1 00:00:15,410 --> 00:00:15,890 Speaker 1: Pushkin. 2 00:00:20,330 --> 00:00:24,570 Speaker 2: A warning before we start. This episode mentions death by suicide. 3 00:00:25,010 --> 00:00:28,370 Speaker 2: If you're suffering emotional distress or you're having suicidal thoughts. 4 00:00:28,610 --> 00:00:31,890 Speaker 2: Support is available, for example, from the nine eight eight 5 00:00:32,010 --> 00:00:35,370 Speaker 2: Suicide and Crisis Lifeline in the US or from the 6 00:00:35,370 --> 00:00:41,130 Speaker 2: Samaritans in the UK. Taking a look at world events, 7 00:00:41,650 --> 00:00:45,650 Speaker 2: anxiety is a fairly reasonable position to take. But when 8 00:00:45,690 --> 00:00:50,610 Speaker 2: does anxiety crossover from a rational, evolutionary response to a 9 00:00:50,650 --> 00:00:56,090 Speaker 2: devastating medical condition, and what happens when the treatments work 10 00:00:56,130 --> 00:00:59,770 Speaker 2: a little bit too well. This episode comes to you 11 00:00:59,890 --> 00:01:03,370 Speaker 2: from the new podcast Drug Story, which looks at some 12 00:01:03,410 --> 00:01:06,530 Speaker 2: of our most common conditions how they affect people, then 13 00:01:06,650 --> 00:01:09,650 Speaker 2: examines the drugs that are supposed to help that come 14 00:01:09,770 --> 00:01:12,770 Speaker 2: with their own list of side effects and of course, 15 00:01:13,330 --> 00:01:17,970 Speaker 2: cautioned me tales. In this episode on Xanax and anxiety, 16 00:01:18,450 --> 00:01:22,850 Speaker 2: host Thomas Getz asks why the decade of anxiety has 17 00:01:22,930 --> 00:01:27,330 Speaker 2: lasted forty years, steps back to ancient Greece and explores 18 00:01:27,370 --> 00:01:29,530 Speaker 2: how a drug meant to help has become one of 19 00:01:29,570 --> 00:01:34,330 Speaker 2: the most abused, most counterfeited drugs in the world. Enjoy 20 00:01:34,370 --> 00:01:36,370 Speaker 2: the episode, and if you want to hear more, you 21 00:01:36,410 --> 00:01:45,170 Speaker 2: can find Drug Story wherever you get your podcasts. 22 00:01:45,410 --> 00:01:48,370 Speaker 3: I was in my apartment and it was morning. My 23 00:01:48,490 --> 00:01:51,050 Speaker 3: husband had left for work, and I was waiting for 24 00:01:51,090 --> 00:01:53,850 Speaker 3: the babysitter, and I live in New York City, and 25 00:01:55,330 --> 00:01:57,410 Speaker 3: I thought I was dying. I thought I was having 26 00:01:57,410 --> 00:02:00,890 Speaker 3: a heart attack. I started racing, like I needed to 27 00:02:00,930 --> 00:02:04,210 Speaker 3: get out of my skin and run away. And the 28 00:02:04,290 --> 00:02:06,850 Speaker 3: babysitter was late, so I put the kids in the 29 00:02:06,850 --> 00:02:09,050 Speaker 3: stroller because I had to get outside. I was afraid 30 00:02:09,330 --> 00:02:12,330 Speaker 3: of dying in front of them. And once I was 31 00:02:12,370 --> 00:02:14,490 Speaker 3: on the street, I ran into the babies that I 32 00:02:14,530 --> 00:02:18,090 Speaker 3: gave her the kids, and I ran into a friend 33 00:02:18,330 --> 00:02:20,530 Speaker 3: who seemed to know what was going on because he 34 00:02:20,610 --> 00:02:23,450 Speaker 3: suffers from anxiety as well, and he got me in 35 00:02:23,450 --> 00:02:24,410 Speaker 3: a cab and he took me. 36 00:02:24,370 --> 00:02:27,530 Speaker 1: To my doctor. This is Martha. 37 00:02:28,290 --> 00:02:31,650 Speaker 3: My name is Martha McPhee. I am sixty years old, 38 00:02:32,050 --> 00:02:36,850 Speaker 3: and I took XANX for about sixteen or seventeen years. 39 00:02:36,610 --> 00:02:37,610 Speaker 1: As you may have guessed. 40 00:02:37,930 --> 00:02:41,610 Speaker 4: Martha is describing her first panic attack back in two 41 00:02:41,650 --> 00:02:42,290 Speaker 4: thousand and six. 42 00:02:43,250 --> 00:02:45,930 Speaker 3: And it was the first one I had ever had, 43 00:02:46,570 --> 00:02:49,370 Speaker 3: and he gave me a prescription for xanax. Then I 44 00:02:49,410 --> 00:02:53,370 Speaker 3: had another one in the subway and that really freaked 45 00:02:53,410 --> 00:02:55,810 Speaker 3: me out. I didn't want to die down there again. 46 00:02:55,890 --> 00:02:59,410 Speaker 3: I thought it was it was like presenting what I 47 00:02:59,410 --> 00:03:02,050 Speaker 3: imagined maybe a heart attack was. But I didn't have 48 00:03:02,130 --> 00:03:04,330 Speaker 3: pain in my chest or anything. But I got out 49 00:03:04,330 --> 00:03:06,450 Speaker 3: of the subway and I remembered the xan x and 50 00:03:06,490 --> 00:03:09,890 Speaker 3: I went home and I took it. It calmed me 51 00:03:10,010 --> 00:03:14,370 Speaker 3: right down. Maybe a few months later I needed one, 52 00:03:14,450 --> 00:03:17,130 Speaker 3: and then a few months after that, and it sort 53 00:03:17,130 --> 00:03:21,330 Speaker 3: of developed slowly. And I've always had a problem sleeping, 54 00:03:21,730 --> 00:03:24,530 Speaker 3: and I discovered along the way early on that if 55 00:03:24,570 --> 00:03:27,170 Speaker 3: I just take a little bite of the xanax in 56 00:03:27,210 --> 00:03:29,330 Speaker 3: the middle of the night when I woke up racing 57 00:03:29,450 --> 00:03:32,530 Speaker 3: for no particular reason, you know that I'd go back 58 00:03:32,530 --> 00:03:34,490 Speaker 3: to sleep and have a decent night of sleep and 59 00:03:34,530 --> 00:03:38,210 Speaker 3: wake up and be totally fine and not hungover in 60 00:03:38,250 --> 00:03:41,130 Speaker 3: any way like sometimes happens if you take like a 61 00:03:41,290 --> 00:03:46,050 Speaker 3: tail and LPM or whatever. And I just slowly started 62 00:03:46,330 --> 00:03:46,650 Speaker 3: using it. 63 00:03:46,690 --> 00:03:48,210 Speaker 1: I never took very much. 64 00:03:48,890 --> 00:03:51,850 Speaker 3: And when i'd ask doctors early on, they'd say, oh, 65 00:03:51,850 --> 00:03:55,050 Speaker 3: you know, aartha, you need to sleep, and you don't 66 00:03:55,050 --> 00:03:58,730 Speaker 3: take much. I would take like a tiny bite of it, 67 00:03:58,810 --> 00:04:01,850 Speaker 3: like a half a bite of the smallest dose, so 68 00:04:01,890 --> 00:04:07,010 Speaker 3: it seemed really benign to me, but it escalated. 69 00:04:08,890 --> 00:04:12,650 Speaker 4: Welcome to Drug Story, a podcast about drugs and the 70 00:04:12,650 --> 00:04:13,810 Speaker 4: diseases they treat. 71 00:04:14,650 --> 00:04:15,610 Speaker 1: I'm Thomas Getz. 72 00:04:16,850 --> 00:04:20,530 Speaker 4: Today's Drug Story is about al praslam, also known by 73 00:04:20,570 --> 00:04:23,810 Speaker 4: its brand name xanax. In fact, I'm going to call 74 00:04:23,850 --> 00:04:26,890 Speaker 4: it xanax most of the time today because xanax is 75 00:04:26,930 --> 00:04:29,450 Speaker 4: a lot easier to say than al praslam. 76 00:04:29,610 --> 00:04:30,730 Speaker 5: Al praslam. 77 00:04:31,050 --> 00:04:35,570 Speaker 4: Anyway, Martha wasn't abusing xanax. She was taking it as 78 00:04:35,810 --> 00:04:41,090 Speaker 4: directed as her doctors had recommended, but they weren't prescribing 79 00:04:41,130 --> 00:04:44,490 Speaker 4: it as recommended in two thousand and six, when she 80 00:04:44,570 --> 00:04:47,770 Speaker 4: started taking the drug. The official guidance from the FDA 81 00:04:48,090 --> 00:04:50,410 Speaker 4: suggests that people should limit their use of xenx to 82 00:04:50,570 --> 00:04:55,130 Speaker 4: no more than four months, But for Martha, four months 83 00:04:55,170 --> 00:04:58,850 Speaker 4: turned into another sixteen years of once a night nibbles. 84 00:05:00,210 --> 00:05:03,410 Speaker 3: I didn't like the way I felt, and I got 85 00:05:03,450 --> 00:05:05,610 Speaker 3: a new doctor and told her what was going on, 86 00:05:05,650 --> 00:05:10,450 Speaker 3: and she said, you're having rebound anxiety, because that anxiety 87 00:05:10,570 --> 00:05:14,130 Speaker 3: doesn't go away when you take the xenex. It's stored 88 00:05:14,250 --> 00:05:17,370 Speaker 3: and then it comes back and comes out, sort of 89 00:05:17,410 --> 00:05:20,650 Speaker 3: like with a vengeance and that made sense to me. 90 00:05:20,690 --> 00:05:23,610 Speaker 3: And when that got in my head, then I became 91 00:05:23,730 --> 00:05:28,450 Speaker 3: much more determined to get off it. I had two doctors, 92 00:05:28,650 --> 00:05:32,010 Speaker 3: and one was a therapist and one was a medical doctor. 93 00:05:32,570 --> 00:05:35,090 Speaker 3: Both said to me, you've got to stop this. It's 94 00:05:35,130 --> 00:05:37,490 Speaker 3: not sustainable, it's not healthy, it's not good for you, 95 00:05:38,010 --> 00:05:42,330 Speaker 3: and this is why you're having that response rebound to anxiety. 96 00:05:42,930 --> 00:05:47,330 Speaker 3: And four months later I stopped it. But what I 97 00:05:47,370 --> 00:05:50,730 Speaker 3: did was I went cold turkey because I had tried 98 00:05:50,810 --> 00:05:53,170 Speaker 3: tapering before it hadn't worked. 99 00:05:54,410 --> 00:05:57,250 Speaker 4: Now, cold turkey is not how you were supposed to 100 00:05:57,330 --> 00:06:03,250 Speaker 4: stop taking xanax, especially after sixteen years. Martha acknowledges as much. 101 00:06:03,530 --> 00:06:05,610 Speaker 4: She said so in a terrific essay she wrote a 102 00:06:05,650 --> 00:06:07,570 Speaker 4: couple of years ago for Vogue magazine. 103 00:06:08,650 --> 00:06:11,090 Speaker 3: It's just sometimes the way I am, I just have 104 00:06:11,170 --> 00:06:13,250 Speaker 3: to do it or it's never going to get done. 105 00:06:13,930 --> 00:06:16,250 Speaker 3: And I was bouncing off the walls. 106 00:06:16,450 --> 00:06:19,930 Speaker 4: It was awful, right, I mean, you still have anxiety? 107 00:06:19,930 --> 00:06:20,690 Speaker 4: How do you cope with it? 108 00:06:20,730 --> 00:06:20,930 Speaker 6: Now? 109 00:06:21,770 --> 00:06:25,610 Speaker 3: My sisters this chorus in my life, They say, oh 110 00:06:25,610 --> 00:06:28,210 Speaker 3: my god, you're a different person. You're so much calmer. 111 00:06:28,730 --> 00:06:31,610 Speaker 3: I can still get, you know, stirred up. But I 112 00:06:31,650 --> 00:06:33,970 Speaker 3: don't get into a state that I stay in. 113 00:06:35,170 --> 00:06:36,730 Speaker 1: Xenx is a curious drug. 114 00:06:37,490 --> 00:06:40,330 Speaker 4: It was approved almost forty five years ago, way back 115 00:06:40,370 --> 00:06:43,330 Speaker 4: in nineteen eighty one, but in many ways, Xenx is 116 00:06:43,370 --> 00:06:46,730 Speaker 4: hitting its peak today, well into the twenty first century. 117 00:06:47,810 --> 00:06:51,530 Speaker 4: Xenax is a perfectly contemporary drug very much of the moment. 118 00:06:52,170 --> 00:06:56,170 Speaker 4: It is widely prescribed and so widely used, often illegally, 119 00:06:56,650 --> 00:06:59,450 Speaker 4: that it is one of the most counterfeited drugs on 120 00:06:59,490 --> 00:07:04,490 Speaker 4: the planet. Xenix is commonly known as a tranquilizer, a 121 00:07:04,610 --> 00:07:06,610 Speaker 4: term that's no longer officially used by the Food and 122 00:07:06,650 --> 00:07:09,930 Speaker 4: Drug Administration because there are more precise, more technical ways 123 00:07:09,970 --> 00:07:14,090 Speaker 4: to classify drugs. But tranquilizer is a term that's still 124 00:07:14,170 --> 00:07:17,170 Speaker 4: used here and there, and it's worth tugging at a bit. 125 00:07:18,250 --> 00:07:21,690 Speaker 4: The root word, after all, is tranquil That's what people 126 00:07:21,730 --> 00:07:27,490 Speaker 4: really want from these drugs, tranquility, calm, peace. But there's 127 00:07:27,530 --> 00:07:31,370 Speaker 4: another word in there, tranquilize, which means something a bit 128 00:07:31,410 --> 00:07:35,930 Speaker 4: different to tranquilize is to make calm, like you know, 129 00:07:35,970 --> 00:07:38,810 Speaker 4: to inject a grizzly bear or a mountain lion or 130 00:07:38,810 --> 00:07:41,370 Speaker 4: a t rex with something like ketamine that just knocks 131 00:07:41,370 --> 00:07:44,330 Speaker 4: them out. It's a kind of sleep, but it's not 132 00:07:44,370 --> 00:07:49,930 Speaker 4: exactly peace. When we call prescription drugs tranquilizers, we kind 133 00:07:49,930 --> 00:07:53,170 Speaker 4: of mean both things at once. People take these drugs 134 00:07:53,170 --> 00:07:55,890 Speaker 4: to fine calm, but they also take them to just 135 00:07:56,010 --> 00:08:03,050 Speaker 4: make things go away. Even if we can't attain tranquility exactly, well, 136 00:08:03,090 --> 00:08:05,930 Speaker 4: we might as well be tranquilized. And the thing about 137 00:08:06,010 --> 00:08:09,610 Speaker 4: Xanax and other drugs like it, they're called benzodiazep or 138 00:08:09,690 --> 00:08:14,090 Speaker 4: benzos for short. These drugs really do work as intended. 139 00:08:14,810 --> 00:08:18,730 Speaker 4: They do the trick. Compared to antidepressants, which can take 140 00:08:18,770 --> 00:08:22,250 Speaker 4: weeks to take effect, drugs like xanax work right away. 141 00:08:23,210 --> 00:08:28,330 Speaker 4: They slow down our nervous systems. They amplify a neurotransmitter 142 00:08:28,410 --> 00:08:32,050 Speaker 4: known as gabba, which lowers our stress, and we just 143 00:08:32,490 --> 00:08:33,970 Speaker 4: feel relaxed. 144 00:08:35,370 --> 00:08:39,810 Speaker 7: If someone's having anxiety symptoms and they are given a 145 00:08:39,890 --> 00:08:45,290 Speaker 7: benzodaz apine that they take as a pill, they're very 146 00:08:45,410 --> 00:08:49,050 Speaker 7: likely to start feeling relief within thirty minutes and quite 147 00:08:49,050 --> 00:08:53,010 Speaker 7: extensive relief within an hour or two, and it does 148 00:08:53,050 --> 00:08:54,570 Speaker 7: feel like a miracle cure. 149 00:08:55,770 --> 00:08:59,730 Speaker 4: This is doctor Andrew Saxon. He's a psychiatrist and he's 150 00:08:59,730 --> 00:09:01,810 Speaker 4: going to help guide us along in this episode. 151 00:09:02,850 --> 00:09:08,050 Speaker 7: I'm a professor emeritus in the Department of Psychiatry and 152 00:09:08,050 --> 00:09:12,810 Speaker 7: Behavioral Science at the University of Washington School of Medicine 153 00:09:12,930 --> 00:09:14,170 Speaker 7: in Seattle, Washington. 154 00:09:15,330 --> 00:09:19,570 Speaker 4: So a miracle cure, that's exactly what we're looking for 155 00:09:19,570 --> 00:09:20,730 Speaker 4: for medicine, right. 156 00:09:21,770 --> 00:09:25,090 Speaker 7: We should also emphasize that it's a miracle for the 157 00:09:25,130 --> 00:09:29,930 Speaker 7: clinician prescribing them, because there are so many both acute 158 00:09:29,930 --> 00:09:33,730 Speaker 7: and chronic illnesses that we as physicians deal with where 159 00:09:33,970 --> 00:09:37,930 Speaker 7: we don't have a treatment that's ideal or a treatment 160 00:09:38,010 --> 00:09:41,970 Speaker 7: that very promptly and thoroughly alleviates the symptoms. And so 161 00:09:42,090 --> 00:09:45,330 Speaker 7: when we see that, we feel a sense of gratification, 162 00:09:45,730 --> 00:09:49,170 Speaker 7: and the clinician feels relief, Oh, I've helped this patient 163 00:09:49,250 --> 00:09:52,330 Speaker 7: and I'm doing my job. But that's for both the 164 00:09:52,370 --> 00:09:55,250 Speaker 7: patient and clinician. It's a little bit of a false 165 00:09:55,690 --> 00:10:01,010 Speaker 7: sense of relief because anxiety disorders are general a chronic condition. 166 00:10:01,130 --> 00:10:05,050 Speaker 7: Certainly a single panic attack is an acute condition, but 167 00:10:05,090 --> 00:10:07,330 Speaker 7: for people have panic disorder, they're going to be getting 168 00:10:07,370 --> 00:10:11,370 Speaker 7: the attacks repeatedly, and so it seems like a victory. 169 00:10:11,490 --> 00:10:14,730 Speaker 1: Oh, I've immediately made. 170 00:10:14,450 --> 00:10:18,050 Speaker 7: The person feel better, And it's a false victory because 171 00:10:18,130 --> 00:10:21,650 Speaker 7: in the long run, we haven't really solved the problem. 172 00:10:22,170 --> 00:10:25,730 Speaker 4: Despite its reputation as a fun drug that people take 173 00:10:25,770 --> 00:10:30,610 Speaker 4: almost casually, Xenix is actually an extremely dangerous drug because 174 00:10:30,610 --> 00:10:33,410 Speaker 4: of how easily abused it can be and how deadly 175 00:10:33,450 --> 00:10:36,570 Speaker 4: it can be when it is abused. So that's what 176 00:10:36,610 --> 00:10:39,570 Speaker 4: we're going to get into today. We're going to explore 177 00:10:39,690 --> 00:10:43,810 Speaker 4: this emotion we call anxiety. It's part of human nature, 178 00:10:44,290 --> 00:10:48,010 Speaker 4: but now it can also be a disorder, a diagnosable, 179 00:10:48,290 --> 00:10:53,090 Speaker 4: treatable medical condition. We're going to travel back to ancient 180 00:10:53,090 --> 00:10:56,570 Speaker 4: Babylon and ancient Greece where they were onto something that 181 00:10:56,650 --> 00:10:59,890 Speaker 4: helped ward off anxiety three thousand years ago, and it's 182 00:10:59,890 --> 00:11:02,890 Speaker 4: starting to come back in vogue today. And we'll learn 183 00:11:02,890 --> 00:11:05,450 Speaker 4: about xanax, a drug that was thought to be harmless 184 00:11:05,850 --> 00:11:07,970 Speaker 4: until it turned out to be a lot more complicated 185 00:11:08,210 --> 00:11:11,570 Speaker 4: and a lot more danger then thought at first. We'll 186 00:11:11,610 --> 00:11:13,970 Speaker 4: get into all of that coming up after the break. 187 00:11:17,330 --> 00:11:19,450 Speaker 4: And I want to say upfront, if you feel you 188 00:11:19,610 --> 00:11:22,690 Speaker 4: need help or are in crisis, there are people ready 189 00:11:22,770 --> 00:11:26,010 Speaker 4: right now to help you. Just dial nine to eight eight. 190 00:11:26,770 --> 00:11:30,410 Speaker 4: That's the nine eight eight lifeline. Counselors are there waiting 191 00:11:30,450 --> 00:11:33,370 Speaker 4: to talk, ready to help. You can call her text 192 00:11:33,450 --> 00:11:35,490 Speaker 4: right now nine eight eight. 193 00:11:39,090 --> 00:11:41,090 Speaker 1: Hi Hang anxiety. 194 00:11:43,050 --> 00:11:45,090 Speaker 8: Whenever you're near. 195 00:11:47,410 --> 00:11:53,650 Speaker 1: Hiang anxiety, it's you that I feel. 196 00:11:55,250 --> 00:11:58,330 Speaker 4: Welcome back, and thank you to Meil Brooks for that interlude. 197 00:11:59,130 --> 00:12:03,250 Speaker 4: Each episode of Drug Story comes in three parts, the diagnosis, 198 00:12:03,530 --> 00:12:08,410 Speaker 4: the prescription, and side effects. This is part one. The diagnosis. 199 00:12:08,890 --> 00:12:11,410 Speaker 4: We look at the condition behind the drug and how 200 00:12:11,450 --> 00:12:15,490 Speaker 4: that condition emerged in modern days. In today's episode, we're 201 00:12:15,490 --> 00:12:22,330 Speaker 4: talking about anxiety. Anxiety is a universal, exceptionally common emotion 202 00:12:23,210 --> 00:12:26,850 Speaker 4: and evolutionary terms. Anxiety is a good thing that helps 203 00:12:26,890 --> 00:12:31,650 Speaker 4: us avoid danger. It is quite literally self preservation. To 204 00:12:31,770 --> 00:12:35,130 Speaker 4: use a cliche, we feel fear when we see a bear, 205 00:12:35,690 --> 00:12:38,130 Speaker 4: and we feel anxiety when we think a bear is 206 00:12:38,210 --> 00:12:39,250 Speaker 4: hiding around the corner. 207 00:12:40,890 --> 00:12:48,570 Speaker 7: Anxiety, well, it's really a primitive reaction that was evolutionarily 208 00:12:48,650 --> 00:12:53,330 Speaker 7: helpful and very appropriate in more primitive human societies when 209 00:12:53,370 --> 00:12:57,570 Speaker 7: there were a lot of very physical dangers and threats 210 00:12:57,610 --> 00:13:01,250 Speaker 7: to our well being and life that were very immediate, 211 00:13:01,810 --> 00:13:05,290 Speaker 7: and if you had an anxiety reaction, which is essentially 212 00:13:05,290 --> 00:13:08,370 Speaker 7: a fight or flight reaction that gave your body a 213 00:13:08,410 --> 00:13:11,530 Speaker 7: surge of a dream and you were prepared either to 214 00:13:11,770 --> 00:13:15,610 Speaker 7: run away from the danger or confront the danger to 215 00:13:15,690 --> 00:13:18,610 Speaker 7: your fullest capacity, with all your systems ready to go. 216 00:13:19,210 --> 00:13:22,730 Speaker 1: This is the scene a bear in the woods. Yes, yes, exactly. 217 00:13:23,330 --> 00:13:27,690 Speaker 7: And much of our anxiety in modern life has to 218 00:13:27,730 --> 00:13:29,570 Speaker 7: do with things where we don't need a fight or 219 00:13:29,610 --> 00:13:33,170 Speaker 7: flight response. We need a more measured This is not 220 00:13:33,290 --> 00:13:36,370 Speaker 7: life threatening. I can handle this. I need to think 221 00:13:36,450 --> 00:13:40,730 Speaker 7: through what is the best approach. But because we're programmed 222 00:13:40,770 --> 00:13:42,690 Speaker 7: to have this fight or flight response, and for some 223 00:13:42,770 --> 00:13:49,570 Speaker 7: people it's more extreme than others, they get this anxiety response, 224 00:13:49,610 --> 00:13:51,210 Speaker 7: it's now maladaptive. 225 00:13:52,370 --> 00:13:55,530 Speaker 4: Even though we consider it a human emotion, anxiety is 226 00:13:55,570 --> 00:13:59,610 Speaker 4: not exclusively a human response. Lots of animals have a 227 00:13:59,650 --> 00:14:04,170 Speaker 4: defensive response to danger. Puffer Fish blow up, skunk spray, 228 00:14:04,290 --> 00:14:07,330 Speaker 4: squids release a burst of ink. Dogs and cats their 229 00:14:07,330 --> 00:14:11,970 Speaker 4: hair stands on it. Well, it just plays dead. And 230 00:14:12,090 --> 00:14:14,770 Speaker 4: many animals take this response to an extreme so that 231 00:14:14,810 --> 00:14:18,970 Speaker 4: it becomes a disorder. Think of dogs with separation anxiety, 232 00:14:19,490 --> 00:14:22,330 Speaker 4: or dogs that hide under the bed for hours after fireworks, 233 00:14:22,970 --> 00:14:25,250 Speaker 4: or lab rats that are removed from their mothers and 234 00:14:25,250 --> 00:14:30,770 Speaker 4: develop something like PTSD. In many ways, anxiety is almost 235 00:14:30,890 --> 00:14:34,450 Speaker 4: like an immune response. It's a physiological reaction that we 236 00:14:34,530 --> 00:14:37,610 Speaker 4: need to stay alive. And just like our immune system 237 00:14:37,650 --> 00:14:40,730 Speaker 4: can work against us, anxiety can also turn on us. 238 00:14:41,490 --> 00:14:45,170 Speaker 4: It can become toxic, a self inflicted harm. Like Martha 239 00:14:45,250 --> 00:14:48,410 Speaker 4: said earlier, a little bit of anxiety is helpful, it 240 00:14:48,450 --> 00:14:53,210 Speaker 4: keeps us safe. Too much anxiety disables us. It renders 241 00:14:53,250 --> 00:14:58,050 Speaker 4: us unable to live our lives. For humans, the physiologic 242 00:14:58,130 --> 00:15:02,130 Speaker 4: response to anxiety is easily measured. The brain releases stress 243 00:15:02,130 --> 00:15:05,850 Speaker 4: hormones adrenaline and cortisol into the bloodstream, and that causes 244 00:15:05,890 --> 00:15:08,090 Speaker 4: our heart to speed up and our breathing to increase. 245 00:15:09,090 --> 00:15:12,690 Speaker 4: Miss Titan, and we begin to sweat. If there is 246 00:15:12,730 --> 00:15:15,650 Speaker 4: a bear nearby, this is all good. But if there's 247 00:15:15,690 --> 00:15:19,090 Speaker 4: no threat, and if we continue to fret, that's called 248 00:15:19,290 --> 00:15:22,890 Speaker 4: a panic attack. Like Martha described, it can feel like 249 00:15:22,890 --> 00:15:25,810 Speaker 4: a heart attack, but it's usually not deadly at all. 250 00:15:26,850 --> 00:15:29,810 Speaker 4: This is when an ordinary emotion can become a disorder, 251 00:15:29,890 --> 00:15:35,010 Speaker 4: a condition. Anxiety in this sense as a disorder. Well, 252 00:15:35,050 --> 00:15:38,490 Speaker 4: that seems like a very modern condition. It seems to 253 00:15:38,490 --> 00:15:42,570 Speaker 4: reflect a particularly contemporary problem of coping with the stress 254 00:15:42,610 --> 00:15:45,130 Speaker 4: and frenzy and demands of life in the twentieth or 255 00:15:45,130 --> 00:15:48,970 Speaker 4: twenty first century. In recent decades, there has been a 256 00:15:48,970 --> 00:15:54,930 Speaker 4: steady stream of best selling books about anxiety, Unwinding, Anxiety 257 00:15:55,170 --> 00:15:59,570 Speaker 4: Notes on a nervous planet, The body keeps score the 258 00:15:59,610 --> 00:16:04,810 Speaker 4: anxious generation, Hope and help for your nerves. Try to 259 00:16:04,810 --> 00:16:08,570 Speaker 4: stop worrying and start living. That last one was written 260 00:16:08,570 --> 00:16:11,370 Speaker 4: in nineteen forty eight by Dale Carnegie, who was most 261 00:16:11,410 --> 00:16:14,050 Speaker 4: famous for his other how to book, How to Make 262 00:16:14,090 --> 00:16:18,930 Speaker 4: Friends and Influence People. But anxiety goes back way back, 263 00:16:19,330 --> 00:16:22,770 Speaker 4: for is long or longer than humans have written things down. 264 00:16:23,570 --> 00:16:26,930 Speaker 4: A four thousand year old tablet from ancient Babylonia suggests 265 00:16:26,930 --> 00:16:30,170 Speaker 4: that people who experience frequent nervous breakdowns and who live 266 00:16:30,170 --> 00:16:33,410 Speaker 4: in constant fear should consider a meal of dates and 267 00:16:33,490 --> 00:16:39,130 Speaker 4: mutton fat. The ancient Greeks, well, they seemed very anxious, 268 00:16:39,610 --> 00:16:42,810 Speaker 4: or at least very aware that anxiety could be a problem, 269 00:16:43,170 --> 00:16:48,050 Speaker 4: especially the Stoic philosophers Cicero and Seneca. Stoicism was a 270 00:16:48,050 --> 00:16:51,690 Speaker 4: dominant philosophy in ancient Greece and Rome for only about 271 00:16:51,690 --> 00:16:55,930 Speaker 4: six hundred years, and today Stoicism is going through something 272 00:16:55,970 --> 00:16:59,450 Speaker 4: of a vogue again. But contrary to how the word 273 00:16:59,490 --> 00:17:02,970 Speaker 4: stoicism is sometimes used, the philosophy does not suggest that 274 00:17:03,010 --> 00:17:07,130 Speaker 4: we suppress our emotions to swallow them down. Rather true 275 00:17:07,250 --> 00:17:09,970 Speaker 4: stoicism as a practice of life offers a way to 276 00:17:10,050 --> 00:17:11,490 Speaker 4: process our fears. 277 00:17:11,130 --> 00:17:13,730 Speaker 1: And warriors to cope with them. 278 00:17:14,330 --> 00:17:17,290 Speaker 4: Among Seneca's pearls of wisdom was to note that there's 279 00:17:17,290 --> 00:17:20,610 Speaker 4: a difference between a state of anxiety and a trait 280 00:17:20,770 --> 00:17:25,370 Speaker 4: of anxiety. As a state, it's a normal response, but 281 00:17:25,450 --> 00:17:28,770 Speaker 4: as a trait, a day in, day out way of being, 282 00:17:29,530 --> 00:17:32,370 Speaker 4: anxiety could be understood as a sickness or a disease, 283 00:17:32,690 --> 00:17:37,650 Speaker 4: a condition that could be diagnosed and hopefully treated. The 284 00:17:37,690 --> 00:17:40,890 Speaker 4: stoics add some very useful practical advice on how to 285 00:17:40,930 --> 00:17:44,290 Speaker 4: treat life's ups and downs. In his book on the 286 00:17:44,290 --> 00:17:48,130 Speaker 4: Shortness of Life, Seneca suggested that he makes his life 287 00:17:48,170 --> 00:17:52,810 Speaker 4: long by combining all times into one, which is basically 288 00:17:52,850 --> 00:17:55,930 Speaker 4: suggesting that we focus on the present moment. And that 289 00:17:56,010 --> 00:18:00,810 Speaker 4: sounds a lot like what today we call mindfulness and 290 00:18:00,930 --> 00:18:05,010 Speaker 4: in fact, stoicism is a cornerstone of cognitive behavioral therapy 291 00:18:05,530 --> 00:18:10,090 Speaker 4: or CBT, a very effective, highly structured form of psychotherapy 292 00:18:10,250 --> 00:18:12,650 Speaker 4: that was developed in the nineteen sixties and it's come 293 00:18:12,690 --> 00:18:16,370 Speaker 4: into wide practice over the past twenty years. CBT is 294 00:18:16,490 --> 00:18:21,170 Speaker 4: proven to be effective in treating depression, anxiety, PTSD, insomnia, 295 00:18:21,210 --> 00:18:26,530 Speaker 4: and eating disorders. Anxiety wasn't exactly considered a medical problem 296 00:18:26,650 --> 00:18:30,890 Speaker 4: until nineteen fifty two. That's when the American Psychiatric Association 297 00:18:31,210 --> 00:18:37,770 Speaker 4: published the first Diagnostic and Statistical Manual, the DSM. Today, 298 00:18:38,010 --> 00:18:41,210 Speaker 4: the DSM is known as the Bible of psychiatry, the 299 00:18:41,250 --> 00:18:45,010 Speaker 4: text that codifies and categorizes all things mental and psychological. 300 00:18:46,410 --> 00:18:48,530 Speaker 4: The first edition of the DSM was an attempt to 301 00:18:48,530 --> 00:18:52,370 Speaker 4: classify mental disorders of all types, from psychosis to what 302 00:18:52,410 --> 00:18:56,490 Speaker 4: we're called psychoneuroses. That's what anxiety was considered at the time, 303 00:18:57,410 --> 00:18:59,850 Speaker 4: and the need for an effective treatment grew after World 304 00:18:59,850 --> 00:19:03,730 Speaker 4: War II, as modern life itself seemed to be creating 305 00:19:03,770 --> 00:19:08,450 Speaker 4: more anxiety in the populace, particularly among American women. In 306 00:19:08,810 --> 00:19:13,810 Speaker 4: six Betty Frieden wrote her classic The Feminine Mystique. She 307 00:19:13,970 --> 00:19:16,650 Speaker 4: noted that in the years since World War two two 308 00:19:16,770 --> 00:19:20,210 Speaker 4: many women were complaining of being trapped by their lives, 309 00:19:20,890 --> 00:19:24,050 Speaker 4: facing the same struggles with anxiety and depression. 310 00:19:25,290 --> 00:19:28,650 Speaker 9: It is no longer possible to ignore that voice, to 311 00:19:28,730 --> 00:19:33,170 Speaker 9: dismiss the desperation of so many American women. New neuroses 312 00:19:33,210 --> 00:19:36,410 Speaker 9: are being seen among women, and problems as yet unnamed 313 00:19:36,410 --> 00:19:41,730 Speaker 9: as neuroses, which Freud and his followers did not predict. 314 00:19:42,570 --> 00:19:46,330 Speaker 4: This apparent rise in anxiety, or the rise in awareness 315 00:19:46,410 --> 00:19:50,530 Speaker 4: of anxiety, was accompanied by a rise in medications, especially 316 00:19:50,530 --> 00:19:55,050 Speaker 4: a new class of drugs called tranquilizers. The first was 317 00:19:55,050 --> 00:19:58,810 Speaker 4: a drug called Milltown. When it arrived in nineteen fifty five, 318 00:19:58,890 --> 00:20:04,170 Speaker 4: Milltown offered something few drugs ever had before, almost instantaneous relief. 319 00:20:06,050 --> 00:20:08,890 Speaker 4: As the ad said, it relaxed both mind and muscle. 320 00:20:09,770 --> 00:20:13,650 Speaker 4: In fact, it worked too well. After a few years, 321 00:20:13,810 --> 00:20:17,170 Speaker 4: it was reclassified as a sedative and removed from recommended 322 00:20:17,210 --> 00:20:21,810 Speaker 4: treatments for anxiety. By that time, though, a different kind 323 00:20:21,810 --> 00:20:26,370 Speaker 4: of drug had arrived, the barbiturates. Barbiturates had been invented 324 00:20:26,370 --> 00:20:29,570 Speaker 4: in nineteen oh three. They were sold then in chocolate 325 00:20:29,610 --> 00:20:33,410 Speaker 4: flavored tablets, but they reached their heyday in those frantic 326 00:20:33,450 --> 00:20:38,410 Speaker 4: days of nineteen sixties prosperity. At their peak, four billion 327 00:20:38,570 --> 00:20:41,890 Speaker 4: tablets were produced per year in the US alone. That 328 00:20:42,010 --> 00:20:46,290 Speaker 4: was enough to relax millions of adults every night. So 329 00:20:46,410 --> 00:20:49,970 Speaker 4: many people took barbiturates because they were so very effective. 330 00:20:50,730 --> 00:20:54,410 Speaker 4: They relieved symptoms of stress and caused cares to melt away. 331 00:20:55,410 --> 00:20:57,330 Speaker 4: But there was another side to these drugs too. 332 00:20:58,370 --> 00:21:00,810 Speaker 8: Because she can't throw a type by it through the windows, 333 00:21:00,810 --> 00:21:01,530 Speaker 8: she can't cry. 334 00:21:01,610 --> 00:21:02,570 Speaker 1: She needs the job. 335 00:21:03,130 --> 00:21:11,770 Speaker 8: But there's another way to gain relief. She's been to 336 00:21:11,810 --> 00:21:14,690 Speaker 8: a doctor and he's prescribed mile sedation to carry over 337 00:21:14,690 --> 00:21:20,210 Speaker 8: the rough points, and it works so not immediately, but 338 00:21:20,290 --> 00:21:22,610 Speaker 8: once she's gotten these little pills inside hers, she knows 339 00:21:22,650 --> 00:21:25,330 Speaker 8: that help is on the way. Half an hour from now, 340 00:21:25,330 --> 00:21:27,610 Speaker 8: she'll be as calm as a Supreme Court judge. 341 00:21:29,170 --> 00:21:33,730 Speaker 4: It was clear that barbiturates carried huge risks. Patients quickly 342 00:21:33,770 --> 00:21:36,570 Speaker 4: grew tolerant of them and needed ever larger doses to 343 00:21:36,570 --> 00:21:39,450 Speaker 4: have an effect, and this in turn created dependence and 344 00:21:39,530 --> 00:21:44,010 Speaker 4: even addiction. As early as nineteen forty seven, an article 345 00:21:44,010 --> 00:21:47,930 Speaker 4: in the Journal of the American Pharmaceutical Association called barbiturates 346 00:21:48,210 --> 00:21:51,370 Speaker 4: a blessing and a menace, and all of a sudden, 347 00:21:51,450 --> 00:21:54,730 Speaker 4: a new kind of overdose victim was showing up in hospitals, 348 00:21:55,010 --> 00:22:00,090 Speaker 4: not heroin junkies, but students and housewives. In nineteen sixty two, 349 00:22:00,290 --> 00:22:04,370 Speaker 4: Marilyn Monroe would become another casualty a barbiturate overdose at 350 00:22:04,450 --> 00:22:08,370 Speaker 4: just thirty six years old. Judy Garland died with barbittrits 351 00:22:08,410 --> 00:22:11,690 Speaker 4: in her system nineteen sixty nine. Jamie Hendrix, same thing 352 00:22:11,770 --> 00:22:16,130 Speaker 4: nineteen seventy. Most famous was probably the nineteen sixty seven 353 00:22:16,210 --> 00:22:19,530 Speaker 4: movie Valley of the Dolls, a camp classic based on 354 00:22:19,570 --> 00:22:23,170 Speaker 4: the best selling book by Jack Glen Suzanne Dolls. And 355 00:22:23,250 --> 00:22:26,570 Speaker 4: I just learned this wasn't describing the cast. It was 356 00:22:26,610 --> 00:22:29,530 Speaker 4: a slang term for barbiturate pills. 357 00:22:30,250 --> 00:22:33,170 Speaker 1: She took the red pills. Sure, I take, Dave. 358 00:22:33,250 --> 00:22:34,250 Speaker 10: I've got to get them sleep. 359 00:22:34,530 --> 00:22:36,370 Speaker 4: I've got to get up at five o'clock in the morning. 360 00:22:36,370 --> 00:22:39,970 Speaker 1: It sparkle, nearly sparkle. May you know it's bad to 361 00:22:40,010 --> 00:22:42,330 Speaker 1: take liquor with those pills? Stray work faster. 362 00:22:43,530 --> 00:22:46,450 Speaker 4: By the late nineteen sixties, it was apparent that barbiturates 363 00:22:46,450 --> 00:22:50,290 Speaker 4: were extremely risky, and in nineteen seventy one, a new law, 364 00:22:50,610 --> 00:22:55,010 Speaker 4: the US Controlled Substances Act, went into effect. Under the Act, 365 00:22:55,170 --> 00:22:59,850 Speaker 4: dangerous drugs, including narcotics, were classified as controlled substances. They 366 00:22:59,850 --> 00:23:03,370 Speaker 4: were divided into five categories or schedules, according to their 367 00:23:03,370 --> 00:23:08,810 Speaker 4: potential for abuse. Barbiturates were so dangerous that several were 368 00:23:08,810 --> 00:23:13,730 Speaker 4: cified as scheduled too, the same class as fentanyl, morphine, 369 00:23:14,130 --> 00:23:15,210 Speaker 4: and methamphetamines. 370 00:23:16,210 --> 00:23:19,130 Speaker 11: We can go into the depressants, or the downers as 371 00:23:19,130 --> 00:23:22,610 Speaker 11: they're known, and these are of course primarily the barbeturiates. 372 00:23:23,610 --> 00:23:28,250 Speaker 11: These are known as the red devils, the second als, 373 00:23:29,170 --> 00:23:34,010 Speaker 11: the nembutols or yellow jackets, see tu and alls or 374 00:23:34,130 --> 00:23:38,210 Speaker 11: rainbows and so forth. These are all, of course the 375 00:23:38,250 --> 00:23:41,690 Speaker 11: barbecurate drugs. They can be taken by mouth, or some 376 00:23:41,730 --> 00:23:44,490 Speaker 11: people prefer to take them out of the capsule and 377 00:23:44,570 --> 00:23:49,770 Speaker 11: give themselves the drug intravenously. Now, the barbecuriates have some 378 00:23:49,850 --> 00:23:52,690 Speaker 11: very severe problems with them. For one thing, they do 379 00:23:52,770 --> 00:23:56,730 Speaker 11: produce tolerance to a certain degree, and it is necessary 380 00:23:56,730 --> 00:23:58,490 Speaker 11: to take more and more of the drug to produce 381 00:23:58,530 --> 00:23:59,770 Speaker 11: the same effect. 382 00:24:01,770 --> 00:24:04,850 Speaker 4: Even as concerns around barbeturates came to a head, a 383 00:24:04,930 --> 00:24:08,610 Speaker 4: new kind of drug emerge to treat anxiety disorders. The 384 00:24:09,130 --> 00:24:12,770 Speaker 4: drugs worked even better and they seemed much more safe. 385 00:24:13,650 --> 00:24:16,930 Speaker 4: These were benzodiazepines, and the first one to make a 386 00:24:16,930 --> 00:24:22,210 Speaker 4: splash was called valium. Almost immediately upon its release in 387 00:24:22,290 --> 00:24:26,930 Speaker 4: nineteen sixty three, Valium would become a cultural phenomenon, a 388 00:24:27,010 --> 00:24:30,970 Speaker 4: wonder drug for an anxious age. We'll get into that 389 00:24:31,410 --> 00:24:35,130 Speaker 4: in Part two, but first here's a clip from a 390 00:24:35,210 --> 00:24:39,810 Speaker 4: nineteen fifty seven film promoting adoraks, an early tranquilizer. 391 00:24:44,410 --> 00:24:48,970 Speaker 12: Today, medical science recognizes that some folks aren't helped by 392 00:24:49,010 --> 00:24:55,090 Speaker 12: relaxing exercises in cases of difficult tension and nervous apprehension. 393 00:24:57,170 --> 00:25:04,850 Speaker 12: Doctors are now prescribing an adoraxic medicine. It makes those 394 00:25:04,890 --> 00:25:07,850 Speaker 12: who fear they're about to quit feel like they're ready 395 00:25:07,890 --> 00:25:12,850 Speaker 12: to begin their darkened spirits. Goodbye, or the calming piece 396 00:25:13,410 --> 00:25:14,650 Speaker 12: of a cloudless sky. 397 00:25:18,210 --> 00:25:22,610 Speaker 4: Welcome back to drug story. This is part two, the Prescription. 398 00:25:24,410 --> 00:25:27,210 Speaker 4: In nineteen sixty six, the Rolling Stones had a new 399 00:25:27,290 --> 00:25:30,210 Speaker 4: top ten hit on the charts, a minor key ditty 400 00:25:30,370 --> 00:25:33,650 Speaker 4: called Mother's Little Helper. You know it and I'm not 401 00:25:33,690 --> 00:25:35,810 Speaker 4: playing it because I don't have that much money to 402 00:25:35,850 --> 00:25:39,130 Speaker 4: license it, But you know the song, Mick Jagger sings 403 00:25:39,170 --> 00:25:41,730 Speaker 4: the praises of those little yellow pills that get mother 404 00:25:41,850 --> 00:25:47,730 Speaker 4: through her busy day. Those pills were valium. The Stones 405 00:25:47,850 --> 00:25:50,010 Speaker 4: were on the bleeding edge of what would be the 406 00:25:50,050 --> 00:25:55,050 Speaker 4: biggest prescription drug since well Sense birth control pills. Vallium 407 00:25:55,250 --> 00:25:58,250 Speaker 4: was a new kind of drug, a benzo diazepine which 408 00:25:58,290 --> 00:26:03,050 Speaker 4: worked remarkably well and remarkably fast to reduce anxiety and 409 00:26:03,090 --> 00:26:08,970 Speaker 4: give people a sense of calm relief, and Vallium was 410 00:26:09,090 --> 00:26:12,730 Speaker 4: actually the second benzodiazepine to reach the market. The first 411 00:26:12,930 --> 00:26:16,490 Speaker 4: was librium back in nineteen sixty, but vallium was more 412 00:26:16,530 --> 00:26:20,930 Speaker 4: potent than librium and more effective. So if librium taught 413 00:26:20,930 --> 00:26:22,890 Speaker 4: physicians that there was a new kind of drug that 414 00:26:22,970 --> 00:26:27,530 Speaker 4: was safer than barbratuates, well valium taught everyone else. It 415 00:26:27,650 --> 00:26:34,170 Speaker 4: was a huge drug. Vallium success was unprecedented. It was 416 00:26:34,210 --> 00:26:36,650 Speaker 4: the first drug to reach one hundred million dollars in 417 00:26:36,730 --> 00:26:39,730 Speaker 4: sales and the most prescribed drug of the nineteen seventies. 418 00:26:40,410 --> 00:26:43,770 Speaker 4: As many as twenty percent of all American women reported 419 00:26:43,810 --> 00:26:47,650 Speaker 4: taking valium at some point, but the miracle of valium 420 00:26:47,810 --> 00:26:52,210 Speaker 4: came with some catches. Vallium could create dependency, and it 421 00:26:52,290 --> 00:26:56,330 Speaker 4: had significant side effects. The chemical lingered in the body 422 00:26:56,450 --> 00:27:00,610 Speaker 4: for days. It made people feel confused and dizzy or drowsy. 423 00:27:01,410 --> 00:27:05,090 Speaker 10: There are countless examples of women being prescribed various drugs 424 00:27:05,130 --> 00:27:08,050 Speaker 10: to help cope with anxiety, and yet before they know it, 425 00:27:08,330 --> 00:27:12,370 Speaker 10: a physiology as well as a psychological dependency can result, 426 00:27:12,650 --> 00:27:17,770 Speaker 10: causing chemical cripples whose lives revolve around medication time. Often 427 00:27:17,810 --> 00:27:21,570 Speaker 10: they are unaware of the dependency symptoms cropping up. Doctor 428 00:27:21,650 --> 00:27:24,890 Speaker 10: Yanchik describes some of the warning signals that may lead 429 00:27:24,930 --> 00:27:25,930 Speaker 10: to possible addiction. 430 00:27:26,690 --> 00:27:29,210 Speaker 5: Well, I think first they need to look at how 431 00:27:29,250 --> 00:27:32,250 Speaker 5: many of these medication how many tablets are they taking 432 00:27:32,450 --> 00:27:35,410 Speaker 5: on a daily basis or a monthly basis? Are they 433 00:27:36,450 --> 00:27:40,610 Speaker 5: continuously thinking about when the next time they need to 434 00:27:40,610 --> 00:27:43,290 Speaker 5: take their medication? In other words, are they revolving their 435 00:27:43,330 --> 00:27:45,450 Speaker 5: life around their medication taking behavior. 436 00:27:46,970 --> 00:27:50,650 Speaker 4: The concerns around valium made room for other benzodiazepines that 437 00:27:50,730 --> 00:27:55,010 Speaker 4: arrived soon after. Compared to valium, and especially compared to barbiturates, 438 00:27:55,450 --> 00:27:59,050 Speaker 4: these new drugs seemed less addictive with fewer side effects. 439 00:27:59,730 --> 00:28:03,330 Speaker 4: First was clonopin, and then there was adavant or lorazepam. 440 00:28:03,530 --> 00:28:05,250 Speaker 1: Are where don't you take him? On the recipams? 441 00:28:05,610 --> 00:28:09,810 Speaker 4: Parkroposi pronounces it best and in nineteen eighty one the 442 00:28:09,850 --> 00:28:16,530 Speaker 4: approval of alprazolam, sold under the name Xenix. Executives at upjohn, 443 00:28:16,650 --> 00:28:19,810 Speaker 4: the pharmaceutical company that developed xanax, well, they knew they 444 00:28:19,850 --> 00:28:22,890 Speaker 4: had a challenge on their hands. Valium was one of 445 00:28:22,890 --> 00:28:25,530 Speaker 4: the most successful drugs of all time, and it had 446 00:28:25,570 --> 00:28:30,210 Speaker 4: wide cultural use and recognition, and klonopin and laurazepam had 447 00:28:30,250 --> 00:28:34,650 Speaker 4: not successfully replaced valium as the go to benzodiazepine. So 448 00:28:34,810 --> 00:28:37,450 Speaker 4: Upjohn landed on a go to market strategy that was 449 00:28:37,610 --> 00:28:44,210 Speaker 4: novel for the day, charming the doctors. First, they decided 450 00:28:44,210 --> 00:28:47,570 Speaker 4: to promote Xanex for the treatment of clinical anxiety. They 451 00:28:47,690 --> 00:28:50,890 Speaker 4: doubled down on the medical understanding of anxiety versus the 452 00:28:50,930 --> 00:28:55,450 Speaker 4: more general malaise that valium was often prescribed for. Second, 453 00:28:55,730 --> 00:28:59,650 Speaker 4: the company emphasized that compared to other benzodiazepines, Xenix had 454 00:28:59,650 --> 00:29:04,170 Speaker 4: fewer lingering side effects such as drowsiness. And Third, they 455 00:29:04,170 --> 00:29:09,490 Speaker 4: went hard after psychiatrists. The marketing team mailed informational materials 456 00:29:09,490 --> 00:29:12,490 Speaker 4: to psychiatrists weeks ahead of the launch, and they even 457 00:29:12,570 --> 00:29:16,690 Speaker 4: offered prescribers of full size color reproduction of an impressionist 458 00:29:16,810 --> 00:29:22,730 Speaker 4: masterpiece by Suzan Vango or Gogan to hang in their office. 459 00:29:22,890 --> 00:29:28,610 Speaker 4: It all worked beyond their highest hopes. Within a few years, 460 00:29:29,130 --> 00:29:34,290 Speaker 4: Xenix was the most prescribed benzodiazepine. It was perfectly timed 461 00:29:34,490 --> 00:29:37,730 Speaker 4: to address what seemed like a growing epidemic of anxiety. 462 00:29:38,290 --> 00:29:41,130 Speaker 4: The American Journal of Psychiatry called the nineteen eighties, the 463 00:29:41,210 --> 00:29:45,410 Speaker 4: Decade of Anxiety. In nineteen eighty seven, anxiety even got 464 00:29:45,410 --> 00:29:49,850 Speaker 4: a dedicated journal, the Journal of Anxiety Disorders. More than 465 00:29:49,930 --> 00:29:54,370 Speaker 4: any other drug, Xenix just clicked with the zegeist. That 466 00:29:54,450 --> 00:29:57,250 Speaker 4: label they gave to the nineteen eighties the Decade of anxiety. 467 00:29:57,610 --> 00:30:00,090 Speaker 4: Help people use the same term to describe the nineteen 468 00:30:00,170 --> 00:30:03,730 Speaker 4: nineties and the two thousands and the twenty tens. We 469 00:30:03,810 --> 00:30:09,530 Speaker 4: are apparently perpetually living in. The Decade of anxiety began 470 00:30:09,570 --> 00:30:12,690 Speaker 4: to show up in pop culture more and more. In 471 00:30:12,770 --> 00:30:16,050 Speaker 4: nineteen ninety nine, on the TV show The Sopranos, Tony 472 00:30:16,090 --> 00:30:19,810 Speaker 4: Soprano was famously prescribed Xanax for his panic attacks. 473 00:30:21,490 --> 00:30:24,170 Speaker 8: I'm going to write a script for xanix, just for 474 00:30:24,210 --> 00:30:25,090 Speaker 8: a couple of days. 475 00:30:26,050 --> 00:30:28,450 Speaker 1: It'll get you over this short term stresses. 476 00:30:29,810 --> 00:30:32,570 Speaker 4: At an auction in twenty twenty four, a prop pill 477 00:30:32,610 --> 00:30:36,770 Speaker 4: bottle of Tony's xanx prescription, prescribed by doctor Melfie, It 478 00:30:36,890 --> 00:30:39,210 Speaker 4: sold for one nine hundred and fifty dollars. 479 00:30:39,530 --> 00:30:41,290 Speaker 1: That was double the pre auction estimate. 480 00:30:42,290 --> 00:30:45,170 Speaker 4: New York Magazine puts Xanax on the cover in twenty twelve, 481 00:30:45,530 --> 00:30:49,090 Speaker 4: saying that Xenix dissolves your worries, whatever they are, like 482 00:30:49,130 --> 00:30:53,770 Speaker 4: a special kiss from mommy. And that's the thing about Xenix. 483 00:30:54,650 --> 00:30:57,570 Speaker 4: Not only does it make your cares fade away almost instantly, 484 00:30:58,010 --> 00:31:00,890 Speaker 4: but it also creates a high, a tiny burst of 485 00:31:00,930 --> 00:31:05,610 Speaker 4: good feeling that special kiss, and that makes it especially 486 00:31:05,650 --> 00:31:06,530 Speaker 4: pleasant to use. 487 00:31:07,090 --> 00:31:09,370 Speaker 1: Doctor Saxon explaints. 488 00:31:09,290 --> 00:31:12,810 Speaker 7: When xanax or el PRAISLAMB was first introduced, it wasn't 489 00:31:12,850 --> 00:31:15,570 Speaker 7: that obvious to everyone that it might be a problem. 490 00:31:16,050 --> 00:31:20,650 Speaker 7: We've talked about how benzodaesepines can induce a sense of 491 00:31:20,690 --> 00:31:25,730 Speaker 7: well being or euphoria, and that that is why people 492 00:31:26,290 --> 00:31:28,810 Speaker 7: might take them once and then go, boy, that felt good. 493 00:31:28,850 --> 00:31:31,810 Speaker 7: I'm going to take them again, and then their brain 494 00:31:31,930 --> 00:31:37,170 Speaker 7: becomes primed to want that sensation and suddenly you lose 495 00:31:37,210 --> 00:31:39,530 Speaker 7: that sensation, and boy, you want it again. And that's 496 00:31:39,530 --> 00:31:43,810 Speaker 7: completely understandable. We all want to feel good. So the 497 00:31:44,410 --> 00:31:49,450 Speaker 7: benzodazapenes vary with the extent to how quickly they enter 498 00:31:49,530 --> 00:31:53,770 Speaker 7: the brain and how rapidly they cause their effect. And 499 00:31:54,450 --> 00:31:57,770 Speaker 7: it turns out that alpraislam is one that gets into 500 00:31:57,770 --> 00:32:01,530 Speaker 7: the brain very quickly and causes an effect very quickly, 501 00:32:02,090 --> 00:32:06,570 Speaker 7: and tends to be more euphorogenic than many of the 502 00:32:06,610 --> 00:32:08,290 Speaker 7: other benzodazepines. 503 00:32:09,170 --> 00:32:11,650 Speaker 1: Thorogenic means euphoria. 504 00:32:11,810 --> 00:32:14,490 Speaker 7: It makes you inducing of euphoria or that feeling of 505 00:32:14,530 --> 00:32:16,450 Speaker 7: well being or feeling really good. 506 00:32:17,810 --> 00:32:21,690 Speaker 4: That feeling explains why xanax is especially prone to abuse 507 00:32:22,290 --> 00:32:24,730 Speaker 4: and why many people take xanax as a party drug. 508 00:32:25,530 --> 00:32:28,610 Speaker 4: A twenty seventeen Bloomberg article noted that Xanax was name 509 00:32:28,690 --> 00:32:32,410 Speaker 4: dropped in rap songs as much as Hennessy, Rolex and 510 00:32:32,450 --> 00:32:36,730 Speaker 4: Air Jordan's. All of this pop culture cred can set 511 00:32:36,770 --> 00:32:39,690 Speaker 4: a very real dark side to xanax and the other benzoes. 512 00:32:40,210 --> 00:32:44,210 Speaker 4: They are likely over prescribed and widely abused. We'll get 513 00:32:44,210 --> 00:32:48,050 Speaker 4: into that in Part three, but first, here are just 514 00:32:48,090 --> 00:32:53,850 Speaker 4: some of the nicknames for xanax Zanni's z bars, zan bars, handlebars, 515 00:32:53,930 --> 00:32:59,370 Speaker 4: totem poles, bars, up jump, blue footballs, bicycle parts, yellow boys, 516 00:32:59,490 --> 00:33:03,450 Speaker 4: white boys, white girls, school bus footballs, planks. 517 00:33:09,210 --> 00:33:13,970 Speaker 6: Ext it fills in, I feel my body's dollarical same. 518 00:33:15,730 --> 00:33:18,170 Speaker 9: Hard chu chit. 519 00:33:23,530 --> 00:33:27,890 Speaker 4: Welcome back to drug Story. This is Part three Side Effects. 520 00:33:29,450 --> 00:33:32,250 Speaker 4: So we've covered how anxiety went from being considered a 521 00:33:32,290 --> 00:33:36,570 Speaker 4: general human emotion to a potential medical condition, and how 522 00:33:36,650 --> 00:33:40,610 Speaker 4: generalized anxiety disorder became a notably common and widely diagnosed 523 00:33:40,650 --> 00:33:45,690 Speaker 4: disorder with various medications and various risks and trade offs. 524 00:33:45,730 --> 00:33:49,450 Speaker 4: Since two thousand, though, rates and anxiety have been generally steady, 525 00:33:49,930 --> 00:33:52,730 Speaker 4: with about twenty percent of Americans reporting that they'd been 526 00:33:52,770 --> 00:33:56,890 Speaker 4: diagnosed with an anxiety disorder, But the number of prescriptions 527 00:33:56,930 --> 00:34:02,650 Speaker 4: for benzodiazepines that's actually going down. In twenty nineteen, more 528 00:34:02,730 --> 00:34:07,290 Speaker 4: than ninety million benzodiazepine prescriptions were dispensed at pharmacies without 529 00:34:07,330 --> 00:34:11,850 Speaker 4: praslam Xanax being the most common, followed by clonazepam and lazepam. 530 00:34:12,690 --> 00:34:16,210 Speaker 4: That's actually about thirty percent fewer than the amount prescribed 531 00:34:16,210 --> 00:34:20,130 Speaker 4: in nineteen ninety six. Most likely, the number is going 532 00:34:20,170 --> 00:34:23,210 Speaker 4: down because the risk of dependency and abuse is so 533 00:34:23,290 --> 00:34:27,410 Speaker 4: much better understood today. But even as the number of 534 00:34:27,410 --> 00:34:31,130 Speaker 4: prescriptions for xanax is falling, the problem may be increasing 535 00:34:31,690 --> 00:34:37,290 Speaker 4: because today counterfeit xanix is everywhere. Millions of fake pills 536 00:34:37,330 --> 00:34:40,690 Speaker 4: are sold in the US and other countries, often laced 537 00:34:40,690 --> 00:34:44,250 Speaker 4: with fentanyl. There are actually two kinds of risk for 538 00:34:44,330 --> 00:34:48,450 Speaker 4: abuse with xanix. The first kind of abuse is people 539 00:34:48,530 --> 00:34:51,890 Speaker 4: using it to party to get that euphoria people taking 540 00:34:51,890 --> 00:34:56,690 Speaker 4: it recreationally or knowingly abusing the drug. What makes the 541 00:34:56,730 --> 00:35:00,410 Speaker 4: recreational use of real xanax so dangerous comes down to 542 00:35:00,450 --> 00:35:03,130 Speaker 4: how the drug works and how it makes people feel. 543 00:35:04,290 --> 00:35:08,490 Speaker 4: The quick action and quick fade of xanix means people 544 00:35:08,530 --> 00:35:12,050 Speaker 4: often take w one pill after another, and that increases 545 00:35:12,090 --> 00:35:15,410 Speaker 4: the risk of overdose. And because the drug, you know, 546 00:35:15,770 --> 00:35:19,410 Speaker 4: eliminates the feeling of risk and fear, while people's sense 547 00:35:19,410 --> 00:35:23,690 Speaker 4: of caution goes out the window. The CDC said in 548 00:35:23,730 --> 00:35:26,410 Speaker 4: twenty sixteen that more people went to ers for non 549 00:35:26,490 --> 00:35:30,370 Speaker 4: medical that's recreational use of benzodiazepines, then went to the 550 00:35:30,650 --> 00:35:35,330 Speaker 4: er for prescription opioids. The bigger problem is that when 551 00:35:35,330 --> 00:35:38,850 Speaker 4: people are abusing xanax, they often are taking more than 552 00:35:39,010 --> 00:35:43,490 Speaker 4: just xanax. Frequently they're taking opioids, and that's where things 553 00:35:43,570 --> 00:35:51,330 Speaker 4: get really deadly. Over fifteen years, benzodiazepine involved overdose deaths 554 00:35:51,650 --> 00:35:55,050 Speaker 4: increased by a facture of ten from thirteen hundred and 555 00:35:55,210 --> 00:36:00,130 Speaker 4: twenty ten to twelve thy five hundred in twenty twenty one. 556 00:36:00,170 --> 00:36:03,170 Speaker 4: More than half of these overdose deaths involved the use 557 00:36:03,210 --> 00:36:07,570 Speaker 4: of prescription opioids at the same time, and then There's 558 00:36:07,610 --> 00:36:10,330 Speaker 4: also the risk of a fake PI laced with fentanel, 559 00:36:10,850 --> 00:36:15,450 Speaker 4: either in addition to or instead of actual alpreslan. Since 560 00:36:15,490 --> 00:36:18,410 Speaker 4: twenty twenty one, the Drug Enforcement Agency has had a 561 00:36:18,410 --> 00:36:24,370 Speaker 4: campaign warning about the dangers of counterfeits. One pill can kill. 562 00:36:24,410 --> 00:36:28,370 Speaker 4: The second kind of abuse, though, is much quieter. This 563 00:36:28,530 --> 00:36:31,490 Speaker 4: is when people are prescribed xanax but they just take 564 00:36:31,530 --> 00:36:35,410 Speaker 4: it improperly. They may be following their doctor's prescriptions, just 565 00:36:35,450 --> 00:36:38,290 Speaker 4: like Martha described at the beginning of the episode, but 566 00:36:38,330 --> 00:36:41,330 Speaker 4: they're taking it in dangerous ways, often without knowing it. 567 00:36:42,210 --> 00:36:45,810 Speaker 4: The original guidance for benzodiazepines indicated that they should only 568 00:36:45,850 --> 00:36:48,290 Speaker 4: be used short term, for a few days or a 569 00:36:48,290 --> 00:36:52,810 Speaker 4: few weeks, but that guidance was often poorly followed. In 570 00:36:52,850 --> 00:36:57,210 Speaker 4: twenty eighteen, half of patients who were prescribed benzodiazepines took 571 00:36:57,290 --> 00:37:01,890 Speaker 4: them for two months or longer. That persistent use for 572 00:37:02,050 --> 00:37:07,130 Speaker 4: months or years or decades. That often creates deep dependency issues, 573 00:37:07,970 --> 00:37:10,450 Speaker 4: and when these people do realize they need to stop, 574 00:37:10,930 --> 00:37:14,490 Speaker 4: it can be extremely dangerous and truly difficult to do it. 575 00:37:15,370 --> 00:37:16,690 Speaker 4: Here's doctor Saxon again. 576 00:37:17,690 --> 00:37:23,210 Speaker 7: There's a big overlap between the withdrawal symptoms and the 577 00:37:23,250 --> 00:37:27,090 Speaker 7: symptoms of an anxiety disorder. And yes, if one's been 578 00:37:27,090 --> 00:37:30,250 Speaker 7: taking bends at azipenes regularly and they stop the benz 579 00:37:30,250 --> 00:37:34,810 Speaker 7: at azipines, they're likely to get withdrawal, and they might 580 00:37:34,970 --> 00:37:38,170 Speaker 7: misinterpret it the withdrawal is just a return of their 581 00:37:38,610 --> 00:37:45,730 Speaker 7: anxiety disorder. So that's one big reason that we generally 582 00:37:45,770 --> 00:37:49,210 Speaker 7: recommend against long term use of bends at aay's appines 583 00:37:49,370 --> 00:37:54,730 Speaker 7: for anxiety disorders, because really the end result is going 584 00:37:54,810 --> 00:37:57,610 Speaker 7: to be you're either going to have to continue the 585 00:37:57,770 --> 00:38:02,290 Speaker 7: bends of a's apenes indefinitely or you're going to actually 586 00:38:02,290 --> 00:38:07,130 Speaker 7: have an exacerbation of your anxiety symptoms right worse than 587 00:38:07,130 --> 00:38:11,450 Speaker 7: what you had before you started the bendazepines or the 588 00:38:11,490 --> 00:38:15,770 Speaker 7: third alternative that sometimes works, but as very challenging as 589 00:38:15,850 --> 00:38:20,610 Speaker 7: you do a very very slow taper or dose reduction 590 00:38:20,730 --> 00:38:24,690 Speaker 7: on the benzodazepines, certainly over at least many weeks, but 591 00:38:24,770 --> 00:38:27,810 Speaker 7: often over many months to see if the body can 592 00:38:28,010 --> 00:38:31,490 Speaker 7: gradually readjust to being off of them. But that often 593 00:38:31,570 --> 00:38:35,890 Speaker 7: fails for many patients because not only do the original 594 00:38:35,890 --> 00:38:39,810 Speaker 7: anxiety disorder symptoms come back, but they're even worse because 595 00:38:39,850 --> 00:38:42,490 Speaker 7: the body has adjusted to being on this medication. 596 00:38:43,730 --> 00:38:46,850 Speaker 4: Since twenty twenty, the FDA has required that a black 597 00:38:46,930 --> 00:38:52,650 Speaker 4: box warning their strongest possible caution appear on all benzodazepine prescriptions. 598 00:38:53,450 --> 00:38:56,050 Speaker 4: It means that every prescription for the drug has a 599 00:38:56,050 --> 00:39:01,050 Speaker 4: big black box that says the use of benzodazepines, including Xenix, 600 00:39:01,530 --> 00:39:05,130 Speaker 4: exposes users to the risk of abuse, misuse, and addiction, 601 00:39:05,730 --> 00:39:10,650 Speaker 4: which can lead to overdose or death. The FDA action 602 00:39:10,930 --> 00:39:14,890 Speaker 4: also strongly cautioned physicians, in particular that these drugs were 603 00:39:14,970 --> 00:39:18,450 Speaker 4: not to be prescribed casually, and it stipulated that when 604 00:39:18,490 --> 00:39:21,250 Speaker 4: a patient stops taking them after weeks or months of use, 605 00:39:21,610 --> 00:39:25,450 Speaker 4: the dosage must be reduced gradually in a process called tapering. 606 00:39:26,170 --> 00:39:29,930 Speaker 4: As doctor Saxon noted, smaller and smaller doses over time, 607 00:39:31,210 --> 00:39:35,610 Speaker 4: tapering isn't easy. In several cases, patients unable to wean 608 00:39:35,610 --> 00:39:39,450 Speaker 4: off the drugs have committed suicide. In recent years, groups 609 00:39:39,530 --> 00:39:43,650 Speaker 4: like the Benzodiazepine Information Coalition have raised a red flag 610 00:39:43,690 --> 00:39:46,850 Speaker 4: around the drugs, warning against what they have called a 611 00:39:46,890 --> 00:39:53,010 Speaker 4: growing national epidemic of benzodiazepine injury. The current guidelines for 612 00:39:53,050 --> 00:39:57,050 Speaker 4: the treatment of anxiety disorders now explicitly do not recommend 613 00:39:57,170 --> 00:40:01,290 Speaker 4: treating the condition with xenax or other benzodiazepines. In fact, 614 00:40:01,570 --> 00:40:06,090 Speaker 4: official bodies like the American Psychiatric Association advise against prescribing 615 00:40:06,130 --> 00:40:11,730 Speaker 4: them altogether, especially for long term use. Instead, they suggest 616 00:40:11,890 --> 00:40:17,210 Speaker 4: cognitive therapy like CBT, or using an SSRI antidepressant, which, 617 00:40:17,370 --> 00:40:20,090 Speaker 4: as we've mentioned, can take several weeks to show benefit. 618 00:40:20,970 --> 00:40:24,490 Speaker 4: Benzodiazepines are only advised for short term relief. 619 00:40:25,730 --> 00:40:31,650 Speaker 7: The recognition dawned to some extent that the benzoazepines were 620 00:40:31,650 --> 00:40:35,090 Speaker 7: not the ideal treatment for, or certainly long term treatment 621 00:40:35,170 --> 00:40:38,210 Speaker 7: for anxiety disorders. Now that's not to say that they're 622 00:40:38,250 --> 00:40:40,730 Speaker 7: not still used, because they are still used, but I 623 00:40:40,770 --> 00:40:45,130 Speaker 7: think the rate of usage has gone certainly in psychiatry, 624 00:40:45,130 --> 00:40:48,770 Speaker 7: it's gone down, and maybe in other areas of medicine 625 00:40:48,770 --> 00:40:53,650 Speaker 7: as well, but not completely eliminated by a long measure. 626 00:40:53,970 --> 00:40:56,570 Speaker 4: Right, I want to acknowledge that this may have been 627 00:40:56,570 --> 00:41:00,210 Speaker 4: something that psychiatrists were much more aware of, the kind 628 00:41:00,210 --> 00:41:05,850 Speaker 4: of false victory of benzodiazepines, where general practitioners, who probably 629 00:41:06,010 --> 00:41:10,330 Speaker 4: prescribe far more of the drugs to patients just by 630 00:41:10,410 --> 00:41:12,850 Speaker 4: virtue of their numbers, they may not have been as 631 00:41:12,890 --> 00:41:14,890 Speaker 4: aware of the risks and downsides. 632 00:41:15,930 --> 00:41:19,010 Speaker 7: I think that's true. I do believe in the hope 633 00:41:19,010 --> 00:41:23,490 Speaker 7: that there is growing recognition in all specialties of medicine 634 00:41:23,570 --> 00:41:27,370 Speaker 7: that there can be problems with long term benzidazepine use. 635 00:41:28,450 --> 00:41:34,250 Speaker 7: I don't think it's necessarily unreasonable in that situation for 636 00:41:34,370 --> 00:41:39,210 Speaker 7: the clinician to start the antidepressant and offer a very 637 00:41:39,850 --> 00:41:44,330 Speaker 7: short term course of benzidazepines, you know, maybe a week 638 00:41:44,410 --> 00:41:48,410 Speaker 7: or two, making clear to the patient this is time 639 00:41:48,450 --> 00:41:53,450 Speaker 7: limited and it's not going to continue. And I can 640 00:41:53,570 --> 00:41:58,250 Speaker 7: understand that it might be a reasonable strategy. The trouble 641 00:41:58,290 --> 00:42:01,290 Speaker 7: with that strategy is two weeks later, the patient comes 642 00:42:01,330 --> 00:42:03,490 Speaker 7: back and you have the same discussion. They made me 643 00:42:03,530 --> 00:42:05,330 Speaker 7: feel so much better, and now you're telling me I 644 00:42:05,370 --> 00:42:09,330 Speaker 7: can't get them anymore. And so, in my opinion, and 645 00:42:09,370 --> 00:42:14,410 Speaker 7: it's most ideal just to address that request at the beginning, 646 00:42:14,490 --> 00:42:18,770 Speaker 7: but it's very challenging to do so. The best treatments 647 00:42:18,810 --> 00:42:25,410 Speaker 7: for anxiety are psychotherapy treatments. That's the best treatment that 648 00:42:25,490 --> 00:42:28,330 Speaker 7: you can get for an anxiety disorder because instead of 649 00:42:28,450 --> 00:42:32,370 Speaker 7: taking a pill, you're developing skills to handle and manage 650 00:42:32,610 --> 00:42:34,850 Speaker 7: the anxiety symptoms. 651 00:42:35,410 --> 00:42:39,530 Speaker 4: What doctor Saxon is describing are basically coping skills, some 652 00:42:39,570 --> 00:42:42,170 Speaker 4: of those same techniques that the Greek Stoics found so 653 00:42:42,290 --> 00:42:46,090 Speaker 4: useful two thousand years ago. It's not always comfortable, but 654 00:42:46,210 --> 00:42:49,570 Speaker 4: sometimes the most healthy thing is to be mindful, to 655 00:42:49,650 --> 00:42:53,370 Speaker 4: live in the present, to appreciate what we have now today, 656 00:42:54,010 --> 00:42:58,330 Speaker 4: instead of worrying about what looms out there in the future, which, 657 00:42:58,370 --> 00:43:01,130 Speaker 4: as it turns out, is what helped Martha too. 658 00:43:03,850 --> 00:43:06,330 Speaker 3: You know my cousin who died of als toward the 659 00:43:06,410 --> 00:43:10,450 Speaker 3: end of his life, he told me be conscious, be conscious. 660 00:43:10,530 --> 00:43:12,330 Speaker 3: I think about that a lot, and I thought about 661 00:43:12,330 --> 00:43:16,730 Speaker 3: that with the xanax too, because I wasn't being conscious, 662 00:43:16,810 --> 00:43:21,610 Speaker 3: and we do so much unconsciously in our lives and 663 00:43:21,650 --> 00:43:25,010 Speaker 3: then they're over or we've made a mistake. And I 664 00:43:25,090 --> 00:43:27,690 Speaker 3: do like to think about that advice from him to 665 00:43:27,770 --> 00:43:32,970 Speaker 3: be and live consciously. There are things that I can 666 00:43:33,010 --> 00:43:36,010 Speaker 3: do to know I'll have a better chance of sleeping, 667 00:43:36,170 --> 00:43:38,930 Speaker 3: not eating pasta at night, not having chocolate at night, 668 00:43:39,610 --> 00:43:43,130 Speaker 3: and those things often help. But then if there's a 669 00:43:43,250 --> 00:43:47,410 Speaker 3: night where I'm just restless, it's trying to do something 670 00:43:47,570 --> 00:43:52,050 Speaker 3: more healthy, then lie there and getting mad and anxious 671 00:43:52,050 --> 00:43:55,370 Speaker 3: and frustrated, get up and read a book or you know, 672 00:43:55,610 --> 00:43:59,890 Speaker 3: just try to think of something pleasant. Yeah, but it's 673 00:43:59,930 --> 00:44:04,890 Speaker 3: not easy, but it's a lot better than taking xanax. 674 00:44:06,690 --> 00:44:10,450 Speaker 4: It turns out that tranquility comes with some costs, some 675 00:44:10,490 --> 00:44:12,290 Speaker 4: trade offs, some risks. 676 00:44:12,970 --> 00:44:13,930 Speaker 1: If a pill. 677 00:44:13,810 --> 00:44:17,690 Speaker 4: Seems like magic, if it suddenly makes everything better just 678 00:44:17,850 --> 00:44:21,370 Speaker 4: like that, well maybe it's too good to be true. 679 00:44:21,450 --> 00:44:25,130 Speaker 4: Everything has a catch. Just one more mention of the 680 00:44:25,210 --> 00:44:28,210 Speaker 4: nine to eight eight Lifeline counselors are ready to help 681 00:44:28,490 --> 00:44:34,210 Speaker 4: call our text nine to eight eight. That's it for 682 00:44:34,250 --> 00:44:37,570 Speaker 4: this drug Story about xanax. For an annotated list of 683 00:44:37,570 --> 00:44:42,810 Speaker 4: our sources for this episode, visit Drugstory dot co. Drug 684 00:44:42,850 --> 00:44:46,250 Speaker 4: Story was created, written, and hosted by me Thomas Getz. 685 00:44:46,970 --> 00:44:51,170 Speaker 4: Molly Warner is our research director from Reasonable Volume. Rachel 686 00:44:51,210 --> 00:44:55,010 Speaker 4: Swabeye produced and Sam designed this episode with assistance from 687 00:44:55,090 --> 00:44:58,170 Speaker 4: Audrey no Elise Hugh was the editor. 688 00:44:58,610 --> 00:45:00,290 Speaker 1: Mark Bush is our engineer. 689 00:45:01,490 --> 00:45:04,810 Speaker 4: Drug Story was produced with support from the University of California, 690 00:45:04,810 --> 00:45:09,090 Speaker 4: Berkeley School of Public Health. Special thanks to Claudia Williams, 691 00:45:09,210 --> 00:45:14,130 Speaker 4: Dean Michael Loop. Thanks also to Martha McPhee, doctor Andrew 692 00:45:14,170 --> 00:45:18,810 Speaker 4: john Saxon, doctor Carlos Bolanos, who also helped us a Ton, 693 00:45:19,130 --> 00:45:23,410 Speaker 4: but we could include him in this episode. Drug Story 694 00:45:23,530 --> 00:45:27,010 Speaker 4: is an independent production. If you'd like to support our work, 695 00:45:27,330 --> 00:45:31,050 Speaker 4: contact us at drugstory dot co. You can also subscribe 696 00:45:31,050 --> 00:45:34,010 Speaker 4: to our substack there and be notified when new episodes 697 00:45:34,050 --> 00:45:38,010 Speaker 4: come out. And if you like what we're doing here, well, hey, 698 00:45:38,170 --> 00:45:41,490 Speaker 4: tell your friends rate us on Apple or Spotify. The 699 00:45:41,570 --> 00:45:44,490 Speaker 4: more people who download and like Drug Story, the closer 700 00:45:44,490 --> 00:45:49,130 Speaker 4: we get to doing a season two more drugs. Next 701 00:45:49,210 --> 00:45:52,850 Speaker 4: up on Drug Story, a look at the phenomenal rise 702 00:45:52,930 --> 00:45:59,250 Speaker 4: of testosterone replacement therapy with millions of men proudly taking hormones. 703 00:46:00,090 --> 00:46:03,650 Speaker 4: Is TRT, the cure to low T and all else 704 00:46:03,810 --> 00:46:06,850 Speaker 4: that ails the American male, we shall see. 705 00:46:08,130 --> 00:46:09,050 Speaker 1: Thank you for listening. 706 00:46:11,690 --> 00:46:14,250 Speaker 4: Listening to this episode of Drug Story may cause you 707 00:46:14,290 --> 00:46:17,050 Speaker 4: to flash back to that embarrassing time in middle school 708 00:46:17,090 --> 00:46:20,050 Speaker 4: that still makes you WinCE. Suddenly, remember that email you 709 00:46:20,090 --> 00:46:22,610 Speaker 4: forgot to reply to, and wonder if you forgot to 710 00:46:22,610 --> 00:46:25,450 Speaker 4: close the garage door. We advise you to live in 711 00:46:25,490 --> 00:46:29,130 Speaker 4: the present, read more ancient Greek philosophy, and to always 712 00:46:29,210 --> 00:46:30,610 Speaker 4: be on the lookout for bears.