Jade Macpepple-Jaja 12B Mrs Hasan/Mrs Stevenson

Figure 1 shows the levels of serotonin in

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.















Jade Macpepple-Jaja 12B Mrs Hasan/Mrs Stevenson

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