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Dr. Bob is Robert Hsiung, MD,
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Posted by qbsbrown on September 13, 2006, at 2:08:07
In reply to Re: BENZO Preferences? one easier to WD???? » qbsbrown, posted by yxibow on September 13, 2006, at 1:26:29
Actually Jay, i've been on diazepam for about 8-9 months.
My only concern is that ativan would be more difficult to come off of than valium.
Brian
Posted by sdb on September 13, 2006, at 8:37:47
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 13, 2006, at 2:08:07
do you take valium once a day and how much is the dosage? I've heard that a benzo eg. valium can increase anxiety after one single dosage.
Posted by qbsbrown on September 13, 2006, at 9:49:11
In reply to Re: BENZO Preferences? one easier to WD????, posted by sdb on September 13, 2006, at 8:37:47
twice daily, 5 and 7.5mgs, morning-night.
the odd thing is that all the literature i look at can't pin down the conversion from valium to ativan.
half says 5mg valium=1mg ativan
the other half says 10mg=1mg ativan
I love when there's billion's of dollars involved, and people's health at stage, and we can't know simple questions like that, eg lexapro=celexa equivalence.
Brian
Brian
Posted by yxibow on September 13, 2006, at 15:59:28
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 13, 2006, at 9:49:11
> twice daily, 5 and 7.5mgs, morning-night.
>
> the odd thing is that all the literature i look at can't pin down the conversion from valium to ativan.
>
> half says 5mg valium=1mg ativan
>
> the other half says 10mg=1mg ativan
>
> I love when there's billion's of dollars involved, and people's health at stage, and we can't know simple questions like that, eg lexapro=celexa equivalence.
>
> Brian
>
> Brian
There's no exact science, especially in the second one, the SSRI equivalence, but the first chart you speak of, I think you're talking about the one on Dr bob's list, is accurate. I know, because I transferred a **load of Klonopin over stages to a **load of Valium and its correct. 1mg Lorazepam is approximately 5mg Valium, a 10mg Valium tablet is approximately a half milligram Klonopin tablet.
I take Valium twice daily even though it has a 24+ hour half life, bulk in the evening.
Posted by yxibow on September 13, 2006, at 16:03:02
In reply to Re: BENZO Preferences? one easier to WD???? » qbsbrown, posted by yxibow on September 13, 2006, at 15:59:28
> There's no exact science, especially in the second one, the SSRI equivalence, but the first chart you speak of, I think you're talking about the one on Dr bob's list, is accurate.
That there's no exact science has the whole load of genetics and then theres the fact that SSRIs target 4 or 5 serotonin subtransmitters and except in lab observations, benzodiazepines primarily hit GABA-A with only slight to obvious variations in how much hypnotic-sedative, anxiolytic, and anticonvulsant activity they have.
Posted by qbsbrown on September 13, 2006, at 16:22:46
In reply to Re: BENZO Preferences? one easier to WD????, posted by yxibow on September 13, 2006, at 16:03:02
Could you cite that conversion talbe for me, or send a link please.
I'm at a loss of what to do. it seems the longer acting benzos give me more depression and irritability, but seem like valium is the easiest to come off of, right?
Brian
Posted by Phillipa on September 13, 2006, at 18:17:39
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 13, 2006, at 16:22:46
5mg of valium=lmg of ativan or .5 of xanax or .5 klonopin=l0mg of valium. Klonopin is the most potent one. The two long acting are valium longest and klonopin not as long. The short acting ones are xanax and ativan. I believe from my experience with all of them that xanax is the shortest. And maybe you just need it as needed? So then a shor term would make sence since the long acting build up in the body valium lasts for more than a day at least the half-life and klonopin too. I think that chart is on the homepage. Love Phillipa
Posted by qbsbrown on September 13, 2006, at 19:48:37
In reply to Re: BENZO Preferences? one easier to WD???? » qbsbrown, posted by Phillipa on September 13, 2006, at 18:17:39
Taking it as needed does sound good, but i've already failed at 3-4 withdrawals because, one was cold turkey, 2-3 were WAY to fast, and 4 i messed w/ my AD in the final weeks.
I do notice the benzo WD significantly, so i think it has to be a long continuous process, correct me if i'm wrong, cause i'd love to try as needed.
Brian
Posted by Phillipa on September 13, 2006, at 21:12:14
In reply to correc me if i'm wrong, posted by qbsbrown on September 13, 2006, at 19:48:37
No you're right. Most definitely right. Love Phillipa
Posted by yxibow on September 13, 2006, at 22:52:56
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 13, 2006, at 16:22:46
> Could you cite that conversion talbe for me, or send a link please.
>
> I'm at a loss of what to do. it seems the longer acting benzos give me more depression and irritability, but seem like valium is the easiest to come off of, right?
>
> BrianCertainly
http://www.dr-bob.org/tips/bzd.html
The first one is quoted elsewhere on the net and my layman's sense, sensed it was pretty much on the dot. As they say, your miles may vary.
Longer acting benzodiazepines (Valium here you mention specifically) are easier to come off of, but all if you have become habituated are a long process (I know personally, I am probably somewhat habituated but there is a special evidence-based reason in my case why I have a high dosage. Nonetheless a smaller one is always better.)Some will quote the "Ashton" (its not actually) her site -- I dont want to get into a PBC about it as I find the nonlinearity and oddness of withdrawal methods there not to what I consider complete scientific standards.
But anyhow, yes, if you have become very habituated it is a long process. One thing to remember though, as long as you don't have something rare like end stage liver disease, is that there is always another day, and being among the safest of psychiatric medications, it will still be there tomorrow.
So if you feel you're going too fast, just hold it steady for another day or week. Then start going down. You can practice other tricks like alternating days when you remove a bit and return a bit the next day, as well. That sometimes works too. You'll get there. Just never cold turkey.
And with Valium, you have the luxury, if there is such a word of doing all these tricks because the half life in your body, specifically only unto you, is bound to be some value above 24 hours. The problems people get into is long use of things like Xanax, because it is sometimes taken 4x a day with a half life as little as 4-6 hours in most people. Then there's the nightmare of shaving off quantities of 4 pills. People have to eventually crush entire tablets at the end, dunk them in orange juice or something and drink a specified milliliter, per day. So you're in a much better place to reduce to what you need to.
-- tidings
Jay
Posted by qbsbrown on September 13, 2006, at 23:26:32
In reply to Re: BENZO Preferences? one easier to WD???? » qbsbrown, posted by yxibow on September 13, 2006, at 22:52:56
So basically you're saying if i want off of benzos, and i'm only at 12.5 mgs valium, that im in a pretty good place, and to forget about the burry vision etc? That switching over to ativan would in fact make the situation more difficult. I believe that ativan and xanax bind to the GABA like 4 times more potent than valium.
I would love to hear and understand your arguments against Ashton. I have read her work, and seen some of her cult followings, whom somewhat scare me, and many are pissed at the psychiatric community as a whole.
I did however notice, although she ran a benzo WD clinic for 10 or so years (and considered the forefront expert on benzo WD) there was only an average of about 10-12 patients treated per year, most of whom were severe cases. So that intrigued me.
Also tell me what is more of a scientific approach to WD. 10% weekly every 1-2 weeks?
Thanks Jay,
Brian
Posted by dbc on September 13, 2006, at 23:47:15
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 13, 2006, at 23:26:32
While valium does in theory have the longest half life its not particularly active in comparison to say klonopin though. Valium in true active half life is more comparable to ativan, its about the middle of the road. Back when i had severe SAD/GAD problems i took somewhere around 5mg daily. When i finally decided i didnt need to be sedated all day everyday i moved over to xanax and slowly lowered the dose down to about .5 a day. I prefer xanax now simply due to the potency of the anxiolyic effects and its short half life.
Posted by qbsbrown on September 14, 2006, at 2:06:33
In reply to Re: BENZO Preferences? one easier to WD????, posted by dbc on September 13, 2006, at 23:47:15
That is somewhat what i feel, is that the longer half life benzos (valium, and klonopin), is that i'm sedated all day, and i feel is holding me back personally and personality wise. I'm only affriad of the tolerance issue w/ Ativan, as where i don't really feel it on Valium.
Is it true that with only 75mgs Effexor, you're not really receiving any of the Norepinephrine benefits? This is what my PDOC is saying, that it will only act as an SSRI at 75mgs. This is what Cymbalta was supposed to improve upon, but the verdict is still out, right?
Posted by dbc on September 14, 2006, at 2:51:02
In reply to quick Effexor question, posted by qbsbrown on September 14, 2006, at 2:06:33
Its generally thought that the norepinephrine action doesnt start kicking in untill the 120ish area and you dont start seeing dopamine action untill 300. I never went beyond 150 and im glad of that because withdrawing is a long and crappy process with effexor.
Posted by yxibow on September 15, 2006, at 3:31:29
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 13, 2006, at 23:26:32
> So basically you're saying if i want off of benzos, and i'm only at 12.5 mgs valium, that im in a pretty good place, and to forget about the burry vision etc? That switching over to ativan would in fact make the situation more difficult. I believe that ativan and xanax bind to the GABA like 4 times more potent than valium.
I'm not saying that one should ignore the blurry vision if you're really worried -- as in an opthamologic issue rather than just a side effect one can live with whilst one is reducing medication. If it doesn't interfere with your daily activities, driving, reading, and is not seeming to be degenerative (progressing any more than status quo), then it probably is not a red flag issue. But that is up to your comfortability.
And you're right, you would create two taper scenarios.
I'm not sure about binding, one would have to read things like Stahl and other sources, but if you mean that Xanax is 10 times more potent by equivalency and Ativan is 5 times more potent by milligram equivalency then that is the case.
All benzodiazepines bind to GABA-A, at subreceptors that are responsible for anaesthesia, sedative-hypnotic, anxiolytic, and anti-convulsant. Each has submetabolites, some of which are other benzodiazepines, e.g. Restoril is a smaller non-main metabolite of Valium. Each binds to those subreceptors in varying degrees but they all bind to them to some degree. Versed, a preoperative anaesthetic, binds strongly to the anaesthesia angle, while Halcion, Dalmane, Restoril, and Rohypnol bind to the sedative-hypnotic side more strongly. Dalmane is quite strong on that angle. Clonazepam and Valium bind varyingly to the anxiolytic and anti-convulsant parts more strongly than other benzodiazepines.GABA-B agents, such as baclofen, operate somewhat differently.
>
> I would love to hear and understand your arguments against Ashton. I have read her work, and seen some of her cult followings, whom somewhat scare me, and many are pissed at the psychiatric community as a whole.
I don't know if its about Ashton per se or the person (unrelated to her) who creates that site. I just prefer to stay away from it, and comments that I have posted in the past equating it to both quackery and a dangerous idea to get all people (including those who have evidence based psychiatric need for benzodiazepines) off benzodiazepines have just resulted in "please be civil" issues so I would just leave it there. One can believe what they choose.
> I did however notice, although she ran a benzo WD clinic for 10 or so years (and considered the forefront expert on benzo WD) there was only an average of about 10-12 patients treated per year, most of whom were severe cases. So that intrigued me.
>
> Also tell me what is more of a scientific approach to WD. 10% weekly every 1-2 weeks?
A scientific approach is whatever works for you and your doctor. But yes, 10% weekly every 1-2 weeks sounds rational if you are having moderately bad withdrawal issues, thats about on par what I am doing at the moment as an experimental test against using less medication to cover the same issues with more clarity of mind.
But you are on a much smaller portion than I, so nonlinearity may prove more positive at some point because it could take 30 weeks and tablet sizes that don't exist to come off of 12.5mg of Valium at that calculation. So I'm not completely against nonlinearity, at some point dose reductions become a matter of a placeboid.
>
>
> Thanks Jay,
>
> Brian
Posted by qbsbrown on September 15, 2006, at 10:06:23
In reply to Re: BENZO Preferences? one easier to WD???? » qbsbrown, posted by yxibow on September 15, 2006, at 3:31:29
Actually the Docs want me to hold steady on the benzo, while im going up on effexor, so i guess i'll continuing the taper when i'm ready. I was angry at benzos for a while. I've never had such bad anxiety since beginning them, and blaming them for so many other issues, i could most definatly be wrong (i was listening to the "benzo island" people for a little while, had i followed them, i'd be dead), probably lack of the other neurotransmitters.
To me, ativan does represent being more clean and clear, not so muggy and muffled like valium, so yes it sounds more attractive.
Brian
Posted by qbsbrown on September 15, 2006, at 18:07:05
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 15, 2006, at 10:06:23
I have experienced this with both klonopin and valium. I vaguely remember experiencing interdose withdrawals from klonopin, thus me being affraid to switch from valium to ativan, although remaining on valium doesn't sound like much fun either.
Brian
Posted by yxibow on September 16, 2006, at 0:45:36
In reply to long acting benzos more apt to induce depression??, posted by qbsbrown on September 15, 2006, at 18:07:05
> I have experienced this with both klonopin and valium. I vaguely remember experiencing interdose withdrawals from klonopin, thus me being affraid to switch from valium to ativan, although remaining on valium doesn't sound like much fun either.
>
> BrianI don't know if there are any evidence based studies regarding this. A number of people on here have submitted anectdotal reports of depression from Klonopin. I think it is entirely an individual matter. Benzodiazepines in general can cause depression in those who are already predisposed towards depression in the first place, which means that the minimum effective (MED) dose should be used. Also, there is a difference between physical (respiratory, muscular) and CNS depression (central nervous system).
If benzodiazepines in general are going to depress someone, I dont think their half life has much to play in it other than interdosal withdrawal syndromes. Long term benzodiazepines just mean a longer wait for the compound at large to eliminate from the system.
But in general I think I've heard most depression comments come from Klonopin than any other benzodiazepine, so either there is something different with it or simply since when something is wrong people tend to complain more and doctors tend to prescribe Klonopin more in the US.
Go figure, there isn't a lot of difference, one is 16+ hours and usually requires twice daily dosing and Valium is 24+ hours and usually doesn't require (but doesnt hurt) twice daily dosing. Valium is shunned more here as well as Xanax because of their street value. Klonopin doesn't particularly have an immediacy feeling to it except for the most benzodiazepine naive and therefore is less likely to be diverted.But in some other country one might be more diverted than another. There's no actual rational patient directed reason why Valium can't be prescribed over Klonopin.
Posted by qbsbrown on September 16, 2006, at 4:07:55
In reply to Re: long acting benzos more apt to induce depressi » qbsbrown, posted by yxibow on September 16, 2006, at 0:45:36
For some odd obsessional reason i've been calling local pharamacists, to get their take on diazepam vs ativan. Most of them think that Ativan is easier to get off of, and that the long half life of diaz is a big setback for long time use, unless there's suregery involved.
Someone please help me figure out this dichotomoy of american VS western european psychiatry. Is it just flavor of the month? I'm sure i'd get 4 different benzos coming out of seeing 4 different PDOCS in the states.
Brian
Posted by ed_uk on September 16, 2006, at 9:50:47
In reply to well Jay, tell me about Ativan VS the others,,,..., posted by qbsbrown on September 16, 2006, at 4:07:55
Hi
I wouldn't listen to American pharmacists, I doubt they know much about Valium. Ativan is significantly more difficult to taper off than Valium.
Ed
Posted by qbsbrown on September 16, 2006, at 14:19:35
In reply to Re: well Jay, tell me about Ativan VS the others,,,... » qbsbrown, posted by ed_uk on September 16, 2006, at 9:50:47
Well, i could always try ativan, and see if i like it better than klonopin/valium, and i can always switch back to valium when i am ready for the taper, right?
Brian
Posted by yxibow on September 16, 2006, at 15:22:53
In reply to Re: well Jay, tell me about Ativan VS the others,,,..., posted by qbsbrown on September 16, 2006, at 14:19:35
> Well, i could always try ativan, and see if i like it better than klonopin/valium, and i can always switch back to valium when i am ready for the taper, right?
>
> BrianAtivan vs Valium? Ativan is one of those benzodiazepines frequently given (or used to be anyhow) in psych hospitals to calm a patient, but its not meant for long term use, its half hour is as little as 8 hours. I only use it for short term use, and in fact my main short term benzodiazepine is really Xanax.
Both Xanax and Ativan would be harder to taper off than Valium which has both a full days' coverage and less of an "immediacy" and "gratification" effect in repeated use than either of the aforementioned.
Posted by qbsbrown on September 16, 2006, at 15:28:15
In reply to Re: well Jay, tell me about Ativan VS the others,, » qbsbrown, posted by yxibow on September 16, 2006, at 15:22:53
I'll humor my family doc here and give it a months try (Ativan). If it's not working, or if im ready to wean, i'll switch back over to valium.
Regards,
Brian
Posted by yxibow on September 16, 2006, at 19:13:30
In reply to Re: well Jay, tell me about Ativan VS the others,,, posted by qbsbrown on September 16, 2006, at 15:28:15
> I'll humor my family doc here and give it a months try (Ativan). If it's not working, or if im ready to wean, i'll switch back over to valium.
>
> Regards,
>
> BrianYou can try -- I'm not your family doc and its his license or the like (I forget if you came back to the US yet or not), but be forewarned that you may feel necessary to take it up to 3x a day. If you're "not ready to wean" then go ahead -- I wasn't really sure whether you were trying to remove benzodiazepines from your system or find a better one.
To health
-- Jay
Posted by qbsbrown on September 16, 2006, at 19:15:48
In reply to Re: well Jay, tell me about Ativan VS the others,, » qbsbrown, posted by yxibow on September 16, 2006, at 19:13:30
I was trying to come off and down, but i just switched to effexor, so i need to put that plan on hold until i get stable on it.
I can always switch back over to valium when i am ready to wean again, right?
Brian
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