Psycho-Babble Medication Thread 891181

Shown: posts 1 to 14 of 14. This is the beginning of the thread.

 

Chronic benzos, mood + memory. Hoover + experts?

Posted by mattdds on April 17, 2009, at 3:48:14

Hi all,

It's nice to see some of the same genius posters still here (you're a legend Larry Hoover).

It's been a while since I posted. Excuses: I went to war (seriously), then back to school, started a long stressful long residency in a surgical subspecialty. Yeah, that stuff is awesome for anxiety and depression!

Background: I've taken clonazepam for 8 years. Overall it has been a tremendous med. Seven years on 1.0 mg bid, over the last year I decreased to 0.5 mg bid. Everything else didn't work or had unacceptable side-effects. (e.g. SSRIs --> tremor, sweating, both very bad in my trade)

To my questions:

1. How well do you think cognitive impairment (memory) and depression secondary to chronic benzodiazepines is supported by the literature. I've seen some small n studies involving older folks cited to back this claim but not much else (I'm young(er), and I want to know about me :) ).

It's hard to judge yourself. Maybe there has been a slow memory decline that I'm not aware of. Perhaps some of my lingering depression could be from long-term benzos.

2. What about the risk of *chronic anxiety itself* on memory and depression? I find it odd that the studies I looked at didn't consider this. It would be hard if not impossible to say whether my memory and persistent low-grade depression would have been better or worse without benzos. I am quite certain that my depression improved significanly in the short term from where I originally was in 2001. Some of my attention might have even been freed up when my anxiety and ruminating thoughts decreased. I'm positive unchecked anxiety precipitates severe depression for me. It almost seems like meds like clonazepam should be neuroprotective in the same way SSRIs and ADs have been shown to be.

3. I worry that some of the literature sort of suggests that memory loss from chronic benzos doesn't come back, or comes back slowly and incompletely. This makes me wonder why Ashton and her followers have developed these beautiful protocols to withdraw. What's the point of a hellish prolonged withdrawal if it doesn't get that much better? I don't believe in extra cool points for being "drug free" for the hell of it (although it would be nice not to have to see a psychiatrist periodically and re-explain my whole situation).

I remember the hope I had years ago for novel medications like Lyrica and the novel CRH antagonists. But Lyrica is not what we hoped and CRH antagonists...what happened there? I hoped clonazepam would bridge the gap while they developed the good stuff, haha.

Please weigh in if you can!

Thanks,

Matt

 

Re: Chronic benzos, mood + memory. Hoover + experts?

Posted by Zana on April 17, 2009, at 11:38:12

In reply to Chronic benzos, mood + memory. Hoover + experts?, posted by mattdds on April 17, 2009, at 3:48:14

Not an expert- except when it comes to clonazepam. I too have taken it for years. I keep questioning my docs about it's effect on depession and memory but they are very blaise about it- think I should continue using it if it helps me. I dunno. I too would be interested in expert opinions.

Zana

 

Re: Chronic benzos, mood + memory. Hoover + experts? mattdds

Posted by Larry Hoover on April 17, 2009, at 17:15:26

In reply to Chronic benzos, mood + memory. Hoover + experts?, posted by mattdds on April 17, 2009, at 3:48:14

> Hi all,

Hey, Matt! I was just thinking about you. Seriously. And there you be.

> Please weigh in if you can!

Hey, who told you I'd put on some weight? :-/

> It's nice to see some of the same genius posters still here (you're a legend Larry Hoover).

Legend? Genius? <Spock eyebrow>

> It's been a while since I posted. Excuses: I went to war (seriously), then back to school, started a long stressful long residency in a surgical subspecialty. Yeah, that stuff is awesome for anxiety and depression!

I well recall your going to war, Matt. I prayed for you many times. Going in theatre with an anxiety disorder seemed pretty courageous to me. Then more schooling and a residency? Sheesh! Way to go, dude!

> Background: I've taken clonazepam for 8 years. Overall it has been a tremendous med. Seven years on 1.0 mg bid, over the last year I decreased to 0.5 mg bid. Everything else didn't work or had unacceptable side-effects. (e.g. SSRIs --> tremor, sweating, both very bad in my trade)
>
> To my questions:
>
> 1. How well do you think cognitive impairment (memory) and depression secondary to chronic benzodiazepines is supported by the literature. I've seen some small n studies involving older folks cited to back this claim but not much else (I'm young(er), and I want to know about me :) ).
>
> It's hard to judge yourself. Maybe there has been a slow memory decline that I'm not aware of. Perhaps some of my lingering depression could be from long-term benzos.

I got news for you. You're aging. No faster and no slower than the rest of us, though. I'm more concerned that a high stress lifestyle might be cumulatively burdensome. I'm big on coping strategies such as regular sleep, exercise, good nutrition, social supports, indulging in hobbies.

> 2. What about the risk of *chronic anxiety itself* on memory and depression? I find it odd that the studies I looked at didn't consider this.

I saw that you brought this up, so I didn't add it to what I said already. Absolutely, a predisposition to anxiety has got to be a risk factor for cognitive problems, poor memory, depression, perhaps comorbid with other contributing factors.

> It would be hard if not impossible to say whether my memory and persistent low-grade depression would have been better or worse without benzos. I am quite certain that my depression improved significanly in the short term from where I originally was in 2001.

I really think you've answered your own question.

> Some of my attention might have even been freed up when my anxiety and ruminating thoughts decreased. I'm positive unchecked anxiety precipitates severe depression for me.

So, why is it you're cutting back on the clonazepam? Not enough risk in your life? <teasing, but seriously teasing>

> It almost seems like meds like clonazepam should be neuroprotective in the same way SSRIs and ADs have been shown to be.

I would think so. There is a realm of adaptation to the environment that changes gene regulation (epigenetics), so we never stop changing. But limiting the intensity of a chronic stressor has got to be sparing in some way.

> 3. I worry that some of the literature sort of suggests that memory loss from chronic benzos doesn't come back, or comes back slowly and incompletely.

I would think that there's no way to test that hypothesis.

I would describe medication for mental illness as generally being an incomplete treatment. If it helps subjectively, that does not mean that it entirely normalizes the underlying disorder which led to treatment in the first place. In other words, there are aspects of the progression of the disorder that are later attributed to the medication, despite the obvious passage of time since treatment began. Yes, there may well have been long term exposure to drugs, but the longer the term, the more other things that have changed also. There's no going back in time to start over.

> This makes me wonder why Ashton and her followers have developed these beautiful protocols to withdraw. What's the point of a hellish prolonged withdrawal if it doesn't get that much better? I don't believe in extra cool points for being "drug free" for the hell of it (although it would be nice not to have to see a psychiatrist periodically and re-explain my whole situation).

I don't have any relevant experience to guide me. I don't know what the motives are.

> I remember the hope I had years ago for novel medications like Lyrica and the novel CRH antagonists. But Lyrica is not what we hoped and CRH antagonists...what happened there? I hoped clonazepam would bridge the gap while they developed the good stuff, haha.

Well, you got me looking. Phase III clinical trials (one for GAD, one for depression) have wound up for Pexacerfont, a CRF-1 antagonist drug. They only recruited females, though. Nothing published yet.

And there is another one called antalarmin. Doesn't work well as a standalone drug, apparently. If they could come up with a CRF-2g antagonist, that might be great, as those receptors are only in the amygdala.

Good to see you, Matt.

Lar

 

Re: Chronic benzos, mood + memory. Hoover + experts?

Posted by sam K on April 17, 2009, at 18:08:45

In reply to Re: Chronic benzos, mood + memory. Hoover + experts? mattdds, posted by Larry Hoover on April 17, 2009, at 17:15:26

hey id like to say that I used to take klonopin a long time ago, Id say 3 years ago. I used alot! Well i was a drug addict and was abusing klonopin, then I was sent to a rehab where they gave me alot of klonopin. Like 2mg a day. AND i swear I cant really remember much of it until recently. Its taken me a long time to fill that gap of memory in my mind.

 

Re: Chronic benzos, mood + memory. Hoover + experts? sam K

Posted by Phillipa on April 17, 2009, at 19:38:18

In reply to Re: Chronic benzos, mood + memory. Hoover + experts?, posted by sam K on April 17, 2009, at 18:08:45

Sam some with seizure disorders take up to 20mg a day of klonopin so 2mg is about average I'd say. Love Phillipa

 

Re: Chronic benzos, mood + memory. Hoover + exper

Posted by mattdds on April 17, 2009, at 19:50:45

In reply to Re: Chronic benzos, mood + memory. Hoover + experts? mattdds, posted by Larry Hoover on April 17, 2009, at 17:15:26

Larry, you're a gentleman and a scholar! Thanks for writing back.


> I well recall your going to war, Matt. I prayed for you many times. Going in theatre with an anxiety disorder seemed pretty courageous to me. Then more schooling and a residency? Sheesh! Way to go, dude!

Honestly, I didn't have it so bad in Iraq. There were a few close calls (indirect fire) but I held up better than I thought. Thank you for your thoughts and prayers!

The mil p-docs even sent me off with a bucket of Klonopin (the only time they were liberal with benzos). Insane who they'll send these days.

I am very fortunate to be back in one piece. Better people than me have not been so fortunate. I did come back with a life experience that few get (or want). I'm not a true believer in the war by any means, but it did build character. I complain a lot less about things back home now.

Yeah, I got out of the quacksilber business and am heading into my second year in OMFS. I don't know why I do this to myself. I do enjoy the work though - it can be very gratifying, and I'm learning tons.

> I got news for you. You're aging. No faster and no slower than the rest of us, though. I'm more concerned that a high stress lifestyle might be cumulatively burdensome. I'm big on coping strategies such as regular sleep, exercise, good nutrition, social supports, indulging in hobbies.

Yeah, you ain't kidding. I feel it big time too. You're absolutely right about the multifaceted approach. With my life choices (i.e. the OMFS residency), all those luxuries like eating food that isn't out of a vending machine and sleeping are not often options.

I seriously considered dropping out during my general / vascular surgery rotation - rounds at 5:30 am, 18-20 very ill vascular patients on the ward, an attending with an ego bigger than...I can't think of anything that big at the moment. Getting out at 10 pm. I truly feel sorry for general surgeons.

Life is good for now, I'm on anesthesia for 2 more months and getting out early and even eating well and exercising. People are happier in that line of work that gets passed on to me. I met my wife and daughter again too! Turns out they're fascinating people!

> So, why is it you're cutting back on the clonazepam? Not enough risk in your life? <teasing, but seriously teasing>

Probably the same reason I chose to take on the residency - overestimating myself and my capacity to cope and continuing to neglect myself (it will pay off eventually... right?).

I'm tapering because my oh-so-caring doc reminded me that I'm a resident surgeon who takes a benzo and that I should take an SSRI and propranolol like all the rest of the good little surgeons do. I was frustrated and baffled, but I took that chance to do a trial taper and it hasn't been as bad as I thought. I'm taking it SLOW, and refuse to feel any withdrawal.

Clonazepam has been a lifesaver over these difficult years, but I love the idea of not being dependent on psychiatrists - I really have gotten fed up with the federal health care system. The good patient-oriented psychiatrists are the exception rather than the rule in my experience. There is far too much cover your a$$ mentality at the expense of the patient. Probably due to the high demand for mental health care in the military, very little thought appears to go into their treatment plans. For anxiety, It's pretty much SSRI or suffering.

> I would describe medication for mental illness as generally being an incomplete treatment.

Couldn't agree more here. As I have gotten older, I've lost a lot of my initial enthusiasm in meds and conventional psych treatments. I could go on about how modern psychiatry hinders a more thorough approach, but that's for another forum. The bottom line is that if you want to get better, you really need to be very proactive with your health, because nobody else will.

> Well, you got me looking. Phase III clinical trials (one for GAD, one for depression) have wound up for Pexacerfont, a CRF-1 antagonist drug. They only recruited females, though. Nothing published yet.

> And there is another one called antalarmin. Doesn't work well as a standalone drug, apparently. If they could come up with a CRF-2g antagonist, that might be great, as those receptors are only in the amygdala.

The name is a bit smarmy - antalarmin? However, I like that these are still being investigated. I hate my amygdala, by the way.

> Good to see you, Matt.

Likewise, Lar. You're a huge intellectual asset here. People who post here, including me, are very fortunate to "have" you.

So now that I vented to you, what have you been up to these days?

Matt

 

Re: Chronic benzos, mood + memory. Hoover + exper

Posted by johnj1 on April 17, 2009, at 22:17:19

In reply to Re: Chronic benzos, mood + memory. Hoover + exper, posted by mattdds on April 17, 2009, at 19:50:45

Wow, you and Larry Hoover in one thread. Nice to hear you are doing well and made it back.

Why no tca's for anxiety? Suprised they only push ssri's??? Some of us just don't do well with those drugs. What about an MAOI? I thought nardil was good of anxiety and panic?

 

Re: Chronic benzos, mood + memory. Hoover + exper

Posted by desolationrower on April 18, 2009, at 0:05:43

In reply to Re: Chronic benzos, mood + memory. Hoover + exper, posted by johnj1 on April 17, 2009, at 22:17:19

yeah, i agree about the getting old thing. some people have a drug they're on, and so attribute it to that, noone wants to think of themselves as 'old'. brain function peaks at 22...

-d/r

 

Re: Chronic benzos, mood + memory. Hoover + exper johnj1

Posted by mattdds on April 18, 2009, at 21:59:50

In reply to Re: Chronic benzos, mood + memory. Hoover + exper, posted by johnj1 on April 17, 2009, at 22:17:19

> Wow, you and Larry Hoover in one thread. Nice to hear you are doing well and made it back.

Thank you! It's nice to be back.

>
> Why no tca's for anxiety? Suprised they only push ssri's??? Some of us just don't do well with those drugs. What about an MAOI? I thought nardil was good of anxiety and panic?

These are two excellent suggestions, but...

I tried imipramine in the past, which was at one time the panic drug to which all others are compared. Even using the "start low and go slow" approach, unfortunately it didn't help at all and made my physical symptoms much worse (sweating, palpitations).

Nardil seemed to help somewhat and was more tolerable than both the TCAs and SSRIs for me. I can't find a doc who is willing to go there again. I did have a mild hypertensive reaction to it which I could not attribute to diet or med interactions. Plus, it had memory effects (difficulty finding the right words) which were much obvious than Klonopin. Overall, just not worth it for me.

Both of these trials were when I was certifiably young too (mid-20's).

Regards,

Matt

 

Re: Chronic benzos, mood + memory. Hoover + experts? mattdds

Posted by garnet71 on April 18, 2009, at 22:29:27

In reply to Chronic benzos, mood + memory. Hoover + experts?, posted by mattdds on April 17, 2009, at 3:48:14

Hi Matt,

It's nice to see another brave guy come home safe :-) My son's brother just came back from Iraq (again) a few weeks ago, he just surprised us and popped in. He said it was boring this time, he's with the 101st. Before he left, someone slammed an armoured humvee door on his leg and broke his ankle. Got a nice reenlistment bonus though.

I'm surprised they let you go over there with an anxiety disorder. Are you in the Army? When i was in the AF, I couldn't even go to Atlanta Georgia for an operations evaluation type exercise while on Effexor. So I quit the Effexor and was able to get my orders 2 days before departure. It seemed odd that people were allowed to have anxiety and be "deployed", but not be on medications and be deployed. Well, I know they have changed the regulations recently for the Air Force. My military doctors were the best doctors in the world.

I'm in a similar situation-trying to find a remedy for anxiety. I take Buspirone 30 mg. x 2; and was taking Adderall but the Adderall didn't work out. I'm not yet sure if the anxiety will be contained w/Buspar, but it has almost no side effects. If you hadn't tried that one, it's worth a try. I was thinking of switching to prevent a possible reoccurence of anxiety when my stressors increase again, but nothing seems to appeal to me right now--especially with the cognitive issues you described; I'm trying to graduate from school.

Oh-do you take magnesium, Vitamin B and all that too? I'm not one of the medical geniouses here, but if you haven't tried Buspirone, you might want to think about it.

Good luck :))

 

Re: Chronic benzos, mood + memory. Hoover + exper mattdds

Posted by Larry Hoover on April 19, 2009, at 8:15:07

In reply to Re: Chronic benzos, mood + memory. Hoover + exper, posted by mattdds on April 17, 2009, at 19:50:45

> The mil p-docs even sent me off with a bucket of Klonopin (the only time they were liberal with benzos). Insane who they'll send these days.

I suspect your skill set might have been one variable they considered.

> I am very fortunate to be back in one piece. Better people than me have not been so fortunate. I did come back with a life experience that few get (or want). I'm not a true believer in the war by any means, but it did build character. I complain a lot less about things back home now.

I'm glad for that. Character building is a good thing. War is often random, and better and lesser men are equals, methinks.

> Yeah, I got out of the quacksilber business and am heading into my second year in OMFS. I don't know why I do this to myself. I do enjoy the work though - it can be very gratifying, and I'm learning tons.

Well, again, I think you're answered your own question. What were you saying about better men? I think I perceive cream rising to the top.

> > I got news for you. You're aging. No faster and no slower than the rest of us, though. I'm more concerned that a high stress lifestyle might be cumulatively burdensome. I'm big on coping strategies such as regular sleep, exercise, good nutrition, social supports, indulging in hobbies.
>
> Yeah, you ain't kidding. I feel it big time too. You're absolutely right about the multifaceted approach. With my life choices (i.e. the OMFS residency), all those luxuries like eating food that isn't out of a vending machine and sleeping are not often options.

I think many people downplay lifestyle factors, thinking a pill is somehow going to fix them. Not that I was suggesting that to you, but stress is inherent in all that you've described. Stress management is my mainstay for mental stability.

> I seriously considered dropping out during my general / vascular surgery rotation - rounds at 5:30 am, 18-20 very ill vascular patients on the ward, an attending with an ego bigger than...I can't think of anything that big at the moment. Getting out at 10 pm. I truly feel sorry for general surgeons.

You could have gone into dermatology. I'm sure that has better hours. ;-)

> Life is good for now, I'm on anesthesia for 2 more months and getting out early and even eating well and exercising. People are happier in that line of work that gets passed on to me. I met my wife and daughter again too! Turns out they're fascinating people!

Heh! heh! I'm glad they'd have you back. :-)

> > So, why is it you're cutting back on the clonazepam? Not enough risk in your life? <teasing, but seriously teasing>
>
> Probably the same reason I chose to take on the residency - overestimating myself and my capacity to cope and continuing to neglect myself (it will pay off eventually... right?).

Everybody tests the boundaries, even the ones forged by their own experience. They forget the importance of the factors that led to their creation. I eat at MacDonald's once every couple of years, and only then do I recall with clarity why it's only once every couple of years.

Somehow, Matt, I suspect that you have not over-estimated yourself at all. Residency is boot camp for doctors. Boot camp teaches the grunts not to under-estimate themselves, right?

> I'm tapering because my oh-so-caring doc reminded me that I'm a resident surgeon who takes a benzo and that I should take an SSRI and propranolol like all the rest of the good little surgeons do. I was frustrated and baffled, but I took that chance to do a trial taper and it hasn't been as bad as I thought. I'm taking it SLOW, and refuse to feel any withdrawal.

I get a sense that you are being asked to fix what ain't broke? Were you having adverse reactions to the clonazepam?

> Clonazepam has been a lifesaver over these difficult years, but I love the idea of not being dependent on psychiatrists - I really have gotten fed up with the federal health care system. The good patient-oriented psychiatrists are the exception rather than the rule in my experience. There is far too much cover your a$$ mentality at the expense of the patient. Probably due to the high demand for mental health care in the military, very little thought appears to go into their treatment plans. For anxiety, It's pretty much SSRI or suffering.

It may be that my exposure to data is biased, but I am of the belief that adverse events are far more likely to accrue to users of SSRIs than to those using benzos. There always seems to be a lag between when a "new and better" treatment comes to the marketplace, and when "sober reflection" is brought to bear on the actual effects of the treatment. Those are two distinct statements, by the way. Next in line, time-wise, behind the SSRIs, would be the atypical antipsychotics. Anyway, getting tangential here.

> > I would describe medication for mental illness as generally being an incomplete treatment.
>
> Couldn't agree more here. As I have gotten older, I've lost a lot of my initial enthusiasm in meds and conventional psych treatments. I could go on about how modern psychiatry hinders a more thorough approach, but that's for another forum. The bottom line is that if you want to get better, you really need to be very proactive with your health, because nobody else will.

Precisely. And I might add, the doctors can't do it all.

> > Well, you got me looking. Phase III clinical trials (one for GAD, one for depression) have wound up for Pexacerfont, a CRF-1 antagonist drug. They only recruited females, though. Nothing published yet.
>
> > And there is another one called antalarmin. Doesn't work well as a standalone drug, apparently. If they could come up with a CRF-2g antagonist, that might be great, as those receptors are only in the amygdala.
>
> The name is a bit smarmy - antalarmin?

I was totally amazed by that name. I thought it more suited to the Internet snake oil school.

> However, I like that these are still being investigated. I hate my amygdala, by the way.

:-)

I think we're getting closer to understanding how to regulate it. I think cannabinoids may be a useful route of inquiry.

> > Good to see you, Matt.
>
> Likewise, Lar. You're a huge intellectual asset here. People who post here, including me, are very fortunate to "have" you.

That's so very kind of you to say. Thank you.

> So now that I vented to you, what have you been up to these days?
>
> Matt

Well, my recent years have been occupied by a novel medical stressor.

I fell and broke my arm in 2004. X-rays indicated a non-displaced radial head fracture, so treatment was conservative (sling and physio). Unfortunately, I had a malunion (step deformity), and it seemed the edge was catching on a ligament. After a lengthy delay to see an elbow specialist, I had an osteotomy and fixation. Unfortunately, I experienced a re-injury of my ulnar nerve during that surgery (first injured during my fall), and came out of the anaesthetic screaming. Since that point in time, I have endured severe and unremitting pain. Thankfully, I was quickly referred to a pain clinic, where I was diagnosed with Type 1 Complex Regional Pain Syndrome (used to be called Reflex Sympathetic Dystrophy, or causalgia).

I could not tolerate opiates after about a year, and since then I've relied on periodic stellate ganglion nerve blockade, and mindfulness meditation. I've only recently been able to post again. I was quite incapacitated by it, for a good long time. I still have hyperalgesia and allodynia, but my symptom baseline is in steady decline since the nerve blocks were initiated.

Apart from the period during which I withdrew from the opiates, my mood has been stable. I attribute that to my collection of coping strategies, mostly acquired from prior experience.

Regards,
Lar

 

Re: Chronic benzos, mood + memory. Hoover + exper Larry Hoover

Posted by mattdds on April 21, 2009, at 1:04:19

In reply to Re: Chronic benzos, mood + memory. Hoover + exper mattdds, posted by Larry Hoover on April 19, 2009, at 8:15:07


> I think we're getting closer to understanding how to regulate it. I think cannabinoids may be a useful route of inquiry.


Excellent! Do you think my docs can give me a scrip for these "cannabinoids" of which you speak ? I have never heard of these, let alone smoked them...hehe.


> Well, my recent years have been occupied by a novel medical stressor.

Ugh. I'm truly sorry to hear that.

> Unfortunately, I experienced a re-injury of my ulnar nerve during that surgery (first injured during my fall), and came out of the anaesthetic screaming.

Wow, I'm on anesthesia rotation right now, so this is particularly interesting. Do you know what they used? I see bad wakeups sometimes when people come out of general quickly with desflurane, but this is just an observation of mine.

> I could not tolerate opiates after about a year, and since then I've relied on periodic stellate ganglion nerve blockade, and mindfulness meditation. I've only recently been able to post again. I was quite incapacitated by it, for a good long time. I still have hyperalgesia and allodynia, but my symptom baseline is in steady decline since the nerve blocks were initiated.


Again, sorry to hear this, but I'm very glad you found something that works and are getting better.


> Apart from the period during which I withdrew from the opiates, my mood has been stable. I attribute that to my collection of coping strategies, mostly acquired from prior experience.

Yeah, I remember you had some great CBT-like coping strategies that we talked about years ago.

Hope you continue to get well.

Matt

 

Re: Chronic benzos, mood + memory. Hoover + exper mattdds

Posted by Larry Hoover on April 26, 2009, at 11:58:58

In reply to Re: Chronic benzos, mood + memory. Hoover + exper Larry Hoover, posted by mattdds on April 21, 2009, at 1:04:19

>
> > I think we're getting closer to understanding how to regulate it. I think cannabinoids may be a useful route of inquiry.
>
>
> Excellent! Do you think my docs can give me a scrip for these "cannabinoids" of which you speak ? I have never heard of these, let alone smoked them...hehe.

I don't know why they don't start with some chromatography, and determine how different fractions might have specific physiological effects. Oh, wait, you can't patent natural products. You can't get rich from other peoples' suffering.

> > Unfortunately, I experienced a re-injury of my ulnar nerve during that surgery (first injured during my fall), and came out of the anaesthetic screaming.
>
> Wow, I'm on anesthesia rotation right now, so this is particularly interesting. Do you know what they used? I see bad wakeups sometimes when people come out of general quickly with desflurane, but this is just an observation of mine.

No, I don't know the agent they used. I don't know that it's relevant. I was still out, but had been moved to recovery. They were positioning my arm to take a post film with a portable x-ray machine. That's all it took, to make the pain yank me out of the anaesthesia. My first recollection is the tech saying, "I didn't do it!". And the sound of my own guttural moaning.

> > I could not tolerate opiates after about a year, and since then I've relied on periodic stellate ganglion nerve blockade, and mindfulness meditation.

> Again, sorry to hear this, but I'm very glad you found something that works and are getting better.

Slow like molasses, but better.

> > Apart from the period during which I withdrew from the opiates, my mood has been stable. I attribute that to my collection of coping strategies, mostly acquired from prior experience.
>
> Yeah, I remember you had some great CBT-like coping strategies that we talked about years ago.

Ya, I well recall. That's one of the reasons you kept coming to mind.

> Hope you continue to get well.
>
> Matt

Thanks, Matt.

Lar

 

Re: Chronic benzos, mood + memory. Hoover + exper

Posted by metric on April 29, 2009, at 14:01:37

In reply to Chronic benzos, mood + memory. Hoover + experts?, posted by mattdds on April 17, 2009, at 3:48:14

> 3. I worry that some of the literature sort of suggests that memory loss from chronic benzos doesn't come back, or comes back slowly and incompletely. This makes me wonder why Ashton and her followers have developed these beautiful protocols to withdraw. What's the point of a hellish prolonged withdrawal if it doesn't get that much better?

I've never seen any compelling evidence that long-term benzodiazepine use causes permanent cognitive deficits. All of the studies I'm aware of involved comparisons of chronic benzo-users with non-users, and there's no way to control for all of the differences inherent in these groups. Nobody is going to conduct long-term randomized placebo-controlled prospective trials of adequate size to measure changes in cognitive function.

I've never seen any human or animal data that demonstrate organic damage from benzodiazepines or even suggest a mechanism by which it might occur (barring massive overdose scenarios that involve hypoxia/ischemia). They are neuroprotective against some types of injury.

In terms of their acute effects of cognition and memory, that's another matter. You're on a very modest dose... You might be able to get away with a single dose at bedtime. That will at least suppress withdrawal during the daytime.

I would be more concerned about long-term SSRI use than benzodiazepines. Worst of all are the antipsychotics, which are *proven* potent neurotoxins (these ought to be generically referred to simply as "poison").

> I don't believe in extra cool points for being "drug free" for the hell of it (although it would be nice not to have to see a psychiatrist periodically and re-explain my whole situation).

I hear ya.

> I remember the hope I had years ago for novel medications like Lyrica and the novel CRH antagonists. But Lyrica is not what we hoped and CRH antagonists...what happened there? I hoped clonazepam would bridge the gap while they developed the good stuff, haha.

Efficacy is a side-issue in psychotropic drug development. The ideal drug candidate is one that lacks "abuse potential"; the rest is amenable to creative marketing.

FWIW, I've taken clonazepam longer than you have.



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[dr. bob] Dr. Bob is Robert Hsiung, MD, bob@dr-bob.org

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