Posted by Squiggles on October 26, 2002, at 15:23:18
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » viridis, posted by Squiggles on October 26, 2002, at 13:59:53
I notice here a point that has been laboured
through this discussion--withdrawal syndrome
occurring at therapeutic dosage:"During the 1960s, withdrawal symptoms were
reported to occur upon discontinuation of long-term
use of benzodiazepines at doses several times
higher than the usual therapeutic dose. More
recently, a number of studies have shown that
withdrawal syndromes can occur even at therapeutic
doses." [p. 20]The syndromes are described and my point that
ideally they should be used symptomatically and
not for long-term is noted. I notice also the
point about respiratory distress. Do they know
why? It is remarked here that in general it is
a contraindication. When I was searching for the
reason why I had panic attacks and dyspnea at night,
I came across an article on respiratory suppression
by benzos, and also another article by an anesthsiologist
who described the benzos as having the effect of
respiratory suppression. Bingo, I said to myself.
Now, if you say that this happens with some people
and not others depending on their age, etc. I will
grant you that any drug, to have an effect required
both the taker and the drug; it is a two-way street,
just as all interactions between a and b are; but this
is also the case with aspirin or any other substance.
It is the case with coffee or milk for that matter.
And if you say that such effects depend on the subject
alone, you are eliminiating the chemical aspect of the
drug for which it is designed, i.e. a human or animal
organism, with a particular area of the brain as target.
Therefore, it should not be surprising that an
anti-depressant effects the brain, whereas a Beta-blocker
effects the vascular system, and predictably in similar
ways.6. STRATEGIES FOR PRESCRIBING BENZODIAZEPINES
a) Screening instruments
I imagine these are questionnaires?
b) The Clinical Interview
I am very happy to see the inclusion of examining
the patient for prior history of dependence on
drugs and comorbid psychiatric disorders. However,
just because we are doing psychology here, does
not mean that there should not be an examination
of PHYSICAL COMORBID DISORDERS. I don't see this
here. For example, hyperthyroidism, heart disease,
etc.c) General Medical Evaluation
This is a projection of the possible problems
of prescribing benzos.d) Physical Examination
This is a one sentence vague proposal for a general
examination. I think the variety of conditions
that induce anxiety and panic, should be outlined;
there are many.
May I suggest that the age of the person, and in
cases where ethnic background has an effect on the
metabolism of benzodiazepines be considered in the
initial examination.
6.2.5 DiscontinuationThe protracted withdrawal syndrome is omitted.
And the re-emergence of an initial anxiety state
is presumed.
These are grave errors.Not all benzos are the same in effect of
withdrawal. I have yet to see the papers which
must exist on what is different about an anxiolytic
and an anti-convulsant - chemically.6.2.6 Withdrawal management
Any kind of management would be humane and welcome.
These drugs have been taken very lightly, and I don't
think that doctors are aware of how serious the withdrawals
are. In a letter to the Health Minister, the
Hon. Alan Rock, and in a similar letter to Hoffman
LaRoche and Upjohn, i had suggested, as a consumer,
that the problem was serious enough to merit the
opening of clinics for withdrawal. I think the
doctors are well-meaning but too busy, considering
the enormous amount of prescriptions for this
3rd ranking class of drugs on the market. Ha!For programs and schedules, see Ray Nimmo's site
www.benzo.org.
6.3.1 and 6.3.2The consideration for children and elderly is
good and the fact that benzos can be more potent
in CNS disorders in these age groups. However,
the age of elderly and children is not defined.6.3.3 Pregnancy
Yes, this is well written; the embryopathy that
is discussed may be damaging to the brain what the
Benzo group call cited many cases of "floppy baby syndrome".
This is discussed here too. They should be used
with caution if at all.6.3.4 Alcohol
I don't know much about this; I have noticed
a compounded effect with a glass of wine or
beer and so if i drink, I drink 1/2 a glass
with dinner or not often. I have heard that benzos with
alcohol are an effective means of suicide,
assuming you do not throw up - not sure of
the dose.6.3.5
Same here, though I imagine they are used
to come down from stimulating drugs. That
would not be a bad thing.
7. SOCIAL AND ECONOMIC ISSUES7.1 Attitudes
The discussion on the public's negative perspective
of people taking benzos must be something someone
did a thesis or research on. I think that all
psychiatric drugs are viewed with some suspicion.
I know someone who was denied insurance on the grounds
of taking an AD, for example.In general the discussion of moral and social
aspects is very extensively covered in David Oaks'
SCI advocacy groups. It's too huge to talk about
here.
9. SUMMARY AND RECOMMENDATIONSActually, I think this is a good report in general;
I would like to see the protracted syndrome mentioned.
And I have a question: have opiates been considered
instead of benzos for similar disorders?And finally, a personal question:
Is clonazepam prescribed for manic depression because
manic depression is considered a species of
epilepsy? Does anyone know why clonazepam is so
difficult to withdraw from (after many years?).I hope that the careful and well-researched
aspects of this report can actually be put
into practice. I believe that doctors in general
may be too busy to follow guidelines like this,
but let us hope; who knows, maybe the pharmaceutical
concerns will see some advantage in assisting
with prescription and withdrawal.I'd like to thank you for letting me know
about this document and for letting me take up
so much bandwidth to comment on it.Squiggles
poster:Squiggles
thread:124171
URL: http://www.dr-bob.org/babble/20021025/msgs/125333.html