and create a tolerance. Drug companies keep coming out with new benzo-
diazepines, like Serax and Klonopin, each a bit slower and, presumably, a
bit less addictive. They couldn’t do much about the tolerance. It was also
discovered that alcohol, barbiturates, meprobamate, and benzodiazepines
develop cross-tolerance, which means that tolerance to one makes you
tolerant to all. These drugs, when combined, potentiateone another.
Effects can be augmented to levels that are dangerous, or even fatal.
Benzodiazepines now are seldom used for generalized anxiety, but
they are used for panic disorder. In the 1980s, when Congress was holding
hearings on the overuse of Valium and Librium, panic disorder was shifted
into a separate diagnostic category from other anxiety disorders. The treat-
ment of choice was Xanax, a newer benzodiazepine that was pretty much
a clone of Valium and Librium. At the time there was some speculation
that rapid treatment with benzodiazepines was necessary in panic disorder
because of the danger of suicide. This danger has not been supported by
research, but it is still very much a part of the folklore that surrounds the
disorder. For a few years people who had panic attacks were regularly
prescribed Xanax three times a day. Because of the dangers of physical
dependence, this practice has all but disappeared.
More than anything else, people with panic disorder want their awful
feelings to just go away. If a medication will do that for them, they are apt
to take it now and ask questions later.
There is no justification for the prescription of long-term daily doses
of benzodiazepines for panic, or any other fear disorder, unless everything
else has failed. They are often prescribed for two to three weeks in con-
junction with serotonergics, drugs that increase available serotonin, which
are safer but take several weeks to work. The justification is that panic
attacks are so painful that patients may get worse or even kill themselves
if they don’t get some immediate relief. This may be true, so it makes sense
to be cautious.
Presently, doctors are well-aware of the dangers of benzodiazepines
and strictly limit the amount they prescribe. Often they give out only a
small supply to be taken, not daily, but as needed to stop panic attacks or
prevent them in specific circumstances. This is a reasonable strategy,
though it does not seem so to some patients. They shop around for doc-
tors who will prescribe them what they want, sometimes using subterfuge.
86 ❧Explosions into Fear