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Dr. Bob is Robert Hsiung, MD,
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Posted by special_k on April 2, 2006, at 7:15:49
In reply to Re: Is Valium more potent than Xanax? » ed_uk, posted by Meri-Tuuli on April 2, 2006, at 3:37:20
hmm.
and now the people come out to play...
so... valium can take a couple days in your system.
does that explain why i puked my guts out at a cocktail party the other night?????
dammit.
Posted by Sobriquet Style on April 2, 2006, at 7:47:17
In reply to Re: Is Valium more potent than Xanax?, posted by bassman on April 1, 2006, at 8:08:34
>In answer to a previous question in this thread, there are oodles of references out there that people that use benzos so they can function generally decrease their dosage as time goes on. If anyone finds that interesting and doesn't want to Google/etc. it, I'd be glad to find some references.
I've been trying to obtain some medical studies about people being maintained on Benzo's longterm (especially Diazepam) and not building tolerance to the anxiety effects. Basically something that will challenge what is said by Ashton at benzo.org.uk.
If you can provide any new information about this, it would be extreamly helpful for me, I've read over 200 studies about benzo's being used longterm and can't find any studies that I need (studies newer than the 1980's!)
~
Posted by bassman on April 2, 2006, at 11:13:09
In reply to Re: Is Valium more potent than Xanax? » bassman, posted by Sobriquet Style on April 2, 2006, at 7:47:17
I hope these will be of help:
Schweizer et al. (58) have conducted an 8-month, placebo-controlled study of continuation therapy for panic disorder with alprazolam and imipramine that found sustained efficacy for both compounds with no dose escalation, suggesting an absence of tolerance to the therapeutic effect
Preliminary evidence for the efficacy of continuation therapy of GAD comes from two studies (43, 47). In both studies the benzodiazepine therapy achieved sustained remission of anxious symptomatology with no tolerance and no dose escalation over a 6-month period.
http://www.acnp.org/G4/GN401000129/CH127.html
A total of 136 patients received clonazepam nightly for a mean 3.5 (+/- 2.4) years, with no significant difference in initial versus final mean dose: 0.77 mg (+/- 0.46) versus 1.10 mg (+/- 0.96). Similar results were obtained with chronic alprazolam treatment and with other benzodiazepine treatments. CONCLUSION: Long-term, nightly benzodiazepine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep resulted in sustained efficacy in most cases, with low risk of dosage tolerance, adverse effects, or abuse.
Fifty-nine panic disorder patients originally randomized to treatment in a controlled trial comparing alprazolam, clonazepam, and placebo were reevaluated in a follow-up study. At a mean follow-up of 1.5 years, 78% of patients remained on medication and the mean dosage of alprazolam and clonazepam did not increase.A 15 year study:
Maintenance medication was common. No benzodiazepine abuse was reported. CONCLUSION: PD has a favourable outcome in a substantial proportion of patients. However, the illness is chronic and needs treatment. The short-term treatment given in the drug trial had no influence on the long-term outcome.I think this is interesting because it basically says the physicians are quite prejudiced concerning benzo use, even when it comes to outcome. Who knows the benefits better, the physician or the patient? That’ s easy.
The participants were 93 patients over 60 years of age using a benzodiazepine for insomnia and 25 physicians comprising sleep specialists, family physicians, and family medicine residents. The main outcome measure was perception of benefit and risk scores calculated from the mean of responses (on a Likert scale of 1 to 5) to various items on the survey. RESULTS: The mean perception of benefit score was significantly higher in patients than physicians (3.85 vs. 2.84, p < 0.001, 95% CI 0.69, 1.32). The mean perception of risk score was significantly lower in patients than physicians (2.21 vs. 3.63, p < 0.001, 95% CI 1.07, 1.77). CONCLUSIONS: There is a significant discordance between older patients and their physicians regarding the perceptions of benefits and risks of using benzodiazepines for insomnia on a long term basis. The challenge is to openly discuss these perceptions in the context of the available evidence to make collaborative and informed decisions.
The Task Force Report, although over 10 years old, is still a standard reference for benzodiazepine use. Its points—that there is undue reluctance to use minor tranquillizers, and that many people are undertreated—still hold, and are borne out by the Roy-Byrne study. Other relevant literature includes a review of 2719 adult out-patient charts2 (medical and psychiatric) for evidence of benzodiazepine abuse that found no patients meeting the criteria. Another study, of long-term alprazolam users, found no dose escalation with long-term use.3 Tyrer’s 19884 paper on minor tranquillizers notes an absence of evidence that benzodiazepine dependence leads to dangerous long-term sequellae, and blames "excessive media attention" for distortion of scientific attitudes.
http://fampra.oxfordjournals.org/cgi/content/full/20/3/347
Benzodiazepines are relatively safe drugs that are probably under- rather than overprescribed. Periodic reassessment of chronic users is appropriate, although generalized anxiety disorder and panic disorder are chronic conditions for which long-term treatment may be necessary. In the more recent era of safer antidepressants, these agents may be able to supplant minor tranquillizers for the control of chronic anxiety in many patients. Long-term benzodiazepine use is appropriate for some patients.
http://fampra.oxfordjournals.org/cgi/content/full/20/3/347
Tolerance is the need to increase the dose of a drug to maintain the desired effects. Tolerance to the anxiety-relieving effects of benzodiazepines is uncommon and most individuals do not increase their benzodiazepine dose
Posted by zeugma on April 2, 2006, at 12:28:54
In reply to Re: Is Valium more potent than Xanax? » SLS, posted by ed_uk on March 31, 2006, at 16:46:24
It's often noted than the benzodiazepines differ more in their pharmacokinetics than in their pharmacodynamics.>>
Hi Ed.
The often-noted greater prevalence of depression as a result of clonazepam relative to other benzos, would appear to disprove this.
BTW I have not experienced depressive symtoms from clonazepam, and the problems I have had with sleep architecture disruption would be common to all benzodiazepines (as far as I know). Benzos suppress NREM stages 3-4 preferentially, presumably as part of their mechanism of anticonvulsant action, and they incidentally reduce REM because one normally enters REM after cycling through NREM stages 1-4. Blockade of NREM 3-4 in someone who does not exhibit this pattern, however, will experience increased REM by means of a process analogous to displacement in physics (if you put a bar of soap in a tub full of water, the tub will overspill, even though no water has been added).
It is a common misconception that benzos block REM, as an intrinsic property of theirs, as evidenced by an authoritative survey I have in my file, which contains many other inaccuracies, but which I will linger on now.
-z
Ed
Posted by ed_uk on April 2, 2006, at 13:37:40
In reply to Re: Is Valium more potent than Xanax?, posted by bassman on April 1, 2006, at 18:00:23
Hi B
It seems common for people to take the XR every 12 hours. XR meds often don't seem to last as long as they're supposed to.
Ed
Posted by ed_uk on April 2, 2006, at 13:39:21
In reply to Re: Is Valium more potent than Xanax? » ed_uk, posted by Meri-Tuuli on April 2, 2006, at 3:37:20
Hi
GPs always refused to prescribe me PRN diazepam, even in small quantities. Pathetic really. You might be able to get some from your new pdoc.
Ed x
Posted by ed_uk on April 2, 2006, at 13:49:18
In reply to Re: Is Valium more potent than Xanax? » ed_uk, posted by zeugma on April 2, 2006, at 12:28:54
Hi Z
>The often-noted greater prevalence of depression as a result of clonazepam relative to other benzos, would appear to disprove this
I don't know. It seems to be more depressing than Xanax, but is it more depressing than the other benzos? Xanax seems to be somewhat unique.
Regards
Ed
Posted by zeugma on April 2, 2006, at 14:29:01
In reply to Re: Is Valium more potent than Xanax? » zeugma, posted by ed_uk on April 2, 2006, at 13:49:18
hello Ed,
this is something I didn't expect to find:
Eur Neuropsychopharmacol. 2003 Mar;13(2):129-34.
Clonazepam in the long-term treatment of patients with unipolar depression, bipolar and schizoaffective disorder.Winkler D, Willeit M, Wolf R, Stamenkovic M, Tauscher J, Pjrek E, Konstantinidis A, Schindler S, Barnas C, Kasper S.
Department of General Psychiatry, University Hospital for Psychiatry, Wahringer Gurtel 18-20, A-1090, Vienna, Austria. dietmar.winkler@akh-wien.ac.at
The value of a long-term treatment with clonazepam in the prophylaxis of affective disorder is discussed controversially in the scientific literature. Altogether there are only a few reports on the use of this compound as a mood stabilizer, most of them describing patients suffering from bipolar affective disorder. The aim of this investigation was to evaluate clonazepam as a phase prophylactic medication in affective disorder. We conducted a retrospective chart review in 34 out-patients of our lithium clinic (15 suffering from unipolar depression, 15 from bipolar disorder, four from schizoaffective disorder), who had been treated with clonazepam as a long-term medication. Clonazepam was either given as monotherapy, or as in the case of lithium non-responders, as adjunctive therapy. Patients with unipolar depression had significantly (P=0.026) less depressive episodes after initiation of treatment with clonazepam. Patients with bipolar disorder did not benefit from this therapy. Neither manic/hypomanic phases nor depressive episodes were reduced in this group of patients. Interestingly, clonazepam also reduced affective phases in our four schizoaffective patients on a trend level. Our results indicate that patients with unipolar depression may benefit from a maintenance treatment with clonazepam. Due to methodological limitations our results need to be replicated in controlled double-blind randomized clinical trials.
>>>>>>>>>>>>>>>>>>>>>>>>>>>
nfortunately, there really is very little literature on clonazepam and depression, other than anecdotal reports here, in which I have seen far more frequent attributions of depression to clonazepam than to any of the other benzos. It is difficult to find literature on the possible antidepressant or depressant effects of other benzodiazepines other than alprazolam and adinazolam.
-z
Posted by ed_uk on April 2, 2006, at 15:14:50
In reply to Re: Is Valium more potent than Xanax? » ed_uk, posted by zeugma on April 2, 2006, at 14:29:01
Hi Z
Clonazepam has been looked at to 'augment' antidepressants. I think the research was Japanese.
>reports here, in which I have seen far more frequent attributions of depression to clonazepam than to any of the other benzos
That's true. Most babblers compare it to Xanax though. In many cases they haven't taken any other benzodiazepines.
>Patients with unipolar depression had significantly (P=0.026) less depressive episodes after initiation of treatment with clonazepam. Patients with bipolar disorder did not benefit from this therapy. Neither manic/hypomanic phases nor depressive episodes were reduced in this group of patients. Interestingly, clonazepam also reduced affective phases in our four schizoaffective patients on a trend level. Our results indicate that patients with unipolar depression may benefit from a maintenance treatment with clonazepam.
That's interesting. I would not consider clonazepam to be a 'mood stabiliser'. There seems to be a trend to refer to all antiepileptics as mood stabilisers, even in the absense of evidence.....Topamax being the most obvious example today..........gabapentin a few years ago.........probably Keppra next.
Kind regards
Ed
Posted by SLS on April 2, 2006, at 15:39:52
In reply to Re: Is Valium more potent than Xanax? » zeugma, posted by ed_uk on April 2, 2006, at 15:14:50
Clonazepam + lithium was more effective than lithium alone in treating my manic reaction to Parnate + desipramine.
- Scott
Posted by zeugma on April 2, 2006, at 16:52:01
In reply to Re: Is Valium more potent than Xanax?, posted by SLS on April 2, 2006, at 15:39:52
> Clonazepam + lithium was more effective than lithium alone in treating my manic reaction to Parnate + desipramine.
>
>
> - Scotthi Scott,
did you only take clonazepam acutely? and if not, what effect did it have?
-z
Posted by Sobriquet Style on April 2, 2006, at 18:09:51
In reply to Re: Is Valium more potent than Xanax?, posted by bassman on April 2, 2006, at 11:13:09
>I hope these will be of help:
I am extreamly grateful, thank you :-)
~
Posted by bassman on April 2, 2006, at 18:31:02
In reply to Re: Is Valium more potent than Xanax? » bassman, posted by Sobriquet Style on April 2, 2006, at 18:09:51
My pleasure. I hope you can get your doc to be reasonable...that's a pet peeve of mine when docs make patients "beg" for medication, because, of course, they know so much better. A month of severe anxiety and depression for them to educate them, I say. :>}
Posted by SLS on April 2, 2006, at 18:45:13
In reply to Re: Is Valium more potent than Xanax? » SLS, posted by zeugma on April 2, 2006, at 16:52:01
> > Clonazepam + lithium was more effective than lithium alone in treating my manic reaction to Parnate + desipramine.
> >
> >
> > - Scott
>
> hi Scott,
>
> did you only take clonazepam acutely? and if not, what effect did it have?
I took clonazepam for 6-12 months. I can't remember exactly. I was also taking Nardil for most of that time. I really don't know what to say other than it helped with sleep and was difficult to discontinue. I wish I had the insight then that I have now regarding the management of withdrawal symptoms. I went through hell.More recently, an attempt at using clonazepam acutely as a sleep aid did make my depression somewhat worse.
The last time I tried using a benzodiazepine (lorazepam) for sleep, I found that it made me more depressed the day after my first dose. However, this depressogenic effect disappeared after a few days.
- Scott
Posted by Phillipa on April 2, 2006, at 19:55:55
In reply to Re: Is Valium more potent than Xanax? » bassman, posted by ed_uk on April 2, 2006, at 13:37:40
Ed that's exactly what a pdoc said. And they have to take regular xanax in between. It doesn't release exactly at the rate it should Love PJ O
Posted by Phillipa on April 2, 2006, at 20:03:18
In reply to Re: Is Valium more potent than Xanax? » ed_uk, posted by Phillipa on April 2, 2006, at 19:55:55
What do you do if you regularly suffer from panic attacks. Did you ever have one you can't even breathe. Love Phillipa
Posted by Meri-Tuuli on April 3, 2006, at 5:51:29
In reply to So If You Live In The UK? » Phillipa, posted by Phillipa on April 2, 2006, at 20:03:18
Its awful. I have no idea what GPs do when they get patients with aniexty problems. I guess try them on BuSpar, but.. then what? And thats not even recommended for panic. I reckon they just put people on an SSRI/TCA and thats it.
My 'mother in law' is on valium, she gets it no problem -- but I think that is because she has been on it for most of her life so the GPs view that completely differently. As for us young 'uns, benzo = forget it.
Sigh. It makes me so mad we can't get the pysch medication we need here in the UK.
Posted by Sobriquet Style on April 3, 2006, at 8:16:49
In reply to Re: Is Valium more potent than Xanax?, posted by bassman on April 2, 2006, at 18:31:02
>that's a pet peeve of mine when docs make patients "beg" for medication, because, of course, they know so much better.
I know exactly what you mean!
:-)
~
Posted by ed_uk on April 3, 2006, at 14:06:15
In reply to Re: So If You Live In The UK? » Phillipa, posted by Meri-Tuuli on April 3, 2006, at 5:51:29
Hi Meri
>Its awful. I have no idea what GPs do when they get patients with aniexty problems. I guess try them on BuSpar, but.. then what? And thats not even recommended for panic. I reckon they just put people on an SSRI/TCA and thats it.
BuSpar is hardly ever prescribed. SSRIs are widely used for panic disorder. Older docs often prescribe dothiepin (a tricyclic). Have you ever tried a tricyclic?
>My 'mother in law' is on valium, she gets it no problem -- but I think that is because she has been on it for most of her life so the GPs view that completely differently. As for us young 'uns, benzo = forget it.
That's exactly right. Elderly women who have been on diazepam (Valium) for many years generally have little problem getting prescriptions. Young people (especially men I believe) are treated very differently. I've actually seen prescriptions for ONE 2mg diazepam tablet. Geez, I need at least 10mg per dose.
Regards
Ed
Posted by Meri-Tuuli on April 3, 2006, at 15:07:55
In reply to Re: So If You Live In The UK? » Meri-Tuuli, posted by ed_uk on April 3, 2006, at 14:06:15
Hello Ed!
> BuSpar is hardly ever prescribed. SSRIs are widely used for panic disorder. Older docs often prescribe dothiepin (a tricyclic). Have you ever tried a tricyclic?
No I haven't. I daren't touch them, as I'm sleepy enough on SSRIs let alone a tricyclic -- I could sleep for 16 hours a day on 20mg of celexa. I believe the tricyclics are quite sedating? I need the opposite! : )
A friend of mine is on Dothiepin, and she does very well on it. I think she even got a benzo from her GP for panic, although I don't know which one/how much. I've emailed her to ask. I'm desperate not to have another one!!
I don't know how we're supposed to cope. Why are GPs so incredibly anti-benzo? I know they are addictive etc but to not prescribe them when they are clearly needed? And why are SSRIs the answer?? They're not! They are pretty bad. I haven't taken one thats helped my anxiety!! And anyway, SSRIs aren't exactly an easy ride when coming off them.
Anyway I still can't believe that my GP doesn't think that ADs are suitable 'in my case'. He doesn't even know which ones I've tried!!!!!!!! Well anyway, the whole establishment with GPs is totally pathetic. I know more about pysch meds than they do. It gets me really mad. Like suicide is the second/third cause of death for young people (I can't remember the exact stats) and what does anyone on the NHS do about it? Nothing!! There should be mental health support groups at every GPs surgery, there should be better counselling services, CBT courses etc etc, but there isn't anything. Well I suppose CPNs but I never found mine particulry useful. Yet I bet if that suicide stat was for say, breast cancer, there would be sooooo much more money and resources availble. Yet suicide is still abit taboo, and somehow the person who did its fault. People don't see it as a diease, they see it as a charactor flaw. Grrrrrrrr
Anyway, sorry to rant on! I should put my ranting energy into something useful, although I've already written a letter to my health centre manager to complain about the mental health services. But I don't what to rock the boat too much, I have to go there....LOL!
>Young people (especially men I believe) are treated very differently. I've actually seen prescriptions for ONE 2mg diazepam tablet. Geez, I need at least 10mg per dose.
I wonder why men specifically? Maybe anxiety is still percieved as primarily a womens disorder.
Oh well.
Take care,
Meri
x
Posted by yxibow on April 3, 2006, at 15:08:10
In reply to Re: So If You Live In The UK? » Meri-Tuuli, posted by ed_uk on April 3, 2006, at 14:06:15
> That's exactly right. Elderly women who have been on diazepam (Valium) for many years generally have little problem getting prescriptions. Young people (especially men I believe) are treated very differently. I've actually seen prescriptions for ONE 2mg diazepam tablet. Geez, I need at least 10mg per dose.
I was going to say ___ out of luck, but Ed put it more politely. Seems the same as lists of things in Australia from what I can tell -- including a government of big brother over movies, which we used to have in the US until it was self-regulated.Its really atrocious that life enhancing and saving medications (i.e. getting housebound people out into the public), even the smallest dose of benzodiazepines are disdained upon by the NHS. Of course maybe one could circuitously freeze this by going to a private doctor. But I imagine the costs would be much greater than NHS.
Of course I speak as a user of (prescribed) high dose benzodiazpines (for a specific disorder that is quite atrocious), but I used to take lower doses frequently in the past of things like Klonopin to augment antidepressants, etc here in the US. Yes, we have the looming DEA, but if you present a good case to a doctor you're likely to get some response for necessary medications. And then we pay more here too, since we don't have the NHS or Canada to regulate drug prices. Argh...
My 2c
-- Jay
Posted by ed_uk on April 3, 2006, at 15:48:07
In reply to Re: So If You Live In The UK? » ed_uk, posted by yxibow on April 3, 2006, at 15:08:10
Hi Yxi
At one point, benzodiazepine prescribing was used as one of several factors which were used to compare 'good prescribing' between primary care trusts in England. Areas in which benzo prescribing was high were assigned the lowest 'marks'.
GPs may try to force patients off benzos in order to meet NHS targets and improve their ratings.
Benzophobia is extreme in the UK. One GPs I saw sneered 'I never prescribe drugs like THAT'. He even had the cheek to tell me than my pdoc should never have prescribed me a benzo.
Most English doctors believe that the long term use of benzos is never valuable and that patients must be withdrawn ASAP. Withdrawing from benzos is (rather nauseatingly) seen as a great necessity, even in people who are apparantly doing well on benzos. Having taken a benzo seems to be viewed as something to keep quite about. Almost as if it was shameful.
Ed
Posted by Meri-Tuuli on April 3, 2006, at 15:49:25
In reply to Re: So If You Live In The UK? » ed_uk, posted by yxibow on April 3, 2006, at 15:08:10
Hi Jay!!
> Its really atrocious that life enhancing and saving medications (i.e. getting housebound people out into the public), even the smallest dose of benzodiazepines are disdained upon by the NHS. Of course maybe one could circuitously freeze this by going to a private doctor. But I imagine the costs would be much greater than NHS.
Well, the NHS costs nothing. We pay a set fee for all drugs, which is about $9 per script, no matter whats being prescribed! But, obviously, we pay more tax, the NHS is funded through tax, but it is free to everybody and generally nobody really has private operations. Unless its for cosmetic reasons... As much as I moan about the NHS, I do generally think it is a good thing. I would hate to have to pay for my healthcare directly and I even think it morally wrong in a way. I mean, I couldn't believe that people in the US actually beg for money to have an operation - I saw this on a trip there. But then, if you have the money, you get the healthcare that you need as opposed to here where they are pretty bad for mental healthcare... But that said, I think the NHS is pretty good for everything other than mental health.... I mean what do you do in America if you have cancer and can't afford to pay for treatment? Do you just have to accept it? I don't know, I honesty can't imagine having to worry about paying directly for my healthcare or having health insurance.... it somehow seems wrong to me.
But then I'm not entirely sure I would like to have it like in the US where people are on a cocktail of 5 pysch meds. That just seems plain scary to me. I don't know. I sometimes think that the med companies push their drugs abit too hard onto GPs and patients. American doctors (and patients?) seem abit too pill happy for me.
Maybe a middle ground between the US and the UK would be good.
Take care
Meri
>
> Of course I speak as a user of (prescribed) high dose benzodiazpines (for a specific disorder that is quite atrocious), but I used to take lower doses frequently in the past of things like Klonopin to augment antidepressants, etc here in the US. Yes, we have the looming DEA, but if you present a good case to a doctor you're likely to get some response for necessary medications. And then we pay more here too, since we don't have the NHS or Canada to regulate drug prices. Argh...
>
>
> My 2c
>
>
> -- Jay
Posted by Meri-Tuuli on April 3, 2006, at 15:53:49
In reply to Re: So If You Live In The UK? » yxibow, posted by ed_uk on April 3, 2006, at 15:48:07
Ed.
Wow, I didn't know that! Sigh. But aren't benzos 'safer' than SSRIs?? I mean, they have been around a very long time. Certainly, SSRIs haven't been around that long.
I wonder if it is the same in other European countries??
M
> Hi Yxi
>
> At one point, benzodiazepine prescribing was used as one of several factors which were used to compare 'good prescribing' between primary care trusts in England. Areas in which benzo prescribing was high were assigned the lowest 'marks'.
>
> GPs may try to force patients off benzos in order to meet NHS targets and improve their ratings.
>
> Benzophobia is extreme in the UK. One GPs I saw sneered 'I never prescribe drugs like THAT'. He even had the cheek to tell me than my pdoc should never have prescribed me a benzo.
>
> Most English doctors believe that the long term use of benzos is never valuable and that patients must be withdrawn ASAP. Withdrawing from benzos is (rather nauseatingly) seen as a great necessity, even in people who are apparantly doing well on benzos. Having taken a benzo seems to be viewed as something to keep quite about. Almost as if it was shameful.
>
> Ed
>
>
>
Posted by ed_uk on April 3, 2006, at 16:00:32
In reply to Re: So If You Live In The UK? » ed_uk, posted by Meri-Tuuli on April 3, 2006, at 15:53:49
Hi
>I wonder if it is the same in other European countries??
Maybe some, but I think it's worse here. Benzos are apparantly readily available in some European countries. Italy, Spain, Greece.... I think.
Ed x
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