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Yet another "What my pdoc said at this appointment"...


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Anyone who has even slightly followed my journey, knows that my pdoc is a real piece of work. She has some kind of personal vendetta against Xanax. She hates it. She tells me at every appointment how much she hates, but every time she comes up with a new excuse for why I should stop taking it. I posted a couple weeks ago about my significant cognitive loss, so this is why what she said today concerns me. She said, and I quote: "We really got to get you off the Xanax. It causes long term side effects. There has been studies done, and proved that Xanax can cause early dementia." I just kind of brushed her off. Right after I left the room where I see her, her nurse did some how of side effects test on me. Just basic stuff like holding my hands out, touching each of my fingers to my thumb, walking across the room, that kinda stuff. The nurse said everything looked good, but whats with the Xanax and Dementia? Is this something known to the world or some more of her stretching the truth??

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There is a recent meta-analysis and a few studies suggesting an association (approximately 1.5 relative risk increase) between lifetime benzodiazepine use and dementia, as compared to people who have never used benzodiazepines: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127836

All of the studies included are cohort or case control (observational) studies, which is a lower quality of evidence than a randomized controlled trial (which wouldn't really be possible in the case of this question), and it's not definitive evidence of causation, but it's a solid meta-analysis which controlled for multiple confounders and continued to find evidence of an association.

It's always an issue of risk versus benefit and the data is not as clear as "benzodiazepines cause dementia".

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In my case, I would honestly put up with the "side effects". I really don't think I could make it through the day without them, and I don't always take my max dose of 1mg 3 times a day. But my pdoc is hell bent on getting me to agree to come off Xanax. That's not going to happen. First she tried to offer Klonopin as an alternate, but I wanted to switch with the Xanax since it's done so great for me for the 10ish years I've been on it. But she was on not only a Xanax rant, but a whole rant about all benzo's. She also told me that I really need to get off my current dosage(which has been the same ever since I got on it), and wean off Xanax. I'm just not willing to do that. I'm back to going back every 2 weeks to see how the meds are working. I had finally got to only seeing her once every 2 months, and thanks to the new med combo, I get to go every 2 weeks.

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The study cited above advises in the conclusion: "Due to limited studies, especially dose-response analysis, and potential reverse causation, these findings should be treated with caution. Large prospective cohort studies with long follow-up duration are needed to confirm whether the association between long-term benzodiazepine use and increased risk of dementia is causal."

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127836#sec025

And, if it makes you feel any better, there was a BMJ study that found "The association with Alzheimer’s disease was stronger for long acting benzodiazepines (1.70, 1.46 to 1.98) than for short acting ones (1.43, 1.27 to 1.61)."  http://www.bmj.com/content/349/bmj.g5205

And in that study at least, "the use of benzodiazepines could be just a signal that people are trying to cope with anxiety and sleep disruption—two common symptoms of early Alzheimer’s disease. If that’s true, their use of a benzodiazepine may not be a factor in causing dementia but an indication it is already in progress." http://www.health.harvard.edu/blog/benzodiazepine-use-may-raise-risk-alzheimers-disease-201409107397

In my case, my psychiatrist thought it best I transition off of xanax after maybe 1-3 years or so (I have a terrible memory) and go onto valium instead. I made the switch probably around 2004.

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