To think the doctor shouldn't refuse me my medication?

[lisaboob]

Hi,I've been a long time sufferer of anxiety for over 10 years.
A lot better now but still really anxious before a big event or a event that's out of my comfort zone.
My doctor prescribed me diazepam 2 years ago (28 tablets ) and they've just ran out.
Went to GP today and said no ..and offered me anti depressants.
I refused and left with nothing.
I use half a tablet before a big event etc hence why they lasted 2 years
Now I have things coming up this year and I'm going to have to cancel now.
Aibu to think this isn't ok?

@Yousicktwistedfruit I'm not surprised as I know diazepam can cause more seizures

YABU. Your regular use suggests a degree of dependence on the drug and your insistence on the inadequacy of any alternative underlines this.

There are lots of alternatives, many of which have been listed above.

Antidepressants are not addictive. The majority are not difficult to come off (although some are).

If you suffer from generalised anxiety then an antidepressant combined with therapy (and/or self help) would benefit you. If you have a flying phobia then specialised therapy for that would help.

You need to stop insisting on diazepam and make an effort to help yourself.

Your regular use suggests a degree of dependence on the drug and your insistence on the inadequacy of any alternative underlines this
What nonsense! I take paracetamol every time I get a headache and I will get into my car at 10pm to go and get some at the supermarket if I've run out. I must be dependent on paracetamol since I automatically take the two pills rather than doing meditation!

Dependency is, not taking a pill when you need it fir something specific. It's dependency when you take it at any specific time because if you don't take it, you suffer withdrawal effect that are bad enough to mean you'll do anything to have it.

You're describing a physical dependence, not a psychological one. If you get anxious or distressed without something to the extent that it's negatively impacting your life then that would be classed as a dependence, regardless of whether or not you have a physical need for it.

Not all dependences are worrying though. You could say a small child who won't sleep without their favourite toy is dependent on it for comfort. That wouldn't concern anyone. But stressing because you can't have a particular drug? That's a whole different level of psychological dependence.

Anxiety begets anxiety. The OP is now anxious that she can't access her way of reducing anxiety. Which will increase anxiety and increase the need for her chosen solution.

If she learns techniques to control her anxiety she will never be without her solution. Just knowing that helps to reduce anxiety in the first place.

@lisaboob it’s used to stop fits and it only may cause more fits but it never did with my dad he only took them when he got warnings so that he could sleep otherwise he would’ve had a fit diazepam is given to people with epilepsy to be used along side the epilepsy tablets and it can be used in gel form up the rectum to stop fits. Don’t really think his epilepsy doctor would’ve prescribed it if he thought it would cause more fits.

Hi again op, as I mentioned upthread I've been taking diazepam for 5 years.

I was due more on Monday but have been really unwell so didn't put my prescription in for the first time ever. I had a couple left over which I took on Monday and have had none since.
I take 2x2mg every day. Have done for over 3 years. Before that I was on 2x5mg every day.

I feel ok. Honestly I do. It's shocked me actually as I don't feel any different. I think that doing the same with my propranolol would be horrific. They really work on the physical symptoms of anxiety.

Please take a look at mindfulness/mediation or hypnosis for anxiety issues on YouTube. There are literally thousands of them.
I can recommend Michael Sealey, he is great and I do believe that I can stop these now. They've had a hold on me for 5 years and unintentionally I've stopped and am ok.

Just to add that I'm taking Venlafaxine ( an anti d ) for my anxiety after 2 shitty years on Prozac ( fluoxetine ) and the difference is amazing.
Not all anti d's are just for depression.

Hi OP. I agree with your GP. It seems to me that you’ve developed a psychological need to have them. I don’t doubt that they did actually help you but I think you are comforted by having them as a safety net and now you’ve had that pulled out from under you and you’re worried. I can see that you’ve already said that you’re going to have to cancel upcoming events. That seems incredibly defeatist and indicates to me that perhaps some therapy on how to cope with nerves and anxiety would benefit you. I think if you had an open mind and explored other options (look at your overall lifestyle - diet, exercise, sleep and screen time) there are SO many ways to manage anxiety. Look at meditation and mindfulness. Don’t be fooled into thinking you actually need this medication. If you’re open to trial and error, you could literally transform your life. You just need to believe you can take control of this.

My suggestions above were incredibly simplistic but could make good starting points.

For gods sake what a lot of silly nonsense. OP is not an addict and it's ridiculous to suggest she could get dementia or other long term effects from taking a small number of diazepam tablets on a low dose infrequently. Some people are more prone to anxiety than others. I am prescribed diazepam for severe dental phobia and so is my dad and its been a lifesaver for both of us. Its so hypocritical, all those saying you shouldn't pop a benzo when a stressful situation comes up, I bet you never have a glass of wine after a bad day? No you should be meditating instead! Ridiculous.

@maxnormal withdrawal symptoms from a medication are not the same as addiction. For a start, if you're withdrawing from medication you don't think "I NEED some anti-depressants to feel good again, I must have them NOW!" (having gone cold turkey and also having reduced anti depressants creating temporary withdrawal symptoms, I know that for a fact)

Withdrawal side effects happen with all sorts of medication, not just anti-depressants.

An addiction is a craving for a substance. Anti-depressants are not the kind of medication that causes you to crave them, because they don't have that kind of immediate effect that causes a craving. They don't get you high. They have to build up in your blood stream to affect the hormones they are trying to correct, which is why it takes time for them to leave your body and means there are withdrawal symptoms associated with the half life of the medication as your brain's chemical balance changes.

I know how the op feels. I have been prescribed diazepam for flying for about ten years now, and was always issued with the 28 x 2mg packs, meaning there was some flexibility about how many to take (never exceeding what my doctor had advised) and I didn’t have to keep asking for a prescription since I fly several times a year.

Last time I asked, I was prescribed the exact number of tablets the doctor would permit for the flight, and that was itself far lower than I’ve been advised to take in the past. I have been allowed to take up to six 2mg tablets in a 24 hour period (never actually taken so many though). This time around I got a total of four 2mg tablets for a return long haul flight - one tablet every six hours. There really was no point!

I’m trying to be positive and take it as an opportunity to work on some techniques, but I have to say the flights were really quite awful! I don’t think I’m an addict, just very disappointed that something that worked very well for me is no longer an option. I take propranolol for anxiety too, and find it good for situations where my heart is racing for long periods of time, but it doesn’t do much for intense panic, which is where Valium really helps. I have the same concerns as the op about SSRIs. I find the six-month commitment really daunting and prefer something I can take as I need.

Let’s hope something else comes along that GPS feel more comfortable prescribing.

I had tried Propranolol and Sertraline for my anxiety and I didn't get on well with either of them so I completely understand that OP. The only thing that worked for me was CBT however it doesn't work for everyone, it did take a good year of me trying it though.

There's obviously a reason why your doctor wouldn't give you a prescription and there have been quite a few comments on this thread which explains why.

Long term, you probably really need to find a different way to get control of your anxiety.

YANBU

Two GPs refused to prescribe any diazepam for me in the throes of horrendous post natal anxiety after my last child, despite being asked by my community midwife, and despite it being a tried and tested safety net previously (in the danger period waiting for sertraline to take effect). They had previously been a huge psychological crutch, taken only a couple of times, and not being prescribed them caused my anxiety to spike further (anyone who has experienced acute anxiety will understand). It was an utterly baffling decision, I recall leaving the surgery with my 8 day old in the sling, having been told no for the second time wondering how the fuck it was acceptable in this day to leave a new mother to suffer. Awful.

I hope you seek a second opinion from someone with more than a BNF and a prescription pad.

Benzos used responsibly absolutely can and are used without abuse - I fly several times a year and am prescribed 6 tablets each trip - 3 outbound, 3 inbound. Unfortunately they ARE extremely addictive and sold on the streets, open abuse. However, any 'good' GP will know their patient's history and whether it's genuine or not.

I wouldn't be able to board the flight otherwise (however weak and pathetic that could mean to some) and having a partner who lives in a different country would mean I'd never see him, no matter how much I wanted to. I know it's an irrational fear, but try telling yourself that when you're absolutely petrified to the point of vomiting and frankly making a fool of yourself in public - so grateful I have an understanding GP, not someone fresh out of med school who takes anything in NICE (guidelines) as law.

Just thinking about this a bit more and posts re: the apparent placebo affect on such a low dose.

Apart from the obvious in that different people react to different drugs - surely if it's even a placebo affect than if the patient is able to face their fears it's a positive rather than costing the NHS way more in a monthly script for anti-d's, propanolol etc

For me, I don't care a jot if it's psychological and a placebo - it' gives me security that I can board that plane and not make a fool of myself with other methods I've hoped would work (hypnotherapy, mediation etc - the hypnotherapy especially spectacularly failed - having to be carried down the stairs to the flight by a mortified flight attendant was not something I, or rather he, would ever want to go through again

I am a doctor in a mental health setting. I am just stating things plainly here. I do not prescribe Diazepam ever. In one year in the community setting I saw it prescribed once in the context of managing withdrawal from alcohol. You have incorrectly stated they cause seizures-they treat seizures by reducing brain excitability, and hence are used in alcohol withdrawal settings.

It is not used as a treatment for anxiety any longer-it is effectively a sedative and not a productive treatment, as well as ( as per what others have documented) causing addiction and tolerance problems. When patients are very agitated or aggressive in the inpatient setting Lorazepam is used as a sedative as it is more short-acting. For anxiety in the inpatient psychiatric ward setting we would prescribe promethazine which is a drowsy antihistamine-you could ask your GP about this as an option.

The only patients I know taking Diazepam have been taking it for years and hence it is extremely difficult to withdraw them, or they have such a severe anxiety/panic disorder +/- PTSD that it has been prescribed short term to facilitate psychological therapies.

If you have anxiety as you state which is above and beyond what would be considered a normal response to a stressful life event then you have an anxiety disorder and treatment is indicated. That means as the GP correctly stated, an anti-depressant. There are various antidepressants with anxiolytic effects. I know you have tried sertraline with poor side effects; you could try a different SSRI drug or there are different classes of drugs. There are venlafaxine & duloxetine which work slightly differently. Pregabalin, which is licensed for pain, is a very effective anxiolytic;it is far less addictive though it still has some street value.

The guidelines do indeed recommend CBT; I know you said you tried this however did you do the homework and are you regularly practicing the techniques? It requires motivation, engagement and to be honest a bit of work, as it is 're-training' your brain. Talking alone won't do it. If you have really tried and found it ineffective then you can ask to be referred for a more intense psychological therapy.

Although there is an element of discretion for GP's their prescribing practices are audited and their arses would be handed to them on a plate if they prescribed in the way you describe. It is far less dangerous for you to have a four week course than use as and when. It introduces so many variables of risk- you state upthread that you took two tablets in one morning which is a double dose. The half life of Diazepam is very long, it stays in your system for days, so when you took 3 in under 24 hours you effectively triple dosed.

I really must hasten to add; don't buy it off the street. Even for personal use this can earn a maximum sentence of two years in prison. I have seen a teenage girl put into a coma by taking what she thought was Diazepam-god knows what it was cut with but thankfully she did make a full recovery.

Just to add although I'll probably be flamed; there is a reason this kind of prescribing stopped. There used to be a benefit of the doubt approach, with people saying 'I won't get addicted' or 'it's only for x and y reason'. Then a good proportion of those people got addicted, and a small but significant minority died from overdosing/combining with alcohol. If your GP prescribes in this way now they are either very brave, or very trusting and have a solid therapeutic relationship with you.

I don't think the doctor was being unreasonable not to prescribe them, I'm afraid. But I do think that since you have been taking them in this way for a long time and clearly weren't expecting there to be a problem, he needed to do more to explain why he can't prescribe them and what the alternatives are.

I couldn't have a much needed MRI scan because a GP refused me a tiny dose of Diazepam (massive claustrophobia due to previous hospital trauma). I totally respect it was over prescribed but I can't help but feel the very people the drug could help were flung under the bus because doctors over prescribed it lazily to the very last people who needed it.

@itwaseverthus

This seems like a strange scenario to me; radiology departments can use sedation for investigations- it would be the department and not the GP though normally. There is space for comments normally when requesting the test and you can say about claustrophobia. Did you get an appointment date?

Two GPs refused to prescribe any diazepam for me in the throes of horrendous post natal anxiety after my last child, despite being asked by my community midwife

It's the easiest thing in the world to give the patient what they want, whether it's benzos or antibiotics: quick consultation, no risk of a patient complaint, no hassle. GPs who refuse to prescribe are knowingly making their own lives harder. They do so because they are trying to follow guidance on best practise. It's an art, not a science, and they won't get it right every time. But it is depressing to see posters describe a GP refusing to prescribe as refusing to help, when it's the exact opposite. They are trying to help by not prescribing a drug that may provide short-term relief, but at the cost of creating long-term problems.

@itwaseverthus

That is an appropriate use of a sedative medication- for a specific purpose, in a hospital/monitored setting. Obviously difficult with limited information and not knowing ins and outs but if not diazepam you should have been able to have a discussion as to what you could have to facilitate the investigation.

@lisaboob yes the amounts you take are safe but you seem to be (in my opinion) dismissing getting to the root cause of your anxiety and tackling it that way. Instead you just want to medicate yourself on the day of the potentially stressful event. Even the fact you are finding numerous situations stressful shows you have a long term issue that is probably best addressed with long term medication. What you won’t get with antidepressants is the feeling of calm and quiet buzz (do you enjoy that feeling?) but you won’t get anxious at all because your emotions are way more in check.