Curbside consults



Question:

What are your thoughts on the common combination of amphetamines and benzodiazepines? This is so very common and even worse in patients with substance abuse. 

The PL answer:

This common combination makes sense, in a rather absurd way. Amphetamines cause anxiety, which is then treated with benzodiazepines. Another relevant reason for the combination is that anxiety states, as discussed above, often cause  impaired concentration.  Such patients then get mistakenly diagnosed with adult ADD, and treated with amphetamines, which worsen the underlying anxiety that caused the inattention to begin with, hence the addition of benzodiazepines.  In short, the effect is mistaken for the cause, and inattention is treated with amphetamines which worsen the causal anxiety, leading to further treatment with benzodiazepines.  

Both classes of agents are addictive potentially, but at least in animal models, amphetamines appear to produce more addictive behavior than benzodiazepines. Certainly the former have more evidence of neurotoxicity harm, as reviewed in last month’s PL issue, than the latter.

Thus, the PL perspective is that if a patient has an anxiety condition...

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