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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 51 to 75 of 107. Go back in thread:
Posted by laima on August 28, 2006, at 12:22:20
In reply to Re: Psychopharmacology of addicting drugs » laima, posted by Squiggles on August 28, 2006, at 11:49:56
I'm going to respectfully disagree, as it doesn't ring true with either my own experience or with the information learned from my psychiarist who is also a Professor of Psychopharmocology at a major medical school. In other words, he is as about as "exert" as I could ever hope to find. My tolerances develope after 4-6 months. If we so disagree, there is no point for me to comment any more or risk an argument. Obviously, people have varying experinces with drugs like klonopin.> > Is this question for me, Laima?
> >
> I posted it in general, for anyone who
> knows about these things.
>
>
> > If I am understanding the question accurately-
> >
> > I am 100% living proof that a person CAN develope a tolerance to clonazepam/klonopin.
>
> After how long?
>
> Requiring more and more to get same effect- even when trying to stick to the prescribed plan. My doses have actually been raised in recognition of tolerance developing.
>
> How often have they been raised? How did you
> know that Klonopin was no longer as effective?
>
>
>
> And, if I stick to exact precribed amount, it eventually loses effectiveness. Not just lose effectiveness, but I develope backlash anxiety as "mini" daily withdrawals get started. Guarenteed. Doctor who is psychopharmocology professor agrees, and has seen it in other patients, too. Pharmacist also concurs.
>
> This has not been the case with the medical
> hospital i have been to. It seems that K
> is given for prolonged periods (7-10 yrs.)
> of time without a change in dose. In my
> case was raised only once, and then again
> i raised myself (asked doc.) when the withrawal
> was a failure and traumatic. A gastrointestinal
> problem has developed but other than that i
> do not feel withdrawal, nor do i know if the
> gastro problem is not infact due to another
> medical problem i have, or maybe even because
> of the raise dose (since K relaxes all muscles).
>
>
> >
> > Best choice in my case has been to taper down, rather than keep going up indefinately. (Note how I found it made me "fuzzier" and "stupider" on higher doses, for one thing--and what would happen when I would reach highest precribable dose, and need to come down froom that???)
>
> I don't have to go up - that's just it - at least
> not for decades, and withdrawing is putting my
> life at risk. I think it changes your brain.
>
>
> >
> > This doesn't mean that it's true for everyone, though.
>
> I am one of those stubborn people who believe
> that it IS the same for everyone, barring
> medical and physical idiosyncracies.
>
> >
> > My withdrawals have been mixed- when sharp and sudden from high "abuse"--very, very, very rough 1-1 1/2 weeks. Slow taper, not so bad. Not fun, but not so bad as some of the other accounts I've read about.
> >
> > I think we all have different tendencies and "other factors" mixed up into our experiences with klonopin and other benzos.
> >
>
> I wouldn't taper unless i was a beginner; after
> some years it is very hard.
>
>
> > Maybe it's sort of like alcohol- some people can always have their 2 glasses of wine and get "happy" or tipsy and not want or crave more- others feel nothing from those 2 glasses, want to get "happy" or "tipsy"- and keep reaching for more and more and more-I know people who can drink an entire bottle and then see with surprise that it's all gone-and they "don't feel drunk yet". And then there are those enviable folks who can have their glass of wine with dinner because they love wine, and are not interested in getting any tipsiness at all-yet don't even mind if it should happen.
> >
>
> No, K is different - it is used for convulsions -
> stronger than alcohol though alcohol shares the
> gaba effect with most benzos.
>
> But once again, from a pharmacologist here or
> a student maybe, is it possible to withdraw
> imperceptibly from an addicting drug over very
> long periods of time while taking the same dose?
> I think so with most benzos, but I think K
> is unique - maybe it changes the brain.
>
> Squiggles
Posted by Squiggles on August 28, 2006, at 12:36:06
In reply to Re: Psychopharmacology of addicting drugs » Squiggles, posted by laima on August 28, 2006, at 12:22:20
>
> I'm going to respectfully disagree, as it doesn't ring true with either my own experience or with the information learned from my psychiarist who is also a Professor of Psychopharmocology at a major medical school. In other words, he is as about as "exert" as I could ever hope to find. My tolerances develope after 4-6 months. If we so disagree, there is no point for me to comment any more or risk an argument. Obviously, people have varying experinces with drugs like klonopin.
>If you what you say about Klonopin is true,
and i have no reason to doubt you, then how
would you explain the extreme withdrawals
that people report after taking the drug
for years; in comparison to the relatively
milder withdrawals of other benzos.Squiggles
Posted by laima on August 28, 2006, at 13:18:24
In reply to Re: Psychopharmacology of addicting drugs » laima, posted by Squiggles on August 28, 2006, at 12:36:06
I just think we have different variables- have different histories of different substance use, which have had different kinds of who knows what sorts of effects, many of us are currently on other various medication combinations, etc. There are so many variables...I do not question anyone's account of their klonopin or other drug withdrawals.And consider- why on earth do we not respond to all the same medications in the same way anyway? If we did, all we'd need in existence is 1 antidepressent and 1 benzo- and we could all use the same. (?) But it's not that simple, and who knows why??
> If you what you say about Klonopin is true,
> and i have no reason to doubt you, then how
> would you explain the extreme withdrawals
> that people report after taking the drug
> for years; in comparison to the relatively
> milder withdrawals of other benzos.
>
> Squiggles
>
Posted by bassman on August 28, 2006, at 13:19:48
In reply to Psychopharmacology of addicting drugs, posted by Squiggles on August 28, 2006, at 11:00:02
Interesting question-but I disagree with you (what a surprise ;>}) on two of your premises. I've never become tolerant of any benzo I've taken except Ativan-so I just tapered off that in a few days. Perhaps you have experiences that suggest tapering off benzos is very dangerous? I just wonder, because the worst that usually happens to people when they withdraw (taper) is that they may feel a bit anxious, at worst. Sure, I wouldn't want to go from 2 mg Xanax to 0 in one day, that's just ignorant, but the vast majority of people that would try that would simply be very, very discomforted, not endangered. And some people might suffer a seizure, but people suffer seizures from both taking drugs and withdrawing from drugs, and just sitting around the house.
I may just be trying to say, "don't worry", just in a convoluted way..and you've had bad experiences and I find that sad.
So...in answer to your interesting question, "no", that wouldn't work, at least for me, because I don't seem to get tolerant. Did you ever try a very, very, very slow Klonopin taper?
Posted by Squiggles on August 28, 2006, at 13:24:05
In reply to Re: Psychopharmacology of addicting drugs » Squiggles, posted by laima on August 28, 2006, at 13:18:24
>
> I just think we have different variables- have different histories of different substance use, which have had different kinds of who knows what sorts of effects, many of us are currently on other various medication combinations, etc. There are so many variables...I do not question anyone's account of their klonopin or other drug withdrawals.
>
> And consider- why on earth do we not respond to all the same medications in the same way anyway? If we did, all we'd need in existence is 1 antidepressent and 1 benzo- and we could all use the same. (?) But it's not that simple, and who knows why??
>
> > If you what you say about Klonopin is true,
> > and i have no reason to doubt you, then how
> > would you explain the extreme withdrawals
> > that people report after taking the drug
> > for years; in comparison to the relatively
> > milder withdrawals of other benzos.
> >
> > Squiggles
> >
>
>Yes, I understand the difference in the
personal states of people taking drugs,
e.g. in the case of clonazepam, no everyone
is epileptic, and therefore can take a smaller
dose, leading to a different tolerance profile.I've been surfing the net for a monograph
on clonazepam, and even Roche does not indicate
how OFTEN the dose should be raised, in any
cases (children, adolescents, adults, seniors,
restless leg sufferers, anxiety-stricken ones,
epileptics, etc.).There's got to be something somewhere - have
not checked PubMed; did see an article by
Goodwin and colleagues, on the dampening of
gaba reaction in prolonged clonazepam treatment;
no sure what that means.I will keep looking for this answer.
Squiggles
Posted by Squiggles on August 28, 2006, at 13:44:41
In reply to Re: Psychopharmacology of addicting drugs, posted by bassman on August 28, 2006, at 13:19:48
> Interesting question-but I disagree with you (what a surprise ;>}) on two of your premises. I've never become tolerant of any benzo I've taken except Ativan-so I just tapered off that in a few days. Perhaps you have experiences that suggest tapering off benzos is very dangerous? I just wonder, because the worst that usually happens to people when they withdraw (taper) is that they may feel a bit anxious, at worst. Sure, I wouldn't want to go from 2 mg Xanax to 0 in one day, that's just ignorant, but the vast majority of people that would try that would simply be very, very discomforted, not endangered. And some people might suffer a seizure, but people suffer seizures from both taking drugs and withdrawing from drugs, and just sitting around the house.
>
> I may just be trying to say, "don't worry", just in a convoluted way..and you've had bad experiences and I find that sad.
>
> So...in answer to your interesting question, "no", that wouldn't work, at least for me, because I don't seem to get tolerant. Did you ever try a very, very, very slow Klonopin taper?
The shorter the period of taking benzo X
and the lower th dose, the easier it is
to withdraw especially if you do it slowly.
I did Xanax in a month (1.50 or 2.0 mg) and
it was a relative snap - some insomnia, anxiety,
etc. Not a big deal, as you say.But clonazepam on only 0.50, after more than
10 years, and a withdrawal schedule lasting
a year and a half, on "metric" gradual
reduction, resulted in a seizure/stroke which
left brain and physically disabled in bed
for a month and a half - high/low blood pressure,
stumbling walk, extreme headache, coming in
and out of consciousness, unrsponsive pupils. It was rough.I think that this K experience was so hard
because of the "length" not dose of taking the
drug. I say this, because when I tried to
stop K in my first few years of taking in, maybe
the first, all i got was an electric zap from
my head down my arm, recovering after a month.Certain variables seem to be important in drugs:
- Length of time taken
- Dose taken
- Duration of withdrawal
- Interaction with other drugs
- Physical condition
- Type of drug (K versus X for example)
- Age
- Liver ability to metabolize
- Sexjust to name some;
Now, back to searching for some guide either
to drs. or to nurses on how often a dose
of K should be raised.Squiggles
Posted by fca on August 28, 2006, at 17:02:10
In reply to Re: Psychopharmacology of addicting drugs » bassman, posted by Squiggles on August 28, 2006, at 13:44:41
"But clonazepam on only 0.50, after more than
10 years, and a withdrawal schedule lasting
a year and a half, on "metric" gradual
reduction, resulted in a seizure/stroke which
left brain and physically disabled in bed
for a month and a half - high/low blood pressure,
stumbling walk, extreme headache, coming in
and out of consciousness, unrsponsive pupils. It was rough."
If so, I have a couple of questions if you don't mind--how old were you when this happened, how was it established that the seizure/stroke was due to the K--after a year and a half of tapering you must have been at a fraction of the dose. Is it possible there were other contributing causes. On the surface this appears such an extreme reaction after that much tapering--thanks fca
Posted by Squiggles on August 28, 2006, at 17:10:33
In reply to Squiggles--are you saying this happened to you, posted by fca on August 28, 2006, at 17:02:10
> If so, I have a couple of questions if you don't mind--how old were you when this happened,48
how was it established that the seizure/stroke was due to the K--after a year and a half of tapering you must have been at a fraction of the dose.It was very difficult all along, but it was the
last cut of the pill (no liquid, and therefore
cuts were too big) that turned things around
suddenly - an axe like feeling in the back of the
head - electric; before that lots of sweats,
insomnia, anxiety, "electric eels" - sensations
of electricity in the head, tinnitus, etc. the
usual withdrawal effects;
Is it possible there were other contributing causes.Yes - it was one of the hottest summers in
my memory - i may have had heat stroke; but
my dr. said it was withdrawal;On the surface this appears such an extreme reaction after that much tapering--thanks
Actually, seizures are noted in the American
Psychiatry Association and many other reputable
organizations for benzo withdrawal;I managed to recover by raising the dose and
staying there, but even that took a long time;
my dr. said not to try withdrawing for another
6 months - i almost laughed in his face -
i suspect it was stroke because i had such
terrible depression after, not at all common
for my drugs;Squiggles
fca
Posted by janeB on August 28, 2006, at 17:35:10
In reply to Re: Squiggles--are you saying this happened to you » fca, posted by Squiggles on August 28, 2006, at 17:10:33
Posted by Squiggles on August 28, 2006, at 17:39:31
In reply to Squiggles--do you take any K now? (nm), posted by janeB on August 28, 2006, at 17:35:10
Yes, at a higher (33%) dose than the
one I took prior to my withdrawal attempt.
It was necessary to stop the "fire" in
the head and unmanageable withdrawals.I'm stable now.
Squiggles
Posted by Phillipa on August 28, 2006, at 19:55:43
In reply to Re: Psychopharmacology of addicting drugs » laima, posted by Squiggles on August 28, 2006, at 11:49:56
Sqiggles why do you think K is unique? Personally it depresses me made me feel suicidal once when I wasn't. I've found over the many years that now they make me tired instead of relaxed And I don't know why. Dose is the same but over 30years of benzos. Love Phillipa
Posted by Phillipa on August 28, 2006, at 19:58:22
In reply to Re: Psychopharmacology of addicting drugs » laima, posted by Squiggles on August 28, 2006, at 12:36:06
I'd explain it by the fact that lmg of klonopin is equal to 20mg of valium. I was shocked to learn this. Wonder why the pdocs use it so much? Love Phillipa
Posted by fca on August 28, 2006, at 20:34:39
In reply to Re: Psychopharmacology of addicting drugs » Squiggles, posted by Phillipa on August 28, 2006, at 19:58:22
Phillipa, I don't think the 20:1 comparison of valium to clonazepam is useful except for tapering or switching benzos--while they are in the same class they have different potency, effects and average dosages per day. It is somewhat like saying that 151 proof rum is 20-30 times stronger than beer or 10-12 times stronger than wine-- it is really a matter that 1 oz of alcohol equals 1 oz of alcohol. Does that make any sense
Posted by Squiggles on August 29, 2006, at 7:53:21
In reply to Re: Psychopharmacology of addicting drugs » Squiggles, posted by Phillipa on August 28, 2006, at 19:58:22
> I'd explain it by the fact that lmg of klonopin is equal to 20mg of valium. I was shocked to learn this. Wonder why the pdocs use it so much? Love Phillipa
Right, i forgot about that. When I was at
benzo.org i wrote to Roche suggesting that
they make the 0.50 pill smaller; and they do
in Europe but not in the West -- that is
because it is was originally intended for
epilepsy, requiring a huge dose; then whe
marketing it for anxiety, they should have
cut the 0.50 mg pill to at least 6 or 4
smaller portions. It was very difficult
to cut for withdrawal.Wonder what the detox centres do -- possibly
they follow Dr. Ashton suggestion of
using another benzo to cover the gaps
in withdrawal. But i don't think that
drs. have the time to invest in this
fall-out. I don't blame them; i blame
the drug companies.Squiggles
Posted by bassman on August 29, 2006, at 10:21:23
In reply to Re: Psychopharmacology of addicting drugs » Phillipa, posted by Squiggles on August 29, 2006, at 7:53:21
I have to say that Dr. Ashton's site is one of the most biased psychoactive drug sites I've ever come across. She says many things that are questionable, to put it charitably. There is no room for benzos as exceptionally safe and effective, as they are for the vast majority of people. If she said something like, "benzos are safe and effective for most people, but like many drugs, there are distinct risks, especially for individuals taking doses significantly higher than the traditional therapeutic range".. I'm sure she sees some cases of people that have gotten themselves into the unfortunate position of taking such a high dose that they are manifesting side effects at the same time that they are highly dependent on the drug- a truly bad situation, which happens with lots of drugs, including alcohol, pain killers, antidepressants, etc. One unfortunate result is that some physicians are convinced that somehow AD’s with their much higher rate of seizure and often intense dependence (take a look at Dr. Bob’s board on withdrawal for Effexor) are somehow a better choice for anxious/depressed patients. I think she’s done a lot more harm than good, taken on balance.
Posted by Squiggles on August 29, 2006, at 10:30:05
In reply to Re: Psychopharmacology of addicting drugs, posted by bassman on August 29, 2006, at 10:21:23
What about Charles Medawar "Power and Dependence"?
Have you read that Bassman? He outlines the
history of benzodiazepines and how drug companies have marketed them, without due caution to the effects on people. Dr. Ashton and other doctors
in that camp, are more concerned with addiction and
withdrawal and how to cope with that, rather than whether or not it is proper to take benzos in certain situations.Squiggles
Posted by bassman on August 29, 2006, at 11:10:07
In reply to Re: Psychopharmacology of addicting drugs » bassman, posted by Squiggles on August 29, 2006, at 10:30:05
I'm just saying Ashton's is not a balanced message. I share your distrust of the pharmaceutical companies (I worked in the field for 25 years). I find it somewhat odd that all the benzos used to be the drugs of choice-before they came off patent. Now you can get any benzo you want dirt cheap. Now they are all horrible drugs (my translation: they aren't big money-makers anymore). But if you want Effexor Cymbalta, the new AP's, etc. they are very expensive. And the TCA's were criticized when the SSRI's came along because the TCA’s were "dirty", that is, they hit more than just the serotonin sites-so of course, you want the newer, cleaner SSRI's. Until they went off patent. Now you're told you want Effexor, Cymbalta which are "dirty" like the TCA's were accused of being. I could rant on about Vioxx, etc.-Big Business surely isn’t watching out for our physical and mental health the way it is looking out for its own financial health-and so I think the day of making your own judgment about medications is upon us. Maybe it always was; I really don’t know.
Posted by Squiggles on August 29, 2006, at 11:22:11
In reply to Re: Psychopharmacology of addicting drugs, posted by bassman on August 29, 2006, at 11:10:07
If it is difficult for the professional
pharmacist to ferret out the truth in
this field, you can imagine how difficult
it is for the layman. The only truly
reliable thing the layman has is his or
her own experience with the drug; but
even that becomes a mystery in the fog
of authority and ignorance as any side
effects can be attributed to other causes.We need more philosophers and logicians
in the field. Think Roche and Glaxo would
be interested in hiring? :-)Squiggles
Posted by laima on August 29, 2006, at 11:22:41
In reply to Re: Psychopharmacology of addicting drugs » bassman, posted by Squiggles on August 29, 2006, at 10:30:05
Dare I suggest the possibility that the chemists developing drugs and the marketers might not be of same motives?
Posted by bassman on August 29, 2006, at 12:31:43
In reply to Re: Psychopharmacology of addicting drugs » bassman, posted by Squiggles on August 29, 2006, at 11:22:11
That's it! Let's start a new field, "Philosophical Pharmaceutical Science". :>} We'd have to have courses like, "PP 101: Why Your Company Shouldn't Make Dangerous Drugs", "PP201: Making Money or Killing People-How to Decide", "PP 301: Why All Moral Ethicists from 12,000 BCE to the Present Were Wrong", "PP 401: Heck, they are Going to Die of Something Anyway", "PP 501: Increasing Market Share by Selling Addictive Drugs", etc.
A person with a degree in PP would, of course demand an unreasonably high salary…
Posted by bassman on August 29, 2006, at 12:57:18
In reply to Re: Psychopharmacology of addicting drugs, posted by laima on August 29, 2006, at 11:22:41
Nah; when it comes to the chemists and the other folks that make and screen the drugs. They don't care one way or the other whether a given drug works other than they'd like to be part of a project that yields a drug that is truly helpful to people. That is a wonderful, wonderful feeling. The real problem comes in when the Project Leader for the drug, years after the chemists, et. al. have seen it, spends his time constantly selling what a wonderful drug it is to management. Then, as often happens, the drug turns out to be more toxic or less effective than it was expected to be, but the company has spent $100 million on the drug because Junior said it was super. Now the PL has one of two choices: go into the CEO and say, "the drug we just spent $100 million on, and that I told you was a blockbuster, is a stinker. Let's cut our losses and get rid of it now" OR, "don't believe that last set of data, Boss, you know how [insert favorite excuse here]" Equally, The Boss doesn't want to go in front of the stockholders and say, "you know that drug we said was going to make $4 billion in 2008 and push the stock price through the roof? We gave it to people and they are seeing little purple pigs run around outside the clinic. We take that as a bad sign..."
Posted by Meri-Tuuli on August 29, 2006, at 13:15:29
In reply to Re: Psychopharmacology of addicting drugs, posted by bassman on August 29, 2006, at 12:31:43
Posted by Squiggles on August 29, 2006, at 13:28:35
In reply to Re: Psychopharmacology of addicting drugs, posted by bassman on August 29, 2006, at 12:31:43
> That's it! Let's start a new field, "Philosophical Pharmaceutical Science". :>} We'd have to have courses like, "PP 101: Why Your Company Shouldn't Make Dangerous Drugs", "PP201: Making Money or Killing People-How to Decide", "PP 301: Why All Moral Ethicists from 12,000 BCE to the Present Were Wrong", "PP 401: Heck, they are Going to Die of Something Anyway", "PP 501: Increasing Market Share by Selling Addictive Drugs", etc.
>
> A person with a degree in PP would, of course demand an unreasonably high salary…
>Hee hee, "The Ministry of Mental Hygiene",
with standards set by BigPharm and applied
by the FDA and other international regulatory health care bodies. Ethicists (logicians,
statisticians, linguists, public health consultants) may contribute to journals edited by The Ministry and supported by grants from The Ministry.
I think we're already there.:=)Squiggles
Posted by laima on August 29, 2006, at 17:35:19
In reply to Re: Psychopharmacology of addicting drugs, posted by bassman on August 29, 2006, at 12:57:18
...it was just an idea! I can't completely believe that they all are thinking on the exact same page, but still-(?) I'm sure there are at least one or two drug developers who have known someone with a mood disorder and have a genuine interest to help out. Just was trying to help contribute to a small postive spin on the matter....lots of "good intentions" go awry, after all. I'm not a fan of "Big Pharmaceutical" either. Something seems "off'.
> Nah; when it comes to the chemists and the other folks that make and screen the drugs. They don't care one way or the other whether a given drug works other than they'd like to be part of a project that yields a drug that is truly helpful to people. That is a wonderful, wonderful feeling. The real problem comes in when the Project Leader for the drug, years after the chemists, et. al. have seen it, spends his time constantly selling what a wonderful drug it is to management. Then, as often happens, the drug turns out to be more toxic or less effective than it was expected to be, but the company has spent $100 million on the drug because Junior said it was super. Now the PL has one of two choices: go into the CEO and say, "the drug we just spent $100 million on, and that I told you was a blockbuster, is a stinker. Let's cut our losses and get rid of it now" OR, "don't believe that last set of data, Boss, you know how [insert favorite excuse here]" Equally, The Boss doesn't want to go in front of the stockholders and say, "you know that drug we said was going to make $4 billion in 2008 and push the stock price through the roof? We gave it to people and they are seeing little purple pigs run around outside the clinic. We take that as a bad sign..."
Posted by Squiggles on August 29, 2006, at 17:52:21
In reply to Re: Psychopharmacology of addicting drugs » bassman, posted by laima on August 29, 2006, at 17:35:19
Drug companies are too big, too rich,
too corporate-minded, too removed from
the welfare of the patient, to patronizing
of doctors and health care workers.I'm afraid of them, but I am also afraid
of not having them as I need the drugs
that they have rightly or wrongly provided.It's part of the evolution of our present
culture I think -- it reminds me so much
of the movie "Brazil" (apologies to Dr.
Bob for forgetting the double quotes previously).Squiggles
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