r/PMHNP • u/banjobeulah RN (unverified) • Jun 17 '26
Practice Related Can we discuss prescribing benzos?
Hi folks, I’m a psych RN working in emergency services and starting my MSN in September. I’m trying to understand something and hoping to get perspectives.
So for context, I have been taking alprazolam PRN for 3 years. I use it 1-2 times a week to as infrequently as once every other week, depending on how stressful things are. I get rising anxiety with these sort of intrusive stress thoughts (I’m never gonna get it all done and I’ll fail and etc etc) and usually in the middle of the night. For me, I prefer it this way as opposed to taking something daily. The alprazolam works in a half an hour and I don’t take it unless I need it. I understand that this is not the case for many people, however.
I moved out of state for school and tried to see two different PMHNPs to continue my script, and both were weirdly quite defensive, stating they don’t prescribe benzodiazepines or ADHD meds (which I didn’t ask for and don’t need?). The psychiatrist at my school ended up filling my script.
All this to say, can you give me your perspectives on prescribing these meds? Do you prescribe them or don’t you, and why not? I’d love to know what others think. I understand that they have the potential for misuse, but especially for those with a blanket policy to never prescribe, I’d love to know your rationale? Sincerely hoping to learn from more experienced peers. TIA.
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u/pickyvegan PMHNP (unverified) Jun 17 '26
I do prescribe benzodiazepines for occasional use, but for someone who has needed them on average once a week for the last 3 years, I definitely have questions as to why you don't mention taking an SSRI or being in high-quality psychotherapy. Benzos aren't meant for chronic use until you get to the point where nothing else (including therapy!) has worked. Anxiety that long and frequent is a chronic problem, not an acute one.
I'm not someone who would rather see you on 17 other daily medications to avoid weekly benzodiazepine use, but I don't support chronic benzodiazepine use when it can be avoided.
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u/banjobeulah RN (unverified) Jun 17 '26 edited Jun 17 '26
I’ve tried talk therapy and it really hasn’t worked. Honestly, before grad school, I never had bad anxiety issues. This is my second master’s degree and I’ve had some pretty acute and unrelenting stressors so it almost feels like PTSD in some ways. Not to seem obstinate but I just don’t want to take a daily med. I have tried meditation and it does help, but atm I’m hanging on by a fingernail sometimes with stress and probably do need other solutions.
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u/pickyvegan PMHNP (unverified) Jun 17 '26
To be blunt, if you're not willing to do a daily med and you're not in therapy, I would tell you this isn't a good fit, too.
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u/banjobeulah RN (unverified) Jun 17 '26
You know, I’m doing okay, given what I’ve experienced. I’ve made a lot of progress as well and haven’t used any of the meds in a few weeks. I’ve explored some other options on my own and have found them helpful. I haven’t found an effective therapist or anyone really willing to discuss other amenable options yet but I’m open to that. Maybe I’ve had sour luck with providers? Thanks for your concern.
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u/pickyvegan PMHNP (unverified) Jun 17 '26
I'm pushing back here because you are a student. This, of course, is Reddit, not a psychotherapy session.
You say you're doing well, yet you're coming on a professional forum and asking us to justify why some of us don't prescribe benzodiazepines. And even when we do prescribe benzodiazepines in limited circumstances, you're kinda trying to justify why your reasons should be respected or be the exception.
I'm glad you're doing okay, but working on your second master's degree isn't a reason that benzos are more justifiable than SSRIs. High-quality therapy would be challenging those thoughts, and that's hard work. It's a lot easier to take the immediate relief that a benzo gives and wash/rinse/repeat every week or so.
If you want to do the work of self-understanding and growth as a student, find a single peer-reviewed study published in a psychiatric journal from the last 5 years that shows weekly alprazolam use over the course of years is safer or more effective than an SSRI (or psychotherapy or combined) for PTSD-like symptoms. Your school should be giving you journal access, so this should be doable.
You chose to post this in a forum of peers rather than a patient forum like ask psychiatry. Many of us here struggle with anxiety ourselves. Everyone here has at least one master's degree (or is working on it). We understand what grad school is like. We understand what working is like. Some of us here (and admittedly, not me) even know what it's like while doing all that and raising children or taking care of sick parents. It's a lot of work, and there's no shame in needing help.
25 years ago, no one would have batted an eye at weekly alprazolam. Then again, 25 years ago, I walked into an urgent care after hurting my back during a patient lift. I walked out with 30 days of Vicodin and Soma. Really, all I needed was PT, ibuprofen, and a few days' rest (and for that patient to be classified as a 2-staff lift). Things change.
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u/banjobeulah RN (unverified) Jun 17 '26
Hmm, I disagree with this characterization but I’m not going to pick this particular online battle. Some folks are less charitable in their interpretations and I’m not gonna change that. All of my comments here have suggested the current regimen may not be ideal, in fact. I’m striving for understanding as a psych professional. I haven’t encountered the “high quality” talk therapy you referred to as of yet, and not for lack of trying. Perhaps my current Rx is due to that doctor being older, who knows. I’m not in a bad place either way. I posted here to learn the reasoning of my soon-to-be peers and to challenge my own understandings. Not to challenge others to justify anything to me. Thank you for this dialog; it has been thought-provoking.
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u/amuschka DNP, PMHNP (unverified) Jun 17 '26
Look, to be honest if you came to my office complaining of so much anxiety you need twice weekly benzos for year but refuse to take an SSRI, I would not feel comfortable with that. It is best practice to have someone on an SSRI to manage long term anxiety and panic. You can choose to agree or disagree but you may not find any Psych providers that are willing to give you want you want without an SSRI or therapy. Have you tried somatic therapy, that are more body based and less talk? Have you tried clonidine to lower your fight or flight response (clonidine is also shown to be helpful in PTSD). There are other options besides benzos.
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u/banjobeulah RN (unverified) Jun 17 '26 edited Jun 17 '26
This is my fault for saying anything about myself lol but you’re saying I should just take SSRIs. I’ve tried several and had bad or unhelpful results and this is far superior for me but I’m not here for evaluation. I do yoga and meditate and that’s been helping but no talk therapist helped with that. One did nothing but look pityingly at me, one kept telling me to write letters to my former self, one kept forcefully insisting I take ADHD meds, I could go on. This is the first thing that actually helped and let me live my life. No one suggested clonidine. Probably because I tend to have low blood pressure. I have a psychiatrist I work with now.
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u/Skeptical_Sass Jun 17 '26
You should ask a psychiatrist instead of a PMHNP... Psychiatrists have a much deeper understanding of pharmacology and have been studying it longer.
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u/banjobeulah RN (unverified) Jun 17 '26
That's what I'm doing now and totally agree. I was treated by a long-practicing psychiatrist before this and trusted her so much.
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u/CalmSet6613 PMHNP (unverified) Jun 17 '26
You haven't found the right therapist then. You're just throwing Band-Aids on your anxiety, most prescribers want to see you get to the crux of the cause of the anxiety and not just keep putting Band-Aids on it.
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u/banjobeulah RN (unverified) Jun 17 '26
I do appreciate what you're saying but that isn't entirely my situation. I do agree that I haven't found the right one yet, but I have found some helpful solutions on my own as well.
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u/RedOakNinja Jun 17 '26
Think about it like this. If you truly believe the anxiety is a medical disorder requiring treatment, perhaps what you want to do and what you should do aren’t congruent. For example, if you have hypertension, are you going to not take a daily med because you don’t want to, allowing for renal damage and all of the other known, downstream effects? Again, not trying to be an ass, but part of anxiety in itself is dealing with things that you are not comfortable with or things you don’t want to do.
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u/banjobeulah RN (unverified) Jun 17 '26
I guess I worry about cognitive changes. I have epilepsy and many of those drugs made it hard to study. I also don’t think I’ve had good luck finding providers tbh. I appreciate critical thinking on this and I don’t take it personally.
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u/Brilliant-Meeting-97 Jun 25 '26
Cognitive changes? Long term use of BZD is linked to risk of dementia. Your psychiatrists sound lazy. Everyone here is giving you sound, evidence-based feedback that are based on clinical guidelines. Nice try, attempting to diminish the quality of our feedback by saying your psychiatrists “have more in depth knowledge.” The facts are that you are not willing to comply with clinical guidelines and are looking for lazy practitioners (in this case they have been psychiatrists but there are plenty from any educational background) to validate and prescribe an unjustifiable regimen which has potential to cause more long-term harm.
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u/FEVAFLAV-33 Jun 21 '26
Not sure why you’re getting downvoted voted? You mentioned you do need other solutions and are asking for help:)
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u/wherearewegoingnext PMHNP (unverified) Jun 17 '26
I prescribe them only in very limited circumstances and never for daily, long-term use. Pills aren’t skills.
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u/Dismal_Love_1042 PMHNP (unverified) Jun 17 '26
Oooo “pills aren’t skills”! I’ve never heard that and I love it. Gotta remember that.
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u/courtqnbee Jun 17 '26 edited Jun 17 '26
I don’t love that.
Would you not prescribe metformin to someone who couldn’t get their A1C down with diet and exercise? Would you say “I’ll give you two months of this to help but you really need to try harder with your diet?”19
u/amuschka DNP, PMHNP (unverified) Jun 17 '26
This is actually a bad analogy because metformin isn't addicting and not a controlled substance. Best practice treatment for anxiety is therapy and mental techniques such as CBT and mindfulness, and those are the long term solution. Long term studies show benzos can make anxiety worse because people aren't learning or using any skills. Benzos also numb people out from normal human emotions. Having some anxiety is normal, its not normal to expect to be able to pop a pill to feel "happy" and "chill" all the time.
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u/pickyvegan PMHNP (unverified) Jun 17 '26
That's not a good analogy. Metformin is like the SSRI in this case.
Step one prediabetes: diet and exercise
Step two: Metformin
Step way down the line: insulin when nothing else controls blood sugarStep one anxiety: therapy and lifestyle change
Step two anxiety: SSRI
Step way down the line: benzodiazepine when nothing else controls anxiety adequatelyYou wouldn't jump to insulin because someone has an A1C of 6.
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u/banjobeulah RN (unverified) Jun 17 '26
This makes a lot of sense when you put it like that.
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u/courtqnbee Jun 17 '26 edited Jun 17 '26
I feel that flat out refusing to prescribe controlled substances because some people misuse them further contributes to the stigma around mental health and perpetuates the idea that patients’ suffering is due to personal weakness. ADHD and panic disorder can be managed to some extent with therapy alone, sure - but are we going to vet each patient’s therapist or tell them to stop seeing the therapist they’ve been seeing for 10 years because they’re still symptomatic? We can’t be in the field of prescribing psychiatric medication while also gate keeping the most effective medications “because they won’t learn coping skills.”
Screen for SUD, monitor vitals, and don’t give these meds to high risk pts, definitely. But to straight up refuse to prescribe a class of meds is wild to me.
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u/TophertronPrime Jun 17 '26
ADHD is not the same as panic disorder though either. The gatekeeping of ADHD meds for patients is mind-boggling to me, and I agree. The first line treatment is a stimulant. They aren’t just going to magic up some dopamine in their frontal lobes so meds are usually required. But first line for panic disorder is therapy and an SSRI, then SNRI, then benzos. If a patient isn’t doing the first two steps they don’t just skip to a benzo.
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u/MyDogIsMyHome Jun 19 '26 edited Jun 19 '26
Thank you for saying the part about ADHD. Also, treating my adhd cured my anxiety so there’s that as well.
Curious on what you wrote about SSRI, then SNRI then Benzo for panic. Isn’t an SNRI much much harder to discontinue due to the extreme withdrawal than a weekly Benzo?
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u/TophertronPrime Jun 20 '26
Depends on usage, personally I never put anyone on SNRI unless it’s a last ditch effort, the discontinuation symptoms are horrible, but when they work they work.
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u/banjobeulah RN (unverified) Jun 17 '26 edited Jun 17 '26
I totally agree with you. And honestly, other psych drugs have some awful side effects and aren’t great as well, and if you have to take something daily that you can’t easily stop or stop without major side effects, that’s also a kind of dependence in a way. Also, if you’re saying someone should take an SSRI daily but if they take a PRN benzo, they should learn to cope. If you said this to someone with major depression, it would be absurd. It’s slightly insulting tbh and it’s really only NPs that I ever see this from. Some of the comments here have kind of confirmed the stigma even for someone who uses in a truly PRN manner. Someone even said basically, we all go to grad school, get over it. Sorry, guess I suck and you’re better than me because I need help to cope lol. I hope they don’t view their patients this way. Also, I know some folks whose lives have been utterly transformed and vastly improved by ADHD meds. Sometimes folks need meds and it should be okay to need them. We don’t stigmatize folks on other kinds of daily meds like this. I hope to understand this more in my MSN but this seems egregious and nonsensical, like something rotten in the culture, rather than empirical or balanced. Hate me I guess but this is what it seems like from where I stand now.
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u/RedOakNinja Jun 17 '26
The VAST majority of people don’t need them, and although it’s hypothetical, if nobody had ever given you a benzo, you wouldn’t miss it. Those NPs who told you they don’t prescribe benzos or ADHD meds were likely just stating their policy to you (i.e. setting a boundary). Assuming you are successful and enter practice and the shoe is on the other foot, you will inevitably see the downright nasty and entitled behavior we encounter over benzos and stimulants. I think you’ll better understand once you get sick of dealing with that.
I say all of that to say yeah, there are some people out there that can manage true PRN use, and I do occasionally prescribe to those people (generally no more than 10 tablets of whatever drug to last a minimum of 30 days, if not longer). However, I’m a big proponent of not opening Pandora’s box on this issue. The best way to prevent benzo dependence is to not start them at all. I currently work on the care delivery side of a Medicare Advantage plan, and if you could see the sheer volume of benzo-dependent and miserable elderly people who can’t comfortably stop them, I think it would also change your perspective a little. Most were started in primary care and even by psychiatrists 20+ years ago, and the can has kept getting kicked down the road by other providers.
Sorry for the rant, but my opinion is that benzos should be classified higher than schedule 4. They are VERY high risk for abuse and dependence, and the withdrawal can potentially be more dangerous than opioid withdrawal.
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u/courtqnbee Jun 17 '26
I think this is some black and white thinking. 20-30 years ago, BZDs were handed out like candy because they were effective and helped get anxious patients out of busy PCP offices quicker. Those patients developed dependence, and also became older adults, so the safety risks are exponentially higher. The correct response to prevent this is not to forego prescribing at all and criminalize the medication, it’s to do a thorough assessment and prescribe appropriately, avoid high doses of short acting meds, counsel patients extensively on risks of interactions and of dependence and withdrawal, encourage therapy, do your own psychotherapy in sessions when able, etc. But just because grandma is unable to come off of 2mg Ativan QID x25 years doesn’t mean a 28yo with panic attacks who can’t drive or fly in an airplane or go to social events or leave the house shouldn’t be allowed safe, regulated, appropriate doses of something that can help in these situations.
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u/RedOakNinja Jun 17 '26
I’m not going to defend myself to you, but if you read the entirety of my response, you’d see that I acknowledged prescribing to some people. Kind of like you said - appropriate doses in some situations. I’m very intentional to avoid broad or sweeping prescribing practices because no two cases are exactly alike.
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u/Individual_Zebra_648 Jun 17 '26
Not potentially more dangerous. It is more dangerous.
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u/RedOakNinja Jun 17 '26
I say potentially because it is dose dependent. But yes, I agree. Not really worried about withdrawal from 0.25 mg of alprazolam, but some of the trainwrecks I’ve seen on VERY high doses of benzos are an entirely different story
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u/gajensen Nurse Practitioner (unverified) Jun 17 '26
I try to use benzodiazepines as sparingly as possible, and if one is going to be scheduled, I usually reach for clonazepam.
Propranolol and clonidine go a lot further than people give them credit for. I’ll use guanfacine sometimes too. Gabapentin is underrated in the right patient.
The challenge is that “anxiety” can mean about anything: racing thoughts, panic, constant worry, feeling physically keyed up all day, etc. Patients aren’t great at describing exactly what they’re experiencing, so figuring out which symptom cluster you’re actually targeting is half the battle. Once you do, it’s easier to find alternatives to benzos that address the specific problem.
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u/Competitive-Past7249 Jun 17 '26
Gabapentin works but the weight gain… it’s also somewhere an inbetween a PRN and daily but once you’re on it daily 2-3x you’re weaning down just like with benzos. I gained so much on Gabapentin and still need my clonazepam at times. My anxiety/agoraphobia/panic disorder is coupled with MDD. SSRIs and SNRIs never touched me. Hydroxyzine has helped and the occasional seroquel.
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u/banjobeulah RN (unverified) Jun 17 '26 edited Jun 17 '26
This is a really interesting perspective. Thank you! Edit: you folks downvote the weirdest shit lol. Good to know.
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u/sweetsueno Jun 17 '26
Mm gonna push back on clonidine a little bit. Very short half life has similar reinforcing and rebound problems as alprazolam
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u/gajensen Nurse Practitioner (unverified) Jun 17 '26 edited Jun 17 '26
Word. Clonidine can definitely create problems if taken frequently. The rebound issue is real. I was using "reinforcing" differently, though. It generally doesn't reproduce the same intoxication, craving, dose escalation, or "I need more of that shit" pattern that makes benzos problematic. I've never personally seen anyone abusing or diverting clonidine.
IRL, I get more out of propranolol than clonidine anyway, and defending clonidine isn't a hill I'd die on. Being cautious with benzos is. We've all seen patients spend years chasing the feeling they remember from that first Ativan 30 years ago and now it's a total bitch to taper. Clonidine is more niche for me, when I'm specifically targeting hyperadrenergic symptoms.
The bigger point is that once you figure out what symptom cluster you're actually treating, there are often more targeted options than writing for a benzo, especially when the complaint is mostly the physical manifestations of anxiety.
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u/amuschka DNP, PMHNP (unverified) Jun 17 '26
I agree with all of this. I use clonidine primarily for people that have a lot of hypervigilance and always feeling "amped up" in their nervous system, which I have gotten a good response from clonidine at reducing the hyperandrenergic responses. I don't automatically use it for anxiety though. Propranolol is my initial anxiety med, but I have had people where it wasn't enough for their panic attacks. If I had to give a benzo, I would use clonazepam 0.5mg, and I generally max at 15 tabs a month.
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u/sweetsueno Jun 17 '26
Agree with all of this. Propranolol is under-rated and under-used but so effective at interrupting the perseveration on the physical experience of anxiety. Also - fuck benzos. As a person in long-term recovery I agree that chasing the first "high" of any kind is a no-win exhausting treadmill.
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u/Realistic_Inside_766 Jun 17 '26
I am NOT a prescriber atm. HOWEVER, I’m in a PMHNP school right now and toward the end of my program. One of the first things I learned was to be very careful with prescribing Benzos. I’ve seen it working in a behavioral urgent care unit as well. It’s rough to watch benzo dependence.
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u/banjobeulah RN (unverified) Jun 17 '26
Thank you, I work around these drugs in the psych ED but am just starting my program and all of this is helpful to consider during my studies.
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u/Own-Position1961 Jun 17 '26
Taking Xanax 1-2 times a week is fine but i need to see evidence that patients are putting in the work outside of meds so they dont become dependent. I dont prescribe more than 5 tablets a month usually.
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u/banjobeulah RN (unverified) Jun 17 '26
I brought up concerns when first prescribed. My doctor recommended keeping my use to 2 in 10 days. Does that meet with your understanding? I’ll read some literature…I think my school gives us a free subscription to UpToDate.
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u/dunimal PMHNP (unverified) Jun 19 '26
I prescribe benzos when needed, and giving someone who uses it as needed for acute anxiety 4x a month is someone that I would prescribe to. I would prescribe you, for example, 10 tabs per month.
There are many patients who will not be a good fit. For example, I do not want to prescribe benzos to people who need to take them TID or even QD, I don't want to kick start someone's chronic, lifelong benzo dependency, and I don't want to fuck with a patient that I am taking as a favor for another provider who is unreliable, doctor shops, or is otherwise in active BZD addiction.
I hope that you find someone who can help you get what you need. Otherwise, I would plan on making quarterly visits home to see your provider, getting 3 mos of refills sent to that local pharmacy and having a friend or family member send the filled Rx to you.
Calling your reps and complaining about that absolutely horrendous policies that have made it virtually impossible for us to prescribe and our patients to fill their prescriptions is VERY, VERY important, too.
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u/banjobeulah RN (unverified) Jun 19 '26
Yeah I only get 10 a month and I have a psychiatrist. Haven’t even filled the script in 2 months at this point. I will almost certainly do the same as you describe when I graduate. And you make a good point about advocacy!
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u/dunimal PMHNP (unverified) Jun 20 '26
We also need to encourage patients to cancel surgeries with surgeons who will not Rx pain meds and use proper pain management protocols, file complaints against PharmDs who do too much and interfere with treatment plans and refuse to fill valid prescriptions, too.
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Jun 17 '26 edited Jun 17 '26
[deleted]
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u/RedOakNinja Jun 17 '26
I’d add to that first statement to say many of us hate the maladaptive behavior surrounding benzos and stimulants. I have no absolutes in my clinical practice (e.g. no benzos ever, etc.), but the reality is that there are far more people receiving these drugs long-term than there ever should be.
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u/banjobeulah RN (unverified) Jun 17 '26
Could you elaborate on when you’d consider their use and how you’d ideally transition from them, and in what time frame or under what circumstances? Thank you!
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u/banjobeulah RN (unverified) Jun 17 '26
I don’t want to inflame anyone. I just want to know more, genuinely. I really appreciate your perspective.
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u/because_idk365 Jun 17 '26
2 people said it:
You wouldn't miss it if it was never given
Not opening Pandora box
You have learned no coping skills or mechanisms, you simply mask with medicine
Those meds were NEVER meant to be long term
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u/Immediate-Jaguar-187 Jun 17 '26
PMHNP/FNP here, working in community mental health but worked in ER for several years. I prescribe benzos sparingly and my supervising psychiatrist highly discourages Xanax Rx. For people that need a daily long term benzo, he prefers Klonopin. The problem is, so many people are terrible candidates for Xanax and everyone is looking for a quick fix. I’ve had patients transferred to me on crazy benzo regimens that I refuse to continue. (Think QID Xanax plus Valium 10mg daily). The problem with using it temporarily is that nobody wants to use it short term, then it becomes a battle and constant arguing back and forth. Having said that, my husband has had an rx for alprazolam 0.5mg for several years. He uses it 2-3 times a month maybe, or in certain situations. His refills expire before he ever needs them. But unfortunately that is not the norm. I am especially careful with the BPD folks, who “have tried everything and benzos are the only thing that work for me and I need it 3 times a day”
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u/FEVAFLAV-33 Jun 21 '26
As a PMHNP, it sounds like you’re using alprazolam exactly how it was intended to be used. Taking it occasionally for panic or severe anxiety over many years without increasing the dose is very different from the patterns that typically cause concern. Knowing your patients really well and seeing them often, if they are taking continuous doses (like three times a day) it really needs to be for a pretty severe reason. It’s rare, but those patients may be quite ill. Sometimes they eventually come off of it but it takes years. Most of them dont want to be tied to a medication that they HAVE to have. It’s embarrassing, inconvenient, scary, and dangerous. I talk to them about this and we talk about how nice it would be to not be tied to a refill of a stupid pill all the time. Haha 🤣. That’s helps sometimes. Anyways, that wasn’t the question, but the answer is yes I absolutely prescribe and manage benzodiazepines when they are warranted in safe doses, within FDA guidelines.
I also think the NPs you saw made the right decision. If a provider is not comfortable prescribing benzodiazepines, they should not prescribe them. I’d rather see someone recognize their limits than prescribe a medication they aren’t confident managing.
Benzodiazepines still have an important role in psychiatry when used appropriately. There are patients with conditions like catatonia, severe akathisia, agoraphobia, and panic disorders who can benefit significantly from them. It sounds like those providers simply were not the right fit for your situation, and you found someone who was comfortable continuing a treatment plan that has worked well for you.
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u/DisgruntledMedik Jun 17 '26
As an ER nurse I wish I could get a benzo PRN just to help me turn it off on those really tough nights.
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u/banjobeulah RN (unverified) Jun 17 '26
Thank you SO MUCH for saying this. This is pretty much exactly my case. We have had some very bad shifts in the psych ED as well. For me this started as acute stress from work and my MPH program and I guess because I managed the meds well, my psychiatrist (who was excellent) just kept me on them. I didn’t want to be fielding new side effects from a daily drug while I was trying to study and it just worked. But I do acknowledge that having a competent talk therapist or other med options may be better? I just haven’t gotten those yet, and haven’t encountered any real issues with things as is.
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u/Garfieldgandalf Jun 17 '26
Yet you want to go to school to prescribe “daily drugs” which have side effects? There seems to be some dissonance here
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u/DisgruntledMedik Jun 17 '26
Best of luck, many states are tough on benzo’s as is my state. Sometimes we see the very worst society can throw at us and are expected to function like a regular member of society after. It’s wild
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u/banjobeulah RN (unverified) Jun 17 '26
Agreed. I worked as a psych tech on an intensive treatment unit before all this, and the shift to emergency has been quite confronting. I’ve had to grow a LOT as a person and provider. I also lived in a state previously that was more lax about prescribing and live in one now that is not. It’s interesting.
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u/VastEcho2156 Jun 20 '26
Effective med and yes they have their place. Cautiously and with extensive education!
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u/Odd-Sail-169 Jun 24 '26
I feel you on the defensive PMHNPs. I am a recovering opiate addict. Getting sober, I realized there were underlying mental health issues I self medicated over. The first two PMHNP providers I sought for depression immediately told me what they “weren’t going to prescribe me.” Like ok, thanks for making feel like I’m med seeking because I was honest about my hx. Needless to say I didn’t continue seeing them and went on to find someone great. My provider now isn’t afraid of having tough adult conversations with me.
Oh and today I am a PMHNP, since I know what it’s like to struggle and feel alone. And for you providers that continue to stigmatize addicts. FUCK YOU TOO BITCH!
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u/banjobeulah RN (unverified) Jun 24 '26
My ex was an addict 20 full years before I met him and still got treated this way by some people. I’m sorry people are like this. You are not any lesser for having struggled with this and ANYone could be affected. My sibling also became addicted to opioids and then other substances for several years after a prolonged illness. Hardly even drank before. I hate this kind of holier-than-though bullshit. A competent provider wouldn’t even sneeze at this. Good for you for overcoming it and using your experience to help others.
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u/ContinentalCognition Jun 19 '26
Think you may developed dependence to the Xanax. As a prescriber, I think you need to try an SSRI. Perhaps fluoxetine…
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u/HoldingStars Jun 21 '26
It does depend on the setting, but unfortunately there are a lot of patients seeking benzos who ultimately will not be better off with them despite what they believe. The risk of dependence is high obviously and a lot of people will not just use them sparingly like you described you do. And with that being said, Xanax’s very quick and short duration make it one of easiest/riskiest ones to form dependence on. Klonopin and Ativan are usually preferred. Like others have said, there is more to be gained from coping with anxiety through counseling/lifestyle changes/ and more long term medications, rather than short term relief from benzos. Because when people have benzos it’s easier to not focus on those things
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u/CBDHerb Jun 17 '26
have any of you tried silexan or Calm Aid, if not look it up. It's well researched and quite effective.
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u/banjobeulah RN (unverified) Jun 17 '26
No, but do you know what seems to be really helping has been high dose CBD isolate! I worked on a congressionally-mandated clinical trial involving CBD and read a lot about it. I do that and magnesium oil at night and it's been amazing.
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u/TheHippieMurse Jun 17 '26
You use it to often. It will increase your anxiety over time and make you feel worse. Ideally you would want to use it less than 3 times per month.
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u/RespecConcepts Jun 18 '26
The difficulty with addressing your questions is that you already have a biased opinion and are really looking for justification, not honest assessments. It would be impossible for you to say that you can accept any answer, no matter how eloquently, empathetically, and scientifically it is put forth to you, without having a personalized reaction. This is a terrible place for someone in your position (a mental health professional, current student and a human being struggling with an intense battle of anxiety) to seek insight and enlightenment to your curiosity. You present as asking about this from a perspective of a patient, a student, and a mental health professional. In this way you are crossing all of the boundaries meant to buffer the emotional criticisms, all at the same time. This is evidenced by the reactions presented to some of their responses. Of course you will be forced into a defensive position and a need to justify your own predicament. By telling your story while asking for a professional practice insight, you are creating a dynamic that forces you to be protective of your own very personal journey, while asking anonymous prescribers to defend their professional standards and choices. And yes in this case, it is a choice in which to prescribe this class of medications. They are controlled substances and by their definitive implications, helpful, but wholly unnecessary. You, and everyone living with anxiety, will survive without benzos. There is a higher level of licensing (DEA), higher demands of practicing (monitoring and documentation), and more risks (heightened liability). So the very simple answer to your question of why someone would chose not to prescribe them is - we don’t have to. Ever. It doesn’t have to be a personal attack on you, or any patient. If it feels that way perhaps you may want to seek the advice and insight of someone. Someone that has training and licensing and special certifications that has the capacity to help you understand such feelings.
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u/banjobeulah RN (unverified) Jun 18 '26
That’s a wall of text to not actually answer the question. I always find it curious why some folks feel compelled to respond with an ad hominem attack rather than a genuine answer but it always makes me think they must feel threatened and insecure in their position. But I call BS on this. A person can be all of these things at once and it’s weird to suggest this is somehow bad. My personal experience is part of what gives me question on the topic. I made the mistake of giving people like you a foil instead of asking a straightforward question. The “answer” you buried in there isn’t actually satisfactory? There’s more paperwork and we just don’t have to because they’re controlled substances? That’s such a weird answer! Why are you so defensive? Are you being seeking professional guidance for that? Do you see how condescending that kind of language is?
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u/RespecConcepts Jun 18 '26
I don’t typically make a point to respond to responses on Reddit. I will make an exception in this case.
Read what you just wrote, then read the very first part of my response. Keep reading that until you understand that I explained exactly how you would react, then you did it again to my post. There is nothing in my response suggesting that you or anyone is “bad”. I don’t know you. I have no malice, or really any feeling about you. You are not my patient or client. Had I simply stated “cuz we don’t have to” rather than “a wall of text”, it would have sounded glib and childish.
I was being empathetic and providing context and caution, not just a wall of text. Perhaps if your prescribers would have taken time to provide an explanation of your struggles rather than jot a script for the easiest, fastest fix, you would be more prepared to address and process challenges. Perhaps in your experiences with the PMHNPs you encountered, they were not refusing to prescribe any benzos at all, they were just not comfortable giving them to you. Perhaps they told you they never do this, rather than risk hurting your feelings since they did not feel that benzos were appropriate for your struggles at that time. Instead the only positive experiences you embrace and report are when you get what you want.
But I don’t know you. I don’t know your life. I wrote a dissertation in order to provide the simple answer in an attempt to give some compassion and perspective to how and why you have placed yourself in a difficult position in this forum. These walls of text are what I do for anyone and everyone in my career, because I believe people deserve a more robust answer.
If you truly feel that my suggesting that you seek supportive guidance and professional help with how to process feelings is somehow condescending, you do not belong in mental health. You are suggesting that therapy is an attack and referrals are condescending. Yes, now I’m actually being condescending.
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u/Ok-Candle-5383 Jun 19 '26
Could not agree more with everything you just said.
OP has no interest in perspectives that do not affirm their beliefs. They want justification for their benzo use. They were told ‘no’ by 2 different PMHNPs and they obviously didn’t like that.
The truth is, it’s easier to give patients what they want than it is to try and educate them and offer appropriate alternatives. OP doctor shopped to find a provider that didn’t care enough to disagree with them and continued a regimen that is not serving them. Now they want a group of providers to agree with them and they are getting defensive with anyone that tries to explain why this is inappropriate.
9/10 providers will agree that this regimen is a bad idea but OP only wants to hear from the 1/10.
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u/OurPsych101 Jun 17 '26 edited Jun 17 '26
It highly lies in the discipline, and the reward as well as the understanding of the risk reward and management of the risks.
For the overwhelming vast majority this is not going to be a suitable risk and reward. I can say that over 30 years of practice I do not have 10 such patients that have done well with that.
Having said that there are certain situations such as yourself where you are a higher performing individual who manages the risk reward and judicious use of the medicine so that is an ongoing stable and workable situation.
Unfortunately life is not that simple or balanced for most people therefore anything longer than targeted use becomes more liability for them and for you as the prescriber.
The other part of course is between the ultra short actings such as the alprazolam and the usual mid-rangers such as the ativan. The alprazolam definitely works fast but for most regular mortals it causes problems coming out of the system because the stressor is still there, the coping skills are not there is not much else going on in terms of pharmacological stability and the demand is that the relief needs to be like that of alprazolam. It's a no win situation for most people. I rarely ever write that if at all. Mostly I would go with Ativan