Effective substitute for Valium?

October 27, 2014 1:32 AM

Long shot but here goes. I have an anxiety disorder and use valium as an occasional circuit breaker, essentially to have the odd night off when other coping mechanisms stop working. It works very well and is part of an agreed upon management plan with my GP and a psychiatrist, both of whom are happy with my level of use of the drug. Recent research is making me concerned about the long term effects of occasional use of the drug, however, and I would like to potentially find an alternative.

I am aware that the research linked above studied more elderly patients (I am 35) and may not be 100% relevant, but the trend of results in current research is not reassuring. Professional opinions on that article and the general state of research in this area are also welcome here.

There's a bunch of other info that may be relevant.
*I take valium once every two weeks or so, sometimes longer, rarely shorter, between doses.
*I tolerate SSRIs and other forms of baseline medication extremely poorly, with side-effects making halfway normal functioning impossible. Mostly brain fog, extreme fatigue (sleeping about 14 hours a day) and dissociation. They don't seem to help with depression or anxiety either.
*Because of the point above I am not on any baseline medication for anxiety at this point.
*I have severe, though often short, depressive episodes. My psychiatrist has left a strong question mark next to bipolar II and I tend to think she may be right. (Actually she would have put me in that category but I don't fit in the DSM criteria properly)
*If I go back to the psych the next medication on offer is Lamotrigine

All options are on the table for treatment in the longer term, but most of the time my current methods of working around things work ok. I've had extensive therapy (CBT and talk), much of which has been helpful and I may look at that again in the future. I suspect mindfulness would help, but that's been a bumpy road. That's all longer term. In the short term valium is extremely helpful and I need it, or a substitute.

Does anyone know of one that has the same short, sharp circuit breaking effect and then gets out of your life but is not another benzo?

posted by anonymous to Health & Fitness (17 answers total)

I don't know of pharmaceutical options, here are some others that could work alongside any talking therapy or medication.
Emotional Freedom Therapy (or EFT or tapping) is a way of releasing emotion, essentially by tricking the mind to go down another pathway. The Sedona method is another method. One I use is lifting emotions with a breathing technique: say to yourself "the feeling of [anxiety/fear/anger/whatever] is lifting completely " as you breathe in slowly for 15 seconds or more. Space out the words so that 'completely ' is at the end of the 15 seconds. Breathe out for 15 seconds, no words. Repeat x6. You need to accurately name the emotion for it to work. Repeat one more set of 6.
Have you explored any alternative therapies? Particularly a holistic therapist who uses massage as part of their work. Emotions can get stored in the body. Again I've found this helpful. I wish you well.
posted by rbrum at 2:45 AM on October 27, 2014 [2 favorites]

According to the BMJ research piece you linked to above, a higher incidence of dementia is associated with an increase in the half life of the benzodiazepine in question. (roughly: how long the benzo hangs out in your system). Valium is one of the longer half-lived benzos according to this chart. Also according to the chart, if you take the advice of the first comment here and switch to Xanax (another benzo) you would be reducing half-life by two-thirds or so.
posted by telstar at 2:58 AM on October 27, 2014 [2 favorites]

The heavier hitting members of the atypical antipsychotic class are sometimes prescribed on a PRN (as-needed) basis for anxiety. I'm personally aware of seroquel and risperdal being prescribed in this manner. There is some discussion of individual experiences with this on the crazymeds discussion forums and elsewhere.
posted by drlith at 3:00 AM on October 27, 2014

Oops. Didn't notice the first comment had been deleted. Actually turned out to be helpful!
posted by telstar at 3:10 AM on October 27, 2014

They won't be nearly as effective as benzos, but you can give a try to herbal supplements: I've tried both bacopa and kava kava and they do reduce anxiety a bit -- honestly they were more effective than I originally expected. Both are available as pills from places like VitaminShoppe.

There are others too, like valerian, passion flower, and L-theanine which I haven't tried but might be worth a shot.

I'm not suggesting herbal supplements are safer -- just another option for something you can try if you don't want benzos.
posted by duoshao at 3:13 AM on October 27, 2014 [3 favorites]

Mod note: Just to avoid further confusion, one comment suggesting Xanax was deleted as OP is asking specifically for non-benzo alternatives.
posted by taz (staff) at 3:29 AM on October 27, 2014 [1 favorite]

I can't help with the short-term anxiety issue directly, but I also have problems tolerating SSRIs, and my PsyD finally gave up trying me in different ones. He put me on an array of supplements (NAC, Theanine, B complexes, etc), but the one that finally worked for me was a heavy dose of omega 3s and vitamin D. (Specifically, Nordic Naturals brand of O3s.) It takes effect within a few days, and has mostly eliminated the need for short-term anti-anxiety drugs like Xanax.
posted by instamatic at 3:37 AM on October 27, 2014 [1 favorite]

Have you tried Mirtazapine? It's not an SSRI, the sleepiness side-effect seems to dissipate at higher doses, and you'll see most of the benefit after two weeks. On the herbal front there's St John's Wort, too.

But it sounds like you're using the valium as a reset button, like someone else might use weed or alcohol. I don't know how useful this will be to your circumstances, but you've heard the old saw "a change is as good as a rest"? Getting into a completely different environment for a while can be a pretty decent reset button. Long-walks-in-the-country-type-stuff. Even if you can't do it every time, its another weapon in your arsenal.
posted by Leon at 3:43 AM on October 27, 2014 [1 favorite]

Inderal--which is a beta blocker--is my usual first-line, with Ativan as my backup, and there's a lot of times that I need something that the Inderal turns out to be plenty. I have no idea how it might intersect with bipolar, but it's pretty tame stuff, it doesn't really fix your head but it does calm down the physiological anxiety response to give you some space to get your brain under control, and it's very helpful for that.

If what you want is a night here and there where you can just chill, that much might depend on how you respond to other substances. If you're at all inclined to addictive or excessive behavior with regards to alcohol, it's a bad choice, but if you're not, I put a lot of effort into things like cocktails as a part of a general relaxation ritual. Usually it involves a drink and a bubble bath and an audiobook or podcast on speaker. Part of my personal rule is that because I am a bit nervous about going too far, I never drink anything intoxicating that I wouldn't drink just for the taste even if it wasn't. Developing good self-care habits is really, really important, and I dunno about you, but I came out of a family that was extremely frugal Yankees on one side, and extremely frugal Mexicans on the other; learning to do things just because they feel good has been kind of a long road and has helped my mental health a lot.

I'd never willingly give up having the Ativan around as a backup, but it's really down to just being a backup. I do think it's very possible to read too much into this, but dementia runs in my family, so I'm being careful about it, too.
posted by Sequence at 4:39 AM on October 27, 2014 [3 favorites]

Benzodiazepines cause me to have suicidal thoughts, which I never have otherwise, so they are a no go for me. My doctor and I talked and he told me that a half a glass of wine would be fine for me instead. He was right. I don't have any alcohol or drug issues though, and I'm not at risk of developing any. My other go-to is exercise. If I can walk a half a mile around my neighborhood, then it calms me. And, I know it isn't a popular thought but, prayer really does it for me.
posted by myselfasme at 4:45 AM on October 27, 2014 [2 favorites]

In my limited experience, not being your doctor and and not being a doctor at all, people who take Ativan chronically take a lot more than you are taking. Some people are on multiple daily doses. I have no idea if you can extrapolate this study to the very small amount you are taking (if you are taking it every two weeks or less). That seems to be a really, really small amount.

The study as far as I can read it is saying that older people who take benzos are more likely to get alzheimers but it is not pointing to benzos as necessarily being the cause. There is no causation implied. It also points to the idea that people who have the need to take benzos may have inherent increased risk of alzheimers.

It sounds like you are being really responsible about it and taking a very small amount.
posted by sully75 at 4:53 AM on October 27, 2014

To sully75s response: unfortunately, the research in question applies to cumulative use of benzos over years and the effect was seen even for amounts significantly lower than what the OP takes.
posted by treehorn+bunny at 5:26 AM on October 27, 2014 [2 favorites]

To be clear, if you did not read the linked article, the increased risk of Alzheimer's is seen in patients who have taken more than 90 total doses of benzos cumulatively. Assuming it is taken 2x monthly you'd hit this in about 3.5 years, it is unclear how long the OP has taken the drug, but, this is potential bad news for all long term benzo users.
posted by treehorn+bunny at 5:35 AM on October 27, 2014 [1 favorite]

I take a similar amount of Valium- about 4 low dose tablets a month.... As a alternative I sometimes take phenergan which is a sedating antihistamine that knocks me out... Sometimes my anxiety will get out of control and I know that I just need to go to bed and wait for my brain to reset.
posted by catspajammies at 7:19 AM on October 27, 2014

Here's my read of the study. They adjusted results for depression, anxiety, insomnia but they did not adjust results for bipolar disorder. Those with bipolar disorder have an increased risk of dementia. It is not clear to me, reading this study, whether use of benzos increase the risk of dementia for this population. If your diagnosis is bipolar this may or may not be reassuring - the ship for dementia risk has already sailed.

If all you want to do is get knocked unconscious as your reset switch, try trazodone. You will have a hangover the next day but it goes away. You could also look at beta blockers for anxiety, I have heard of propranolol rx'ed for this. Atypical anti-psychotics can also be used for this task, but for your level of use it might be treating a fly with a sledgehammer.
posted by crazycanuck at 1:47 PM on October 27, 2014

They also seem to have been exclusively looking at people who indeed had been taking the drug over time, but "over time" when they were already elderly; the text really doesn't sound like they were making some real attempt to look for people who'd been taking benzos their whole lives. But I don't think it's unreasonable to want to be cautious, and it's especially not unreasonable to want to develop coping methods that aren't potentially-addictive drugs.

catspajammies reminded me that while Phenergan (promethazine) is not OTC, there are related things that are--you might try Benadryl or Dramamine if you're okay with sleepiness.
posted by Sequence at 9:10 PM on October 27, 2014

If you're willing to try alt.med approaches, I found some pretty interesting stuff in this thread.

It lists 29 different supplements, herbs, and medications that the author claims have helped him to eliminate entirely a severe anxiety problem. He says that the three most effective are n-acetyl-glucosamine, flaxseed oil, and turmeric. What I have isn't (as far as anyone can tell) primarily an anxiety disorder, but I am tense and restless constantly and I get a lot of headaches. For this set of symptoms, I've tried just about everything under the sun: Valium, Xanax, anti-depressants, Kava Kava, magnesium, Flexeril, Baclofen, St. John's Wort, Taurine, GABA, hydrocodone, oxycodone, piracetam, and probably three dozen others. When I had surgery a few years ago, they gave me midazolam before and morphine after. I mean, I've tried everything and the best I've ever managed was to make a temporary dent. So I tried the n-acetyl- glucosamine and, honestly, nothing has ever relaxed me so much. It's pretty amazing. The effects, unfortunately, wear off very quickly. And I find that it screws with my appetite something fierce, probably because it's a sugar and I can't tolerate anything even a tiny bit sweet. But I have enormous faith in the ability of this stuff to turn down the dial on the central nervous system.
posted by Clay201 at 12:50 AM on October 29, 2014 [1 favorite]