![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 41 to 65 of 175. Go back in thread:
Posted by Squiggles on October 21, 2002, at 8:45:30
In reply to Re: My Klonopin (Clonazepam) isnt working » Squiggles, posted by Alan on October 20, 2002, at 23:41:44
I agree with this 100%. It would be ideal
if the drug companies provided drug doctors;
i think doctors are overwhelmed with
a new field for which they never trained-
psychopharmacology. Very often the drug
is just misadministered. (Euripides, Eumenides):=)Squiggles
Posted by Alan on October 21, 2002, at 9:35:46
In reply to Re: My Klonopin (Clonazepam) isnt working » Alan, posted by Squiggles on October 21, 2002, at 8:02:43
> If you mean they are prescribed long-term,
> and that is the case we are discussing, as
> a layman, i really think that is a mistake--not
> only for benzos (though they particularly
> addictive) but for all psychiatric drugs.
> I suspect that the prophylactic business is
> really a matter of expediency.
>
> Squiggles
===========================================
Then I guess that chronic and severe (enough) don't warrant a compassionate response by doctors - the same as we were talking about re: opioids?For much of the panic population, sustained, stable, medical dependence is a norm that is here to stay as a realised, effective, and as the preferred form of treatment....especially, as you agree, the doctors learn more about the correct usage of the drug....without the spin of "addiction" added to their's and their patient's benzophobia.
Benzophobia is of course anxiety related and compounded with AD commercialism pushing the phobia over the top. Adding fuel to the fire of worry by using the "A" word is not helping the general population that would benefit from stable medical dependence on these medications that have by all non-commercial credible accounts including the W.H.O. (the most independent group left) that explicitly state that the saftey and efficacy for short and long term bzd monotherapy is not even in question.
Alan
Posted by Squiggles on October 21, 2002, at 9:58:04
In reply to Re: My Klonopin (Clonazepam) isnt working » Squiggles, posted by Alan on October 21, 2002, at 9:35:46
With regard to benzos, there is good reason
to keep the patient on indefinitely or forever;
the withdrawals are so horrendous. Any argument
against this is an argument against all the
testimony and the Pharmaceutical Association's
caution about addiction; not to mention the
APA, the AMA, and all the texts. They all say
that benzos should be used short-term (3 months
and no more, or for crisis situations).There is nothing morally wrong with addiction,
but consider that if you start at a young age,
you will hit tolerance faster, which means you
will have to raise the dose indefinitely. Again,
with most benzos there is nothing wrong with that,
except that the side effects will accumulate with
age.As for putting someone on a psychiatric drug
for the rest of his or her life--this may be
necessary if the depression or mania or anxiety
is a life-long disorder. In some cases that
may be so. I was reading Kraeplin last night and
he kept charts on how often the swings occurred
in mania and depression. In some people it was
every 7 years, in some every 10, in some every 20,
in some only once in a lifetime, and in some almost
daily.With regard to anxiety, the disorder is so unnatural
that one must ask whether it is not infact a side effect
of a drug (i have witnessed this myself); whether it is
not infact a result of hyperthyroidism, or any other
20 or 30 possible causes OTHER than a disease itself.
To do that, the doctors must devote some more precious
time and eliminate the other possible and more likely
causes.Squiggles
Posted by Squiggles on October 21, 2002, at 11:54:05
In reply to Re: My Klonopin (Clonazepam) isnt working » Squiggles, posted by Alan on October 21, 2002, at 9:35:46
Alan,
I should be frank with you. I am iatrophobic.
I don't wish to deceive anyone here, but I do
fear that doctors and drug companies are against
mental patients, in the sense that they do not
know or care about what they're doing.This is a dangerous flaw because it leads many
i am sure to experiment with their drugs and
maybe become very sick. It also has encouraged
the anti-psychiatry groups like benzo (parts of
it - because much of what is said is true) and
others.I try to be cautious, and i confess i have
sometimes caused myself some trouble because of
this.It's the damned side effects - that is the
cause, i'm sure. I hope you understand.Squiggles
Posted by Jefff on October 21, 2002, at 23:59:06
In reply to Re: My Klonopin (Clonazepam) isnt working Alan » Jefff, posted by Alan on October 20, 2002, at 12:18:15
>> Why are you consistently smoking pot? This, as alchohol, is usually used most of the time, in the way that you describe it, for self medication. If you finally did find a doc that you felt safe admitting this to, they would still have a hard time justifying prescriptins of a bzd...but then again, if there is some way of convincing yourself AND them that you are not gong to smoke pot while at the same time taking xanax they my at least be inclined to listen.
> Smoking pot to physicians is "drug-seeking behaivour" and almost immediately disqualifies you for xanax because of your penchant to seek highs. In their minds, "potential for abuse goes way up".
> That's not to say that you want to , with the help of an open minded doc that you are willing to be monitored as to your quit seeking this high, and substitute the xanax or ativan or whatever for the pot.
> It seems entirely up to you if you are serious about confronting these issues.
> Rehabilitate off of the pot first, prove that to your doctor, and hope that you have one compassionate enough to understand that you were self-medicating with pot.
> Many AA members are successful at making the switch from the bazooka-like effect of alcohol to the lazer-like effect of bzds to treat anxiety disorder (this is the diagnosis, yes?). Or is it depression secondary to the overwhelming anxiety?
>
> AlanAlan,
At my final visit with my Dr a couple weeks ago I asked him what my official diagnosis was.
He claimed this:
#1-Dysthymia...(which IMO is wrong as I dont have "MILD depression", I have life long, never ending moderate to severe depression which fluctuates in intensity).
#2- Social Phobia...(which IMO Id say was more like severe social anxiety along with general anxiety over many different things (perhaps GAD).
#3- Schizoid personality disorder... (which I may or may not be... but it does sound like I am when I read the online diagnosis. The actual term sounds pretty scary/crazy and not something Id like to admit to too many people).
#4-Body Dysmorphic disorder... (which again, I may or may not be... I tend to believe that Im not and that Im just extremely self conscious/anxiety ridden to the extreme point where I have never felt attractive or worthy enough to ever have sex/intimacy with someone Ive been attracted to. Ive never focused on one particular thing that was out of the ordinary... its always just been a conglomeration of things- such as too thin or too fator not toned enough or the acne or this or that.)
Regarding the pot issue, yes Im definitely self medicating with the pot. Its all I have to keep me from going crazy (can you imagine going through your whole life with those mental issues PLUS being only 33 years old and having spent the past seven years inside a very small house completely isolated from the entire world- aside from your cats, roomate and shrink?)
No way in hell Id tell my new (or old) shrink about the pot. Sure, Id gladly quit smoking it if I had no need to..and honestly (which I mentioned in another post ) the few days that I had the Xanax it interestingly very much curbed my "need" to smoke the pot. But I definitely dont trust, need or want any doctor restricting or withholding beneficial medications from me just because I smoke pot.
Im wondering though if it would be a good or absolutely stupid idea to tell me new med. prescriber that I had recently sampled Xanax? If she knows that it worked for me, and that the clonazepam really isnt, wouldnt she be more willing to let me use it?
Oh God...I cant even describe how much I resent and hate having my sanity/mental health regulated and under the control of someone else.
Jeff
Posted by hiba on October 22, 2002, at 5:25:54
In reply to Re: My Klonopin (Clonazepam) isnt working » Alan, posted by Squiggles on October 21, 2002, at 9:58:04
Dear Squiggles,
Hats off to your stubbornness. You still see benzos as addictive and leave all those newer and older antidepressants without even bothering to mention their names. Zoloft, paxil, effexor, wellbutrin, remeron all causes dependence and they obviously produce more severe withdrawal symptoms than benzos. You don't want go any other sites for the clarification. Just see the posts in this forum.
Have you ever experienced a hollow-feeling ? I hope you didn't and will not experience it in your life. I have gone through that hollowness and I swear, it is the worst thing to experience. Worst than a seizure, I dare to say that.
ACE inhibitors are extensively being used to treat hypertension. But see the pharmaceutical manuals. There is warning: ACE inhibitors can cause kidney failure!! . Still millions are being treated with vasotec and captopril.....
Does it ring any bell??
HIBA
Posted by Squiggles on October 22, 2002, at 8:04:58
In reply to Re: My Klonopin (Clonazepam) isnt working ??, posted by hiba on October 22, 2002, at 5:25:54
Are the ACE inhibotors the same as Beta-blockers?
I am sorry i did not mention the ADs by name;
I know that the SSRIs are particularly hard to
get off of and all psychiatric drugs now carry
a policy of "washing out" when changing.As for experiences hollowness, my depression prior
to lithium was so bad that i could not stand
inside my skin. I actually went out to run in
front of a car, but took a turn to the hospital;
it was fortunate that we then still had a hospital
near us.I cannot describe the depths of the depression -
it was unbelievable - something like Hades i guess.So, i sympathize, and i wonder what kind of derpession
you have so you can get the right drug.Squiggles
Posted by musil on October 22, 2002, at 11:55:43
In reply to Re: My Klonopin (Clonazepam) isnt working » viridis, posted by Squiggles on October 20, 2002, at 21:35:57
Regarding the benzophobic groups, I also fell prey to their pseudoscientific reasonings and suffered greatly during a 4 month withdrawal. BUT there was no medical reason for me to withdraw: at 1.5mg clonazepam for 18 months I hadn't experienced tolerance and the benefits of bzd therapy were evident in my functionality. I restarted diazepam recently and all is well again.
I'm trying not to point fingers, but deceptive advertising bothers me and the antibenzo movement reminds me of a cult. For example, I participated in a forum that advertised itself as a supportive environment for those undergoing withdrawal from benzodiazepines.
However, once I began participating in the forum the irrational drive to quickly taper was made manifest -- I felt a clear pressure to taper as quickly as possible and then wallow in the withdrawal symptoms with other sadists in the forum. I was undergoing an emergence of a previously contained GAD and psychotic major depression, perhaps related to the withdrawal, perhaps not; only a doctor could advise me wisely.
The overarching antibenzo stance of the forum wasn't made manifest until the moderator posted his antibenzo stance when I began to waver in my taper; support quickly became conditional on tapering, regardless of the efficacy of bzd or the severity of the withdrawal.
All symptoms, including a raging sinus infection, were blamed on bzds. A re-emergence of a serious mental illness was never considered.You might well ask what the hell I expected from such a group, and that's a good question. I guess I expected support without the politcal stance.
Conclusions:
a) I was really naive.
b) I was incredibly anxious and susceptible to
any perceived "support" no matter how biased.
c) Black and white thinking about meds should be immediately suspect.
d) Be careful, there are cults.> Viridis,
>
> I really don't think you will have problems
> with Klonopin, as long as you stay on it.
>
> Had i listened to my doctor, and not tried to
> get off it after 15 yrs. i would not have had
> such problems. Unfortunately, i succumbed to
> the enthusiasm of the benzo group--which has
> many useful and informative testimonials. And
> even there, variation between individuals
> is great.
>
> One thing is certain--benzos are addicting.
> But, so what? As long as you are taken off easy,
> IF you have to be taken off.
>
> Squiggles
Posted by Squiggles on October 22, 2002, at 12:29:16
In reply to Re: My Klonopin (Clonazepam) isnt working, posted by musil on October 22, 2002, at 11:55:43
Hi Viridis,
I appreciate your post. I don't recall meeting
you there. I can tell you that when I joined
that group, I felt as if i was in the 60's. It
was almost a sense of elation. Ray Nimmo was
SO smart. I have kept a description of his
moans and groans--i swear the Monty Python crew
could not have written something so funny. I
would walk down the street and crack up. The man
is a genius. He is also very enterprising and
vengeful. He just won a lawsuit in England for
40,000 pounds for brain damage from benzos.The reason I went there was just after I had gotten
off Xanax, which (as i have described in another
post) caused me panic attacks for about 10 yrs.
I found out the cause was tolerance. I demanded
to be taken off--i don't believe my drs. knew the
real problem. This encouraged me to try to get
off Rivtoril.Ray Nimmo and David Woolfe and Jan, were the people
I worked with--writing the FAQ. I really felt that
I was involved in meaningful advocacy work. Rand
was taking the Canadian front. And there is great
truth in what they were saying-- the withdrawals
from benzos are dangerous and worse MISLEADING.
For example, I still don't know and probably never
will, if Valium withdrawal during college did not
present manic depression symptoms, mistaken for the
real thing.As for the enthusiasm and religious devotion to
getting off all pyschiatric drugs--yes, it's a cult.
Ray did not push me, but really thought, i suppose
from his experience that, that these drugs are
very pernicious. You must have heard of Dr. Loren
Mosher (x-president of the American Psychiatric
Association resigning over the overprescription
of drugs), Dr. Breggin, Lawrence Stevens J.D., Charles
Medawar, David Healy to some extent, and so many
others, who are of the same opinion.I was very happy to work with Ray. However, the
trouble started when the withdrawal from Klonopin
made me sick every day, and all i had ahead of me
was hope, hope, hope, that there was a light at
the end of the tunnel, the only way out is through
[through what I wondered sometimes - through my
*ucking grave]... and I started to whine and
protest that possibly bipolars should not do this.Anyway, I finally came to 0.125 from 1.0mg Klonopin,
and that is when i had the stroke. Ray, actually
had the gall to say to me that I was weak to reinstate--
something which my husband encouraged me to do as i was
literally hugging the walls. Hmmmmm.....Well, i can't say if my w/d was so hard because
of so many years of taking it and thus the brain
had changed, or whether i really need the drug.
In any case, I can't get off--i risked my sanity.The only reason i can offer for the zeal of that
group is the knowledge of the tremendous suffering
that people have gone through in dosage misadministration,
withdrawal, forgetting or stopping without guidance.
Benzo withdrawal REALLY is incredibly awful, compounded
by dose, time, and other factors in the individual.Whether they are Scientologists or not--perhaps some
are, but I don't think that is the MAIN reason
for the push to get off benzos.There were some mysterious events at times which
made me suspicious, but I have not put together
all the pieces of the puzzle.You must understand, that in this world of lies,
filing practices which pass for medical treatment,
lack of compassion, and lack of imagination in
the cognitive and pharmacological arts, a group
like that is very attractive, maybe even transcendent.Squiggles
Posted by Squiggles on October 22, 2002, at 13:47:40
In reply to Re: My Klonopin (Clonazepam) isnt working » musil, posted by Squiggles on October 22, 2002, at 12:29:16
Sorry, i got the names mixed up.
Squiggles
Posted by Alan on October 22, 2002, at 17:25:07
In reply to Re: My Klonopin (Clonazepam) isnt working ??, posted by hiba on October 22, 2002, at 5:25:54
The bottom line about the subject, an argument put forward by many a professional that know their business based on the most reliable and recent clinical and statistical information is two-fold:
1) If one is unwilling or unable to distinguish between addiction and medical dependence, one could talk until doomsday and it would be nothing other than an incredible waste of time.
2) One can not generalise their own situation and extrapolate out for the general population based on their experience. It is not a logically sound form of reasoning - especially in the science of medicine.
Needless to say, both still prevail in the anti-benzo movement and that doesn't even take into account the similarly commercially driven opinions of the APA, ASA, APDA, AA, AAPRA, AAA, AARP, BSA, 20 year old texts, or whomever you want to list (all, by the way, relying on the original prescribing information made by the companies and completely ignoring the plethora of more independent studies over the last 40+ years - reviewed by the World Health Organisation).
Yeah, I've dialougued with Ray and Rand and similar anti-benzo zealots and it's a waste of time. The only positive outcome of such invasions by them is to counter bad information with better information. Then it becomas painfully clear to the vulnerable anxiety sufferer that they're attempting to broadside that there's no great mystery and demon factor when it comes to these medications - more than any other. It's just their "thing" to do.
The profit motive in promting AD's for anxiety disorders from "face time" is laughingly obvious - and has even emboldened pharmecutical representatives to infiltrate bboards of vulnerable anxiety suffers to "advise" them as if giving out medical advice....second hand from a small group of doctors they've "consulted" with.
I mean, come on. How much more obvious can this elephant standing in the room become before someone says anything?
Alan
Posted by Squiggles on October 22, 2002, at 17:29:33
In reply to Re: My Klonopin (Clonazepam) isnt working ??, posted by Alan on October 22, 2002, at 17:25:07
I don't wish to discuss addiction versus
medical dependence. I will talk about it
with a linguist, or a philosopher but that's
it.If you don't mind saying Alan, i am interested
in knowing whether you are a doctor or a nurse.
I notice that you constantly refer to the World
Health Organization, and I wonder why you do
so.Squiggles
Posted by Alan on October 22, 2002, at 19:15:50
In reply to Re: My Klonopin (Clonazepam) isnt working ?? » Alan, posted by Squiggles on October 22, 2002, at 17:29:33
> I don't wish to discuss addiction versus
> medical dependence. I will talk about it
> with a linguist, or a philosopher but that's
> it.Then the refusal to make the distinction (what all physicians make all of their decisions based on - on a daily basis worldwide) is your own decision to put into the catagory of linguistics or philosophy. There's nothing to stop you from doing that. But for the reasons that I mention, the reasons that make that point relevant, are indeed also based in science and medicine.
>
> If you don't mind saying Alan, i am interested
> in knowing whether you are a doctor or a nurse.
> I notice that you constantly refer to the World
> Health Organization, and I wonder why you do
> so.
>
> SquigglesI am not in the medical profession but know a lot about medicine based on the struggle to understand this disorder myself..and talking with other knowledgeable people and other doctors that know their stuff.
If you want to read about the one remaining, least commercially, idealological influenced, broad minded organisation left to adjudicate through all of the crap put out by cults and zealots alike, then just read the 57 page report they put out on the subject at:
http://whqlibdoc.who.int/hq/1996/WHO_PSA_96.11.pdf
By the way, just because Healy and Breggin stand up for patient's rights and for full transparency and disclosure from big pharm. doesn't necessarily always make them fall under the influence of the anti med/bzd lobby. They are consumer advocates that want rightfully to hold the corporations to a higher standard.
Of course that doesn't keep the cults from using them and misrepresenting them out of contesxt for their own political and moralistic purposes....
Alan
============================================
Posted by Squiggles on October 22, 2002, at 20:29:17
In reply to Re: My Klonopin (Clonazepam) isnt working ?? » Squiggles, posted by Alan on October 22, 2002, at 19:15:50
Alan,
I would like to read this, but I have to
print it first. It may take some time as
I have to find someone to print it for me.Thank you--i'm really delighted to have
access to it. Just glancing at the References,
I must say that the familiar names: Bousto,
Ashton, and many others are interesting.I'll get back to you on this and make comments
if that means anything to anyone.Squiggles
Posted by hiba on October 22, 2002, at 23:49:05
In reply to Re: My Klonopin (Clonazepam) isnt working ?? » hiba, posted by Squiggles on October 22, 2002, at 8:04:58
Dear Squiggles,
ACE inhibitors are not in the class of beta blockers. They are very safe medicines if used properly. But what I was trying to prove is, pharmaceutical manuals always carry more than enough warnings to terrify patients. If you are following manuals, you can't use any antibiotics because almost all antibiotics carry a risk of renal toxicity. ACE inhibitors too have this side effect. But simply emphasizing on the risks and toxicity of life-saving medications doesn't make enough fun at all. This is the same with benzos.
Benzos carry a risk of dependence. Yet this risk can vary from person to person. But it is very unfortunate to see a well informed one like you is always emphasizing on the dependence potential of benzos and conveniently ignoring their potential in treating the agony of excessive anxiety and obsessive worries. The dependence potential of benzos is only a very small price a patient has to pay, because if you go through the side effect profile of any benzo, and compare it with other medicines used in psychiatric, or general practice, I am sure you can feel the difference. Almost all antidepressants carry a risk of seizure especially in susceptible individuals. But can you show me a single benzo that will cause a seizure? Rather some benzos are very useful in treating seizure disorders. Older tricyclics carry a risk of agranulocytosis. A potentially life threatening disorder which requires very immediate medical intervension. Newer ADs like mianserin and mirtazepine both have this risk with a higher incidence.There are reports of tardive dyskinesia attributed to prozac use. It is an irreversible movement disorder. But benzos are absolutely free from toxic adverse reactions. The only toxicity that can be attributed to benzos is they cause seizures if stopped abruptly after long-term use . Still a gradual tapering never cause this problem and there is no fatality at all. I have seen some patients with significantly impaired renal function because of the long-term exposure to anti-inflammatory analgesics. And fatal nephrotoxicity is not uncommon in constant antibiotic exposure. Beta-blockers if stopped abruptly after long term use can cause myocardial infarction. This warning can be seen in the safety profile of Visken(pindolol). Still I am not trying to prove all these medicines are toxic and cannot be touched. If used properly under medical supervision, they can be life saving miracles. But if you try to project their risks, there will be no medicine a patient can use.
Now I like to make a comparison.The only risk factor of benzos is their potential for dependence. But what will you chose when you are given a choice between irreversible physiological damage and a slight medical dependence ?About the hollow-feeling: This is what accompanies when you come off prozac and similar SSRIs. It is neither depression nor anxiety. But it is a nothing like feeling. It is very difficult to describe in words. You will not understand what is wrong with you, but there will be only a nothingness inside your head. Terrible! I am still on prozac only to escape from this hellish feeling. Recently I tried to quit prozac and gave wellbutrin a try. But only to boost my depressive symptomatology. So the reinstatement of prozac was inevitable.
Good luck Squiggles, take care!
HIBA
Posted by viridis on October 23, 2002, at 0:29:01
In reply to Re: My Klonopin (Clonazepam) isnt working ??, posted by hiba on October 22, 2002, at 23:49:05
Medical dependency is a small price to pay for peace of mind and the ability to think and function normally. For some, like me, benzos provide this option, without side effects or substantial medical risks. Arguments over benzo dependency, "addiction", etc. are just plain silly. This class of meds may not be appropriate for everyone, but they're a great deal safer and more tolerable than much of what's out there.
Posted by Squiggles on October 23, 2002, at 7:34:59
In reply to Re: My Klonopin (Clonazepam) isnt working ??, posted by hiba on October 22, 2002, at 23:49:05
HIBA,
I hope you find something to wean you off PROZAC--
it is ironic that these SSRIs present with as many
and possibly as serious discontinuation problems
as benzos.I think you make excellent points about the relative
side effect profile of all drugs. It is true that they
all carry their risk and that the risk is described
in the brochure that comes along with the drug (a tome
in itself for the busy doctor with 100 patients to
tend to).I also agree that some benzos are necessary for
convulsion conditions such as epilepsy. Infact,
I think that the correct administration of benzos
may not be that problematic. But there's the rub:
"the correct administration"--it is only with the
loud group advocacy of such groups as the benzo
group, that it has been brought to the attention
of physicians and pharmacists that benzos can be
addictive in the same way as heroin. And by that I
mean that after some time the drug will not only
NOT work, but created withdrawal which is horrible
and can be mistaken for another disorder.One more thing that is different about benzos
from other drugs, is the number of people who
are taking them are have been in the past 30 yrs.
or so. I do not have the statistics at hand but
I know that Xanax and Valium for example were way
understimated in their adverse effects and given
out as the aspirin of anxiety.The result is--a generation addicted to benzos.
And once again, I do not have anything against
addiction--infact, I wish they would consider
giving opioids for anxiety on a small dosage level--
but the unexpected and savage withdrawals as well
as the protracted withdrawal syndrome.I believe that Dr. Heather Ashton and Dr. Busto and
others have described these symptoms very well.I will read that WHO report today or tomorrow I hope
and look forward to gleaning through these aspects.Thank you for the thoughful and informative post.
Squiggles
Posted by Squiggles on October 23, 2002, at 7:47:37
In reply to Re: My Klonopin (Clonazepam) isnt working ??, posted by viridis on October 23, 2002, at 0:29:01
I confess that this "appropriate for everyone"
line does get on my nerves. Nothing personal,
but the variables are kept constant when discussing
a pharmacological problem like this. Otherwise,
it is just unscientific and illogical thinking.In any event, I know that these drugs have
almost magical anxiolytic properties and I know
that they are necessary under certain condtions.Once again, let us hope that your doctor knows
when the time is right to raise the dose, and
not to let you get off without supervision.If you want to know the effects of not having
that kind of vigilance, you can read 'em and weep
at the benzo group through the testimonials of
hundreds of people who have had access to the net
and describe them.Squiggles
Posted by musil on October 23, 2002, at 8:38:02
In reply to Re: My Klonopin (Clonazepam) isnt working ??, posted by viridis on October 23, 2002, at 0:29:01
I wonder if the use of atypical antipsychotics for managing anxiety carries far more risk than long term bzd? I intend to approach my pdoc tonight on this subject, as I'd like to get off Seroquel having gained 15lbs. I did well on bzd but got so afraid of them I wouldn't take them when needed -- and now I know to be worried more about Seroquel than bzd. This thread has been very meaningful to me, BTW, thank you all for your contributions.
> Medical dependency is a small price to pay for peace of mind and the ability to think and function normally. For some, like me, benzos provide this option, without side effects or substantial medical risks. Arguments over benzo dependency, "addiction", etc. are just plain silly. This class of meds may not be appropriate for everyone, but they're a great deal safer and more tolerable than much of what's out there.
Posted by Alan on October 23, 2002, at 10:01:25
In reply to Re: My Klonopin (Clonazepam) isnt working ??, posted by viridis on October 23, 2002, at 0:29:01
> Medical dependency is a small price to pay for peace of mind and the ability to think and function normally. For some, like me, benzos provide this option, without side effects or substantial medical risks. Arguments over benzo dependency, "addiction", etc. are just plain silly. This class of meds may not be appropriate for everyone, but they're a great deal safer and more tolerable than much of what's out there.
================================================
Of course, you're correct. To corner and demomise one class of medication as Hiba also so astutely points out is discriminatory - especially when using inflammitory language such as "addiction" when not appropriate to the situation or comparing illicit medications that drug addicts are "hooked" on. What would drive a med-phobic anxiety sufferer faster from consideration of a medication that is the most effective for the general population for anxiety disorder than any other?
Is someone "addicted" to the medications in exactly the same way that one is addicted to AD's for instance?
All "addiction" is not created equal and when those that insist on focusing so tightly upon one drug use that to inflame those fears that are already med-phobic as a result of their anxiety disorder, then all distinctions are lost
(actually what we're seeing now is ssri-avoidant behaivor in these instances because of these drug's anxiety provoking properties).
Perhaps this message from our own elizabeth will give just one small glimpse into why it's important to make the distinction between "addiction" and a "sustained medical dependence". Perhaps her posting will enuciate more clearly than I a bit of the substantial importance of making such distinctions:http://www.dr-bob.org/babble/20010618/msgs/67768.html
Alan
Posted by Alan on October 23, 2002, at 10:38:28
In reply to Re: My Klonopin (Clonazepam) isnt working ?? » hiba, posted by Squiggles on October 23, 2002, at 7:34:59
> HIBA,
>
> I hope you find something to wean you off PROZAC--
> it is ironic that these SSRIs present with as many
> and possibly as serious discontinuation problems
> as benzos.Actually more serious since the manufacturers have tried to dumb down the public with euphemisms such as "discontinuation syndrome" for withdrawal and "poop-out" for tolerance. They even have covered up their own test results which showed such manifestations during drug trials. That is what the paxil suit is all about. BZD tapering has been the norm from the very beginning as suggested by their own manufacturers.
>
> I think you make excellent points about the relative
> side effect profile of all drugs. It is true that they
> all carry their risk and that the risk is described
> in the brochure that comes along with the drug (a tome
> in itself for the busy doctor with 100 patients to
> tend to).
>
> I also agree that some benzos are necessary for
> convulsion conditions such as epilepsy.But not long term for chronic anxiety disorders?
Infact,
> I think that the correct administration of benzos
> may not be that problematic. But there's the rub:
> "the correct administration"And this has been my point all along. The proper diagnosis, teatment, and management (follow-through) is what will eliminate a majority of the misunderstandings about what some peole are misunderstanding as the "dangers" of these medications.
--it is only with the
> loud group advocacy of such groups as the benzo
> group, that it has been brought to the attention
> of physicians and pharmacists that benzos can be
> addictive in the same way as heroin. And by that I
> mean that after some time the drug will not only
> NOT work, but created withdrawal which is horrible
> and can be mistaken for another disorder.Actually, the stridency of these "advocacy" groups (a euphemism unto itself) is finally deterring doctors and patients alike - especially those that follow the appropriate diagnosis, treatment, and mangement - from being persuaded of the commonality and epidemic terms in which their arguments are framed.
The "facts" have been so demagoguged by these groups that these sites don't even pass the laugh test when it comes to physicians that know their stuff about these medications.
The attempt at polarising the situation can not work in an atmosphere of anecdotal evidence and extrapolation based on an individual's experience.
>
> One more thing that is different about benzos
> from other drugs, is the number of people who
> are taking them are have been in the past 30 yrs.
> or so. I do not have the statistics at hand but
> I know that Xanax and Valium for example were way
> understimated in their adverse effects and given
> out as the aspirin of anxiety.
>
> The result is--a generation addicted to benzos.It is precisely for this reason (inappropriate prescriptions) that many physicians and patients have had trouble with these medications. That's just part of the life-cycle of a drug. The backlash being felt only now after overprescription when the drug first came out. Same is happening now with SSRI'S.
> And once again, I do not have anything against
> addiction--infact, I wish they would consider
> giving opioids for anxiety on a small dosage level--
> but the unexpected and savage withdrawals as well
> as the protracted withdrawal syndrome.
>
> I believe that Dr. Heather Ashton and Dr. Busto and
> others have described these symptoms very well.Unexpected? After all of the rationale that you've presented? Savage for those that are drug addicts or who were mismanaged or misdiagnosed or misprescribed, or had a predisposition to addictive behaivor in the first place - maybe. Adjust statistically for all of those variables and you've basically got a red herring as far as the importance of bzd "dangers" are concerned.
Of course that doesn't mean that there aren't bad reactions to medications....but proportionally, bzds have proven to be at least 75% effective in the vast majority of the population for good reason.
By the way, "protracted withdrawal syndrome" is not even on the radar screen when it comes to medical diagnosis is concerned. And the more those that push for such a diagnosis will continue to hurt a cause which may be legitimate.
There are long term consequences for many on many different drugs that deserve being looked at since these drugs are highly idiosyncratic in some respects. For instance, "protracted" meaning what exactly? For those that prescribe Zoloft and don't expect a withdrawl and see one after 4 weeks...is that protracted - simply because the doctor wasn't expecting it?
And the claim that manifestations of various symptoms are a "syndrome". What is to distinguish these syndromes from other maladys or return of or worsening of original symptoms when heightened symptoms could easily appear while the patient was on the medication? What is to be done about these possibilities - especially if the point of getting the medical comunity to look at something seriously is to persuade rather than hype? It goes against human nature to be persuasive and yell hyperbole at the same time.
I'm not saying that these possibilities are to be dismissed, but to exclusively pinpoint anecdotal reports as fact hurts the cause if indeed these problems do exist.
But one can only cry wolf for so long.
>
> I will read that WHO report today or tomorrow I hope
> and look forward to gleaning through these aspects.I'm sure that your observations will prove to be quite interesting.
Alan
Posted by Squiggles on October 23, 2002, at 10:57:52
In reply to Re: My Klonopin (Clonazepam) isnt working ?? » Squiggles, posted by Alan on October 23, 2002, at 10:38:28
Alan,I will read the WHO report and in my net
search on pharmaceutical corporations and
their government relations, i see that i
am a novice in this area. Nevertheless,
it is interesting and if i have the time i
will continue to read the stuff.I confess though, that this idea has crossed
my mind: as i don't know who you are, the
possibility crossed my mind that you are
setting me up to do the devil's advocate work.But what the hell--i always wanted to
be a lawyer :-)Squiggles
Posted by Alan on October 23, 2002, at 12:11:30
In reply to Re: My Klonopin (Clonazepam) isnt working ?? » Alan, posted by Squiggles on October 23, 2002, at 10:57:52
>
> Alan,
>
> I will read the WHO report and in my net
> search on pharmaceutical corporations and
> their government relations, i see that i
> am a novice in this area. Nevertheless,
> it is interesting and if i have the time i
> will continue to read the stuff.
>
> I confess though, that this idea has crossed
> my mind: as i don't know who you are, the
> possibility crossed my mind that you are
> setting me up to do the devil's advocate work.
>
> But what the hell--i always wanted to
> be a lawyer :-)
>
> Squiggles
>======================================
No such intent from my end.I'm just an educated consumer that at one time got burned by the medical system (like yourself) but in my case it was the witholding of BZDS as an equal option to all other psychotropics for chronic anxiety disorder (because of the effective scare tactic "they were "addictive" misinformation") that led to my wanting to join others to set the record straight..at least straighter than it has been. Proportionality in risk assessment is all that I am trying to iform people about - without all of the hype.
I am afraid that as technical (and comprehensive, which is my point) as the report is, there is only one way to dispute it. Either disredit the organisation or take out of context those bits that are what gives it the comprehensive strength that it enjoys.
I really do not view this as a competition of stats knowing the highly idiosyncratic nature of individual responses throughout the psychiatic field concerning psychotropics.
Sincerely,
Alan.
Posted by Squiggles on October 23, 2002, at 20:34:11
In reply to Re: My Klonopin (Clonazepam) isnt working ?? » Squiggles, posted by Alan on October 23, 2002, at 12:11:30
Hi Alan and musil, viridis, hiba, whoever
else is interested in the WHO "Rational Use
of Benzos" document:My husband kindly printed it for me. I started
reading it tonight. It's rich. It is also
from 1996; nevertheless, i am amazed at how
many similarities i see (just skimming it) with
the knowledge acquired at the Benzo Group.1. General Introduction
I am glad that the target audience is both
psychiatrists and GPs as both use them.2. Epedimiology
2.1 Introduction
These drugs are prescribed in 3rd place, after
heart and circulatory drugs. Why is this? Is
it because anxiety is rampant, or backaches,
or insomnia; or is there some other reason, such
as dependence necessitating the continued prescription
of these drugs;2.2. Indications
The recent restriction of benzos to fewer
disorders is a goo move. The marked discrepancy
for which they are prescribed and the knowledge
or perception that the patient has, is a very good
point. In my case, i have no idea why I was prescribed
the anti-convulsant Clonazepam. I was certainly not
having convulsions. I have heard rumours that
bipolars are epileptics and have seizure-type electrical
activity in the brain, but i think this was at least
theoretical in my time (20 yrs. ago).The recommendation for short term prescription
is also something that the Benzo group was aware
of as the wisest course of action. I was taking
Xanax and Clonazepam for about 12 years, every day.2.4 Prescription Data
The statistics show a high propensity for
physicians to prescribe for non-psychiatric
reasons.2.5 Consumption of benzos
Some interesting hints of contradictory data
here:- "Difficulty in disontinuing the medication was
linked to age (over 45) and duration of use,
but not to the kind of benzodiazepine nor to the
sex of the use (Dunbar et al., 1989). Comparing
data with Balter, these researchers concluded that overall
prevalence use might have declined, but long-term
regular use of benzodiazepines had increased
substantially."- how do we interpret the above; may i suggest
that discontinuation was just unsuccessful and
continued use was the result? Also, i don't know
about the studies here (probably none) but for
some reason clonazepam is more difficult to withdraw
from than others. That was my experience and it
was also reported at the Benzo group.2.6 Conclusion
Benzo prescription and use is increasing.
3. PHARMACOLOGY
3.1 Introduction
A sentence that caught my attention points to
the significant pharmacological differences
between benzos (though of course there are mostly
similarities). Wonder what they are, besides
time and absorption.3.2 Benzo receptors
I notice that the mean duration of benzo treatment
for patients is 50 months. He he he.--- much which is techinical in these sections--
3.4 Clinical importance of pharmacokinetics3.4.1 Anxiolytic use of benzos
This is the main use of benzos. Withdrawal
problems are well described and well known here;
why don't the doctors read this stuff?3.4.3 Anticonvulsive use
They are used for epilepsy; i see no mention
of manic-depression;3.4 Clinical importance of pharmocokinetics
Mania:
This is an excellent and rational use of
benzos! The point is made here that benzos
are used in the initial phases of benzos and
in when in other psychiatric disorders for the
very good reason that they do not counteract
with the anti-psychotics such as lithium. Lithium
with neuroleptics instead of benzos, would
easily result in the truly undesired tardive
dyskinesia and neuroleptic malignant syndrome.But indefinitely? I guess.
-------------I am going to stop now and resume
tomorrow; as i said I am quite amazed at how
consistent the facts here are with the documents
collected at the Benzo group.--------
Squiggles
Posted by Alan on October 23, 2002, at 22:12:32
In reply to Re: My Klonopin isnt working ?? (WHO Benzos) » Alan, posted by Squiggles on October 23, 2002, at 20:34:11
Yes but considering that the Devil is in the details, it's how that "information" is interpreted and ultimately used and disseminated that distinguishes benzo.org and other anti-benzo movements as to whether their claims could possibly withstand the test of time within the structure of science generally and in medicine particularly.
Alan
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