Fear of Flying

The Health Centre at the University of Sussex has reviewed it’s benzodiazepine prescribing at a practice meeting and established this new policy not to prescribe benzodiazepines or sedatives (such as diazepam) to patients for fear of flying. Many other GP practices have a similar policy.

Benzodiazepines including Diazepam (also known as ‘Valium’) have short-term deleterious effects on memory, co-ordination, concentration and reaction times, they were also addictive, with withdrawal leading to fits, hallucinations, agitation and confusion.  Furthermore, they were found to have long-term effects on cognition and balance.

The following short guide outlines the issues surrounding its use with regards to flying and why the surgery no longer prescribes such medications for this purpose.

There are a number of very good reasons why prescribing this drug is not recommended.

  • Diazepam is a sedative. This means, the medication makes you sleepy and more relaxed. If there would be an emergency during the flight, this could impair your ability to concentrate, follow instructions, or react to the situation. This could seriously affect the safety of you and the people around you.
  • Sedative drugs can make you fall asleep, however, when you sleep it is an unnatural non-REM sleep. This means, your movements during sleep are reduced and this can place you at an increased risk of developing blood clots (DVT). These blood clots are very dangerous and can even prove fatal. This risk further increases if your flight is over 4 hours long.
  • Although most people respond to benzodiazepines like Diazepam with sedation, a small proportion experiences the opposite effect and can become aggressive. They can also lead to disinhibition and make you behave in ways you normally wouldn’t. This could also impact on your safety and the safety of your fellow passengers or could lead you to get in trouble with the law.
  • According to the prescribing guidelines doctors follow (British National Formulary) diazepam is contraindicated (not allowed) in treating phobic states. It also states that “the use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate”. Your doctor would be taking a significant legal risk by prescribing against these national guidelines. Benzodiazepines are only licensed short term for a crisis in generalised anxiety. If this is the case, you should be getting proper care and support for your mental health and not going on a flight; benzodiazepine doses used for flying previously are not likely control an acute crisis in generalised anxiety disorder.

If this is the problem you suffer with, you should seek proper care and support for your mental health, and it would not be advisable to go on a flight.

  • In the UK is a Class C/Schedule IV controlled drug. Similarly, in several other countries, diazepam and similar drugs are controlled substances or in some cases are illegal. They would be confiscated, and you might find yourself in trouble with the police for being in control of an illegal substance.
  • Diazepam has a long half-life. This means it stays in your system for a significant time and you may fail random drug testing if you are subjected to such testing as is required in some jobs. We appreciate a fear of flying is very real and very frightening and can be debilitating. However, there are much better and effective ways of tackling the problem.

We recommend you tackle your problem with a Fear of Flying Course, which is run by several airlines. These courses are far more effective than diazepam, they have none of the undesirable effects and the positive effects of the courses continue after the courses have been completed.