News that controversial Canadian psychologist Jordan Peterson has been struggling with the negative effects of a common anti-anxiety medication came as no surprise to Dennis Amott. The Vancouver resident has dealt with the same thing.
Similar to Peterson, Amott developed a physical dependency to benzodiazepines soon after he was prescribed them. Instead of getting better on the drugs, he said, his health worsened over time.
“They stopped working, and then all hell began to break loose,” he said.
Earlier this month, Dr. Peterson’s daughter Mikhaila Peterson posted a video on YouTube, stating that the University of Toronto psychology professor was in Russia seeking medical detox from a benzodiazepine, which he took for years as prescribed for anxiety. She said he has been in “unbearable discomfort from the drug.”
His is the latest high-profile case to raise questions about the risks involved in taking benzodiazepines, a class of depressant drugs that includes Valium, Ativan, Klonopin and Xanax. In recent years, actress Lena Dunham has publicly discussed recovering from a dependency to Klonopin, which she took for anxiety and post-traumatic stress disorder, while singer Justin Bieber has opened up about his past misuse of Xanax.
Benzodiazepines, typically prescribed for anxiety, insomnia and seizure disorders, have been used for many decades and are considered a relatively safe replacement for barbiturates, since they have a lower potential for fatal overdoses, said Silvia Alessi-Severini, an associate professor in the College of Pharmacy at the University of Manitoba. But it is well known that individuals can develop a tolerance to the drugs, and that these medications are prone to abuse, she said.
“It’s very hard for patients who have been using them for a relatively long time to get off,” she said, explaining they may experience withdrawal syndrome, which can involve agitation, tremors, cravings, restlessness and movement disorders.
According to Health Canada, short-term effects can include memory loss, drowsiness and loss of coordination, while long-term effects can also include physical dependence, problems learning or concentrating and substance-use disorder.
Because of these potential adverse effects, clinical practice guidelines recommend limiting the use of benzodiazepines for a short period, ranging from two weeks to two months, depending on the diagnosis, Alessi-Severini said. Some psychiatrists suggest longer-term use of these medications can be beneficial for certain patients with anxiety disorders, she added.
Nevertheless, she said, clinicians need to recognize there are risks to using the drugs.
Amott said his doctor prescribed him clonazepam more than 10 years ago, not because he had anxiety or insomnia, but because he experienced mild recurring headaches. The medication seemed to rid him of his headaches for a while, but over time, he developed new, more painful headaches that lasted all day. Since his doctor told him he could safely take clonazepam for the rest of his life, if he wanted to, he stayed on the medication for five years.
Despite slowly and successfully tapering off the drug five years ago, under professional guidance of another doctor, Amott said his health problems are worse than ever. These issues, he said, include a constant headache, memory loss and sensory and motor symptoms, such as muscle aches, tingling throughout his body, heart palpitations, leg cramps and tinnitus. (Many of these symptoms are not included in Health Canada’s list of side effects and risks of benzodiazepines.)
In Jordan Peterson’s case, Mikhaila Peterson said her father experienced a rare “paradoxical reaction,” where he had the opposite reaction to the drug’s intended effect. She said he also developed a movement disorder called akathisia, characterized by restlessness and an incontrollable urge to move – which made him suicidal.
Alessi-Severini said a paradoxical reaction is very rare, occurring in certain individuals who may be more susceptible, such as those who have experienced brain trauma or an underlying neurological condition.
It can be difficult to tease apart whether an individual’s symptoms arise from their withdrawal of the medication, from the condition it was intended to treat or from another underlying or co-morbid disorder, she said. Moreover, individuals can react differently.
“Unfortunately, with almost all drugs, there are rare reactions that some individuals, for some reason, can experience,” she said.
For those who develop a dependency to benzodiazepines, doctors generally reduce the doses slowly over time until they stop using the drug, she said. (One should not stop using the medication suddenly, nor should getting off the drugs be done without professional guidance.)
To put the harms of these drugs into perspective, alcohol far surpasses benzodiazepines in terms of the impact on and costs to society, said Sarah Konefal, research and policy analyst at the Canadian Centre on Substance Use and Addiction.
There is no evidence that the use of prescription sedatives, including benzodiazepines, are on the rise in Canada, Konefal said, explaining the number of prescriptions has, in fact, declined over the past five years.
However, benzodiazepines are involved in an increasing proportion of opioid overdose-related deaths, she said. Since benzodiazepines have the same effects on the brain as other central-nervous-system suppressants, such as alcohol and opioids, use of these other substances while on the drug is not recommended, she said.