![]() ![]() ![]() ![]() Severe anxiety and sleepless nights, however, are not benign conditions. For sleep issues, cognitive-behavioral therapy is given as the gold-standard treatment, while in my practice I have found it difficult to motivate patients to engage in it, and of those who do, it is sometimes helpful, but not a panacea. “Just say no,” is often the advice, and perhaps it’s more about the doctor’s discomfort than it is about the individual patient. I’ve been surprised at how often the respondents insist the patient should be told he must taper off the medication. They have tried other medications that were not helpful. These are outpatients coming for routine care, and they find the medications helpful and don’t want to discontinue them. In the Facebook group, “Psychiatry for All Physicians,” it’s not uncommon for physicians to ask what to do with older patients who are transferred to them on therapeutic doses of benzodiazepines or zolpidem. They provide fast relief in conditions where there are not always good alternatives. Still, there are circumstances where patients find these medications to be helpful, where other medications don’t work, or don’t work quickly enough. Because of the problems that are associated with their use, benzodiazepines and their relatives, the Z-drugs used for sleep, have become stigmatized, as have the patients who use them and perhaps even the doctors who prescribe them. ![]()
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