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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Paul Smith on April 24, 2005, at 16:30:30
Some say only 3 months. Some say that there is no distinction between the sedative and anti-anxiety effects. Some say there clearly is, and though no longer making one sleepy, benzos can work on anxiety for decades. In other words, according to the first opinion, as soon as they stop making you sleepy they are doing nothing for your anxiety. Opinions and opinions on the net. And some in here say their benzos do not work for their anxiety any longer, that they only take theem to hold off withdrawal effects. What does everyone think?
P.S. Sorry for all the questions but i just have a lot of them. :-)
Posted by zeugma on April 24, 2005, at 17:54:18
In reply to how long do benzos work?, posted by Paul Smith on April 24, 2005, at 16:30:30
I can't speak for anyone else, but clonazepam still works for my anxiety even though I don't get a sedative effect from it.
-z
Posted by Phillipa on April 24, 2005, at 18:38:19
In reply to Re: how long do benzos work?, posted by zeugma on April 24, 2005, at 17:54:18
I've been on them over 30yrs, and valium still helps me sleep. Fondly, Phillipa
Posted by Ame Sans Vie on April 25, 2005, at 10:08:08
In reply to how long do benzos work?, posted by Paul Smith on April 24, 2005, at 16:30:30
I have to concur with zeugma. I've been on Klonopin at an average dose of 8mg/day for five years now and its effect (thank goodness!!) hasn't diminished in the slightest. And FWIW, I've *never* felt a sedative effect from clonazepam, but I'm a special case in that I also feel no sedative effects from Ambien, Sonata, Halcion, Restoril, Elavil, etc.
~Michael
Posted by Phillipa on April 25, 2005, at 16:53:38
In reply to Re: how long do benzos work?, posted by Ame Sans Vie on April 25, 2005, at 10:08:08
So how do you manage to fall asleep and stay asleep if none of the sleep meds help? Fondly, Phillipa
Posted by Mr.Scott on April 25, 2005, at 21:23:22
In reply to how long do benzos work?, posted by Paul Smith on April 24, 2005, at 16:30:30
I think it's hard to say. I guess I have less anxiety but more depression from long-term clonazepam use. More cognitive sedation, and befuddling, but less panic level anxiety.
Scott
Posted by Paulbwell on April 25, 2005, at 22:11:56
In reply to Re: how long do benzos work?, posted by Ame Sans Vie on April 25, 2005, at 10:08:08
> I have to concur with zeugma. I've been on Klonopin at an average dose of 8mg/day for five years now and its effect (thank goodness!!) hasn't diminished in the slightest. And FWIW, I've *never* felt a sedative effect from clonazepam, but I'm a special case in that I also feel no sedative effects from Ambien, Sonata, Halcion, Restoril, Elavil, etc.
>
> ~MichaelHi Ya Michael,
Do you still use Tuinal or Seconal for sleep?
Cheers
Posted by chemist on April 26, 2005, at 0:36:05
In reply to how long do benzos work?, posted by Paul Smith on April 24, 2005, at 16:30:30
> Some say only 3 months. Some say that there is no distinction between the sedative and anti-anxiety effects. Some say there clearly is, and though no longer making one sleepy, benzos can work on anxiety for decades. In other words, according to the first opinion, as soon as they stop making you sleepy they are doing nothing for your anxiety. Opinions and opinions on the net. And some in here say their benzos do not work for their anxiety any longer, that they only take theem to hold off withdrawal effects. What does everyone think?
>
> P.S. Sorry for all the questions but i just have a lot of them. :-)hello there, chemist here...add me to the list of the other posters who find that long-term use remains effective...it has been just over 10 years now, and i've found comfort with alprazolam, an atypical benzo with a well-earned caution in re: dosage reduction. that said, clonazepam, diazepam, and lorazepam remain suitable and effective substitutes in my mind....alprazolam is just a nose ahead of the bunch for me...all the best, chemist
Posted by woolav on April 26, 2005, at 9:28:04
In reply to Re: how long do benzos work? » Paul Smith, posted by chemist on April 26, 2005, at 0:36:05
do u know anything about Prazepam? I have never heard of it. Is it like klonopin or xanax? I really cant find much about it on the net. I dont even know if its approved in the U.S.?
Thanks
S
Posted by chemist on April 26, 2005, at 9:58:25
In reply to Re: how long do benzos work?chemist, posted by woolav on April 26, 2005, at 9:28:04
> do u know anything about Prazepam? I have never heard of it. Is it like klonopin or xanax? I really cant find much about it on the net. I dont even know if its approved in the U.S.?
>
> Thanks
> Shello there, chemist here...prazepam is no longer marketed in the u.s., and the structure includes a 3-carbon ring tethered where one would find a hydrogen in a ``normal'' benzodiazepine...it has at least one relative i can name - flutoprazepam - also unavailable in the u.s. both drugs were synthesized within 10 years of sternbach's pioneering work in the area, and i suspect that these - and numerous other benzos/derivs - simply were redundant in terms of efficacy and hence are not on the shelves....just a guess....all the best, chemist
Posted by woolav on April 26, 2005, at 10:59:40
In reply to Re: how long do benzos work?chemist » woolav, posted by chemist on April 26, 2005, at 9:58:25
Posted by lgmg on April 29, 2005, at 6:30:57
In reply to Re: how long do benzos work? » Paul Smith, posted by chemist on April 26, 2005, at 0:36:05
i've been on lorazepam and i've always wondered if alprazolam might work better, do you hve any thoughts on the difference?
Posted by mattw84 on April 29, 2005, at 22:37:45
In reply to Re: how long do benzos work? - chemist, posted by lgmg on April 29, 2005, at 6:30:57
lgmg,
Name is EmDubya, I'm an MS2 med student. From my perspective there is little to no *subjective* difference between the two -- aside from a general preference towards Ativan(Lorazepam) in US institutions. The most significant difference is only in what the FDA has approved respective uses thereof. Ativan is usual the first line anxiolytic because:
1) ...it is extremely fast acting.
2) ...has superior anticonvulsant properties compared to Xanax.
3) ...likely is more profitable in clinical practice.
4) ...is more retro/anteroamnestic than Xanax. (Useful in a clinical setting, but let's not get into that.)
5) ...has a lower equipotent maximum dosage to that of Xanax.Those might not all seem like significant reasons as to why lorazepam is preferable, but they is what they be...
Alprazolam is *indicated* for anxiety with concomitant depression. Even though no evidence suggests that Lorazepam is any less likely to induce depressive states.
They are both short-acting, with T to 1/2 plasma concentrates occurring <8 hours post administration. So is there really any superiority between the two? Alprazolam likely has a slight edge on Lorazepam, only because it does act *very* mildy as 5HT agonist, whereas the former shows no evidence thereof. That aside -- outside of an inpatient setting, profit margins are much greater than with Lorazepam, especially with the advent of Xanax XR.
With equal respect, both produce rapid physiological dependence and tolerance. Alike, approximately 50% of those administered either are likely to be long-term customers.
My personal opinion is to simply use either pro re nata, or not at all. Though they both illustrate long-term efficacy, the choice is yours... I'll leave the rest of this up to the chem, assuming he'll break it down in terms more appeasing.
Best of luck with whatever you choose to do.
Regards,
M.W.
Posted by chemist on April 30, 2005, at 0:52:20
In reply to Re: how long do benzos work? - chemist, posted by lgmg on April 29, 2005, at 6:30:57
> i've been on lorazepam and i've always wondered if alprazolam might work better, do you hve any thoughts on the difference?
hello there, chemist here...matt is correct in that i will happily spill the intricacies of subunit binding domain differences for the GABA A, B, and C LGICs if you like...matt's post is one that makes me think that he should open up a practice near my home: they truth balanced with practical aspects that obviously enter on the side of the prescribing m.d. (``do i have to worry about this patient drinking alcohol with their xanax or is the dose escalation speeding along?'' etc.)....
the anti-depressant effects of triazolo- derivs. of benzos are documented but the drugs are not used to combat depression alone, obviously, thus any effect will augment. likewise, if the benzo is more sedating - diazepam is commonly thought of in this light - then you will be, yes, a little more tired and perhaps ``down.''
if you take a drug p.r.n. for panic, diazepam beats lorazepam for onset - this is a property of the substances - but lorazepam has more pronounced action. alprazolam is a quick sledgehammer in my opinion and experience: i take it and have taken numerous benzos and with minor dose adjustment, i could swap one for another. BUT we are talking chronic use.
which brings me to matt's post. if think the change from lorazepam to alprazolam would be ill-advised unless you are having breakthrough panic or finding that your consumption is getting out of hand. that said, i doubt any reasonable doctor would switch a person from lorazepam to alprazolam if the patient was appearing to become a little more fond of benzos than one should.
do let me know if you wish a discourse concerning the vageries of ligand binding domains and conformational analyses of changes in large proteins upon binding of substrate: i will bore the audience with vigor....all the best, chemist
Posted by FredPotter on May 1, 2005, at 15:47:58
In reply to Re: how long do benzos work? - chemist, posted by lgmg on April 29, 2005, at 6:30:57
I've taken benzos for 41 years, currently Xanax. I would say it's not much good against the unfocussed dread I feel, but suspect it's effective against panic
Posted by Declan on May 1, 2005, at 17:39:22
In reply to Re: how long do benzos work? - chemist » lgmg, posted by FredPotter on May 1, 2005, at 15:47:58
Hey you didn't say this, but it's not a case of turning panic/fear into dread with benzos is it? I read a case study of a dozen or so agoraphobics. When they stopped using benzos and got over the wd the agoraphobia resolved itself in all cases. I've used them since 1972.
Declan
Posted by FredPotter on May 2, 2005, at 0:14:23
In reply to Re: how long do benzos work? - chemist, posted by Declan on May 1, 2005, at 17:39:22
Thanks Declan that's an interesting notion. Perhaps I'd better give it a try
This is the end of the thread.
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