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Klonopin tolerance vs. Ambien tolerance » Budgie

Posted by mattdds on October 3, 2003, at 0:51:09

In reply to Ambien- dependency potential?, posted by Budgie on October 2, 2003, at 11:28:39

Chris,

>>Matt pointed me towards some evidence a while ago that Klonopin causes less dependency when taken on a normal schedule

I should clarify this. What I meant to convey is that Klonopin works best in terms of *less side-effects* when taken consistently, rather than as-needed. This is due to differential tolerance (i.e. sedation, memory impairment, ataxia all go away, but anti-anxiety properties remain).

There is also good evidence that as-needed dosing interferes with cognitive therapy (which I believe you are still doing?). Continuous dosing does not seem to interfere with the CBT, and maintains its anxiolytic effect long-term.

In terms of *dependence*, continuous use of Klonopin *does* cause it. If you take a benzodiazepine for longer than a month (arbitrary, could be shorter or longer for some), you will need to slowly taper if and when you decide to discontinue the drug to prevent a withdrawal syndrome.

Now this is the downside of benzos (one of the only ones, in my opinion). You need to taper off slowly when discontinuing! But some people simply need ongoing therapy, and the fact is that for the vast majority, benzos continue to work, so this dependence is quite worth it.

It's like taking a beta-blocker for hypertension. Going off "cold turkey" has dangerous consequences. Patients with hypertension taking beta-blockers are indeed *dependent* on their medication. This is absolutely no different from taking a benzodiazepine for another medical disorder (anxiety disorder).

But your question was in relation to Ambien. Ambien is not a benzodiazepine, although it does act on the same receptor sites (albeit in a slightly different manner).

Here is the answer: there is no evidence of tolerance or dependence to zolpidem in a great number of studies. Patients will simply return to baseline (pre-treatment) sleep patterns after discontinuing Ambien. It's really that simple. This parallels the many anecdotal reports on this board - people come off "cold turkey" and return to how they were before - no better but certainly no worse!

Best,

Matt


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