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benzos 'n' stuff Cam W.

Posted by Elizabeth on December 15, 2001, at 11:25:21

In reply to Re: klonopin 0.5 Elizabeth, posted by Cam W. on December 14, 2001, at 17:26:35

> > What about nordiazepam, BTW?
> Sorry, I don't know this one, off the top of my head. Is it a metabolite of diazepam?

Yes, and some other benzos too (Librium, Tranxene). I may have gotten the name wrong, though; for some reason it's spelled "nordazepam" in some places (I think it means the same thing, though: desmethyldiazepam). It's even marketed as a separate drug in other countries. It has a very long half-life. So Valium should be very long-acting -- but it's not (at least, not with a single use). Why not?

> Short answer: cause it worked before.
> I think that I see it used a lot in schizophrenia, but this may just be a quirk of the couple of psychiatrists, in my area, who use it.

Well, it [clorazepate, that is] seems like a fine drug. A friend of mine takes it (for anxiety) and says it's very long-lasting, which I think is always nice. I wonder what dose would be required for panic disorder, though.

> For example, I asked why it was used in someone with very severe PTSD and schizophrenia who is taking 900mg of Clozaril a day.

Oof, that's a nasty set of problems to have to face.

> This person (Q), is a refugee from a wartorn country (losing side), and maintains own apartment, has our social welfare system figured out, and "sends" money home (from a meager long term disabilities cheque).

Well, good for Q. I wish I could figure out *our* social welfare system (such as it is -- it's really mainly for disabled people and the extremely poor, and even then it's pretty meager) so I could get Medicaid (state-sponsored health insurance), but it's a tough battle.

> The doc told me Q's story, and said that 15mg of Tranxene in the morning relieved all of Q's PTSD symptoms (those that weren't controlled by the Clozaril). I had seen Q floridly psychotic, complete with persecutory delusions and audiovisual hallucinations. I saw Q two months later (after starting Clozaril and Tranxene) and the change was incredibly remarkable.

That's terrific! Although I wonder why Clozaril and not one of the atypicals.

> I here that Q may be getting a paying job, but unfortunately the prescriptions medications cost approx. $3000.00/month, so Q cannot make too much money or will lose drug coverage < sigh >.

That's a problem here, too: you go back to work, and even if it's only part-time, you might lose your benefits (and part-time employment seldom provides health care coverage).

> Anyway, the doc told me that he gave Q Tranxene, because it had worked in a similar case that he treated, but it hadn't worked as well as it did for Q. It is nice to have a success story every now and then.

Yeah, especially for someone who has illnesses that are so impairing. Gives me hope.

> In the short term, maybe Valium seems to be short-acting, but once steady state is reached (approx. 7 days), a constant blood level and antianxiety effects and muscle relaxing effects seem to be maintained.

That makes sense. I don't hear of Valium being used constantly like that much, though -- the high-potency bzds seem to have largely replaced it. I guess that as a muscle relaxant it might be used that way still. I don't know. I tried it as a MR (for back pain) and wasn't impressed -- in fact, it seemed to have no effect at all (including side effects) up to 40 mg. But then, I'm weird.

> The problem with Valium is that it may cause motor side effects at the initiation of therapy that disappear fairly quickly. Many people, especially in the 1960s equated the motor side effects, with therapeutic effect.

Yes, it's like people today who assume their Klonopin isn't working because they can't "feel it kick in."

> Many would say that anxiety is psychological, but the more I learn about brain process and neural interconnections; the more I realize that there is no magic in the world.

That was my point, really: I use the word "psychological" to refer to certain types of events that are experienced by the conscious mind, but really it's all "biological" in the end. Then there's the dichotomy between events related to external "experience" vs. events that come from inside ("endogenous" is the word some people use). I think this is largely misleading because there are really so many feedback loops between temperament (the ways in which a person tends to react to things, much of which most likely originates from inside the person) and external experience. And it's *all* biological: even the "placebo effect."

> In the case of 0.125mg of clonazepam, if the effect is psychological, very similar (but probably not "exactly" the same) neural pathways and brain structures are active, as if the clonazepam dose were actually effective (ie you would see an enhancement of GABAergic-neuronal activity, resulting in decreases in electrical activity of the above anxiety circuits (and others).

Again, I interpret "psychological" here to mean that the effect is caused not by the drug but by expectation, and that the neural processes underlying it are similar (though probably not identical) regardless. Am I totally missing it here, or are we on the same wavelength?

> > > You would never guess that mania almost destroyed this person's life.
> >
> > I hope that one day someone will say something like that about me (substitute "depression" for "mania").
> Me too, Elizabeth, me too. (Hey, I you've accomplished a lot for someone "dealt such a shitty hand". You truly know the meaning of hard work and perseverence.

Well, thanks...I try. I don't see myself as having "accomplished a lot," though. I'm certainly nowhere near being the functional person I'd like to be.

> I'd like to work with you on producing a non-fictional tome, the ultimate look at mental illness from the inside...a Kay Jamison-like book, but on depression...and better written).

I never read any of Jamison's work. But yeah, that would be interesting -- I've always wanted to write a book, but I feel like I'm too mentally disorganized. Plus it would be neat to combine perspectives with another person who's experienced the same kind of stuff. It would be interesting to write it in the form of a dialogue.

I feel like it's important that physicians realize that patients today expect more and more to be taken seriously and treated with respect by their doctors, and that there really are those of us (perhaps 10-20% of depressives) who don't respond adequately to the standard medications and who need to be able to try more creative approaches. I guess those are the two main issues that are gnawing at me right now. What about you -- what kinds of specific subjects would you like to write about?





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