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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 28. Go back in thread:
Posted by torrid on October 8, 2011, at 20:55:09
In reply to Re: what meds are just as effective as benzo's, posted by jono_in_adelaide on October 8, 2011, at 18:01:10
It's an antihistamine, I use it for sleep and anxiety
Posted by Chairman_MAO on October 8, 2011, at 23:26:12
In reply to what meds are just as effective as benzo's, posted by rjlockhart04-08 on October 8, 2011, at 17:55:02
For as-needed use, they are innocuous drugs. For long-term use, the physicial dependence is _serious_ and coming off of them can be a _nightmare_, especially if you do not have a doctor willing to do a proper taper method ("Ashton Protocol").
Tolerance generally develops to the anxiolytic effect, but not complete tolerance. I'd go for an MAOI for chronic anxiety over a benzo. Let me say this again: the physiological dependency is a _big issue_.
And so, if you want it for as needed use, ask your doctor what the problem is. If you want it for long-term use around-the-clock, then I suggest using them only as a last resort--unless you plan on taking them for the rest of your life and are willing to take the chance that one day you might end up on a high dose and it _still_ won't be working the way you want it to.
Posted by jono_in_adelaide on October 9, 2011, at 4:52:01
In reply to Re: what meds are just as effective as benzo's » rjlockhart04-08, posted by Chairman_MAO on October 8, 2011, at 23:26:12
Realy, the only substitute for a benzo is another benzo.
There are studies that show alprazolam has logn term (8 plus) months efficiacy in panic disorder, so tolorance cant be compelte.
There was a logn term stuudy of nitrazepam in the BMJ in tthe mid 70's that showed it continued to improve sleep over a six month period, again indicating thaat tolotance isnt total.
I think that it is more of an issue for those with addictive personalities - thye are the ones who will end up taking 20 Valium a day and still wanting more...... most people will hapily take their 5mg tid for years, although they migght be dependant.
Posted by Chairman_MAO on October 9, 2011, at 8:17:57
In reply to Re: what meds are just as effective as benzo's, posted by jono_in_adelaide on October 9, 2011, at 4:52:01
Tolerance is not complete--you are correct--but there is tolerance.
FWIW, 2mg lorazepam qhs worked indefinitely for me as a sleep aid for a few years on end.
There can be a change in the effectiveness of the drug in some people _years_ down the line.
I happily take my 4mg clonazepam daily, but it's been about 5 months and it is nowhere near as good as phenelzine was for anxiety/phobia after 5 months of phenelzine. It could remain this effective indefinitely, or 15 years from now I might notice that all of a sudden it does nothing.
Posted by Emme-V2 on October 9, 2011, at 8:39:56
In reply to Re: what meds are just as effective as benzo's » jono_in_adelaide, posted by Chairman_MAO on October 9, 2011, at 8:17:57
> Tolerance is not complete--you are correct--but there is tolerance.
For many people, but it's not a given. I have taken xanax for years. Zero diminishing of effectiveness, zero need for dose increase - if anything my dosages have decreased, and zero withdrawal if I don't feel the need to take it.
In the past I've been on Klonopin. I did need to wean off of that when I wanted to stop it. It took a few weeks and it really was not bad at all.
Yes, tolerance and withdrawal can happen. And for some, withdrawal can be bad. But that is not the case for everyone. Physiology varies from person to person, and experiences with drugs vary.
Posted by Chairman_MAO on October 9, 2011, at 9:53:03
In reply to Re: what meds are just as effective as benzo's » Chairman_MAO, posted by Emme-V2 on October 9, 2011, at 8:39:56
What is your daily dose of alprazolam and how often do you take it?
Posted by Chairman_MAO on October 9, 2011, at 9:59:57
In reply to Re: what meds are just as effective as benzo's » Emme-V2, posted by Chairman_MAO on October 9, 2011, at 9:53:03
Tolerance to the sedation, muscle relaxation, etc. develops much more rapidly than tolerance to the anxiolytic effect. And, as I said in my initial post, tolerance to the anxiolytic effect is not complete. A problem here is that we don't have the language to adequately describe these subjective states.
There are people who can remain at the same dose of a benzo for _decades_ and then all of a sudden the therapeutic effect vanishes--or there can be a paradoxical increase in anxiety.
Posted by jono_in_adelaide on October 9, 2011, at 17:46:56
In reply to Re: what meds are just as effective as benzo's » Chairman_MAO, posted by Chairman_MAO on October 9, 2011, at 9:59:57
I agree with you btw Chairman, long term use of a benzo should only be considered after an SSRI, Buspar, Atarax and Remeron have failed to relieve the anxiety.
That was what happend in my case - GAD, panic disorder and depression..... tried all of the above for the anxiety/panic to no avail (soloft and edronax controlled the depression well but didnt touch the anxiety) so started on Xanax.
1 person in 3 who uses benzos long term will become physicaly dependant, 2 in 3 wont...... but like smoking and lung cancer, you dont know who the 1 is until it happens.
But, for me, the risk was worth it, Xanax gave me my life back..... I spent a year not working, barely leaving the house (I would visit one friend, and go to the local strip mall and supermarket for food supplies)..... with Xanax 1mg tid I am back working in a professional job and have somthing of a social life. It isnt perfect, but its a damned site better than it was.
I have been on Xanax 1mg tid for a year without tolorance developing - I'd love to ditch it, I feel ashamed that I need "mothers little helper" to get through the day, but at the moment I just need to accept that and get on with living.
And, I am a lot less dependant on my Xanax than a diabetic is on his insulin!
Posted by Phillipa on October 9, 2011, at 19:32:36
In reply to Re: what meds are just as effective as benzo's, posted by jono_in_adelaide on October 9, 2011, at 4:52:01
Jono that's me low doses over 41 years never wanted more. Phillipa
Posted by Phillipa on October 9, 2011, at 19:53:51
In reply to Re: what meds are just as effective as benzo's, posted by jono_in_adelaide on October 9, 2011, at 17:46:56
Didn't have SSRI's when got panic so was given valium three times a day, and mepbrobamate 400 I think. Had three kids, went to school for nursing, and taught Aerobic Dance, was also a runner. One day just stopped the mephrobamate and never a withdrawal. Didn't need it. Wasn't til thyroid went at menopause that an SSRI was given to me by then had been switched to latest and greatest all low doses ativan to xanax. Lower and lower doses now. Phillipa
Posted by Chairman_MAO on October 9, 2011, at 20:06:36
In reply to Re: what meds are just as effective as benzo's, posted by jono_in_adelaide on October 9, 2011, at 17:46:56
Anyone who has a steady-state concentration of a benzodiazepine in their system for a long period of time _will_ develop a physiological dependency. It is virtually guaranteed at a high enough dose.
As I said before, complete tolerance does not develop to the anxiolytic effect.
Diabetics have no choice but to take insulin. There are other drugs people can take besides benzodiazepines for, let's say, agoraphobia. Unfortunately, there are very few that actually work as well. Frankly I think the irreversible MAOIs (particularly phenelzine) might be the only other ones. Apparently SSRIs work, but I didn't get the memo. Every one I've tried made me miserable and did precious little for my condition.
You should not feel ashamed using a drug. It is your right, your body. If that is what works for you, great. Just know that you're grossly understating the problem of physiological dependence with regard to the benzodiazepines.
Kicking heroin is a drive in a Corvette on a Sunday Afternoon in the summertime compared to cold-turkey benzodiazepine withdrawal after long-term use.
A year is nothing. It could turn on you in fifteen years. That is true with any drug; the problem with the benzodiazepines is that long-term structural and functional changes occur (people are still arguing back and forth about this in academia but the evidence keeps mounting). Other drugs may stop working, too, but very few have withdrawal syndromes that are so prolonged and are so severe.
I truly hope you never have to taper off of the drug, and that if you do, you have a compassionate physician that will let you do a gradual taper over a year or so.
Posted by Chairman_MAO on October 9, 2011, at 20:11:51
In reply to Re: what meds are just as effective as benzo's » jono_in_adelaide, posted by Phillipa on October 9, 2011, at 19:53:51
Were you still taking the Valium when you stopped the mepbrobamate? If so, that is why you experienced no withdrawal symptoms.
Posted by jono_in_adelaide on October 9, 2011, at 22:33:01
In reply to Re: what meds are just as effective as benzo's » jono_in_adelaide, posted by Chairman_MAO on October 9, 2011, at 20:06:36
I did taper it a while back over 2 weeks, and it was quite easy, but the original symptoms were still there, so I went back on it.
The 1 in 3 thins is a fairly widely quoted statistic, though of course I dont know the veracity of it.
In my case, benzos are the only drugs that have worked to control the severe anxiety/panic, SSRI's, NARI's, Atarax, Buspar and Remeron all failed (although a cocktail of SSRI and NARI works very well for my depression)
So, Id decided that it was better to be a normal functional human being on Xanax than a mad hermit without it.
Posted by jono_in_adelaide on October 9, 2011, at 22:37:33
In reply to Re: what meds are just as effective as benzo's » Phillipa, posted by Chairman_MAO on October 9, 2011, at 20:11:51
But, I agree, daily long term benzo use should be a last resort, not a first response.
In hope the drug industry finds an anxiolytic that is as effective as the benzos without their potential for dependance.
I'd like to try pregabalin, but in Australia insurance wont cover it for anxiety, and its about 200 bucks a month cash, vs about 12 dollars for 100 Xanax
Posted by Phillipa on October 10, 2011, at 18:27:24
In reply to Re: what meds are just as effective as benzo's » Phillipa, posted by Chairman_MAO on October 9, 2011, at 20:11:51
Yes I was. Isn't the mepbromate the stronger of the two? Phillipa
Posted by jono_in_adelaide on October 10, 2011, at 19:53:42
In reply to Re: what meds are just as effective as benzo's » Chairman_MAO, posted by Phillipa on October 10, 2011, at 18:27:24
Meprobamate is less effective an an anxiolytic, but more likely to result in severe withdrawl symptoms - that is why it fell out of favour when Valium and Librium hit the market, they were both safer and more effective.
Posted by Phillipa on October 10, 2011, at 21:24:31
In reply to Re: what meds are just as effective as benzo's, posted by jono_in_adelaide on October 10, 2011, at 19:53:42
I guess shows how bad the panic was at the time. I guess the valium prevented withdrawal. But that pdoc was flabergasted to hear I just cold turkeyed it and never missed it at all. Phillipa
Posted by Chairman_MAO on October 11, 2011, at 12:07:08
In reply to Re: what meds are just as effective as benzo's » Chairman_MAO, posted by Phillipa on October 10, 2011, at 18:27:24
"Stronger" is too broad a term to use. Benzodiazepines are probably equally or _more_ effective for anxiety than meprobamate. To put it simply, benzodiazepines potentiate the action of GABA (and Cl- opening), while meprobamate and the barbiturates will open the
http://en.wikipedia.org/wiki/Chloride_channel
without GABA. This makes benzodiazepines extremely safe drugs with regard to overdose; generally healthy people will not die even if they ingest many hundreds of times (or more) of the therapeutic dose of a benzodiazepine--it takes another respiratory depressant administered along with the benzo to be fatal.
In the real world, though, the withdrawal syndrome after high-dose benzodiazepine use can be more protracted and ultimately more debilitating than even that of the barbiturates, meprobamate, etc. because of long-term changes that happen after chronic administration of the drugs.
Withdrawal from any a high enough dose of any of these drugs can be fatal.
Posted by Phillipa on October 11, 2011, at 19:34:34
In reply to Re: what meds are just as effective as benzo's » Phillipa, posted by Chairman_MAO on October 11, 2011, at 12:07:08
So mep is good as muscle relaxant more so than benzos and benzos better at relaxing non skeltal muscles. Hence Soma would relax muscles not reduce anxiety? Or did I get it wrong again? Thanks Phillipa
Posted by Phillipa on October 11, 2011, at 19:49:40
In reply to Re: what meds are just as effective as benzo's » Phillipa, posted by Chairman_MAO on October 11, 2011, at 12:07:08
Found this also I think was on 400mg?. Just stopped it? Phillipa
Posted by Chairman_MAO on October 12, 2011, at 13:33:45
In reply to Re: what meds are just as effective as benzo's » Chairman_MAO, posted by Phillipa on October 11, 2011, at 19:34:34
Unfortunately, I cannot answer your question; it is beyond the scope of my knowledge. I could speculate, but it wouldn't be worth much.
Read the wikipedia article about meprobamate and then about benzodiazepines. Once you have clicked on all the links on that page to read about everything (GABA-A receptors, limbic system, etc., etc.) that _those_ articles reference that you do not understand, then we can continue. ;-)
The only thing I'm virtually certain of is that you have established a false dichotomy and so I doubt it is possible to answer your question as asked. :(
Posted by Phillipa on October 12, 2011, at 19:58:45
In reply to Re: what meds are just as effective as benzo's » Phillipa, posted by Chairman_MAO on October 12, 2011, at 13:33:45
Thanks that will take a while I'm sure!!!! Phillipa
Posted by Chairman_MAO on October 12, 2011, at 21:12:56
In reply to Re: what meds are just as effective as benzo's » Chairman_MAO, posted by Phillipa on October 12, 2011, at 19:58:45
Yeah, it will. And by the way, once you do, I'll be referencing them again, because not only am I out of practice, but I have to take a holiday from the Dexedrine while starting Marplan so I'm going to be back in zombie mode for a while. @_@
Posted by Phillipa on October 12, 2011, at 21:27:16
In reply to Re: what meds are just as effective as benzo's » Phillipa, posted by Chairman_MAO on October 12, 2011, at 21:12:56
Well write. We can suffer together!!!!Phillipa
Posted by Chairman_MAO on October 13, 2011, at 7:50:30
In reply to Re: what meds are just as effective as benzo's » Chairman_MAO, posted by Phillipa on October 12, 2011, at 21:27:16
I won't be doing too much else probably. While it is possible that 40mg/day is going to help, I needed 90mg/day of Nardil for it to really kick in. I just forgot to ask him if he could just titrate me up to 60mg/day within the first month so I could get back on the stimulant sooner. Oh well, in the grand scheme of things (6-12 months, etc.) that's not much of a difference.
Naturally, it's hard to be patient with these things and deal with uncertainty. I could have just taken Milnacipran (that is what he was offering this last time) and kept the 60mg/day of Dexedrine, but I wanted to "go for the gold" (MAOIs always worked the best for me).
But I'll likely be here quite often waiting for new posts to respond to ... aah, the fog is setting in. I'm on a half-dose of my Dexedrine, and I will continue cutting it in half until the Marplan comes in. Then, when starting that, I can't take it until he gives me the green light again. I _really_ hope this is worth it.
Thanks for your support.
This is the end of the thread.
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