benzodiazepines

(updated 12/2014)

Benzodiazepines should not be thrown off the edge of the earth. But they must be used carefully and patients should be warned that sometimes they’re hard to get off of.  Just surf around a little bit and you’ll find people hating them. What you don’t hear so much is the voice of people whom they help.

These medications don’t work great, long term (short term, for sure). Psychotherapy, in general, is preferable. If you can get it. Remember there are free online therapies nowadays. I’d certainly rather have someone get that, and really give it a try to get through the whole online course, rather than start one of these.

Unless there is good reason to think that you can get on it and off of it in two weeks. In that time, physiologic dependence is extremely uncommon. I’m not even sure it’s physically possible but I’m sure someone out there was “addicted” in two weeks or less. But that is not at all the way this usually works. So I figure I can give someone a benzo’ for two weeks without too much risk, as long as they’re getting off of it after that. Roger that? :  as long as they’re getting off of it after two weeks.

If the plan is to stay on long-term, and there are a few good reasons to do that, then clonazepam is generally thought of as the best for this role. It seems to hang on to its benefits better than the others; and secondly, people don’t love it , so they don’t turn it up on their own very often.  But sometimes they really don’t love it: they dislike how they feel on it and can’t use it. That’s fairly common, more than the others in that way.

generic name trade name proper­ties duration of effect* dose equiv­alents **
alprazolam Xanax too fast, too short 3-4 hrs 0.5 mg
temazepam Restoril about right for sleep 5-6 hours 15 mg
lorazepam Ativan medium speed, length 6-8 hrs 0.5 mg
clonazepam Klonopin less dose escalation;
“wet blanket” feel?
12-14 hrs 0.5 mg
diazepam Valium long-­acting, fast several days 5 mg
chlordiazep­oxide Librium long-­acting, slower several days 25 mg

*average duration of action; this is quite variable!

** these estimates vary and are not precise