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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by miss amor on December 15, 2003, at 16:38:18
Just wanted a little advice, i am pretty new to the site and am amazed at how knowledgable many of you are. i on the other hand havent really done very much research on my own disorders or medicines. until very recently i thought the dr would surely do the right thing for me and have since been let down. so my question is this: i have gad, ocd. was thought to have add, but strongly disagree with this. i have taken benzo. meds and ssui's in past. that is actually why i found this site, i was looking for opinions on the lastest drug my dr suggested-lexapro. and from what i found here made my own decision not to even try it out. i was first prescribed prozac at age 21 and it did not work well with me and i didnt even take it an entire month. that was the first med i had tried and i thought screw this, and didnt even bring up meds for a yr and half. my dr prescribed klonopin to me .5mg 2xday. he said was very low dose and should help with my anxiety and ocd. he said more the anxiety we were trying to treat. ( i cant seem if i get very anxious and then began my obsessing/compulsing or if all the obs/comp is what makes me anxious??) i was very anxious to try any meds, but also trusted mr dr. ( had been dr 15+ yrs.) the klonopin (or clonzepam) did seem to work really well and i took it consistantly for 2 months, then went to india for a trip and decided not to take it at all. which worked out fine. i had no side effects or withdrawls or anything like that. so about 4 months after returning from travels i moved, got new job and dr. my anxiety was bascially paralyzing me and had panic attack (a whole new thing to me.) so i then asked my new dr to prescribe klonopin to me. she did with several refills and said i should taper off when my anxiety subsides. i took the klonopin daily for four months and called her one day when i had a horrible panic attack. i just told her that i dont think i should have them if i am being treated with med. and taking it properly (before i had been a little sparatic and taking lots of med holidays.) she called in a prescription for xanax and also paxil. i really knew nothing of paxil and thought it was probably like klonopin. i went to website and was happy to take it! i thought it looked great. it made me feel so crazy i couldnt stand it. it also lasted all day and my se's would barely subside even late in the day. after one week i couldnt do it anymore, i hated the way i felt. so i called her and left a message that the paxil was too crazy for me and i would resume taking klonopin. when her nurse returned my phone call i found that she had left the country for holiday. ( this was very recent) so her associate called me back and i was very freaked out that the dr. would give me such a med, tell me nothing of what i should expect from taking it and leave the country. the new dr. called in xanax and said to quit taking the paxil and set an appt with her for following week. when i went to appt. i told her i wanted to keep taking klonopin (1mg per day) and xanax when needed. she flipped out and said they were so addictive and made me feel really weird. she then gave me prescription for effexer (i said no) then zoloft ( i said no) then lexapro~she promised it wasnt like other ssui. she kept refusing to give me the medicine i asked for (klonopin.) so thats when i researched lexapro and found such horrible se's that i called her and told her no i wasnt filling it or taking it. i explained how klonopin was doing really well just when i had extreme anxiety or panic it didnt help that so i would take xanax or alprolzam when i needed it. she thought i had lost my mind and acted like i was trying to get drugs to either get high? or sell? thats what i figured. if i wanted to get f*cked up id take some of the paxil or prozac i have and drink a bottle of wine. my question is do some ppl not have the same drawing to become addicted. i never asked for an increase and have yet (month 5) on klonopin developed tolerance. also i took ritalin for 1.5 yrs and the dose never increased and i never abused it, like some ppl do with this type of drug. also when i get pain meds i dont even take them, probably 1/4 of the recommended dose. and i think both of those drugs are considered addictive. i just am wondering if i am kidding myself that i am not going to get addicted to any meds. i have just started therapy and plan to get taper off if needs be when i feel the time is appropiate. i dont plan to take anything besides my liquid vitamin every day for the rest of my life. i anticipate your responses. thanks in advance.
Posted by MelD on December 15, 2003, at 19:22:47
In reply to always addictive?, posted by miss amor on December 15, 2003, at 16:38:18
I imagine you will get varied opinions on this, but i can only tell you my own experience with Klonopin. I have been taking it over 15 years, usually at .5mg for sleep. I have taken vacations from it, increased to 1mg on occasion when things were tough and then backed down to .5 with no problem and i have also occasionally taken .5 during the day for extreme anxiety. Ive never had any trouble with withdrawal, building up a tolerance or dependence. Best of luck to you, Melodie
Posted by KellyD on December 15, 2003, at 20:15:35
In reply to Re: always addictive?, posted by MelD on December 15, 2003, at 19:22:47
I am in big agreement with MelD. Klonopin has been good for me. It is the ONLY med I take. If anxiety is your primary problem, benzo's are approiate treatment for some. Careful use and monitoring is required, but, they can be used very well in some individuals - even for long term treatment.
You need to do some research on addiction versus phyical dependence and the DIFFERENCE..... and present this to your Dr. and if that doesn't work... find a new Dr.
There is much misinformation about the approiate use of benzo's and their role in treatment of anxiety based disorders. Education to disspell this misinformation will probably never be adequate and benzo's will probably always get a bad reputation.
Posted by Viridis on December 16, 2003, at 0:02:47
In reply to Re: always addictive?, posted by KellyD on December 15, 2003, at 20:15:35
These issues with benzos keep coming up here, and the bottom line is that there simply isn't any evidence that benzos are addictive for the vast majority of users. However, they do cause medical dependency, just like all sorts of other medications do.
Addiction is a situation in which a person craves a substance, becomes obsessed with it, usually increases the dose despite negative consequences, etc. -- in other words, loses control and lets the drug become the center of their life (think cocaine etc.).
Dependency means that your body becomes used to a substance and if you decide to quit it, you have to reduce the amount gradually. This applies to benzos, most antidepressants, some blood pressure meds etc.
Although a few people do become "addicted" to benzos (Xanax seems to carry the highest risk, and Klonopin one of the lowest) this isn't too common. If your doctor is monitoring you properly and sees signs that you want more and more, then he or she will probably want to re-evaluate your use. But many people stay on the same dose of Klonopin etc. for years with no change in usage pattern or dose (me, for example).
One comment that my psychiatrist made was intereresting -- he's cautious with benzos but will prescribe them when he thinks it's appropriate. He said that the people who really need benzos the most seem to be the ones least likely to abuse them. I suspect that most of the misuse that does occur is with people who didn't necessarily need benzos in the first place, but find that they have a euphoriant effect and want more. I don't get any euphoria from them, just anxiety relief, and if I take more than a normal dose it just makes me sleepy. Others here who benefit from benzos seem to have similar reactions.
I certainly wouldn't discontinue Klonopin suddenly (and don't want to quit anyway, since it's helped so much), but dependency is a small price to pay for the relief from constant anxiety and panic. Besides, I'd have the same concerns if I were taking Paxil, Effexor, and so on. Of course, these meds aren't labelled as "addictive", probably because they're still under patent and heavily promoted, whereas the benzos are available dirt-cheap as generics.
Benzodiazepines have a very long track record of safety and effectiveness, and it's a shame they get slammed so often by people (including doctors) who don't know any better.
Posted by scott-d-o on December 16, 2003, at 0:32:50
In reply to Re: always addictive? » KellyD, posted by Viridis on December 16, 2003, at 0:02:47
Agree entirely with your post. What is most frustrating is when you know a drug like Klonopin is very helpful for you, however, you learn very quickly that requesting a benzo by name is a sure way to get a dirty look and be thrown out of the office. However, if you don't, the doctor (whom is uneducated and I wouldn't let prescribe a med for my cat) is likely to put you back on zoloft and say you didn't give it a long enough trial (2 months in my case), or say you need to try brand of med that is in the same f'ing class of meds (SSRI), even though in the past it increased your anxiety, caused terrible insomnia, and gave you panic attacks. As you can see, I'm somewhat bitter.
Posted by gabbix2 on December 16, 2003, at 1:20:46
In reply to always addictive?, posted by miss amor on December 15, 2003, at 16:38:18
Here's a link to a post I found particularly eloquent on this subject I actually brought it to my own Dr.
http://www.dr-bob.org/babble/20021223/msgs/133706.htmlYou might find the entire thread interesting. There are several such threads in the archives. Everything else I have to say has already been said in this one. Seems you have found yet another Doctor offering you marketing fueled "healthcare"
Posted by scott-d-o on December 16, 2003, at 6:43:42
In reply to Re: always addictive? » Viridis, posted by scott-d-o on December 16, 2003, at 0:32:50
Now that it has been established that benzodiazepines are not addictive and only dependency can develop I think a more interesting question is how did benzo's get such a bad reputation? After requesting Klonopin, I honestly had a pdoc tell me that Klonopin was the same thing as Xanax which he referred to as a "street drug" and said was "more addictive than heroin", which almost caused me to burst out laughing and ask where he received his doctorate (I want to go there, it must be easy as sh*t.)
Who thinks its because companies that hold SSRI's on patent are whispering "benzo's are addictive, prescribe more SSRI's," over and over into their ears?
Or is it because they *are* sold on the black market. The only reason being because they are bought either by people who are suffering and can't get a prescription because of this myth and it is the only way to find relief, or by people whom are abusing street drugs, who are going to continue to abuse those drugs whether they get the benzo or not.
scott
Posted by KellyD on December 16, 2003, at 7:33:35
In reply to how did it get this bad?, posted by scott-d-o on December 16, 2003, at 6:43:42
> Now that it has been established that benzodiazepines are not addictive and only dependency can develop I think a more interesting question is how did benzo's get such a bad reputation?
~ I think there are many answers to that question and a number of them began many years ago with, indeed, inapproiate prescribing - I think they are "addicting" to certain individuals. Interestingly, the media is always quick to report anybody's "addiction" to anything and it almost will always likes to report of a benzo "addiction". Though, this is getting replaced with the pain killer "addiction".
Widespread misinformation is more available than anything positive on the the use of benzos - ie: the famous UK site. There are more published studies to support the "addiction" findings than the long term "good outcome" findings.... sadly.
>After requesting Klonopin, I honestly had a pdoc tell me that Klonopin was the same thing as Xanax which he referred to as a "street drug" and said was "more addictive than heroin", which almost caused me to burst out laughing and ask where he received his doctorate (I want to go there, it must be easy as sh*t.)~Bad information is more harmful than good.
> Who thinks its because companies that hold SSRI's on patent are whispering "benzo's are addictive, prescribe more SSRI's," over and over into their ears?
~ Money does get attention in these matters.
> Or is it because they *are* sold on the black market. The only reason being because they are bought either by people who are suffering and can't get a prescription because of this myth and it is the only way to find relief, or by people whom are abusing street drugs, who are going to continue to abuse those drugs whether they get the benzo or not.
~ A bit of both, I guess. Again, back to inapproiate vs. approiate use. Drs. are very keen on the liability issues involved - people misuse, doctors get sued, a nasty situation.
~ I wish I thought things would improve and the resistance for use in correct situations wouldn't be there. But, I don't see change on the horizon. The mindset is well, set, for a number of Drs. and people are suffering because of it...
Best to you. Good question - complicated answers.
Posted by scott-d-o on December 16, 2003, at 9:50:44
In reply to Re: how did it get this bad? » scott-d-o, posted by KellyD on December 16, 2003, at 7:33:35
> > Who thinks its because companies that hold SSRI's on patent are whispering "benzo's are addictive, prescribe more SSRI's," over and over into their ears?
>
> ~ Money does get attention in these matters.
>Thanks for the response, my personal opinion is that the above is the *main* reason although they all have contributed something. It seems a majority of the drugs currently under patent never get labeled with addiction like the benzodiazepines do. However, I see more people on this board complaining of withdrawl from Effexor, yet I have never seen any claims of it being addictive, and pdocs will hand them out like they could cause no more harm than a tic-tac. Yes, you could say Effexor is prescribed more often now, but it is also a relatively new drug so people withdrawling from it have not been on it very long. Whereas with Klonopin I have seen people at the same dose for over 20 years who were then able to taper off *very slowly* with minimal side effects. I'm not a conspiracy theorist but I am positive there is way too much going on 'under the table' here and a lot of it involves money. I'm sure the situation currently going on with the lawsuit against the manufacturer of Neurontin that accuses them of rewarding doctors for writing the most prescriptions goes on more often than not, but someone who should be doing something about it is turning their head the other way and getting paid to do so.
Posted by miss amor on December 16, 2003, at 10:38:10
In reply to Re: how did it get this bad? » KellyD, posted by scott-d-o on December 16, 2003, at 9:50:44
thank you for your responses-i love all of your input. i had another question about benzo. meds- taking 1mg a day, is it better to take all at once or break up the dosage? my dr. said to take 2 x's per day. but then has asked me how i take it almost every time i go, asks me how it works out better for me, morning, night or when. i was thinking to take it all in the evening, since it lasts so long in system, but was wondering how others take it, also it being a pretty small dose i think. thanks!
Posted by scott-d-o on December 16, 2003, at 10:56:02
In reply to Re: how did it get this bad? » KellyD, posted by scott-d-o on December 16, 2003, at 9:50:44
I should also add that the evidence corruption is going on is evident in the stark contrast you see between the doctor's office and just about every anxiety message board on the internet. At the doctor's office most all you hear is "benzo's are addictive", however if you go on these message boards most of what you will hear is "benzo's saved my life" with an occasional complaint of addiction. I can't say I have seen very many success stories resulting from the use of the SSRI's. In fact, my personal belief is that they are entirely *ineffective* in 100% of true anxiety disorders since I believe an anxiety disorder manifests itself as a dysfunction of the GABA system, not of the serotonin system. Every other drug that has ever shown high efficacy in treating anxiety disorders has affected GABA or at the very least the balance between GABA and Glutamate; even the MAOI Nardil does. I do not doubt that SSRI's are effective in some people for depression, OCD, and even premature ejaculation in men. However, I believe the people who have found relief from anxiety as a result of the SSRI's just had depression which was causing *symptoms* of anxiety. Depression can cause a lack of self-esteem, motivation, etc. that can *cause* anxiety. IMO, anxiety caused by depression or OCD is not the same thing as an anxiety *disorder*. However, there is a definite grey area there where a patient could easily be misdiagnosed.
My opinion is that the 20% or so of the people that SSRI's were shown to be effective for over placebo in the trials to get them approved for these uses were a result of misdiagnosis. Also, as is also cited in the lawsuit against Neurontin's manufacturer Parke-Davis, it is not hard for a drug company to pay for several inexpensive clinical trials and make sure only the ones that show the drug to be effective are the ones that get published. I should also add I think the result of all this is a great injustice not only to the patient but to the manufacturers of the first benzodiazepines. It is quite a shame that the company that invented Klonopin and is responsible for helping so many people probably didn't even make back the money to cover it's R&D costs on developing it since it could only market it as an anticonvulsant. Yet every SSRI manufacturer is filthy rich because of the mighty dollar and a corrupted system.
Okay, I've said my peace now and apologize for rambling on. :-)
Posted by KellyD on December 16, 2003, at 11:47:40
In reply to Re: how did it get this bad?, posted by miss amor on December 16, 2003, at 10:38:10
I have experimented with this (when I take my dosing) and for me, I generally split mine up - AM and afternoon. If I take it once a day, I usually take it in the afternoon. I tritate my dosing as to how I feel or what is going on in my life, so I use a range, as opposed to a "set in stone" dose. That's just what works for me. For the first six months or so, I did a set dose AM and PM. After that I could go up or down within a range and I've never had to go over the top number of mgs. in almost 2 years of use.
I find my mornings are pretty good and I have more symptoms of my anxiety toward late evening and at night.
We are all different and you'll work it out as to what works best for you, may take a bit of experimenting.
Posted by scott-d-o on December 16, 2003, at 13:47:27
In reply to Re: how did it get this bad?, posted by miss amor on December 16, 2003, at 10:38:10
> thank you for your responses-i love all of your input. i had another question about benzo. meds- taking 1mg a day, is it better to take all at once or break up the dosage? my dr. said to take 2 x's per day. but then has asked me how i take it almost every time i go, asks me how it works out better for me, morning, night or when. i was thinking to take it all in the evening, since it lasts so long in system, but was wondering how others take it, also it being a pretty small dose i think. thanks!
I would really have to know which benzo you are taking to answer that question since all of them have a different half-life. However, I think that for whichever med you happen to be taking, for a generalized anxiety disorder, meaning *not* situational or acute anxiety (such as panic attacks), a low-dose should be taken in the morning. If one pill causes fatigue, you should split the pill in half. If this still causes fatigue, you should split it into forths. If a benzo causes you to become fatigued or tired at the smallest dosage you can possibly take then you probably do not have an anxiety problem and should not be taking a benzodiazepine. Find a new doctor and ask them to look for other possible causes of your anxiety. Take only enough of a benzo in the morning to remove anxiety and that is it. Take it at night as well only if you are then still having problems with night-time anxiety which is causing insomnia. Some people only have to take Klonopin once a day since it has the longest half-life of all the benzo's, however, any other benzo will most likely have to be taken more than once a day. However, I wouldn't recommend anything but Klonopin for this type of disorder but then again I guess I'm not really qualified to recommend anything at all since I'm not a M.D.
People that have panic attacks usually use a benzo with a very short half-life like Xanax because it's half-life is very short so it kicks in quicker. The general consensus is that Xanax is harder to withdrawal from but as I said before I believe that *no benzo is addictive*. I'm sorry but anyone who says otherwise does not know the medical definition of the word.
Posted by jbs on December 16, 2003, at 21:36:19
In reply to Re: how did it get this bad? » miss amor, posted by scott-d-o on December 16, 2003, at 13:47:27
Fact: benzos are a drug of abuse in the street; they have a street value.
Fact: every doctor has been had by a savy benzo abuser (that sticks in their memory).
Fact: Doctors who are found to have prescription patterns for benzos which are markedly different then their peers, will generally be investigated by the DEA
Fact: some states make benzo writing an unwelcoming prospect for a doctor (eg NY state triplicate prescriptions with no refills.)These are the things that discourage pdocs from prescribing benzos more frequently; coming into their office, refusing to try anything but the benzo, isn't gonna come off well, even if it's right!
Posted by scott-d-o on December 17, 2003, at 3:30:52
In reply to Med seeking, legal issues., posted by jbs on December 16, 2003, at 21:36:19
> Fact: benzos are a drug of abuse in the street; they have a street value.
Yes, but my argument is that the only reason they have this street value is *because* of this myth. If doctors were just as tight on SSRI prescriptions as they are on benzodiazepines then I'm sure they would have a street value as well.
> Fact: every doctor has been had by a savy benzo abuser (that sticks in their memory).
So their belief is others should suffer because of this fact?
> Fact: Doctors who are found to have prescription patterns for benzos which are markedly different then their peers, will generally be investigated by the DEA
Exactly my point, why do you think the DEA singles out these meds?
And for that matter, why should a doctor even be worried if he honestly feels the patient needs the med. What can the govt do to a doctor to punish him if there is no way he could have known that the patient was lying about not abusing the med? How can they accuse a doctor of not knowing that a patient was lying to them? They are doctors, not polygraph machines. These companies that have SSRI's on patent obviously have an extraordinary amount of pull in the govt to get these obsurd policies instituted in the first place.
> Fact: some states make benzo writing an unwelcoming prospect for a doctor (eg NY state triplicate prescriptions with no refills.)
Again, why? Political influence. Besides, at a rate of $200 for an hour of their time you figure taking the time to fill out one of these prescriptions is not too much to ask, assuming it is the med that will be most beneficial. I don't understand how the refill thing has any effect; don't they want their patients to come back once a month anyhow?
> These are the things that discourage pdocs from prescribing benzos more frequently; coming into their office, refusing to try anything but the benzo, isn't gonna come off well, even if it's right!You would hope that a doctor would have some integrity and prescribe what he thinks is best for the patient. I don't think suggesting a med to a doctor should automatically be grounds to get you thrown out.
If the doctor can justify the reason why he thinks I don't need the med or why he thinks something else would work better, then I would have be satisfied. Instead, the doctor I saw f*cked with my head by merely raising the dosage of the same drugs that were ineffective for me in the past and diagnosed me with OCD even though I never even complained of one obsession or compulsion. When I told him I disagreed with his diagnosis of me and asked how he came to that conclusion he got very defensive and acted like he couldn't believe I would have the audacity to ask him this. He proceeded to toy with me further, "well, what do you think I should prescribe for you?" Well, I was thinking that maybe this guy is alright after all and I replied that I was considering Klonopin or Provigil. He immediately snapped back at me "Well, I disagree" and nothing more. Then he told me my time was up and told me to leave! Needless to say, I didn't appreciate this at all after pouring out all my problems to this asshole for an hour. This is the third time I have felt this way after an appointment out of four appointments with different pdocs.
Part of my problem with social anxiety is that people think I am lying even if I'm telling the truth because I am not assertive and don't make good eye contact. My condition in itself is the reason I and people who need certain meds cannot get them and the only people who *are* still fooling the doctors are the people who don't have a disorder and are selling them on the street. Something has to give. The very condition I am trying to get prescribed for is exactly what is making them think I am lying to them!
All that has resulted from all of this is that dealers on the black market can make more money off benzo's now since the price has gone up as a result of increased demand, *not* a decrease in supply. So in effect the only people benefiting from these anti-benzo policies are drug dealers and pharmaceutical companies that hold SSRI patents. And if these pharmaceutical companies are happy, so are politicians, and the cycle continues...
scott
Posted by Dr. Bob on December 17, 2003, at 8:35:05
In reply to Re: Med seeking, legal issues. » jbs, posted by scott-d-o on December 17, 2003, at 3:30:52
> > Fact: benzos are a drug of abuse in the street; they have a street value.
>
> Yes, but my argument is that the only reason they have this street value is *because* of this myth.I'd like to redirect follow-ups regarding general legal issues to Psycho-Social-Babble. Here's a link:
http://www.dr-bob.org/babble/social/20031217/msgs/290875.html
Thanks,
Bob
Posted by miss amor on December 17, 2003, at 10:36:21
In reply to how did it get this bad?, posted by scott-d-o on December 16, 2003, at 6:43:42
i guess this could be one reason, one the news last night-(i live in hou. tx.) there was a big story about a co. of jr. high girls that gave their teacher a xanax in her coffee. the teacher freaked out and went to hospital, but is now doing fine. it sounded life and death and made xanax sound like a total street drug. the news anchors were interviewing children that were like 12 yrs old saying " no i dont take xanax but i have heard of it and know that it has been going around the school" and other commments quite the same. it was embarassing. to be prescribed a med that seems like a thrill!
work like you dont need the money~
love like you have never been hurt~
and dance like nobody is watching!
carpe diem~
Posted by miss amor on December 17, 2003, at 10:56:49
In reply to Med seeking, legal issues., posted by jbs on December 16, 2003, at 21:36:19
I understand the concern, have actually had a family member addicted to a drug in benzo catagory. i remember- it wasnt pretty. but i didnt understand why there was a problem period, as i am a grown woman with no history of med seeking, abuse or anything simuliar. i have had one dr. act weird to me about this and it was quite a surprise to see her go from sympathetic to suspicious. i really think her views were a little slanted to begin, as she wanted to prescribe me a ssri that would make me gain weight. i am a personal trainer and have recently recovered from exercise bulimia-which at the time i didnt realize i even had because i didnt have anorexia or overeating. but i was exercising a crazy amount, ( self medication is what dr. said it was-crazy 12 mile jogs and hours in gym.)
i have finally gotten over this and it is so central to my gad, ocd that i want to keep it subsided. i am too scared to take a med that will make me gain weight. and my dr. thinks my fears are unrealistic because i am healthy weight and look normal. also i did not want "long term treatment" she wanted me to get on med. for a long time but i am too young in my opinion, (want to get married and reproduce soon!!) i understand some ppl take meds their whole life but i dont want to. that is another reason for the ssri avoidance. i feel like i know what i need and maybe i dont~
Posted by Viridis on December 17, 2003, at 23:58:55
In reply to Re: Med seeking, legal issues. » jbs, posted by scott-d-o on December 17, 2003, at 3:30:52
Unfortunately, you usually have to see a range of pdocs to get proper treatment. It's not much different from mechanics, plumbers, etc. -- a large proportion are incompetent, many are OK but dogmatic, and a few are very good. That's just human nature and seems to extend across all occupations that I've encountered.
I've seen the whole range, and many others here have too. Just because someone is an MD or pdoc doesn't guarantee good judgement, so you have to decide whether someone is right for you. Don't settle for 2nd or 3rd best -- after all, your mental health is at stake.
This is the end of the thread.
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