EXTRACTS FROM
Life Without Tranquillisers
Dr Vernon Coleman, MB, ChB, DSc (Hon)Hardcover: Piatkus 1985
Softcover: Corgi 1986
OUT OF PRINT
Valium, Librium, Mogadon: these are just some of the brand names of drugs in the benzodiazepine group which today pose a horrifying addiction problem for many ordinary people.
Although they are widely prescribed by doctors, these drugs are not only highly addictive but they can cause brain damage, mental confusion and anxiety itself - which is the very symptom for which the drugs are most commonly prescribed.
"Life without Tranquillisers" gives you the harsh facts about the dangers of these 'happy pills' and being hooked on them. There are wise guidelines on how to relax and overcome the stresses of modern life without turning to pills for help.
Most important of all, Dr Coleman clearly explains exactly what action you should take so you can safely cut down on and then stop your drug intake.
INTRODUCTION
Although they have been available for less than a quarter of a century, benzodiazepines such as Valium, Librium and Mogadon have become among the most popular drugs in the world. They are so common that if you empty handbags and pockets at any gathering where there are more than half a dozen people present, you'll probably find at least one bottle of these pills. They are used to help people get to sleep, to help people cope with anxiety, and to deal with hundreds of physical and mental symptoms so varied that a full list would look like the index to a medical textbook.
Drug-addiction experts claim that getting people off the benzodiazepines is more difficult than getting addicts off heroin. And yet doctors in hospitals and in general practice continue to write out prescriptions for these drugs. Ten years ago I forecast that the benzodiazepines would prove to be addictive. Medical libraries around the world are stuffed with papers describing the hazards associated with these drugs. And yet still they are prescribed in enormous quantities.
Statistics for benzodiazepine consumption are staggering. Figures vary from country to country but on average something like one in every ten individuals takes a benzodiazepine. Despite the fact that these drugs are known to work properly only if taken for a very short period of time, there are millions of people around who have been taking one of these drugs for more than a year. There are, indeed, millions who have been taking benzodiazepines for several years. Most of the long-term consumers are women, and most are over the age of forty, but the numbers of people involved are so huge that no category of human being seems exempt. Men, women. children - they all take benzodiazepines.
For several years now pressure-groups have been fighting to help addicted individuals break free from their pharmacological chains. But the fight has been a forlorn one. As fast as one individual breaks free from one of the benzodiazepines another patient somewhere else becomes addicted.
I believe that the main reason for this is that doctors are addicted to prescribing benzodiazepines just as much as patients are hooked on taking them. I don't think that the problem can ever be solved by gentle persuasion or by trying to wean patients off these drugs. I think that the only genuine long-term solution is to be aware of these drugs and to avoid them like the plague. The uses of the benzodiazepines are modest and relatively insignificant. We can do without them. I don't think that the benzodiazepine problem will be solved until patients around the world unite and make it clear that they are not prepared to accept prescriptions for these dangerous products.
In this book I've tried to do several things. First, I've tried to explain precisely why I think the pressure and stresses in our society are so great that many millions of people need help. Second, I've explained in precise detail just why I don't think that the benzodiazepines provide a safe answer. Much of the research information that I've included here has remained hidden in medical journals around the world until now. Third, I've provided very specific information for those individuals already taking benzodiazepines and wanting to stop taking them. Getting off these drugs is not easy. But it can be done. And finally, I've provided a good deal of information on just how I believe that the individuals suffering from stress and anxiety can cope with their fears and problems more effectively and more efficiently.
I hope this book helps to sound the death knell for the benzodiazepines. But I also hope it offers those millions of individuals using benzodiazepines a viable alternative.
Vernon Coleman, London, September 1984
The benzodiazepines - a much-needed solution
Chapter 2 pp38-43
For badly trained, unprepared medical practitioners suddenly facing an epidemic of mental disease, these drugs were an answer to many, if not all of their problems. The manufacturers' claims made it clear that the drugs were not only safe but that they were effective for just about all the problems doctors were likely to have to face. The inevitable result was that doctors greeted the new products with unbridled enthusiasm.
Within a year or two the benzodiazepines were among the most widely prescribed drugs in the world - with both Librium and Valium hitting the top of the best-selling drug charts around the world. For hospital doctors the benzodiazepines were a blessing and a boon. For general practitioners they were a lifeline. With a prescription pad on his desk and a pen in his hand, a general practitioner could become a saviour to his patients.
Right from the start doctors found that their patients were happy to take Valium and similar drugs. The GP who happily prescribed the benzodiazepines without question would quickly become both popular and successful. The GP who was cautious about using the drugs would soon acquire a reputation for being rather difficult or mean. It was fashionable for doctors to prescribe the benzodiazepines. And it was quickly fashionable for patients to take them too.
By the early 1960s the drugs in this general category were being prescribed not only for straightforward anxiety states but also for a whole range of physical disorders, Shapiro and Bacon showed in 1961 that drugs in this group were being widely prescribed for patients with high blood pressure or with heart problems. They also reported that these drugs were being widely used for allergic, metabolic, respiratory, endocrine and nutritional conditions.
In 1962 Bacon and Fisher confirmed that doctors were prescribing these drugs for chest and heart problems but also added the information that they were using them for gastro-intestinal problems too.
As the years went by it became increasingly clear that doctors, particularly doctors in general practice, were using the benzodiazepines to treat the whole range of physical and mental disorders known to be associated with stress, pressure and anxiety. Valium and its relatives had become the single answer to all the mental and physical manifestations of stress.
As their enthusiasm for Valium continued to grow many doctors started prescribing benzodiazepines in other rather inappropriate ways. So, for example, a survey done by Johnson and Clift in Manchester in 1968 showed that over half the patients started on night-time sedation with sleeping drugs were prescribed these pills because they were being kept awake by physical problems. Most of the patients, for example, were unable to sleep because of pain caused by problems such as arthritis, muscle pains and backache. It would, of course, have been far more appropriate to treat the cause of the sleeplessness rather than the insomnia itself.
Similarly it is difficult to understand why doctors used tranquillisers so often in the treatment of obesity, chronic bronchitis and other largely physical disorders.
It seems that the early success they had with Valium convinced many doctors that it was a universal panacea, suitable for all conditions known to man. So, when faced with a difficult diagnosis the doctor would reach for his prescription pad and scrawl the name of his favourite benzodiazepine.
The use of benzodiazepines is now so widespread that it is difficult to be dogmatic about just who is likely to receive a prescription for one of these drugs. It does seem, however, that anyone who visits a doctor with anything other than a single clear-cut request for specific treatment is likely to end up with a benzodiazepine. Visit your doctor with vague mental symptoms, with continuing aches and pains, or with any set of symptoms difficult to diagnose and the prescription you receive is likely to be for a benzodiazepine.
There is evidence too that many doctors (both male and female) exhibit signs of sexual discrimination when prescribing Valium. Over a dozen studies done in Europe, America, Canada and Australia, for example, have confirmed that women are far more likely to receive prescriptions for benzodiazepines than men. In particular it has been shown that women in their late forties, fifties and early sixties are extremely likely to be given pills in this group.
And where separate factors add together, then Valium becomes inevitable. A woman of fifty who goes to her GP with vague symptoms of any kind will almost certainly leave clutching a prescription for a benzodiazepine. Menopausal symptoms, insomnia, boredom, marital problems, aches and pains - the answer is the same.
Why did doctors accept the benzodiazepines so uncritically?
The thousands of doctors who suddenly started to prescribe Valium and so on in huge quantities really knew very little about the drugs they were using. They simply accepted what they were told by the manufacturers.
There were two reasons for this incredible act of prescribing faith.
First, most doctors in practice today have grown up in a world where they are accustomed to getting their prescribing information from drug companies. For all doctors this is indeed the easiest way to keep up to date. A physician who qualified ten or more years ago will be quite out of touch with modern pharmacology, and won't understand a pharmacology journal even if he troubles to pick one up. If he isn't going to show his ignorance by using leeches and herb powders, then he has no option but to accept the easy-to-read brochures and leaflets from the drug-company representatives and to accept the promises, claims and assertions printed on them. Even recently qualified doctors have to learn about new drugs in the same rather questionable way since medical schools treat pharmacology in much the same sort of way that they treat psychiatry - it is a very minor subject.
The second reason why doctors were happy to accept what they were told about the benzodiazepines was that they wanted to believe and needed to believe everything they read and heard. They desperately wanted the benzodiazepines to work. And so they never dreamt of questioning the promises and claims that were made.
As a result of their startling ignorance doctors in general practice commonly make mistakes when prescribing benzodiazepines. The most common errors are the following:
They allow patients to take Valium or some other drug in one of these groups for more than two months. This suggests clinical incompetence for two reasons. First the drug is known to be addictive and should, therefore, be used only for short-term problems. Second, the drug's efficiency drops as the weeks go by and after two months most patients taking a benzodiazepine will need to increase the dose in order to obtain any useful effect. (The increase in dosage may also be needed to disguise the symptoms produced by the drug itself, see page 82.) Third, the drug has no known clinical role in the treatment of long-term problems. It is a palliative and not a curative drug.
They prescribe in the wrong dosage. Because they get used to their chronic patients needing high doses of Valium, GPs will often prescribe those same high doses for new patients. This dangerous practice usually means that the patient suffers unduly from side effects. It also means that when the patient needs to increase his dosage in a month or two's time the daily intake must reach very high levels.
They mix benzodiazepines, often prescribing several drugs in this category for one patient. There isn't much point in this since there is little, if any, difference between the various available products.
They regularly use benzodiazepines for patients who can't get to sleep. Something like six per cent of the population of the United Kingdom take a sleeping tablet every night. In some hospitals the percentage of patients taking sleeping pills is very much higher - where pills are routinely handed out to all new patients the figure may get very close to 100 per cent.
But using sleeping pills as a long-term solution is both pointless and dangerous. It is pointless because there is now evidence to show that most sleeping pills work for no more than fourteen days. After that they lose their effectiveness and the dose needs to be increased for a similar effect to be obtained. And it is dangerous because there is also evidence to show that when a benzodiazepine sleeping pill is taken for a long period it can produce dependence.
What makes this ignorance particularly inexcusable is the fact that the hazards associated with the benzodiazepines have not been hidden but have been available to any doctor prepared to read anything other than drug-company sponsored publications.
So, for example, in a book called Discoveries in Biological Psychiatry, edited by Ayd and Blackwell, and published by Lippincott in 1970, Frank Ayd, then editor of the International Drug Therapy Newsletter wrote:
'Although vast quantities of minor tranquillisers have been prescribed it must be stated that not all have been dispensed judiciously by some practitioners. Such misuse is indicative of physicians who unwisely accede to the demands of patients or who supplant sound clinical judgement for expediency. The disregard of these doctors for the potential abuse of minor tranquillisers and for the welfare of their patients is further manifested by their prescribing large quantities with no restrictions on refills and with no insistence that the patient return at regular intervals for evaluation of the response to or the need for the medication. . . these practices not only warrant condemnation but invite drug abuse. Clearly the abuse of some psychoactive drugs may call for the indictment of the physician and pharmacist rather than the drugs.'
The benzodiazepines and addiction
Ch3 pp56-66
Although the numerous manufacturers producing and selling benzodiazepines make many different claims for their products, these drugs are fundamentally very similar. There really isn't as much difference between the various available products as the drug companies would like us all to believe.
So, for example, although Valium is sold for use as an anti-anxiety drug and Mogadon is sold as a sleeping pill, there is not much basic difference between the two substances. Doctors prescribe Valium for day-time use because they have been told to do just that. And they prescribe Mogadon as a sleeping tablet because that is what they have been told it is.
Because the basic constituents of these drugs are similar, the side effects and problems associated with them are similar too. So, each of the warnings and pieces of advice in this section can be applied to the majority of benzodiazepines currently available and likely to become available in the future.
In recent years the problem of benzodiazepine addiction has attracted an enormous amount of publicity. Numerous magazine and newspaper articles have been written on the subject and almost every time the subject has been mentioned the authors concerned have received hundreds of letters from men and women who have recognised that they have the same symptoms as the reported addicts. Doctors who have done radio phone-ins will confirm that if one caller rings up and talks about tranquilliser addiction the phone lines will usually become jammed with people complaining of identical symptoms.
Subjective reports like this are not scientific evidence, of course, and there are many who argue that the benzodiazepines do not cause addiction.
For two decades, for example, some people who make and sell the benzodiazepines have consistently argued that these drugs do not cause any such problems. They have been supported by a number of advisers and medical experts who have published papers extolling the virtues of this group of drugs. The whole question has been confused by the fact that there have been many discussions about what is meant by words such as 'addiction', 'dependence', 'tolerance', 'adaptation' and so on. The academic arguments about the meaning of these terms has often obscured the fundamental question of whether or not people who take Valium, and similar drugs, can get hooked.
My feeling is that in practice it doesn't matter whether people taking drugs simply develop a bad 'habit' or a physical 'dependence'. Nor does it make much difference whether they take increased doses because they have established a physical 'tolerance' to the drug or because they simply cannot manage without it.
After studying scores of existing research papers I am totally convinced that there is a real risk that anyone taking a benzodiazepine for more than a week or two will get hooked. And, moreover, I believe that the evidence in favour of the benzodiazepines producing dependence has been overwhelming for some years. The size of the addiction problem associated with these drugs has been regularly underestimated because most benzodiazepine addicts are allowed free access to supplies of the drug and the incidence of withdrawal symptoms has been consistently underestimated because relatively few individuals have tried to kick the benzodiazepine habit.
In support of my claim that the benzodiazepines do cause addiction I offer the following facts:
In 1975 three doctors from the Drug Dependence Treatment Center at the Philadelphia VA Hospital and University of Pennsylvania, Philadelphia, published a paper in The International Journal of the Addictions entitled 'Misuse and Abuse of Diazepam: An Increasingly Common Medical Problem'. Doctors Woody, O'Brien and Greenstein referred to papers published as far back as 1970 which had documented instances of physical addiction to chlordiazepoxide and diazepam and reported that since the end of 1972 they had noticed an increasing amount of diazepam misuse and abuse. Their paper concluded: 'All physicians should know that diazepam abuse and misuse is occurring and careful attention should be given to prescribing, transporting and storing this drug.'
In 1970 Dr Norman Imlah, Medical Director and Consultant Psychiatrist at All Saints Hospital, Birmingham, an expert on drug addiction, published a book called Drugs in Modern Society. He wrote about the benzodiazepines: 'This is much too short a time to make a thorough assessment...' but went on to say that 'they are, however, regarded as very safe drugs, free from undesirable side reactions apart from a tendency to create dependence.'
So, even then, before the other side effects now associated with the benzodiazepines had been noted, it was clear that these drugs caused dependence.
In 1961, just a short time after chlordiazepoxide had been introduced into clinical practice, a clinical report appeared in Psychopharmacologia which was written by three physicians from the Veterans' Administration Hospital, Palo Alto, California. Entitled 'Withdrawal Reactions from Chlordiazepoxide "Librium", the paper described very dramatically how patients who had been taking the drug suffered from withdrawal symptoms when the drug was stopped.
The authors described how eleven patients who had been taking fairly high doses of chlordiazepoxide for up to six months were quite suddenly taken off the drug and given sugar tablets instead. Ten of the eleven patients experienced new symptoms or signs after the withdrawal of the chlordiazepoxide. Six patients became depressed, five were agitated and unable to sleep, two had major convulsions or fits. Most of the symptoms developed within two to nine days after the chlordiazepoxide was stopped, with most appearing between the fourth and the eighth days.
It is of course quite impossible to suffer withdrawal symptoms without being in some way addicted to a drug.
This report was, I repeat, published in 1961. There are today, two decades later, doctors who still do not know that the benzodiazepines can cause addiction.
Testifying to a US Senate health sub-committee in Washington in 1979, a psychiatrist from a Californian rehabilitation unit claimed that patients can become hooked on diazepam in as little as six weeks. The same committee heard testimony that it is harder to kick the tranquilliser habit that it is to get off heroin. One expert witness said that tranquillisers provide America's number one drug problem apart from alcohol.
In a paper called 'Benzodiazepine Dependence', published in the British Journal of Addiction in 1981, Dr Petursson and Professor Lader of the Institute of Psychiatry in London reported that the 'benzodiazepines are fully capable of inducing both physical and psychological dependence'. They concluded their analysis of the problem by writing 'a careful examination of the problem... is a matter of urgency.'
In a symposium at the Royal Society of Medicine in April 1973, Dr John Bonn, at the time a senior lecturer and Consultant Psychiatrist at St Bartholomew's and Hackney Hospitals, London, said that 'The benzodiazepines are medications to be avoided, unless the patient is under close supervision.' He explained that he saw a number of benzodiazepine-dependent patients, and that when these patients were taken off their drugs they often felt much better than they had for years.
Despite the strength of this evidence the benzodiazepines are still easy to obtain. Doctors can prescribe them without any restrictions and although the drugs have been said to be even more addictive than drugs such as heroin they remain outside dangerous drug-control legislation.
One can but admire the power and effectiveness of the drug-industry lobby and their public relations and marketing advisers who have succeeded in persuading doctors to keep prescribing these drugs in huge quantities, and in persuading Government agencies to leave the drugs virtually outside the control of the law.
Ten years ago there was enough evidence to suggest that the availability of the benzodiazepines should be controlled by legislation. How much longer do we have to wait?
The benzodiazepines and brain damage
At a conference at the National Institute of Health in Washington, USA, in 1982, a British Professor of Psychopharmacology, Malcolm Lader, reported that brain scans done on a small group of patients who had been taking diazepam for a number of years had produced evidence suggesting that their brains had been damaged.
Although warning that his preliminary findings needed more research Professor Lader pointed out that the work he had done suggested that the brains of regular benzodiazepine takers were damaged and shrunken when compared to the brains of people who had not taken benzodiazepines.
There are no precise figures about the number of people who have taken diazepam for long periods of time, but Professor Lader calculates that something like 250,000 British people and over a million patients in America have taken tranquillisers for more than seven years - and could therefore have damaged brains.
I don't think anyone really knows what long-term effects the benzodiazepines are likely to have on brain tissue. But research reported at a neuropsychopharmacology congress in Jerusalem in 1982 suggested that the benzodiazepines may affect memory. Research has shown, for example, that volunteers who have taken benzodiazepines are unable to remember things like telephone numbers and map routes.
In addition to these suggestions that the benzodiazepines may damage your brain cells and produce real physical damage to your thinking processes, there is also the risk that the benzodiazepines will cause psychological damage. So, for example, there is the risk that while you are taking one of these drugs your emotional make-up will be dramatically changed. You may no longer suffer acute attacks of anxiety or depression while you are drugged. But, at the same time, you may also fail to enjoy the peaks of pleasure in your life. You may become 'zombie'-like in your attitude to life, and boring and uninteresting to those around you. As a result of these definite and obvious changes in your personality your relationships with other people may change. You may lose friends, you may lose your job and you may find that your marriage breaks up.
The benzodiazepines can affect your ability to think and your ability to enjoy life. They can have a powerful effect on your personality and on your relationships with the people closest to you too.
The benzodiazepines and memory capacity
In 1982 the Scandinavian Journal of Psychology published a paper entitled 'Amnesic Effects of Diazepam: "Drug Dependence" Explained by State-Dependent Learning'. The paper, written by two Danes, Hans Henrik Jensen of the University of Aarhus and Jens Christian Poulsen of the Psychiatric Hospital, Aalborg, described one of the most remarkable pieces of research to involve the benzodiazepines.
Jensen and Poulson began their work knowing that diazepam can produce amnesia for events which take place when the drug is being used. This effect is considered a useful bonus when diazepam is being utilised to sedate patients about to undergo surgery. The research done by Jensen and Poulson was designed to find out just how much patients on long-term diazepam treatments are affected by this phenomenon.
What they found was that if a patient takes diazepam he won't be able to remember things that he learned while taking the drug - unless he takes it again. This discovery is extremely important. For, as Jensen and Poulson imply, it suggests that if a patient learns to cope with his pressures and his problems and learns to relax and deal with external stresses while he is taking diazepam he will forget everything that he has learned when he stops taking the drug. As soon as he gives up his pills his memory will deteriorate so much that he'll forget all that he has learned about relaxing.
But if he then starts to take his diazepam again his memory will return. And he will, once more, be able to relax and deal with his pressure. He will feel comfortable and happy. Everything he has learned about how to cope without diazepam will be of value only when he is taking diazepam.
It's the ultimate Catch-22 situation.
And it is hardly surprising that diazepam, and the other benzodiazepines, are very difficult to give up!
The benzodiazepines and anxiety or depression
Diazepam and the other benzodiazepines are frequently prescribed for patients suffering from anxiety and mild depression. It is rather surprising, therefore, to discover that the benzodiazepines can actually cause these symptoms.
One report - published in 1972 in the American, Journal of Psychiatry and written by Lt Cdr Richard G. W. Hall, MC, USN, and Joy R. Joffe, MD, when both were working at the Johns Hopkins University School of Medicine, Baltimore described how six patients on diazepam had exhibited a cluster of symptoms which included tremulousness, apprehension, insomnia and depression. The patients had all been previously emotionally stable and the symptoms, which started suddenly, were quite severe. When these patients were taken off their diazepam their symptoms disappeared.
Other reports have confirmed the suggestion that the benzodiazepines may produce anxiety rather than cure it. In Holland in 1979, for example, a psychiatrist contributed a paper to a Dutch medical journal in which he described how four patients taking a benzodiazepine sleeping tablet had developed severe anxiety and intolerable psychological changes. The report led to about 600 other, similar, complaints about the drug.
In 1982 a psychiatrist from the Royal Edinburgh Hospital, Edinburgh, reported that twenty-one middle-aged individuals who had been taking a benzodiazepine with a very short half life to help them sleep had become slowly more anxious. Research suggested that even benzodiazepines thought to have a very short life in the body could produce noticeable anxiety for some time afterwards.
The really worrying thing about this research is perhaps that the link between the taking of benzodiazepines and the development of anxiety, although now well established by researchers, has still not been widely accepted by prescribing doctors. There are many general practitioners and hospital doctors who, when faced with anxious patients, will immediately write out prescriptions for benzodiazepines. Then, if their prescriptions don't seem to work and their patients become more anxious and more irritable, they will increase the dose.
In the light of the evidence now available this is difficult to explain.
In addition to this, there is now evidence to show that these drugs can also cause depression. There have been several such reports published but one of the earliest was perhaps the one published in the Journal of the American Medical Association in 1968. Most of the eight patients discussed in this research were taking diazepam in the normal dose of 5mg three or four times a day but the authors reported that their deepening depression was so severe that in seven patients suicidal thoughts and impulses occurred. Two of the patients are said to have made serious attempts to kill themselves while two succeeded.
Five of the patients showed improvements in three or four days after their diazepam was stopped.
No one really knows why there should be a link between the benzodiazepines and depression but could it be, perhaps, that when patients live exclusively in a dull, grey world where they are numbed and deprived of any peaks of pleasure, they drift very easily into despair and depression? Could it be that the benzodiazepines flatten emotions too effectively?
Finally, in this section I must point out that although those who favour the use of the benzodiazepines will often argue that these drugs are exceptionally safe when taken in large quantities the truth is that anyone who takes diazepam (or any other benzodiazepine) in large quantities is in real danger.
In one year in the early 1970s the number of deaths from diazepam (due either to suicide or accidental poisoning) reached sixteen in England and Wales alone. According to a paper published in the Journal of the Royal Society of Medicine in 1979, self poisoning with tranquillisers, sleeping drugs and similar pills obtained on prescription accounts for 61,000 hospital admissions each year.
From the evidence which is available to us it seems that the benzodiazepines are not suitable for use by anxious, depressed or suicidal patients.
The benzodiazepines and aggression
When they were first introduced into clinical practice in the early 1960s both chlordiazepoxide and diazepam were publicly acclaimed for their ability to quiet, calm and tame wild animals. Because of these early animal experiments it was assumed that these drugs would have a similarly calming effect on human beings.
However, the research that was done in the 1960s did not really support this hypothesis. There was, to say the least, much confusion.
So, for example, although Kalina in 1964 gave diazepam to fifty-two prisoners and later reported that he had obtained complete control of violent, destructive and anti-social behaviour, Kelly and Giavold in 1960 found that chlordiazepoxide had the opposite effect.
And while Gleser in 1965 showed that male delinquents could be made less hostile with chlordiazepoxide, Feldman in 1962 had found that diazepam not only had no favourable effect on the hostility of patients, but that in many cases patients' hates became more, and not less, intense.
Other workers too found that the benzodiazepines seemed to increase hostility, aggressiveness and irritability, making patients more self assertive than usual.
One researcher who had studied the question of aggressiveness caused by benzodiazepines was Alberto DiMascio of the Department of Mental Health at the Commonwealth of Massachusetts and Tufts University School of Medicine, Boston. In 1975 he published a paper in Psychopharmacologia entitled 'The Effects of Benzodiazepines on Aggression. Reduced or Increased?' in which he summarised the conflicting evidence and suggested that before doctors could know for sure whether a benzodiazepine they were prescribing would cause more or less aggression more research would be needed.
For a while the problem of whether or not the benzodiazepines could have an effect on human aggression was the subject of some controversy within the medical journals. In 1975, for example, the British Medical Journal published an editorial entitled 'Tranquillisers Causing Aggression' in which the author recalled that way back in 1960 two authors writing in The Lancet had reported that a patient taking chlordiazepoxide had physically assaulted his wife for the first time in their twenty years of marriage.
It was also pointed out that the sort of people most likely to become hostile when taking benzodiazepines were those subject to frustration, and the author of the editorial concluded that 'If these are valid conclusions then they provide clear evidence that there may be dangers in the growing practice of prescribing minor tranquillisers for anxiety and tension brought about by environmental frustration and disturbed inter-personal relationships.'
Other doctors have agreed with that conclusion. It has, for example, been suggested that there is a link between baby battering and tranquillisers. Young mothers, it is said, take benzodiazepines because they cannot cope with their babies' demanding behaviour. But the behaviour doesn't change, and nor does the environment. The drugs make the mothers more aggressive - and when the baby cries again it is battered.
Despite this evidence the benzodiazepines are still widely used for people under pressure. The current baby-battering epidemic which is causing so much concern may well be a result of doctors over-prescribing these drugs.
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