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PTSD & Benzos: New Information You Really Need to Know

How to treat PTSD

Passing judgment on a treatment of choice for someone struggling with a mood or anxiety disorder is cold. Yet, risks need to be shared. Treating PTSD with benzodiazepines seems to make a whole lot of sense. However, new research says otherwise. Let’s dig-in…

Benzodiazepines are ineffective for PTSD treatment and prevention, and risks associated with their use tend to outweigh potential short-term benefits.

Okay, so who can’t understand why someone enduring posttraumatic stress disorder (PTSD) would want to use a benzodiazepine (benzo)? I mean, think about flashbacks, nightmares, social anxiety, panic, and more. Xanax, Klonopin, Ativan, etc. may make life, at the very least, tolerable.

As you read, please understand my job isn’t to pass judgment on how you find relief. But I think it’s my responsibility to share risks as I become aware of them. If you’re enduring PTSD, I came upon some information you really need to know. And, of course, you can decide what you want to do with it.

Benzodiazepines for PTSD?

According to a systematic review and meta-analysis published in this month’s Journal of Psychiatric Practice, benzos may not be effective in the treatment of PTSD. In fact, they could be downright harmful. By the way, this was the first comprehensive review and meta-analysis dealing with the issue.

From Wright State University’s Dr. Jeffrey Guina and colleagues…

Benzodiazepines are ineffective for PTSD treatment and prevention, and risks associated with their use tend to outweigh potential short-term benefits.

Ouch!

But there’s more. The team also found evidence suggesting the use of benzos in patients who experienced recent trauma may, in fact, ramp-up the onset of PTSD.

In their review, the team pulled from clinical trials or observational studies pertaining to the use of benzos in PTSD patients. Also included were patients with recent trauma who’d been evaluated for possible PTSD.

So Why All the Hubbub?

Fact is, benzos are frequently used in the treatment of PTSD – and it’s controversial. See, clinicians on one side of the fence say benzos can reduce the anxiety, irritability, and insomnia associated with PTSD. However, clinicians on the other side of the fence suggest using benzos may prolong and worsen an already very unpleasant situation.

Given the latest round of inadequate treatment of veterans with PTSD, Dr. Guina believes this kind of ongoing analysis is merited.

Benzodiazepines for PTSD? The Review & Results

Okay, so Guina and team dived-in to 18 studies, which included 5,200+ participants who’d survived one or more traumas. Included were physical injuries, combat-related trauma, life-threatening medical conditions, disasters, and sexual trauma.

Based upon the evidence from these particular studies, benzos were associated with no improvement in, or worsening of, overall severity, psychotherapy outcomes, aggression, depression, and substance use.

Now, 12 studies met criteria for a meta-analysis. And the results suggested benzos were associated with no improvement in PTSD-related outcomes. Furthermore, the results suggested using benzos in patients with recent trauma increased PTSD risk.

From Guina and team…

Those studies providing sufficient data suggest that the risk of developing PTSD is two to five times higher in groups receiving benzodiazepines than in control groups.

Why Don’t PTSD & Benzos Play Well Together?

If benzos seem to provide relief for some anxiety disorders, why aren’t they a natural for PTSD? And why are they potentially harmful?

According to Guina and the gang, perhaps it’s because the anxiety associated with PTSD develops differently than in other anxiety disorders.

Catch this interesting tidbit…

Benzodiazepines might be effective if they selectively inhibited the stress and anxiety centers of the brain that are often hyperactive in PTSD. Instead, they indiscriminately target the entire brain – including areas that are already hypoactive in PTSD, such as the cognitive and memory centers.

It seems that because benzos have ongoing impact upon memory, they may hinder patients from learning how to cope with PTSD symptoms. You have to keep in mind that evidence-based trauma-focused psychotherapies require patients to experience and, ultimately, master anxiety.

Well, benzos can impair that experience by numbing emotions, decreasing learning efficiency, and inhibiting memory processing of material learned in therapy.

Let’s Conclude

Guina and team acknowledge there are only four randomized trials, to date, that conclude benzos worsen PTSD. So, obviously, they believe more work needs to be done.

However, in the meantime, based upon the precious little evidence of efficacy – and stronger evidence of potential risks – Dr. Guina and the gang submit that benzos are “relatively contraindicated” in trauma patients.

In fact, they go on to recommend a variety of evidence-based treatments, including psychotherapy, antidepressants, and adrenergic inhibitors. They believe all of these should be exhausted before turning to benzodiazepines.

So there you have it. Powerful information, I think – brought to you without judgment, in the spirit of dialing you in to new and relevant information.

And that about does it, except for how you feel about it. How ’bout sharing in a comment?

Thanks to Wolters Kluwer Health: Lippincott Williams and Wilkins and sciencedaily.com for the scoop.

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