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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by qbsbrown on June 5, 2009, at 9:36:47
I've done fine on the brand name, but am taking Mylan, and it's basically a placebo, sugar pill sincce day one. It makes me physically i'll.
My sleep is terrible, i've developed food sensitivities etc, heart palpitations, things I've never experienced on the brand name.
But I am working on a taper, and i'm sure many of these things are common to arise.
Posted by Phillipa on June 5, 2009, at 10:52:27
In reply to What's your favorite version of generic Valium?, posted by qbsbrown on June 5, 2009, at 9:36:47
I also take mylan. Always have since years ago. Seems since have taken so long keep needing less and less doesn't work for anxiety just makes me tired. Dose now l0mg at night. But after 40 of various benzos figured this was normal. Phillipa
Posted by yxibow on June 5, 2009, at 14:49:15
In reply to What's your favorite version of generic Valium?, posted by qbsbrown on June 5, 2009, at 9:36:47
> I've done fine on the brand name, but am taking Mylan, and it's basically a placebo, sugar pill sincce day one. It makes me physically i'll.
>
> My sleep is terrible, i've developed food sensitivities etc, heart palpitations, things I've never experienced on the brand name.
>
> But I am working on a taper, and i'm sure many of these things are common to arise.Its the taper.
I can't see how even if you had 80% of the Valium you had before it would be a "sugar pill". I take the Mylan version. Watson used to be the one standard at the pharmacy.
I had to increase it because I believe it is helping with some breakthrough symptoms (I no longer 'feel' Valium, its subtle anyhow and I'm partially habituated) -- but not because of the generic difference, which had been changed long enough for the plasma level to easily adjust.
There has been a lot of discussion of what's your generic X, and without discounting a possibility of some differences for some, I think there is a lot of suggestibility, placebo effects, and causality not being causation.
Personally I can't even believe any major pharmacy (or minor, they have even worse cost issues) would be dispensing the "real" Valium which came out in what, 1961 or so...
There are cases where companies held on to their original and there were no generic probably because of supply and demand.
My particular choice in anticholinergics, Akineton, never had a generic since its manufacture sometime probably around the 1970s.
And it was discontinued, and since there was no generic, one less for Parkinson's patients and pseudoparkinsonism and other side effects of other medications.
-- Jay
Posted by qbsbrown on June 5, 2009, at 17:42:00
In reply to Re: What's your favorite version of generic Valium? » qbsbrown, posted by yxibow on June 5, 2009, at 14:49:15
Thanks Jay.
And it seems to be the consensus that valium is the best to taper with. I've had multiple docs suggest that.
Sometimes i consider doing a taper with klonopin, cause i can actually feel it and get some effect.
But that said, klonopin gives me bad depression/irritabiilty, interdose WD, tolerance withdrawals etc, just makes me a nasty person, lol.
Well wish me luck on my last benzo taper, it's been a long time comin.
Posted by bleauberry on June 5, 2009, at 18:55:13
In reply to What's your favorite version of generic Valium?, posted by qbsbrown on June 5, 2009, at 9:36:47
Well, I know enough about how my doctor operates, and I view him as a genius detective, that I can say with some certainty this is what he would have you do if you were his patient:
1. Switch back to brand and return to the last dose you were on during your taper. Stay there and see what happens.
2. Don't make another move until you see what happens from #1 above. Whatever happens, that is your evidence to decide what your next move is.
In other words, don't guess and don't wonder. Let it tell you the story the way it is.
You have unacceptable symptoms right now. Granted, you are in a taper. But the level of discomfort is not only uncomfortable but unhealthy as well. It is putting you at risk of worsening the underlying disease and creating new ones. The taper needs to be more friendly.There are two variables involved. One, the size of the dose. Two, the maker of the drug. Return to the previous dose and the previous maker to eliminate those variables. Then, you can continue your taper. Along the journey, you will discover clearly without any guessing whether the symptoms are from the drug maker or a taper that is too fast.
Never introduce more than one variable at a time.
Posted by yxibow on June 6, 2009, at 0:25:08
In reply to Re: What's your favorite version of generic Valium?, posted by bleauberry on June 5, 2009, at 18:55:13
> Never introduce more than one variable at a time.Completely agree.
It is said in medicine, if it can be isolated, that the last thing done is a likely culprit
-- Jay
Posted by rollingthunder on June 6, 2009, at 22:15:41
In reply to Re: What's your favorite version of generic Valium? » bleauberry, posted by yxibow on June 6, 2009, at 0:25:08
My Pdoc said that heroin users have told him that certain benzos are harder to get off of than heroin.
Posted by yxibow on June 7, 2009, at 3:17:02
In reply to Re: What's your favorite version of generic Valium?, posted by rollingthunder on June 6, 2009, at 22:15:41
> My Pdoc said that heroin users have told him that certain benzos are harder to get off of than heroin.
All benzodiazepines in the end with mapped out equivalencies (http://www.dr-bob.org/tips/bzd.html, chart #1) share the same similar properties as the first one created in the lab more than 50 years ago, chlordiazepoxide, Librium.
They share four subtransmitter properties -- sedative, hypnotic, anxiolytic and anticonvulsant.
All benzodiazepines exhibit these properties -- it is just some have more affinity -- e.g. midazolam (Versed) has sedative affinity, clonazepam (Klonopin) has anticonvulsant affinity, temazepam (Restoril) has hypnotic affinity, and Xanax has anxiolytic affinity...
...that is more than other ones in this class.
There are additional GABA subreceptors which get more complex, such as those that are targeted by pseudobenzodiazepines such as zolpidem (Ambien).
Well, I don't know about the chronic heroin user who is more than just physiologically addicted, but is also psychologically addicted, that is the key to getting off it (if you want to, and is certainly a good idea considering needles, a life that is in shambles. etc).
Yes, intense heroin withdrawal (a la Trainspotting), basically is a week or so of absolute and complete hell, psychosis, dysphoria, and beyond the pale diarrhea.......(opiates are anti-diarrhea medications, such as the OTC loperamide (Imodium), which basically does not cross the blood-brain barrier probably >99%, and the prescribed Lomotil (diphenoxylate/atropine)....
...and when withdrawn, -some- will cause reverse arrest of diarrhea.
As for benzodiazepines, it is entirely (well heroin too I imagine) dependent on the person, their biochemical makeup, etc.There are still people who are on Librium or Valium since the 1960s and are not particularly habituated.
However, this is probably not the norm -- I am partially habituated but caught in a catch 22 where I still need to take Valium because it helps with my symptoms but I cant "feel it". Going off of it or the Seroquel would put me at risk of relapsing into a bad area...
...this is a double catch 22 because I wish I could "zero out" and start over again.... but that is a story for me, not part of this discussion and it would take months of possible psychosis, etc...
....Xanax does basically nothing for me, and Ambien or Lunesta is not usable at sub dangerous doses.
So with that all said... I became semi-habituated after about four years. But my load of Valium was large, for a specific reason, from specific literature. It is now a bit more than half of what I used to take.
The drug that is hardest to get off than heroin though is nicotine (cigarettes, etc.) And that's not just a repetition of mantras, it is pretty true. A small number of people can smoke for a few months and never do it again.Large numbers of people though go through years of attempting to quit, patches, psychological interventions, etc.
There are people who can't quit smoking when they are at the point of having a tracheotomy and smoke through it with emphysema, cancer, etc, to be graphic.
But yes, the saying that one should be on one no longer than four weeks probably holds some water, but sometimes say, klonopin is the only agent that helps someone with social anxiety disorder get out of the house.It would be better to transfer to an SSRI such as Paxil or other agent but sometimes that doesnt work.
There really is no good answer, in summary as to how long until habituation. It just is something that unfortunately comes from knowing that your benzodiazepine doesn't appear to give you a "buzz", say, any more after taking it, for example.
I would say though that the use of short half life benzodiazepines for long term use is not the best idea and could lead to more issues, such as Xanax and Ativan. They lend themselves to PRN (as needed) use, more.
There are definitely more dangerous benzodiazepines, not because of publicity, but because of the possibility of mixing with other medications, and these are typically the ones stronger on hypnosis -- such as flunitrazepam (Rohypnol, still available in some parts of the world), triazolam (Halcion), and a few others.And yes, some are harder to get off of, but typically, the procedures to remove them are similar... I'm not going to into the controversial, alternative, and not mentioned in the psychiatric community particularly, the "Ashton Methodd"....
... the basic evidence based psychiatric method is about 10% reduction per week, more or less if it can be managed, until it is discontinued.
The thing is -- the benzodiazepine will always be there, and it is, when payed attention to properly, one of the least.... can't find the word... adverse medications in psychiatry.
So since it is already there, there's no shame in taking enough time so one isn't losing so much functionality of reducing or eliminating it. But also there's no need of following someone's regimen -- it should be up to the patient; after all they are the ones with the withdrawal effects.
So that is a very long answer to your comment.
-- tidingsJay
Posted by manic666 on June 7, 2009, at 12:04:12
In reply to Re: Benzodiazepine, Heroin, and Nicotine reduction » rollingthunder, posted by yxibow on June 7, 2009, at 3:17:02
you are on target with the benzo,s Jay, i dont get nothing much from the 4mg of ativan, i told the pharmcy to stop giving loz an stick to ativan its a in a the mind thing, you no they are both the same but i dont like taking white meds , silly i no but in my head white is paracetemol. an blue is cool,if i take a loz now i discount any effect.the 4mg ativan are my life line they do nothing but the minimum , but the nightmare of shedding the 6 that time wont go away ,an i carnt do it again , whats the point , i would need them again at sometime. ATIAN IS THE DADDY OF BENZOS , AN IF I NEW I COULD TAKE 20MG A DAY FOR LIFE WITHOUT ANYTHING ELSE AN NO RAISE ON THE DOSE/////////BRING IT ON
Posted by manic666 on June 7, 2009, at 12:06:36
In reply to Re: Benzodiazepine JAY, posted by manic666 on June 7, 2009, at 12:04:12
O SH*T I MISSED THE V IN ATIVAN.
Posted by Phillipa on June 7, 2009, at 20:04:00
In reply to Re: What's your favorite version of generic Valium?, posted by rollingthunder on June 6, 2009, at 22:15:41
Jay that was an absolutely incredibly well written post. Thanks. Your knowledge is awesome. Love Phillipa
Posted by Brainbeard on June 16, 2009, at 9:10:26
In reply to Re: Benzodiazepine, Heroin, and Nicotine reduction » rollingthunder, posted by yxibow on June 7, 2009, at 3:17:02
Theodore Dalrymple (aka Anthony Daniels) has written critically of the myths surrounding opiate withdrawal. As a doctor, he claims that the opiate withdrawal syndrome PHYSICALLY is like a bad case of the flu at worst, although it might SUBJECTIVELY and PSYCHOLOGICALLY (EXCUSE the capitals) be a nightmare.
As a contrast, sudden benzo withdrawal could literally kill you, just as sudden alcohol withdrawal could. It seems to be a medical fact that opiate withdrawal couldn't possibly kill anyone. The man has a point: that IS a significant difference.
Nicotine withdrawal is a similar story. Physically, it only takes three weeks, of which the first three days are worst. Psychologically, it takes a lifetime. Although admittedly there is a physical component: the brain tends to never forget those shortlived nicotine highs (or any other high, for that matter).
Anyway, I'm one of those people who smokes every now and then. On average not more than a cigarette a week. I have been a heavy smoker and I just wouldn't wanna go back. Mind over matter? It might not be as hard as some people think.
There have been experiments in which heroin junkies were taken off the drug and on exotic vacations, and guess what? They hardly even missed their heroin. That would never work with benzo addicts.
This is the end of the thread.
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