Hari Srinivasan
Prof David Presti
GSI Carson McNeil
Drugs & the Brain
Homework 5 - Outline for Research Paper
Benzodiazepines
My paper will talk of the unnecessary over-prescription of benzodiazepines without regard to potential long term dependence, side effects and withdrawal issues, especially amongst the intellectual disabilities population and the elderly population.
The study by Oswald et al. (2007) shows for instance that almost 70% of children over age 8, with the Autism Spectrum diagnosis were prescribed some form of psychoactive medication including benzodiazepines. Another study by Kalachnik et al. (2002), suggests that many behavioral symptoms in the intellectual disabilities population could be caused by the Benzodiazepines and be mistaken for other psychiatric behaviors which need to be further treated. The irony is that Benzodiazepines are given to to this population to mitigate those very behavioral symptoms.
Interestingly, the older 1983 study by Owen et al. on the use of Benzodiazepines on the intellectual disabilities population reflected my own experiences with Benzodiazepine usage. That is to say, prolonged use does cause dependence and sudden withdrawal could cause seizures. Other withdrawal symptoms were also included in their study. Their claim is a 5-15 days withdrawal period but my personal experience and the experiences of families I know seem to stretch the withdrawal time of such medications up to even 6 weeks.
The other major group to whom benzodiazepines were overprescribed were the aging population leading to dependence. The study by Bloom et al (1993) finds that the elderly are unnecessarily being over prescribed benzodiazepines often due to lack of knowledge by Family Practitioners about their dependence and withdrawal issues.
Benzodiazepines are very effective in the short term. They are so effective that their use is continued to prolong the “good” effects on mood and anxiety. In the meantime, tolerance builds up as does dependence. It is like caught between caught between scylla and charybdis, can’t live with them, can’t do without them either as other medications are less effective.
I chose the topic of Benzodiazepines as I have been on two of them for a number of years now. A pediatrician in Foster City had first prescribed a sublingual spray version of short acting Lorazepam in 2009 to take the edge of agitation produced by anxiety especially during travel. Since Lorazepam is highly addictive, it was not to be used on a regular basis. In fact, if it was used over multiple days in a row, its efficacy decreased. In the meantime psychiatrists were playing about with other meds to be taken on a regular basis to handle my behavioral and anxiety issues. The head of pediatric child psychiatry at John Muir Hospital finally decided on Clonazepam, a cousin of Lorazepam. Clonazepam stayed longer in the blood stream and the claim was that my dosage was low enough to not build any kind of dependence. Lorazepam was still to be used as needed address any immediate agitation and anxiety as that was faster acting. It is now 2017 and I am still on Clonazepam and its not working as well anymore as well. In 2015, an attempt was made by the doctor to wean me off. Clonazepam was stopped over a 2 day period and an anti-seizure Trileptal was put in its place. I had a tonic-clonic seizure the day after Clonazepam was stopped. Apparently two days was not enough of a wean off period despite the fact that an anti-seizure med had replaced it. Clonazepam was put back on. A team of Stanford psychiatrics have been trying to wean me off the clonazepam and stabilize my meds since 2015, with limited success. In the meantime I continue to struggle with fluctuating mood and anxiety issues. It is frustrating that Psychiatry is still such an inexact science.
Works Cited
Bloom, J. A., Frank, J. W., Shafir, M. S., & Martiquet, P. (1993). Potentially undesirable prescribing and drug use among the elderly. Measurable and remediable. Canadian Family Physician, 39, 2337–2345.
Donald P. Oswald and Neil A. Sonenklar. Journal of Child and Adolescent Psychopharmacology. July 2007, 17(3): 348-355. https://doi.org/10.1089/cap.2006.17303
Owen, R.T. & Tyrer, P. Drugs (1983) 25: 385. https://doi.org/10.2165/00003495-1983
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Homework #5: - To be turned in to your Discussion Section GSI during the week of October 30 to November 3, 2017
Write a brief (1-2 paragraphs, single -spaced) summary of your topical essay ideas, including what it is you are writing about and why the topic is interesting to you. List at least 3 references you are using and briefly indicate what kinds of information you have found in these references. Use the format for references described on page four of the Topical Essay Guidelines.
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