The benzodiazepines are a class of drugs typically prescribed for the treatment of anxiety or chronic seizure. They work by slowing the electrical activity in the brain, resulting in a sedative effect. Doctors may prescribe these drugs for brief or prolonged periods, or simply as needed—such as in the event of a panic attack. The potential adverse effects of benzodiazepines are fairly well understood by the medical community. People may experience drowsiness, headache, dizziness, and an unsteady feeling. High doses have an intoxicating effect similar to alcohol consumption.

However, the effect of chronic low doses of medications like Xanax (alprazolam) and Klonopin (clonazepam) on human tissue and organs is still to be determined. Previous studies have suggested that long-term administration of benzodiazepines may weaken the immune system, although no conclusive evidence of such a link exists.

A clinical experiment with rats tested the effects of Klonopin and Xanax on stressed and nonstressed male rats. The stress procedure involved confining the rats to a small mesh cage for 2.5 hours each morning. Some rats received Klonopin, some Xanax, and others only a control solution of distilled water. The study continued for four weeks, after which the rats were euthanized and the clinicians carefully examined them. The research team was most interested in the health of the immune system, and they primarily investigated lymph glands and blood cell counts. The findings have implications for the treatment of anxiety in humans.

Both stressed and nonstressed rats showed immune system deficits after treatment with either Klonopin or Xanax. Rats treated with Xanax demonstrated the most serious deficits, possibly because of the medication’s unique chemical structure. Because of the experimental design, researchers were able to distinguish between immune deficiencies caused by stress alone and those caused by medication. Nonstressed, medicated rats showed less decline than their stressed counterparts, but the decline was still clinically meaningful. It’s worth noting also that these rats received relatively low doses of medication. Continued administration beyond four weeks might reveal even more profound immune system effects.

These results argue for more caution when prescribing anti-anxiety medications. Both Xanax and Klonopin appear to degrade the immune system in distinct ways. Overall, Klonopin’s effects were less severe than those of Xanax, but were still worrisome. Patients with already compromised immune systems may want to avoid this class of medications if possible. Otherwise, Klonopin may be the safest choice. In addition, short-term use of the drug is definitely preferable to a long-term prescription.

References:

1. Elmesallamy, G. E., Abass, M. A., Refat, N., and Atta, A. H. (2011). Differential effects of alprazolam and clonazepam on the immune system and blood vessels of non-stressed and stressed adult male albino rats. Interdisciplinary Toxicology, 4(3), 132-143.
2. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Alprazolam. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000807/

Making a diagnosis of generalized anxiety is sometime a tricky proposition. Anxiety has many manifestations as well as many underlying causes. Anxiety may be chronic and always at the edge of a person’s consciousness or the condition may flare up in acute episodes called panic attacks. Appropriate treatment is essential and typically involves a mix of cognitive-behavioral therapy, pharmaceuticals, and careful follow-up by the treating physician. Xanax (alprazolam) is currently one of the preferred medications for dealing with many anxiety-related psychological illnesses. Anxiety should not be ignored, as the effects of nervous tension and fear include a decrease in quality of life, along with possible secondary effects such as high blood pressure.

Researchers in the Netherlands recently tested a model for understanding the nature of anxiety in humans. At the same time, the experiment highlighted the effectiveness of certain medications at reducing some aspects of anxiety. Specifically, these researchers used the startling effects of white noise and electric shocks to induce surprise or fear in the subjects. In addition to Xanax, subjects were given Lyrica (pregabalin), diphenhydramine (a common sedative ingredient in over-the-counter cold remedies), or placebo. Individual anxiety levels were measured through subjective reporting and a number of objective tests, including eye movements, pupil dilation, and skin conductance. The design of the experiment included random shocks and noises, both with and without prior warning.

As expected, shocking events preceded by a warning produced less anxiety than those that came by surprise. Both Xanax and diphenhydramine reduced overall levels of anxiety but for very different reasons. Whereas Xanax works by altering certain neurotransmitter levels, diphenhydramine has a more general, systemic effect. Surprisingly, subjects given Lyrica showed very little modulation of their anxiety levels. Researchers surmised that because Lyrica takes longer (up to 6 hours) to reach peak effectiveness, the experiment wasn’t capturing an accurate picture of events.

This experiment confirmed that Xanax is effective at reducing one manifestation of anxiety: the so-called “fear-potentiated startle response.” However, the results were less informative about anxiety in general than the researchers had hoped. The sample size was too small to uncover any new revelations about the nature of human anxiety. Ideally, research will one day make the work of quickly and accurately diagnosing anxiety disorders much easier and more straightforward.

References
Baas, J., Mol, N., Kenemans, J. L., Prinssen, E. P., Niklson, I., Xia-Chen, C., et al. (2009). Validating a human model for anxiety using startle potentiated by cue and context: the effects of alprazolam, pregabalin and diphenhydramine. Psychopharmacology, 205, 73-84.

Since my last blog, Depression Medications: How Can You Get Your Libido Back? a number of you have asked for more information about possible sexual side effects caused by antidepressants. Before I say more—a cautionary word—I’m a psychotherapist/counselor, not a medical doctor/psychiatrist. So what I write in this blog is drawn from my (extensive) experience working with people who have challenges and/or difficulties with sex—I’m a sexologist, not a psychopharmacologist!

Some of the worst culprits, or libido smashers, are the selective serotonin reuptake inhibitors (SSRIs) such as Effexor, Paxil, Prozac, and Zoloft. Unfortunately, these are all heavily prescribed. I mentioned last month that many folks can benefit from a so-called “drug holiday,” when they forgo their medication for a few days. Be aware that this intervention does not work for Prozac. This is due to the much longer period of time that Prozac remains in the bloodstream, compared to the other shorter-acting SSRIs, like Zoloft.

Several types of antidepressants have virtually no side effects. The most common ones that I hear about are Wellbutrin, Xanax, and Klonopin. I’ll often suggest, to the new people I see, substituting (with the agreement of their medical doctor, of course) Xanax or Klonopin for Wellbutrin because the latter can exacerbate anxiety or “agitated depression,” as it’s called by psychiatrists.

Wellbutrin is also infamous for causing insomnia and headaches, which tend to make most of us anxious, and it certainly doesn’t contribute to an enjoyable sexual connection! Wellbutrin is pharmacologically distinct from the SSRIs, as it enhances the neurotransmitter dopamine, which has the opposite effect on libido and orgasm of serotonin. Xanax and Klonopin are usually prescribed to combat anxiety, not serotonin, so they tend to have very few sexual side effects.

I will often recommend that people who are leery about psychotropics try St. John’s Wort, which is most effective, I’ve found, for Type A blood types (remember, I’m not prescribing, just using anecdotal experience to make these suggestions!). Because it’s not regulated as a pharmaceutical substance, I’m told that efficacy can vary widely.

[fat_widget_left] The individuals I see in my office have reported that Viagra is effective for SSRI-induced absence of orgasm, and I’ve known people of both genders who swear by the botanical preparation ginkgo biloba to reverse libido, arousal, and/or orgasm problems. One sex therapist colleague tells me that Viagra can be helpful for women as well, but no one I work with has directly reported this to me.

If switching to an alternative psychotropic is not clinically appropriate or effective, some doctors might recommend adding another medication on a daily or as-needed basis. Many people are hesitant about taking one drug, let alone two! But for those who are comfortable with it, a second medication can often offer an antidote to the side effects of an otherwise helpful medication.

Most commonly, a sexual-savvy psychiatrist will prescribe a single low dose of Wellbutrin for people complaining of sexual side effects from other antidepressants—employing lower does of Wellbutrin than would be necessary to treat depression alone. These small doses can restore the serotonin-dopamine balance that I mentioned earlier, alleviating sexual side effects.

People starting out with me often ask if I suspect that their sexual problems are relationship issues or caused by medication. I always ask them how long the sexual challenges have been occurring. SSRI-induced sexual dysfunction follows a fairly typical pattern: it begins within days or weeks of starting the new psychotropic medication. For example, a woman may report that she can no longer reach orgasm with her husband within weeks of beginning Prozac for obsessive compulsive disorder.

Women rarely volunteer this immediately, but I ask LOTS of questions, which makes it easier to discuss sexual concerns. Men usually have less hesitation talking about such problems, and as one man said to me recently, “that’s why we came to a sex therapist and not the marriage therapist down the street!” The fact that I coach by phone also seems to help, especially for men, who might have difficulty opening up “when the plumbing doesn’t work!”

Don’t forget—if you have questions about your medications, make sure to discuss them with your medical doctor or psychiatrist.