Posted by ed_uk on March 21, 2005, at 17:21:45
In reply to Re: Carbamazepine and Propantheline, posted by Nickengland on March 21, 2005, at 16:37:27
Hi Nick!
>Is diazepam easy to get prescribed by a psychiatirst?
Diazepam is by far the most widely prescribed anti-anxiety benzo in the UK. Many elderly people have been on it for decades. In the UK, doctors are STRONGLY discouraged from starting any new patients on long-term diazepam, even for severe anxiety. Some doctors are happy to prescribe diazepam for 'as required' use or short-term use for a couple of weeks. Some doctors will refuse to prescribe it at all, which I personally think is dumb.
>Surely if they helped though that would look better than being ill.
There is always the concern that you would develop tolerance and that the treatment would no longer work. It is impossible to predict who will develop tolerance, some people find it effective in the long-term, others do not. The withdrawal symptoms can be severe when you stop, it is necessary to reduce the dose gradually if you've take it for more than a couple of weeks, this helps to reduce the severity of the withdrawal symptoms. Some people are angry because they are having side effects from their benzo but they can't come off it because of the withdrawal symptoms. Diazepam is often best used in 2-4 week courses, to treat periods of severe anxiety. Some people do seem to benefit greatly in the long run, but it is important to remember the risks of long-term treatment. After long-term use, physical dependence on benzos is very common, withdrawal symptoms are likely if the drug is stopped. 'Drug addiction' in the sense of 'drug addict' is very unlikely unless the patient abuses their medication in an attempt to get high.
>I feel they are afraid to presribe them.
Yes, they are. They are protecting themselves from future legal action!
In England, primary care trusts (PCTs, groups of GPs surgeries) are given 'star ratings' for performance- you've probably heard about these on the news. Several different 'performance indicators' are used to assess the quality of service. Surprisingly, benzo prescribing is one of the official 'performance indicators'. The more benzos GPs prescribe, the lower the star rating of their PCT!!!!!!!!! I don't think this applies to psychiatrists though because they work in secondary care. Personally, I think this is pretty dumb system, the total 'volume' of benzos prescribed is hardly an accurate indicator of whether GPs are prescribing the drugs appropriately. Furthermore, GPs are strongly discouraged from prescribing benzos (2-4 weeks) to patients who might really benefit. Anyway, I don't like the idea of people being forced to stop the sleeping tablets they've been taking for the last 30 years just because their GP wants his PCT to get a better rating.
>Do you think diazepam would be the most likely one they would give out of all the benzodiazepines?
Yes.
Doctors often prescribe diazepam at very low doses, you'll need to find the dose which is most effective for you, there is a lot of variation between individuals. In general, I wouldn't recommend long-term use of diazepam unless your anxiety is very severe and you've exhausted all the other options.
>Yes in a sense, I mean lithium and sodium valproate are very strong antimanic's and I feel these push my mood too far down if you know what I mean.
What was your lithium level when you were 'stabilised'? It may have been too high- lithium can work as an antidepressant and as an antimanic at low levels.
>My thinking is all thats left would be gabapentin and topiramate.
Gabapentin isn't usually that effective as an anti-manic, it can be effective for anxiety and insomnia though. The anti-manic effectiveness of topiramate compared to other anticonvulsants hasn't been well studied yet, if carbamazepine CR and Trileptal are not to your liking, you could ask for a trial of topiramate. Topiramate often causes quite a lot of cognitive impairment, it is popular among overweight people though becasue it often causes weight loss!
I'm not sure how easy it will be to get Trileptal prescribed, you may have to find some research to show your psychiatrist!
Take care,
Ed.PS. Where in England do you live?
poster:ed_uk
thread:473135
URL: http://www.dr-bob.org/babble/20050317/msgs/473716.html