss, insomnia for narcolepsy.

+1
aaaaaaaaaaab12 hours ago
sascha_sl13 hours ago

If your brother told you that with this exact framing, he's in the wrong industry.

Health, and especially not mental health is very much not visible or even obvious. Just ask any disabled person that is not bound to a wheelchair 100 percent of the time.

wit2214513 hours ago

> His "medical degree" and insurance demands that he "treats" his patient.

Completely lost me here. Why does the doctor have air quotes around their medical degree? And what’s wrong with treating disease? Or are you saying insurance requires unnecessary prescriptions? Because that’s definitely not the case, insurance would prefer no prescriptions financially at least and the doc is paid the same either way. Overall I think you just have an axe to grind against medicine for some reason. It’s not a perfect system but I don’t think you really know what you’re talking about and are concerned with the wrong things.

matheusmoreira12 hours ago

Benzodiazepines are not even first line treatments for anxiety though. More like a last resort. They are very useful in aborting panic attacks and that says a lot about the intensity of symptoms necessary to justify their use.

SSRIs and SNRIs have a much better risk/benefit profile. Sertraline in particular is a really effective drug. I don't really understand why other doctors prescribe benzodiazepines so frequently but I'm not doing it.

heavyset_go13 hours ago

SSRI-like drugs and drugs like buspirone are considered the gold standard for anxiety disorders now. They do not act like benzodiazepines at all in the brain.

symlinkk11 hours ago

How do they act? I just started taking buspirone for crippling social anxiety and I’m not sure if it’s helping or not.

heavyset_go10 hours ago

SSRIs are speculated to work via activation and downregulation of certain serotonin receptors, in particular 5HT1A, an autoreceptor responsible for regulating release of other neurotransmitters in the brain. Buspirone acts directly on 5HT1A as an agonist, I believe, which is more direct than the shotgun approach of SSRIs. In theory, activation of 5HT1A and its downregulation can help with depression and anxiety. Buspirone also blocks some dopamine receptors, but not any that are associated with dopamine blockade from antipsychotics, so their serious dopamine-related side effects aren't something to worry about, but the blocking might also contribute to anxiolytic effects.

Newer SSRI-like drugs that block the serotonin transporter and activate 5HT1A also exist, combining the actions of both drugs.

It typically takes serotonin receptors about two weeks to downregulate, and possibly even months to see any effects on depression and anxiety. Buspirone is not like benzodiazepines that work pretty much instantly, but it doesn't come with any of the risks benzodiazepines do.

swayvil13 hours ago

You are speaking beside his point.

ZanyProgrammer13 hours ago

You're taking a very specific article about benzos and making unsubstantiated leaps about medicine in general.

bcook11 hours ago

You've got a dangerous level of confidence.

jotm12 hours ago

If you look closer at others, you'll notice they have a new spark. But "new medication" won't be your first thought.

nickstinemates24 minutes ago

I read studied like this and just am thankful/grateful I don't need medication to function. People who live with having to be medicated sure have it rough.

glerk13 hours ago

Benzos are pretty terrible drugs in general. The physical addiction potential and withdrawal people are going through are enough to dissuade me from touching them. For folks dealing with anxiety, I recommend trying propranolol. It is not as powerful, but sometimes it is enough to achieve the desired effect and the side effects are way less severe.

colechristensen11 hours ago

Propranolol does almost, but not quite nothing for me. It does, however, put me on a daily(!) withdrawl cycle where when I'm on it, it does a small amount which is right up near the level of noticing, and when it wears off amplifies my normal symptoms.

Xanax was the only thing I ever took that did more than took the edge off (or some things which just made me loopy, sleepy, and/or high), it could at appropriate dosages simply turn my symptoms off and I went about doing normal productive human things that I wanted to.

But the state that I live in, and every doctor that I've met since I moved across the country has wanted to try every other drug in the book (again) before even considering, and none have thought raising the dosage beyond the literal smallest dose (despite me being 6'2" >200lbs). It is extremely frustrating.

natly13 hours ago

I recommend working out, it helped me a ton with anxiety. It basically cured it (I don't work out much anymore but a short intense few months of hard workouts seems to have almost removed it from my system years afterwards).

bowsamic3 hours ago

Mindfulness meditation totally cured my anxiety. People don’t believe me and say I’m making it up, but it’s true. How do I know? Before if I smoked weed I would panic, now I can have a bong hit and be fine. I don’t think there’s a clearer indicator than that. It was easy to, I just had to learn to mindfully see the moment my anxiety arises and let it go. On the other hand, depression has been much harder to deal with

cameronh9012 hours ago

Interestingly working out is a trigger for my anxiety. I'm currently trying graded exposure therapy for exercise, but so far it's not working.

fb0312 hours ago

Was about to say this.

Do you also trigger while trying to exercise? I have had pretty intense panic attacks while trying to work. to the point of having dizziness, weakness, closing throat feelings, the works! Pretty shitty stuff. 15 minutes later, you are absolutely normal and feeling bummed and sometimes embarrassed as well.

I would also not wish a panic attack to my worst enemy.

What I'm trying to do now is short walks and getting more 'confidence'. I think what gets us/me is the "what if I trigger" thing.

So, going slow helps build a little of confidence. That's my current plan, at least. I know an attack is bound to happen, and I will not win every time, but I'm not gonna be deterred by it. I know exercise helps a ton.

Thank you for this reply and wish you well!

+1
orangepurple11 hours ago
projectazorian7 hours ago

Have you been checked out for asthma? It could be exercise induced asthma. I used to suffer from these symptoms a lot, finally broke down and asked my doctor about trying an albuterol inhaler - which has nearly cured it, as long as I remember to use it prior to exercise.

natly12 hours ago

This was the case for me too! :) I really hated running at the start because it triggered anxiety. In the end it turned out to be a blessing because it provided me with basically a safe (not socially connected etc) way to activate it at my own comfort and degree I was comfortable with and basically feel like my twisted up brain connections got smoothed out by doing it for a while. (Basically exposure therapy as you mention.) Lions mane may have been part of helping too but idk.

fb0312 hours ago

That's my current plan as well. Just getting back to my exercise routine and work my fitness levels and also 'exposure'/'desensitization'.

Wish you well!

blagie13 hours ago

There are sources of anxiety without clear solutions. I have a stalker. There's low-level harassment continuously, but every few months, she does something crazy, and my life is completely disrupted. I have no idea what to do about it.

It's nearing a decade....

Nextgrid12 hours ago

Can police help?

Alternatively, (non-violent) retaliation? Seems like there's no downside for this person to be harassing you. Creating a downside might make her think twice next time.

+1
cameronh9012 hours ago
natly13 hours ago

Sounds awful. My cause was definitely more caused by developmental period weird wiring, so definitely different. Hope you find some way to resolve it one day somehow.

cycomanic12 hours ago

Yes, it's unfortunate that exercise is not prescribed more for these issues as there are tons of studies showing the benefits of working out against depression, anxiety etc.. I think we should really be seeing a mechanism where doctors can prescribe time off for exercise to deal with mental or physical issues, without repercussions for the employee. Maybe it's too much of a hope to see that in the US, but at least in Europe.

kayodelycaon13 hours ago

Just a warning to anyone who has asthma, propranolol is a older beta blocker from the 1960s and has made asthma worse in various trials.

My doctor and psychiatrist recommended I use other classes of medications.

matheusmoreira11 hours ago

Yes. Asthma is treated with beta agonists. Beta blockers will block the effect of the asthma medication.

kayodelycaon11 hours ago

Yup. Newer, more specific beta-blockers are supposed to be safer, but I’m not really interested testing that. :)

matheusmoreira10 hours ago

Yeah. Asthma is treated with beta-2 agonists. Newer beta blockers such as metoprolol are beta-1 selective and so have "almost no effect" on beta-2 receptors. Older beta blockers like propranolol are not selective at all.

Not interested in taking unnecessary risks either since there are better and safer drugs for general anxiety disorder.

hawthornio2 hours ago

Another happy propranolol user!

leach12 hours ago

I take a benzo ICE as needed, but was on them for a while and never really noticed degenerative affects though I’m young though. Should I be worried?

kayodelycaon12 hours ago

From the article:

> When diazepam medication was stopped, the effects lingered for a while but were eventually reversed.

I think you’ll be okay.

leach12 hours ago

That’s good, I’m conflicted because they’ve helped me but they are nasty little drugs. I’ve only ever been prescribed would never take them recreationally.

I was on them daily for a while and eventually, even though I never really worried or got anxious, other emotions where muted as well. I felt like I didn’t need it anymore and my doctor didn’t tapper me off them correctly so for two weeks strait I barely slept and had terrible withdrawal symptoms. Having them ICE is nice but I would never recommend them to people to take daily they are just to intense.

jotm12 hours ago

Most drugs that actually work are terrible. If you're gonna abuse stimulants for relaxation, it's obvious to everyone but you that it will be a very bad time, for example.

That said, the recommended dosages are basically bullshit. For anything, I'd say take 1/2 or 1/3 of what they recommend in the first few days/weeks and taper up.

But please use your own brain when taking advice from strangers.

pizza13 hours ago

Much of the brain is about error correction of information transfer, bc two neurons have a typical *less than ten percent* chance of a message from A reaching B.

So if I were to put on my speculator’s hat for a second, having something that destroys neural connections at a local scale would probably be compensated with increased volume of noisy communication at a global scale.

And having heard ex-benzo addicts describe the withdrawal as like having your brain lit on fire, well, that tracks..

meowface13 hours ago

>Experiments conducted by the researchers revealed that synapse loss in mice that were given a daily sleep-inducing dosage of the benzodiazepine diazepam for several weeks resulted in cognitive deficits.

I know it's only in mice, but it's pretty scary if it also has this effect in humans even when only taking it for a few weeks. Based on the title, I was initially kind of expecting something like daily use for years.

kayodelycaon12 hours ago

This doesn’t surprise me. I have Klonopin for as needed use. (Since early 2019, I’ve used 106 0.5mg pills, so not a significant amount.)

Being bipolar, I find they are necessary for suitations my regular medication and coping mechanisms can’t handle. Without them, living a normal life would be difficult.

That said… benzos scare me. Taking one pill will calm me today, but at the expense for increased anxiety the next two.

If I go to a convention, I’ll have ramped up to my max dose around the second or third day. After that, it becomes less effective because I can’t (and won’t) increase it more. I’ve only gone five days at most and by the fifth day, my anxiety is the same it would be without medication. Coming off that afterwards is brutal.

If I had another effective option, I would use it. I’ve tried very hard to “power through” my symptoms or find alternatives during my first year being diagnosed. My psychiatrist, therapist, and friends had to just about physically slap me to use them.

ineedasername9 hours ago

>sleep-inducing dosage

I don't know why benzos are used for sleep anymore. It's generally a higher dose than what's needed to manage anxiety, so there's increased risk of dependency and you build up tolerance quickly.

In contrast, something like a low dose of Seroquel is at least as effective, has a much lower addictions & abuse profile, and tolerance doesn't build up very quickly at all.

On top of which there should very rarely be any need for regular sleep aids. Chronic idiopathic insomnia is relatively rare, and any other forms should have treatment protocols that don't involve heavy duty maintenance meds.

deusum4 hours ago

Seroquel is an anti-psychotic for bipolar, schizophrenia, and other disorders.

Maybe it makes you sleepy, but that doesn't feel like a safe alternate course. Not quite as aggressive as MJ taking propofol to sleep, I'll give you.

colechristensen8 hours ago

They work. Other things don’t always.

ineedasername7 hours ago

Yes, in rare cases of idiopathic insomnia antihistamines and other types of cns depressants may not work, but a benzo should very rarely be the first choice when trying to treat it. (Various stages of mania may be exceptions, and generally only short term until any underlying issues are addressed)

colechristensen7 hours ago

From personal experience, in periods of high stress and other things going wrong, nothing but benzos could reliably allow me to choose to fall asleep. Short term (for me it was just a few times a month) I’m sure the side effects were harmless. A handful of other things simply did not work.

Having a strong lever to push my sleep schedule back towards healthy even when I had, say, taken a five hour afternoon nap, was extremely useful.

Being given other things that not only didn’t make me fall asleep but let me lethargic most of the rest of the next day… and having to wait months while doctors experimented with “safer” things was extremely frustrated and led to worse effects than were feared from avoiding benzos.

jimmar12 hours ago

I took 1 benzodiazepine bill once about 15 years ago and I still remember the effect--instant total relaxation. I remember thinking that it felt too good and that it's something I shouldn't let myself have again. Hearing about its long term effects, I feel somewhat lucky.

colechristensen11 hours ago

The first time I took Xanax I cleaned my kitchen and it went from mildly embarrassing to quite presentable in an hour or two. I could actually execute the things I wanted to do without fighting though ridiculous feelings.

I am treated like an addict or ridiculous when I tell doctors I'd rather not "try SSRIs" or a series of strange sedating substances because they're all so afraid of prescribing something with addiction potential (and the regulators trying to stop them).

fritztastic7 hours ago

I've been on multiple prescriptions for depression/anxiety/panic attacks (had a lot of traumatic events happen in close succession to one another). Combinations of different SSRIs and whatnot but the one thing that had an immediate and hugely beneficial effect was Xanax. I truly felt like my problems were solvable and I could see how to go about making the necessary changes. It was truly life changing for me because up until that point I could no longer believe that sich relief was possible. I haven't ever had a prescription though, and most doctors will refuse if asked. So I just have that one experience where it was given to me during a panic attack emergency, but knowing that it is even possible to feel like things can get better was a huge help to remember what to keep fighting for.

matheusmoreira11 hours ago

Wouldn't you be afraid? Patients who get addicted to benzodiazepines are likely to end up taking them their whole lives, even in old age, in ever escalating dosages due to tolerance. Elderly patients on these drugs are at higher risk of losing their balance, falling, fracturing a femur and entering a fragile state after losing their functionality and independence. If anything doctors aren't afraid enough. Polypharmacy is one of the geriatric giants and iatrogenic complications are common.

colechristensen10 hours ago

I have a healthy respect for substances and try to understand the things they do with me, but have never had any problems at all with addiction. I'm not saying other people shouldn't make their own assessments for themselves.

PragmaticPulp8 hours ago

> I am treated like an addict or ridiculous when I tell doctors I'd rather not "try SSRIs"

If you’re willing to take Xanax but you’re not willing to try SSRIs, you have probably been severely misled about the relative risks of each.

Seriously, the internet misinformation machine is terrible for SSRIs.

One thing to keep in mind when reading online reports of drugs is that they tend to correlate quite heavily with the liking effect of a drug. Patients will rate drugs with rewarding effects significantly higher because they literally trigger the neurons in your brain that say “this is good and you want it now”.

colechristensen8 hours ago

My primary disinterest with SSRIs is first hand experience with people taking them and going on and off them. I don’t want to go into it or discourage anyone from taking them, but my experiences and reading papers reporting side effects results in a hard no for me.

bowsamic2 hours ago

I don’t recommend SSRIs. I’m just one case but the side effects were bad: memory loss, total lack of emotion, unable to laugh or cry, etc. I ended up stopping them bc I stopped feeling in love with my wife. They were giving me a half life. I tried them again, this time with much worse memory loss, I don’t remember what it was like that time. I just remember sitting around people laughing with a dazed out smile, unable to join them. I felt fundamentally separated from the highs and lows of human life. First time was 50mg Zoloft, second time was 100mg Zoloft. I cannot recommend except in extreme cases

ad404b8a372f2b911 hours ago

I was prescribed some after a severe accident and it really helped me, both during while dealing with the pain and stress, and after to get over the trauma and anxiety attacks.

I've always been fervently anti-meds but sometimes when you're in a tough spot they are magical and going without is the worse alternative.

For what it's worth after 2 years of occasional use, I have no addiction at all. I've been tracking my use daily for the past year and as my anxiety has waned I've stopped taking them entirely.

op00to12 hours ago

When I am having a bad panic attack and take 1 Ativan, if I am lucky I go from being convinced I am dying to able to function with some difficulty. Lotsa brains, lots of different reactions to the drug.

rootw0rm8 hours ago

Not too long ago I had an abundant supply of phenazepam from my days as a dealer in designer drugs. Being the raging addict that I was, I used it daily for insomnia. After wrecking my car while on a mix of MXE/phenazepam/alcohol I entered treatment and embraced sobriety. 6 months later I still feel like I'm recovering from the effects...

arbuge9 hours ago

From the article: "When diazepam medication was stopped, the effects lingered for a while but were eventually reversed."

parentheses6 hours ago

Benzo use results in therapeutic benefits for many. The synaptic losses can pale in comparison to the anxiety it’s exchanged for. I know this to be true for at least one person close to me.

sibeliuss12 hours ago

As someone with a few family members addicted to Xanax (long term) and have repeatedly bore witness to the destruction, I can say with certainty that it's an evil drug. It's like the person crawls inside a space where they can safely project all of their anxieties onto others. Their problems becomes your problems, a fully projected virtual experience. It's definitely psychosis-like, and I've always wondered if there was some brain damage involved. Well, here's the answer to that.

fuzzfactor9 hours ago

You already had the answer to that for years.

Now here's the answer for mice.

colechristensen8 hours ago

Missing from the reactions here is the following line:

>When diazepam medication was stopped, the effects lingered for a while but were eventually reversed.

Also when making a conclusions from this mouse model to a human is how much were they actually giving the mice… a sleep inducing dose could be small or heroic.

kbos8710 hours ago

I’ve been on Xanax on two occasions for very short periods of time to handle some acute anxiety issues and I can see why they are so addictive. At least at first, they are so clearly and massively effective.

My doctor very thankfully instilled a level of fear and skepticism in me from day one when he prescribed them, explaining that while they were a viable option for me in the moment, the effect begins permanently wearing off very quickly. They got me through some stuff but I was happy to stop taking them and hope I never am at the point where I need to consider them again having heard where it so often goes for people.

samhw10 hours ago

On the bright side, has anyone else ever considered what an amazing amount of information there must be for mouse vets?

zosima12 hours ago

This is quite interesting as for a long time there has been some evidence that Benzodiazepine usage can increase the risk of Alzheimer's diseases and it has often shown up as a risk factor when doing large-scale database studies. Summary here:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6960222/

I won't jump to the conclusion that this is the mechanism, or be certain that the we are talking about causation rather than correlation, but evidence like this certainly tilts the weight towards causation.

bunnyfoofoo3 hours ago

Anyone have a mirror of the study [1]? It’s not available on scihub yet.

1: https://www.nature.com/articles/s41593-022-01013-9

jmcgough13 hours ago

Daily use of benzos is extremely bad in general - the physical addiction is not pleasant to withdraw from, and it significantly increases the risk of dementia in old age.

trevorishere13 hours ago

> dementia in old age.

Spoke to a psychiatrist on this one. He was saying The Lancet longitudinal study was bunk and that Xanax use was not one of concern.

I'm not saying he's correct, but he literally laughed at my objection to Xanax, including it's now very long history of use with an average dose of 6mg/day.

twstdzppr13 hours ago

Xanax use is cause for concern in general. Acutely it is safe, but chronic administration is definitively not, and not something to laugh about or take lightly.

mistrial913 hours ago

this man laughed at you for suggesting this? Xanax is a "benzo" wikipedia tells me.. Consider the source

SemanticStrengh12 hours ago

doctors often laugh at their own ignorance and pride

fermentation13 hours ago

Had some anxiety issues in France and a doctor that I met with (who I had trouble speaking to) prescribed daily benzos for a month. Towards the end of the month it felt like my body NEEDED the pills. It was scary.

jmcgough13 hours ago

Your brain chemistry acclimates to using a GABA agonist every day and will get out of whack if you stop taking it :( like anxiety will be WAY WORSE when going through withdrawal.

I still use a benzo (lowest dose lamictal) but only about once a month when I need hit the panic button. It's really not meant to be a daily use drug, scared me when a friend was prescribed it as a daily medication.

kayodelycaon12 hours ago

Lamictal is an anticonvulsant, not a benzo. I take it daily as a mood stabilizer for bipolar disorder.

Aloha9 hours ago

I take Temazepam with no ill effects, I take it nightly except sometimes when I forget, its been a game changer for me.

trevorishere12 hours ago

Lamictal is not a benzo and must be used consistently (daily) to prevent SJS as it requires titration. Generally, those who need it (epileptic patients or those with bipolar disorder) must use it for the duration of their life.

cameronh9012 hours ago

Daily use of benzos gave me sleep paralysis, false awakenings and made me sleep walk.

Not saying that proves anything, but it was scary.

sedeki12 hours ago

Is it reasonable to assume that the same thing applies to the Z-drugs too, specifically Zolpidem?

I have a family member that I'm worried about, that has taken Zolpidem for several years straight (apart from minor breaks in between prescription refills because of overconsumption during the previous refill...).

gzer012 hours ago

As zolpidem is associated with drug tolerance and substance dependence, its prescription guidelines are only for severe insomnia and short periods of use at the lowest effective dose [1].

Zolpidem increases risk of depression, falls and bone fracture, poor driving, suppressed respiration, and has been associated with an increased risk of death [2].

I would recommend you to seek a second opinion from another medical professional about whether this family member should perhaps slowly taper off of the Zolpidem.

[1] https://www.nice.org.uk/guidance/ta77/chapter/1-Guidance

[2] https://escholarship.org/content/qt08d9f3d5/qt08d9f3d5.pdf?t...

mtlmtlmtlmtl12 hours ago

From skimming the article, it seems they've linked this effect to benzos interacting with a specific protein in microglia. This is not the interaction benzos share with Z-drugs, which is modulation of the GABA-A receptor. So it seems unclear whether this can be extrapolated to Zolpidem.

However, Z-drugs(and benzos as a sleep aid) generally should not be used daily for longer than a few weeks until a better solution is found. Unfortunately, doctors often do this anyway, following the path of least resistance, I suppose.

I wouldn't worry about any kind of brain damage, but I would recommend reviewing their options, maybe seeing another doctor. Lots of people can manage just fine with something like extended release melatonin, or indeed nothing.

matheusmoreira10 hours ago

Z drugs are better than benzodiazepines but not by much. Their pharmacodynamics are similar: they act on the same GABA receptors.

Zolpidem is best used for a couple to regularize sleep patterns and help establish proper sleep hygiene. Trazodone at lower doses is better for long term use, especially in older patients.

peri8 hours ago

I'm unsure why this took so long to be published here; the pre-print versions were also very clear about this with regards to other tranquilizers with similar methods of activity/chirality.

NB: I am a senior network security software engineer with a B.A. currently applying for Ph.D.s. I suggest that nobody believe anything online, regardless of provenance, until 10 years after publication.

thepasswordis5 hours ago

In many people the alternative to benzodiazepine use is suicide.

foolfoolz13 hours ago

i think mental health medication has been borderline fraudulent for over 50 years. the drugs rarely beat placebos. when they work the methodologies of study are rarely replicated. this is just hanging some giant exit sign in front of desperate people saying we can get out out of this mess all the while knowing it’s a gamble. a gamble you’re paying with your health and someone else is winning by taking the money.

the “mental health movement” ignores this and is mostly lip service. clean your room. take a walk.

no one really cares about you but you and learning how to care for yourself is so hard. i hope we can train people in proper self care so we don’t need to prescribe their life away

narag10 hours ago

I know someone that has been abusing benzos for more than forty years. In hindsight, the weird thing is she's still somehow functional, at least in Twitter. But of course: needs four or five pills to sleep four hours a day, paranoia, migraines and dissociative behaviour.

codeulike12 hours ago
dang12 hours ago

Ok, we've inmiced the title above.

I had to add the c-word, though ("causes"). The article uses it several times, so I suppose it's ok for the title. Please let's not repeat the usual "C is not C" business.

ppg67712 hours ago

I take a half tablet (10mg) of Xanax every once in awhile. (Maybe once a month on average).

It makes me feel so relaxed.

I knew it was too good to be true.

b0tch712 hours ago

I take 5mg about once a week which I thought was pretty harmless :(

kayodelycaon12 hours ago

You’re not taking high doses every day, which is what the article is about.

abstrct8 hours ago

I will always miss those I’ve lost to benzos. Some of my favourite people that I’ll never again share a new memory with.

smithmayowa12 hours ago

Just came off benzos withdrawal those things are insanely horrible, delirium, depersonalization, derealization, muscle tremors, and persistent headaches were some of the symptoms I experienced. Thank God I did not have seizures.

holler10 hours ago

I have a good friend who had grand mal seizures about once per month for 6months+ after coming off them... Very scary.

SemanticStrengh12 hours ago

take magnesium lthreonate for an effective synapse recovery

ineedasername9 hours ago

As a PSA, something to be aware of is the stimulant paradox for anxiety due to ADHD. Typically anxiety & stimulants would be a no-go combination, but for folks with ADHD-induced anxiety stimulants can actually help. I know someone whose child was (finally) properly diagnosed with ADHD only after they let their child try a tiny bit of their coffee and there was a significant change. It was the revelation needed to get to a good treatment path.

PragmaticPulp9 hours ago

FYI - The idea that stimulant response can be used as a diagnostic tool for ADHD is a myth. No researcher or professional who studies the subject actually takes that seriously.

Nobody should be interpreting their response (or a child’s response) to stimulants as a diagnostic indicator for ADHD. It’s also worth noting they caffeine isn’t an effective ADHD treatment (it had been studied) and caffeine and Adderall don’t actually overlap as much as people seem to think.

ineedasername8 hours ago

You say it's a myth, and yet I have direct knowledge of a case where it went that way. To be clear though, the stimulant response was not by itself the only diagnostic criteria. They we're engaged with a process of trying to determine a correct diagnosis. The child's response to a stimulant was one piece of data, and happened to be the one that made everything else click into place. If there is a myth here, it is only the idea that a response to a stimulant by itself is sufficient for a diagnosis. It's not.

Also, yes-- caffeine isn't a great treatment here either. With respect to ADHD there are more effective methods.

Related research:

https://pubmed.ncbi.nlm.nih.gov/6110701/#:~:text=The%20admin....

https://psychcentral.com/blog/adhd-millennial/2018/06/when-s...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617411/

https://www.psychiatryadvisor.com/home/topics/child-adolesce...

PragmaticPulp5 hours ago

> You say it's a myth, and yet I have direct knowledge of a case where it went that way.

Anecdotes like this are purely coincidental. Parents think they notice one thing, then later get an ADHD diagnosis and assume they’re both related.

Like I said, caffeine and ADHD medications don’t actually substitute for each other and have drastically different effects. Caffeine is not an effective ADHD medication, so it’s not relevant to the studies you’re linking.

SemanticStrengh12 hours ago

few people know it but you can fight a benzo addiction with flumazenil injections. You can even do it yourself if you have to avoid multiyear waiting lists.. (e.g. OTC on indiamart) however you must be extremely extremely careful to take the minimum needed dose, if you take too much you risk passing out/epilepsy. but at the medical dose, it is safe and will accelerate recovery time and quality dramatically.

extant_lifeform6 hours ago

We now know what happened to jordan b peterson

tunnuz12 hours ago

I was prescribed Diazepam some time ago (and loved it). But as far as I know you're not supposed to be on benzodiazepines for very long?

johntfella12 hours ago

be interesting to study someone, or a mouse I guess with said damages and doses of ambien for repair (https://jamanetwork.com/journals/jamaneurology/article-abstr...)

pyuser5836 hours ago

The effects it mentions in humans are not new.

ilikeitdark12 hours ago

Doctor gave me for anxiety in the day and sleeping at night. On it for way too long,and horrible. Definitely not worth it.

inmyunix10 hours ago

Does anyone have access to the article? I'm curious what the relative dose was.

Commodore6313 hours ago

Jordan Peterson had a horrible time with these drugs and resorted to extreme measures to get off them (eight days in an induced coma!) Even today he might still be on them - he is pretty cagey about his present pharma situation when asked about it on podcasts.

https://nationalpost.com/health/jordan-peterson-benzodiazepi...

Horrible drug.

77pt7712 hours ago

He claimed he had no idea what they were.

Someone that identifies as a neuroscientist.

He knew very well but thought he was special.

The only thing special is that he went cold turkey (extremely dangerous) and had to be placed into an induced coma in Russia because no one else would do it.

seattle_spring12 hours ago

It's also pretty obvious that he is cognitively impaired.

s530012 hours ago

Peterson is a verified idiot with nonexistent self-control. Not the slightest modicum of it.

Basing anything off of his antics is asinine. So weird to see people who put him on a pedestal on HN.

& benzos aren’t “horrible drugs”

People who don’t know how to manage themselves and their usage of them are horrible people though, especially when they try to cut down others who have no issues using them responsibly, which sometimes literally saves their entire lives.

jyscao10 hours ago

> which sometimes literally saves their entire lives.

considering how benzos came into existence barely half a century ago, i highly doubt not having benzos as part of one's pharmaceutical cocktail is the fundamental difference maker to one's life or death. so even to those who are now dependent on them, their long-term health will almost certainly be better served by getting to the root cause of their health issues. not saying that's an easy thing to do, but that's still the reality.

batshit_beaver8 hours ago

> i highly doubt not having benzos as part of one's pharmaceutical cocktail is the fundamental difference maker to one's life or death. so even to those who are now dependent on them, their long-term health will almost certainly be better served by getting to the root cause of their health issues. not saying that's an easy thing to do, but that's still the reality.

Dude, I've spent my entire 20s in therapy while trying various "safe" drugs to get ahold of my anxiety issues. Nothing worked. I was offered electroconvulsive therapy or daily benzos. I went with benzos. I've been taking them for years now and my life is infinitely better as a result. I've changed careers, gotten married, and traveled the world. Before benzos I was living with parents, too anxious to go across the street to get the mail.

I really don't think it's right to dismiss a whole class of highly effective and generally safe medication that can have life-altering benefits for some people. I'm okay with being slightly more retarded in my later years if it means I actually get to live a life outside my parents' basement.

andrekandre9 hours ago

  > Basing anything off of his antics is asinine. So weird to see people who put him on a pedestal on HN.
not sure if its putting him on a pedestal as much as an example of what some prescribed drugs can do to people when they aren't careful...
s53008 hours ago

Sorry, the pedestal bit was not aimed at the parent comment.

I’ve just seen a confusing amount of HN users who do speak of him in such a manner & thought I would make reference to that for context.

symlinkk11 hours ago

You know what else causes brain damage? Anxiety

jquery6 hours ago

I wrote a long comment and then deleted it. I'm just here to say benzos are no joke. Do not take them unless you absolutely have to. Please, stop taking them if you suspect you are dependent, with a professional helping you taper and prescribing alternative non-benzo drugs as needed.

Benzos are a deal with Satan incarnate. They can be lifesaving but they extract a terrible cost.

listless11 hours ago

I take .5 mg Klonopin for sleep every night.

anonuser12345611 hours ago

Not a great idea in the long run.

SemanticStrengh12 hours ago

anyone knows wether ghb is neurotoxic?

cosmiccatnap11 hours ago

I thought this was well known as Peterson effect.

tinyhouse12 hours ago

Why there aren't more studies on humans? It's not difficult to find people who have been taking benzos or other related drugs for years.

colechristensen11 hours ago

I researched long term impairment in humans for benzos and was only able to find very mild (i.e. on the edge of measurability) cognitive impairment which was mostly recoverable after a period of abstinence.

tinyhouse12 hours ago

Benzo got a terrible rep because of addicts. People who have addiction problems shouldn't be prescribed benzos. I can tell only my own experience working with a psychiatrist. I started on SSRI and the first month was horrible. They gave me benzo to help with anxiety and sleep. It really did the job, my sleep improved a lot. I used a low dose (1/2 of what I was prescribed) and had no symptoms besides being a bit more sleepy when walking up in the morning. I stopped taking it after two months of taking it daily, when things started to stabilize. I had no bad symptoms stopping it besides a hard time falling a sleep in the first few nights. About 4 days after I went back to normal and never had issues since.

I also know that in many countries benzos are the more common sleep drugs, unlike the US where z-drugs are more common. I know at least one person in my family that is now 90 who has been taking benzos for sleep for about 40 years. He is doing well cognitively. This is of course very anecdotal.

randomopining13 hours ago

Was just in Mexico and took them 3-4 days in a row (0.5mg - 2mg) to sleep after drinking or the next morning. Slept amazing those few nights. Felt terrible 2 days after the last one, and even now close to a week later I don’t even feel that good. Pretty sure they are terrible for you.

colechristensen11 hours ago

That's quite a lot, especially mixed with alcohol.

s530012 hours ago

Thank you for informing us of the fact that you take benzos with alcohol in your system.

Self PSA that probably nobody should take your opinions seriously.

aaaaaaaaaaab12 hours ago

Benzo after drinking? Jesus...

copperx11 hours ago

I've heard of doctors taking benzos after drinking. It's a potentially lethal combination, as you can stop breathing in your sleep. However, if you wait until the alcohol has metabolized in your system and becomes a stimulant (when your BAC is about 0.05, or about 4 hrs after moderate drinking), a short-acting benzo in a low dosage can counteract the stimulant effect of alcohol and let you sleep. I have done it before, and works very well, but that's because I have a breathalizer, very low dosage Xanax, and I am responsible with my health. I would never recommend this to anyone, as a wrong calculation can result in death; that's how many hollywood and rock stars have died.

transfire13 hours ago

Benzos disrupt REM sleep. Eventually you will go mad.

twstdzppr13 hours ago

They are easily one of the most harmful classes of medications. Sure, they combat anxiety acutely, but wreck ones cognitive abilities in the process. This has been readily observable for a long time.

Plus, the anxiolytic effect quickly turns into a dependency, as when the withdrawal starts kicking in you're inclined to start having anxiety attacks.

Suppose you want to get off them. Now you have a significant problem. Can't quit cold turkey -- you're likely to have a seizure.

SemanticStrengh12 hours ago

xan not workib

AirStreamer2710 hours ago
holly7612 hours ago
andrewinardeer12 hours ago

> Long-term use of benzodiazepines has been linked to cognitive

Like, no shit?