I. BENZODIAZEPINES
Benzodiazepines are a class of anxiety-reducing medications which includes Klonopin (clonazepam), Ativan (lorazepam), Xanax(alprazolam), Valium (diazepam), Restoril (temazepam), and a few
others. All benzodiazepines are classified by the FDA as controlled substances due to their potential for abuse and dependence.
As a general rule, our providers do not prescribe benzodiazepines on a long-term basis. This is because we do not believe they are either
safe or effective as a long-term treatment for anxiety or other mood disorders.
If you are currently taking one or more benzodiazepines, and are interested in stopping, we can help. Over the years, our providers have helped many people successfully taper off benzodiazepines, in a manner designed to minimize any withdrawal effects. The process of tapering is usually gradual and may take a period of weeks or
months, depending on the needs of the patient.
In most cases, we have seen that the patient experiences substantial improvement of symptoms and greater mood stability after these medications have been stopped.
Note that there is one minor exception to our “no benzodiazepines” policy. Occasionally, our providers will encounter a patient with a specific phobia that is not triggered very often (e.g. fear of flying, fear of needles, fear of getting a medical procedure such as an MRI). For these patients we will sometimes prescribe a very limited supply of
benzodiazepines to be used exclusively for situational anxiety (e.g., a dose of Ativan prior to a plane flight). In these cases, the use of benzodiazepines is typically very infrequent (e.g. a few times a year).
II. STIMULANTS
Stimulants are a class of medications which are commonly prescribed for ADHD (and occasionally for other disorders). Examples include Adderall, dextroamphetamine, Ritalin, Concerta, Focalin,
Vyvanse, and a few others. Much like the benzodiazepines, these medications carry a substantial risk of abuse or dependence and are
classified by the FDA as controlled substances.
Our providers do sometimes prescribe stimulant medications when we and the patient both agree that the benefits of the medication outweigh the potential risks. However, please be aware that our
providers prescribe stimulant medications very selectively. Like many of our colleagues, we believe that these medications are currently over-prescribed. Over the past 25 years, the use of stimulant medication in the United States has increased by over 500%. We believe that this increase has been largely driven by financial and
sociological factors, and not by clinical necessity.
If you are a prospective patient who is concerned about issues with focus or attention, you should be aware of the following considerations:
(1) The diagnostic criteria for ADHD (as outlined in the DSM-V) are notoriously subjective. Physicians frequently disagree with each other about whether a specific patient meets criteria for ADHD. Thus, the
fact that you have been previously diagnosed with ADHD by another physician does not guarantee that we will arrive at the same diagnosis.
(2) Patients often come to our clinic stating that they “want to be tested for ADHD” (or, in some cases, stating that they have already “been tested for ADHD”). Unfortunately, there is no standardized test available which either definitively confirms, or definitively rules out, a diagnosis of ADHD. Psychiatrists do sometimes order “neuropsych
testing” during their evaluation of ADHD patients. Although these tests may be of some value in identifying problem areas, there is an extensive body of research which shows that they do not correlate well with the presence or absence of ADHD.
(3) Problems with attention/focus are often caused, in whole or in part, by clinical issues other than ADHD (e.g. sleep issues, emotional issues, undiagnosed medical conditions, medication side effects, etc.). Our goal as physicians is always to identify and address these issues before considering a course of treatment with stimulant
medication.
Please note that if you are currently taking a medication which is known to cause significant issues with focus/attention (e.g. a benzodiazepine), we will not be able to prescribe stimulant medication.
In cases where we do prescribe stimulants, we make efforts to prescribe the lowest effective dose and encourage patients to take “breaks” from stimulant use when possible. (For example, many patients will elect to skip stimulant medications on weekends or
vacations). We also encourage patients to periodically re-evaluate their attentional symptoms and to re-evaluate whether there is an ongoing need for stimulant medication.
Thank you for reading to the end of this list of guidelines! Our guidelines reflect what we believe to be clinical best practices, which we have arrived at after many years of experience, reflection, and
discussion with other health care professionals. Please be aware that other psychiatrists may take a different approach to the use of controlled substances.
Before scheduling an intake appointment with us, please consider carefully whether you are in agreement with our treatment philosophy
and whether this philosophy will be a good “fit” for you as a patient.