Thursday 5/9/16 APNA CPI preconference discussion on benzo pitfalls: notes from the lecture

Benzo discussion Dr. Limandri:

My impression: great info, so much material to cover though so she mostly skimmed the surface. Lots of the info seemed to come from her own experience. Some material came from the UK — Ashton Manual which I refer to often and it’s full of good info.

Below are my mostly unedited notes from this session along with some lyrics from a famous Rolling Stones song relevant to subject.

  1. Women use this class of med more than men. 25-50 yr age range is highest; multitasking requirements for women in that age bracket; middle aged, white, wealthier higher utilizers of benzos. The Rolling Stones wrote a famous song about women using Valium, “Mother’s Little Helper” in the 1960s — here are the lyrics:

What a drag it is getting old
“Kids are different today, ”
I hear ev’ry 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 a mother’s little helper
And it helps her on her way, gets her through her busy day

“Things are different today, ”
I hear ev’ry mother say
Cooking fresh food for a husband’s just a drag
So she buys an instant cake and she burns her frozen steak
And goes running for the shelter of a 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 ev’ry 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 ev’ry mother say
The pusuit 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

Notes con’t:

2. More deaths for those who were regular daily users v the infrequent.

3. 3 weeks is the longest time they should be prescribed, per the speaker. Most long term users stay at same dosages, but they have rebound anxiety and end up raising the dose over time. When your patient c/o anxiety while on a benzo — and you choose to up the dose — you’ve done opposite of what you were supposed to do.

4. Primary care providers are the bigger offenders, that is, prescribe benzos the most, possibly because they feel pressured to solve all the problems of their patients.

5. Studies are reporting on stats by psychiatrists and not NPs. Add the NPs and the stats would be different.  For many providers it’s much quicker to write the script than it is to  do MI or other counseling in an effort to back off the dose or taper off. There are providers out there that will write for benzos with no intent to stop because it’s lucrative work, sad to say.

6. GAD has so many somatic c/o so they end up in primary care and while there they end of getting a rx for benzo.

7. Best anxiolytics are SSRIs. Take a bz to bridge until they kick in, for 2-3 weeks, and then stop without taper.

8. DSM5: MDD with anxious distress… emphasize the last part and that it’s linked to the first, as say of encouraging someone to try and SSRI.

9. Why do many people with trauma dislike taking bzd? They feel a loss of control when on them, less reactive, less fight/flight.

10. Dementia and increased falls.

11. It’s expensive to treat all the collateral damage, eg, falls, car accidents, etc.

12. 2.5 x higher rate of suicide attempts: from a big study in Taiwan she mentioned (I don’t have the reference).

13. Anterograde amnesia (use midazolam in your teaching and why it’s used in medical procedures), dissociation, cognitive impairment, paradoxical anxiety that is proven in PET scans. It makes you not care about the anxiety, not care about possible risks. hinders fight/flight — exactly what trauma survivors don’t want.

14. Cognitive impairment makes it hard to learn the skills needed to curb anxiety.


16. CBT to get people off benzos: question why you think it’s helping your anxiety.

Questions from the audience:

State hospitals and volatile patients and common use of bzd’s: increases impulsivity but they’re slower and we can catch them. Use a different gaba med that’s not the benzo receptor: lamictal and gabapentin. both slow the firing and allow staff time to think. State hospitals may want to use benzo cause it’s cheaper.

Alternative anxiolytics: Effexor — more adrenergic at higher doses. 75mg is antidepressant. Fetzima more adrenergic at lower doses so better tolerated. Buspar helpful; others: lamitical and gabapentin. alpha and betas blockers: trauma clients do better on these and feel it right away.

Schizophrenia and benzos: no indication but had been used for akathisia.

Meditation reduces PTSD symptoms in nurses | National Nursing News

Meditation reduces PTSD symptoms in nurses | National Nursing News.

We need as much science to support PTS therapies, especially from our profession.

“Practicing a form of meditation and stretching can help relieve symptoms of post-traumatic stress disorder and normalize stress hormone levels, according to a study of nurses.

More than 7 million adults nationwide are diagnosed with PTSD in a typical year, according to background information for the study, which is scheduled for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism”.

Support “Helios Warriors” In Asheville, NC

helios image

Helios Warriors is an Asheville, NC non-profit  holistic healing practice that’s providing much-needed complimentary and alternative health services to veterans on a sliding fee scale. They provide therapies to ALL veterans, and specialize in treating Post-Traumatic Stress  (PTS), Traumatic Brain Injury (TBI), and military sexual trauma.

Until it can receive outside funding, it’s being operated by an incredible team of volunteers, including the board of directors. Practitioners volunteer their time and skills providing services such as chiropractic, massage, Reiki, health coaching, emotion code therapy, Jin Shin Jyutsu (the “Grandmother of Acupuncture”), and healing touch. They are providing an incredibly needed service to veterans, the Asheville community, and the nation at large.

If you are a holistic health practitioner and would like to donate your time and skills (even just a couple of hours a month), or make a tax-deductible donation (any amount goes a long way), it will help Helios to continue on with their mission of providing this much-needed care for our veterans.

Helios Warriors is a grassroots organization founded in 2007 by Gayle Sovinee and Deborah Nixon-Karistinos of Asheville.

Helios is the Greek word for Sun, which provides warmth, light and life.  A Warrior is a person who shows courage and demonstrates bravery and self-sacrifice for others. Therefore, Helios Warriors provides affordable holistic healing therapies and support to veterans who have served and sacrificed for us all.

251D Haywood Street, Asheville, NC  28801 (between Montford Avenue and Patton Avenue)

Phone number:
(828) 299-0776


For Some Caregivers, the Trauma Lingers –

For Some Caregivers, the Trauma Lingers –

lotus_flower 2

Dr. Judy Stone’s story in this NYT article is just like mine. I became overwhelmed during the 5 years I cared for my mother (diagnosed with Alzheimer’s in 2007). I underestimated my ability to provide professional nursing care for her while simultaneously caring for my own family and myself. My standards of care for the entire medical community have always been high — plus I’m a huge patient advocate. So when our (broken) medical system kept failing her at crucial moments I began to feel powerless, and eventually succumbed to a terrible case of caregiver burnout.

Healthcare providers need to be extra mindful when we take on the role of being caregivers for our own loved ones to ensure we have adequate supports in place for ourselves. That old adage “ignorance is bliss” would have come in handy many times during those 0300 nights she and I sat alone together in the ER.