Saturday, February 16, 2008

My Three Shrinks Podcast 42: The Benzo Wars (or, Xanax Reloaded)

[41] . . . [42] . . . [43] . . . [All]

Dinah, Clink and I get into a podcast brawl about the use of benzodiazepines (such as Xanax/alprazolam, Ativan/lorazepam, and Valium/diazepam) in the practice of psychiatry. See how many rounds we go, and who is left standing at the end.

February 16, 2008: #42 The Benzo Wars

Topics include:
  • Round 1: Why Docs Don't Like Xanax (or, Xanax Reloaded). This is what started it. Then there was Xanax Blues in Podcast 19. Also, this one from Oct 10.

  • Round 2: Dose Dependence. Our blog commenters dissent.

  • Round 3: Just Say No! Clink offers sage advise to fellow prescribers.

  • Round 4: The Trouble with Tapering. How slow can you go? See Perchance to Dream.

  • Round 5: Need It Versus Want It. Is there a difference?

  • Final Round: Last Shrink Standing. What are the situations where you feel very uncomfortable prescribing benzodiazepines? Roy wraps things up by quoting from his Jan 12 comments from Dose Dependent.
[Ed: I forgot that I had transcribed a few comments from the podcast when I was on a plane recently. I've added them below, including the time in the podcast where they occur]

15:06 Dinah: "So, shut up a minute!"

17:20 Roy: "Benzo's modulate GABA receptors... You've got glutamate, which is an excitatory amino acid, and you've got GABA, which is an inhibitory amino acid. So, they kinda balance each other. If you have too much glutamate, that's bad, you can have ... seizures... If you have too much GABA, that's bad because then your brain is s-o s-l-o-w-e-d d-o-w-n that you can't do anything."
17:45 Dinah: "What's his point?"
18:00 Roy: "So, benzo's effectively increase the role that GABA plays in the brain. So does alcohol. In fact, for the most part, your brain can't tell the difference between alcohol and a benzo."

20:20 Roy: "You can be dependent but not addicted."

21:00 Clink: "Why is it that this [coming off Xanax] is so bothersome to you?"
21:22 Clink: "When you start hearing that 'this is the only thing that works', then the red flags should go up."
22:20 Clink: "I see the addictions that are started by physicians, and we need to address this as a reality."
24:00 Dinah: "We have this dilemma... is this a medicine that this person needs versus is this somebody who's addicted?"

24:20 Dinah: "There are circumstances where I encourage people to take benzos, and I'll tell you what they are..."
24:27 Roy: "Like now!"

Feel free to add your favorite quotes in the comments.

The background music is from the mash-up I made for podcast #24, Dr. Phil on Skype.

Find show notes with links at: The address to send us your Q&A's is there, as well (mythreeshrinksATgmailDOTcom).

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