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Dr. Bob is Robert Hsiung, MD,
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Posted by Quintal on August 11, 2007, at 21:13:11
In reply to Re: Tolerance to Benzo Anxiety Effects, posted by boveni3 on August 11, 2007, at 20:56:48
I think the problem is that you have to withdraw from benzos first in order to use flumazenil safely - it could cause convulsions (not to mention extreme distress) in people who are dependent on them. A similar strategy is sometimes used with the opioid receptor antagonist naltrexone as a rapid detox from, you guessed it, opiates. http://en.wikipedia.org/wiki/Naltrexone
With benzos, there's still the problem of cognitive impairment and amnesia to contend with though, tolerance to which also will be reset by flumazenil.
Q
Posted by boveni3 on August 11, 2007, at 21:29:20
In reply to Re: Tolerance to Benzo Anxiety Effects » boveni3, posted by Quintal on August 11, 2007, at 21:13:11
I think you may want to read more about this drug. All benzodiazapines have longer half-lives making its use is very limited. See below:
Flumazenil (also known as flumazepil, code name Ro 15-1788, trade names Anexate, Lanexat, Mazicon, Romazicon) is a benzodiazepine antagonist, used as an antidote in the treatment of benzodiazepine overdose. It reverses the effects of benzodiazepines by competitive inhibition at the benzodiazepine binding site on the GABAA receptor. It was introduced in 1987 by Hoffmann-La Roche under the trade name Anexate.
The onset of action is rapid and usually effects are seen within one to two minutes. The peak effect is seen at six to ten minutes. The recommended dose for adults is 200 μg every 1-2 minutes until the effect is seen, to a maximum of 3 mg per hour. It is available as a clear, colourless solution for intravenous injection, containing 500 μg in 5 mls.
All benzodiazepines (including midazolam) have longer half-lives than flumazenil. Therefore, repeat doses of flumazenil may be required to prevent recurrent symptoms of overdosage once the initial dose of flumazenil wears off. It is hepatically metabolised to inactive compounds which are excreted in the urine. Subjects who are physically dependent on benzodiazepines may suffer benzodiazepine withdrawal symptoms, including seizure, upon administration of flumazenil.
Posted by Quintal on August 11, 2007, at 21:36:53
In reply to Re: Tolerance to Benzo Anxiety Effects, posted by boveni3 on August 11, 2007, at 21:29:20
Yes, that's why I said in my previous post flumazenil probably didn't catch on because people have to withdraw from benzos first, or suffer withdrawal symptoms and possibly seizures, making it dangerous in people who are dependent on them.
Q
Posted by barbaracat on August 12, 2007, at 15:50:51
In reply to Re: Tolerance to Benzo Anxiety Effects » boveni3, posted by Quintal on August 11, 2007, at 21:36:53
I've noticed a progressive tolerance building up now that I've been taking benzos more frequently because of some stresses. I take clonazepam and lorazepam, interchanging them. It's getting to where I could easily take a small handful and hardly feel it.
This has happened periodically and I'll usually ramp down on the doses. I usually find no withdrawal problems, but I never just discontinue, only reduce slowly.
I find that gabapentin will help in these situations. It binds to the GABA receptors differently and even though it has a very short tolerance life, the action seems different and I can at least get some relief when benzos have pooped.
What I'm searching for now is a way to replenish the GABA naturally and have been trying various aminos and herbs. Amino GABA doesn't do squat since it doesn't cross the bbb, but L-theanine, an amino acid, may be a contender. Another is rosavin, a high mountain flower which strengthens the adrenals and lifts the mood. I order Ameriden brand over the net.
One thing that's become clear is the importance of Omega 3's and 6's, fish oil, flax oil and evening primrose oils for example. These keep the fatty surfaces of the cell membranes fluid and permeable so the neurons can do their work of receiving and releasing molecules in a more healthy state.
- BarbCat
Posted by boveni3 on August 12, 2007, at 16:19:54
In reply to Tolerance to Benzo Anxiety Effects - suggestions, posted by barbaracat on August 12, 2007, at 15:50:51
Hi Barbcat
"Amino GABA doesn't do squat since it doesn't cross the bbb, but L-theanine, an amino acid, may be a contender."
My reasearch found that benzos do not deplete or inhibit GABA, it interferes with the reuptake of GABA. Additionally, new research shows that long-term us of benzos may cause this to be a permanent problem.
Unfortunately, taking GABA has no value.
Posted by barbaracat on August 12, 2007, at 19:45:25
In reply to Re: Tolerance to Benzo Anxiety Effects - suggestions, posted by boveni3 on August 12, 2007, at 16:19:54
Yes, as I found out with the amino form. What I wonder is if this tolerance is with all variants of the GABA receptor/molecules or just the subtypes of that particular benzo. Why would the re-uptake pump not eventually revert back to it's genetically encoded behavior if the aggravating substance was absent? I also wonder about the longevity of the neuron itself. Since we now know that neurons can possibly replace themselves, what is the lifespan of a particular cell and do they or don't they revert back to their original coding?
I particularly wonder about this same situation existing in regards to SSRIs. I don't know of a single person, myself included, who has had a long-term (note 'long-term', as in years) relationship with an SSRI who has been able to stay off them permanently. One could say 'well, that shows you need them'. I'm not so sure. I suspect there is a long-term (I cringe to use 'permanent') modification of the actual cell mechanism that prevents/destroys the cell/brain system from physically readapting to it's pre-SSRI functioning.
What particularly strikes me are those people who were not endogenously but situationally depressed, i.e., grief, trauma - and just fine before taking the med. However, after a moderate stint on an SSRI as a temporary coping measure, they found that eventually they had to go back on. Something had changed and they were now chronically depressed. Who knows how long this would have lasted if they white-knuckled it longer, or if it was now a permanent maladaption?
This stuff concerns me greatly, but I have faith in the plasticity of our wondrous brains and hope they knows what they're supposed to do given the right conditions. That's why I preach Omega 3 & 6 oils to give them every chance of help possible.
Best wishes and keep in touch,
-BarbCat
Posted by Quintal on August 12, 2007, at 20:12:46
In reply to Re: Tolerance to Benzo Anxiety Effects - suggestio » boveni3, posted by barbaracat on August 12, 2007, at 19:45:25
Well I took benzos for about five years more or less continuously (only stopped them for a week or a few days each time) and I've now been off them for a year. At the height of my addiction I took 20mg Klonopin a day (very briefly), but my usual dose was around 4mg. I also took SSRIs and related rugs for most of that time. I have no lingering problems from having been on these drugs, though I managed to get off them in the time-honoured way of replacing one addiction with another - opiates, codeine to be specific. Codeine does a much better job than all of the above put together.
I think it's possible for people to come off these drugs and make a full recovery, but the withdrawal needs to be managed carefully. It's interesting about the inverse agonist theory, and I wonder if something similar is happening when people have lingering withdrawal symptoms from SSRIs etc.? There's no evidence as yet that benzos cause permanent brain damage, but there may be functional changes at the receptors, and the same could be true for SSRIs.
Q
Posted by Squiggles on August 12, 2007, at 20:18:29
In reply to Re: Tolerance to Benzo Anxiety Effects - suggestio, posted by Quintal on August 12, 2007, at 20:12:46
I'm glad i didn't take SSRIs. I was actually offered them when I withdrew from Xanax (piece of cake) on the idea i think, that i would have continued to have panic attacks. But the panic attacks were due to hyperthyroidism from Synthroid.
I don't know how Dr. Preskorn does polypharmacy. I think he's a real drugstore cowbody. :-)
Squiggles
Posted by Phillipa on August 12, 2007, at 20:53:18
In reply to Re: Tolerance to Benzo Anxiety Effects - suggestio » Quintal, posted by Squiggles on August 12, 2007, at 20:18:29
Same reason I've always taken very small doses of ssri's don't trust them never will. Benzos are a piece of cake for me too to get off if I chose to and have in the past. Only when my thyroid began to destroy itself did I resume benzos. I'm a lifer on them no question of that and still low doses after a total of almost 40 years and same dose don't see a problem. And I do agree with the SSRI's altering your brain. As more serotonin enters the synapse your brain doesn't need to produce as much. And also grief and life situations do change. Love Phillipa
Posted by Quintal on August 12, 2007, at 21:01:13
In reply to Re: Tolerance to Benzo Anxiety Effects - suggestio » Quintal, posted by Squiggles on August 12, 2007, at 20:18:29
You need to actually take these drugs to properly assess the effect they will have on you. Many people take them without problems, and there are differences between drugs of the same class, such as Xanax and Klonopin for example. Xanax withdrawal you describe as a piece of cake, yet with Klonopin you say you suffered horribly. I will find the relevant posts if necessary. I always take into consideration whether people are still taking the drug in question, or one in the same class, when assessing self-reported claims of absence of withdrawal effects.
Q
Posted by Squiggles on August 12, 2007, at 21:18:20
In reply to Re: Tolerance to Benzo Anxiety Effects - suggestio » Squiggles, posted by Quintal on August 12, 2007, at 21:01:13
> You need to actually take these drugs to properly assess the effect they will have on you. Many people take them without problems, and there are differences between drugs of the same class, such as Xanax and Klonopin for example. Xanax withdrawal you describe as a piece of cake, yet with Klonopin you say you suffered horribly. I will find the relevant posts if necessary. I always take into consideration whether people are still taking the drug in question, or one in the same class, when assessing self-reported claims of absence of withdrawal effects.
>
> QOh definitely, Xanax does not compare with clonazepam; not for me. Clonazepam is more potent and either is an anti-convulsant or by being more potent has greater anti-convulsant properties. I could not get off clonazepam.
Squiggles
Posted by FredPotter on August 12, 2007, at 21:30:34
In reply to Re: Tolerance to Benzo Anxiety Effects - suggestio » boveni3, posted by barbaracat on August 12, 2007, at 19:45:25
ME! I went through every SSRI over many years. The last one was Celexa. I then went on Effexor and now Nardil. It's about 6 years since I took an SSRI
Posted by Squiggles on August 12, 2007, at 21:51:02
In reply to Re: Tolerance to Benzo Anxiety Effects - suggestio » barbaracat, posted by FredPotter on August 12, 2007, at 21:30:34
Imagine being on a super-side-effect drug for 30 years and stoically suffering through life and generally having a very miserable time. After stopping it under appropriate supervision, you discover that you never needed it in the first place.
What do you do, laugh, cry, hope that something horrible happens to you so you can take the same da*n drug again and justify a wasted life? It's sort of like risking your life to find gold and discovering it's pyrite after losing all your posessions, family, and crew.
Now that's a case for consulting a cognitive dissonance psychologist.
It just may have happened to some. If you hear of an example, let me know.
Squiggles
Posted by UgottaHaveHope on August 13, 2007, at 23:58:04
In reply to Re: Tolerance to Benzo Anxiety Effects - suggestio » FredPotter, posted by Squiggles on August 12, 2007, at 21:51:02
nm
Posted by Phillipa on August 14, 2007, at 19:45:14
In reply to Re: Tolerance to Benzo Anxiety Effects - suggestio, posted by UgottaHaveHope on August 13, 2007, at 23:58:04
Our new nardil king. Welcome back. Love Phillipa
Posted by barbaracat on August 14, 2007, at 20:52:44
In reply to Re: Tolerance to Benzo Anxiety Effects, posted by Phillipa on March 30, 2006, at 21:41:22
Hi, Philippa,
BarbaraCat here. I haven't been posting for quite a while, but I think I'm hooked on Babble again! I read your post with great interest. I didn't know you'd accomplished all that -- good for you!I too have had the same experience with alcohol. Used to come home from work and down a bottle of chardonnay every night. I've since toned it down quite alot, but it's the only substance I know that can halt a panic attack, a spiral down into anxiety almost immediately. Too bad it feels so sh*tty the next day and the liver don't like it either. William Styron, who wrote 'A Darkness Visible' went into his massive depression when he quit drinking, BTW.
I've been thinking alot about dopamine lately and how it hardly ever gets put into the medical brews we take. Everything centers around serotonin and too much of that can cause anxiety. Dopamine is a little explored player in our various ills. Alcohol is a potent GABA and DOPAMINE enhancer!!
I have fibromyalgia and it causes ADD as one of the symptoms, so I asked for Adderall to help with it. To my surprise, it took away the pains, it immediately lifted my depression, it even helped with anxiety. It feels like the missing piece. If I take just the 30mg extended release and don't abuse it (I used to have a real jones for speed when I was younger - a clue?), it causes no bad effects and I can sleep just fine. The days I don't take it, I feel that something is missing, i.e., motivation, focus, interest, energy.
I have this feeling that those of us who rely on alcohol to lift the horrible feelings may have a dopamine deficiency. I'm currently researching this, mainly with the fibromyalgia focus, but what I'm finding is that many of us do have a real dopamine problem that causes all the ills we're so familiar with. There are herbs that can help, such as macuna pruriens which you might want to give a try. I'll try to keep you posted on what I find, but it's very interesting and opening up a new vista for me.
Love, BarbCat
Phillippa wrote:
>I don't know what to say. Since the 1970's when I started on valium for panic attacks they really worked well. So well in fact that I went on to go to nursing school divorce, raise three kids and run an Aerobics Dance business at the same time. Deans list graduated magna cum laude. Then ativan came out and I took that for years then xaxax which worked the best low dose down to .125mg at bed at one time. Then there was klonopin which depressed me. So back to the xaxax and it still worked. Then I went on Diability after my thryroid quit working and at the same time so did the benzos. Enter SSRI's and for two years l0mg of paxil with xanax worked well. I forgot to mention all this time I was drinking either beer or wine 5-6 cornaoas at night. When I stopped the drinking I became depressed and havent't worked since and the benzos don't work the same at all. Anyone have any possible reason for this. As right now I'm seriously thinking of getting off the luvox, valium(NOW) and starting to drink again as I felt well then. Love Phillipa
Posted by Phillipa on August 14, 2007, at 21:41:00
In reply to Tolerance to Benzo Anxiety Effects - dopamine? » Phillipa, posted by barbaracat on August 14, 2007, at 20:52:44
I remember you I think you were posting when I first started dopamine is in alchohol? My whole family has anxiety takes benzos and drinks I did quit but the rest of them are still happy functioning creatures please let me know what you learn. You have my permission to babblemail me also if you like. I think if I remember correctly in going through the achieves did you discover something with bipolar and boy I could be very mistaken as I haven't been there in a long time. Great to see you back. Love Phillipa
Posted by rina on August 18, 2007, at 19:03:29
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please » ed_uk, posted by yxibow on April 5, 2006, at 0:57:21
Valium and chlordiazepoxide (Librium)were introduced in the early 1960s by Roche. These benzodiazepines were lauded as a safer alternative to barbiturates and meprobamate because they were thought to be non-habit forming and less lethal in overdose.
Since the late 1960s there has been considerable debate over their side effects, potential for addiction, and abuse.Valium is prescribed for anxiety disorders and the short-term relief of the symptoms of anxiety.
In acute alcohol withdrawal, Valium provides symptomatic relief of acute agitation, tremor, impending or acute delirium tremens and hallucinations.
As a long-acting benzodiazepine, Valium is often prescribed to patients withdrawing from shorter-acting benzos, such as Xanax.Valium depresses the nervous system much like alcohol and is abused by all segments of society.Valium is both physically and psychologically addicting and as is considered one of the toughest addictions to break. With chronic use, its abuse potential is high. Withdrawal symptoms can be seen after only 2 or 3 days of repeated use.
Essentially, withdrawal symptoms from Valium are like the mirror of its therapeutic effects. Valium withdrawal can produce especially severe withdrawal symptoms similar to those in alcohol and barbiturate withdrawal, including jittery, shaky feelings and any of the following: rapid heartbeat, tremor, insomnia, sweating, irritability, anxiety, blurred vision, decreased concentration, decreased mental clarity, diarrhea, heightened awareness of noise or bright lights, impaired sense of smell, loss of appetite, loss of weight, muscle cramps, seizures, tingling sensation, and agitation. In more extreme cases, typically associated with sudden cessation of the drug, users may experience convulsions, tremor, abdominal and muscle cramps, vomiting and sweating.
After extended abuse, abrupt discontinuation should be avoided and a gradual dosage tapering schedule carefully followed.
Sources:
http://www.pdrhealth
http://www.addictionwithdrawal.com.htm
Posted by rina on August 18, 2007, at 19:16:38
In reply to Re: Tolerance to Benzo Anxiety Effects - dopamine? » barbaracat, posted by Phillipa on August 14, 2007, at 21:41:00
This is what I found. The combined effects of benzodiazepines and alcohol or other CNS depressants (drugs that slow the central nervous system) can be very dangerous, leading to unconsciousness or, rarely, even death.
Anyone taking benzodiazepines should not drink alcohol and should check with his or her physician beforeusing any CNS depressants. Taking an overdose of benzodiazepines can also cause unconsciousness and possibly death.
Anyone who shows signs of an overdose or of the effects of combining benzodiazepines with alcohol or other drugsshould get immediate emergency help. Warning signs include slurred speech or confusion, severe drowsiness, staggering, and profound weakness.
Benzodiazepines may cause behavior changes in some people, similar to those seen in people who act differently when they drink alcohol. More extreme changes, such as confusion, agitation, and hallucinations, also are possible.
Anyone who starts having strange or unusual thoughts or behavior while taking this medicine should get in touch with his or her physician.
http://www.faqs.org/health/topics/37/Benzodiazepines.html
Posted by FredPotter on August 19, 2007, at 15:24:36
In reply to Re: Tolerance to Benzo Anxiety Effects - dopamine?, posted by rina on August 18, 2007, at 19:16:38
Yes but it just doesn't ring true. I've mixed alcohol and Xanax for years, not now though as I hardly ever drink. It's also been commonly said that the lethal dose of a benzo is the amount required to suffocate you. This is what makes them so safe. And talk of withdrawal effects is irrelevant if you never intend giving up
Posted by FredPotter on August 19, 2007, at 15:28:12
In reply to Re: Tolerance to Benzo Anxiety Effects - dopamine?, posted by rina on August 18, 2007, at 19:16:38
. . . and to talk of benzos as having a similar effect to alcohol - you've got to be joking. Alcohol is like a sledge hammer compared to them. There's also virtually no euphoria compared to alcohol. This reminds me of AA "solid alcohol" talk. When I challenged them they said the chemical structure was similar. Well CO is chemically similar to CO2, but their properties are quite different
Posted by Squiggles on August 19, 2007, at 15:31:57
In reply to Re: Tolerance to Benzo Anxiety Effects - dopamine? » rina, posted by FredPotter on August 19, 2007, at 15:28:12
> . . . and to talk of benzos as having a similar effect to alcohol - you've got to be joking. Alcohol is like a sledge hammer compared to them. There's also virtually no euphoria compared to alcohol. This reminds me of AA "solid alcohol" talk. When I challenged them they said the chemical structure was similar. Well CO is chemically similar to CO2, but their properties are quite different
I know what you mean; but the brain is affected by the same substance on the same receptors; could it be that alcohol being in liquid form is absorbed quickly and immediately, going directly to the brain in a shorter period of time than the pill form?
Squiggles
Posted by Quintal on August 19, 2007, at 16:42:08
In reply to Re: Tolerance to Benzo Anxiety Effects - dopamine? » FredPotter, posted by Squiggles on August 19, 2007, at 15:31:57
Benzos aren't the same as alcohol, but they exert most of their effects on the GABA system, like alcohol. Alcohol also binds to the GABA-A benzodiazepines receptors. In a sense, benzos are 'cleaner' than alcohol because alcohol binds to many other receptors and is quite noxious to many organs/systems.
I've drunken huge quantities of alcohol with hefty doses of Klonopin before and had no problems, but that doesn't mean other people haven't. I think most fatalities have been due to overdosing on extreme polypharmacy though, such as Heroin + overdose of benzos combined with a few bottles of Whiskey. Benzos enhance the effect of alcohol, but at truly moderate amounts of both there should be no problem for healthy people provided they follow the usual precautions and don't operate heavy machinery or perform skilled tasks under the influence.
Q
Posted by Squiggles on August 19, 2007, at 16:51:44
In reply to Re: Tolerance to Benzo Anxiety Effects - dopamine?, posted by Quintal on August 19, 2007, at 16:42:08
I rarely drink, except perhaps a glass of wine
or a glass of beer with a meal. I have noticed that drinking alcohol while on clonazepam has a stronger effect. For that reason if i drink anything, i do at most once or twice a week and a small amount. I just can't stand any more pain from any source any more, including medications and their withdrawals. I really should get to a Nunnery. :-)Squiggles
Posted by barbaracat on August 19, 2007, at 19:07:26
In reply to Re: Tolerance to Benzo Anxiety Effects - dopamine? » Quintal, posted by Squiggles on August 19, 2007, at 16:51:44
A while back, maybe 8 years ago when I was in severe mental agony, my 'drug' of choice was a few glasses of chardonnay (had to be chard, nothing else had the same effect) with a Vicodan chaser. Sheer bliss. Nothing like it. A buzzy, energetic euphoria. My anxious exhausted depression suddenly lifted, replaced by the energy and focus to cook, clean, straighten up, dance, chat on the phone, whatever. Plus, the Vicodan prevented next-day hangover.
I was an undiagnosed bipolar I and taking a very high dose of Zoloft with no mood stabilizer and spiraling in a constant mixed state. And while I was quite aware that alcohol wasn't helping my chemistry one bit, nothing else was helping either, absolutely nothing except my cocktail.
BTW, no amount of tranqs - clonazepam, lorazepam, Xanax, even Sinequan - would touch the panic or psychotic anxiety I lived with - only chardonnay and Vicodan. Any takers on this?
I'd come home from work and look forward to my cocktail - maybe 5 years of this nightly escape on a pretty regular basis. I realized then and now it wasn't good for me (poor liver!) but in some ways I think it saved me. Anything was worth the relief from the nightmarish hell I'd descend into at 6pm sharp every evening, and I knew I could count on this cocktail to help me survive what had become intolerable.
But booze is so sneaky - betcha can't have just one! What started with a few glasses of chard started escalating into a bottle and then another bottle. No amount of Vicodan was helping with how sh*tty I'd feel the next morning or the embarrassment of what I might have done the night before. A raving bipolar and a zippy-doo-dah brew - whew! do I have some stories to tell - and so does my poor long-suffering husband. And all for some soothing GABA and energizing dopamine.
Of course, it was all self-medicating and since I've been on lithium and the right meds, over time the need and the problem resolved. I believe I was both crazy and desperate to allow my health conscious, meditating, yoga-practicing self to do that to myself. It was my heh-heh dirty little secret too, since my oh-so-righteously-healthy friends would be appalled!
If I now have the occasional alcoholic drink, I'll still take one Vicodan - one, not 3-4 like before - to boost the high without wanting to drink more and definitely to offset the inevitable headache or morning-after yuck. I have no problem with this, it works on many levels and it's a pretty rare event these days. Whereas before, I was in a desperate escalating attempt to just feel better, and there was little I could do to change it until my chemistry changed.
- BarbCat
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