StayOnTop: Depression

You probably didn’t miss the news that last Saturday, singer Whitney Houston was found dead in her Los Angeles hotel suite. Autopsy results will take several weeks, but as the first details trickle in, it seems ever more likely that Xanax, a medication in the benzodiazepine class, may have played a role in her death.

    I’ve written already a lot about medication lately. Actually I had intended to return to other, more varied topics and experiences now: for this is supposed to be a depression blog in a wider sense, not a one-sided medication blog. But what appears to have happened here, is just too important to pass by.

    According to several news sources such as this page at FoxNews, Whitney Houston may have died in her bathtub as a consequence (either directly or indirectly, by drowning) of using Xanax in combination with alcohol. This is a dangerous combination that among other things can cause extreme drowsiness. Her family confirmed she was using it; bottles were found in her room.

    Benzodiazepines such as Xanax are often used in cases of depression too, because they have a calming effect, reducing panic, anxiety, sleeping problems etcetera. In the past I’ve been using the same kind of medication myself for a while. On prescription by my psychiatrist I had Lorazepam, a similar one in this same benzodiazepine class. For myself, I soon found out that the numbing effects caused me more trouble than relief. After about a year, I decided to never touch the stuff again. But I do know there are also people who got more positive results with this kind of medication.

    Every psychiatrist, when prescribing something like this, will expressly and emphatically warn you for the very well-known risks of combining these benzodiazepines with alcohol. Still, that risk is your risk and avoiding it is of course also your responsibility. Even more so when you are unwise enough to start using these pills without adequate medical supervision. Some people take them without a really urgent need, or even just for a pleasant effect.

    In the US, such overuse and misuse of benzodiazepines is a big problem. Due to their widespread availability, they are “recreationally” the most frequently used pharmaceuticals. A 2006 large-scale nationwide government study by SAMHSA (the Substance Abuse and Mental Health Services Administration) found that 28% of all drug-related visits to hospital emergency and urgent care facilities involved the improper use of pharmaceuticals, and an additional 10% involved the use of pharmaceuticals with alcohol. Among these many urgent cases, between 2004-2006 those involving benzodiazepines had increased with 36%.

    I can only repeat what I’ve said here several times before. Medication – any kind of medication in the context of depression – should be taken only as a means of last resort, when there are no therapeutic alternatives left. And it should never be taken without proper authorization and supervision by a medical professional.

    As for the combination with alcohol, I must admit that in everyday reality, while I was still using antidepressants, I sometimes allowed myself a glass of beer – one a day. But there, I drew the line. Even that one glass did not always work out very well in that situation. Maybe this is one of the accidental reasons why I happen to be still around today.

    This unexpected death leaves many of us with a feeling of sadness and loss. Even more so because this is a tragedy that might well have been prevented. I suppose the best tribute to Whitney Houston now is her own great voice.

So here she is:

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• tip: Psychoactive medication can be risky in so many ways – you don’t need a bathtub to get into the danger zone. You should always ask yourself: what is more dangerous to me, my depression or the antidepressants I’m tempted to use?
    Use those pills only when there is no therapeutic alternative left. As for combining this kind of medication with alcohol, draw your own conclusion.

• update: For a very detailed discussion of the possible role of Xanax in this case, see this Huffington Post article by the well-known “anti-pill” psychiatrist Peter Breggin: Xanax Facts and Whitney Houston.

 
Author: Henk van Setten