1.1 Characteristics of Benzodiazepines

1.1.1

Benzodiazepines can be very effective for treating a number of acute anxiety conditions, especially where the patient has been exposed to sudden or serious trauma. However, Benzodiazepines soon lose their effect and for this reason it is recommended that they are not prescribed for any longer than about 2~4 weeks.

1.1.2

Also, they do not mix well with other drugs, and they should not be used in multiple combinations with each other, and subsequently, it is recommended that no more than one kind is prescribed at a time, otherwise, there is an increased possibility of side-effects and dependency forming.

1.1.3

As Benzodiazepines are very effective for short term treatment, patients will likely experience an initial settling of symptoms soon after the treatment begins. However, if the treatment is prolonged, it is likely that the patient’s body will neuro-adapt i.e. develop tolerance. When this happens the drugs lose their therapeutic effect and patients may notice a return in some of their symptoms that were initially suppressed.

1.1.4

The symptoms can often be contained by increasing the dosage amounts; however, this usually escalates the state of tolerance and increases the likelihood of withdrawal symptoms occurring and is best avoided.

1.1.5

In cases where the treatment continues long term (anymore than a few months), the patient becomes more tolerant of the drugs and dependency can be formed. This can result in withdrawal symptoms occurring during the course of treatment, as well as when the patient begins to reduce. Some patients can experience a Protracted Withdrawal Syndrome, which can last for over a year.

1.2 Diagnosing Benzodiazepine Dependence

1.2.1

When diagnosing Benzodiazepine dependence, it is common practice to use the DSM-IV-TR, which is the standard used by the American Psychiatric Association. As noted in the DSM-IV-TR, drug dependence is a maladaptive pattern of drug use leading to clinically significant impairment or distress, which is manifested by 3 or more of the 7 Criteria occurring at any time in the same 12 month period.

1.2.2

When applying these criteria, it is not a simple case of looking at each of them individually. Rather, they should be looked at in a way that considers their relationship to one another within context of the overall clinical picture.

1.2.3

Also, when doing a symptom’s analysis, it is not a simple case of saying that the original symptoms must have been due to anxiety and that the new symptoms must have been due to dependence. It is not that simple and clear cut. Quite often symptoms of withdrawal consist of original symptoms changing in nature, frequency and intensity; e.g. worsening of symptoms. Further, Benzodiazepine dependence often mimics the very same symptoms the drugs are intended to treat.

1.2.4

Subsequently, it must be made clear that a dependence diagnosis cannot be made on a symptoms analysis alone, although, certain symptoms patterns do act as useful indicators for specific conditions such as tolerance and withdrawal. Rather, symptoms should be considered within context of the overall clinical picture.

1.3 Prescription Duration / Dosages & Patient Files

1.3.1

The content of Dr. X’s patient file clearly shows that he prescribed Wayne a mixture of 5 different drugs, including 3 different Benzodiazepines and a Tricyclic antidepressant, which continued for almost a 7 month period without any change in dosage. This regime was then prolonged with new prescriptions of Benzodiazepines, which included 2 different kinds, after Wayne sought alternative treatment at the O Medical Center in January 2001.

1.3.2

Subsequently, before we even begin to consider the content of Wayne’s patient files, his symptoms, the overall clinical picture and the application of the DSM-IV-TR, we can already determine that there was at least a 50~100% chance that he was dependent simply based on the duration and dosages of his prescriptions alone.

NB: The reason for the wide range in possibility of dependence is because individuality needs to be considered.