Recent years have seen a clear increase in awareness of mental illnesses, especially among the younger generations, which has implied significant increases in the demand for psychological and psychiatric services, and consequently a greater number of diagnoses and prescriptions of psychotropic drugs.
Specifically, according to data from the Ministry of Health , between 2008 and 2020 the consumption of benzodiazepines (the ‘family’ that groups together the anxiolytics commonly used today) has increased by 57%. Of the total population, 10% of people consume this type of drug (following a prescription or not) .
These figures can be shocking when we look at the fact that, being psychotropic drugs, they have a direct effect on the entire functioning of what we call ‘mind’, which includes emotions, perception and thought. For those who do not have the experience, it can be difficult to understand or imagine the nature of this distortion , which overlaps with what may already be causing a mental health problem when use is part of a treatment.
“I could get on with my life”
“The first time they prescribed me anxiolytics,” Claudia, a 21-year-old student from Madrid, tells 20Minutos , “I think I was 16 years old.” His case is typical: the majority of those who consume this type of drug do it, or at least begin to do so, under medical prescription . “It was because of depression and anxiety, which is why they have been prescribed for me again now.” For this diagnosis, they have also prescribed antidepressants in both cases.
“The first time I was taking Lorazepam, and then they changed it to Lormetazepam,” he explains. “At first, I was sleepy and it was hard for me to find out what was happening; but once my body got used to it, I no longer felt so ‘zombie'”.
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“That first month was complicated, but it is true that I could be more clear to continue with my life, ” she continues.
“I felt at peace. Quiet. It gave the feeling that everything was fine .” similarly expresses Javi, 26, who works in the marketing field and, like Claudia, began taking anxiolytics (Diazepam, Lorazepam and Alprazolam) as part of a prescribed treatment, in this case for anxiety, depression and disorder bipolar and in combination with antidepressants, mood regulators and antipsychotics. “For someone with anxiety it is a highly desired effect.”
Of course, these types of sensations can help temporarily relieve anxiety. Dani (not her real name), a 21-year-old photography student who was first prescribed Lorazepam and then Alprazolam for depression and anxiety, explains in the same way that “I go from strong anxiety symptoms (nervousness, tachycardia …) to feeling more calm , ‘normal’. With the trankimazín (Alprazolam) I have been able to begin to control the peaks of anxiety, it is effective for me “.
“Anxiolytics help at the time of crisis, although they are only a crutch. They do not solve the basic problem, but they help to survive and function day by day,” says María (not her real name), a 25-year-old illustrator and graphic designer who was treated with antidepressants and Lorazepam for obsessive anxiety disorder and sleep disorder.
“During the drug treatment I did not receive psychotherapy, only psychiatrist sessions once every two months. Later I stopped the antidepressants and began to go to psychotherapy: that was when I began to improve,” he adds, and concludes: ” I should have started with a psychotherapeutic approach from the beginning, and not psychiatric. I suppose that in many cases the most effective is to combine both treatments, but this is something that is not available to most. “
“You are generating tolerance as time passes”
All the previous descriptions respond to the efficacy of the short-term treatment. However, the assessment that these young people make of the long-term effect of it varies widely.
“When I did it, I didn’t take it badly and I was able to go through the days without constantly drowning or being able to stop crying, which was (is) something I appreciated,” argues Claudia.
“I take ‘rescue’ anxiolytics” (the name given to the pattern by which anxiolytics are taken only when an anxiety attack occurs) tells Dani “and they calm the anxiety that prevents me from carrying out tasks and plans. In any case, it does compensate me. ” However, he details that his experience has been “complicated”: “I have been many months without noticing anything with the different prescription drugs, and they have had to change the doses a lot”.
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“The medicine works to calm you down,” agrees Sara, a 25-year-old unemployed young woman treated first with Lorazepam and then with Clonazepam after suffering an anxiety attack. However, he also warns: ” you are generating tolerance as time passes.”
Naturally, the differences in the effectiveness of benzodiazepine treatments (which, broadly speaking, differ from each other in aspects such as the potency and duration of their effects) in each patient are the result of the combination of many very different factors. Specific medications, doses, guidelines, diagnoses, comorbidities, and coincidence with other pharmacological treatments influence the outcome; but it is that, even with the same diagnosis and the same treatment, we must never forget that each patient is different and can respond to treatment in a different way.
That is why there are many voices that, without necessarily assuming antipsychiatric positions, have highlighted the need to carry out an exhaustive evaluation and close follow-up of each case before prescribing benzodiazepines, something that collides with common practices such as their prescription from the beginning. health centers by non-specialist doctors; especially considering that these substances are not without risks.
This last case was that of Sara, who explains it like this: “From my health center I have never been referred to a psychologist or psychiatrist even though I have been prescribed an anxiolytic on a chronic basis. It is important that treatment with anxiolytics is complemented with psychotherapy, but my GP prescribed the anxiolytics without having made an appointment with a psychologist or psychiatrist who, in addition to diagnosing me, can monitor my process “
“I was starting to feel tired”
The first of these risks, and perhaps the most obvious, are possible side effects . Although it is not possible to attribute them all with certainty exclusively to benzodiazepines (remembering that in most of these cases they coincide with the taking of other drugs), these young people report some of them.
“At first, they made me very drowsy,” recalls María, coinciding with the drowsiness that Claudia also reported. “And a complete lack of sexual appetite during treatment.”
Anxiety attacks are usually brief, but cause great discomfort.
“In higher doses, especially shortly after changing them, it went from the intense symptoms of anxiety to a feeling of tiredness , drowsiness and a little dizziness”, adds Dani.
“I have less control of fine motor skills , less concentration, mood swings …” Sara reports for her part. “In addition to feeling too anesthetized to carry on a normal conversation. On the other hand, one of the long-term side effects it has caused me is depression and thoughts of self-harm.”
“It affected me a lot more than I wanted to admit at the time,” says Javier. “I had significant memory gaps . There are still time lapses of months that I can’t remember. In addition, many times they reinforced my irresponsible behavior. When I felt chemically that ‘everything was fine’ I saw no reason not to do ‘this or that’ and I ended up getting in trouble for this. “
These side effects, if necessary, can be very serious, especially when the doses are very high. In fact, it should be noted that, although this is statistically rare today, they are drugs with the potential for overdose . Dani exemplifies it like this: “On one occasion I had an overdose that led me to lose consciousness for several hours, being very close to a practically lethal dose”.
“I was aware of the clock so that it was time to take it”
Another of the dangers, more insidious and invisible, is their addictive potential and as drugs of abuse, something that is amplified by the tolerance they generate and by the fact that they can produce withdrawal syndrome. For example, Claudia says, “The first week after quitting was terrible. At the end of the day, I was hooked on the effect they were having on me and I knew it was going to take its toll.”
” It was hard for me to get out of bed and be in the mood for anything; I was not necessarily sad or bad, but I didn’t feel anything and moving was too much of an effort. By the second week, things started to improve, although it wasn’t until a month I did not really feel ‘well’, “she continues, and confesses that although her psychiatrist was betting on a gradual reduction of the doses, she cut off the treatment at once.
“Sometimes I have felt nervous and with a great need to take the anxiolytic, waiting for the clock to mark the time to take it “, says Sara, who is currently carrying out this progressive reduction of the treatment: “It makes me feel irritation , nervousness and a sense of existential emptiness. “
“I went to the black market”
From this point of view, the testimony of this young man is particularly heartbreaking: “The anxiolytics were withdrawn when I began to develop a dependency on them . It is no longer that I needed them to deal with crisis situations, but rather that I needed them to deal with normal situations. The withdrawal syndrome was so hard that I kept turning to them on the black market for a while. “
“I had reached a point where to carry my day I needed a pill. Then three, then 10 …”, he recalls. “Being something (consuming them without a prescription) that I did in a ‘prohibited’ way, this had a negative impact on a psychological level. It was like a dark secret, I didn’t want my environment to know that I depended on them, I tried to hide it and that too I was worse off with myself. “
Lorazepam pill, the most widely used anxiolytic.
Javier even combined benzodiazepines with other psychoactive substances (legal and illegal), a pattern of consumption in which many patients with very different mental health problems are at special risk of falling.
“Sometimes with alcohol, but it ended up on the floor. Mostly I combined them with cannabis. They ended up canceling me anyway and I spent the day in a cloud, but the impact was more mental and less physical than mixing it with alcohol.”
All this situation brought him to a point where the impact on his day-to-day life was severe. “I have fallen asleep in situations that I should not have. I have forgotten important time lapses, with the consequences that this had in my day to day life. Not knowing what day it is , if you have an exam, if you have money left in your account … . “.
“It is possible to get out of there”
“I came, once, to try to commit suicide with them . I woke up in the emergency room without remembering very well what had happened except the feeling of wanting to die,” Javier confesses harshly.
Fortunately, he managed to overcome this situation: “Years ago I stopped consuming them. In my case the main thing was to make the decision. To get to the point where I realized that they were not being a medicine for me, rather the opposite. I got to a point where I regretted my history with them so much that the only valid option was not to take them anymore. “
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“The withdrawal syndrome was horrible. All the anxiety that I had been avoiding came back on the rebound. I could not sleep or eat, I lived in a state of constant anxiety and alertness ,” he continues.
“But hey, I’m glad I took them off and even if it costs, it ‘s possible to get out of there.”
The complex reality of anxiolytics
The truth is that the cases of all these young people, each one of course with its peculiarities and unique, do not illustrate anything that is new in the pharmacological literature. There is much research on benzodiazepines that has described their different dosages, their effectiveness, their side effects and their potential for abuse.
What they do, instead, is give a human dimension to both their lights and their shadows. Mental health disorders are unfortunately an increasingly daily reality in our societies (and even today it is suspected that a good number of cases are never diagnosed), affecting people around everyone; their true impact cannot be understood without understanding the experiences of those who live with them.
Therefore, when dealing with such a sensitive subject, it is important to understand (and this is something that medical science is increasingly aware of every day) that, both when deciding whether a psychotropic drug is suitable for clinical use and when When prescribing a certain treatment, a balance must be made between the improvement in the patient’s quality of life that they can achieve and, on the contrary, the damage that they can cause.