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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 35. Go back in thread:
Posted by fires on April 29, 2005, at 23:08:11
In reply to Re: is klonopin really all that addictive? » fires, posted by Phillipa on April 29, 2005, at 21:40:10
> When valium was popular that's what was Rx'd. When ativan came out the same. The same with xanax and klonopin. Now I've come full circle and am back on valium. I have an older pdoc who is familiar with the older drugs. Her philosopy is "if it ain't broke, then don't try to fix it." I'm lucky because the young pdoc I had before her tried to take me off all the banzos and I ended up in a neurologist's office shaking and unable to speak. He told me to find a doc who isn't benzo phobic. Fondly, Phillipa<
I'll bet the benzo phobics are also MAOI phobics.
Posted by Mr.Scott on May 2, 2005, at 20:53:46
In reply to is klonopin really all that addictive?, posted by tendency on April 29, 2005, at 16:26:58
Let me be frank.
Tolerance will develop slowly but probably completely to almost all the desired effects. However the effects on your cognitive functioning will probably never go away and may in fact become worse particularly with longer acting compounds. There is a good chance you will experience more psychopathology as a result of long-term benzodiazepine usage including increased depression or chronic anxiety, personality changes, relationship problems, etc. all the while believing or just trying to justify that it's still working (this is true of many addictive compunds, but even moreso when you have a doctor giving it to you for a disorder).
If you become a long-term benzodiazepine user (years) and ever find a physician with enough balls to try and get you off, you will invariably experience great discomfort and depending on the dosage your withdrawal will likely make Heroin and Alcohol withdrawal look like a little girls birthday party. Whats more is that most rehabs won't take you and insurance won't cover a hospital stay for it, and if you do it outpatient you'll probably get divorced and or lose your job trying.
It really only complcates matters in long the run I believe. If you can, do yourself a big favor and avoid them. Thats just my opinion however. If you must take them for anxiety and some people do. Exhaust all other options first. ALL other options.
Scott
Posted by fires on May 2, 2005, at 22:08:22
In reply to Re: is klonopin really all that addictive? » tendency, posted by Mr.Scott on May 2, 2005, at 20:53:46
> Let me be frank.
>
> Tolerance will develop slowly but probably completely to almost all the desired effects.Hasn't happened to me in over a decade of use.
>> However the effects on your cognitive functioning will probably never go away and may in fact become worse particularly with longer acting compounds. There is a good chance you will experience more psychopathology as a result of long-term benzodiazepine usage including increased depression or chronic anxiety, personality changes, relationship problems, etc. all the while believing or just trying to justify that it's still working (this is true of many addictive compunds, but even moreso when you have a doctor giving it to you for a disorder).<<
My MD was a top psychopharmacologist.
>
> If you become a long-term benzodiazepine user (years) and ever find a physician with enough balls to try and get you off, you will invariably experience great discomfort and depending on the dosage your withdrawal will likely make Heroin and Alcohol withdrawal look like a little girls birthday party. Whats more is that most rehabs won't take you and insurance won't cover a hospital stay for it, and if you do it outpatient you'll probably get divorced and or lose your job trying.<<Can you site a source for the above? Why the need for a rehab? Worse than Heroin....
I have a pdoc, a neuro., an internist, and a couple other MDs who I think would disagree with you.
>
> It really only complcates matters in long the run I believe. If you can, do yourself a big favor and avoid them. Thats just my opinion however.<<<Opinion?
If you must take them for anxiety and some people do. Exhaust all other options first. ALL other options.And those options are?
>
> Scott
Posted by anneL on May 2, 2005, at 23:05:37
In reply to Re: is klonopin really all that addictive? » tendency, posted by Mr.Scott on May 2, 2005, at 20:53:46
Getting divorced, rehab, insurance denying coverage for rehab. If this is personal experience, I am very sorry this happened to you. Not everyone shares your view of benzodiazepines. It is perfectly acceptable to say, "I experienced. . . or "this happened to me" in sharing your experiences with medication instead of making blanket statements.
Posted by Phillipa on May 2, 2005, at 23:50:25
In reply to Re: is klonopin really all that addictive? » Mr.Scott, posted by anneL on May 2, 2005, at 23:05:37
I think he said in my opinion. He was just saying try other options first. I myself have been on benzos for over 35yrs. I will never be able to come off of them. My brain chemistry has been altered just as an alcholics is. I worked in rehab. And it's true insurance companies will not pay for rehab. If you're lucky, you may get 3 days in a detox center. But that was 8 yrs ago. I don't think this is even paid for now. Maybe a state hospital but even if you are suicidal they wiil discharge you in a couple of days. Fondly, Phillipa
Posted by fires on May 2, 2005, at 23:58:04
In reply to Re: is klonopin really all that addictive? » anneL, posted by Phillipa on May 2, 2005, at 23:50:25
> I think he said in my opinion. He was just saying try other options first. I myself have been on benzos for over 35yrs. I will never be able to come off of them. My brain chemistry has been altered just as an alcholics is. I worked in rehab. And it's true insurance companies will not pay for rehab. If you're lucky, you may get 3 days in a detox center. But that was 8 yrs ago. I don't think this is even paid for now. Maybe a state hospital but even if you are suicidal they wiil discharge you in a couple of days. Fondly, Phillipa
Can you provide medical research/documentation that your "brain chemistry has been altered just as an alcholics is"? I am interested if there is such info. out there.
Posted by Phillipa on May 3, 2005, at 16:41:37
In reply to Re: is klonopin really all that addictive? » Phillipa, posted by fires on May 2, 2005, at 23:58:04
Good question as any MRI I've had done is read as normal. I would like the answer to this myself. That is really a good question. Thanks Phillipa
Posted by Mr.Scott on May 3, 2005, at 21:50:06
In reply to Re: is klonopin really all that addictive? » Mr.Scott, posted by anneL on May 2, 2005, at 23:05:37
I apologize for being offensive. Let me restate.
My experience both personal and from other long-term users that I know personally indicates that for the majority of people long-term use is neither indicated, nor effective, nor helpful. I am of the opinion that while benzos represent a major advance over their predecessors, they have not lived up to their promise and anyone considering using them for a chronic condition should try any and all other available options first. So yes I think they are highly addictive.
However, if anyone really does want research to support my ranting and ravings and I'm bored enough, I can surely produce it.
Scott
Posted by Phillipa on May 3, 2005, at 22:52:07
In reply to Sorry, posted by Mr.Scott on May 3, 2005, at 21:50:06
Scott, The last two nights make me think you are right. Up until now i thought they did no harm. But I haven't been able to sleep the last two nights. Keep waking and ranting and raving. Driving my husband nuts. Nightmares! I just want to go back to sleep and I can't. I used to be able to sleep with the meds so well. What can I do? Fondly, Phillipa
Posted by NealMcCoy on May 4, 2005, at 2:17:48
In reply to Re: is klonopin really all that addictive? » Phillipa, posted by fires on May 2, 2005, at 23:58:04
Benzos are the brutally hard to come off of. It can takes months or even years to come off of them. Scott is absolutely right in what he sais. Benzos should be last resort for everyone. If you don't believe me then try coming off of them yourself. You'll be crying for your mommy to come and save you.
Posted by anneL on May 4, 2005, at 9:20:01
In reply to Re: is klonopin really all that addictive?, posted by NealMcCoy on May 4, 2005, at 2:17:48
Everyone has to make their own decision as to what constitutes quality of life. I think the original question was about "addiction" not "dependence". Yes, I agree that longterm benzo use creates dependence and can be difficult to taper off. I think addiction depends entirely on the patient's history, genetics, and personal predisposition. I understand that you are trying to warn people not to use these as a first line medication, however, for some, these medications have literally been life saving. Lets make the clear distinction between "dependence" vs. "addiction". Very different entities IMHO.
:) anneL
Posted by anneL on May 4, 2005, at 9:30:32
In reply to Sorry, posted by Mr.Scott on May 3, 2005, at 21:50:06
Hi Scott,
No need for apologies. I think that as oldtimers on this board we have a responsibility to preface our statements with, "This has been my experience. . . "Your own mileage may vary. . ."
I have not found the end of human suffering in a pill form, but in my experience thus far, some areas of my life have been improved by medication, at a cost. Another point is that I realize there is confusion over the terms "addiction" and "dependence". Two different phenomenon with different behaviors and strategies. Just my thoughts on the subject.
Posted by Mr.Scott on May 4, 2005, at 16:51:25
In reply to Sorry, posted by Mr.Scott on May 3, 2005, at 21:50:06
Poor word choice.
I mean to say mildy addictive at best, Highly dependence inducing at worst.
Scott
Posted by JaneB on May 4, 2005, at 18:01:53
In reply to Re: Sorry » Mr.Scott, posted by Mr.Scott on May 4, 2005, at 16:51:25
In my opinion, it is no less difficult to go off SSRI's than benzos.
Posted by fires on May 4, 2005, at 18:40:43
In reply to my opinion, posted by JaneB on May 4, 2005, at 18:01:53
> In my opinion, it is no less difficult to go off SSRI's than benzos.
I was on an MAOI, Parnate, and slowly tapered off of it, after being on it for 14 years. No problems at all.
Posted by anneL on May 4, 2005, at 22:06:21
In reply to my opinion, posted by JaneB on May 4, 2005, at 18:01:53
> In my opinion, it is no less difficult to go off SSRI's than benzos.
>>>>My experience has been that I can use a logical tapering schedule with Klon and not experience discomfort. On the other hand, I have had a heck of a time tapering off of Effexor. Sign me, still on it after all these years!
Posted by Kon on May 4, 2005, at 22:26:47
In reply to Re: is klonopin really all that addictive? » tendency, posted by Mr.Scott on May 2, 2005, at 20:53:46
There are probably more studies suggesting that tolerance to anti-anxiety effects is more of a rarity than a common occurrence, even after long-term use. As one of many examples, a recent 2005 review suggests that clinical evidence does not support the development of anti-anxiety tolerance in most cases. There is also little evidence of any relationship between half-life of a benzo used in anxiety disorders and potential irreversible cognitive impairment. To the best of my knowledge no such long-term comparisons have ever been made. And despite some speculation that long-term benzo use may cause permanent brain damage that could be observed, overal neuroimaging studies have been unable to find brain abnormalities in patients treated long term with benzodiazepines. There are some cognitive deficits seen that appear to recover somewhat following discontinuation of long-term benzo use (although not completely) but "the deficits appear to be insignificant in the daily functioning of most patients."
Wrt to severity of withdrwal, in reviewing 9 controlled long-term benzo studies (mean 3 years, range 1-16 years) followed by abrupt discontinuation of benzo, Perry et al (2003) write:
"Overall, withdrawal symptoms occurred in ~ 50% of patients receiving a therapeutic dose of benzo for an average of 3 years. Most symptoms experienced were of mild to moderate intensity...A review of the controlled studies of long-term therapeutic doses of benzo indicates that nearly 50% of patients ingesting a benzo for an average of 3 years will experience a minor withdrawal syndrome when the drug is discontinued."
http://www.vh.org/adult/provider/psychiatry/CPS/33.html
Not to deny that a major withdrawal cannot occur occasionally but this doesn’t appear to be the norm. Even in Ashton’s anti-benzo site if you look at Tyler’s work (another author on the site) you will find similar data. Ashton’s much higher incidence of serious withdrawal symptoms (100%) is because her subjects were highly selective (long-term benzo users who had already previously failed to quit benzos). So if you take the worse of the crop, you will overestimate incidence and severity of withdrawal. It’s like taking the worse 10% and claiming that that’s the norm.
Posted by notfeelingthebest on May 4, 2005, at 23:21:59
In reply to Re: is klonopin really all that addictive?, posted by Kon on May 4, 2005, at 22:26:47
What is the difference between dependence and addiction? They're the same thing. There is however a difference between being a benzo addict and a crack addict. This is the distinction that people seem to have trouble with.
Everybody's always crying about how you have to get off benzos or youll never be "yourself" again. Dudes, did you forget why you started taking them in the first place? If youre taking them long term, you probably werent blessed with perfect mental or emotional health to begin with. So lets forget all this talk about going back to being "normal." If you feel a little odd after you quit, remember that you were a little odd to begin with.
But, it has been said, for some long term Benzo users withdrawal is up there with trying to quit booze. And thats far worse than all of those scenes in movies where our heroes are "going through hell" as they try and kick heroin.
Posted by Phillipa on May 4, 2005, at 23:47:40
In reply to Re: is klonopin really all that addictive?, posted by notfeelingthebest on May 4, 2005, at 23:21:59
I agree with what you said about the benzos and not being lperfect. But going off alchohol wasn't hard for me. i just quit. The pdoc said no more. I think in my case it was i just needed someone to tell me no. My parents never said no to me as a child. i was a brat. My pdoc at the time was my "father". Fondly, Phillipa
Posted by notfeelingthebest on May 5, 2005, at 17:28:37
In reply to Re: is klonopin really all that addictive? » notfeelingthebest, posted by Phillipa on May 4, 2005, at 23:47:40
well it depends on what kind of a drinker you were. I was talking about the "bottle of brandy under your pillow" type of alcoholics; people who drink with the utmost severity.
Posted by anneL on May 6, 2005, at 0:06:16
In reply to Re: is klonopin really all that addictive?, posted by notfeelingthebest on May 5, 2005, at 17:28:37
That must be why my neck hurts. LOL
Posted by anneL on May 6, 2005, at 0:16:17
In reply to Re: is klonopin really all that addictive?, posted by notfeelingthebest on May 4, 2005, at 23:21:59
Yes, I agree with notfeelingthebest that we must look at where we were at in terms of mental health/functioning (or are) when we initially started taking meds such as benzodiazepines. In my situation, I started taking Klonopin to get over the overwhelming start-up side effects with Effexor. That was five years ago. I am very much aware of my physical dependence with Klonopin. If I miss a dose, I will have physical withdrawal symptoms. Yes, there is a big difference between "addiction" and "dependence". Addiction implies escalating usage and drug-seeking behaviors. Dependence implies physical and/or mental discomfort when the drug/med dosage is decreased or stopped. At any rate, Klonopin seems to be a good med for me.
Posted by HedgeHog on May 7, 2005, at 0:31:12
In reply to Re: is klonopin really all that addictive?, posted by anneL on May 6, 2005, at 0:16:17
I have been taking Klonopin 0.5 mg once a day for the past four months. I was initially prescribed it to help address relatively acute anxiety and depressive symptoms while I was trying out a series of other medications (Remeron, Wellbutrin, Cymbalta, etc.). This has been my first experience in taking a benzo for an extended period of time; I had taken Ativan PRN in the past, although no more often than once or twice a month. I am 28 years old and diagnosed with your standard unipolar depression.
I found this topic to be of particular interest in that I began to reduce my Klonopin dose four days ago. Per the advice of my psychiatrist, over the past four days I have taken 0.375 mg rather than 0.5 mg (a 25% reduction). Rather than trying to split the actual 0.5 mg tables, I obtained a prescription for the Klonopin Wafers which are available in 0.25 mg and 0.125 mg form. Unfortunately, they aren't available as a generic so they're a little more expensive.
This is my second "attempt" to reduce my Klonopin usage in the past month. On the first attempt, I cut the dose in half (from 0.5 mg to 0.25 mg) and suffered from a host of moderate to severely uncomfortable symptoms. I would characterize these symptoms as sharply increased ("rebound") anxiety, increased difficulty falling and staying asleep, noticeable shaking in my hands and legs, and feelings of panic ranging from perceived difficulty breathing to just feeling plain old fashioned scared for no reason. These symptoms were significant enough to return to my 0.5 mg dose.
This time, I have started with a slower taper and hence have had the above symptoms but on a smaller scale. Given the relatively long half life of Klonopin (~16 hours), in my experience there has been an approximately one day lag between decreasing the dose and experiencing withdrawl symptoms.
While I certainly appreciate that everybody has their own unique situation, I would state my opinion that discontinuing Klonopin has been much tougher than I would have imagined. I have had thought that a "small" 0.5 mg dose taken once a day over a "short" four month period of time would lead to any sort of physical dependence whatsoever.
My advice to anybody attempting it would be to go as slowly as possible. It has been a very helpful medication for me but you need to respect the potential difficulty in getting off it.
Posted by notfeelingthebest on May 7, 2005, at 2:14:08
In reply to Re: is klonopin really all that addictive?, posted by HedgeHog on May 7, 2005, at 0:31:12
This is true. If you're planning on quitting, take it slow. It seems that at some point, no matter how slow you take it, you're going to have to endure a nasty spell. It just baffles me that it has this effect on people at such low doses. It seems like a smurf's dose.
Posted by Mr.Scott on May 7, 2005, at 9:23:49
In reply to Re: is klonopin really all that addictive?, posted by notfeelingthebest on May 7, 2005, at 2:14:08
This is the end of the thread.
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