![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 16 to 40 of 131. Go back in thread:
Posted by Phillipa on August 7, 2007, at 21:30:48
In reply to Re: beta carbolines to reverse benzo cognitive pro » FredPotter, posted by Quintal on August 7, 2007, at 0:48:13
Quintal you know my pdoc has never heard of Heather Ashton and has published papers for Jama on addiction. Interesting as she also changed my valium to xanax today along with the luvox to continue. I had a bunch of suggestions none of which she liked. Love Phillipa
Posted by Quintal on August 7, 2007, at 22:42:25
In reply to Re: beta carbolines to reverse benzo cognitive pro » Quintal, posted by Phillipa on August 7, 2007, at 21:30:48
Are you happy with switching to Xanax? Hmmm.... well that might explain why she's so happy with prescribing benzos :o) Heather Ashton's work is the most thorough research I know of in the area of benzodiazepine dependence and withdrawal, so it's surprising/worrying that an addiction specialist has never heard of it. What else is she unaware of? Maybe it's because American doctors dislike the conclusions Ashton reaches? Still, that's a poor reason for excluding it. Even Dr. Bob's benzodiazepine equivalence chart contains no mention of Ashton's work. It's a shame because the tables he uses instead are of poor quality and contain serious (and blindingly obvious) inaccuracies. Unfortunately that seems to be the standard of American research on benzodiazepines in my experience.
What dose of Xanax did she give you?
Q
Posted by Phillipa on August 7, 2007, at 23:38:44
In reply to Re: beta carbolines to reverse benzo cognitive pro » Phillipa, posted by Quintal on August 7, 2007, at 22:42:25
Quintal lower than the pdoc up here only a total of 2mg a day. But I still find it interesting that codeine is over the counter in England and you can take much as you want without even a script. Hummmmm to that one too. She used to be on google Judith Yongue. Can't remember middle initial, And you must have read about your pic on social you really are a good looking guy. Love Phillipa
Posted by Quintal on August 7, 2007, at 23:46:36
In reply to Re: beta carbolines to reverse benzo cognitive pro » Quintal, posted by Phillipa on August 7, 2007, at 23:38:44
How much Valium were you taking before? No, you can't take as much codeine as you want. As with other countries where codeine is OTC, it has to be mixed with paracetamol, ibuprofen or aspirin to people raising the dose indefinitely. There are some pure codeine products available but very few pharmacists would be willing to dispense them to anyone that came asking, for obvious reasons.
I see she's an older doctor - graduated 45 years ago. Maybe she just can't be bothered to keep up to date with modern research any more?
Q
Posted by Phillipa on August 7, 2007, at 23:54:43
In reply to Re: beta carbolines to reverse benzo cognitive pro » Phillipa, posted by Quintal on August 7, 2007, at 23:46:36
Quintal she's still there I'll have to look. And she has Emsam so she's very up to date. Just 20mg is all. I can go from one to another they don't bother me as have done it many times before. And I know the luvox makes the valium stronger we talked about that and that's the reason she said a higher dose of luvox now too. And some codeine is better than none. Love Phillipa ps she has patients on nardil and parnate too
Posted by Quintal on August 8, 2007, at 0:13:13
In reply to Re: beta carbolines to reverse benzo cognitive pro » Quintal, posted by Phillipa on August 7, 2007, at 23:54:43
So would she be willing to give you Nardil if the Luvox doesn't work out? That's probably the one drug that would help you the most.
Q
Posted by Phillipa on August 8, 2007, at 0:17:14
In reply to Re: beta carbolines to reverse benzo cognitive pro » Phillipa, posted by Quintal on August 8, 2007, at 0:13:13
Quintal I don't want nardil and would never take it. Maybe still the EMSAM as I just figured out it's the only ad with no weight gain as it doesn't go through the digestive tract. Liver yes stomach no. Posted a thread at the bottom of the board. Love Phillipa bed time now
Posted by Quintal on August 8, 2007, at 4:49:25
In reply to Re: beta carbolines to reverse benzo cognitive pro » Quintal, posted by Phillipa on August 8, 2007, at 0:17:14
Yeah, that's what I thought from the beginning. So are you going to ask for EMSAM if Luvox doesn't work out? I suppose it means taking the risk of it making you better.
Q
Posted by Quintal on August 8, 2007, at 4:50:25
In reply to Re: beta carbolines to reverse benzo cognitive pro » Quintal, posted by Phillipa on August 8, 2007, at 0:17:14
Posted by LlurpsieNoodle on August 8, 2007, at 6:32:15
In reply to Re: beta carbolines to reverse benzo cognitive pro » Quintal, posted by Phillipa on August 8, 2007, at 0:17:14
> Quintal I don't want nardil and would never take it. Maybe still the EMSAM as I just figured out it's the only ad with no weight gain as it doesn't go through the digestive tract. Liver yes stomach no. Posted a thread at the bottom of the board. Love Phillipa bed time now
Phillipa, I thought you already tried emsam? maybe I'm mistaken, but if you did, what made you change your mind?
btw, there are lots of antidepressants that are weight neutral. the one I'm on (zoloft) shows slight weight loss initially (no wonder, my tummy hurts) but chronic use some moderate weight gain. I don't think that this is something that you can't manage with diet and exercise. And remember that studies show that the more exercise you get (I know about your bike riding- maybe add some weight lifting too?) you need a smaller dose of SSRI.
I hope the xanax works for you. Take as directed.
-Ll
Posted by linkadge on August 8, 2007, at 11:02:55
In reply to Re: beta carbolines to reverse benzo cognitive pro » LlurpsieNoodle, posted by Quintal on August 6, 2007, at 20:09:08
Actually, there is some evidence that low dose lorazepam (ie 0.25mg twice per day) improves a number of aspects of cognative functioning.
There was an article, I will look for it. It suggested that a number of spacial tasks could be improved with a low dose of lorazepam. A second study confirmed the findings.
They hypothesized it was related to CCK or something.
Linkadge
Posted by linkadge on August 8, 2007, at 11:08:50
In reply to Re: beta carbolines to reverse benzo cognitive pro » Phillipa, posted by LlurpsieNoodle on August 8, 2007, at 6:32:15
My main reasoning was this. The beta carbolines have a short half life. Probably shorter than the shortest acting benzo (I would need to double check that claim). Anyhow, say you needed to concentrate just for an hour, but you just took a long acting benzo recently. Have a cup of coffee?
Not to get into the whole upper + downer thing, but I just wonder.
Linkadge
Posted by Quintal on August 8, 2007, at 13:04:45
In reply to Re: beta carbolines to reverse benzo cognitive pro » Quintal, posted by linkadge on August 8, 2007, at 11:02:55
I think I've read similar studies link, but the people here aren't taking small doses of benzos. It's really great you pick up on all these esoteric studies/mechanisms but you also need to consider their relevance. I don't think I've ever read of anyone taking such a small dose of lorazepam for anxiety. When I got my first script for Ativan I was surprised to learn that the dose used to induce post-surgical amnesia was actually *less* than the therapeutic dose I was prescribed for anxiety.
I find the results of this study interesting, particularly the results of the opiate group:
__________________________________________________A six year study on 51 vietnam veterans, who were drug abusers of either, mainly stimulants (11 people), mainly opiates (26 people) or mainly benzodiazepines (14 people), was carried out to assess psychiatric symptoms related to the specific drugs of abuse. At 6 year follow up, opiate abusers had little change in psychiatric symptomatology, 5 of the stimulant users had developed psychosis and 8 of the benzodiazepine users had developed depression. Therefore long term benzodiazepine abuse and dependence seems to carry a negative effect on mental health with a significant risk of causing depression.
http://en.wikipedia.org/wiki/Benzodiazapene
__________________________________________________Shame doctors don't use bupe or codeine more often for anxiety.
Q
Posted by Quintal on August 8, 2007, at 13:19:51
In reply to Re: beta carbolines to reverse benzo cognitive pro, posted by linkadge on August 8, 2007, at 11:08:50
>My main reasoning was this. The beta carbolines have a short half life. Probably shorter than the shortest acting benzo (I would need to double check that claim). Anyhow, say you needed to concentrate just for an hour, but you just took a long acting benzo recently. Have a cup of coffee?
Yes that is very true link, and I agree with your reasoning. I hadn't looked up the half-life of beta carbolines. I'm curious if they can cause benzo withdrawal symptoms in large doses? I can't say I noticed any when I was combining them with coffee. Maybe they antagonize different subsets of benzodiazepine receptors to flumazenil? Do you have a link to the study?
Q
Posted by FredPotter on August 8, 2007, at 15:34:47
In reply to Re: beta carbolines to reverse benzo cognitive pro, posted by linkadge on August 8, 2007, at 11:08:50
I take Nardil and Xanax. Every morining I now get up at 5:30 and write music until work at 8:00. I then do a whole day of statistics and then come home and write music again until 11:00. I can also reverse my car into small spaces. I wouldn't say I'm at all cognitively affected except for the thought blocking I mentioned and I had that long before any of these drugs
Posted by FredPotter on August 8, 2007, at 15:38:17
In reply to Re: beta carbolines to reverse benzo cognitive pro » linkadge, posted by Quintal on August 8, 2007, at 13:04:45
This is a flawed study because presumably the abusers were not allotted their drug of abuse at random. It's highly likely that the benzo "abusers" were actually "users" medicating for anxiety and depression in the first place
Posted by Quintal on August 8, 2007, at 15:58:10
In reply to Re: beta carbolines to reverse benzo cognitive pro » Quintal, posted by FredPotter on August 8, 2007, at 15:38:17
I've remarked to friends in private that I've noticed a sharp decline in the cognitive function of Nardil users - that's why I don't want to take it myself despite the relief it might bring.
How can you say that the study was flawed based on a presumption? There's a clear decline in the mental health of the benzodiazepine users, but not for the opiate users. If the people in that study were being prescribed benzos for mental illness as you claim then that's pretty good evidence that they are ineffective for that purpose, and even harmful to mental health when taken long-term. I'd say this study reflects real life more accurately than one based on artificial randomly-assigned drug choices. Since opiates are also excellent anxiolytics (before tolerance sets in of course - just like benzos) I'd say they're superior to benzos in this regard. Thanks for the babblemail.
Q
Posted by Quintal on August 8, 2007, at 17:11:02
In reply to Re: beta carbolines to reverse benzo cognitive pro » Quintal, posted by FredPotter on August 8, 2007, at 15:38:17
Look, before any more animosity and retalliation wells up I'd like to point out what I'm saying here. Sure, the benzos have relieved many people for intolerable suffering and even saved lives. I'm grateful that they exist. But they're no panacea and they have cause much suffering to the people who became involuntarily addicted to them, and they've also claimed lives in the form of suicide resulting from benzo-induced depression.
The SSRIs are pretty much a crap shoot as a monotherapy for all but the mildest conditions, as most of us here know. Don't we all want safer, more effective anxiolytics? I'm thinking, for example, of the synthetic flavonoid 6,3'-dinitroflavone that's said to have fewer adverse effects on learning and memory than classical benzos. That's only the tip of the iceberg and there's much potential for further development of drugs like this, but I can't see any of them being approved in the near future can you? Even though they're the most effective anxiolytics we have right now, I still think we have to see the benzos for what they really are and what they do.
Yes, remedies like beta carbolines might be helpful for reversing some of the side effects, but it's odd that we have a thread of people approving of a remedy for a problem they deny exists. Benzos couldn't be used effectively in a medical setting unless they caused consistent sedative and amnesic effects, and they certainly do. If equally effective anxiolytics were available that did not cause cognitive impairment and amnesia I'm pretty sure we'd all jump at the chance to take them, and consign the benzos to retirement in operating theaters and dentists chairs.
Q
Posted by FredPotter on August 8, 2007, at 19:02:10
In reply to Re: beta carbolines to reverse benzo cognitive pro » FredPotter, posted by Quintal on August 8, 2007, at 15:58:10
I have to presume because they don't say, or you don't say. From prior expectations the benzo group would be likely taking them for a mental condition, whereas opiate takers are probably taking it for physical pain or for fun, meaning they're probably mentally healthy. It is perfectly OK (and vaguely Bayesian) to take prior expectations into account. Look at it this way - the abusers had to be "abusing" at the start of the experiment since you can't turn anyone into an abuser merely by making them take a drug. We know opiates aren't dished out very freely for mental conditions. All this means that the mental health at the start of the trial was unevenly distributed among the groups.
Far more likely is a hidden agenda to demonise benzos when for millions of people they are the only thing that works. And all because of some ill-defined psychobabbly thing called "cognitive blunting" or "cognitive" something. I personally wish the word cognitive had never been invented. Anxiety and panic disorder are emergencies. Those who suffer should never be put off by these scare tactics. And certainly not by the flawed study mentioned. Yes benzos don't work well in the long term and aren't really affective against depression
Fred
Posted by FredPotter on August 8, 2007, at 19:14:41
In reply to Re: beta carbolines to reverse benzo cognitive pro, posted by Quintal on August 8, 2007, at 17:11:02
Thanks for the information. I discover
6,3'-dinitroflavone has a benzodiazepine partial agonist profile
which doesn't sound too promising. And only on rats so far
Posted by Quintal on August 8, 2007, at 20:22:58
In reply to Re: beta carbolines to reverse benzo cognitive pro » Quintal, posted by FredPotter on August 8, 2007, at 19:02:10
Well here is the abstract of the study. All of your assumptions (and the conclusions you derived from them) seem to have been wrong Fred; note "Initial psychiatric examinations showed low symptom levels in all groups but no statistically significant differences among them." And: "but our data suggest that abuse of particular drugs has a major role in the development of specific psychiatric illnesses." Meaning that the benzodiazepines actually caused depression in previously healthy persons. The opiates did not.
____________________________________________________1: N Engl J Med. 1979 Dec 13;301(24):1310-4.Links
Development of psychiatric illness in drug abusers. Possible role of drug preference.
Mc Lellan AT, Woody GE, O'Brien CP.The origin of the psychiatric illnesses observed in drug abusers is often unclear. This study examines the causal relation between drug abuse and specific psychiatric disorders. Fifty-one male veterans first seen in 1972, who were admitted at least once per year for six consecutive years for inpatient drug-abuse treatment, underwent psychiatric assessments at each admission. Eleven men mainly used stimulants, 14 depressants, and 26 opiates. Initial psychiatric examinations showed low symptom levels in all groups but no statistically significant differences among them. By the end of six years, five of the stimulant users had psychoses, and eight of the depressant users had serious depression. The narcotics users showed no change in psychopathology. Differences between the groups were significant at the 0.01 level. These changes were not due to acute toxic reactions, but our data suggest that abuse of particular drugs has a major role in the development of specific psychiatric illnesses. The possibility that different preexisting personality disorders lead to different kinds of drug abuse cannot be excluded.
PMID: 41182 [PubMed - indexed for MEDLINE]
__________________________________________________>6,3'-dinitroflavone has a partial agonist profile.
Yes Fred I know.
>which doesn't sound too promising.
On the contrary. That's probably why it lacks the amnesiant and cognitive blunting effects of the classical full agonists
>And only on rats so far
As with all research chemicals (including benzodiazepines) at that stage of testing. I'm not sure if these flavonoids can actually be patented, probably not. If so we never never see it tested on humans.
Q
Posted by Phillipa on August 8, 2007, at 21:05:24
In reply to Re: beta carbolines to reverse benzo cognitive pro » FredPotter, posted by Quintal on August 8, 2007, at 15:58:10
Quintal explain then why after l6 years of benzo use I went back to school nursing and graduated magna cum laude, clepped my Englishes, and won all the awards enabling me to do my second year of school free. All based on awards. And then was always charge nurse. And the only RN allowed to float to ICU, CCU, and ER along with all the other specialties and first out at night as I was so efficient. Only made one mistake in whole career and that was when my thyroid went and I never went back and the mistake was only bringing the narcotic keys home and brought them right back. And was in charge of all groups, meds, and admissions that night. Typical night for me. Oh I also drank beer with my xanax blessings of my pdoc. And I decided to stick with the low dose luvox today and the valium as it is gone the next day. Guess I must be a fast metabolizer. Love Phillipa
Posted by linkadge on August 9, 2007, at 8:34:21
In reply to Re: beta carbolines to reverse benzo cognitive pro » linkadge, posted by Quintal on August 8, 2007, at 13:04:45
Possably. Or perhaps a depressive neurotic would be more prone to tend towards a drug that would kill anxiety?
I know long term use can cause depression in some people though.
On another note, 0.25mg twice a day is small but not that small.
It is enough to have an antianxiety effect.
Linkadge
Posted by linkadge on August 9, 2007, at 8:42:19
In reply to Re: beta carbolines to reverse benzo cognitive pro » FredPotter, posted by Quintal on August 8, 2007, at 15:58:10
I'd have to see more than one study suggesting that long term benzo use causes depression, and that it wasn't associated with something like a nutrient deficiancy, and that it wasn't reversable upon withdrawl.
As for the Nardil comment, I think it is the way the drug affects sleep cycles not the drug itself. Any drug which dramatically reduced REM sleep in such a way would be sure to have an effect on learning and memory.
Anyhow, its also worth questioning if benzos are just creating temprorary depression or long term depression after the drug is withdrawn. The former is not a big deal.
Also it would be worth studying which benzos were supposed to have lead to depression, because depressive reactions are not always a class effect.
Linkadge
Posted by linkadge on August 9, 2007, at 9:00:13
In reply to Re: beta carbolines to reverse benzo cognitive pro, posted by Quintal on August 8, 2007, at 17:11:02
>But they're no panacea and they have cause much >suffering to the people who became involuntarily >addicted to them, and they've also claimed lives >in the form of suicide resulting from benzo->induced depression.
Depression and suicide are two entirely different things. According to the most recent studies, a suicide victom shows very specific abnormalties aside from the average depressed person. I don't think it is fair to say that a drug that induces depression is completely responsable for a suicide.
>The SSRIs are pretty much a crap shoot as a >monotherapy for all but the mildest conditions, >as most of us here know.
While the SSRI's don't work for everybody, I don't think there is any solid data to suggest that severe depression responds significantly more poorly to SSRIs than to other drugs. Sure, TCA's and MAOI's can sometimes help resistant patients, but there need not be a correlation between depresison sevarity and treatment resisance. There are plenty of severe depressions that have responded to current treatments including SSRI's.
>Don't we all want safer, more effective >anxiolytics? I'm thinking, for example, of the >synthetic flavonoid 6,3'-dinitroflavone that's >said to have fewer adverse effects on learning >and memory than classical benzos.
Yes, but just because it is natural doesn't mean it can't have bad side effects of its own. I had a hell of a withdrawl from valerian. Valerian withdrawl can actually cause cardiac failure. While I prefer chamomile, I can get depressed if I drink too much, and I also have withdrawl if I stop it abruptly. Only time would verify if this flavanoid is truly as devoid of cognative symptoms as is stated.
>Yes, remedies like beta carbolines might be >helpful for reversing some of the side effects, >but it's odd that we have a thread of people >approving of a remedy for a problem they deny >exists.
People have the right to deny it exists, because it honestly may not. It is totally state dependant. Just like there are those of us (God bless their hearts) who don't get SSRI sexual dysfunction. The brain is a mystery, its not possable to say that one drug will affect a person the same way as another.
For instance, a person who is high in estrogen, which desensitizes GABA-A, may have much less effect of a standard dose of valium than somebody who has high progesterone (sensitizes GABA-A).
With the right dose, and the right amount of receptor activation, side effects might be greatly diminished.
>Benzos couldn't be used effectively in a medical >setting unless they caused consistent sedative >and amnesic effects, and they certainly do.Well, seing as they are not approved for inducing amnesia, I can totally see why they could be effective without causing amnesia. You are saying that you read people's minds based on a few studies and some personal experience. The highest concentration of benzodiazapine receptors is in the amydala. For a person who's cognition is hampered by an overactive amydala, who knows how the cognition might actually improve when the amydala is tamed down. Its just like how Dilantin is used as a nootropic. For some people, it apparently improves cognition.
>If equally effective anxiolytics were available >that did not cause cognitive impairment and >amnesia I'm pretty sure we'd all jump at the >chance to take them, and consign the benzos to >retirement in operating theaters and dentists >chairs.
I hope better drugs are developed too.
Linakdge
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.