![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 15 to 39 of 73. Go back in thread:
Posted by ed_uk on January 5, 2006, at 15:01:30
In reply to Re: When are benzos justified?, posted by MGOLDW on January 5, 2006, at 14:31:15
Hi
>Everyone talks about long term Bezo use. What is considered long term use?
I consider benzo use to be long term when a person has taken a benzo on a daily (or almost daily) basis for more than 4 weeks.
Ed
Posted by James K on January 5, 2006, at 18:19:07
In reply to When are benzos justified?, posted by detroitpistons on January 3, 2006, at 15:21:05
I take generic Klonopin (clonazepam)1 or 2 mgs a day. I've taken it off and on for years and not abused. Even though I've had serious alcohol problems. It's the only thing that helps me with the "brain fog" of chronic fatigue syndrome.
One thing I would point out is that I have been hospitalized several times in the past couple of years, and almost everyone with an addiction problem it is meth and xanax, or just xanax. So in my opinion based only on personal observation, klonopin is safer than xanax if potential addiction behavior is a fear.
A thing about habituation - If you take it everyday and get habituated to it, then forget to take it, You may feel like crap mentally and not realize why.
just chiming in,
James K
Posted by Glydin on January 5, 2006, at 19:31:42
In reply to Re: When are benzos justified?, posted by James K on January 5, 2006, at 18:19:07
I think there is alot of confusion and misinformation regarding how the word "addiction" is used when speaking of meds with addiction/abuse potential. I know a number of folks who believe any med with withdrawal symptoms or a discontinuation syndrome constitutes one is "addicted" if one experiences such.
Medical dependence is the legit approiate use of a chemical to treat symptoms.
Addiction is hallmarked by four characteristics: Psych-Social disruption, Drug seeking behavior, Inapproiate use, Tolerance.
Posted by yxibow on January 6, 2006, at 0:46:24
In reply to Re: When are benzos justified?, posted by MGOLDW on January 5, 2006, at 14:31:15
> Everyone talks about long term Bezo use. What is considered long term use? One month, one year, ten years?
> Also, is there a significant difference between regular use or as needed use in terms as long term use?There are people who have been on Librium since it came out in 1960 and Valium since it came out in 1963 with no habituation. Its inventor recently died at 97, if that gives any idea of the length of time psychiatric medications have been around. That is definately long term use.
The difference between regular use and as needed use is that after about a certain period of time, weeks to months (dependent on the benzodiazepine, there are more than 3 dozen though not all are approved in every country) one can and usually becomes habituated to it. At that point, it may still has clinical use, but if one wants to discontinue, it has to be gradual withdrawal or anything can happen from seizures to extreme anxiety, tremor, chills, and other typical signs of drug withdrawal.
Do not attempt to "cold turkey" a long term use of any benzodiazepine. I did for a variety of reasons (I thought it was starting to interfere cognitively and in other ways) although my so-called doctor at the time allowed an amount back again that wasn't enough, but that's neither here nor there. I still have occasional scalp spasms and back oddities from it.
That doesn't mean benzodiazepines don't have their place -- even with my experience, benzodiazepines are still the safest psychiatric medication and there will be those from the benzo.org.uk camp that will say otherwise, and I am not going to make slander for I once commented about it and it was not taken by Dr Bob in its context -- and one can respect their opinion if they wish.
As needed / PRN, is exactly that, when moderate to severe anxiety occurs, on a fortnight or once or twice or three times a week, or a few times a day here and there. The distinction is that tolerance is generally not built up and benzodiazepines with a more "immediate" action are generally used, like Ativan.
hope that clears that question
tidings
Posted by James K on January 6, 2006, at 8:22:35
In reply to Re: When are benzos justified?, posted by Glydin on January 5, 2006, at 19:31:42
> I think there is alot of confusion and misinformation regarding how the word "addiction" is used when speaking of meds with addiction/abuse potential.
---Was this directed at my post? I know the difference between medical dependence and addiction. I was attempting to point out that the young people around here take "bars" (xanax) by the handfuls, and they have high street value. I've never seen this with klonopin. I will try to be more precise in the future. I said it was only my opinion between the two medicines.
If you were just trying to give the gentleman more information, and I'm just feeling paranoid, let me apologize in advance. It's been a tense space around here. I'm already sorry.
>
> Medical dependence is the legit approiate use of a chemical to treat symptoms.
>
> Addiction is hallmarked by four characteristics: Psych-Social disruption, Drug seeking behavior, Inapproiate use, Tolerance.
Posted by Glydin on January 6, 2006, at 8:55:32
In reply to Re: When are benzos justified? » Glydin, posted by James K on January 6, 2006, at 8:22:35
> > I think there is alot of confusion and misinformation regarding how the word "addiction" is used when speaking of meds with addiction/abuse potential.
>
> ---Was this directed at my post? I know the difference between medical dependence and addiction.
No, No, a thousand times No..... I am very sorry it appeared that way to you. I posted that due to just a general opinion of mine. I have in the past, on this board, been told I was "addicted" due to my use of Klonopin. I am sensitive and prehaps in light of your post, I should not have even posted what I did. I did as we were discussing benzo's and addiction versus dependence.I know from your post you are very knowledgable of the difference. I don't think everyone is.
I hope you will accept my apologies.....
Posted by detroitpistons on January 6, 2006, at 9:07:04
In reply to Re: When are benzos justified? » James K, posted by Glydin on January 6, 2006, at 8:55:32
How long do you have to take Xanax (roughly) before you'll experience withdrawal? Assume 1 mg daily. Can I become dependent within a couple of weeks?
The reason I ask is because I've been taking it lately and my next pdoc apt isn't till the 11th.
Posted by MGOLDW on January 6, 2006, at 10:57:40
In reply to Re: When are benzos justified?, posted by detroitpistons on January 6, 2006, at 9:07:04
I am going to see a therapist today. This will be a first for me. I know the causes for my depresion and my anxiety. Do you guys think that I will benefit from therapy? or am I just waisting time and money?
Lexapro 10mg/day
Xanax .25mg as needed
Posted by detroitpistons on January 6, 2006, at 11:30:32
In reply to Re: When are benzos justified? One more question?, posted by MGOLDW on January 6, 2006, at 10:57:40
> I am going to see a therapist today. This will be a first for me. I know the causes for my depresion and my anxiety. Do you guys think that I will benefit from therapy? or am I just waisting time and money?
> Lexapro 10mg/day
> Xanax .25mg as needed
My view on therapy is that it can help anyone, regardless of how happy they are...My brother in law, who is one of the happiest, successful, most well grounded people I know, has gone to therapy and benefitted from it.When I was in therapy, I was in the middle of a pretty bad depressive episode, and it was really hard to talk, but I did feel better sometimes after leaving therapy. That good feeling, however, was pretty short lived...The next day I was still anxious and depressed. I didn't continue with the therapy because I moved to a different city, but I would like to start again just to sort out the types of issues that everybody has.
Basically, if you have insurance that will cover it (my insurance would cover 26 visits per year--copay is like 20 bucks per visit), and you have the time to go, you should try it, even if only for a couple of sessions. At least then you will know if therapy helps you. Also, the therapist/ psychologist may be able to recommend if other forms of therapy could be beneficial to you, based on your unique circumstances.
If you're paying completely out of pocket, then it's a bit more of a risky proposition, simply because your therapist may not even be the right one for you, and you could spend a lot of money just looking for the right one (just like with meds).
Again, if you have insurance, it can't hurt to try it.
Posted by vbAgent on January 6, 2006, at 11:35:37
In reply to When are benzos justified?, posted by detroitpistons on January 3, 2006, at 15:21:05
Improving your quality of life doesn't need justification... ;-]
Weigh the benefits and risks. If it works, stick with it. Bear in mind that the therapeutic value of benzos are compromised by their abuse potential (but you already knew that).
Peace...
Posted by irishcatholic on January 6, 2006, at 11:46:06
In reply to Re: When are benzos justified? » detroitpistons, posted by Glydin on January 3, 2006, at 22:03:41
Great post! Excellent insight!
1 x 20 mg generic Proz + 2 x .5 mg generic Xanax per day has been a big help for me, over 2 yrs now. If it goes bad in the future, I'll have to deal with it, but for now I (and my pDoc) see no reason to mess with it. I call it an 80% solution. Took 2 years to get there in the first place because I got discouraged about all the failed drug trials we did.
Posted by valene on January 6, 2006, at 15:30:08
In reply to When are benzos justified?, posted by detroitpistons on January 3, 2006, at 15:21:05
I don't want to scare you but I have been going through HELL trying to get off xanax 3mg. - I am down to 1.5mg. after one whole year.
It worries me that you are already on effexor and consider adding a benzo to make a cocktail - I know someone on another forum who is losing her mind trying to get off both effexor and valium.
I am not an alarmist, just stating the fact. Try going to the benzo@yahoogroups and reading some of the posts over there and you will see these people are really suffering big time trying to get off benzos.
Please think it over carefully before trying a benzo for any length of time! They can be very scary, ugly drugs to get off and the recovery can take many many months. In my case I was left on them for several years before I realized how much my body was addicted to them (I say addicted because it is a true physical addiction). I hate them with a passion but still need them for now. My hair has thinned way out (a benzo withdrawal symptom) and that's the least of it.
Best of luck
> 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 detroitpistons on January 6, 2006, at 16:06:15
In reply to Re: When are benzos justified?, posted by valene on January 6, 2006, at 15:30:08
> I don't want to scare you but I have been going through HELL trying to get off xanax 3mg. - I am down to 1.5mg. after one whole year.
>
> It worries me that you are already on effexor and consider adding a benzo to make a cocktail - I know someone on another forum who is losing her mind trying to get off both effexor and valium.
>
> I am not an alarmist, just stating the fact. Try going to the benzo@yahoogroups and reading some of the posts over there and you will see these people are really suffering big time trying to get off benzos.
>
> Please think it over carefully before trying a benzo for any length of time! They can be very scary, ugly drugs to get off and the recovery can take many many months. In my case I was left on them for several years before I realized how much my body was addicted to them (I say addicted because it is a true physical addiction). I hate them with a passion but still need them for now. My hair has thinned way out (a benzo withdrawal symptom) and that's the least of it.
>
> Best of luckHi,
I appreciate your concern...I knew how hard it is to get off of Effexor because I was already on it once. I've also gone through Paxil withdrawal, and it was complete hell. Yet, I still went back to Effexor because I felt so badly that I felt the benefit of the med outweighed the withdrawal.
I'm going to wait and see what my doctor says, but at this point I don't see any alternative to augmenting the Effexor. It only works on my depression, and my anxiety is still going strong. If I don't relieve the anxiety, the Effexor WILL poop out and I will slide into another depression. In fact, I'm thinking now that if I can control the anxiety, I may not even need an antidepressant in the future, because my depression is largely anxiety driven. Theoretically, if I could treat myself with Klonopin alone, I would be ecstatic. In my opinion (as well as others on this board), Klonopin is much safer and benign than the AD's.
There are lots of people who don't find relief from one drug and find the need to augment. Believe me, I am weighing the benefits and risks. I resisted taking meds for a long time, but it's time for me to enjoy life.
Posted by James K on January 6, 2006, at 16:48:22
In reply to Re: When are benzos justified? » James K, posted by Glydin on January 6, 2006, at 8:55:32
I was dreading coming home and checking the board because I knew I had jumped to a conclusion. I'm posting this here rather than social or psychology just to make sure you notice it. Part of my behavior involves being overly sensitive. Your understanding about my misunderstanding allows me to learn a lesson without major consequences. So thank you.
James K
Posted by Glydin on January 6, 2006, at 16:54:17
In reply to Thanks and sorry » Glydin, posted by James K on January 6, 2006, at 16:48:22
You are so very welcome. No problem at all. The timing of my post right after yours did not turn out well and I can understand your confusion. It was never my intention to cause you anger, distress or any untoward feelings.
I'm very glad you accepted my apology.
Best to you,
Glydin
Posted by Phillipa on January 6, 2006, at 17:45:51
In reply to Oh, James K, posted by Glydin on January 6, 2006, at 16:54:17
I feel it's true. Benzos have been around a long time and there are really no long term consequences of taking them. I myself have been on one for over thirty years. And I don't consider it an addiction just necessary as my whole family has severe anxiety problems. Genetic. Fondly, Phillipa
Posted by Declan on January 6, 2006, at 18:37:01
In reply to Re: Oh, James K, posted by Phillipa on January 6, 2006, at 17:45:51
Hi Everyone
I think this addiction thingo is an anxiety that is not intrinsically relevant. I've always preferred to say that I was addicted to, say, benzos or opiates, even if my dose was stable and moderate. I liked the term because it reflected the enchainment to the drug.
I try not to let the mass anxieties about this issue affect me. I perfectly understand that people may not wish to be labelled as addicts, some of whom behave badly, many of whom are treated badly, who have their situation sensationalised etc.
Isn't the argument about the words a semantic avoidance of blame? Certainly, as far as I (or anyone here, I think) am concerned, blame doesn't enter into it.
Declan
Posted by valene on January 6, 2006, at 21:03:14
In reply to Re: Oh, James K, posted by Phillipa on January 6, 2006, at 17:45:51
I am pointing out that benzos can be worse than "heroin" to withdraw from: this has been said over and over if you do an internet search or talk to someone who has been through horrific withdrawal.
Are you calling me a liar? I went through one year of hellish withdrawal symptoms. Just go to benzo.org.uk and read Professor C. Heather Ashton's description of benzo w/d symptoms and tell me this is not a physical dependence. I don't appreciate your inferring that I am lying about benzo withdrawal. I have read thousands of articles and posts about benzo withdrawal and it is REAL.
Some very lucky people apparently get away with no w/d symptoms or very slight w/d but the percentage is quite low.
How can you say it is not addictive also when if you C/T it you run a big risk of grand mal seizures????
> I feel it's true. Benzos have been around a long time and there are really no long term consequences of taking them. I myself have been on one for over thirty years. And I don't consider it an addiction just necessary as my whole family has severe anxiety problems. Genetic. Fondly, Phillipa
Posted by Phillipa on January 6, 2006, at 21:22:17
In reply to Re: Oh, James K-Phillipa, posted by valene on January 6, 2006, at 21:03:14
My post was not directed at you. I'm sorry you've had such a hard time. But not everyone experiences the same thing. As long as a doctor monitors your doseage and response. Some people suffer from anxiety disorders that only a benzo will work for. Unfortunately antidepressants don't work for me. But maybe it's not unfortunate as I've been able to gradually wean off benzos many times over the course of the years I've been on them. As a matter of fact I'm now on the lowest amt that I have been over the past few years. There are been times that I have been totally benzo free. I'm sorry you feel so horrible. Good luck to you. Fondly, Phillipa
Posted by James K on January 6, 2006, at 21:53:39
In reply to Re: Oh, James K-Phillipa, posted by valene on January 6, 2006, at 21:03:14
I've suffered from chronic fatigue syndrome for years. The article on this page is the main reason I take clonazepam.
http://www.fibromyalgiasupport.com/library/print.cfm?ID=3154&t=CFIDS_FM
I'm not putting this here to discount valene's or anyone elses experience, or to cause controversy. Not everyone has CFS, but I do and I trust this doctor's work.
I would welcome any of you science or alternative medicine experts on this forum to say if you think this guy is a quack or his methodology is suspect. My mind and my health are too important to automatically discount relevant information.
I'm going to go take a look at the benzo site referenced in the above post and see what that's about. I know that the singer Stevie Nicks thinks klonopin nearly destroyed her.
thanks. (I hope the one who started this thread isn't completely confused now)
James K
Posted by yxibow on January 7, 2006, at 0:08:49
In reply to Re: Oh, James K-Phillipa, posted by valene on January 6, 2006, at 21:03:14
> I am pointing out that benzos can be worse than "heroin" to withdraw from: this has been said over and over if you do an internet search or talk to someone who has been through horrific withdrawal.
>
> Are you calling me a liar? I went through one year of hellish withdrawal symptoms. Just go to benzo.org.uk and read Professor C. Heather Ashton's description of benzo w/d symptoms and tell me this is not a physical dependence. I don't appreciate your inferring that I am lying about benzo withdrawal. I have read thousands of articles and posts about benzo withdrawal and it is REAL.Benzodiazepine withdrawal is real, I wont deny that However. The website is a controversial one and I will again get lambasted I am quite sure about this site because there are people here who believe in it, and there are people who are squarely against it. One is free to choose, so I hope I clearly am placing that disclaimer when I say the following things, and note, I am also speaking of a person who has withdrawn from benzodiazepines I would say at least two to three times, mostly safely. Once cold turkey and while I still suffer from some strange but fairly benign spasms from it now and then, what can I do?
Professor Ashton has an agenda to remove people from benzodiazepines, not to mention that there is a blatant Christian symbol placed squarely in the center of the website. By this I am not attacking any religion, but I do not believe it has any place in a website that is to neutrally disseminate important medical information. I speak not for any drug company, and I believe in things like HON and general good practices of medical web ethics.
Additionally medical "experts" sited on the web site include Peter Breggin, MD, who you can believe or not, but is definately a "quack" as identified by Quackwatch, which is generally on the level about medical ethics [http://www.quackwatch.org/11Ind/breggin.html].
> Some very lucky people apparently get away with no w/d symptoms or very slight w/d but the percentage is quite low.Every medication out there has a potential for medical complications from withdrawal, especially abrupt, from long term use. No dispute here. Antidepressants, antipsychotics, beta blockers, the list goes on.
> How can you say it is not addictive also when if you C/T it you run a big risk of grand mal seizures????There are a lot of medications out there that can risk up to and including grand mal seizures when you "Cold Turkey" them, that don't just include benzodiazepines. All anticonvulsants carry this risk. This includes Tegretol, Depakote, Neurontin, Keppra, Lamictal, Trileptal, Topamax, and practically every medication invented for epilepsy that are used off label for psychiatric purposes.
No medication will be without side effects as no tool in one's garage or garden will be without danger to its user. Its good to read up on information. But that has to be solid, scientifically based information, with double blind trials, and the lack of scare tactics.One can choose to go down the path and never take any medication because it might cause something in the future. One can sit suffering in silence. Or maybe one doesn't need it at all. I personally feel I do need medication so I again make a disclaimer that I speak also personally as someone who takes antipsychotics and has risk of TD, has taken antidepressants and gained weight, and has had withdrawal symptoms from medications, including benzodiazepines.
Heroin withdrawal for the grand majority population may not include seizures, but one can get a pretty good idea from Trainspotting as to what it entails.
A planned, gradual withdrawal and taper from benzodiazepines for one reason or another of discontinue, over periods of weeks to months depending on the dose and medication will for the vast majority of individuals successfully remove the patient from the substance. And I do mean gradual.
There is also, and I will repeat again, a distinction between withdrawal, dependence, addiction, and habituation.
Withdrawal is a medical sign of the lack of a drug in a system that has been habituated in an individual for the majority of individuals.
Dependence and addiction are another category -- physical dependence on a substance for no value or purpose other than some form of gratification from that substance that may possibly even be a genetic disposition such as alcohol abuse.
In conclusion, the responsible use of benzodiazepines when they are called for are still the most safest psychiatric medications, and believe it or not, there are people happily kept in balance since they were invented in 1958 (brought to market in 1960) to replace the ancient barbiturates that had been in use, some of whose effective doses can be near their lethal range.
I cannot think of a psychiatric medication that has been tested for 46 years that has fewer side effects than the proper use of benzodiazepines by their very virtue of 46 years of experience.People brought out of crippling social phobias and panic disorder that had previously been housebound. I dunno, I could go on. There is good, and bad, and inbetween. But comparing a C-IV medication to C-I Heroin is a little on the absurd spectrum, I am sorry.
Tidings.
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
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