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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by HIBA on December 14, 2002, at 2:41:16
Hello Everyone,
Benzo monotherapy or antidepressants? I think still there is enough left to discuss about.One should consider the fact that benzos were around here over more than four decades. After their first introduction to the market, soon it became clear that they are subject to cause a dependece if used over an extended period of time. The story roughly stopped there. Over years and years we have still been hearing stories of benzo dependence. DEPENDENCE only.Nothing more to accuse. No more serious side effects. No long term damages, other than this slight medical dependence.
Now let me ask a question. Is it still the same with antidepressants ? When prozac hit the market, benzos suffered another major set back as if adding insult to injury, because prozac and newer antidepressants showed fewer and lesser side effects than older tricyclics. This was a major relief to most physicians, as they were confused over whether to try a tricyclic or benzo in patients with anxiety disorders. Some preferred tricyclics because of the fear of benzo dependence, while others still relied on benzos due to the fact that benzos don't cause serious adverse effects that associated with tricyclics. Anyway SSRIs roughly changed this scenario and benzo dependence once again projected as fatal than ever.
Now, after years of evolution, more and more are being revealed. Some docs say, day by day they are hearing of more adverse reactions of newer antidepressants. Unlike the benzo-dispute which roughly concentrated on the subject of dependence, the story never ends with SSRIs and other newer ADs. SSRIs already proven toxic in many aspects. Memory loss, protracted sexual impairment, inner ear damage, parkinsonism, ulcerative collitis,...... The table continues and will. Don't forget all these happen within a decades of their introduction. So how many more to expect in the near future ?So it is time to rethink. What makes sense when it is a matter of a slight medical dependence against serious physical damage ? That is what benzo monotherapy versus antidepressants for anxiety disorders.
HIBA
Posted by viridis on December 14, 2002, at 21:45:44
In reply to Benzo Monotherapy or Antidepressants ?, posted by HIBA on December 14, 2002, at 2:41:16
Hi Hiba,
Of course benzo therapy is the best option for many people, and the newer antidepressants should be used much more cautiously than they are. I hope the pendulum will swing back to benzos (as appropriate), but there's a lot of negativity to overcome -- the antibenzo lobby is powerful (though mostly silly). Fortunately, many of the SSRIs are going off-patent, which should lessen drug company pressure on doctors for now.
Good psychiatrists like mine still recognize the value of benzos and don't pay attention to the anti-benzo nonsense, but unfortunately many GPs etc. (like mine) have been taken in by the propaganda. With any luck, this will fade as the SSRI hype subsides and people recognize that these drugs can be much more dangerous than benzos.
Posted by utopizen on December 15, 2002, at 0:59:58
In reply to Re: Benzo Monotherapy or Antidepressants ?, posted by viridis on December 14, 2002, at 21:45:44
Okay, I want to see Pez team up with Roche and make Klonopin Pez. But even I think the idea of benzos getting more prescribed than AD's is out there.
No one has ever gone to detox for Celexa withdrawls. You will never see someone with an IV and tubes in them so they can get off Zoloft. You will never see any of this with any AD, but you will see all of it with any benzo.
Posted by viridis on December 15, 2002, at 1:47:54
In reply to Re: Benzo Monotherapy or Antidepressants ?, posted by utopizen on December 15, 2002, at 0:59:58
What you see is a bunch of people who've been prescribed ADs suffering terribly from withdrawal, and doctors denying that this is possible, or downplaying it as "discontinuation syndrome". I expect there will be clinics for AD withdrawal quite soon, if not already. SSRIs and related drugs such as Effexor top the World Health Organization's list of prescription drugs (of all kinds) that are hardest to discontinue, while benzos are much further down the list.
I doubt there are many IVs etc. associated with benzo withdrawal -- that's pretty straightforward and well established (and has been for decades), and usually follows a standard tapering schedule. Benzos are generally safer and better understood than the newer ADs, despite the propaganda to the contrary.
Posted by utopizen on December 15, 2002, at 9:27:53
In reply to Re: Benzo Monotherapy or Antidepressants ?, posted by viridis on December 15, 2002, at 1:47:54
Xanax is considered one of the hardest to detox from... During the benzo addiction spike in the 80's, special detox centers were established especially for the benzos in the UK.
Detoxing has a lot to do with how quickly the drug leaves the bloodstream. As you know, Paxil is harder than, say, Celexa to detox from because it leaves the bloodstream faster. Xanax leaves very fast.
And yes, if you become a Klonopin addict, you cannot simply taper off, you should definitely check in to a center.
Posted by utopizen on December 15, 2002, at 9:31:04
In reply to Re: Benzo Monotherapy or Antidepressants ?, posted by viridis on December 15, 2002, at 1:47:54
I'd also like to mention that unless we're talking about like AIDS or something, the WHO is kind of a bit off a few french fries from being a happy meal.
They think 2 liters of flouridated water is toxic, and that no water system should be flouridated. They also recently said that french fries cause cancer because they're fried, and this has a certain substance that causes cancer. It's like they take a bit of data that's true and extrapolate it to outlandish ends without considering, "hey, um, so I guess Americans have never died from flouridated water, so maybe toxic isn't the right word to use?"
Posted by viridis on December 15, 2002, at 23:09:28
In reply to Re: Benzo Monotherapy or Antidepressants ?, posted by utopizen on December 15, 2002, at 9:31:04
I think the real point is that when you take these meds (benzos, ADs, etc.) they change the signaling pathways in your brain. That's what they're supposed to do -- make your brain work in a more normal way. So, this isn't necessarily a bad thing, if it improves your quality of life. And of course, the longer you take them, the more dependent your system becomes on having them, just like it would for a diabetic using insulin replacement.
I don't think it's fair to equate dependency with "addiction". Some people do become addicted to benzos (I've known a couple of people who continually escalated their doses of Xanax or Valium way beyond what was prescribed). That's where you get into trouble. But the available evidence indicates that people who take benzos for serious anxiety conditions don't tend to do this.
I discussed the issue at some length with my psychiatrist when I started on benzos. He's very cautious with them, because he says he's occasionally seen addictive/abusive behavior with these drugs, and if this happens, he insists on shifting to a different med regimen. But he also told me that long-term benzo therapy can be appropriate for some people (like me), and that withdrawal for those who use benzos responsibly is pretty straightforward -- it just has to be done gradually. I trust his experience; he's very direct, is much more knowledgeable than any other pdoc or GP I've seen, and has dealt with many patients using benzos for varying lengths of time.
Many others on this board have reported little difficulty in withdrawing from benzos (although a few have had serious problems). I've never done it (and don't plan to if I can avoid it). So far I've done well on a low dose of Klonopin that hasn't needed any adjustment, but I certainly wouldn't stop it suddenly. Reports of serious withdrawal from ADs are abundant, and I've had major trouble coming off Prozac in past (probably the longest half-life SSRI). I know others who have had severe withdrawal problems with ADs that range from Prozac to Serzone. So, these drugs aren't benign relative to benzos when it comes to discontinuation.
My impression is that both benzos and ADs are very useful meds, and their efficacy is highly individual-specific. But whatever route you choose, it seems that almost any med that provides relief from psychiatric problems is likely to be difficult to come off suddenly. Again, these drugs rewire your brain (often in a positive way) and it's not surprising that stopping them suddenly will have serious consequences. I don't think that benzos are unique in this respect.
My original point was that at least with benzos, we have decades of experience to work with when it comes to withdrawal, whereas with the newer ADs methods for managing withdrawal are only beginning to be understood.
Posted by HIBA on December 16, 2002, at 8:03:21
In reply to Re: Benzo Monotherapy or Antidepressants ?, posted by utopizen on December 15, 2002, at 9:27:53
Hello Utopizen,
ABRUPT discontinuation of any benzo after long-term use may cause troubles and sometimes lead a way to detox centers. You are right.But the discontinuation of paxil or effexor will often lead patients not to detox centers but to psychiatric clinics. That is why my trial to discontinue prozac ended up in psychiatric admission. (Remember prozac is the easiest in this class to withdraw.
The side effect prfiles of benzos are totally benign in most cases and if there is any they soon disappear after continuous use. But the story is never the same with antidepressants. Apart from a few, most of their downsides continue their dominance as long as a person taking them, and the worst of all, even after the discontinuance, some side effects persist and last unusually long if not for a lifetime. Problems with benzos only arise when one tries to discontinue them abruptly, but the evils of antidepressants start revealing during the use to persist there for a long time. Unusually long even after the discontinuance.
This is not to defame antidepressants and to underestimate their potential in treating major hellish depression. But antidepressants are hard drugs and should be reserved in cases of severe depression. An antidepressant should never used in treating anxiety disorders, because there are much safer benzos available for that purpose.
Posted by viridis on December 16, 2002, at 11:03:31
In reply to Re: Benzo Monotherapy or Antidepressants ?, posted by utopizen on December 15, 2002, at 9:31:04
I'm no expert on the World Health Organization, but from what I can tell they're a pretty well-respected group, and I don't really understand your criticisms of them. The WHO as a group supports fluoridation of water supplies (although some member countries don't). I'm not sure what their stand is re: the recent discovery of acrylamide in some fried foods (I believe this finding first arose in one of the Scandinavian countries and has since been replicated by other researchers). But, I can certainly tell you that acrylamide is serious stuff -- I work with it in the lab on a daily basis and have to take great precautions to avoid exposure. It's a cumulative toxin that can be carcinogenic and neurotoxic with long-term exposure. So, if there's evidence of it in common foods, I'd say that's a cause for concern, although I have no idea what the level of risk is.
The WHO report on rational use of benzodiazepines is very thorough and is based on decades of study. It examines the pros and cons of their applications and concludes that both short- and long-term use are safe for the appropriate patients. This is reassuring, especially coming from a group that seems to err on the side of caution.
Posted by linkadge on December 16, 2002, at 14:54:56
In reply to Re: WHO » utopizen, posted by viridis on December 16, 2002, at 11:03:31
It is true that benzos are a lot more likely
to cause problems on withdrawl. My mother has
taken the benzo route all her life. Started with
Valium 20 some odd years ago and is now at
60+mg of florazepam. Abrupt withdrawl from this
would put her in emerg. People are more likely to crave the feeling a benzo gives.For those who know what they are doing, benzos
are fine in my oppinion, but most people don't.
Anxiety is very often a sign of underlying depression - or at least unnusually low mood. You will rarely see people who are in high spirits and extremely anxious at the same time.If you miss a celexa/prozac dose you're angry and depressed, but if you miss a fairly high benzo dose you have significantly lower sizure threshold.
If a benzo is to be used long term, it should be something that is less depressing. Some people start fairly anxious but not depressed on Valium, and end up very depressed and not too anxious.
Benzos also tend to be a blunter. People take them to end or stop mental pain, while AD's generally improve a patients ability to handle a situation, they change the user's interpretation of a stressfull event. I would tend to take benzos to escape - while I take Celexa to beat the problem. On benzos I am still think of the upcoming test the same way - only I am surprised that I am not getting the syptoms of anxiety.
On celexa I don't think of the test in the same way.Linkadge
Linkadge
Posted by bluedog on December 17, 2002, at 22:00:54
In reply to Re: WHO » utopizen, posted by viridis on December 16, 2002, at 11:03:31
Could someone please provide a link to this WHO report on benzo's that everyone is talking about.
I'd love to read it!!!
Thank you
bluedog
Posted by utopizen on December 17, 2002, at 23:43:54
In reply to Lets keep things in perspective, posted by linkadge on December 16, 2002, at 14:54:56
ABCNews asked the inventor of Valium if he ever pops some of his creation back to relax, and he said he doesn't, it makes him depressed.
Posted by viridis on December 18, 2002, at 13:54:53
In reply to Re: Lets keep things in perspective, posted by utopizen on December 17, 2002, at 23:43:54
I'm not surprised -- of the benzos I've tried, Valium was definitely different from the others for me. It made me dull, lethargic, and "stoned" in an unpleasant way, unlike Xanax or Klonopin. But it seems to work wonders for some people, and its discovery definitely was a breakthrough.
This is the end of the thread.
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