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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 16 to 40 of 65. Go back in thread:
Posted by gilbert on June 14, 2001, at 13:41:26
In reply to Re: Xanax » Fred Potter, posted by Elizabeth on June 14, 2001, at 13:21:51
Grapebubblegum,
Here I am wining for a week on the post about how sensitive the ssri users are and you frreaking out on me about Cam's joke. I like his joke. I love my little peach friends. They are gillies little helpers. I used to love the color of the prozac pills too...the 10mg were a super nice shade of green. I think the benzo stigmas need a little humor. Like I said in my posts below that we are sensitive to people criticizing our meds because it threatens us. If we lighten up and have a little fun with it maybe the stereotypes will fade. Now Cam that damn song is going to be stuck in my head all day.......Mothers little helpers na na na na na na na na na na na na....it's the Stones right.......
Gil
Posted by Elizabeth on June 14, 2001, at 13:48:26
In reply to Is that REALLY what they call it?, posted by grapebubblegum on June 14, 2001, at 10:28:45
> What, you're serious? That is the pharmacist's slang?
>
> I thought that was reserved for stuff like Valium. Or was that the mothers little helper of yesteryear?Some people still feel that way about benzos.
Hey, when you say "stuff like Valium," what do you mean? Like, do you think that there's a serious difference between Klonopin and Valium (other than potency and a few differences on the molecular level), and if so, what is it?
> Is klonopin really called a "M.L.H."? I'm just incredulous because I find it does not actually seem like a little helper at all except that it prevents panic attacks.
I would call that a *BIG* helper. < G >
> If anything, although I am functioning fine now, I find that my temper is a bit of a problem now that I am on klonopin monotherapy. I have been wondering (and I know you could only wager the vaguest of guesses) could this be attributable to klonopin itself, or to discontinuation of Paxil, or could my slight temper problem be my "real" personality resurfacing?
How long ago did you stop taking the Paxil?
SSRIs do often have the effect of smoothing out irritability/overreactivity/bad temper. (I think that this often results in a feeling of flatness or apathy, like you described.)
> I'm not being touchy toward you, Cam, becasue I know you were winking, but does the general populace really think klonopin is a feel good pill?
I don't think that it's that well known. But if you asked Joe Average whether someone who takes Valium or Xanax every day is a "drug addict," my guess is that he'd probably say yes.
-elizabeth
Posted by Daveman on June 15, 2001, at 0:56:10
In reply to Gillies little helpers, posted by gilbert on June 14, 2001, at 13:41:26
In the immortal words of Mick Jagger and Keith Richards: "What a drag it is getting old....."
Dave
Mothers little helpers na na na na na na na na na na na na....it's the Stones right.......
>
> Gil
Posted by grapebubblegum on June 15, 2001, at 9:44:57
In reply to Mother's Little Helpers, posted by Daveman on June 15, 2001, at 0:56:10
No worries, Cam, I wasn't upset at your joke but I was wondering if that is the pharmacist's slang (and y'all are allowed slang, of course) but not directing it at you, my bestest pharmacist friend, yes, of course I was sensitive to a possible stigma for that particular drug I had heretofore not heard of.
Gil, I had not seen your posts about SSRI users being sensitive (insensitive? I'm lost, direct me).
At that moment in time I had little sense of humor, having just had the mini-lecture from the pdoc who typically understands me so well, and of course I was a little bent.
Elizabeth, interpret no implications in my "stuff like Valium" phrasing... I just don't know benzos from shinola, that's why I ask Cam these things. I have no prejudice against or for any of them except we all know that Valium has been the scapegoat of drug stigma for decades... am I right? I grew up in the seventies and eighties and Valium was the household word when wanting to describe someone as being addicted.
Lots of stigmas out there. I told you guys that my sister is an R.N. and she admits that whenever she hears "psychoactive meds" a prejudice closes right down over her brain. I asked her why and she said, "Because we see so many people checking in to the hospital who are addicted." I want to say, "But----" but her mind is already closed.
My doc does seem pretty smart, and I didn't quote her exactly. I do give her a lot of credit, though.
As a non-sequitur to the above discussion, since we can never sort out the topics of people who need/use wisely prescriptions and those who don't, depending on who is doing the judging, many of whom make the rest of us "look bad" (as in my sister's closed-minded 'tude) I'm gonna post a link below for you, Cam, or anyone who is interested. Come on out and at least READ one thread in my message board, folx! Many of you are so smart and witty (Gil)(I didn't say that; it was a subconscious thought you imagined I said) that I'd love to have you guys as witty banter partners. I have been weeding out juvenile and obnoxious posters, with Dr. Bob as my moderation style mentor.
Anyway Cam, the link may be of interest to you, or you may say "*yawn* I know that happens all the time, what else is new."
Posted by grapebubblegum on June 15, 2001, at 10:18:17
In reply to Gil, Cam, Eliz...... everyone..., posted by grapebubblegum on June 15, 2001, at 9:44:57
In this thread, the poster "A Tetherball From Bouganville" is talking about selling her Rx meds at school.
Now, maybe I'm getting old and crotchety. I graduated from high school in '83, and sure, plenty of drugs went around, but I don't think kids even got Rx meds back then (high school kids, I mean.) Also notable to me is the way kids don't even know what the meds are or what they are for. http://pub66.ezboard.com/fbeckoranythingelsechatterhostedbygrapesfrm2.showMessage?topicID=55.topic
btw, I am the big cheese there, grapeswhizzzz, the board owner. :o]
Oh, and I hope you don't mind, Gil, but I quoted you in another thread in which we were discussing meds and sex, I quoted your hilarious, "Celexa, no sexa" etc. essay.
Posted by gilbert on June 15, 2001, at 16:23:15
In reply to Linky-link, posted by grapebubblegum on June 15, 2001, at 10:18:17
Linky-link,
Go ahead use what ever you want the only usefull data in my posts are humor or sarcasm....got all these med geniuses around here I feel like an undescended testicle most of the time.
Grapebubblegum,
Check out any threads from this week or last week and you will see I was complaining about ssri attitude of acceptance versus the scarlet letter benzos. By the way I was kind of teasing you too....probably shouldn't pile on when someone is in the middle of a med change.......Sorry your benzo buddy......
Gil
Posted by Elizabeth on June 15, 2001, at 17:21:22
In reply to Gil, Cam, Eliz...... everyone..., posted by grapebubblegum on June 15, 2001, at 9:44:57
> Elizabeth, interpret no implications in my "stuff like Valium" phrasing... I just don't know benzos from shinola, that's why I ask Cam these things. I have no prejudice against or for any of them except we all know that Valium has been the scapegoat of drug stigma for decades... am I right? I grew up in the seventies and eighties and Valium was the household word when wanting to describe someone as being addicted.
I rememeber very little of the '70s (not from too much Valium, but just because I was quite young!), but Valium does have a reputation for being one of the more abusable benzos. It's rapidly taken up into the CNS and then redistributed throughout the body, so it acts rapidly but briefly. Some people find it pleasurable, weird as this seems. I've taken it a couple times and didn't find it particularly exciting. It's also not as good an anxiolytic as the high-potency benzos (Klonopin, Xanax, Ativan), IMO.
> Lots of stigmas out there. I told you guys that my sister is an R.N. and she admits that whenever she hears "psychoactive meds" a prejudice closes right down over her brain.
Gosh. "Psychoactive meds" like imipramine, propranolol,
Well, I guess it's a good start that she recognises it as a prejudice.> I asked her why and she said, "Because we see so many people checking in to the hospital who are addicted." I want to say, "But----" but her mind is already closed.
That is a shame. I think that a lot of doctors who specialise in addictions also tend to be against prescribing benzos, opioids, etc., even when they're clearly indicated.
Posted by Elizabeth on June 15, 2001, at 17:37:11
In reply to Linky-link, posted by grapebubblegum on June 15, 2001, at 10:18:17
> In this thread, the poster "A Tetherball From Bouganville" is talking about selling her Rx meds at school.
Antidepressants, no less!
I have a friend whose father is a doctor and who went to high school in the '70s. He used to raid the supplies at his father's office. Not antidepressants or benzos -- stuff like Dilaudid, Quaalude, Seconal, etc.
> Now, maybe I'm getting old and crotchety. I graduated from high school in '83, and sure, plenty of drugs went around, but I don't think kids even got Rx meds back then (high school kids, I mean.) Also notable to me is the way kids don't even know what the meds are or what they are for.
Jeez. I started taking Prozac in 1990, my junior year in high school. I knew a few kids who were taking things like Ritalin or lithium (Prozac was pretty new at the time), but it wasn't a common thing. By the time my sister was in high school (she's 6 years younger), though, there were lots of kids taking psych meds.
> btw, I am the big cheese there, grapeswhizzzz, the board owner. :o]
So what is it with you and grapes, anyway? Not that I have anything against grapes. Some of my best friends are grapes. :-)
-elizabeth
Posted by paulk on June 15, 2001, at 18:53:43
In reply to more about Xanax and depression, posted by Elizabeth on June 12, 2001, at 16:37:42
I hadn’t heard that there was a XR version anywhere. Who is making it?
I talked to a University Psydoc about this very issue - he said because the patent was out, no one would pay for the studies - etc. etc. (and several other cures are gone wanting for the same reason)
I’m taking a very low dose (.25mg/day) of Clonazepam, which is also suspected of having some antidepressant effect (some study mentioned some seritonin activity), but in my mind Xanax (Alprazolam) was even better that way. Unfortunately, it was quite a bear to manage frequent dosing at a low level, so I stopped it many years ago. Xanax quits so fast and nasty that I can see why it would be addictive. Sure wish there was an XR version to try.
I’m now also taking Nardil. Figured out why it is started the way it is – (starts off at 15mg – ramps quite rapidly and then back to 15 – 30mg/day) – the drug only has a 1-2 hour half-life – so it seems strange – until you figure that the enzyme it is deactivating has a much longer half-life of being replaced (no mention of this in the PDR BTW). You need to have about 90% of MO enzyme deactivated before it can start to work – and then it might take a few weeks. It seems like it may have started working just in the last day or so – not bad so far.
Do you know if the low BP side effect is a ‘primary’ effect of the drug or a result of the lowering of the MO enzyme level?
I understand why one shouldn’t take SSRIs and the like but I don’t understand why there would be a need to discontinue other MOAIs when switching between types? After all, the Nardil would wash out in a day or so? Are they acting on different enzymes?
I’m also wondering if I should get a med-alert bracelet - I understand that Demerol (meperidine) can be fatal – I would hate to be in a car accident and get Demerol in the ER that could kill me.
Posted by paulk on June 15, 2001, at 19:02:35
In reply to Re: Didn't appreciate my pdoc calling it a feel-good » grapebubblegum, posted by Cam W. on June 14, 2001, at 10:02:01
> G-Bub - How dare she! Everyone knows we call them "mother's little helper". (Sorry, I couldn't resist) - Cam
>
> ;^)
Actually, "mother's little helper" used to mean a mix of amphetamines that is now sold as Adderal – back when the song came out it had a different name and was used (unsuccessfully) as a diet pill.
Posted by paulk on June 15, 2001, at 20:02:09
In reply to Linky-link, posted by grapebubblegum on June 15, 2001, at 10:18:17
> > Back to my point, my pdoc did renew a klonopin Rx for me recently but with some reservations. Typically I think she is the smartest pdoc in the world, and maybe she is, but I didn't appreciate her mini-lecture that klonopin is ok only for a very short-term therapy because it does not address the root of the panic disorder (like SSRIs DO address it? I think not) and that klonopin is only a "feel-good" pill.Seriously, your pdoc doesn’t seem to be up on the seritinergic effects of klonopin. Klonopin is THE benzo of choice for long-term treatment.
> >The "root cause" argument is a common error that people make when trying to justify undermedicating anxiety disorders (and pain, for that matter). I get that rap all the time when I mention that I take buprenorphine for depression. The fact is, nobody knows what the "root cause" of panic disorder (or any other psych disorder, for that matter) is. There's no reason whatsoever to suppose that antidepressants "address the root cause" and that benzos don't.
>I sometimes think that the "root cause" fallacy is a red herring, that what people really mean when they say this kind of thing is that suffering is good for the soul and that if you have spontaneous panic attacks (or whatever), you must deserve them in some way. Ahh, modern Puritanism.
> > I was disappointed in her basically pooh-poohing the only med that has made me feel normal for a long time.
>I know just how you feel.
> > Keep in mind I only take .125 mg three times per day, which is ridiculously miniscule but actually helps me.
>Like, a quarter of the smallest strength tablet? Weird. I wonder if maybe you don't metabolise it normally or something. That's a very low dose even for someone who's taking it around the clock (although, as you note, taking it that way has the advantage of preventing panic attacks).
Not that weird. I only need just a little - .25/day. Many others are in the same boat. My doc tells me he has many that take .25 at bedtime and .125 for the day.
See my rant at http://www.dr-bob.org/babble/20010605/msgs/65469.html> In my experience, a tiny steady dose of benzo keeps me feeling normal and raises my threshhold for P.A.s; if not prevented, P.A.s once underway require so much benzo it would kill me to derail the attack.
DITTO – BULLS EYE – EXCELLENT POINT! I hope some docs read what you just said. ( I think this phenomena is called ‘kindling’ in the litature.)
The worst problem with Benzos is the memory side effect. I think a good way to figure if you are taking too much benzos is if it starts to kill memory. Seems like it would be easy to run some tests for this. Tell your doc to test you if she thinks you are on a detrimental dosage (you aren’t) to test your memory.
I have seen folks deteriorate over time on very large dosages Benzos.
If the benzo is long acting, it sure seems it is easier to keep it at a low dose for me. I Really don’t think it is good practice to use benzos per attack (unless its for someone who is bi-polar.) If it is a short acting benzo “as per needed” is a good way to get someone with PA in even bigger trouble.
Klonopin, for me, even at a VERY low dose makes all the difference in what I do when I lose my temper. It also prevents the panic attacks (although I didn’t have that many).
Getting off higher dosages of Benzos can be nightmarish. I watched a fellow patient go through the “cold wet sheet pack treatment” getting off Valium. I think switching to klonopin and tapering would have been a much better way.
- Paulk
Posted by Elizabeth on June 15, 2001, at 22:10:17
In reply to Re: more about Xanax and depression » Elizabeth, posted by paulk on June 15, 2001, at 18:53:43
> I hadn’t heard that there was a XR version anywhere. Who is making it?
Pharmacia & Upjohn, the same company that makes regular Xanax. Xanax SR isn't marketed in the USA, though.
> I talked to a University Psydoc about this very issue - he said because the patent was out, no one would pay for the studies - etc. etc. (and several other cures are gone wanting for the same reason)
That's true, although there is something called a "use patent" (which is why you still can't get generic Prozac in the US).
> I’m taking a very low dose (.25mg/day) of Clonazepam, which is also suspected of having some antidepressant effect (some study mentioned some seritonin activity), but in my mind Xanax (Alprazolam) was even better that way.
Most people find it to be, and there's evidence that Xanax is an antidepressant when used in high doses.
> Unfortunately, it was quite a bear to manage frequent dosing at a low level, so I stopped it many years ago. Xanax quits so fast and nasty that I can see why it would be addictive. Sure wish there was an XR version to try.
Addiction results from using large doses of a drug to get high. Anybody who's been taking Xanax for a long time will get withdrawal symptoms; that's not drug addiction, it's a normal reaction.
> I’m now also taking Nardil. Figured out why it is started the way it is – (starts off at 15mg – ramps quite rapidly and then back to 15 – 30mg/day) – the drug only has a 1-2 hour half-life – so it seems strange – until you figure that the enzyme it is deactivating has a much longer half-life of being replaced (no mention of this in the PDR BTW).
Nardil is an irreversible enzyme inhibitor; its elimination half-life isn't relevant. There's no reason to take it in divided doses, even, except perhaps to even out any side effects that you might get.
I know a guy who was able to decrease his need for Xanax dramatically when he started taking Nardil. Nardil is a great drug for anxiety.
> You need to have about 90% of MO enzyme deactivated before it can start to work – and then it might take a few weeks.
That's because antidepressant effects aren't due to the direct effects of the drugs, they're due to longer-term adaptations to the direct effects. (MAOIs seem to work faster than other ADs sometimes, though, and the anxiolytic effects of Nardil in particular may kick in sooner.)
> Do you know if the low BP side effect is a ‘primary’ effect of the drug or a result of the lowering of the MO enzyme level?
I'm not sure I understand the question. Orthostatic hypotension (slowed cardiovascular adaptation to changes in posture) is probably due to central activation of alpha-adrenergic receptors (which results from increased norepinephrine, which results from destruction of MAO).
> I understand why one shouldn’t take SSRIs and the like but I don’t understand why there would be a need to discontinue other MOAIs when switching between types? After all, the Nardil would wash out in a day or so? Are they acting on different enzymes?
That one is a mystery. It may only be a problem when switching between Nardil or Marplan (the hydrazide MAOIs) to Parnate (an amphetamine-like MAOI).
> I’m also wondering if I should get a med-alert bracelet - I understand that Demerol (meperidine) can be fatal – I would hate to be in a car accident and get Demerol in the ER that could kill me.
Demerol's pretty crappy anyway. They should use morphine. :-) Yeah, it probably is a good idea to have a medical emergency bracelet or necklace. (I prefer the latter; the bracelets seem to get in the way a lot.)
-elizabeth
Posted by Elizabeth on June 15, 2001, at 22:15:35
In reply to Re: Didn't appreciate my pdoc calling it a feel-good » Cam W., posted by paulk on June 15, 2001, at 19:02:35
> Actually, "mother's little helper" used to mean a mix of amphetamines that is now sold as Adderal – back when the song came out it had a different name and was used (unsuccessfully) as a diet pill.
There used to be diet pills that combined amphetamines with short- or intermediate-acting barbiturates, with names like Desbutal (methamphetamine + pentobarbitol) and Dexamyl (d-amphetamine + amobarbitol). I have trouble imagining what the purpose of such a combination pill would be, other than to get really trashed. (The reasoning for adding the barbiturate was that a lot of people get anxious on stimulants.)
-elizabeth
Posted by Elizabeth on June 15, 2001, at 22:32:07
In reply to Re: Linky-link » grapebubblegum, posted by paulk on June 15, 2001, at 20:02:09
> Seriously, your pdoc doesn’t seem to be up on the seritinergic effects of klonopin. Klonopin is THE benzo of choice for long-term treatment.
Not necessarily, although it is definitely a first-line treatment for panic disorder or generalised anxiety. Most benzos have the potental to cause or exacerbate depression, though, including Klonopin; Xanax is often preferable for people with anxiety and depression, despite the need for frequent dosing.
> >Like, a quarter of the smallest strength tablet? Weird. I wonder if maybe you don't metabolise it normally or something. That's a very low dose even for someone who's taking it around the clock (although, as you note, taking it that way has the advantage of preventing panic attacks).
>
> Not that weird. I only need just a little - .25/day. Many others are in the same boat.That's surprising. I took Klonopin for a few weeks at one point, and I needed 4 mg/day (1 mg in the morning and afternoon, 2 mg at bedtime). What do you take it for? (I was taking it for panic disorder and a REM sleep parasomnia.) And most people I know who take Klonopin for panic or anxiety disorders need at least 1 mg/day.
> DITTO – BULLS EYE – EXCELLENT POINT! I hope some docs read what you just said. ( I think this phenomena is called ‘kindling’ in the litature.)
Kindling refers to increased frequency of seizures in untreated epilepsy. (More generally it can refer to the same type of phenomenon in mood disorders or panic disorder.)
> I have seen folks deteriorate over time on very large dosages Benzos.
I haven't. But I have seen people take the same dose for years without problems and without needing to increase it.
> I Really don’t think it is good practice to use benzos per attack (unless its for someone who is bi-polar.)
Huh? Benzos are sometimes used to reduce psychomotor agitation in mania, but they're also used for various types of episodic anxiety. It's completely reasonable.
I think it makes more sense to take the benzo around the clock if you have frequent panic attacks. I take an antidepressant around the clock and Xanax as needed, because the antidepressant reduces the frequency of panic attacks.
> If it is a short acting benzo “as per needed” is a good way to get someone with PA in even bigger trouble.
That doesn't make sense to me. If you only take it as-needed, you don't need to be concerned about pharmacologic dependence if you ever want to go off it (or if you miss a dose). Anxiety patients, as a rule, don't abuse their medication (those who do are almost invariably abusing other drugs too).
Xanax has the additional advantage for as-needed dosing that it's fast-acting, so it can prevent an attack if you take it as soon as you feel the attack.
> Klonopin, for me, even at a VERY low dose makes all the difference in what I do when I lose my temper. It also prevents the panic attacks (although I didn’t have that many).
Benzos for anger? That's interesting. Some people with anger problems become disinhibited on benzos (like alcohol).
> Getting off higher dosages of Benzos can be nightmarish.
That's true if you take them around the clock. But then again, a lot of people really do need much higher doses. You're lucky -- maybe it's because you're taking it primarily for anger and never had frequent panic attacks.
> I watched a fellow patient go through the “cold wet sheet pack treatment” getting off Valium. I think switching to klonopin and tapering would have been a much better way.
That's the right way, yes: switch to a long-acting benzo, such as Klonopin or Tranxene, and then taper off *very* slowly. Any doctor who takes someone off benzos cold-turkey should have his license revoked, IMO.
-elizabeth
Posted by Cam W. on June 15, 2001, at 23:22:42
In reply to Re: Didn't appreciate my pdoc calling it a feel-good » Cam W., posted by paulk on June 15, 2001, at 19:02:35
> Actually, "mother's little helper" used to mean a mix of amphetamines that is now sold as Adderal – back when the song came out it had a different name and was used (unsuccessfully) as a diet pill.
Paul - I had wondered about that as I wrote my original post. It would make more sense. I had thought that it would be an amphetamine. Preludin™ came to mind, but I am not sure what was in them. I know my mom sure liked them. She did all her housework very quickly with them and was sure upset when the doc would not give her any more. - Cam
Posted by Daveman on June 16, 2001, at 0:06:29
In reply to Re: Linky-link » grapebubblegum, posted by paulk on June 15, 2001, at 20:02:09
One of the things I like about this site is the sane discussion of benzos. When reading these discussions I'm always reminded of my college philosophy courses in Hegelian logic. To simplify, Hegel believed that ideas go through three phases: Thesis (where the idea is presented absent criticism), Antithesis (where the idea comes under attack), and Synthesis (where the original idea, tempered by criticism, is modified to a more rational conclusion). In this case, benzos first were thought of as "wonder drugs" because they were so much safer than what came before as minor tranquilizers, such that they were wildly overprescribed, particularly Valium, thus the Thesis; then came the Antithesis, where the problems of benzo dependency became apparent and there was a tremendous backlash against their use. Hopefully we are starting to arrive at a Synthesis, where benzos are only prescribed were appropriate, the doses are kept at a reasonable level, and patients are properly monitored. I for one don't know what would have happened had Xanax not been available to break my panic spiral earlier this year that saw me go more than a week with almost no sleep.
Incidentally, the SSRI's are going through the same process. First the "wonder drug" Thesis, with SSRI's being given for everything from depression to anxiety to PMS to, it seems, the common cold. Now we are entering the Antithesis phase, where critics are pointing out the problems with the SSRI's, particularly the withdrawal problems that many patients were not warned about and thus suffered unnecesarily by quitting "cold turkey". Eventualy the SSRI's will reach a synthesis phase, particularly as they go generic and stop being such a cash cow for the pharmaceutical manufacturers (I say this as a happy but properly warned and monitored Celexa customer).
Dave
Posted by Cam W. on June 16, 2001, at 0:18:17
In reply to Hegelian logic and benzos, posted by Daveman on June 16, 2001, at 0:06:29
Dave - Nicely stated. Mind if I use your interpretation of meds using Hegelian logic (thesis - > antitheis - > synthesis) in some of my presentations? I think that it explains our beliefs and stances on meds very nicely. - Cam
Posted by grapebubblegum on June 16, 2001, at 11:32:15
In reply to Re: Hegelian logic and benzos » Daveman, posted by Cam W. on June 16, 2001, at 0:18:17
You all overwhelm me with your smartness.
Cam: I am a lousy housekeeper. It amazes me that women could get Rx's to do housekeeping faster way back when, and those of us who need fractions of the lowest dose of clonazepem to survive get rolled eyes from jaded health care professionals. Anyway, maybe I finally know why I can't clean house worth a darn. Did they actually have any reason given for the Rx's? Did docs diagnose needs for women to get Rx's very easily back them? I'm assuming they felt they had a good psychiatric reason to prescribe "mothers little helpers."
Elizabeth: I missed it if you stated this before, but are you a physician or some sort of professional other than a plain old layperson like myself? I'm just curious since you seem to know your shizzit.
Whoever mentioned this: (can't remember who - can't remember,it's that klonopin, right? arggghhhh!) (that was a joke)
My pdoc was probably unfairly selectively and even misquoted by me. She did say that clonazepam is excellent for the purposes for which I am using it and she did say that if I am taking it, it is preferable to take it round the clock rather than "as needed," although taking it as needed is most definitely preferable to not taking it at all should a crisis arise as she would prefer to see me go to sleep rather than go to E.R. if things get that bad on any particular night.
She did say also that she has seen a huge range of responses to clonazepam with some people needing very little and some needing a lot in terms of responsiveness and tolerance.
I was joking when I said, "the amount needed to derail a P.A. would kill me." What I mean was that I have taken I think... 1.5 mg over the course of a bad evening and STILL stumbled into the E.R., and while I could hardly stand, walk or talk, the P.A. was still raging within my brain. It was like a fight between my brain and my body. One particular occasion I remember included a nurse giving me a shot of Ativan in my posterior and I could feel the Ativan pulling me down and my brain pulling me back up, like a battle. It's like my P.A. kept coming back up for air, gasping to say alive, and as I lapsed into unconciousness, the final image in conscious brain was a vague vision of vicious dog with bared teeth, then I went out. I'm not afraid of dogs, per se...I'm sure it was just a general "anxiety" picture pulled at random from that card catalog at the back of my brain.
But my point was.... She was not overjoyed to hear that the E.R. docs gave me Ativan and sent me home with a bottlefull the next day... I took one dose as directed and walked around and literally could not remember what I did that day. I guess that's why she does not favor Ativan except maybe at the time the E.R. docs did what was best for that situation.
She does keep reminding me that clonazepam can worsen depression. I don't know what to make of that. I don't think I am a classically depressed person. At one time she had me on clorazepate (tranxene) and she felt it was not good enough and that is when she switched me to clonazepam which I believe is her favorite benzo (she admits it does a good job and that is why she prescribes it.)
As for valium, I was given that once during a medical procedure and it made me sleepy but did not do a good job of alleviating the panic attack that ensued from the pain of the procedure. It was bad: like being too knocked out to move or speak but panicking inside. She was also not pleased to hear that I was given IV valium for a procedure that is normally done under general anesthesia. Incidentally, I saw on the b.p. monitor that my b.p. was 80/40 or less.
Posted by paulk on June 16, 2001, at 15:07:23
In reply to Re: more about Xanax and depression » paulk, posted by Elizabeth on June 15, 2001, at 22:10:17
>That's true, although there is something called a "use patent" (which is why you still can't get generic Prozac in the US
Tell me more – how much longer can they stretch it out with this?
> > Do you know if the low BP side effect is a ‘primary’ effect of the drug or a result of the lowering of the MO enzyme level?
>I'm not sure I understand the question. Orthostatic hypotension (slowed cardiovascular adaptation to changes in posture) is probably due to central activation of alpha-adrenergic receptors (which results from increased norepinephrine, which results from destruction of MAO).
From what you said that would be a secondary effect – the primary effect of the drug would be the destruction of MAO. A secondary effect would be the increase in neuro transmitters. I saw some lowering of my BP quite as soon as I took the med – I’m thinking it might be a primary effect?
> > Unfortunately, it was quite a bear to manage frequent dosing at a low level, so I stopped it many years ago. Xanax quits so fast and nasty that I can see why it would be addictive. Sure wish there was an XR version to try.
>Addiction results from using large doses of a drug to get high. Anybody who's been taking Xanax for a long time will get withdrawal symptoms; that's not drug addiction, it's a normal reaction.
Not sure I’m tracking you here – my father gave some of his terminal patients enough painkiller for them to become ‘physically addicted’ – in my mind if there are physical side effects from withdrawal one is physically addicted. On the other hand, I would say there are lots of people who are psychologically addicted to coffee.
I think we agree on this – I might be using a different definition of addiction? I would even call the fever I got discontinuing Effexor a physical addiction. Perhaps I’m just not being PC enough< grin >. I see no problem in getting physically addicted to a drug if it is beneficial in the long term.
I think I remember hearing a ‘modern’ definition about addiction being where one loses the ability do deny oneself the drug (I guess I might be addicted to food - some of the amino acids can make me feel much better - (unfortunatley they tend to be found in association with high fat content)).
> > I understand why one shouldn’t take SSRIs and the like but I don’t understand why there would be a need to discontinue other MOAIs when switching between types? After all, the Nardil would wash out in a day or so? Are they acting on different enzymes?
>That one is a mystery. It may only be a problem when switching between Nardil or Marplan (the hydrazide MAOIs) to Parnate (an amphetamine-like MAOI).
My guess is that the different MAOIs must be knocking out different MAOs or they would all have the same effect other than their side effects.
> > I’m also wondering if I should get a med-alert bracelet - I understand that Demerol (meperidine) can be fatal – I would hate to be in a car accident and get Demerol in the ER that could kill me.
>Demerol's pretty crappy anyway. They should use morphine. :-)
Or heroin – it is supposed to be the best painkiller (there might be some new synthetics – I don’t know about). Back when heroin was used as a painkiller most folks had no problem becoming dependent on it. The name had something to do with the heroic effect it had combating pain. It probably got its bad reputation because so many coming back from the war had been treated with it at one time. Out of this large number enough had addiction problems that it earned its ‘bad drug’ status. If a different opiate had been popular for pain control at that time it would have earned the same ‘bad drug’ status. (I suppose one could make some points about the half-life of some opiates makes them more addicting.) Anyway – many people who were given large amounts of heroin for pain had no problems getting off the drug.
There are times when I have a bad influenza that I wish I could get some opiate for a day or two while I recover – it is near impossible to get codeine cough syrup and when I’m sick, I’m not likely to go to more than one drug store.I also, have had a run-in with opiates=bad when I had my second kidney stone. (I had no idea what was happening with the first one.) I came into the emergency room – told them I was having a kidney stone. The ER thought I was an addict and just put me on hold for 45 min – until I got mad and demanded they run an IVP on me so I could prove I really did have a stone and get the pain med I needed. I didn’t get pain med for over 2 ½ hours.
Posted by paulk on June 16, 2001, at 15:09:16
In reply to diet pills » paulk, posted by Elizabeth on June 15, 2001, at 22:15:35
> > Actually, "mother's little helper" used to mean a mix of amphetamines that is now sold as Adderal – back when the song came out it had a different name and was used (unsuccessfully) as a diet pill.
>
> There used to be diet pills that combined amphetamines with short- or intermediate-acting barbiturates, with names like Desbutal (methamphetamine + pentobarbitol) and Dexamyl (d-amphetamine + amobarbitol). I have trouble imagining what the purpose of such a combination pill would be, other than to get really trashed. (The reasoning for adding the barbiturate was that a lot of people get anxious on stimulants.)
>
> -elizabethI remember those also - but what is now Adderal was once known by a different name.
Posted by paulk on June 16, 2001, at 15:45:00
In reply to Re: Linky-link » paulk, posted by Elizabeth on June 15, 2001, at 22:32:07
> > Seriously, your pdoc doesn’t seem to be up on the seritinergic effects of klonopin. Klonopin is THE benzo of choice for long-term treatment.
>
> Not necessarily, although it is definitely a first-line treatment for panic disorder or generalised anxiety. Most benzos have the potental to cause or exacerbate depression, though, including Klonopin; Xanax is often preferable for people with anxiety and depression, despite the need for frequent dosing.
>
I sure think it would be better in a XR version.> > Not that weird. I only need just a little - .25/day. Many others are in the same boat.
>
> That's surprising. I took Klonopin for a few weeks at one point, and I needed 4 mg/day (1 mg in the morning and afternoon, 2 mg at bedtime). What do you take it for? (I was taking it for panic disorder and a REM sleep parasomnia.) And most people I know who take Klonopin for panic or anxiety disorders need at least 1 mg/day.Our neuro-chemistry is probably much more variable than the shapes of our faces – YMMV. Also the effects at high dosages may not at all the same as what I get out of the drug. A similar example – Effexor has very little NE effect at 75mg and acts mostly like a SSRI, but at 300mg it becomes a true SNRI.
> > DITTO – BULLS EYE – EXCELLENT POINT! I hope some docs read what you just said. ( I think this phenomena is called ‘kindling’ in the litature.)
>
> Kindling refers to increased frequency of seizures in untreated epilepsy. (More generally it can refer to the same type of phenomenon in mood disorders or panic disorder.)
>
Yes, I’m talking about kindling as it refers to mood.
> > I have seen folks deteriorate over time on very large dosages Benzos.
>
> I haven't. But I have seen people take the same dose for years without problems and without needing to increase it.It isn’t pretty. I went to a funeral of a friend who had lost his hygiene habits after too many bezo over 15 years. He died choking to death on a hotdog. (this is not a joke)
>
> > I Really don’t think it is good practice to use benzos per attack (unless its for someone who is bi-polar.)
>
> Huh? Benzos are sometimes used to reduce psychomotor agitation in mania, but they're also used for various types of episodic anxiety. It's completely reasonable.
>
I guess I’ve seen too many people who got in trouble with benzos when I was in hospital. That dosen’t mean everyone will, but some do.> > If it is a short acting benzo “as per needed” is a good way to get someone with PA in even bigger trouble.
>
> That doesn't make sense to me. If you only take it as-needed, you don't need to be concerned about pharmacologic dependence if you ever want to go off it (or if you miss a dose). Anxiety patients, as a rule, don't abuse their medication (those who do are almost invariably abusing other drugs too).
>
I would humbly disagree; the short half-life of Xanex causes withdrawal symptoms of ‘panic and anxiety’ in some patients with a single dose. When I took Xanex – I would get quite irritable as the drug wore off. This makes a drug spiral – take Xanex for anxiety – it works, but as it wears off anxiety is there, but worse – take more – and more. Now, this doesn’t happen to everyone – but it sure happens to some folks.> > Klonopin, for me, even at a VERY low dose makes all the difference in what I do when I lose my temper. It also prevents the panic attacks (although I didn’t have that many).
>
> Benzos for anger? That's interesting. Some people with anger problems become disinhibited on benzos (like alcohol).Not me – I still get mad – I just don’t kindle into a rage.
>
> > Getting off higher dosages of Benzos can be nightmarish.
>
> That's true if you take them around the clock. But then again, a lot of people really do need much higher doses. You're lucky -- maybe it's because you're taking it primarily for anger and never had frequent panic attacks.
>
Yes – more I’m more of GAD with Atypical depression – my entire life.> > I watched a fellow patient go through the “cold wet sheet pack treatment” getting off Valium. I think switching to klonopin and tapering would have been a much better way.
>
> That's the right way, yes: switch to a long-acting benzo, such as Klonopin or Tranxene, and then taper off *very* slowly. Any doctor who takes someone off benzos cold-turkey should have his license revoked, IMO.They tapered – the anxiety returned – only treatment was CWSP. This was a hospital that was down on drug therapy and thought they could talk away everyone’s problems (sadly some who had thyroid disease)
Posted by Daveman on June 16, 2001, at 18:22:51
In reply to Re: Hegelian logic and benzos » Daveman, posted by Cam W. on June 16, 2001, at 0:18:17
> Dave - Nicely stated. Mind if I use your interpretation of meds using Hegelian logic (thesis - > antitheis - > synthesis) in some of my presentations? I think that it explains our beliefs and stances on meds very nicely. - Cam
Feel free. It's not original to me after all:)
Dave
Posted by Elizabeth on June 25, 2001, at 23:58:25
In reply to Re: more about Xanax and depression » Elizabeth, posted by paulk on June 16, 2001, at 15:07:23
> >That's true, although there is something called a "use patent" (which is why you still can't get generic Prozac in the US
>
> Tell me more – how much longer can they stretch it out with this?It's not clear. However long the FDA will continue accepting bribes, I guess. < g >
> >I'm not sure I understand the question. Orthostatic hypotension (slowed cardiovascular adaptation to changes in posture) is probably due to central activation of alpha-adrenergic receptors (which results from increased norepinephrine, which results from destruction of MAO).
>
> From what you said that would be a secondary effect – the primary effect of the drug would be the destruction of MAO. A secondary effect would be the increase in neuro transmitters....because one of their major metabolic pathways is cut off, right. (There are other enzymes, such as catechol-O-methyltransferase (COMT), that catalyse the metabolism of these neurotransmitters, but those are relatively minor. I did once speak to someone who'd tried using a COMT inhibitor for depression and ADD, but he wasn't impressed by it in comparison to the MAOIs.)
> I saw some lowering of my BP quite as soon as I took the med – I’m thinking it might be a primary effect?
It's (probably) a consequence of the increased neurotransmitter concentrations (norepinephrine in particular). It's not a "direct" effect in the sense you seem to mean, but it is observable after a single dose, as opposed to the AD effects which usually require chronic dosing (for at least a couple weeks, although my impression has been that many people find that MAOIs work faster than other ADs).
> >Addiction results from using large doses of a drug to get high. Anybody who's been taking Xanax for a long time will get withdrawal symptoms; that's not drug addiction, it's a normal reaction.
>
> Not sure I’m tracking you here – my father gave some of his terminal patients enough painkiller for them to become ‘physically addicted’ – in my mind if there are physical side effects from withdrawal one is physically addicted.I discussed this in another post:
http://www.dr-bob.org/babble/20010618/msgs/67768.html
"Addiction" is a really loaded word and can cause confusion since different people have different ideas of what it means.
> On the other hand, I would say there are lots of people who are psychologically addicted to coffee.
Caffeine causes a mild withdrawal syndrome -- fatigue, headaches, etc. I once heard somewhere that something like 80% of adult Americans are pharmacologically dependent on caffeine, though (in other words, they need their morning coffee).
> I would even call the fever I got discontinuing Effexor a physical addiction.
The presence of withdrawal symptoms is evidence of what you call "physical addiction," yes. (I personally don't like that term because "addiction" is such a loaded word, and because it implies that mental processes are somehow "nonphysical.)
Besides its moral/political overtones, "addiction" also implies a pathological condition, whereas withdrawal symptoms are normal consequences of discontinuing certain drugs after you've been using them regularly for a while. Almost anyone who takes morphine for a few weeks will experience some uncomfortable withdrawal signs and symptoms if they attempt to stop taking it, especially if they stop "cold turkey." Most people who take morphine for pain have no trouble staying off it after stopping it, once the initial withdrawal period has abated (assuming that the source of their pain was treated so that they no longer require an analgesic).
> I think I remember hearing a ‘modern’ definition about addiction being where one loses the ability do deny oneself the drug (I guess I might be addicted to food - some of the amino acids can make me feel much better - (unfortunatley they tend to be found in association with high fat content)).
That's the defining characteristic of "addiction," yes. If an "addict" goes too long without their drug of choice, he starts obsessing about it and experiencing intense cravings -- even if he doesn't experience withdrawal symptoms.
> My guess is that the different MAOIs must be knocking out different MAOs or they would all have the same effect other than their side effects.
Nope. Nardil and Parnate are both nonselective inhibitors of MAO. They do have other effects in addition to MAO inhibition, though: Nardil is also an inhibitor of GABA metabolism, while Parnate is *thought* to have some sort of dopaminergic effect (perhaps induction of dopamine release: Parnate is chemically extremely similar to amphetamine).
> >Demerol's pretty crappy anyway. They should use morphine. :-)
>
> Or heroin – it is supposed to be the best painkiller (there might be some new synthetics – I don’t know about).No, fentanyl (which isn't all that new) is probably a better analgesic. Heroin (diacetylmorphine) is really just a semisynthetic version of morphine. The acetyl groups cause it to be taken up into the CNS very rapidly if it's taken intravenously (heroin, if taken through other routes, is transformed into morphine before it makes it to the CNS).
> Back when heroin was used as a painkiller most folks had no problem becoming dependent on it.
Well, they often became dependent on it (often in the form of unlabeled patent remedies with names like "Mrs. Brown's Soothing Syrup"). But because they had unlimited access to it, they didn't have trouble functioning as a result of their dependence.
> It probably got its bad reputation because so many coming back from the war had been treated with it at one time.
I'm kind of embarrassed to say that I don't know which war you're referring to. < G > But anyway, like almost every illegal drug, heroin's bad reputation originated in racism -- it was the recreational drug of choice of many of those wild, creepy, dangerous (i.e., black) jazz musicians.
> If a different opiate had been popular for pain control at that time it would have earned the same ‘bad drug’ status.
A number of different opiates, including morphine and laudanum, were used widely as analgesics in the late 19th and early 20th centuries. They were used in a wide variety of "nervous disorders" (anxiety and depression -- laudanum could be said to be the original "mother's little helper") as well.
> (I suppose one could make some points about the half-life of some opiates makes them more addicting.)
Not the half-life: the rapid onset of action. Heroin "hits" extremely fast when injected into a vein. Oral heroin, on the other hand, is effectively the same as morphine (which isn't very orally active itself: oxycodone has much better bioavailability when taken by this route).
> Anyway – many people who were given large amounts of heroin for pain had no problems getting off the drug.
Of course they didn't. Neither do most people who take the strongest opioid analgesics -- fentanyl, hydromorphone (Dilaudid), oxymorphone (NuMorphan), etc. -- today. Try explaining this to a politician, though!
> I also, have had a run-in with opiates=bad when I had my second kidney stone.
Oh jeez. I never had those, but I know how painful they are. There seem to be a lot of doctors out there -- especially ER docs -- who hate getting duped so much that they'd rather leave people in agony than risk giving "narcotics" to an addict (because if these doctors felt they'd been had, their precious egos would suffer irreparable bruising).
-elizabeth
Posted by Elizabeth on June 26, 2001, at 1:54:50
In reply to Re: diet pills » Elizabeth, posted by paulk on June 16, 2001, at 15:09:16
> I remember those also - but what is now Adderal was once known by a different name.
Obetrol.
-e
Posted by Elizabeth on June 26, 2001, at 2:56:27
In reply to Re: Linky-link » Elizabeth, posted by paulk on June 16, 2001, at 15:45:00
> Our neuro-chemistry is probably much more variable than the shapes of our faces – YMMV.
That's for sure. The human brain is one of the most complicated objects in nature.
> Also the effects at high dosages may not at all the same as what I get out of the drug.
Maybe, but I wonder if in this case there might be a difference of metabolism involved. 4 mg/day of Klonopin is a pretty typical dose for panic disorder (and the upper end of the recommended dose range for epilepsy is 20 mg/day).
> > I haven't. But I have seen people take the same dose for years without problems and without needing to increase it.
>
> It isn’t pretty. I went to a funeral of a friend who had lost his hygiene habits after too many bezo over 15 years. He died choking to death on a hotdog. (this is not a joke)That's terrible, but I do hope your example doesn't scare people unnecessarily! I really would be interested to know the details, if you're comfortable discussing them -- like the individual's age, why he was taking the benzos (and which ones and how much), whether he had other medical conditions that could have contributed, etc.
Some people abuse benzos, and they can develop truly massive tolerance. The worst case of this I've heard of involved a guy who was using more than 100 mg of Xanax a *day*. Some people have general sedative abuse problems, and they often combine benzos with other CNS depressants, such as alcohol, barbiturates, meprobamate, industrial solvents (inhalants), etc. As I mentioned, most people who abuse benzos also abuse other drugs.
However, most anxiety patients who take therapeutic doses (which can mean up to around 6 mg/day of Xanax or Klonopin) do not have problems with them. They certianly don't become demented or unable to care for themselves; on the contrary, benzos can eliminate crippling anxiety. It is true that some people suffer cognitive impairment (slowed thinking, memory problems) from benzos; these people usually end up taking alternative anxiolytics (such as antidepressants) instead (although most people I know who take ADs for panic disorder still occasionally need to take benzos).
> I guess I’ve seen too many people who got in trouble with benzos when I was in hospital. That dosen’t mean everyone will, but some do.
That's rather surprising. Anxiety patients tend to use medication as directed or, if anything, to use *less* than the prescribed amount, not more.
> I would humbly disagree; the short half-life of Xanex causes withdrawal symptoms of ‘panic and anxiety’ in some patients with a single dose.
Some people might experience rebound anxiety (just as people who use short-acting benzos such as Halcion for insomnia may be subject to waking up in the middle of the night when the med wears off), but if they are truly taking the drug only on an occasional basis, rebound effects (if any) are unlikely to be serious. Also, people who have continuous anxiety (rather than, or in addition to, short-lived anxiety or panic attacks) will become anxious again after a benzo wears off: that's not a rebound reaction. Single, isolated doses of benzos do not cause dependence, by any definition you use.
> When I took Xanex – I would get quite irritable as the drug wore off. This makes a drug spiral – take Xanex for anxiety – it works, but as it wears off anxiety is there, but worse – take more – and more. Now, this doesn’t happen to everyone – but it sure happens to some folks.
Ahh. Irritability isn't an indication for benzos, and they have been known (and documented) to cause bad reactions in some people who had preexisting mood-regulation disorders (which often tend to manifest as irritability or atypical/mood-reactive depression). I don't know all the details, just that the disinhibiting effects of benzos can cause serious problems for some people. It would be interesting to read these reports in more detail; it might turn out that the patients described were suffering from a sort of rebound effect. Xanax has a particularly bad reputation for this compared to other benzos, incidentally. (I haven't ever read, or even heard, of such a rebound effect in people who take benzos on an ad-lib basis for anxiety or panic attacks.)
People do vary widely in their tendency to adapt to drug effects. Some people rapidly develop tolerance and dependence to a particular class of drugs, or to drugs in general. I wouldn't rule out the possibility that certain identified patient populations are unusually liable to become tolerant to drugs. (Tolerance and dependence are both due to adaptations: some people may adapt very rapidly to drugs.)
> They tapered – the anxiety returned – only treatment was CWSP.
"CWSP?" (Is there something I'm supposed to know about here?)
> This was a hospital that was down on drug therapy and thought they could talk away everyone’s problems (sadly some who had thyroid disease)
< groan >
-elizabeth
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