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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 36 to 60 of 73. Go back in thread:
Posted by ed_uk on January 7, 2006, at 4:06:31
In reply to Re: Oh, James K, posted by Declan on January 6, 2006, at 18:37:01
Hi Declan
How does your experience of benzo withdrawal compare with your experience of opioid withdrawal?
Ed
Posted by Declan on January 7, 2006, at 7:03:48
In reply to Re: Oh, James K » Declan, posted by ed_uk on January 7, 2006, at 4:06:31
G'day Ed
In Benzo withdrawal, fear and tension are prominent; in opiate withdrawal, a coldness, fatigue, pain and insomnia. Sort of. The fear in benzo withdrawal is awful. Methadone withdrawal is prolonged.
Once I cut my benzo dose to 1/4 of what it had been. It was bad, but not impossible. There's no way I could have done that with methadone (or any of the major opiates).
Declan
Posted by valene on January 7, 2006, at 12:04:50
In reply to Re: Oh, James K-Phillipa » valene, posted by yxibow on January 7, 2006, at 0:08:49
Hi yxibow,
Not to belabor the point, but if you take a glance at the "heroin and opiate withdrawal" forum (and in the archives) you will see many people who have been on a benzo (albeit some abusing them too) but some on legitimate doses and who say that opiate or heroin withdrawal is a walk in the park compared to benzo withdrawal. Not my words because I have never been addicted to heroin or opiates.Heather Ashton may not impress you but she is the only perseon who did successfully taper 100's of people off benzos and has extensively studied them. I would not just write off her research.
http://www.heroin-detox.com/topic.asp?TOPIC_ID=6508&SearchTerms=benzos
Posted by ed_uk on January 7, 2006, at 12:46:29
In reply to Re: Oh, James K » ed_uk, posted by Declan on January 7, 2006, at 7:03:48
Hi Dec
Opioids and benzodiazepines both have horrible withdrawal symptoms :(
The scary thing about being physically dependent on a prescribed opioid or a benzo is that your 'access' to the drug might be removed at any time. Some people are forced to withdraw quite abruptly. If your docotor retires, if you move to a different part of the country, if your doctor suddenly gets 'uncomfortable' about prescribing...........
Many psych drugs (notably Effexor) are associated with unpleasant withdrawal symptoms. Dependence on antidepressants is a lot less scary though. Almost all doctors are willing to prescribe SSRIs and Effexor. You don't get suspected of misusing your medication. No one tries to force you to withdrawal abruptly. Access to prescriptions is easy. You're less likely to get 'funny looks' in the pharmacy.
I'd never want to be dependent on a benzo in the UK. There are too many problems, forced withdrawal is likely. In countries where benzos are readily available, the problems associated with physical dependence are likely to be less.
Ed x
Posted by reefer on January 8, 2006, at 8:52:58
In reply to When are benzos justified?, posted by detroitpistons on January 3, 2006, at 15:21:05
I have an easy answer to that question. If i could just go into the pharmacy and buy all the benzos i wanted i would put myself on 10 mg of Xanax XR today without a second thought. Cause i know how horrible the shame of asking my doc for a new clonazepam script is. And it's not this doc that created this fear, it's the doctor i used to have before. The same doc that put me on it in the first place. As it is now i am on 0.5 mg of clonazepam per day. I would like to go much higher and my doc would let me. But now i just need a new script every six months if i increase the dosage i will need to ask for it more often. My problem has never been the drug itself, rather the opio/benzo phobia around me. That's just my five cents....
Posted by zeugma on January 8, 2006, at 9:28:51
In reply to Re: When are benzos justified?, posted by reefer on January 8, 2006, at 8:52:58
My problem has never been the drug itself, rather the opio/benzo phobia around me. That's just my five cents.... >>
My social phobia is worse than my embarrasment at the sidelong looks of benzophobic pharmacists. Social phobia makes it all but impossible for me to eat in public, for example, without Klonopin.
A couple of minutes of embarrasment at the pharmacy is nothing to being able to moderate my unrelenting claustrophobia, social phobia, and aggravations of IBS caused by episodes of severe anxiety. Klonopin moderates them: suggestions made by authors such as Dr. David Burns, in his book "Feeling Good", that benzos are undesirable in the treatment of anxiety disorders because they 'magically' ameliorate all anxiety, thus discouraging patients from continuing to enlist in his CBT programs, and then induce tolerance, so escalating dosages are required to achieve the same effect, are just not true, at least in my case. Well, it is true that i have lost all motivation to engage in CBT. But that is because of problems with CBT, not because of magical but fleeting effects of a benzo. The effects are neither magical nor fleeting, but very useful in my case , unlike effects of CBT. As a matter of fact one should realize that Burns is in the marketing business and benzos are clearly competition. Burns' praise for SSRI's as an adjunct to CB therapy is perhaps a reflection on the differential effectiveness of SSRI's vs. benzos in treating severe anxiety. (There is no question however, from reading this board, that SSRI's work much better than benzos for some forms of anxiety.)
As to the question of dependence/addiction: like Dr. Heather Ashton, Dr. David healy is a controversial figure in psychiatry. He is one who IMO has given much thought to matters involving benzos, SSRI's, and marketing issues, and was stripped of an appointment at a major Canadian university, allegedly because that university was the recipient of a large grant from from Eli Lilly, and Healy has lectured extensively on the adverse effects of prozac and other SSRI's. here is the link, to be read with a critical eye (just because I think he's on target is no reason anyone else should):
http://www.socialaudit.org.uk/58092-DH.htm
Perhaps he's wrong about the relative risks of benzodiazepine vs. SSRI withdrawal, but anyone capable of this astute obseervation:
<<Indeed, given that pharmaceutical companies now regard SPcs and PILs as advertising material that goes direct to the consumer, it is not clear that it is possible to regulate in a manner that prescinds from marketing>>
deserves to be taken seriously.
By the way, this is just a pedantic note but for what it's worth: I visited Ashton's site, and the 'overt Christian imagery' mentioned by an earlier poster appears to actually be the seal of the university she is affiliated with. That is merely a comment about a particular detail of her site, and neither validates nor invalidates any points made by any poster here.-z
Posted by ed_uk on January 8, 2006, at 9:49:34
In reply to Re: When are benzos justified?, posted by reefer on January 8, 2006, at 8:52:58
Hi Reefer
Benzos are available without a prescription in some European countries. You'll have to move!
Ed
Posted by ed_uk on January 8, 2006, at 10:01:28
In reply to Re: When are benzos justified?, posted by zeugma on January 8, 2006, at 9:28:51
Hi Z :)
>A couple of minutes of embarrasment at the pharmacy.....
.......is unpleasant but is not the reason why I would be frightened to take a benzo regularly.
The fear of being forced to withdraw would be my concern. Anyone who is considering initiating long-term benzodiazepine treatment must ensure (as much as possible) that long term 'access' to the drug will be relatively straight forward.
This depends on many factors.......
1. What country you live in
2. Whether benzos are OTC in your country
3. The attitude of the local doctors towards benzodiazepines
4. The attitudes of your own doctor toward benzodiazepines
5. Whether your current doctor is likely to remain your doctor for a prolonged period of time
6. Whether you are planning on moving to a different area
7. Whether you have a history of drug misuse
Regards
Ed
Posted by zero on January 8, 2006, at 11:55:29
In reply to Re: When are benzos justified? » reefer, posted by ed_uk on January 8, 2006, at 9:49:34
What countries Ed?
> Benzos are available without a prescription in some European countries. You'll have to move!
>
Posted by reefer on January 8, 2006, at 15:53:25
In reply to Re: When are benzos justified? » reefer, posted by ed_uk on January 8, 2006, at 9:49:34
> Hi Reefer
>
> Benzos are available without a prescription in some European countries. You'll have to move!
>
> EdYeah i guess, but moving to get it would be strong drug seeking behaviour. So in the end that would make *them* right! Wouldn't it!?
Posted by 4WD on January 8, 2006, at 21:55:59
In reply to When are benzos justified?, posted by detroitpistons on January 3, 2006, at 15:21:05
Benzos are justified for me for the simple reason that they are keeping me out of a psych ward. When I was not taking Klonopin, I was crawling in the floor, crying and screaming at God to please make the fear stop. Now I just am scared.
Marsha
Posted by sdb on January 9, 2006, at 8:32:40
In reply to Re: When are benzos justified?, posted by 4WD on January 8, 2006, at 21:55:59
justified remembers me to justice and thus guiltiness. I would ask: "When does a sufferer really has remarkable relief with benzos?"
Posted by valene on January 9, 2006, at 10:20:11
In reply to Re: When are benzos justified?, posted by 4WD on January 8, 2006, at 21:55:59
Hi Marsha,
I totally empathize with your statement below. May I ask if you had this severe fear and anxiety *before* you ever took Klonopin, or did you try to cut back on it and thus had the awful fear? I am trying myself to get off the xanax but it is so very difficult and I am riddled with fear and obsessive, dark thoughts and feelings. I did not feel this way before I ever went on the benzos. Not nearly as bad.Valene
> Benzos are justified for me for the simple reason that they are keeping me out of a psych ward. When I was not taking Klonopin, I was crawling in the floor, crying and screaming at God to please make the fear stop. Now I just am scared.
>
> Marsha
Posted by reefer on January 9, 2006, at 18:51:32
In reply to Re: When are benzos justified? - 4WD, posted by valene on January 9, 2006, at 10:20:11
> Hi Marsha,
> I totally empathize with your statement below. May I ask if you had this severe fear and anxiety *before* you ever took Klonopin, or did you try to cut back on it and thus had the awful fear? I am trying myself to get off the xanax but it is so very difficult and I am riddled with fear and obsessive, dark thoughts and feelings. I did not feel this way before I ever went on the benzos. Not nearly as bad.
>
> Valene
>Xanax is a good benzo to be on. It is a horrible benzo to taper off of(not for everyone but for a lot of people). I suggest you switch to a benzo with a longer halflife. Preferebly diazepam, but clonazepam can also be ok.
Posted by 4WD on January 9, 2006, at 21:49:01
In reply to Re: When are benzos justified? - 4WD, posted by valene on January 9, 2006, at 10:20:11
Hi Valene,
I had the anxiety before I started the Klonopin. That's why I started it. It started when I went off Effexor. First switched to Paxil and had to go on Xanax for a couple of weeks. Gave up on Paxil, and quit the Xanax. Back to Effexor and was okay again. Tried again with Paxil and the same thing happened. Tried Cymbalta and the same thing happened. I couldn't go back to Effexor because it wasn't working at all for depression and I had to have an AD that would work.
Anyway, the anxiety/terror started BEFORE the benzos. So it's not withdrawal. I've been through benzo withdrawal before (15 years ago with Ativan) and this is different. I hadn't taken a benzo since 1986 when this panic started out of the blue.
Marsha
> I totally empathize with your statement below. May I ask if you had this severe fear and anxiety *before* you ever took Klonopin, or did you try to cut back on it and thus had the awful fear? I am trying myself to get off the xanax but it is so very difficult and I am riddled with fear and obsessive, dark thoughts and feelings. I did not feel this way before I ever went on the benzos. Not nearly as bad.
>
> Valene
>
> > Benzos are justified for me for the simple reason that they are keeping me out of a psych ward. When I was not taking Klonopin, I was crawling in the floor, crying and screaming at God to please make the fear stop. Now I just am scared.
> >
> > Marsha
>
>
Posted by Declan on January 10, 2006, at 1:10:35
In reply to Re: When are benzos justified? - 4WD, posted by valene on January 9, 2006, at 10:20:11
Yeah Valene, that's how I feel. The problems I had that led me to take benzos are as nothing compared to the problem of giving them up. It certainly puts those problems in perspective, I guess. That's just how it's been for me. I wish I'd never gone to the psych in the first place, and found a better place to look for a soul doctor.
Declan
Posted by Declan on January 10, 2006, at 1:13:48
In reply to Re: When are benzos justified? - 4WD » valene, posted by 4WD on January 9, 2006, at 21:49:01
Marsha, you've got something different, haven't you, if I remember correctly, waking in fear and stuff. I certainly don't want to be prescriptive.
Declan
Posted by 4WD on January 10, 2006, at 22:25:56
In reply to Re: When are benzos justified? - 4WD » 4WD, posted by Declan on January 10, 2006, at 1:13:48
> Marsha, you've got something different, haven't you, if I remember correctly, waking in fear and stuff. I certainly don't want to be prescriptive.
> DeclanYeah, I wake up scared with fear and dread and guilt in the pit of my stomach. And I'm jittery and nervous like I have too much adrenaline in my bloodstream. (Although I'm not nearly as bad now as I was a year ago).
I hadn't taken a benzo in almost 20 years before this happened. I fought tooth and nail against the idea of Klonopin or any other benzo because I've been there before (using Ativan as a sleep aid for 10 years and stopping it cold turkey). But when I reached the point of suicide from the fear, I gave up and took the effing Klonopin.
At one point I went off it for about a month because I got to thinking maybe my recurring anxiety was because I had gotten used to the K. AFter a month off it, my anxiety was just getting worse. AGain, almost ended up in the hospital to keep myself safe - the fear was that intense.
So now I take my Klonopin. I'm supposed to be taking .5mg three times a day but I only take it twice a day. I'm still terrified of it and am living for the day when the anxiety abates to the point that I can stop it.
I feel guilty for taking a benzo because I abused Ativan in the past. But I don't abuse the Klonopin at all. My pdoc is always trying to get me to up the dosage and I just have a phobia about it. I just can't bring myself to take more than 1mg a day and I'm constantly trying to figure out how to get by with less. (And reducing my dosage without telling him).
Benzos are scary. I hate them. But Klonopin definitely saved my life.
Marsha
Posted by detroitpistons on January 11, 2006, at 20:57:04
In reply to When are benzos justified?, posted by detroitpistons on January 3, 2006, at 15:21:05
Well, the last think I expected was to come home from my pdoc appointment with a sample box of Lamictal in hand...
I went in and basically told him that I wasn't deeply depressed anymore, that the Effexor had basically taken care of that. But then I told him that I've still been feeling anxious, that the GAD was still present. I went into some detail, telling him that I just felt agitated and nervous. I described it as "directionless energy." I also mentioned that I'd been experiencing racing thoughts and that I've had a really hard time focusing and concentrating, and at times have felt somewhat hyperactive (lately I've been wondering if maybe I've got some mild form of ADD -- just searching for answers). If anything, I was expecting him to suggest Klonopin or maybe even Strattera.
Instead, he said that it sounded like I was in a kind of hypomanic state. I was pretty surprised by this. My uneducated impression of hypomania is that you feel euphoric and grandiose. Euphoria and grandiosity are far, far from what I've been feeling lately.
So I just took my first 25 mg dose of Lamictal, and I'm hoping for the best, but it's just kind of a shock to me. I hope the doc is right.
I don't know anything about Lamictal. Anyone care to comment on this? Does it seem right that I'm taking this? How long does it take Lamictal to work? The first 2 weeks are 25 mg, then 50 mg for the next 2 weeks, and then 100 mg the 5th week. I go back to see the doc in 2 weeks.
Marc
> I've been thinking about starting Klonopin, but I just wanted some feedback from other benzo users. I take small amounts of Xanax and I can feel better by taking as little as .25mg. However, it can make me depressed and lethargic.
>
> I'm on Effexor XR 225 mg, and it has not totally relieved me of anxiety, although it picked me up out of a depressive episode. I'm familiar with the pro-benzo vs anti-benzo debate. I guess what I'm trying to get at is this: How bad does anxiety have to be in order to justify taking a benzo? I realize this is a very difficult question to answer, but I just wanted to hear some other people's thoughts.
>
> I can generally function without a benzo (or even an AD for that matter)...I can leave the house, go to work, be in social settings with people I don't know (although rarely comfortably). In short, I can get along with life, but I never feel quite right. I feel like everything is forced. I feel like I'm operating at 75%. I probably wouldn't regard my anxiety as severe (not agoraphobic, for example), but I do think it interferes with my life and prevents me from being all I can be.
>
> Where is the line? When is taking a benzo justified? I've always been scared to overmedicate myself. In fact, it took me a good amount of pain and suffering before I broke down and tried an AD. I've never liked the idea of taking 1 psych drug, much less 2 or 3. Sometimes I feel like I'm "cheating," like the only people who should really be on meds are the ones who can't get out of bed in the morning, can't leave the house, can't go to work, etc.
>
> Can anyone relate to this sort of "psych med reckoning" I'm going through?
>
> And back to the original point, any thoughts from benzo/Klonopin users? The first and only psych med I took that worked was Effexor, and it seemed like a godsend at the time (for both anxiety and depression). Now I tried it again, and it just doesn't seem to be working as well on the anxiety. I think my condition(s) may have worsened over the past couple of years, and quite frankly, it feels like the meds may have contributed to that (e.g. caused a permanent change in brain chemistry--which I know sounds very paranoid).
>
> Any thoughts?
Posted by James K on January 11, 2006, at 22:06:18
In reply to Re: When are benzos justified? -- UPDATE, posted by detroitpistons on January 11, 2006, at 20:57:04
In retrospect, I'm suprised lamictal didn't spring to my mind right away. I'm taking it basicaly for the same kind of reasons you describe.
Some of the others around here can give you some science on it, but I have some personal experience.
It is some kind of atypical anticonvulsant that is used very extensively as a mood stabilizer. Kind of the drug of choice at the moment. You don't have to have the classic mania symptoms to need a mood stabilizer. I've come to believe the result is more important than the diagnosis.
You do have to start very slowly (and i think stop slowly too) I don't remember many side effects, but so many things go on at once I could have missed them.
My new pdoc said 200 was the standard therapuetic dose after she found out I had gone down to 50 on my own. I'm currently on 100 along with 300 welbutrin and my depression and agitation are stabilizing.
I remember you are kind of "not wanting to be on meds. feeling" so I think this is a good choice because it works without any noticable effects. Only danger is very rare but serious rash.
The subject has been discussed in past on board, but I'm kind of new so if anybody else can come in with knowledge, I'd also welcome it.
Good luck,
James K
Posted by Glydin on January 12, 2006, at 7:55:16
In reply to Re: When are benzos justified? -- UPDATE, posted by detroitpistons on January 11, 2006, at 20:57:04
There was a time that route of treatment would have puzzled me too, but there is a definite trend toward changing diagnoses – thus changing of the treatment plan. The “anxiously depressed” or “depression with anxiety” is being thought to be somewhere on the bipolar continuum or at least, that seems to me to be how it's going.
Like you, I always thought of BP as a disorder of extremes – thus the name. There is much talk and action, in the field, of the symptoms being looked at differently with grading by severity.
At best, we can hope this tend is correct and people will get better treatment and (maybe) more apporiate treatment for their struggles. There is a lot crossover in head meds.
I can’t give you any insight into Lamictal but I can send you really good wishes that this works out well for you.
Thanks for the update and I hope you will keep us posted. I would be interested to know how it goes for you.
Posted by 4WD on January 12, 2006, at 20:13:56
In reply to Lamictal » detroitpistons, posted by James K on January 11, 2006, at 22:06:18
Hi all,
Lamictal is supposed to be more or less without side effects but I experienced some. I got sharp shooting pains in different parts of my body that would come and go for maybe a couple of hours then disappear then reappear elsewhere in a day or two. No big deal.
But they finally settled into a kind of neuralgia in my lower front teeth. Still tolerable. But I also got a chronic low grade headache. And it made the SSRI-induced muscle tightness in my back and neck much much worse.
OTOH, it did help with the hyper, jittery, wired feeling. I was able to reduce my Klonopin very considerably while on it. I never even reached a therapeutic dose, just up to 50mg.
Marsha
Posted by cache-monkey on January 16, 2006, at 13:14:02
In reply to Re: Lamictal, posted by 4WD on January 12, 2006, at 20:13:56
Too bad to hear about the pain. Have you considered something like Neurontin? This could help neuropathic pain and *may* provide additional mood support...
As far as only getting up to 50 mg, randomized trials (e.g. http://tinyurl.com/c2oy4) indicate that there is significant response among some people benefit from doses that low.
Good luck,
cache-monkey> Hi all,
>
> Lamictal is supposed to be more or less without side effects but I experienced some. I got sharp shooting pains in different parts of my body that would come and go for maybe a couple of hours then disappear then reappear elsewhere in a day or two. No big deal.
>
> But they finally settled into a kind of neuralgia in my lower front teeth. Still tolerable. But I also got a chronic low grade headache. And it made the SSRI-induced muscle tightness in my back and neck much much worse.
>
> OTOH, it did help with the hyper, jittery, wired feeling. I was able to reduce my Klonopin very considerably while on it. I never even reached a therapeutic dose, just up to 50mg.
>
> Marsha
Posted by detroitpistons on February 1, 2006, at 10:26:55
In reply to Re: When are benzos justified? -- UPDATE, posted by detroitpistons on January 11, 2006, at 20:57:04
I have another update...On my next doctor visit, he diagnosed me as bipolar II. We had a fairly long discussion about my past and my current symptoms, and he said I may be rapid cycling. To me, the best way to describe it would be a mixed state with rapid cycling, but that could be redundant, depending on symantics.
I'm up to 50 mg of Lamictal now, and he's having me go down on the Effexor. Right now, I'm down from 225 mg to 187.5, and tomorrow I will go down to 150.
I have to admit, I am still trying to sort out this diagnosis, because this is all new to me...I was inclined to think that this current mixed state, which is completely new to me, is just caused by the Effexor. I have been moody and irritable in the past, along with just having a sort of cyclical nature to my moods, but I can't say that I ever remember really being euphorically hypomanic. If I was, it was very short lived.
Then I read the following passage from psycheducation.org:
"Bipolar II seems to get worse with time in many people....As the illness gets worse, medications that seemed to have helped a person in the past don’t seem to "work" anymore. Antidepressants start to cause mixed state symptoms (can’t sleep, anxious, can’t concentrate, irritable — as well as depressed) and rapid cycling, where at first they were actually very helpful."
This is EXACTLY what happened with Effexor. Furthermore, in an example provided above this passage, Dr. Phelps introduces this "kindling effect." The man in the example had at least two episodes of depression prior to his first manic or hypomanic episode, which occured at the age of 27. I am 27. This could explain why it took so long for these bipolar mixed state symptoms that have never occurred before.
Therefore, my previous thinking that my symptoms are simply med induced could be flawed...Rather than Effexor causing bipolar symptoms, my current situation (reaction to meds) may be diagnostic of bipolar disorder. In other words, meds simply brought this underlying condition to light, rather than causing the symptoms (based on the quote above).
Any thoughs?
Posted by detroitpistons on February 2, 2006, at 8:47:13
In reply to Re: When are benzos justified? -- UPDATE II, posted by detroitpistons on February 1, 2006, at 10:26:55
I just wanted to change the title in order to maybe generate some interest. Any bipolar II's out there, I'd really like to hear your feedback.
> I have another update...On my next doctor visit, he diagnosed me as bipolar II. We had a fairly long discussion about my past and my current symptoms, and he said I may be rapid cycling. To me, the best way to describe it would be a mixed state with rapid cycling, but that could be redundant, depending on symantics.
>
> I'm up to 50 mg of Lamictal now, and he's having me go down on the Effexor. Right now, I'm down from 225 mg to 187.5, and tomorrow I will go down to 150.
>
> I have to admit, I am still trying to sort out this diagnosis, because this is all new to me...I was inclined to think that this current mixed state, which is completely new to me, is just caused by the Effexor. I have been moody and irritable in the past, along with just having a sort of cyclical nature to my moods, but I can't say that I ever remember really being euphorically hypomanic. If I was, it was very short lived.
>
> Then I read the following passage from psycheducation.org:
>
> http://72.14.203.104/search?q=cache:L0perCxdsMgJ:www.psycheducation.org/depression/03_treatment_app.html+mixed+episode+with+rapid+cycling+kindling+psycheducation&hl=en&gl=us&ct=clnk&cd=2
>
> "Bipolar II seems to get worse with time in many people....As the illness gets worse, medications that seemed to have helped a person in the past don’t seem to "work" anymore. Antidepressants start to cause mixed state symptoms (can’t sleep, anxious, can’t concentrate, irritable — as well as depressed) and rapid cycling, where at first they were actually very helpful."
>
> This is EXACTLY what happened with Effexor. Furthermore, in an example provided above this passage, Dr. Phelps introduces this "kindling effect." The man in the example had at least two episodes of depression prior to his first manic or hypomanic episode, which occured at the age of 27. I am 27. This could explain why it took so long for these bipolar mixed state symptoms that have never occurred before.
>
> Therefore, my previous thinking that my symptoms are simply med induced could be flawed...Rather than Effexor causing bipolar symptoms, my current situation (reaction to meds) may be diagnostic of bipolar disorder. In other words, meds simply brought this underlying condition to light, rather than causing the symptoms (based on the quote above).
>
> Any thoughs?
>
>
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