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spidercat • today at 2:49 AM • 1 reply • view on HN

Benzodiazepines are really gnarly stuff. Like alcohol, withdrawal from a benzodiazepine can be fatal. IIRC, some post-acute withdrawal symptoms can last indefinitely for some people. Benzos have their utility but they can be really, really awful stuff to become dependent upon.

I've had anxiety issues my entire life, and I feel exceedingly grateful that I haven't fallen into the benzo trap. I've had prescriptions for them, but I always found them too impairing for anything other than very sporadic use (like on airplanes, back when I had anxiety around flying).

I actually find beta blockers, taken as-needed, to be infinitely more beneficial when it comes to managing anxiety. There's some really interesting research on propranolol specifically and how it disrupts memory reconsolidation - which (deceptively) sounds like a bad thing, but it actually has beneficial implications on fear extinction and trauma responses.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8201901/

https://pmc.ncbi.nlm.nih.gov/articles/PMC8979654/

Just to drop a couple links. There's a good amount of research out there.

I successfully eliminated my fear of flying with beta blockers (this was after xanax made it much worse, which turns out is a documented phenomenon https://pubmed.ncbi.nlm.nih.gov/9299803/). I like that, at least for more specific fears/anxieties, propranolol's fear-extinction mechanism means that you often need the drug less and less the more often you take it for that purpose. I haven't flown medicated in many years; my "amygdala is rewired" in that area and it seems it's more or less permanent.

I take beta blockers maybe a few times per year, on average, but I always keep my prescription up to date.

I'm something of a beta blocker evangelist (if it wasn't obvious), but I think they're deeply underappreciated when it comes to treating anxiety. I think a lot of people get spooked when they see that it's "heart medication", but it's really well-tolerated medicine for most people.


Replies

bbarn • today at 4:12 AM

Funny, I tried beta blockers before xanax for flying. They didn't seem to do anything, and the xanax I take a dozen times a year works wonders. Everyone's different.

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