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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by herpills on September 12, 2014, at 13:47:07
good article from Boston Globe...
When withdrawal is the hardest part
By Jeremy C. Fox
| Globe Correspondent September 08, 2014
John Zielin realized his daughter was in trouble when she called him unexpectedly, saying, Youve got to come and get me. Somethings wrong.Alison Page was catering a Waltham wedding in the summer of 2012 when she began feeling ill.
At sunset, I just got really dizzy, said Page, 29. I go outside, and Im sitting down, and everythings spinning. I felt like a wild animal that was being preyed upon. It was petrifying.
Zielin, 66, arrived to find Page in a parking lot, her eyes filled with fear and confusion. In the car on the way to their Andover home, she experienced her first panic attack. Ive seen people like that, but they usually have a long history of it, said Zielin, a retired social worker. This stuff is showing up out of nowhere.
The family later learned that Page was experiencing withdrawal between doses of Ativan, a drug often prescribed for anxiety or insomnia. After taking a dose that night, Page felt fine for the moment. But her struggle to recover continues more than two years later.
While rampant abuse of heroin and prescription opiates dominates public attention, dependency on benzodiazepines a group of tranquilizers that includes drugs such as Ativan, Klonopin, and Xanax remains less widely acknowledged or understood.
Doctors say benzodiazepines are effective for short-term stress, as in the days following the death of a loved one or another emotionally difficult event. But problems can arise when use continues for more than a few weeks.
The federal Food and Drug Administration requires warning labels that describe dependency risks the Ativan label lists 35 reported withdrawal symptoms, including anxiety, depression, hallucinations, panic attacks, and seizures.
But doctors and patients say physicians often prescribe benzodiazepines with no discussion of the dangers and the drugs declining effectiveness over time.
People get used to prescribing these drugs and they forget what theyre dealing with, said John Kelly, associate director of the Center for Addiction Medicine at Massachusetts General Hospital.
Representatives for the pharmaceutical companies Roche, maker of Klonopin, and Pfizer, maker of Xanax, issued statements saying that physicians prescribing the drugs should study the safety information provided in the drugs labels and discuss the benefits and risks with their patients. A spokeswoman for Valeant Pharmaceuticals, the manufacturer of Ativan, did not respond to requests for comment.
Kelly said patients can feel a false sense of security when taking any drugs prescribed by their doctors. With benzos and stimulants and opiates, because theyre prescribed, people do have this perception that theyre safe, or much safer than illicit drugs youd obtain on the street, he said.
Kelly said many abuse benzodiazepines in combination with substances like opiates, cocaine, and alcohol. But for Page and many others, dependency can develop under a doctors care.
Page was prescribed Ativan by a psychiatrist in 2009, she said, as she adjusted to working as a receptionist after graduating from Northeastern University. As a shy person, she found the front-and-center role a tough fit, she said.
Page moved on to work as a mental health counselor and entered nursing school, taking the drug periodically and sparingly, as her psychiatrist advised, she said, but her health began to decline.
My anxiety was getting worse; I was getting dizzy spells; I was getting sick more often, and my capacity to deal with stress was less, Page said. I thought I had a worsening anxiety disorder.
Over time, these symptoms worsened while new ones arose, and despite good grades, she had to leave nursing school, she said. When her psychiatrist suggested additional medications, her father said no.
Page said she was switched to another benzodiazepine and tapered off the drug over three weeks, she said, but afterward her withdrawal symptoms seemed to worsen.
I didnt sleep for two months, she said. I would be in fear states for maybe four, five, six hours a day. . . . It was almost like this primal feeling that youre about to be attacked by a lion; youre about to be killed.
Calls to Pages psychiatrist were referred to a spokeswoman for Steward Health Care System, owner of the hospital where he practices, who said she could not comment because of federal patient privacy laws. But the spokeswoman said that the companys medical personnel are careful when prescribing medications to patients.
Dr. James Berry of the Mercy Recovery Center in Westbrook, Maine, estimated that a third of those who are prescribed benzodiazepines experience dependency and painful withdrawal, but there is no sure way to predict who will have those reactions, though the dangers increase with prolonged use.
Generally, withdrawal symptoms . . . are the opposite of what a drug does, he said. If a drug relieves anxiety, the drug causes anxiety during withdrawal.
Berry recommends that those who have become dependent reduce their doses gradually over a six-month period before they cease using the medication, but some doctors advise patients to stop taking the drugs over just a few weeks, he said.
Even a six-month tapering process isnt sufficient for some, according to Berry. For a small percentage, it can take years for withdrawal symptoms to recede.
Benzodiazepines have been used widely since the 1960s, and concerns about them are long established.
Massachusetts Senator Edward M. Kennedy convened a congressional hearing in 1979 to raise awareness, saying benzodiazepines like Valium and Librium had brought relief to many, but that, For others, these drugs have produced a nightmare of dependence and addiction, both very difficult to treat and to recover from, the Associated Press reported.
The risks, though, remain little discussed, some patients say. Page finally understood her symptoms when she found the online support group Benzo Buddies, she said.
Founded a decade ago, the group has about 16,000 members around the world. Cofounder Colin Moran said the online forum was created because there was almost no real-world support at the time.
In Britain, where Moran lives, benzodiazepines have been discussed in Parliament, and the British Medical Association is reviewing use and prescribing habits, but there has been little movement toward reducing use or increasing warnings, he said.
Moran and Berry both said doctors in the United States have been even slower to address concerns.
We still hear from members [in the United States] that their doctors claim there is no potential for dependency or addiction with this class of drug, Moran said in an e-mail. Some doctors even sometimes cold turkey their patients off large doses of benzodiazepines, even after protracted use. This is extremely dangerous.
Zielin said Benzo Buddies saved his daughters life. The importance of having a supportive network around people going through this is just critical, he said. I dont know how people can go through this alone.
Medford resident Karen Psaledakis was prescribed Ativan to treat panic attacks after her fathers 2006 death. Her psychiatrist offered zero warnings, she said.
I never received one wary comment or anything that would suggest I should look into it more, she said.
Psaledakis, 44, said she took the drug as directed, but within three months began experiencing muscle and nerve pain, gastrointestinal problems, and other physical issues.
After an unsuccessful stay in a holistic treatment center that tried to help her taper off the drug too quickly, and two stints in a psychiatric hospital, Psaledakis was able to stop taking the drug in early 2012, with support from Benzo Buddies, she said.
Psaledakiss physical symptoms disappeared last fall, but she said she still experiences depression and states of intense fear that she believes are withdrawal symptoms.
I have to make an effort to think about the things that have gotten better, but I know that they have, she said. Some things have gotten worse, but that is just sort of the nature of this beast.
For Page, recovery has been like a roller coaster ride, she said, with symptoms disappearing and recurring, usually less intense with each bout. She thinks total healing could take two or three years more.
Its just back and forth, back and forth, but overall the trajectory is toward healing, she said.
Posted by gadchik on September 12, 2014, at 14:12:34
In reply to When withdrawal is the hardest part, posted by herpills on September 12, 2014, at 13:47:07
Thanks! Benzobuddies is helping me w/d from my c/o to valium from klonopin. Just like they helped the lady in the above article. It's hell tapering a benzo, and a long one at that! But Im doing it. No way could I have tapered directly from klon.
Posted by Phillipa on September 12, 2014, at 17:38:41
In reply to Re: When withdrawal is the hardest part, posted by gadchik on September 12, 2014, at 14:12:34
Hi G what you down to now? P
Posted by Fred23 on September 12, 2014, at 18:10:59
In reply to When withdrawal is the hardest part, posted by herpills on September 12, 2014, at 13:47:07
Maybe Ativan wasn't the most approriate benzo to prescribe in the first place.
Posted by Hugh on September 12, 2014, at 19:32:41
In reply to When withdrawal is the hardest part, posted by herpills on September 12, 2014, at 13:47:07
Good article. Thanks for posting this. I also found BenzoBuddies, and The Ashton Manual, helpful in getting off Ativan.
Posted by gadchik on September 12, 2014, at 20:27:41
In reply to Re: When withdrawal is the hardest part » gadchik, posted by Phillipa on September 12, 2014, at 17:38:41
I am at 6.5mg, about to cut another .5mg to 6mg. Then I will stay there for 3 or 4 weeks. This is taking forever. But it's doable, unlike the klonopin tapering I attempted. Thanks for asking! Hope youre doing well?!
Posted by Phillipa on September 12, 2014, at 20:57:22
In reply to Re: When withdrawal is the hardest part » Phillipa, posted by gadchik on September 12, 2014, at 20:27:41
G that klonopin sure is a lot stronger than valium is then. 7.5mg is the highest take at night with .5 total xanax. Since they work and my age not worth getting off. I used to just stop and start at will until I started using the internet. I am one who should avoid it at all costs. P
Posted by gadchik on September 13, 2014, at 7:11:20
In reply to Re: When withdrawal is the hardest part » gadchik, posted by Phillipa on September 12, 2014, at 20:57:22
I think I would just stay on it at your age, not that you're really old! But I have read that some do well on a small dose, and it's worse to get off of them, once you're older. I really didnt have any issues with klonopin. Just want to get off it since Im 50. If I was in my lates 60s, on it, and it was working, I'd stay on it. Who knows, I may even get back on it once Im 70! Im always gonna have an anxiety disorder. It has to be controlled. I would prob just take valium tho. I do ok with exercise right now for anxiety. We'll see once Im totally off, how I do!
Posted by Phillipa on September 13, 2014, at 9:42:07
In reply to Re: When withdrawal is the hardest part » Phillipa, posted by gadchik on September 13, 2014, at 7:11:20
G I decided the same thing myself. Why one reason is the stress of trying to get off them would create even more anxiety. If I leave myself alone I seem to also take less. When things are not really stressed here but normally they are I take less. In my case also although family has history of anxiety disorders seems I have a habit of always thinking the worse. I do still ride the bike the 6 miles which helps. Thanks for answering. I should decide to get off the low doses of SSRI's as they don't do a thing and sub theraputic. P
Posted by Phil on September 13, 2014, at 14:18:44
In reply to Re: When withdrawal is the hardest part » Phillipa, posted by gadchik on September 13, 2014, at 7:11:20
My aunt took Valium for ten years back in the '70s I think. We were talking about benzo's one time when she was up in her 70's. she said, wouldn't mind having that again. LOL.
Posted by Beckett on September 13, 2014, at 14:46:40
In reply to Re: When withdrawal is the hardest part » gadchik, posted by Phil on September 13, 2014, at 14:18:44
Valium is pretty dreamy.
Back in the day, I wish my doctor had told me. This was before the internet. At the beginning, Xanax felt like a miracle.
Posted by gadchik on September 13, 2014, at 16:31:39
In reply to Re: When withdrawal is the hardest part, posted by Beckett on September 13, 2014, at 14:46:40
Yes, those first few pills ARE dreamy! I remember feeling as if I was floating away on a soft, puffy cloud, happy as a clam, no intrusive thoughts! The anxiety melted away. Wish it always felt that way, alas, tis not so... : (
Posted by gadchik on September 13, 2014, at 16:34:30
In reply to Re: When withdrawal is the hardest part » gadchik, posted by Phil on September 13, 2014, at 14:18:44
Phil, when it's gettin close to the end game, I wont hesitate to take valium and enjoy it! I shall not suffer the spoils of anxiety as an old woman!
Posted by herpills on September 16, 2014, at 21:39:29
In reply to Re: When withdrawal is the hardest part, posted by gadchik on September 12, 2014, at 14:12:34
> Thanks! Benzobuddies is helping me w/d from my c/o to valium from klonopin. Just like they helped the lady in the above article. It's hell tapering a benzo, and a long one at that! But Im doing it. No way could I have tapered directly from klon.
I'm so happy to hear your taper is going well, I've been following your progress. Can I ask, was it your doctor's idea to do the c/o to Valium, or did you request to do it that way? I've read the Ashton stuff and it seems to make a lot of sense but I've never had a prescriber suggest this way. I'm trying to taper down my Ativan use from a daily med to an as needed basis right now. The nice thing is that the PA that I work with knows that the withdraw can be really hard and promised me I would never get "cut off" and that I am in control of the pace. That alone is much better than the time I was forced to do a 1 month taper off klonopin which ended up being a very traumatic experience. And it was with a pdoc who should have known better. I had been on daily klonpin for 3 years! Always took it as prescribed...
Please continue to post about your path to benzo free it really helps me to hear success stories. Thanks!
Posted by gadchik on September 17, 2014, at 6:23:41
In reply to Re: When withdrawal is the hardest part » gadchik, posted by herpills on September 16, 2014, at 21:39:29
Hi! Thanks for asking about my experience! I wanted to taper off of my benzo, esp once I turned 50. I tried and tried, w/o telling my pdoc, to taper directly from klon. I found Benzo Buddies and started reading. I actually learned about Dr Reg Peart and decided to follow his c/o and taper plan. But, I did have to go in, tell my pdoc what I wanted to do, and boy, was I nervous. I rehearsed it all a million times! But she agreed, and rxd me 5mg and 2mg valium pills(Im using generic) to mix and match. Im going very slowly .5mg cut every 4 weeks. Im not having any withdrawal probs now, feel fine! Below is Dr Peart's info!
I too would like to only use a benzo if Im having a panic attack or if some issue that cause me extreme anxiety happens, then just take it a month or so, then taper. Good luck to you!http://www.drregpeart.org/Dr%20Peart%20Sample%20Schedules%20with%20Notes%2022Sep06.pdf
Posted by gadchik on September 17, 2014, at 6:31:26
In reply to Re: When withdrawal is the hardest part » herpills, posted by gadchik on September 17, 2014, at 6:23:41
I also wanted to say, that I feel no diff on valium than I did on klonopin. I thought valium would make me depressed but it hasnt. I dont have anxiety or any issues with it. My sleep seems better tho.I take it once daily, at night, just like I took Klonopin. I still do take a crumb of remeron just very occ if I feel like I cant sleep. I will be cutting to 6mg on Friday.
Posted by herpills on October 2, 2014, at 9:56:17
In reply to Re: When withdrawal is the hardest part, posted by gadchik on September 17, 2014, at 6:31:26
> I also wanted to say, that I feel no diff on valium than I did on klonopin. I thought valium would make me depressed but it hasnt. I dont have anxiety or any issues with it. My sleep seems better tho.I take it once daily, at night, just like I took Klonopin. I still do take a crumb of remeron just very occ if I feel like I cant sleep. I will be cutting to 6mg on Friday.
Thanks for the encouragement! I'm currently down to only 0.5mg/day and so far I feel fine but it's only been a week at that dose. I'm not surprised to hear you're sleeping better, I think Klonopin is bad for sleep and I know I slept a lot better once I got off it. I take mirtazapine every night, it was prescribed for my depression, but it's been really helping my anxiety a lot, I think that's why it's been easier this time to lower the Ativan. Thanks again
Posted by gadchik on October 3, 2014, at 15:37:24
In reply to Re: When withdrawal is the hardest part » gadchik, posted by herpills on October 2, 2014, at 9:56:17
Thanks for responding. Glad ur doing well. I like mirtazapine too. I took 7.5mg for 2 1/2 yrs. I will take it everyday if I need to as I get lower and finally off of valium. Are you going to taper completely off the Atvian? I'd like to just take a benzo "as needed". I also did well on Zoloft and will consider that one as a daily med, if I need one. Zoloft and Mirtazapine worked well together, in low doses, for me.
Posted by Beckett on October 3, 2014, at 19:05:46
In reply to Re: When withdrawal is the hardest part » herpills, posted by gadchik on October 3, 2014, at 15:37:24
Herpills and gadchick, I am impressed you're tapering on your own! Congratulations on your strength and determination.
Many times I tried to taper from Xanax on my own with no success. I could get down to .5mg, but at that dose I was symptomatic. Once an horrible doctor insisted I do a three week crossover to Valium. I had panic breakthroughs through the Valium--I don't think she prescribed a sufficient dose to begin with. After three weeks she cut me off, and I had panic attacks and physical symptoms like an uncontrollable stutter, and I don't stutter. I showed up at a psych's office, and I was in such a state, he put me back on Xanax and increased my dose even. Long story short, I went into a psych ward and cross-tapered with phenobarbital. For a few months after withdrawing, I had random panic attack. It was awful!
I feel much better now. My anxiety level, I feel, is back to pre-Xanax. I believe benzodiazepines created refractory anxiety. I wish had been told when initially prescribed Xanax.
Posted by Phillipa on October 3, 2014, at 20:26:06
In reply to Re: When withdrawal is the hardest part, posted by Beckett on October 3, 2014, at 19:05:46
Beckett what is refractory anxiety? This could be what I have too. P
Posted by gadchik on October 4, 2014, at 11:27:52
In reply to Re: When withdrawal is the hardest part » Beckett, posted by Phillipa on October 3, 2014, at 20:26:06
Well, I am determined to get this benzo monkey off my back. I want nothing more to do with this thing that will cause me such horrific w/d if I cant get it. However, I will save it for a major panic attack. Works gr8 for that. Im starting to believe the ssris are what should be taken for long term anxiety. You just have to get the right one, the right dose, and give it the right amt of time. Of course exercise is number one in my book for anxiety. But for extreme cases, you just have to take a benzo. I will never do daily tho. Im now worried about all this alzheimers association with more than 180? doses of a benzo? Lord knows Ive had more than that. Geez, why didnt they do all this research yrs ago???
Posted by Beckett on October 4, 2014, at 13:16:49
In reply to Re: When withdrawal is the hardest part, posted by gadchik on October 4, 2014, at 11:27:52
I haven't heard of that research. Do you know anything about risks associated with long term ssri use?
You're likely right about ssri's and anxiety. My doctor worked sometime at getting me to take one, and now I do feel better. Because I withdrew quickly, I think I suffered from paws. That's what it's called, yes?
Posted by Beckett on October 4, 2014, at 13:25:42
In reply to Re: When withdrawal is the hardest part » Beckett, posted by Phillipa on October 3, 2014, at 20:26:06
Hi P, well, I mean that my anxiety increased as I developed tolerance to my daily Xanax dose. I didn't understand tolerance. I kept my dose the same for years (hovering at 1 mg), and I assumed that was good, but it in order to address my true level of anxiety after years on Xanax, it would have been necessary to adjust the dose. And my doctors either wanted to increase or prescribe buspar, AP's, gabapentin.... Really, I made up the use of refractory in reference to anxiety. And I'm not sure that is the case with you, so please try not to worry!
I've managed to decrease the lyrica dose, but I needed something like that after I detoxed.
Posted by Phillipa on October 4, 2014, at 21:09:24
In reply to Re: When withdrawal is the hardest part, posted by gadchik on October 4, 2014, at 11:27:52
44 years of them think I'm doomed. But there is also studies on the SSRI's and about every med you can name has side effects so weight the pros and cons. Easier said than done. P
Posted by gadchik on October 5, 2014, at 9:33:53
In reply to Re: When withdrawal is the hardest part » gadchik, posted by Phillipa on October 4, 2014, at 21:09:24
Yes, these studies havent proved cause and effect, just association. I wouldnt let it concern me, just keep exercising and doing the things that they know helps your brain. Do you eat fish? Thats supposedly been proven to help brains not shrink as we age. : ) I may get into fish oil supplements again.
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