someone with and without anxiety Are Benzodiazepines the best treatment for Anxiety? What is GAD and what causes it? Anxiety is a reaction to stressful situations which all people experience and is often called the flight or fight response. People who have generalised anxiety disorder have difficulty controlling it and it may negatively affect their day-to- day living. Doctors say you have an anxiety disorder if you worry too much on most days for at least six months meaning the condition is fairly long term. More than 1 in 10 people are likely to have a disabling anxiety disorder at some stage in their life (1) and 1.7% more of the population of England (15% compared to 13.3%) were experiencing an anxiety-related common mental health disorder in 2007, compared to 1993 (2) and twice as many women as men are affected. When Doctors are diagnosing someone with GAD they look for many other symptoms as well as the constant stressing such as ; Feeling restless, on edge, irritable, muscle tension, or keyed up a lot of the time, Tiring easily, Difficulty concentrating and your mind going blank quite often and finally insomnia. One of the main biological causes of GAD is genetics. Many Scientists and psychiatrists see a relationship between the mental health of parents or grandparents and the development of Anxiety in the patient. Studies have shown that some people are more genetically prone to anxiety disorders than others. Furthermore many studies have shown that brain chemistry imbalances are a very likely causes of anxiety disorders. This research has shown that those suffering from anxiety often have issues with several neurotransmitters (brain chemicals), including serotonin, norepinephrine and gamma-aminobutyric acid. In addition to the chemicals themselves, studies of brain imaging have shown that some people with anxiety have different brain activities than those without anxiety. Those with anxiety disorders may have anomalies in blood flow and brain metabolism, as well as structural abnormalities in different parts of the brain.
Another biological cause of anxiety, related to a neurotransmitter imbalance, is conditioning. If a person goes through an extended stressful period, she is more likely to develop an anxiety disorder. Her brain becomes accustomed to the increase in adrenaline, and begins to produce extra amounts on its own, without the stressful stimuli there to provoke the feelings. This problem is related to the fight or flight response; after extended exposure to stressful situations, the body begins to create the fight or flight response when there is no threat present. This Jade Macpepple-Jaja 12B Mrs Hasan/Mrs Stevenson
is often the case in individuals who have been involved in wars, natural disasters, abuse or other incredibly stressful. Less commonly, there may be some medical conditions that lead to increased anxiety. This occurs when some disease or illness effects the brain, causing a disruption in brain chemistry. In these cases, treating the underlying condition will generally prevent further anxiety. Hormones can also lead to anxiety conditions. This biological cause of anxiety is most common in women, and explains why women are more likely than men to suffer from an anxiety disorder. During extreme changes in a woman's hormone levels, such as after the birth of a child, menopause or starting or stopping hormonal birth control, a woman may develop an anxiety disorder. The hormone that contributes to a woman's ability to handle stress and anxiety is progesterone. During the days leading up to a woman's period, immediately after birth and during the beginning stages of menopause, the levels of progesterone in a woman's body drops, leaving her less able to handle stress and much more likely to experience high levels of anxiety. After a period of time, progesterone levels increase again and she experiences fewer feelings of anxiety. However, in some women, this decline stretches out and can lead to general anxiety disorder. There are many other possible causes of GAD that are not biological such as childhood trauma, life change, upbringing and stress. A combination of biological, psychological and environmental factors.
The solution Benzodiazepines are a class of psychoactive drugs used to treat anxiety, insomnia, and a range of other conditions. The first benzodiazepine was chlordiazepoxide (Librium), which was created for medical uses during the 1960s. Shortly after, the drug Valium was developed and it quickly became the highest-selling prescription drug from 1972 until 1978. The body produces different brain chemicals which either have a quietening or excitatory effect on the brain. These natural brain chemicals are in fact neurotransmitters which send messaged from one brain cell to another. About 40% of the billions of brain cells, all over the brain, respond to GABA. GABA is the brains quietening or tranquillising neurotransmitter. Benzodiazepines and related drugs enhance the effect of GABA.When one suffers from anxiety then the brain becomes over active and it needs the transmitters associated with the quietening chemicals to come into action. These respond by sending messages to the brain cells slow down or stop and because the number of brain Jade Macpepple-Jaja 12B Mrs Hasan/Mrs Stevenson
cells responsive to these transmitters is high the it has the quietening effect on the brain. The diagram below compares anxiolytic efficacy in chronic anxiety patients treated with diazepam, phenobarbital and placebo. Patients were assessed two and four weeks after beginning drug treatment. The reduction in anxiety was measured on a scale of 0 to 3, where 0 = no improvement, 3 = very much improvement. From the results they saw that the benzodiazepine Diazepam can improve the reduction of anxiety quicker within a short period of time rather than over a long period of time of taking the medication however it still does help reduce anxiety.(3)
Benzodiazepines are an appropriate solution for anxiety because they firstly help ease the symptoms of anxiety within 30 to 90 minutes of taking the medication. This means that the patient will get relief from the stress quickly and efficiently. In addition to this Benzodiazepines are easily accessible as they can be prescribed by doctors. In addition to this taking these drugs are not as time consuming as other treatments which could be used to treat GAD. The Implications The main social implication is Addiction. The current long-term Benzodiazepine user population in the UK is estimated at between 1.2 and 1.9 million. Additionally there are an estimated 0.5 million medium term users and up to 3 million short term users. Involuntary Addicts are supervised and serviced by a prescriber who maintains the supply of the drug for years or even decades. Often the patient is not informed of his situation and may remain on Benzodiazepines for 20 to 30 years. The individual Benzodiazepine victim/patient is typically initiated into the drug by a trusted General Practitioner or Psychiatrist, as a supposed treatment for a minor medical complaint or life problem. The onset of addiction varies according to the individual but can occur Jade Macpepple-Jaja 12B Mrs Hasan/Mrs Stevenson
very quickly, often within two or three weeks and is usually unrecognised. The addiction locks the addict into a gradual toxic build up and poisoning by Benzodiazepines. Another social implication is the amount of deaths caused In the period from 1990 to 1996 Benzodiazepines caused more deaths than all Class A drugs put together(5).Benzodiazepines were responsible for 1810 deaths. Additionally Benzodiazepines have long been known to cause suicidal ideation(6). Benzodiazepines can be the cause or motivation of a suicide but because another method of suicide is used the death will not appear as Benzodiazepine related in statistics. A less well known social implication of Benzodiazepine is their use for date rape Benzodiazepines are known to be used as date rape drugs. Rohypnol is misused in this way (7). The amnesic effect of Benzodiazepines makes prosecution more difficult. The main Economic implication of Benzodiazepines is the Cost the cost of the Benzodiazepine problem is enormous, almost incalculable. The hidden cost to the NHS alone from Benzodiazepines related problems are huge. Benzodiazepine addicts experience numerous bizarre and intense side effects which many doctors treat with lots of other prescribed drugs
The Disadvantages Benzodiazepines consist of similar chemicals to those produced by the body for quietening effects and when these are added to those produced naturally by the body it means that there are a greater number of transmitters sending out messages to the brain cells resulting in an excessive slow down or shut down of these cells. As a consequence of this increase in the numbers of cells being slowed down the brains output of excitatory transmitters is reduced. These excitatory transmitters are vital for normal alertness, memory co-ordination emotional responses heart rate and blood pressure. The failure to produce enough excitatory transmitters therefore effects the functioning of the systems and therefore affects the body working normally. Benzodiazepine poisoning is insidious and invisible and leads to the inexorable and progressive deterioration in the life of the individual. The patient experiences bizarre and inexplicable side effects and often becomes isolated. They quickly lose higher functions such as their awareness self-awareness and the ability to self-assess themselves or their own health. patients become unable to comprehend the inexplicable deterioration of their life. They suffer confusion in an extreme and total form of the senses, the organs, the body and mind. Benzodiazepines destroy the chemistry of the brain. Benzodiazepines inflict progressive, neurochemical brain damage. This process begins with the ingestion Jade Macpepple-Jaja 12B Mrs Hasan/Mrs Stevenson
of the first tablet and the damage remains after ingestion ceases. There is no treatment for Benzodiazepine damage. Furthermore Because of their tendency to create dependence, benzodiazepines are classified as a Schedule IV drug. Drugs placed in this category have a lower potential for abuse and are accepted as a medical treatment, but they can still lead to limited physical or psychological dependence. In addition to this benzodiazepines lead to many side effects and are highly addicted when taken over a long period of time side effects include: Drowsiness Dizziness Upset stomach Blurred vision Headache Confusion Depression Euphoria Impaired coordination Changes in heart rate Trembling Weakness Amnesia Hangover effect (grogginess) Dreaming or nightmares Chest pain Vision changes Jaundice Dissociation or depersonalization Paradoxical reactions
The Advantages The advantages of Benzodiazepines is that If you are feeling very anxious, benzodiazepines can make you less worried and more relaxed. They can also help some patients sleep better. furthermore they work faster than other treatments for anxiety such as CBT and can be accessed easily through ones local general practitioner. Benzodiazepines have an effect on ones anxiety levels quickly and calm the patient down at a rate which is needed with such a condition. Alternative Solution Cognitive behavioural therapy (CBT) is one of the most effective types of treatment for GAD. Research suggests that around half of people who have CBT recover from GAD and many others get some benefit. CBT works by helping you Jade Macpepple-Jaja 12B Mrs Hasan/Mrs Stevenson
identify unhelpful and unrealistic beliefs and behavioural patterns. You and your therapist work together to change your behaviour and replace unhelpful beliefs with more realistic and balanced ones. CBT mainly focuses on the problems you have at the moment, rather than events from the past. It teaches you new skills and helps you understand how to react more positively to situations that would usually cause you anxiety. The National Institute for Health and Clinical Excellence (NICE) recommends that you should have 12 to 15 hour-long sessions of CBT over four months. Your treatment will usually involve a one- to two-hour session a week. The highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and computer programs. Also skills you learn in CBT are useful, practical and helpful strategies that can be incorporated into everyday life to help you cope better with future stresses and difficulties.
The disadvantages of this solution The main disadvantage of this method is that it is extremely time consuming. Therefore this treatment does not provide fast relief from the anxiety which can be frustrating for patients. furthermore due to the structured nature of CBT it may not be suitable for people with more complex mental health needs or learning difficulties. In addition to this Some critics argue that because CBT only addresses current problems and focuses on specific issues, it does not address the possible underlying causes of mental health conditions, such as an unhappy childhood.
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Referencing 1)Ehlers, A. Anxiety disorders: Challenging negative thinking. Quoted in the Welcome Trust Reviews, 1997. 2)Mental Health Foundation (2009). In the face of fear. 3) 4)) List of references and extracts from academic articles on benzodiazepines 5))Home Office Figures on Benzodiazepine Deaths 1990-96 from Martin Corkery 6))Ryan et al. JAMA, 1968 203,13,1137 7) Professor C.H. Ashton in "Drink, Drugs and Dependence" Ed. Caan & Belleroche