[Noua]

Hi,

I have been suffering from Body Dysmorphic Disorder for 5 years. Over time the mild fixation/anxiety over my appearance has dramatically escalated and made me, for the most part, unable to leave the house for more than a couple blocks without panicking. I try to go outside every day but my trips outdoors are very calculated--even going out for one errand takes a lot of energy and planning.

I've done exposure therapy, dbt, cbt, SSRIs, etc., but I feel like it hasn't helped with the physical panicking sensation that keeps me from leaving the house. In the past, I have been prescribed Ativan and Valium as PRNs and as far as I can recall they did decrease the physical agitation I got from being outdoors.

However, I am very hesitant to ask my current psychiatrist for benzos because of the addiction/dependency/etc associated with them.

How do you know when benzos are a necessity and not a 'crutch?' I don't particularly want to be on them, but it seems as though out of all the treatments I've done they were the most helpful.

Thanks for reading.

[TicTacGo]

When the anxiety is so intense that other treatment options (be it meds or therapy) do not stand a chance.

So for example, an SSRI may be prescribed, but a benzo will also be prescribed for the time in which the SSRI is still trying to take effect. Otherwise the week or two of waiting for the SSRI to work would be pure hell.

Hence, the benzo is only used temporarily and not as the basis of the treatment.

I have lorazepam and oxazepam as a PRN. Lorazepam I usually take for sleep-related issues (such as evening anxiety that would make me unable to sleep, being too agitated to sleep, and just plain insomnia), oxazepam for panic, agitation (during the day) and if I have "too many bad memories assaulting me all at once", especially if these things interfere with me going to school.
The 'trick' with benzo's is to not take them if you don't absolutely need them. So for example, say that right now you can go 4 blocks with bad anxiety. Then only take them if you have to 5 blocks away. If you also use them when you "only" have to go 4 blocks, you'll end up using them also when you have to go 3 blocks, later 2, and eventually you use them all the time. You'd become unable to deal with even "mild" anxiety by yourself without the pill.
When I just started using oxazepam I wrote down when and why I used them and how much (half a pill or one pill), and usually also what coping skills I'd tried before taking the pill, and I'd discuss this with my psychiatrist at appointments.

[facefulloffuzz]

I agree with Breadfish 100%, only when you need them. I'm afraid of an addiction because I've seen withdraw inpatient and it's no fun. For me, if I know I'm close to going into panic then I'm taking an Ativan. Sometimes if I know a situation has the potential for me to have an attack I'll jump the gun, but I'm always careful and my doctor expects me to be as well.

[WildcatVet]

Benzos should only be used short term ~ 4-6 weeks ~ and only as needed.

[Travelinglady]

Glad to see you posting! I take as needed, but do take a small dose of Xanax in the a.m. and p.m. currently. As was said, when nothing else helps. There's a good thread about other things that help:https://forums.psychcentral.com/anxi...ml#post5882388

Originally Posted by WildcatVet

Benzos should only be used short term ~ 4-6 weeks ~ and only as needed.

And what if you only take 1 a month? You'll only get to take 1 your whole life?

[Guiness187055]

I always have xanax as a prn but really only use it when really needed. I do use klonopin nightly for sleep and no issues with having to increase dosage.

[WildcatVet]

Originally Posted by Breadfish

And what if you only take 1 a month? You'll only get to take 1 your whole life?

I was referring to the damage done when people take benzos daily for months and years.

https://en.wikipedia.org/wiki/Effect...ffect_on_sleep

[*Laurie*]

I have been on Klonopin for 20+ years. I spent the previous year going off the Klonopin. Over the summer I became so anxious that my throat tightened and I was completely panicked at all times. My pdoc put me back on the Klonopin. The anxiety is still present, but not nearly so much. I can cope. I have a life. The throat tightening, however, has severely impacted my life. I don't know how it will resolve. My pdoc said that there are some people who truly need to be on benzos for extended periods of time.

If your anxiety has overtaken your life, if you are experiencing physical symptoms due to anxiety (for example, throwing up from anxiety or other extreme, recurring physical symptoms)...those are some reasons to take a benzo.

[Nammu]

It's best to never start

Originally Posted by Nammu

It's best to never start

I honestly agree with this, as someone who does take a benzo on occasion. It provides anxiety relief for sure but I believe it has also intensified my depression and dulled my ability to show emotions.

I take 2mg of ativan 3-4 times a week on average, during times of high anxiety, although I try to go as long as possible without. The longest I have gone without since starting is 3 days. I started at 1mg and after a few months felt like it wasn't working the same and bumped it up.

Unless these anxiety symptoms are eliminating your ability to function I would recommend not starting.

[Guiness187055]

Ultimately everyone is different. Some people can go 20 years without an issue while others have problems in 6 months. I for one would not be able to function at times without my xanax.

[Mountaindewed]

I try to only take my Ativan when absolutely necessary. I try working through my anxiety as much as I can.

Friday night I thought of taking one just to make sure I wouldn’t get anxious. I wasn’t even very anxious. I was pretty disgusted at myself for that mindset. That’s excatly the opposite of how to handle benzos

If my doctor knew I almost did that he’d never prescribe it again.

I did not take one.

[*Laurie*]

For me, I feel my best when on Klonopin. I can function well, my sleep is of better quality, I am not crippled with anxiety. Guiness is correct; everyone is different.

Have you tried gabapentin?

Some people on here say it doesn’t work, but it helps me.

It’s not supposed to be addictive, but it can be abused from what I’ve read — because it gives you a buzz, and in my opinion it is more relaxing than a pain pill like Vicodin.

[boogiesmash]

Originally Posted by key tones

Have you tried gabapentin?

Some people on here say it doesn’t work, but it helps me.

It’s not supposed to be addictive, but it can be abused from what I’ve read — because it gives you a buzz, and in my opinion it is more relaxing than a pain pill like Vicodin.

Gabapentin helps me at well, but when I have panic attacks they are useless. That’s when I take a benzo klonopin. I don’t take klonopin frequently, but it depends on hen I have an attack. Sometimes few months, other times few weeks.

[Blue_Bird]

I take klonopin as needed. Once or twice a week at the MAX. Its a low dose too. I only do it when my anxiety gets so bad and overwhelming I get suicidal. Then if nothing else works to calm me down I take it. Usually praying or doing a puzzle helps calm/relax me. I see nothing wrong with them as long as they're used correctly.

[marcoleap]

I realize that long-term benzo use is associated with a number of problems, including depression. On the other hand, long-term, uncontrolled anxiety can also cause a host of problems, including depression. I think people should do whatever they can to manage their anxiety without benzos, but if you're doing that and still having trouble functioning, then I think using these medications--either PRN or long-term--makes sense. People's feelings about medication often seem to be extreme to me: either "psych meds are the silver bullet" or "psych meds are a total hoax and Big Pharma just wants us all to be customers." There is also a lot of shame around taking meds. I feel it myself, and it's not healthy. If you can look yourself in the mirror and say you are doing the best you can to try to help yourself, then I don't see why you should be ashamed of taking medication.

[Noua]

Thank you for the replies.

I am well aware of the risks with benzos, the withdrawals/dependency/etc. I've taken them before, alongside SSRIs.

I guess I am just confused on whether or not I, personally, need them, or if I just haven't tried hard enough in other areas of treatment... DBT and CBT helped slightly, exposure did nothing, the SSRI I'm on seemed to work for maybe 3-4 months. It feels like every goal I have is impossible because of my inability to go really outside.

[*Laurie*]

Originally Posted by marcoleap

I realize that long-term benzo use is associated with a number of problems, including depression. On the other hand, long-term, uncontrolled anxiety can also cause a host of problems, including depression. I think people should do whatever they can to manage their anxiety without benzos, but if you're doing that and still having trouble functioning, then I think using these medications--either PRN or long-term--makes sense. People's feelings about medication often seem to be extreme to me: either "psych meds are the silver bullet" or "psych meds are a total hoax and Big Pharma just wants us all to be customers." There is also a lot of shame around taking meds. I feel it myself, and it's not healthy. If you can look yourself in the mirror and say you are doing the best you can to try to help yourself, then I don't see why you should be ashamed of taking medication.

Thank you for this excellent post

[marcoleap]

Originally Posted by Noua

Thank you for the replies.

I am well aware of the risks with benzos, the withdrawals/dependency/etc. I've taken them before, alongside SSRIs.

I guess I am just confused on whether or not I, personally, need them, or if I just haven't tried hard enough in other areas of treatment... DBT and CBT helped slightly, exposure did nothing, the SSRI I'm on seemed to work for maybe 3-4 months. It feels like every goal I have is impossible because of my inability to go really outside.

It sounds to me like you have worked hard to manage your anxiety without using benzos, but only you can answer that. One option would be to use the benzos but keep going with the other forms of treatment, such as DBT or CBT, and then reassess whether you need the benzos in another few months.

[still_crazy]

hi. i think one big problem is that the benzos just suppress anxiety; they don't 'fix' anything. then again...one can say that about --every-- psych drug out there. stop taking any psych drug, you'll probably have the old problems back, plus a rebound effect from discontinuing psych drug treatment.

i think it also depends on your doctor. some are hardcore, anti-benzos. others are a bit too accomodating. many, it seems, are in between. one's personal history is a concern, of course; some people are more prone to dosage escalation and dependence than others.

having dealt w/ high(ish) dose benzo treatment by prescription in my late teens, id advise against it. my experience was hellish. my psychiatrist used the benzodiazepines as leverage to control me, then i was blamed by other doctors for "getting hooked" (addictive personality, etc.). ive read that sort of thing happens to some people, and i certainly would not wish it on anyone, ever.

still...especially in today's very competitive world, you gotta do what you gotta do. i would say try to keep the dosage low, and try to take the benzodiazepine just as needed, if you can. some benzodiazepines are better (for most people...) than others. valium, the golden oldie, is often easier to taper than klonopin or xanax, for instance.

hope this helps.

[Nike007]

I only take Ativan PRN for presentations or music performances, as I get really bad panic attacks. It helps me get through the short but extreme stressor.

Benzos should only be used short term or PRN due to addiction.

[*Laurie*]

People need to stop stating that 'benzos should only be used'...a certain way. Unless you are a doctor and familiar with a patient's medical history, you should not be telling anyone how medication should be used.