Benzodiazepine Had Been a Favoured Means of Helping PTSD Sufferers: But Other, Safer, More Effective Options Now Prevail
Benzodiazepines (like Xanax) were once routinely issued to veterans suffering from post-traumatic stress disorder (PTSD) in order to treat their anxiety and insomnia. But that practice is now discouraged due to myriad risks associated with the drug, and the availability of better, safer alternatives.
This study will consider the reasons for and implications of this shift for veterans, the disproportionate prescribing of benzodiazepine for female veterans, the use of benzodiazepine for non-veteran civilians, and the alternatives now employed to help everyone with PTSD.
How and Why Veteran Benzodiazepine Use Changed
Benzodiazepines were first approved for medical use in the US in the early 1960s, and gained popularity among many veterans suffering from PTSD for their immediate ability to alleviate anxiety and insomnia.
But as the long-term effects of benzodiazepine have become better understood, study data tells us that their prominence amongst the veteran community has declined.
Back in 2009, 31.3% of veterans suffering with post-traumatic stress disorder (PTSD) were prescribed benzodiazepines. Yet by 2019, the percentage had plummeted to just 10.7% – and is set to decline even further in coming years.
The inexorable shift away from benzodiazepine began in response to the 2010 U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) Clinical Practice Guidelines, and was further cemented in 2013 following further VA/DoD initiatives that reinforced the guidelines, which made the case that the drug was both ineffective and unsafe.
Benzodiazepine Downsides
Although for a long time used to counter the effects of PTSD, analysis of U.S. Department of Veterans Affairs data tells us that benzodiazepines actually worsen symptoms.
The drug increases levels of aggression, depression, and substance abuse. Despite some potential short-term gains – temporary relief from anxiety, for example – benzodiazepines are now, on balance, considered a PTSD-negative, with too many associated risks, and too little overall benefit.
As study data reveals, benzodiazepines can stultify the brain’s ability to link and learn that a feared stimulus is no longer associated with threat, making it much harder for veterans to overcome their fears, or manage their PTSD. Additionally, the Food and Drug Administration (FDA) has issued warnings about the addictive nature of benzodiazepines.
And yet, despite this, a disproportionate number of women veterans suffering with PTSD continue to be treated with benzodiazepine. But why?
The VA Benzodiazepine Gender Divide
According to Psychiatrist.com, women veterans with PTSD are 67% more likely to be prescribed benzodiazepines (and other non-recommended medications) than their male counterparts, despite guidelines recommending against their use.
The given reasons for this are that healthcare providers often misinterpret female PTSD symptoms, and that PTSD simply doesn’t present in women the same way it does in men. For women, benzodiazepine can mask or mimic various conditions, its effects difficult to measure compared to a more homogenous response among men.
Yet it can also cause menstrual irregularities, mood swings, prolonged bouts of insomnia, and acute withdrawal once treatment stops, as well as even higher anxiety and drug craving than men. And to complicate matters further, women veterans more often suffer an array of combined mental issues associated with PTSD – with benzodiazepine used as in such cases as a general fix for multiple problems.
As study data suggests, such gender disparity in recommended benzodiazepine prescriptions means that gender-conscious or individually tailored medical recommendations are overdue, and much needed, to avoid the inappropriate and over-simplistic administration of potentially risky medications.
Civilian Use Of Benzodiazepines
Although historically popular as a veteran PTSD treatment, benzodiazepine is also used to treat civilians suffering from PTSD – primarily as a short-term amelioration of anxiety and insomnia. However, long-term administration of benzodiazepine to civilians afflicted with PTSD is rare, and in all prescribed cases, each individual is carefully considered regarding patient preference and co-existing conditions that might clash with the drug. Ultimately, clinicians are – as is the case with veterans – shifting their focus away from benzodiazepine towards alternative means of treatment.
Alternatives To Benzodiazepine
A combination of psychotherapeutic and pharmacological alternatives are now primary options when it comes to PTSD treatment. Two main elements of treatment, advocated by VA/DoD Clinical Practice Guidelines, are as follows.
Trauma-focused psychotherapies:
- Cognitive Behavioral Therapy (CBT)
- Cognitive Processing Therapy (CPT), and
- Prolonged Exposure Therapy (PE).
Pharmacological alternatives to benzodiazepine that show positive results include:
- Selective Serotonin Reuptake Inhibitors (SSRIs): paroxetine, sertraline, and
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): venlafaxine
.
These alternative treatments are now among the primary means of combating PTSD due to both their effectiveness, and the lower risk they represent compared to benzodiazepines.
As further alternatives to benzodiazepine, the VA also includes eight approved Complementary and Integrative Health (CIH) practices as part of a suite of veterans’ PTSD care.
This element includes acupuncture, biofeedback, clinical hypnosis, guided imagery, massage therapy, meditation, Tai Chi/Qigong, and yoga.
CIH is also increasingly popular with civilians, with National Institutes of Health data emphasizing the fact: the percentage of individuals using at least one CIH approach increased from 19.2% in 2002 to 36.7% in 2022.
Evidence of CIH efficacy varies, although study data confirms that CIH practices have shown promise when it comes to reducing PTSD symptoms and improving overall well-being.
SKY Breath Meditation (SKY – also known as Sudarshan Kriya Yoga) has also significantly improved anxiety levels for veterans and civilians with PTSD, and has demonstrated efficacy in reducing many other PTSD symptoms. In fact, a randomized controlled trial found that SKY was as effective at alleviating symptoms as Cognitive Processing Therapy (CPT) – a gold-standard PTSD treatment.
In summary, the historically important role of benzodiazepine will continue to diminish, as safer, more organic means of combating PTSD are increasingly pursued. With the ability to scrutinize the long-term results from alternative solutions, like therapy, yoga, and other forms of mediation, benzodiazepine may become a rare emergency measure to offset acute cases in their initial stage.
But its days of being the go-to solution for veterans enduring the ravages of a terrible affliction, and often making it worse, are already long over. And as its prevalence as PTSD relief among the general population continues to wane due to the popularity of alternative options such as therapy and SKY yoga, benzodiazepine will become even more of a niche option.
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