Diazepam

[panic_down_under]

Currently I am taking 2mg once daily and am wondering how long I will be allowed to take this.

That's a question for your GP. Benzodiazepines (BZDs) appear to be less likely to be prescribed in the UK than elsewhere, though this seems to be also becoming the case in my part of OZ.

The uncertainty of getting prescriptions renewed is certainly something to be aware of. Even if your GP is willing to prescribe BZDs today, there are no guarantee they will tomorrow. Even worse when some GPs have their anti benzo hallelujah moment they may insist their patients wean off them within weeks, sometimes immediately, causing much misery.

But there is a far bigger problem with BZDs. When taken regularly they can worsen the biological cause of these disorders and reduce the effectiveness of antidepressants. Anxiety and depression are the emotional manifestations of an underlying physical brain malfunction, atrophy of the twin hippocampal regions of the brain caused by high brain stress hormone levels, particularly of cortisol, killing brain cells and inhibiting the growth of replacements. See also: Depression and the Birth and Death of Brain Cells (PDF). Both therapy and antidepressants work by stimulating the growth of new hippocampal brain cells. The cells produce the therapeutic effect, not the treatments directly.

BZDs have the same effect on hippocampal neurogenesis as cortisol and other stress hormones [1], as does alcohol, btw. In light of these studies BZDs should probably be limited to a couple of weeks when first taking antidepressants just to ease the initial spike in anxiety due to the increased serotonin activity, for a while after AD dose increases for the same reason and thereafter for occasional breakthrough anxiety.

Find it works much better than anti-depressants which made me feel very ill.

You've not been on an AD long enough for it to have a positive effect. They typically take 4-12 weeks to kick-in as it takes about 7 weeks for hippocampal cells to grow and mature, though some improvement in mood can begin earlier.

Although there are no guarantees, the SSRIs which seem generally to be the least likely to produce severe initial side-effects are citalopram (Celexa) and escitalopram (Lexapro). They are essentially the same med sharing the same active drug. Citalopram also contains a mostly inactive form of it. Despite this it would be my pick of the two.



References:

[1]
Boldrini M, Butt TH, Santiago AN, et al. (2014)
Benzodiazepines and the potential trophic effect of antidepressants on dentate gyrus cells in mood disorders.
Int J Neuropsychopharmacol. Dec;17(12):1923-33 (Abstract | Full text)

Sun Y, Evans J, Russell B, et al (2013)
A benzodiazepine impairs the neurogenic and behavioural effects of fluoxetine in a rodent model of chronic stress.
Neuropharmacology. Sep;72:20-8 (Abstract)

Song J, Zhong C, Bonaguidi MA, et al (2012)
Neuronal circuitry mechanism regulating adult quiescent neural stem-cell fate decision.
Nature. Sep 6;489(7414):150-4 (Article | Study full text)

Wu X, Castren E. (2009)
Co-treatment with diazepam prevents the effects of fluoxetine on the proliferation and survival of hippocampal dentate granule cells.
Biol Psychiatry. Jul 1;66(1):5-8 (Abstract)

See also: the 'Ugly' part of Benzodiazepines: The Good, The Bad, and the Ugly.