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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 107 to 131 of 175. Go back in thread:
Posted by viridis on October 27, 2002, at 22:10:55
In reply to Re: Klonopin as a dumb drug » viridis, posted by Rick on October 27, 2002, at 10:52:55
Hi Rick,
Actually, I did notice some short-term memory loss early on (maybe for a couple of weeks), but it seemed to diminish pretty quickly. It's hard for me to accurately assess the memory issue, because I've always been prone to short-term forgetfulness (although my long-term recall is excellent).
Pre-K, when I was experiencing severe anxiety or (especially) depression, my short-term memory was terrible. In a deep depression, I could completely forget something someone said a few minutes earlier, even if we'd discussed it in detail.
So in summary -- I've always experienced short-term forgetfulness. K seemed to make this worse at first, then this disappeared, or at least went back to what I think is my normal state, and this is much better than when I'm anxious and/or depressed.
By the way, I've always been awful with names. I can run into someone I've met before and remember all sorts of details except the person's name -- where we met, what the person does, what we discussed previously, etc. My wife is very aware of this, and always asks a person's name before I'm obligated to introduce her to them, to avoid any awkwardness. It's always been this way, so I don't think K has much to do with it, except maybe briefly.
Posted by hiba on October 27, 2002, at 23:33:11
In reply to Re: Evidence Please!! Squiggles, ok » hiba, posted by Squiggles on October 27, 2002, at 8:11:10
Hello Squiggles,
Thank you for responding to my input. You are referring the sixth edition of Goodman and Gilman, which is slightly different from what I have in my hand. But I was referring the most updated version of it.
Even after reading those sentences, I don't see any instance of "Protracted withdrawal syndrome". It only says "withdrawal syndrome may not occur for week after abrupt discontinuation". Still fails to note a "Protracted withdrawal syndrome". PROTRACTED" means "lasting longer than expected or longer than usual". Does the book mention such a phenomenon? NO
The links which you provided took me to the anti-benzo group. I am sorry, I can't take their words without a grain of salt.
Then, interestingly if you read in your own response, there are a lot of points which I can use for my argument. "Although benzodiazepines have a reputation for causing only a low rate of *abuse* and *dependence*the possibility of this complication of chronic use must not be overlooked."
This is an instance.I think you will allow me to reproduce some sentences in your message with a slight change in fonts.
"Benzodiazepine MAY cause paradoxical effects.Anticonvulsant benzodiazepines SOMETIMES inducemotor stimulation and precipitate grand mal
seizures. Antianxiety benzodiazepines have been
reported to release bizarre uninhibited behavior in SOME USERS with low levels of anxiety. Paranoia,depression, and suicidal ideation OCCASSIONALLY accompany the use of antianxiety benzodiazepines".Note this "May, Sometimes, Some Users, Occassionally". It is sufficient to make this statement inconclusive.
Again let me quote from your own message.
"HIGH DOSES of benzodiazepines MUST BE given
for long periods of time and then ABRUPTLY withdrawan before marked withdrawal symptoms, including seizures, appear (see Allquander, 78)"Does this sentence help your arguments ? I don't think so. After reading it carefully, I think I can use it to argue. Mr. Alan will also benefit from it.
I have posted a link to Merck manual in one of my thread, assuming that will help benzo defenders. Still what you took from Merck is inconclusive.
"There is considerable debate about benzodiazepine
dependence. ... ABRUPT discontinuation after significant exposure may lead to withdrawal syndrome remarkably similar to that associated with alcohol withdrawal, including anxiety, irritability, tremor, nauseahypertension, tachycardia, hyperacusis, muscle twitching, hyperreflexia, depersonalization, hallucinations,
and major motor seirzures.....
Discontinuing the medicine will lead to a
complicated differential of drug withdrawal vs.
symptom reemergence. [in other words they don't
know if the withdrawal is continuing or if they
can attribute it to an "underlying disorder" popping
up again]."What is defined in this sentence is mainly the complication of an ABRUPT withdrawal. Did I ever argue Benzos can be abruptly stopped?? Rather I was insisting abrupt discontinuation from any psychoactive drug will cause complications.
And the last part of this sentence is not an evidence of "Protracted withdrawal syndrome". Longer than unusual withdrawal symptom is not mentioned here. Rather it makes a confusion over withdrawal symptom and underlying disorder.
((I notice that the words "protracted withdrawal
syndrome" do not occur. I would not take that
as evidence that this syndrome does not exist
therefore. It is quite possible that follow-up
studies of ABRUPTLY (??)discontinued patients were
not undertaken at that time.))
How can a patient stop benzos abruptly if he or she is under medical supervision ? Weren't we discussing about medically supervised benzo users? Besides Dear Squiggles, Benzos are here for over 40 years. And I was referring the drug manuals which published after the year of 2000. I wonder when they are going to find "BENZOS ARE ADDICTIVE AND THEY WILL CAUSE PROTRACTED WITHDRAWAL SYNDROME"? If 40 years are not enough to make a remarkable finding, I don't think another 40 years or more will make any difference.Lastly I should reveal why I am more allegic to anti-benzo group: I have seen a number of patients in my experience who gave up their benzos for the sake of this group and suffered. Now what is common in psychiatric practice is "If a medication works for a patient, DON'T change it." Because psychiatry has come upto realize how complicated psychiatric disorders are. So do you think I should back those benzophobics ??
Good luck Squiggles, Take care
HIBA
Posted by hiba on October 27, 2002, at 23:37:12
In reply to Re: Klonopin as a dumb drug » viridis, posted by Rick on October 27, 2002, at 10:52:55
Dear Rick,
You are right. Low doses of klonopin improves cognitive function. Improved concentration, sharpened memory.. all are the benefits. There is a website which emphasize this property of klonopin. I will post it later.
HIBA
Posted by hiba on October 28, 2002, at 3:55:41
In reply to Re: Klonopin as a dumb drug » Rick, posted by viridis on October 27, 2002, at 22:10:55
Hello Everyone,
Here is that missing link which describes klonopin's unique properties. Please check this.
http://www.immunesupport.com/library/showarticle.cfm/id/3154
Thanks
HIBA
Posted by Squiggles on October 28, 2002, at 6:39:44
In reply to Re: Not a Convincing Evidence at alll..Squiggles,, posted by hiba on October 27, 2002, at 23:33:11
I anticipated these objectionss; possibly the
maybes, some, etc' is a reflection of a lack
of accurate statistic taking, or possibly you
are right, they are rare.I agree that the protracted syndrome is not mentioned.
I don't know why.I would like to know why you think the articles
I sent you on Protracted Withdrawal syndrome
from the Benzo group are to be taken with a grain
of salt. They are after all articles from
doctors and addictionologists, not Benzo undercover
agents.Squiggles
Posted by Squiggles on October 28, 2002, at 6:47:16
In reply to Re: A Link For the Klonopin Users, posted by hiba on October 28, 2002, at 3:55:41
Regarding Dr. Cheney's inclusion of KAVA
as a neuroprotective agent, the FDA and the
AMA has recently pronounced extremely toxic
to the liver.Dr. Cheney sounds like he has some nutrition
experience. He omits Lithium as not only
a neuroprotective but neurogenerative agent.Squiggles
Posted by Dr. Bob on October 28, 2002, at 8:13:16
In reply to Re: please be civil (Dr. Healy) » Dr. Bob, posted by Squiggles on October 27, 2002, at 9:38:02
> "The Creation of Psychopharmacology"
> Harvard U. Press, 2002I'd just like to plug the new double double quote feature. But I don't mean to be pushy. Did you deliberately not use it to link to Amazon? If so, I'd be interested in why, over at PBA:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks,
Bob
Posted by hiba on October 28, 2002, at 9:12:00
In reply to Re: Not a Convincing Evidence at alll..Squiggles, » hiba, posted by Squiggles on October 28, 2002, at 6:39:44
Dear Squiggles,
<<I would like to know why you think the articles
I sent you on Protracted Withdrawal syndrome
from the Benzo group are to be taken with a grain
of salt. They are after all articles from
doctors and addictionologists, not Benzo undercover agents.>>Because all of those articles have failed in final clinical evaluation and couldn't make any impact in clinical settings. That is why "Protracted withdrawal syndrome" is not yet mentioned in much updated pharmaceutical manuals. Benzo.org is notorious for their biased views. And as a rule of debate it is not acceptable to refer such a controversial source. I could have posted you a lot of links which encourage the use of benzos freely. (prepared by medical professionals). But I didn't do it due to the controversies surrounding them. Those pharmaceutical manuals which I referred in my message is commonly accepted in clinical practice without any exception at all.
Good luck Squiggles, Thank you for responding, Take care
HIBA
Posted by Squiggles on October 28, 2002, at 9:18:45
In reply to Re: Not a Convincing Evidence at alll..Squiggles,, posted by hiba on October 28, 2002, at 9:12:00
You mean the protracted syndrome has actually
been tested? One of the problems would be
that it take some time after the fact, i.e.
after the withdrawal and some months to years
to actually record these effects.I'm not trying to be contrary for the hell of
it... i really am concerned with the facts
being discovered.It is very disconcerting to deal with medical
controversies. Where there is doubt, there
is ignorance, and where there is ignorance there
is malpractice.Anyway, i'm not asking for more on this as it
has probably run its course. Anyone interested
CAN look at these articles on the benzo group.I'm still curious about why you refer to it
as somehow unworthy of consideration; i don't see
this reaction to other similar groups so
understandably it makes me suspicious of something
sinister going on. But if it is, I can't see it.Squiggles
Posted by Franz on October 28, 2002, at 20:18:38
In reply to Klonopin as a dumb drug, posted by viridis on October 27, 2002, at 0:14:29
Thanks for your post viridis, you give hope.
Coincidentally, I received a similar comment from a friend who is on klono. It surprised me she told me she felt NO sedation or numbness at a small dose 2/3 times/day.
I have postponed for years the regular use of a benzo, but I think it is time to consider it.
Today I felt bad most of the day. I finally took 1/4 alprazolam 0.5mg. I went to bed and had a nap. I woke up and could go out to buy something to eat (I often crave carbos after a benzo, plus I had almost no food today). Then I could go to the gym. many times I can do more when the benzo worked good.
I read all your posts in this thread -you are in my read list now :-). Good to see there are not big problems with memory. Sure anxiety and depression kill your memory.
You have a good doctor it shows. I wonder why he chose klonopin and not alprazolam, maybe for the longer effect?.
> It's interesting how differently people react, even to different drugs within the same class. Klonopin hasn't dulled me out at all (except a bit in first 1-2 weeks that I took it). In contrast, my thinking became much sharper and more focused -- maybe because I wasn't constantly agonizing over trivial details, sleeping 2-3 hours a night, and so on. It's not just my imagination either, since friends, family, and co-workers commented on how I'd suddenly become so "on target" and enthusiastic.
>
> On the other hand, Valium really is a "dumb drug" for me -- when I take even a small amount, it puts me in a haze (and not pleasant, just a general stupid/drugged feeling).
Posted by Dr. Bob on October 28, 2002, at 20:34:57
In reply to Re: Not a Convincing Evidence at alll..Squiggles,, posted by hiba on October 28, 2002, at 9:12:00
> Benzo.org is notorious for their biased views. And as a rule of debate it is not acceptable to refer such a controversial source.
Keeping in mind that different points of view, even if biased, are encouraged, while posts that could lead others to feel accused or put down are discouraged, could you please rephrase that? Thanks,
Bob
PS: Follow-ups regarding posting policies, and complaints about posts, should be redirected to Psycho-Babble Administration.
Posted by hiba on October 28, 2002, at 22:10:22
In reply to Re: please rephrase that » hiba, posted by Dr. Bob on October 28, 2002, at 20:34:57
Dear Dr. Bob,
I shouldn't have made such a remark on benzo.org. It was not intentional. I strongly believe, they have their right to express their views. Besides I don't think they are totally wrong or right.
I like to rephrase the sentence like this. benzo.org has some biased views as do every other organization, but still they worth consideration. But as a rule of debate, I like to refer more widely accepted sources.
I hope this might be appropriate
HIBA
Posted by hiba on October 28, 2002, at 23:14:16
In reply to Re: Not a Convincing Evidence at alll..Squiggles, » hiba, posted by Squiggles on October 28, 2002, at 9:18:45
Dear Squiggles,
Yes, I do mean protracted withdrawal has been clinically evaluated. It happens in outpatient settings and that makes it more difficult to make a conclusion. In my own experience (I have volunteered for a detoxification centre) I have seen some examples of protracted withdrawal in those who abruptly stopped their high dose of benzo intake. After the treatment in in-patient setting, they were not showing any kind of withdrawal symptoms at all. But some weeks later when they were available for follow-up they were complaining of some withdrawal like syndromes. But as I stated above, to find a causal relationship was difficult, because they were multiple drug users with various personality disorders. So it was not fair to attribute those symptoms as a consequence of their benzo intake and abrupt cessation.
<<I'm still curious about why you refer to it
as somehow unworthy of consideration; i don't see
this reaction to other similar groups so
understandably it makes me suspicious of something
sinister going on. But if it is, I can't see it.>>There is nothing sinister going on. Dear Squiggles, I have gone through most of the benzo related sites on the net and have read a number of books and articles on this subject. I never argue, benzos are not without drawbacks. But what I always emphasized is their relative safety and efficacy over hard antidepressants and antipsychotics. Benzophobia had come upto a point as some Docs began (or I doubt still) to prescribe antipsychotics to treat anxiety disorders, ignoring the fact that antipsychotics can cause irreversible physical damages. Now the scenario has changed and still changing. Psychiatrists now realize the complexity of psychological disorders and I think the use of antidepressants for anxiety and panic disorders will gradually decline and fade because more of their serious adverse long-term effects are being manifested. In the 28 th edition of MARTINDALE EXTRA PHARMACOPOEA, you can't see any waning on dependence potential of antidepressants. But now in the 32nd edition of the same manual, there is a warning with all antidepressant data sheets. It follows as ".........should be withdrawn gradually to reduce the risk of withdrawal symptoms" (You can fill the blank with any name of antidepressants). See the difference!!
This is where anti-benzo groups fail. Their studies haven't made any impact, that is why benzos are still safe from protracted withdrawal symptoms in clinical manuals. If there is a conclusive evidence it should have been appreciated. But as long as they fail, I think I can better ignore them. That is all. Nothing sinister at all.
Good luck Squiggles, Take care
HIBA
Posted by viridis on October 29, 2002, at 2:03:29
In reply to thanks Re: Klonopin as a dumb drug » viridis, posted by Franz on October 28, 2002, at 20:18:38
Hi Franz,
I hope that you can find the best treatment that works for you, and if benzos fit the bill, then I'd follow that course. I worried a lot about dependency etc. early on, but Klonopin really has improved my life greatly, so I plan to stay with it. Even if I do develop dependency (or already have) I'm much better off now than before, without any side effects.
By the way, my pdoc prescribed both Klonopin (clonazepam) and Xanax (alprazolam) simultaneously, and I used the Xanax quite a lot at first. I perceive Xanax as "stronger" than Klonopin in the sense that I can actually feel its effects coming on, whereas Klonopin is extremely subtle, but effective. I have lots of Xanax around but rarely take it now. However, it's a great help for very stressful situations, and doesn't seem to interact with the Klonopin. So, if I have an especially intense meeting or presentation coming up, or am having a really rough day, I take 0.25-0.50 mg Xanax in addition to the regular dose of Klonopin . Otherwise, I don't take it. A dose of Xanax over 0.5 mg makes me very sleepy, but 0.5 mg or below adds an extra calming effect that I seem to need once in a while. My pdoc seems quite willing to prescribe both (although he is cautious with benzos), because I use them responsibly and have responded so well. He's a very reasonable, intuitive person and really listens to what his patients say, unlike so many out there.
Posted by Squiggles on October 29, 2002, at 6:38:49
In reply to Re: Not a Convincing Evidence at alll..Squiggles,, posted by hiba on October 28, 2002, at 23:14:16
Comparing benzos with ADs is like comparing
apples with oranges; and comparing benzos with
APs and ADs is like comparing apples with nuts
and bolts. They are of different classes pharmacologically,
and if they have effects (protracted or even
permanent and more serious in the case of say
Haldol for example), this does not mean that benzos
do not.I think that in the detox centre you cite there may
be a lack of proper and continued study of the
effects of benzos.As for their relative safety over *certain* AD's,
I don't think i would argue with that at all,
from what I have read. In the case of ADs however,
the patient, once hit with immediate effects such
as depersonalization, or rage, or agitation, will
stop the drug and report the effects to the doctor.
The benzos are more insidious, because like alcohol,
their immediate effect is almost always pacifying,
and even pleasant, and only in the long-term do
their addictive properties show up.Once again, with Klonopin I have not experienced
any problem at all--it is a great benzo (and maybe
others mid-life like it are too, AS LONG AS YOU
DON'T GET OFF after taking it for many years. In
that case, it can be worse than any of the others
and downright dangerous.Squiggles
Posted by hiba on October 29, 2002, at 9:58:34
In reply to Re: Not a Convincing Evidence at alll..Squiggles, » hiba, posted by Squiggles on October 29, 2002, at 6:38:49
Dear Squiggles,
This is a sudden shock for me. I found the instance of "Protracted withdrawal syndrome" associated with benzodiazepines in the latest version of MARTINDALE THE COMPLETE DRUG REFERENCE. Although the reference they given is Dr. Ashton,( the figure most benzo lovers don't approve,) I think there should be some fact in it. I know the importance of "MARTINDALE" in the world of medicine.
So, you are right in this regard dear Squiggles, the existence of long and unusual withdrawal symptoms should not be necessarily a benzophobic hypothesis. I appreciate your determination to stand for what you found right. It is only because of that I went through MARTINDALE once again.
HIBA
Posted by Squiggles on October 29, 2002, at 10:12:03
In reply to Re: Convinced At last ! Thank you Squiggles..., posted by hiba on October 29, 2002, at 9:58:34
Thanks for being so thorough in your search
hiba. I remember MARTINDALE's (infact i think
i have it bookmarked, and i will look at it --
if you have a minute maybe a section header
you found this in would help;take care
Squiggles
Posted by Franz on October 29, 2002, at 17:04:52
In reply to Re: thanks Re: Klonopin as a dumb drug » Franz, posted by viridis on October 29, 2002, at 2:03:29
Hi viridis
Today I had my session with my psychotherapist.
I asked him (he is not a medical doctor) if he had any idea of the results of Klonopin use in patients. He did not recognize the drug. He told me benzodiazepines, especially bromazepam have caused many memory problems.
Also, he told me he did not see me excited for a benzo and maybe the new drugs that target obsessiveness could be better, which one, he does not know. Is it Effexor?.
What do you think?. It is true that I am not (or show external signs) too anxious and maybe a bit depressed, like anxiety drained my energy time ago.
I still think Klonopin could be worth trying. Maybe the anticonvulsant properties could have an effect on ruminations or obsessiveness too?.
I think I could try Klonopin before going the AD route.
Please comment, sorry to put you to work, but I like your way of thinking, thanks.
Posted by Dr. Bob on October 29, 2002, at 18:28:15
In reply to Re: Convinced At last ! Thank you Squiggles..., posted by hiba on October 29, 2002, at 9:58:34
> I found the instance of "Protracted withdrawal syndrome" associated with benzodiazepines in the latest version of MARTINDALE THE COMPLETE DRUG REFERENCE.
I'd just like to plug the new double double quote feature. But I don't mean to be pushy. Did you deliberately not use it to link to Amazon? If so, I'd be interested in why, over at PBA:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks,
Bob
Posted by hiba on October 29, 2002, at 22:50:23
In reply to Re: thanks Re: Klonopin as a dumb drug » viridis, posted by Franz on October 29, 2002, at 17:04:52
Dear Franz,
Shall I answer your question regarding klonopin? I have a wonderful experience on klonopin. It is a unique benzodiazepine which can be used as a monotherapy for treating obsessive worries. The only benzodiazepine which kept my obsessive worries away effectively. Yes it definitely worths a trial before you are going an AD route. It is much safer than now available antidepressants, although in a long run a medical dependence is possible. But this kind of dependece is a possibility in almost every kind of medicines.
HIBA
Posted by viridis on October 30, 2002, at 5:09:17
In reply to Re: thanks Re: Klonopin as a dumb drug » viridis, posted by Franz on October 29, 2002, at 17:04:52
Hi Franz,
Like Hiba, my experience is that Klonopin is excellent for reducing ruminating thoughts without cognitive dulling or other side effects. Rumination is a form of obsessiveness, although there's also "true" obsessive-compulsive disorder (OCD), in which people do things like wash their hands every few minutes, check to see if a door is locked 50 times, etc. I know that for OCD, high doses of the SSRI Luvox (fluvoxamine) are sometimes used. Effexor, which you mentioned (it affects both serotonin and norepinephrine reuptake) might be used for it too, but I'm not sure about that. In any case, it doesn't sound like you're talking about OCD, although this may be what your therapist is thinking of.
My advice would be to see an experienced psychiatrist or psychopharmacologist. Of course, a lot of psychiatrists don't like benzos either, and you might be someone who could benefit from certain ADs (although most of these can cause medical dependency, like benzos and many non-psychiatric meds). You really need expert advice and treatment, and if the first psychiatrist's approach doesn't work, you may have to try others. Benzos like Klonopin are great for some of us, and your positive reaction to Xanax (alprazolam) suggests that you may be in that category -- this is something to discuss with someone who's qualified to diagnose mental illness and prescribe psychiatric medications. My experience is that therapists and GPs/family doctors often don't have a clue about these things, so I would go to a psychiatrist if at all possible.
Your therapist's "knee-jerk" negative reaction to benzos is common, and I'm guessing from what you've said that he isn't really familiar with the medication side of treating mental disorders. One thing, though -- I get the impression you might be from outside the U.S. (in part, because you mentioned bromazepam, which I don't think is commonly used here). In some countries such as Canada, Klonopin is marketed as "Rivotril" (and it probably has other names too). The generic name for it is clonazepam. If you are from another country, this might also explain the therapist's lack of recognition of "Klonopin".
In any case -- please try to see a psychiatrist!
Good luck!
Viridis
Posted by Squiggles on October 30, 2002, at 7:08:24
In reply to Re: thanks Re: Klonopin as a dumb drug » Franz, posted by viridis on October 30, 2002, at 5:09:17
Actually,
my doctor is a GP in one of the most prestigious
universities in Canada; when the area of
pharmacological expertise is not in his scope,
he consults some of the best researches in
psychiatry and pharmacology in the world; I
think that is common practice in teaching
hospitals, so whether you get a GP's advice
or a psychiatrist's you end up getting the same
information.An added advantage of being in the hands of
a GP is that he is more likely to know your
entire health condition and prescribe in that
context.Squiggles
Posted by viridis on October 30, 2002, at 11:33:01
In reply to Re: thanks Re: Klonopin as a dumb drug » viridis, posted by Squiggles on October 30, 2002, at 7:08:24
Hi Squiggles,
Your situation sounds ideal, and I know (second-hand at least) that being treated in a university/research setting often exposes you to open-minded doctors who are eager to seek out expert advice. I was thinking of the more common situation in which a person sees a GP who deals with hundreds of patients and conditions, and doesn't have time to learn about or research each one. In those cases, I think you're more likely to be successful going directly to a specialist.
I shouldn't condemn GPs across the board, because I'm sure some are excellent. Mine is not, nor have I been very impressed with others I've seen. And, I've seen some bad psychiatrists too. But, barring access to the kind of setting you're in, I'd still start with a psychiatrist.
By the way, I'm Canadian too, although I've lived in the states for years.
All the best,
Viridis
Posted by Rick on October 30, 2002, at 22:22:19
In reply to Re: thanks Re: Klonopin as a dumb drug » Squiggles, posted by viridis on October 30, 2002, at 11:33:01
Klonopin is just wonderful for me, not only for my social anxiety, but in other ways as well (some of which were completely unanticipated). I'm so glad it's available. However, one thing it *doesn't* seem to help me with is my compulsive and obsessive tendencies (I'm not talking about outright OCD). I still have plenty of ruminating thoughts, although they *are* a lot less likely to be worry-filled and fearful than before.
But clearly clonazepam can have this benefit for some, as Hiba and Viridis attest.
Rick
Posted by Squiggles on October 31, 2002, at 6:13:58
In reply to Re: Klonopin as a dumb drug - Hiba, Viridis, Franz, posted by Rick on October 30, 2002, at 22:22:19
The strange thing i found about Klonopin,
is that i never felt a thing taking it,
only when not taking it.Squiggles
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