Feature

High Strung

The anxiety epidemic in the U.S. has driven many sufferers to short term treatment.
January 2014

More than 40 million American adults are currently diagnosed as having anxiety, making it the most common mental health disorder in the United States. Judging by the numbers, it seems as if our country is experiencing a collective nervous breakdown. But perhaps what should really be causing our angst is the all-too-common—and some say dangerous—way we’ve come to treat our unease: with a benzodiazepine prescription. 

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Come summer, when the high desert heat rolls into Durango, waves of fatigue, anxiety, and insomnia settle into Jennifer Roeder’s body. The 47-year-old, who resembles Bonnie Raitt, can’t think clearly. She’s easily overwhelmed by stress, noise, and large crowds. Her heart races and she feels dizzy and weak, short of breath. She often takes to her bedroom, drawing the curtains and lying down with the air conditioning cranked up. When the sun sinks low and twilight finally begins to cool the day, she walks the hills around her southwestern Colorado town, trying to calm her raging mind and wayward body, both of which have been ravaged by a 10-year battle with benzodiazepines.

On a 93-degree scorcher in early July, Roeder sits in a Starbucks. She is articulate and intelligent and has spent the past week on the Front Range visiting her 16-year-old daughter, who lives in Longmont. “I had goals,” Roeder says. “I intended to get a master’s degree. I wanted to work as a counselor. I had big plans.” This was before she was prescribed benzodiazepines—a wildly popular family of psychotropic drugs used to treat anxiety that includes Xanax, Valium, Klonopin, and Ativan. “I lost everything,” she says, including her health, her career, and ultimately the ability to care for her daughter. These days, Roeder is on a mission to warn others about what she says are serious risks associated with benzos. But today she is struggling: It’s because of the drugs’ lingering side effects that the heat has become so insufferable for her.

Forty miles away in Fort Collins, Dr. Scott Shannon, 57, is waging his own war against benzos, which have been one of the go-to treatments for anxiety disorders in the United States for 60 years. An avid runner and snowboarder with a graying mustache and soul patch and a laid-back demeanor, Shannon’s fight is altogether different than Roeder’s. In 2010, Shannon opened the Wholeness Center, the country’s largest and most comprehensive integrative psychiatry clinic, where he has been pioneering a new approach to mental wellness; one that favors a mind-body-spirit approach rather than psychiatric labeling and prescriptions.

jenThe University of Arizona– and Columbia-trained psychiatrist and former president of the American Holistic Medical Association is a pioneer in integrative psychiatry: In 2001, he penned its first textbook and followed that up with two more books on the subject, including Mental Health for the Whole Child, released this past July, and Parenting the Whole Child, released in November. He describes his philosophy as one that evaluates all the external influences that might affect a patient’s mental well-being. “I try to understand people as a comprehensive whole,” Shannon says. He does this by focusing on how an individual’s diet, exercise, traumatic life events, stressors, and relationships impact his or her mental health. Once he has a grasp on what may be causing an individual’s anxiety (or any other psychiatric affliction), he offers what he says are safe, effective, evidence-based techniques—meditation, cognitive behavioral therapy, nutritional supplements, acupuncture, and diet modifications—to bring relief. While he’s not opposed to writing a script, it’s not his starting point. And he rarely, if ever, prescribes benzodiazepines.

The first benzo, Miltown, hit the U.S. market in 1955, followed by a slew of others including Librium in 1960, Valium in 1963, Klonopin in 1975, Ativan in 1977, and Xanax four years later. All of these drugs affect gamma-aminobutyric acid (GABA), a chemical—or neurotransmitter—in the brain that helps calm the mind and ease anxiety. Think of GABA as a key roaming the brain looking to find the right lock, or receptor, to open. When it does, it attaches to its corresponding GABA receptor and unlocks GABA’s soothing effects. Benzodiazepines work by attaching to GABA receptors and amplifying the neurotransmitter’s effects, thereby creating an artificial sense of peace. By 2011, Xanax had emerged as the most popular antianxiety medication in the country with nearly 50 million prescriptions dispensed in that year alone, making it the most prescribed psychiatric drug (besting antidepressants Zoloft and Prozac) and the 10th most-prescribed medication overall.

It’s not difficult to understand why benzos are all the rage in the United States: According to the World Health Organization, we are the most anxious country on the planet. More than 40 million American adults (including about 627,748 Coloradans) currently live with a diagnosis of anxiety—a disorder with many variations—which is generally defined as excessive fear or unrealistic worry even if there is little to incite those feelings. And it seems that our fears are growing exponentially: Diagnoses have seen a 600 percent jump since 1990.

Likewise, prescriptions for benzodiazepines have jumped—17 percent since 2006 and 44 percent since 1981. The drugs are a hit because in the short term, they’re cheap, effective, and have relatively few side effects. With the pop of a pill, all that stress about work, family, finances, and your dying mother melts away.

But here’s the issue: There is no medical study that shows long-term benzo use improves anxiety. What researchers have demonstrated is that long-term benzo use can cause structural changes to the brain and central nervous system, depression, and memory loss and may lead to other psychiatric diagnoses. Reports have simultaneously shown that even short-term benzo use can damage cognitive and intellectual abilities. And, ironically, benzos have been known to worsen symptoms of anxiety.

Still, doctors from New York to California—and here in Colorado—continue to prescribe the drugs. Mainstream psychiatrists like Dr. Robert Davies, an associate professor of psychiatry at the University of Colorado School of Medicine who specializes in anxiety disorders and sometimes prescribes the drugs (though he prefers selective serotonin reuptake inhibitors, like Prozac, for treating anxiety), acknowledge benzos’ double-edged sword. While Davies says the drugs can provide short-term benefits for many people, he cautions about their potential for addiction, abuse, and the development of tolerance and depression and says, “There are a variety of reasons they shouldn’t be used long-term.”

The hours of lying awake, staring at the ceiling had finally gotten to Roeder. It was April 2003, and she had been suffering from insomnia for what seemed like forever. She ultimately decided it was time to visit a mental health clinic in Durango. “I told the nurse practitioner I was having trouble sleeping from anxiety that I felt was caused by stress,” Roeder says. At the time, she was 37, a single mom to a five-year-old daughter, and she worked part time while pursuing a bachelor’s degree at Fort Lewis College. With her time and energy stretched, she worried about meeting her young daughter’s emotional needs. She stressed over paying the bills and juggling her responsibilities. She asked for something that would ease her anxiety and help her sleep. She also requested the prescription drug be non-habit-forming. The nurse practitioner prescribed her one milligram of Ativan, a low dose of the benzo, and told her not to worry. “You’ll be fine,” Roeder remembers him saying.

DrShannon is aware of how easily benzos are doled out—and how problematic they can be. In fact, treatment for anxiety is one of the primary reasons people come to Shannon’s Wholeness Center, which has 14 practitioners, ranging from psychiatrists and psychologists to nutritionists, naturopaths, and acupuncturists. Patients visit the center with specific concerns, but just as often, it’s free-floating worry and ruminations about everything and nothing in particular that bring people to Shannon. And he gets it. He just doesn’t agree that all 40 million Americans diagnosed with anxiety need medication, especially benzos. Instead, he considers anxiety to be a far more nuanced problem. “External factors actually play a much stronger role in things like anxiety and depression than genetic factors do,” he says. In short, sleep, diet, exercise, stress, work, relationships, family, pets, and electronic stimulation (hello iPhone!) are powerful forces that affect how we express our genetic predispositions and, in due course, impact our mental wellness.

Shannon cites an analysis in which 18 different studies looked at the long-term cognitive effects of benzo use three months to three years after people had gotten off of them. “They found deterioration in every area of intellectual and cognitive testing they studied,” Shannon says. He believes benzos short-circuit a person’s natural ability to manage anxiety, creating a vicious cycle of tolerance, dose increase, and dependence. Ultimately, he says, “Benzos don’t really effectively treat chronic anxiety. They just create a dependency. In the long run, it backfires.” Shannon estimates that 40 to 60 percent of his patients who have used benzos long-term for chronic anxiety develop some sort of dependency. National numbers back up his approximations: Rehab visits involving benzos have tripled between 1998 and 2006 in the United States.

Dr. Mark Foster, a Denver-based family practice physician, also cautions against benzos. “For most patients, the risks of treating chronic anxiety with chronic benzodiazepines far outweigh any benefit.” Dr. Janet Settle, a Denver-based integrative psychiatrist, agrees. “A lot of people use a benzodiazepine as a Band-Aid—you know, ‘Let’s just make the symptoms go away.’ Unfortunately, too much of the time, I think we’re making symptoms go away that may be valuable signals about underlying problems that really need to be addressed.”

There is a place for psychotropic drugs at the Wholeness Center, but they are not the default option. Instead, Shannon focuses on reducing or eliminating the need for such medications. “We’ve gotten evidence in the past 10 years that our psychiatric medicines are not as good as we thought and they have significant risks,” he says. “There are a lot of other tools we’ve ignored in our rush to pharmacology.” To that end, Shannon—and doctors with similar sensibilities, such as Settle and Foster—is more likely to prescribe cognitive behavioral therapy, meditation, and a lifestyle overhaul than a bottle of pills.

Shannon also encourages the use of natural supplements such as Inositol, L-theanine, 5-Hydroxytryptophan, and magnesium to treat anxiety. And while critics say there’s not enough evidence to support those alternative therapies, Shannon says he doubts there ever will be. “Unfortunately, money is only made off commercial entities—prescriptions—and it costs $100 million to $200 million or more to bring a drug to market,” he explains. “So the only time we’re going to get large-scale studies and an FDA indication is with commercial prescription agents.”

In 2006, Roeder graduated from Fort Lewis College and moved to Santa Fe to pursue a master’s degree in counseling at the University of New Mexico. By that time, she had been on benzos for three years and was taking 2.5 milligrams of Klonopin a day. Roeder says she took the drugs as prescribed, but the benzos had started to affect her cognitive abilities, and her anxiety—which the benzos were supposed to alleviate—had reached an acute level. She had also built up a tolerance to her prescribed amount and needed to increase it in order to feel the medication’s soothing effects. “I knew it was time to either go up to three milligrams or come off the drug.” On July 11, 2006, she filled her last prescription.

What most people don’t know is how difficult—and dangerous—stopping benzos can be. Long-term use damages the brain’s natural ability to produce and access GABA. When benzos are discontinued, the brain and central nervous system go into overdrive, and the results can be excruciating: extreme anxiety, panic attacks, insomnia, seizures, shortness of breath, and heart palpitations, among other things. “Your brain and central nervous system are on fire; that’s what it feels like,” says Matt Samet, a Gunbarrel-based writer and benzo survivor who chronicled his seven-year war to get off benzos in his 2013 memoir Death Grip. And it’s not just long-term users who have trouble. Shannon has treated patients who had been on low doses for a short time and then subsequently took years to get off them.

Unfortunately for Roeder, there were—and still are—limited resources available for helping people learn how to come off benzos. Though she did not have medical supervision, she decided to taper off the drugs and did so over three months (a psychiatrist later told her he would have taken her off the drugs over a two-year period to avoid the withdrawal symptoms she suffered). The abrupt withdrawal shocked her system and triggered a rash of physical and mental symptoms that continue to this day. “The mental torture I felt from the initial withdrawal was incredible,” she says. “I came completely undone.”

Over the next seven years, she became so sick she was unable to begin her master’s degree program or take care of her daughter. Ultimately, the 45-year-old mother made the difficult decision—what she calls the most painful choice of her life—to place her daughter in a group home, where she has lived since 2011. Even though Roeder has been off the drugs since 2006, the stress of raising her daughter, or any kind of stress for that matter, can trigger her withdrawal symptoms, making it difficult for her to lead a functional life.

Shannon estimates that of the 3,600 patients who have sought treatment at the Wholeness Center, about five percent have come to get off benzos. He also says that over the course of his 30-year career, he has weaned hundreds of patients off the medications and has seen, in rare cases, patients with withdrawal symptoms as severe as Roeder’s. More typical, however, are cases like that of Barbara,* one of Shannon’s current patients.

A 54-year-old graduate student at Colorado State University, Barbara began taking Klonopin for insomnia 13 years ago. She took the medication for two years and then successfully stopped taking it. Then, in 2008, she was flying to Hawaii for a vacation and experienced a severe panic attack on the plane after a bout of turbulence. When the panic hadn’t subsided by the time she reached Maui, she visited a local doctor, who prescribed Klonopin. Since that trip more than four years ago, Barbara has been working with Shannon to get off the medication. In addition to gradually lowering her dose, Shannon has advised Barbara to take supplements like Inositol, to practice yoga and meditate, to exercise vigorously in the morning, and to avoid sugar and caffeine (stimulants known to rev up anxiety), among other things. These recommendations have helped and over the four years, Barbara has tapered down from one milligram to .125 milligrams, but whenever she tries to go down any farther, Barbara says, “It feels like someone has come along and taken my true personality out of me and inserted this miserable, depressed person that I don’t even recognize or like.” In Barbara’s opinion, hers is a physical dependence, not a psychological one. In hindsight, she wishes she’d known more about benzodiazepines before she began taking them. “Now I would exercise every other avenue for relief of symptoms before I took Klonopin,” she says.

These days, Roeder is vigilant about managing her lifestyle so as not to spark her symptoms, but she hasn’t been able to cope with the heat, a withdrawal symptom many benzo survivors experience. She meets regularly with a psychotherapist and visits a family therapist with her daughter several times a year, which has helped heal their relationship. She avoids sugar and caffeine when she can and takes supplements such as omega-3s, which help the brain produce chemicals that moderate mood and anxiety. Meditation, a practice she picked up before benzos, has been critical to her continuing recovery. In 2012, she started a support group in Durango called Freedom From Psych Drugs, which aims to help others who are weaning off psychiatric medications. Roeder still thinks about the counseling degree and career she once wanted, but those things are not high on her list of priorities. Mostly she wants to get well enough to bring her daughter home. For the time being, though, she is content helping others survive the hell she experienced firsthand. Though her journey has been long and difficult, she believes that a benzo-free life is worth the struggle. “It’s like when a house is burning down and you know there are people inside,” she says. “I can’t just walk away when others are suffering and I can help. I’m going back in to pull other people out.”

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