![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 66 to 90 of 175. Go back in thread:
Posted by Squiggles on October 24, 2002, at 8:41:31
In reply to Re: RATIONAL USE OF BENZODIAZAPINES » Squiggles, posted by Alan on October 23, 2002, at 22:12:32
Alan,
Once statistics are out, and the further
understanding of the effect of benzos on
the GABA system is accomplished, the
"interpretation" of those devilish details
should not exceed the capacity of an
intelligent physician.I continue from 3.4, where I made a remark
that if benzos must be used for agitated
depression or anxiety or mania along with
an anti-psychotic, then THIS is a good thing.
And it is a pleasure to see the vigilence
against tardive dyskinesia and neuroleptic malignant
syndrome if the antipsychotics are mixed with
antidepressants.Something I missed on 3.3.6 about the lipophilic
tendency of the benzos. I am quite surprised to
see this here because in the Benzo group, some
people claimed that benzos tended to stay in the
fat cells and therefore could delay the withdrawal
process or introduce erratic w/d symptoms. Others,
said this was just pseudo-science. It is no longer
1996 so perhaps some current research has settled
this question.
4. INDICATIONSThis means for what these drugs are given (mainly
anxiety and insomnia). Anxiety is defined pretty
extensively. However, the causes and duration of
anxiety is not mentioned, which I think would certainly
influence the understanding of why benzos must commonly
be administered for longer than a year.It is interesting that there are different headings
for Phobias and Panic Attacks; though different
in name, if a doctor were to look at the physical
manifestations (such tachycardia, sweating, dry mouth,
trembling, infact all the autonomic overactivity
symptoms) they would see that there is little
difference. This might reduce the number of
prescriptions that have escalated since 1996, making
the benzos among the top 5 drugs prescribed.Again--differential diagnosis. Autonomic overactivity
may also be caused by thyroid toxicity and other
physical disorders; and as the medical psychiatry
model knows so very well--the body influences the
mind.Mania is very briefly discussed. I think it
is inadequate. "In manic episodes benzodiazepines
may be used adjunctively with mood stabilizers."
Does this mean that we wait for the manic episode?
Do we give the benzo to those described as manic depressives.
And, this is a point which disturbs me greatly--
is mania a possible side effect of unrecognized
benzo withdrawal, for which more benzos are prescribed?Again--differential diagnosis-- ask the patient
if he or she has been taking benzos, and if she or
he has stopped suddenly or forgotten to take them
for some weeks or decided on his own he no longer
needs them.4.1.4 Benzo and alcohol withdrawal
I did not know that chlormethiazole could be used
for withdrawal; i thought phenobarbitol was.
Anyway, the statement that benzos are of great
value in the management of the withdrwal state
ensuing abstinence from alcohol or benzos or hypnotics,
begs the question in the case of benzos. Why,
would one want to get off benzos if they are
prescribed for these disorders so effectively?
Does the patient say, I no longer have a phobia,
or insomnia, or mania? And if that is the case,
how will the doctor distinguish between the
"underlying disease" having been cured by benzos,
and the assumption that time alone has cured it.
What medical criteria are there for these
diagnostic problems?4.1.5 Personality Disorders
I think this is a good assessment, and
takes into account very important aspect
of the patient's health such as physical
problems, drugs taken, and personal toleration
of these drugs. The voluntary aspect may
be something to consider too, and again where
panic is mentioned, a physical examination
should be stressed.4.1.2 Psychoses
I'm going to break here before continuing with
Psychoses.Squiggles
Posted by Rick on October 24, 2002, at 22:46:25
In reply to Re: My Klonopin (Clonazepam) isnt working at all!!!!! » Jefff, posted by Alan on October 19, 2002, at 23:02:14
Seriously, I've taken it for three years and haven't noticed any increase in iritability frequency or intensity except while taking it with other meds including Serzone and Provigil (both of which I like, BTW). Of course, YMMV. Maybe it's more likely to have this effect at higher doses or in combos.
Rick
P.S. I haven't read the whole thread, so my apologies if anything I've posted is redundant. No wait..why should I apologize? Why should I be expected to waste my time reading EVERYTHING??? Who do you people think you are, anyway?!?! <fume, fume>
Posted by utopizen on October 25, 2002, at 6:03:52
In reply to Re: RATIONAL USE OF BENZODIAZAPINES » Alan, posted by Squiggles on October 24, 2002, at 8:41:31
What I never got was why there's so many people on this board, including me, who have been working with a doctor for a while trying a lot of different drugs, and then don't get benzos, which are seen as a last resort by our docs.
Then we get to turn our heads and see benzo sales top so high other prescriptions. I mean, I can't even get Klonopin prescribed, and would never even bother asking my doc for something like Valium or Xanax. Yet sitcoms mention it like it's sold next to the hard candies, and somehow enough people get prescribed it to top sales listings. So why are people who resorting to boards like this everyday for help still not getting them, then people who probably couldn't spell them get them given without asking (as I assume, since so many are sold, and only a certain percentage are of those who bother to research these things).
Still, they do sedate, which I don't like...
Posted by Squiggles on October 25, 2002, at 8:13:14
In reply to Re: RATIONAL USE OF BENZODIAZAPINES, posted by utopizen on October 25, 2002, at 6:03:52
These observations may be personal. I think
that you are generalizing. Maybe there are
doctors who ARE prescribing them, but you are
not there at the scene to see it.Maybe there has been some influence from the
noisy Brits and Canadians about using caution
in prescribing them for every little thing.
(I have noticed some papers for example on
the elderly and how their driving may be
impaired in taking these drugs on the Internet
Mental Health network and McGill Research Dept.Is it possible that it is just your doctor
that does not think it advisable for you to
take them?Squiggles
Posted by Squiggles on October 25, 2002, at 9:18:38
In reply to Re: RATIONAL USE OF BENZODIAZAPINES » Alan, posted by Squiggles on October 24, 2002, at 8:41:31
OK - back again and continuing remarks on the
WHO document at 4.1.2:4.1.2 Psychoses
Organic Psychoses
a) Acute organic brain syndrome
BTW, i like the title of that, it's very general
indeed---what does it mean and how many conditions
does it cover? Also, is there inorganic brain
syndrome?I remember the 60s, when it is mentioned here
that benzos are used for LSD or hallucinogenic-
induced psychosis or "freaking out". Yup, my
friends had mentioned something - Valium i think
and i recall thinking--yikes! they want to take
another drug too!As for neuroleptics, i have read so many awful
things about them and their ability to induce
neuroleptic malignant syndrome, that i hope a
new edition of this document would get rid of
them altogether.
b) Chronic organic brain syndromeFirst they define this as dementia, then they
say that benzos are not good for it; since the
definition is so general, what if includes
something like Parkinson's or Alzheimer's
or any of the myriad other CNS disorders?Too general. Benzos may infact be good for
Parkinson's if THAT particular brain syndrome
presents with anxiety.Schizophrenia and related disorders:
Well, i should hope that by now there may be
new drugs for schizophrenia. I find the use
of benzos for catatonia rather pardoxical but
i'm no doctor.Other psychoses
4.1.3 Mood Disorders
Depression
I think they've got this one right; antidepressant
for depression with the adjunct benzo for the
effects of the antidepressant. Once stabilized
thought, one wonder why these drugs are given
prophylactically.. is this really necesssary?Mania
They've got this right too-throw out the
neuroleptics.
Once stabilized
thought, one wonder why these drugs are given
prophylactically.. is this really necesssary?
4.1.4 Drug and alcohol withdrawal syndromesYes, yes, yes. I don't know about alcohol, but
I can tell you pesonally, that in the case of
benzos, withdrawal should be tapered not only
with time (which is what I tried to do with the
Chunk-0-Meter) but with another benzo--e.g. Valium
or anything longer-life than the one you are
addicted to. With Xanax time was enough and I have
been told the withdrawal is relatively easy
because i was covered by the Rivotril. But with
Rivotril, time did not work; i should have tapered
off with Valium as Dr. Heather Ashton recommends.BTW, we have taken off the Chunk-0-Meter from
the Benzo group, because of the stroke or aneurysm
or whatever I got after 1 and a half yrs w/drawing
from 1.0mg Rivtoril. I think that time is not
enough. Again I did not know chlormethiazole was
used.
4.1.5 Personality disorderIf there is one thing that curls my hair, it's
"dependent personality disorder" and "emotionally
unstable personality disorder", and "Dahli fan
personality disorder", thouth this last one may
be an organic brain disorder indeed. Sigh...
well, at least they do not recommend drugs
for character.4.1.6 Suicidal patients
I don't know about this; maybe cocaine first or
something like it along with a benzo... a
sucidal person may be very depressed as well
as agitated - problem is how to turn that around
fast.
4.2 Other medical disorders4.2.1 Seizures
What are dissociative convulsions?
Status epilepticus - obviously you need
an anti-convulsant; but is manic depression
a species of epilepsy? Or was it the fashion
to just give it for accompanying anxiety or
GAD as it is affectionately called;4.2.2 Tardive dykinesia and akathisia
--
4.2.3 Somatic presentations
What are these? Is this what one of the people
at Benzo has - complaining of the entire body
being in pain from withdrawal of benzos?4.2.4 Muscle spasm
I think it was the vogue in the 70's to give
benzos for muscle pain; infact i think a relative
of mine was given these and got addicted. This
may explain the effects of addcition which looked
like an inexplicable state of anxiety and
rage. Benzos unless taken properly and on a
rigid program, can present with truly psychotic
episodes and behaviour. And nobody would suspect
it unless they knew the effects of intermittent
withdrawal, underdose, overdose, discontinuation,
etc. Muscle spasm, unless something medically
serious, should be considered as a minor ailment
for which benzos should be prescribed short-term
and some physiological therapy following it.
4.2.5Other indications
---
4.3 Symptomatic use4.3.1 Sleep disorders
Insomnia
I think this is the worst reason for giving benzos;
first of all the REM is changed, and your sleep
is crappy, but most importantly, the reason for
insomnia is not examined. The person, i bet you
more often woman gets hooked; it inevitably escalates
into addiction and having the responsibilities of
work and family the person has no choice.
But I think they realize this here.Disorders of arousal
--
4.4. Other situationsYup, this is excellent. Benzos should be used
as psychological ban-aids until the wound is
treated and healed.The next section is 5. (ADVERSE EFFECTS) hee hee!
(sorry to have to break now--i hope you can
follow it); BTW I wonder if this is the latest
version of WHO or a next one is coming up;
Squiggles
Posted by linkadge on October 25, 2002, at 19:07:38
In reply to Re: RATIONAL USE OF BENZODIAZAPINES » Alan, posted by Squiggles on October 24, 2002, at 8:41:31
For some reason I am under the impression
that Klonopin has dopamine raising effects,Kurt Cobain used this drug (probably abused it)
in his attempt to withdrawl from Heroin. In him it caused psychosis.Does anyone have information as to wheather this drug raises dopamine levels.
Linkadge
Posted by Ritch on October 25, 2002, at 20:11:44
In reply to Does Klonipin have dopamine effects, posted by linkadge on October 25, 2002, at 19:07:38
> For some reason I am under the impression
> that Klonopin has dopamine raising effects,
>
> Kurt Cobain used this drug (probably abused it)
> in his attempt to withdrawl from Heroin. In him it caused psychosis.
>
> Does anyone have information as to wheather this drug raises dopamine levels.
>
> LinkadgeI do not believe it does. I have heard it has a mild serotonergic effect. It is an anticonvulsant (albeit a benzodiazepine), and they can cause psychotic or "paradoxical" symptoms in a tiny subset of people. Behavioral side effects rank somewhat higher with clonazepam than the usual BZD sfx, from what I remember. Interestingly, the two benzos that have the strongest antimanic efficacy are clonazepam and lorazepam.
Posted by Squiggles on October 25, 2002, at 20:22:07
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (4.1.2) » Squiggles, posted by Squiggles on October 25, 2002, at 9:18:38
Hi,
back again: 5: ADVERSE EFFECTS
The benzos are favourably compared to ADs and
neuroleptics and considered safe and without
severe side effects. A brief look at the benzo
group will certainly contest this statement.
I have observed people getting off tricyclics
and SSRIs and as hard as that is, there is no
comparison with benzos. Benzos really should
be compared to heroin withdrawal. I've not yet
come to such variables as KIND of benzo, TIME taken,
and DOSE. These are decisive in the withdrwal
severity.In unmonitored, erratic dosing of benzos,
symptoms of psychosis may be indistinguishable
from the real thing (i.e. endogenous or non-benzo
related).
5.1 General adverse effectsAgain, I direct you to Ray Nimmo's site for
a collected array of side effects. I'm glad to
see the *falling* symptom here; when my Rivotril
dose was raised I got up from the chair and fell,
breaking my foot. I told my dr. i thought it
was the Rivotril that made me lose my balance but
it was hard to believe. Oh, and I am not elderly,
though I may look it by now :-).The inability to distinguish between adverse
effects and symptoms of underlying chronic diseases
is a good observation. However, this is a two-edged
sword, as the underlying chronic disease may take
precedence in the diagnosis to the the effects of
the benzos. This is particularly the case, in
withdrawal, sub-withdrawal, or erratic dosing, or
sudden stopping.
5.2 Withdrawal syndrome and dependence5.2.1 Withdrawal syndrome
Yes, they've got this right: only a therapeutic
dose is enough to cause withdrawal, given enough
time of taking the drug.The "nocebo" effect is nonsense. The rest is
very good. What is missing the "protracted withdrawal"
syndrome. This is even stranger than the paradoxical
and rebound phenomena.... my guess is that changes
take place in either the structure or the chemistry
of the brain, after the drug is used for a long time.
Stopping the drug, leaves the brain in a state that has
lost its initial equilibrium and either takes a very long
time (may GABBA receptors or dendrites have to regrow
or something) or equilibrium is never ever reached again.
Dr. Heather Ashton speaks of some long-term users suffering
motor effects for up to 15 years, for example.If you would like a personal example, I have had
diarrhea, and peripheral neuropathy as well as
tinnitus, and botched body temperature control since
the withdrawal... most of these after 2 years about,
have disappeared gradually fading.
5.2.2 DependenceThe definition should not concern a doctor so
much as a linguist. For purposes of medical
observation, cessation of the drug is followed
by very unpleasant and painful syndromes, which
can be reversed to some extent by reinstating
the drug. Call it "dependence" or "addiction"
or whatever; the main point is the practical
aspect of being on the drug, stopping the drug,
and reinstating the drug. It is true, there is
no craving, just extreme syndromes caused by
discontinuation.5.3 Overdose
I have heard, contrary to this "suicide-safe"
aspect of benzos, that with alcohol, they are
lethal. I recall a benzo member telling me how
much it would take, but I forget.
6. STRATEGIES FOR PRESCRIBING BENZODIAZEPINES6.1 Introduction
This is good advice, if followed.
6.2 General approach
I cannot find anything lacking or to disagree
with in this section. It's very wise. I would
only stress the necessity of monitoring and
carefully tapering the patient off, once the
treatment has been completed. Regarding the
chronic problems, such as panic disorder--i have
my reservations. I do believe that panic
and anxiety are symptoms and not a disorder itself.
Long-term treatment is very attractive for its
simplicity, but may be quite mistaken, by mistaking
the symptom for the sign.6.2.5 Discontinuation
Much can be learned from the Benzo group here.
I am glad to see that some physicians use
long-life benzos to get people off. The reduction
is smooth for some benzos but not others. The difference
between different benzos is not discussed here.
Again the "addictive" personality problem requiring
longer tapering, is at least insulting and at most
medically irresponsible.
6.2.6 Withdrawal managementThe time give 4-8-16 weeks worked for me for
Xanax at the therapeutic dose of 1.0 taken over
12 years or so. I still do not understand why
the clonazepam was so hard not just for me but
for many people reporting difficulty on the
Benzo group. Is its chemical structure different?
As an anti-convulsant, is this why i got a seizure
and myoclonic seizure as diagnosed by an emergency
doctor the year before (not my dr.).In general, i think this is quite good; part
of the problem is that physicians do not believe
that benzodiazepines can have such withdrawal effects,
and stick it to the "addictive personality" or
a hypochondriacal or hysterical patient. And, the
patient being in the majority women, this may
present a problem.
----got to go again--nest is 6.3 Special situations
Squiggles
Posted by Rick on October 25, 2002, at 22:24:26
In reply to Does Klonipin have dopamine effects, posted by linkadge on October 25, 2002, at 19:07:38
> For some reason I am under the impression
> that Klonopin has dopamine raising effects,Why is that? While many drugs can simultaneously have both pro and anti-dopaminergic effects, most studies have put Klonopin primarily in the latter category. Which in one way is odd, since both Klonopin and Dopamine Agonists are meds of choice in Restless Legs Syndrome.
> Kurt Cobain used this drug (probably abused it)
> in his attempt to withdrawl from Heroin. In him it caused psychosis.Like many psychotropics, Klonopin can have paradoxical effects in certain people, especially when the dose is high and it's combined with other agents. Even though Klonopin is sometimes used as an adjunct mood stabilizer, the following is an example of where it apparently induced mania:
DICP 1991 Sep;25(9):938-9
Mania associated with clonazepam.
Dorevitch A.
Faculty of Medicine, Hadassah Hebrew University, Jerusalem, Israel.
Clonazepam is a potent, long-acting benzodiazepine approved for use in myoclonic and petit mal seizures. Initial reports have demonstrated encouraging results with clonazepam in the treatment of acute mania as well as a favorable side-effect profile. A trial of adjunctive clonazepam was initiated in a 41-year-old patient with chronic schizophrenia. Two weeks later, while on an 8-mg dosage, he became manic, developing pressured speech, euphoria, inflated esteem, agitation, and insomnia. Initiation of electroconvulsive therapy with gradual tapering and discontinuation of the clonazepam resulted in amelioration of the manic episode and a return to his previous clinical status. Clinicians should be alerted to the potential of clonazepam to cause manic-like behavior in susceptible patients.
Rick
Posted by hiba on October 26, 2002, at 1:15:00
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » Squiggles, posted by Squiggles on October 25, 2002, at 20:22:07
Oh Dear Squiggles,
You are going far and far.
"In unmonitored, erratic dosing of benzos,
symptoms of psychosis may be indistinguishable
from the real thing (i.e. endogenous or non-benzo
related)"This is a wonderful finding. Do you have any scientific evidence to back this ? Benzos, if used for a long time in very high doses and stopped abruptly can cause a syndrome that resembles to psychosis.(But unlike stimulant psychosis which is irreversible, this can be reveresed and treated successfully). Is this what
you mean ? Some benzos in fact used to treat psycosis. Chlordiazepoxide, lorazepam and clonazepam for instance.
And if you have an access to ABPI DATA COMPENDIUM, please see the data sheets of antidepressants (especially tricyclics). You can see the warning: Tricyclics may cause activation of psychosis. Can you show me any such warning in benzodiazepine data sheets ?You are determined to rate benzo withdrawal as heroin withdrawal. I have witnessed many heroin and benzo withdrawals. And in the light of my experience, I can only laugh at your attempt. You are obsessed with the anti-benzo group.
About side effects: If you have experienced more side effects on benzos, you have a right to claim. But generally benzos are much much safer than hard antidepressants and all other medications used in psychiatric practice.. Pharmaceutical manuals (which you always refer in
your messages) will definitely clarify this.ABOUT WITHDRAWAL SYMPTOMS: Since you are not a Doc or clinical professional, I think it is better to give the reference along with your statements. I am not a Doc or professional . So I don't speak on my own. Let me quote American Psychiatric Association's Task force report on benzos:
"All psychiatric drugs, if taken for more than a brief period, may produce discontinuance signs and symptoms when abruptly stopped, and these symptoms may be an intensified recurrence of the original signs and symptoms, or may be the mirror image (for example, the opposite of the normal therapeutic effect of the drug). Sudden discontinuance of antidepressant drugs, for example, may produce a severe depression, rebound cholinergic symptoms, or agitation, or it may precipitate a manic state. Withdrawal dyskinesia is commonly seen after neuroleptics are abruptly stopped, and a recrudescence of manic symptoms has been reported after abrupt lithium termination." (Page 15)Then why should you blame benzos solely for dependence???
"What is missing the "protracted withdrawal"
syndrome."Oh! what is this? protracted withdrawal syndrome? Any scientific evidence to clarify this PROTRACTED? Plese don't quote those benzophobics or Dr. Ashton. There are enough pharmaceutical manuals which you would like to refer. Any hint from them? I can name some, if you need.
1. MARTINDALE:THE COMPLETE DRUG REFERENCE.2. PHYSICIAN'S DESK REFERENCE.
3. PHARMACOLOGICAL BASIS OF THERAPEUTICS.
4. ABPI DATA COMPENDIUM.
".... my guess is that changes
take place in either the structure or the chemistry
of the brain, after the drug is used for a long time.
Stopping the drug, leaves the brain in a state that has
lost its initial equilibrium and either takes a very long
time (may GABBA receptors or dendrites have to regrow
or something) or equilibrium is never ever reached again."You have your right to guess. But please don't impose them on patients in this board. Besides "GUESS" shouldn't always necessarily be right. The term GABBA for instance. It is not GABBA but GABA.(GAMMA-AMINOBUTYRIC ACID)Please check in your message.
I have personal experience of using benzodiazepines. I have used klonopin upto two years and gradually tapered WITHOUT ANY PROBLEMS AT ALL. Now I am afraid of those "PROTRACTED WITHDRAWAL SYMPTOMS"!!! I hope there will be a benzophobic to predict when I should begin to experience "PROTRACTED WITHDRAWAL SYMPTOMS".
If a benzo has made you sick, it is not fair to make all benzo users sick. There are millions who use benzos very effectively and benefit from them. Tell us your experience. It is welcome. But insisting on all patients should experience what you experienced is not fun at all.
About Ashton protocols: Her protocol is not working for everyone. The substitution of valium for xanax is not that effective. I have a friend who followed Ashton protocol to withdraw xanax and in his case it was an utter failure. Still I don't generalize this failure. But theoretically xanax is better substituted with klonopin. This is true in practice also.
Dr. Ashton is a single soul. I don't usually rely on such sole findings. Rather I will go for the combined work of scientists where there is only a very small possibility of error.. The references I named above are not the works a single scientist. They are compiled by some groups of reputed scientists.
Good luck Squiggles, Take care
HIBA
Posted by Squiggles on October 26, 2002, at 8:22:09
In reply to Re: Does Klonipin have dopamine effects » linkadge, posted by Rick on October 25, 2002, at 22:24:26
Interesting; while i was being treated
for hypothyroidism, and had been given
an excess dose, at one hospital reception
area i waiting to see the doctor; among
other symptoms like sweating, extreme hunger,
panic, grey palour, etc. i was also experiencing
what may have been a manic state--pacing
uncontrollably--i don't remember skipping my
Klonopin, though i may have. It sure looked
foolish and scary; it's very humiliating to
be under the adverse influence of drugs.Squiggles
Posted by Squiggles on October 26, 2002, at 10:32:44
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.), posted by hiba on October 26, 2002, at 1:15:00
> Oh Dear Squiggles,
>
> You are going far and far.
>--I would like to pause for a while here,
and consider the criteria and methodology
that are necessary in assessing the detrimental
effects of benzos.
>
> "In unmonitored, erratic dosing of benzos,
> symptoms of psychosis may be indistinguishable
> from the real thing (i.e. endogenous or non-benzo
> related)"
>
> This is a wonderful finding. Do you have any scientific evidence to back this ? Benzos, if used for a long time in very high doses and stopped abruptly can cause a syndrome that resembles to psychosis.(But unlike stimulant psychosis which is irreversible, this can be reveresed and treated successfully). Is this what
> you mean ? Some benzos in fact used to treat psycosis. Chlordiazepoxide, lorazepam and clonazepam for instance.
> And if you have an access to ABPI DATA COMPENDIUM, please see the data sheets of antidepressants (especially tricyclics). You can see the warning: Tricyclics may cause activation of psychosis. Can you show me any such warning in benzodiazepine data sheets ?
>--It seems clear that my personal testimony, no matter
how similar it may be with the evidence presented at the
Benzo group, is insufficient to convince you of the
typical effects of adverse, withdrawal, and protracted
aspects of this class of drugs. I do feel a bit like
a sock puppet in trying to defend this side. And before
i continue with the presentation of references, articles,
and statistics, i have to now that *some* sort of
evidence will satisfy you, and i am not just blowing
in the wind.
> You are determined to rate benzo withdrawal as heroin withdrawal. I have witnessed many heroin and benzo withdrawals. And in the light of my experience, I can only laugh at your attempt. You are obsessed with the anti-benzo group.Now now, no need to get personal.
>
> About side effects: If you have experienced more side effects on benzos, you have a right to claim. But generally benzos are much much safer than hard antidepressants and all other medications used in psychiatric practice.. Pharmaceutical manuals (which you always refer in
> your messages) will definitely clarify this.--I am not trying to defend my rights here. The effects
of prolonged benzo use, and the addictive nature of these
drugs is something that has been experienced by people
who have come together to discuss their common complaint from
many countries and many walks of life.
>
> ABOUT WITHDRAWAL SYMPTOMS: Since you are not a Doc or clinical professional, I think it is better to give the reference along with your statements. I am not a Doc or professional . So I don't speak on my own. Let me quote American Psychiatric Association's Task force report on benzos:
> "All psychiatric drugs, if taken for more than a brief period, may produce discontinuance signs and symptoms when abruptly stopped, and these symptoms may be an intensified recurrence of the original signs and symptoms, or may be the mirror image (for example, the opposite of the normal therapeutic effect of the drug). Sudden discontinuance of antidepressant drugs, for example, may produce a severe depression, rebound cholinergic symptoms, or agitation, or it may precipitate a manic state. Withdrawal dyskinesia is commonly seen after neuroleptics are abruptly stopped, and a recrudescence of manic symptoms has been reported after abrupt lithium termination." (Page 15)--This is true. But it is not in contradiction to discontinuation syndromes
with benzos as well. I have quoted the Merck before here and
The American Family Physician, and Goodman and Gillman's
Pharmaceutical Therapeutics on the addictive nature and need
for caution in benzo withdrawal, which also mention the
risk of seizure upon sudden discontinuation.
>
> Then why should you blame benzos solely for dependence???--I don't;
>
> "What is missing the "protracted withdrawal"
> syndrome."
>
> Oh! what is this? protracted withdrawal syndrome? Any scientific evidence to clarify this PROTRACTED? Plese don't quote those benzophobics or Dr. Ashton. There are enough pharmaceutical manuals which you would like to refer. Any hint from them? I can name some, if you need.
> 1. MARTINDALE:THE COMPLETE DRUG REFERENCE.
>
> 2. PHYSICIAN'S DESK REFERENCE.
>
> 3. PHARMACOLOGICAL BASIS OF THERAPEUTICS.
>
> 4. ABPI DATA COMPENDIUM.
>
>
> ".... my guess is that changes
> take place in either the structure or the chemistry
> of the brain, after the drug is used for a long time.
> Stopping the drug, leaves the brain in a state that has
> lost its initial equilibrium and either takes a very long
> time (may GABBA receptors or dendrites have to regrow
> or something) or equilibrium is never ever reached again."
>
> You have your right to guess. But please don't impose them on patients in this board. Besides "GUESS" shouldn't always necessarily be right. The term GABBA for instance. It is not GABBA but GABA.(GAMMA-AMINOBUTYRIC ACID)Please check in your message.
>
> I have personal experience of using benzodiazepines. I have used klonopin upto two years and gradually tapered WITHOUT ANY PROBLEMS AT ALL. Now I am afraid of those "PROTRACTED WITHDRAWAL SYMPTOMS"!!! I hope there will be a benzophobic to predict when I should begin to experience "PROTRACTED WITHDRAWAL SYMPTOMS".
>
> If a benzo has made you sick, it is not fair to make all benzo users sick. There are millions who use benzos very effectively and benefit from them. Tell us your experience. It is welcome. But insisting on all patients should experience what you experienced is not fun at all.
>
> About Ashton protocols: Her protocol is not working for everyone. The substitution of valium for xanax is not that effective. I have a friend who followed Ashton protocol to withdraw xanax and in his case it was an utter failure. Still I don't generalize this failure. But theoretically xanax is better substituted with klonopin. This is true in practice also.
>
> Dr. Ashton is a single soul. I don't usually rely on such sole findings. Rather I will go for the combined work of scientists where there is only a very small possibility of error.. The references I named above are not the works a single scientist. They are compiled by some groups of reputed scientists.
> Good luck Squiggles, Take care--The virtue of studies and observations taken by
doctors like Dr. Heather Ashton, are the advantage
of long-term studies of addicts of benzodiazepines.
Her clinic in London ran withdrawal cases for more
than 12 years. I think that should be regarded as
an opportunity (solitary as it may be) rather than
an abberation in benzo studies.Once again, what kind of evidence would you like?
Statistical evidence can only be gathered by
testimonials of people who have taken these drugs
for a long time. Would you rather rely on the
behaviour of rats over a period of 3 months, under
the supervision of Hoffman LaRoche or Eli Lilly's
white-coats?I confess, that I have considered the possibility
that in my case, perhaps the reason I had such
severe withdrawal, may have been something else
like White Nile Virus, or cancer, or brain tumour;
when I suspected the XANAX to be causing my panic
attacks, the doctors i saw first thought Celexa might
do the trick; but I after reading the Merck, and
studying the books on the net, I was pretty sure
that the cause was inter-dose withdrawal of long-term
addiction to Xanax. Infact, one pharmacist actually
suggested to my dr. that i had been taking Xanax too long;
So, I demanded to get off Xanax. And hard as it was
to get off, once I did, I have not had a panic attack since.
Doh!Regarding the Rivotril, as i said, Ashton and other
addiction centres, even this WHO manual recommend
another benzo or another drug to be gotten off.
I did it with time. It did not work. Possibly,
it may have, had I been gotten off with another
drug. The question with Rivotril is whether i
need it at all or not; the fact that my doctor
let me try to get off, is evidence to me that
there was some doubt about its necessity in the
first place.Squiggles
> HIBA
>
>
>
>
>
>
>
>
Posted by Dr. Bob on October 26, 2002, at 12:06:00
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.), posted by hiba on October 26, 2002, at 1:15:00
> in the light of my experience, I can only laugh at your attempt. You are obsessed with the anti-benzo group.
Please be sensitive to the feelings of others and don't post anything that could lead them to feel accused or put down, thanks.
> You have your right to guess. But please don't impose them on patients in this board.
Please respect the views of others -- even if you think they're wrong. Whom then to trust can be a hard (and subjective) question:
http://www.dr-bob.org/babble/faq.html#trust
But I think the people here, especially with input (including alternative points of view) from others, can make up their own minds.
Bob
PS: Follow-ups regarding posting policies, and complaints about posts, should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by BrittPark on October 26, 2002, at 12:21:03
In reply to Re: Does Klonipin have dopamine effects » Rick, posted by Squiggles on October 26, 2002, at 8:22:09
The problem with boards like this is that, for the most part, people report negative results. The weight of clinical evidence is that benzos are safe for both short and long term use and that withdrawal symptoms are mild to non-existent if discontinuation is handled slowly.
I've taken very large doses of both clonazepam and alpralozam (up to 6mg/day) on several occasions and have never had any withdrawal symptoms when discontinuing.
My 2 cents,
Britt
Posted by viridis on October 26, 2002, at 13:13:09
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » hiba, posted by Squiggles on October 26, 2002, at 10:32:44
Hi Squiggles,
I'm sorry to hear that you had such a bad experience with benzo withdrawal, and I know that some people do react in very negative ways. However, the weight of scientific evidence indicates that withdrawal for most can be managed very effectively by slow taper and careful supervision. You spoke in an earlier post about "variables" and "objectivity". When dealing with medications, the patients themselves are major variables in the sense that different people have different reactions to both the drugs and discontinuation of the drugs, whether you're talking about benzos, ADs, blood pressure meds, or most other classes of medications.
I haven't attempted benzo withdrawal, and have no plans to do so in the near future, since Klonopin has been so beneficial for me in terms of anxiety, depression, and general quality of life. So, I can't offer any personal experience there. However, I can relate my pdoc's experiences and advice based on his use of benzos for numerous patients, both short and long-term. He screened me very carefully before prescribing benzos, explained that medical dependency was likely to develop, and said that he is very alert to signs of escalating dosage and misuse (although he was also very willing to increase the dose if appropriate). After well over a year at the same low dose of Klonopin (1 mg/day) plus occasional Xanax, he and I are very pleased with the results. When I asked him about what would happen if I decided to discontinue it, he said that he's rarely seen a problem as long as the withdrawal is gradual. He emphasized that these are not drugs that should be stopped suddenly, but said that supervised withdrawal is generally quite straightforward in his experience.
For me, though, he predicts that discontinuation would return me to the same pattern of anxiety/ panic attacks/ severe depression that I've experienced since childhood. I'm not willing to live that way any more (and I expect it would shorten my life -- not that I'm suicidal, but chronic anxiety takes a toll on a person's mental and physical health). Approaches such as antidepressants, therapy, alternative treatments, and lifestyle changes were of no or limited use, or actually made things worse (SSRIs, Wellbutrin). So for me, long-term use of Klonopin seems like the most sensible option, and my pdoc agrees.
Posted by Squiggles on October 26, 2002, at 13:59:53
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » Squiggles, posted by viridis on October 26, 2002, at 13:13:09
I think you have come to an amiable and
satisfactory solution to your anxiety problem
with your doctor. And your doctor sounds
well-informed.Klonopin (i hate to repeat myself so many times),
is not likely to produce the inter-dose withdrawals
that Xanax does. I have never had such, except
when after 7 yrs. my dr. raised the dose upon
strange somatic complaints. They differ.Please understand that my aim is not to proselytize
against benzos. I am not anti-benzo. Just as the
WHO document attempts to draw outlines for the
rational and cautious prescription of these drugs,
so I too, try to make footnotes from my experience
and my collaboration at the Benzo group on personal
discoveries and experiences.Once again, the amount of dose, the length of time,
the abruptness of cessation, and the increase or non-increase
of dose over time, are variables that will influence
the severity of withdrawal with these drugs. I can
tell you that after 2 years getting off K is not the same
as trying to get off after 15.As for side effects, with K, I do notice edema,
and dyspnea. When I was taking Xanax as well,
the dyspnea and apnea was so bad that I would wake
up gasping at night. That's a polypharmacy quirk.I will continue with the WHO document, sometime this
weekend, since I started.Cheers
Squiggles
Posted by Rick on October 26, 2002, at 15:22:55
In reply to Re: Does Klonipin have dopamine effects, posted by BrittPark on October 26, 2002, at 12:21:03
> The problem with boards like this is that, for the most part, people report negative results.
This is a great point that bears regular repeating. Clearly, someone who is, or has, had severe withdrawal (or even addiction) difficulties is much more motivated to write, either looking for support/advice and/or to share their experiences as a good-intentioned warning to others. (And there's also the occasional benzophobe who is making the whole thing up for effect, though I don't get the impression that this happens much on this board). While those with significant difficulty may represent a pretty small proportion of responsible benzo users who taper off appropriately, there are so many benzo users in total that the absolute number of bad experiences is large.
Rick
>The weight of clinical evidence is that benzos are safe for both short and long term use and that withdrawal symptoms are mild to non-existent if discontinuation is handled slowly.
>
> I've taken very large doses of both clonazepam and alpralozam (up to 6mg/day) on several occasions and have never had any withdrawal symptoms when discontinuing.
>
> My 2 cents,
>
> Britt
>
Posted by Squiggles on October 26, 2002, at 15:23:18
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » viridis, posted by Squiggles on October 26, 2002, at 13:59:53
I notice here a point that has been laboured
through this discussion--withdrawal syndrome
occurring at therapeutic dosage:"During the 1960s, withdrawal symptoms were
reported to occur upon discontinuation of long-term
use of benzodiazepines at doses several times
higher than the usual therapeutic dose. More
recently, a number of studies have shown that
withdrawal syndromes can occur even at therapeutic
doses." [p. 20]The syndromes are described and my point that
ideally they should be used symptomatically and
not for long-term is noted. I notice also the
point about respiratory distress. Do they know
why? It is remarked here that in general it is
a contraindication. When I was searching for the
reason why I had panic attacks and dyspnea at night,
I came across an article on respiratory suppression
by benzos, and also another article by an anesthsiologist
who described the benzos as having the effect of
respiratory suppression. Bingo, I said to myself.
Now, if you say that this happens with some people
and not others depending on their age, etc. I will
grant you that any drug, to have an effect required
both the taker and the drug; it is a two-way street,
just as all interactions between a and b are; but this
is also the case with aspirin or any other substance.
It is the case with coffee or milk for that matter.
And if you say that such effects depend on the subject
alone, you are eliminiating the chemical aspect of the
drug for which it is designed, i.e. a human or animal
organism, with a particular area of the brain as target.
Therefore, it should not be surprising that an
anti-depressant effects the brain, whereas a Beta-blocker
effects the vascular system, and predictably in similar
ways.6. STRATEGIES FOR PRESCRIBING BENZODIAZEPINES
a) Screening instruments
I imagine these are questionnaires?
b) The Clinical Interview
I am very happy to see the inclusion of examining
the patient for prior history of dependence on
drugs and comorbid psychiatric disorders. However,
just because we are doing psychology here, does
not mean that there should not be an examination
of PHYSICAL COMORBID DISORDERS. I don't see this
here. For example, hyperthyroidism, heart disease,
etc.c) General Medical Evaluation
This is a projection of the possible problems
of prescribing benzos.d) Physical Examination
This is a one sentence vague proposal for a general
examination. I think the variety of conditions
that induce anxiety and panic, should be outlined;
there are many.
May I suggest that the age of the person, and in
cases where ethnic background has an effect on the
metabolism of benzodiazepines be considered in the
initial examination.
6.2.5 DiscontinuationThe protracted withdrawal syndrome is omitted.
And the re-emergence of an initial anxiety state
is presumed.
These are grave errors.Not all benzos are the same in effect of
withdrawal. I have yet to see the papers which
must exist on what is different about an anxiolytic
and an anti-convulsant - chemically.6.2.6 Withdrawal management
Any kind of management would be humane and welcome.
These drugs have been taken very lightly, and I don't
think that doctors are aware of how serious the withdrawals
are. In a letter to the Health Minister, the
Hon. Alan Rock, and in a similar letter to Hoffman
LaRoche and Upjohn, i had suggested, as a consumer,
that the problem was serious enough to merit the
opening of clinics for withdrawal. I think the
doctors are well-meaning but too busy, considering
the enormous amount of prescriptions for this
3rd ranking class of drugs on the market. Ha!For programs and schedules, see Ray Nimmo's site
www.benzo.org.
6.3.1 and 6.3.2The consideration for children and elderly is
good and the fact that benzos can be more potent
in CNS disorders in these age groups. However,
the age of elderly and children is not defined.6.3.3 Pregnancy
Yes, this is well written; the embryopathy that
is discussed may be damaging to the brain what the
Benzo group call cited many cases of "floppy baby syndrome".
This is discussed here too. They should be used
with caution if at all.6.3.4 Alcohol
I don't know much about this; I have noticed
a compounded effect with a glass of wine or
beer and so if i drink, I drink 1/2 a glass
with dinner or not often. I have heard that benzos with
alcohol are an effective means of suicide,
assuming you do not throw up - not sure of
the dose.6.3.5
Same here, though I imagine they are used
to come down from stimulating drugs. That
would not be a bad thing.
7. SOCIAL AND ECONOMIC ISSUES7.1 Attitudes
The discussion on the public's negative perspective
of people taking benzos must be something someone
did a thesis or research on. I think that all
psychiatric drugs are viewed with some suspicion.
I know someone who was denied insurance on the grounds
of taking an AD, for example.In general the discussion of moral and social
aspects is very extensively covered in David Oaks'
SCI advocacy groups. It's too huge to talk about
here.
9. SUMMARY AND RECOMMENDATIONSActually, I think this is a good report in general;
I would like to see the protracted syndrome mentioned.
And I have a question: have opiates been considered
instead of benzos for similar disorders?And finally, a personal question:
Is clonazepam prescribed for manic depression because
manic depression is considered a species of
epilepsy? Does anyone know why clonazepam is so
difficult to withdraw from (after many years?).I hope that the careful and well-researched
aspects of this report can actually be put
into practice. I believe that doctors in general
may be too busy to follow guidelines like this,
but let us hope; who knows, maybe the pharmaceutical
concerns will see some advantage in assisting
with prescription and withdrawal.I'd like to thank you for letting me know
about this document and for letting me take up
so much bandwidth to comment on it.Squiggles
Posted by Rick on October 26, 2002, at 15:38:18
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » Squiggles, posted by viridis on October 26, 2002, at 13:13:09
For the most part, my pdoc's reaction was the same. He's been prescribing benzos for 20 years,and says that as long as I never exceed 3 mg Klonopin (I'm nowhere near that, BTW), it's not very likely a slow withdrawal will present significant difficulty.
He actually preferred that I be treated with an AD, but not becuase of dependence or addiction concerns. Instead, it's because he feels that some benzos, especially Klonopin, are "dumb drugs." (The extent to which that's true is another issue for debate.) But at this point, he feels, "whatever works" is the way to go. Although, every once in awhile he asks if I'd like to try Tranxene (clorazepate) again instead of Klonopin. (I'm starting to digress here...) Of course I always give a quick "no" to that suggestion. I don't think Social Anxiety is one of his areas of specialty, although I like the fact that he's cautiously open-minded about treatment alternatives. E.g., at my request, he recently agreed to let me try adding hydergine to my regimen. (That stuff sure isn't easy to find in U.S. pharmacies, at least in my area!)
> Hi Squiggles,
>
> I'm sorry to hear that you had such a bad experience with benzo withdrawal, and I know that some people do react in very negative ways. However, the weight of scientific evidence indicates that withdrawal for most can be managed very effectively by slow taper and careful supervision. You spoke in an earlier post about "variables" and "objectivity". When dealing with medications, the patients themselves are major variables in the sense that different people have different reactions to both the drugs and discontinuation of the drugs, whether you're talking about benzos, ADs, blood pressure meds, or most other classes of medications.
>
> I haven't attempted benzo withdrawal, and have no plans to do so in the near future, since Klonopin has been so beneficial for me in terms of anxiety, depression, and general quality of life. So, I can't offer any personal experience there. However, I can relate my pdoc's experiences and advice based on his use of benzos for numerous patients, both short and long-term. He screened me very carefully before prescribing benzos, explained that medical dependency was likely to develop, and said that he is very alert to signs of escalating dosage and misuse (although he was also very willing to increase the dose if appropriate). After well over a year at the same low dose of Klonopin (1 mg/day) plus occasional Xanax, he and I are very pleased with the results. When I asked him about what would happen if I decided to discontinue it, he said that he's rarely seen a problem as long as the withdrawal is gradual. He emphasized that these are not drugs that should be stopped suddenly, but said that supervised withdrawal is generally quite straightforward in his experience.
>
> For me, though, he predicts that discontinuation would return me to the same pattern of anxiety/ panic attacks/ severe depression that I've experienced since childhood. I'm not willing to live that way any more (and I expect it would shorten my life -- not that I'm suicidal, but chronic anxiety takes a toll on a person's mental and physical health). Approaches such as antidepressants, therapy, alternative treatments, and lifestyle changes were of no or limited use, or actually made things worse (SSRIs, Wellbutrin). So for me, long-term use of Klonopin seems like the most sensible option, and my pdoc agrees.
Posted by Alan on October 26, 2002, at 15:41:05
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » viridis, posted by Squiggles on October 26, 2002, at 13:59:53
> Once again, the amount of dose, the length of time,
> the abruptness of cessation, and the increase or non-increase
> of dose over time, are variables that will influence
> the severity of withdrawal with these drugs.
================================================
And if I may interrupt, here is of where much of the misunderstanding lies within the tightly knit anti-benzo movement.Since an individual's respose to a drug is so highly idiosyncratic as to the above mentioned points, especially regarding psychotropics, not just bzds, it is virtually impossible to extrapolate that these variables apply to the population in general. They are mere basic medical guidelines that don't increase the risk TO THE INDIVIDUAL as implied by the anecdotal and highly indiviual adverse responses to these meds as reported by a small minority of the population at benzo.org and similar sites.
Statistics and pharmacokenetic curves in some texbook or pharmrep presentation do not apply to the individual - which becomes quite evident when one understands that these medications are so highly effective IF PRESCRIBED, DIAGNOSED, AND MANAGED properly....or to directly use the words of the report..."Used rationally".
The key complaint is that Benzo.org-like sites seize on risk appropriate to the individual and then mistakenly generalises for the population.
So what does the average consumer think when they read this? Where does it leave their naturally anxiety ridden, hyperaroused, med phobic minds? Oh! This must apply to me...extrapolating in the same style by example of that which the benzo.org folks have already (mistakenly) used as their model.
Terribly misleading as to proportionality of risk/benefit assesments applied to any medication much less bzds. What is particular unethical is the exploitation of the "A" word (addiction) when it is used as a pejorative.
Refusing to accept the distinction to "sustained medical dependence" is a conscious choice to continue exaggeration of risk to the individual consumer. The term "Addiction" is used as inflammitory rhetoric to push an agenda that would otherwise be a relative non-issue.
This is not to minimise those cases that have bad experiences coming off of bzds but to acknowledge that it happens to a small minority of the poulation henceforth the use of "RATIONAL USE" as the title of the report.
Alan
Posted by Alan on October 26, 2002, at 15:44:26
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » viridis, posted by Rick on October 26, 2002, at 15:38:18
How do you use hydergine? and what has it done for you re: your dx. I take Klon maint. and ativan PRN for breakthrough with GAD and SAD.
Thanks!
Alan
Posted by Rick on October 26, 2002, at 16:31:03
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » Rick, posted by Alan on October 26, 2002, at 15:44:26
Just started it about ten days ago. Take 3mg/day of generic ergoloid mesylates. That's the max recommended by the FDA; my pdoc says he's gone as high as 6 mg. I know in Europe it's typically given in higher doses, e.g. 9 mg/day.
It's too early to report any results. I've noticed some mild improvement in memory, and some added "calm alertness," but at such an early stage these could very well be coincidences/placebo effects -- although I certainly hope it's a sign that the med is starting to work for me. If indeed it works, the effects of hydergine are said to be quite gradual. I sure haven't experienced any side effects, other than some barely-noticeable nausea at first and less-variable blood pressure (a good thing).
At the moment the only other psychotropic med I'm on is my mainstay daily Klonopin (1 mg, all first thing in a.m.), for non-depressive social phobia.
I'll report back as the experiment continues.
Rick
> How do you use hydergine? and what has it done for you re: your dx. I take Klon maint. and ativan PRN for breakthrough with GAD and SAD.
>
> Thanks!
>
> Alan
Posted by Rick on October 26, 2002, at 16:59:01
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » Squiggles, posted by Alan on October 26, 2002, at 15:41:05
Well said!
In additional to the irrational reasons you and others have cited, I believe that some of today's benzophobia was fueled by the early days of benzos -- especially Valium -- when many GP's would indiscriminately hand them out like candy. You had people coming in with what was clearly a depressive, rather than anxious, disorder, and the doc would throw benzos at the patient.
Long before I had ever heard of social phobia (even though I sure had it!), I asked a college counselor to prescribe something to help me get through job interviews without shriveling and quavering. She refused, but later left me a note which included a reluctant prescription for Valium. (I guess I've always been good at laying guilt trips.) I was completely naive to anything but over-the-counter drugs at that point, and found the Valium useless -- not even a placebo effect.
I'm so glad different benzos have different properties, because for my social phobia the difference between Valium (or my pdoc's "beloved" Tranxene) and Klonopin is night-and-day.
BTW, in all fairness to Tranxene (drugs have feelings, too, y'know), I understand it can very smooth and effective for GAD.
Rick
> > Once again, the amount of dose, the length of time,
> > the abruptness of cessation, and the increase or non-increase
> > of dose over time, are variables that will influence
> > the severity of withdrawal with these drugs.
> ================================================
> And if I may interrupt, here is of where much of the misunderstanding lies within the tightly knit anti-benzo movement.
>
> Since an individual's respose to a drug is so highly idiosyncratic as to the above mentioned points, especially regarding psychotropics, not just bzds, it is virtually impossible to extrapolate that these variables apply to the population in general. They are mere basic medical guidelines that don't increase the risk TO THE INDIVIDUAL as implied by the anecdotal and highly indiviual adverse responses to these meds as reported by a small minority of the population at benzo.org and similar sites.
>
> Statistics and pharmacokenetic curves in some texbook or pharmrep presentation do not apply to the individual - which becomes quite evident when one understands that these medications are so highly effective IF PRESCRIBED, DIAGNOSED, AND MANAGED properly....or to directly use the words of the report..."Used rationally".
>
> The key complaint is that Benzo.org-like sites seize on risk appropriate to the individual and then mistakenly generalises for the population.
>
> So what does the average consumer think when they read this? Where does it leave their naturally anxiety ridden, hyperaroused, med phobic minds? Oh! This must apply to me...extrapolating in the same style by example of that which the benzo.org folks have already (mistakenly) used as their model.
>
> Terribly misleading as to proportionality of risk/benefit assesments applied to any medication much less bzds. What is particular unethical is the exploitation of the "A" word (addiction) when it is used as a pejorative.
>
> Refusing to accept the distinction to "sustained medical dependence" is a conscious choice to continue exaggeration of risk to the individual consumer. The term "Addiction" is used as inflammitory rhetoric to push an agenda that would otherwise be a relative non-issue.
>
> This is not to minimise those cases that have bad experiences coming off of bzds but to acknowledge that it happens to a small minority of the poulation henceforth the use of "RATIONAL USE" as the title of the report.
>
>
> Alan
>
>
Posted by Squiggles on October 26, 2002, at 18:02:18
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » Squiggles, posted by Alan on October 26, 2002, at 15:41:05
The pejorative and loaded use of the word
"addiction" occurs only amongst the most
radical reactionaries and bible thumpers.
Not all are of this group on Benzo.As for the extrapolation to all people;
if you grant me that this group is a group
which has experienced withdrawal and addiction
with benzos, then i will grant you that you
have knowledge of a counter-group which has
not.Comparing notes may be interesting, given
the same variables.Squiggles
Posted by Alan on October 26, 2002, at 23:17:11
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » Alan, posted by Squiggles on October 26, 2002, at 18:02:18
> The pejorative and loaded use of the word
> "addiction" occurs only amongst the most
> radical reactionaries and bible thumpers.
> Not all are of this group on Benzo.Anyone that does not, but indeed outright refuses to make the medical distinction between "addiction" (which appears too many times to count on the websites of this nature) and "pharmcological dependence" is using it out of ignorance or as a pejorative. It is not wordsmithing as you have suggested earlier because not only the word is changed but the fundamental concept behind the word is entirely different.
The deliberate blurring of the lines of these distinctions by these groups is actually the glue that holds their speculative ramblings together. Without them, poof! Their rationale disappears. There is no foundation in which to support their house of cards.
>
> As for the extrapolation to all people;
> if you grant me that this group is a group
> which has experienced withdrawal and addiction
> with benzos, then i will grant you that you
> have knowledge of a counter-group which has
> not.
>
> Comparing notes may be interesting, given
> the same variables.
>
> SquigglesEverybody experiences withdrawal in degrees of severity. It is the hallmark of drugs that build tolerance. Ad's are no different.
Well the problems are many-fold. Two that come immediately to mind are:
1) Addiction is not the proper word to use in the "rational" use of bzds, only when in circumstances that they were misprescribed, used to get from high to high, and most importantly sought out by the individual reflecting the attitude towards the drug of seeking a high -predisposed or not.
2) If they are "addicted" and indeed in the same way like those withdrawing from illicit drugs such as heroin and cocaine ("information" that these groups like to strut around infront of the public like a badge of honour), then these folks don't even equate with the panic population that use the drug properly for legitimately diagnosed anxiety disorders that have very little of the dire risk of severe withdrawal symptoms that this group extrapolates for!
So from where I stand, the middle ground stands right where I've laid it out. One doesn't compromise what is known to be true in a barter for what is known not to be.
Thanks but I'll pass.
Alan
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