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Re: Evidence Please!! Squiggles, ok » hiba

Posted by Squiggles on October 27, 2002, at 8:11:10

In reply to Re: Evidence Please!! Squiggles,,, posted by hiba on October 27, 2002, at 0:49:33

hiba,

It's OK - i am not really offended at all,
though I see that Dr. Bob is very cautious
about things escalating to a higher level
of conflict (LOL):

Here are some articles on Protracted Withdrawal Syndrome:

http://search.freefind.com/find.html?id=3519954&pid=r&mode=ALL&n=0&query=Protracted


___________________


The Edition of Goodman and Gilman, which I have
is the 6th edition.

Ch. 17 HYPNOTICS AND SEDATIVES

- Stewart C. Harvey

BENZODIAZEPINES:

Adverse Psychological Effects:

"Benzodiazepines may cause paradoxical effects....
Anticonvulsant benzodiazepines sometimes induce
motor stimulation and precipitate grand mal
seizures. Antianxiety benzodiazepines have been
reported to release bizarre uninhibited behavior in
some users with low levels of anxiety. Paranoia,
depression, and suicidal ideation occasionally
accompany the use of antianxiety benzodiazepines.
..........
Although benzodiazepines have a reputation for
causing only a low rate of *abuse* and *dependence*
the possibility of this complication of chronic
use must not be overlooked."

p. 439

Tolerance and Physical Dependence

"High doses of benzodiazepines must be given
for long periods of time and then abruptly withdrawan
before marked withdrawal symptoms, including
seizures, appear (see Allquander, 78). Habituation
can occur however, because of the long half-lives
and conversion to active metabolites; withdrawal
symptoms after chronic use may not appear for a week
after abrupt continuation of the drug."

__________________________


THE MERCK (16th Edition)

p. 1633


"Benzodiazepine Abuse and Dependence
....
There is considerable debate about benzodiazepine
dependence. ... Abrupt discontinuation after significant
exposure may lead to withdrawal syndrome remarkably
similar to that associated with alcohol withdrawal,
including anxiety, irritability, tremor, nausea
hypertension, tachycardia, hyperacusis, muscle
twitching, hyperreflexia, depersonalization, hallucinations,
and major motor seirzures.....
Discontinuing the medicine will lead to a
complicated differential of drug withdrawal vs.
symptom reemergence. [in other words they don't
know if the withdrawal is continuing or if they
can attribute it to an "underlying disorder" popping
up again]."

[Query:
Could it be that it is not the withdrawal syndrome
itself which causes these long-yeared waves of
protracted symptoms, but the abruptness with which\
the patient has been pulled off the drug?]


I include this part as it points to importance
of physical pre-examination (something not emphasized
in the WHO document, though mentioned):

"Treatment with Benzodiazepines


Very few patients need continuous treatment.
..... The causes of anxiety are many, but
ordinary environmental causes should be searched
first; e.g. occupational or marital problems, [etc.]
MANY MEDICAL DISORDERS CAN BE SIGNIFICANT: E.G.
HYPERTHYROIDISM, ARRHYTHMIAS, CHRONIC PULMONARY
DISEASE, HEART FAILURE, ABUSE OF CAFFEIN OR OTHER
STIMULANTS, ALCOHOL WITHDRAWAL, AKATHISIA ASSOCIATED
WITH ANTIPSYCHOTICS, COMPLEX PARTIAL SEIZURES, AND
PEHOCHROMOCYTOMA [my emphasis]....."


I notice that the words "protracted withdrawal
syndrome" do not occur. I would not take that
as evidence that this syndrome does not exist
therefore. It is quite possible that follow-up
studies of abruptly discontinued patients were
not undertaken at that time.

One more observation about protracted withdrawal
syndrome: although reinstatement of a dose or
even higher (as is recommended in the cases of
seizure withdrawal) may stop the very severe
aspects, there are waves which continue regardless'
of the reinstated benzo dose. This suggests to
me that some sort of damage or immediately
irreversible chemical state has taken place which
requires a long time to return to ground 0.

Squiggles


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poster:Squiggles thread:124171
URL: http://www.dr-bob.org/babble/20021025/msgs/125402.html