Posted by Squiggles on October 25, 2002, at 20:22:07
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (4.1.2) » Squiggles, posted by Squiggles on October 25, 2002, at 9:18:38
Hi,
back again: 5: ADVERSE EFFECTS
The benzos are favourably compared to ADs and
neuroleptics and considered safe and without
severe side effects. A brief look at the benzo
group will certainly contest this statement.
I have observed people getting off tricyclics
and SSRIs and as hard as that is, there is no
comparison with benzos. Benzos really should
be compared to heroin withdrawal. I've not yet
come to such variables as KIND of benzo, TIME taken,
and DOSE. These are decisive in the withdrwal
severity.In unmonitored, erratic dosing of benzos,
symptoms of psychosis may be indistinguishable
from the real thing (i.e. endogenous or non-benzo
related).
5.1 General adverse effectsAgain, I direct you to Ray Nimmo's site for
a collected array of side effects. I'm glad to
see the *falling* symptom here; when my Rivotril
dose was raised I got up from the chair and fell,
breaking my foot. I told my dr. i thought it
was the Rivotril that made me lose my balance but
it was hard to believe. Oh, and I am not elderly,
though I may look it by now :-).The inability to distinguish between adverse
effects and symptoms of underlying chronic diseases
is a good observation. However, this is a two-edged
sword, as the underlying chronic disease may take
precedence in the diagnosis to the the effects of
the benzos. This is particularly the case, in
withdrawal, sub-withdrawal, or erratic dosing, or
sudden stopping.
5.2 Withdrawal syndrome and dependence5.2.1 Withdrawal syndrome
Yes, they've got this right: only a therapeutic
dose is enough to cause withdrawal, given enough
time of taking the drug.The "nocebo" effect is nonsense. The rest is
very good. What is missing the "protracted withdrawal"
syndrome. This is even stranger than the paradoxical
and rebound phenomena.... my guess is that changes
take place in either the structure or the chemistry
of the brain, after the drug is used for a long time.
Stopping the drug, leaves the brain in a state that has
lost its initial equilibrium and either takes a very long
time (may GABBA receptors or dendrites have to regrow
or something) or equilibrium is never ever reached again.
Dr. Heather Ashton speaks of some long-term users suffering
motor effects for up to 15 years, for example.If you would like a personal example, I have had
diarrhea, and peripheral neuropathy as well as
tinnitus, and botched body temperature control since
the withdrawal... most of these after 2 years about,
have disappeared gradually fading.
5.2.2 DependenceThe definition should not concern a doctor so
much as a linguist. For purposes of medical
observation, cessation of the drug is followed
by very unpleasant and painful syndromes, which
can be reversed to some extent by reinstating
the drug. Call it "dependence" or "addiction"
or whatever; the main point is the practical
aspect of being on the drug, stopping the drug,
and reinstating the drug. It is true, there is
no craving, just extreme syndromes caused by
discontinuation.5.3 Overdose
I have heard, contrary to this "suicide-safe"
aspect of benzos, that with alcohol, they are
lethal. I recall a benzo member telling me how
much it would take, but I forget.
6. STRATEGIES FOR PRESCRIBING BENZODIAZEPINES6.1 Introduction
This is good advice, if followed.
6.2 General approach
I cannot find anything lacking or to disagree
with in this section. It's very wise. I would
only stress the necessity of monitoring and
carefully tapering the patient off, once the
treatment has been completed. Regarding the
chronic problems, such as panic disorder--i have
my reservations. I do believe that panic
and anxiety are symptoms and not a disorder itself.
Long-term treatment is very attractive for its
simplicity, but may be quite mistaken, by mistaking
the symptom for the sign.6.2.5 Discontinuation
Much can be learned from the Benzo group here.
I am glad to see that some physicians use
long-life benzos to get people off. The reduction
is smooth for some benzos but not others. The difference
between different benzos is not discussed here.
Again the "addictive" personality problem requiring
longer tapering, is at least insulting and at most
medically irresponsible.
6.2.6 Withdrawal managementThe time give 4-8-16 weeks worked for me for
Xanax at the therapeutic dose of 1.0 taken over
12 years or so. I still do not understand why
the clonazepam was so hard not just for me but
for many people reporting difficulty on the
Benzo group. Is its chemical structure different?
As an anti-convulsant, is this why i got a seizure
and myoclonic seizure as diagnosed by an emergency
doctor the year before (not my dr.).In general, i think this is quite good; part
of the problem is that physicians do not believe
that benzodiazepines can have such withdrawal effects,
and stick it to the "addictive personality" or
a hypochondriacal or hysterical patient. And, the
patient being in the majority women, this may
present a problem.
----got to go again--nest is 6.3 Special situations
Squiggles
poster:Squiggles
thread:124171
URL: http://www.dr-bob.org/babble/20021025/msgs/125237.html