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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 gadchik on November 10, 2011, at 6:23:37
My decision to remain on klonopin has,of course,caused me to be researching the good & bad about the benzos.What Ive found is that one can find so many diff opinions from various professionals.Ive gotten myself so confused about whether or not its the right choice for longterm use.They say its a great longterm med for anxiety,they say its damaging,they say it repairs a damaged nervous system,they say it makes you an addict for life,on & on.What's an anxious person to do?I feel happy,normal,good on k,but I always start to wonder,should I taper,should I be on this forever,is k gonna let me down?Should i learn to do w/o it?
Posted by Christ_empowered on November 10, 2011, at 6:33:44
In reply to why cant there be one story about benzos?, posted by gadchik on November 10, 2011, at 6:23:37
There are some benzo horror stories. There are also horror stories for every psychiatric medication under the sun. In my personal opinion, if you're able to keep the dose low, you don't develop drug-induced depression, and you don't have side effects, low-dose or PRN benzo use over the long haul is probably a good option.
I'm not a doctor though. However, I've noticed that even shrinks don't have 1 story to tell about the benzos anymore. Some say they're good, others say they're evil, many are in between.
Posted by gadchik on November 10, 2011, at 6:59:00
In reply to Re: why cant there be one story about benzos?, posted by Christ_empowered on November 10, 2011, at 6:33:44
Youre right about drs having diff opinions.My current pdoc is very much ok w/longterm benzos.Others,have said,we dont prescribe any benzo.My pcp said "it is safe to take the benzo forever".Then, I see a new pcp,the other left the practice,and he says"its alcohol in a glass.it wont help you longterm"
Posted by Chairman_MAO on November 10, 2011, at 7:32:57
In reply to why cant there be one story about benzos?, posted by gadchik on November 10, 2011, at 6:23:37
The reason why it is so hard to get an answer is because to give a full account of it is extremely complex. In general, it is better to avoid cementing a dependency on a benzodiazepine as a first-line treatment for anxiety. It would be dishonest of me to pretend that I understand issue fully--in fact, I believe very few people actually do.
Perhaps we should start by you describing exactly what the words "anxiety" and "treatment" mean to you. I know this sounds pedantic, but bear wtih me.
One thing it does _not_ do is "make you an addict for life". A physiological dependency does not for an addiction make.
A big problem with benzodiazepines is that insidious problems can surface _many_ years down the road. A taper is almost always possible, but some people require tapering over the course of a year or more in order to make it painless.
By "do without it", do you mean that you are only taking it "as needed"? If so, how often is "as needed"? I'd say that if you're using it more than once every 48-72hr, you should switch to a shorter-acting benzodiazepine.
Taken occasionally, benzodiazepines are usually extraordinarily benign. It is the physiological dependence that's the problem.
Posted by Raisinb on November 10, 2011, at 8:45:19
In reply to why cant there be one story about benzos?, posted by gadchik on November 10, 2011, at 6:23:37
I have strong opinions on this issue. Frankly, I think those long term addiction horror takes are a load of crap. I have been on Xanax for sleep for three years, and I have never grown tolerant and had to take more. I know a lot of people in that situation. I think there are a lot more of us than there are crazed addicts. Now, long term benzo use does change the structure of certain brain receptors, so benzos are physically addictive, technically. But so are antidepressants. In both cases you have to taper slowly to avoid severe withdrawal.
Posted by gadchik on November 10, 2011, at 9:49:34
In reply to Re: why cant there be one story about benzos?, posted by Raisinb on November 10, 2011, at 8:45:19
Same here,been on klonopin .5mg for 3 yrs.Take before bed.Have taken 1/2 a pill before a flight,etc.I take for sleep and anxiety.I initially only wanted to take it short term.Now 3 yrs,still on it,Im doing well.Do you think theres such a thing as a gaba deficiency that the benzo is correcting? My pcp mentioned that.I have no depression now,no side effects.Just some thoughts sometimes that I should handle life pill free.I was able to taper zoloft & remeron,once I got over the worst of depression,but anxiety is forever,I think.
Posted by gadchik on November 10, 2011, at 9:56:42
In reply to Re: why cant there be one story about benzos? » gadchik, posted by Chairman_MAO on November 10, 2011, at 7:32:57
Thanks for your thoughts.I take it every night,.5mg,for 3 yrs. Ive wrestled w/the decision to remain on it,as you can read. What are your thoughts on a gaba deficiency that the benzo is correcting? I tapered off zoloft & remeron due to weight gain,and no longer being depressed.I see your point, that there could be problems down the road,if I were to stay on it.Ive had cbt,but still needed the klonopin.I fear my brain was just wired from birth to be anxious.The klonopin has definately saved me many times.Yet I still question long term usage.
Posted by Phillipa on November 10, 2011, at 11:52:51
In reply to Re: why cant there be one story about benzos? » Chairman_MAO, posted by gadchik on November 10, 2011, at 9:56:42
Just my experience my whole extended family is on or was on some type of benzo. So I do think I inherited the startle reflex hence anxiety since a child. Only treated after haver two children and having severe panic attacks at the time rendering me totally nonfunctional. This was early 70's given valium and meprobamate. I recovered and went on to accomplish a lot first giving up cold turkey mepbrobamate after a year or so. Stayed with valium 5mg TID drank a few beers at night. Then took up running, Aerobic Dance program of own then stopped the alchohol as went to RN school. I took the valium and extra if extra school stress. And after starting to work so happy that was able to cut down over the years. 41 years later on .25xanax at night and 7.5mg valium. Many different combos over the years. Now have luvox for 12 year now low dose and lexapro upped the dose to 5mg no changes so will down that again as why take if not working. And it's been two years. Lots of stresses bad ones now in life. So for me meds just probably keep me kind of going. My agoraphobia is not being able to stay in the house but not go out alone. New pdoc don't like but only 2 here that take medicaire. Phillipa
Posted by gadchik on November 10, 2011, at 11:58:52
In reply to Re: why cant there be one story about benzos?, posted by Phillipa on November 10, 2011, at 11:52:51
Me again worrying over long term benzo use.Do you think anxiety is just something that never goes away? And here comes menopause,how do you do that w/o a benzo?
Posted by Raisinb on November 10, 2011, at 12:29:45
In reply to Re: why cant there be one story about benzos? » Raisinb, posted by gadchik on November 10, 2011, at 9:49:34
I used to have that feeling, like I should handle life pill free, and lately I am frustrated with all the pills that are not working. But Xanax is the only thing that for me is working. I used to have horrible insomnia, ambien, lunesta, all stopped working. Now I have a good solid 8-9 hours every night. I think if something actually works for you it is a big thing.
Posted by Phidippus on November 10, 2011, at 14:50:27
In reply to why cant there be one story about benzos?, posted by gadchik on November 10, 2011, at 6:23:37
Just concentrate on how the medication makes you feel and what side effects it imparts on you. Make thing simple. No use in worrying on long term effects, those too will become apparent to you. Not everyone reacts to any one medication the same way someone else does.
Eric
Posted by Phillipa on November 10, 2011, at 20:55:38
In reply to Re: why cant there be one story about benzos? » Phillipa, posted by gadchik on November 10, 2011, at 11:58:52
Oh if at menopause anxiety gets worse but if I'd had the opportunity at the time I would have seen a bioidentical hormone doc who can test saliva, or blood for your personal hormone levels then compound the exactly right formulation of bioidentical hormones for you. They come in creams made by compounding pharmacies or pellets with troche. You are lucky to be able to regulate hormones before it gets worse or you lose bone and get osteoporosis. Phillipa
Posted by JONO_IN_ADELAIDE on November 10, 2011, at 23:58:01
In reply to Re: why cant there be one story about benzos? » gadchik, posted by Phillipa on November 10, 2011, at 20:55:38
Sorry, it cant be that simple, benzos are very usefull, but also have a big down side..... a bit like morphine, its an invaluable drug, but one that needs to be used with discression.
Benzos are fine if used "as needed", taking a pill when things are particularly bad, but there are issues if they are taken daily long term....however, daily use is justified if nothing else works.
Sorry, but it isnt black and white, its all shades of grey
Posted by Christ_empowered on November 11, 2011, at 8:58:50
In reply to Re: why cant there be one story about benzos?, posted by JONO_IN_ADELAIDE on November 10, 2011, at 23:58:01
I think you also have to realize that this is psychiatry, not science. Some docs pride themselves on being as conservative as possible--no benzos, limited stimulants, etc. Others strive to make their patients' lives more comfortable, so they don't mind benzo use. It has a lot to do also with when the doc in question went to medical school. My former shrink went to medical school in the early 80s, when benzos were considered the best thing for anxiety and also for sedation when needed. She was fine with benzo use. I had another shrink who had just gone to medical school, and he wouldn't give me a benzo (I was inpatient) even though I had acute neuroleptic induced akathisia and was dissociative. Obviously, I'm more fond of the older doctors. The newer ones are all "controlled substance=bad," unless its "ADHD" or whatever, and they'll give you all kinds of uppers.
Also, in psychiatry, it seems like a new treatment comes along, its hailed as the best thing ever, for everything, and then something newer comes along and suddenly the older drugs are "bad." Example: the SSRI drugs replaced the TCA and MAOIs. Then the SNRI and newer AD drugs were sold as being "better" than SSRIs. Benzos were so much better than barbiturates (actually, they're safer in overdose, but that's about it), so barbiturates fell from favor. Then benzos were "bad" because there were SSRI drugs on the market.
Its BS. Also, it gets expensive. Lots of people are on "atypical" antipsychotics for anxiety when a cheap benzo could do the trick for less money and with fewer side effects. Also, in more severe cases, lots of people are on "atypicals" when some perphenazine at a moderate dose could do the trick for 1/10th the cost.
Ridiculous situation, and its probably not going to change anytime soon.
Posted by gadchik on November 11, 2011, at 9:38:22
In reply to Re: why cant there be one story about benzos?, posted by Christ_empowered on November 11, 2011, at 8:58:50
Thanks for your thoughts,everyone.I do feel safer w/a benzo than the newer meds,and it does the trick for me,but I would prefer to use "as needed" instead of daily.However,my brain may not agree w/ that scenario.
Posted by ed_uk2010 on November 11, 2011, at 11:56:41
In reply to Re: why cant there be one story about benzos?, posted by Christ_empowered on November 11, 2011, at 8:58:50
>Ridiculous situation, and it's probably not going to change anytime soon.
Nope, everyone is making way too much money :)
Posted by Chairman_MAO on November 11, 2011, at 13:01:56
In reply to Re: why cant there be one story about benzos? » Chairman_MAO, posted by gadchik on November 10, 2011, at 9:56:42
> Thanks for your thoughts.I take it every night,.5mg,for 3 yrs. Ive wrestled w/the decision to remain on it,as you can read. What are your thoughts on a gaba deficiency that the benzo is
correcting?There is no GABA deficiency. What you are experiencing is the drug effect, plain and simple. If you want me to get technical, I will, but I don't want to get off track. Anything like a "GABA deficiency" (whatever that would look like; what is the objective diagnostic test which shows this?) would be treated with a drug like a GABA-T inhibitor or Gabitril (gaba uptake inhibitor). Benzodiazepines have a broad spectrum of complex effects. Were you to take those drugs, I highly doubt you'd experience anything like what you get from the benzo.
If clonazepam works, great. Just be aware that it can turn on you at any time. I'm not saying it will; I hope it doesn't. Your daily dose is so low I think you should just keep taking it unless something changes. Whatever works.Look at the wikipedia article about benzodiazepines; they have a specific action at various areas in the brain that would take paragraphs to explain adequately.
Posted by gadchik on November 11, 2011, at 13:40:03
In reply to Re: why cant there be one story about benzos? » gadchik, posted by Chairman_MAO on November 11, 2011, at 13:01:56
Thanks for the suggestion. I will have to study it.The benzos dont increase your gaba,right,so that wouldnt work if there were such a thing as gaba deficiency.I guess it is just the effect that is doing something in my brain to keep me steady.But I think I should at least give tapering a serious shot & see how I do.When I tapered off zoloft & remeron, it was exhilarating to see that I could do w/o.But I did still have the klonopin to catch me.However,I do think about it turning on me,no longer working,now that's enough to nudge me into trying a taper
Posted by Chairman_MAO on November 14, 2011, at 19:23:39
In reply to Re: why cant there be one story about benzos? » Chairman_MAO, posted by gadchik on November 11, 2011, at 13:40:03
I think it's probably a good idea to see if you can do without it.
There is no rush in tapering. Heck, you could decrease the dose by 0.125mg every 14 days if you wanted to.
This is the end of the thread.
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