What a drag it is getting old

By Michael Fingerhood, MD, Johns Hopkins Medicine

 

Benzodiazepines, or benzos as they’re known, were introduced in the 1960s and gained attention from the Rolling Stones in their 1966 song “Mother’s Little Helper.” Benzodiazepines were to be miracle drugs, alleviating emotional pain and helping people get through a difficult day. The first benzodiazepine was Valium (diazepam), introduced as a new way to cope with life stressors that was safe and non-addictive. Like most things that seem too good to be true, this was not true. New benzodiazepines were introduced that were “safer”—lorazepam and clonazepam. They were not safer.  

 

So, what should you do/say when patients ask for them to be prescribed or don’t want to stop them?  Here are some related questions and answers: 

 

1. What are the reasons patients (or families) ask for them? 

Anxiety symptoms, depression with anxiety, insomnia, and/or agitation related to cognitive decline. 

 

2. What are the main concerns with prescribing?  

They’re prescribed for anxiety symptoms, without recognition of underlying causes: depression, normal worry, or cognitive impairment. Most importantly, once prescribed they’re difficult to stop. 

 

3. What are the risks of benzodiazepines?

Motor vehicle accidents (comparable with alcohol), falls, drowsiness, memory impairment, confusion, incontinence, dependence (they cannot be abruptly stopped due to risk of seizures), and overdose. 

 

4. What can you say to a patient asking for one? 

Explain the risks and the safer alternatives—both pharmacologic and especially non-pharmacological—meditation, exercise, yoga, and counseling. 

 

5. What if a patient says that a benzodiazepine is the only medication that works for them? 

“I understand it helped your symptoms, but I’m concerned about harm that will occur over time.” 

 

6. What can you say to a patient already receiving a benzodiazepine from a previous clinician? 

“I’m worried about problems (specify) that are related to (name of medication). You would benefit from us working to taper your medication.” 

 

7. What if there’s resistance? 

“I understand that I need to treat your symptoms, but we need to do so without causing you other problems. We’ll reduce the medication very slowly and will stay in close contact. I think limiting medication will improve your quality of life.” 

 

8. Isn’t it easier just to prescribe benzodiazepines? 

Taking the time to build rapport with patients and form a therapeutic relationship is far more effective patient care than simply prescribing a pill doomed to cause harm. 

 

“What a drag it is getting old,” Rolling Stones, 1966

“Kids are different today,” I hear every mother say
Mother needs something today to calm her down
And though she’s not really ill, there’s a little yellow pill
She goes running for the shelter of her mother’s little helper
And it helps her on her way, gets her through her busy day

“Things are different today,” I hear every mother say
Cooking fresh food for her husband’s just a drag
So she buys an instant cake, and she burns a frozen steak
And goes running for the shelter of her mother’s little helper
And two help her on her way, get her through her busy day

Doctor, please, some more of these
Outside the door, she took four more

What a drag it is getting old

“Men just aren’t the same today,” I hear every mother say
They just don’t appreciate that you get tired
They’re so hard to satisfy, you can tranquilize your mind
So go running for the shelter of a mother’s little helper

And four help you through the night, help to minimize your plight

Doctor, please, some more of these

Outside the door, she took four more

What a drag it is getting old

“Life’s just much too hard today,” I hear every mother say
The pursuit of happiness just seems a bore
And if you take more of those, you will get an overdose
No more running for the shelter of a mother’s little helper
They just helped you on your way, through your busy dying day

 

 

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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.