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Re: Chronic benzos, mood + memory. Hoover + experts? mattdds

Posted by Larry Hoover on April 17, 2009, at 17:15:26

In reply to Chronic benzos, mood + memory. Hoover + experts?, posted by mattdds on April 17, 2009, at 3:48:14

> Hi all,

Hey, Matt! I was just thinking about you. Seriously. And there you be.

> Please weigh in if you can!

Hey, who told you I'd put on some weight? :-/

> It's nice to see some of the same genius posters still here (you're a legend Larry Hoover).

Legend? Genius? <Spock eyebrow>

> It's been a while since I posted. Excuses: I went to war (seriously), then back to school, started a long stressful long residency in a surgical subspecialty. Yeah, that stuff is awesome for anxiety and depression!

I well recall your going to war, Matt. I prayed for you many times. Going in theatre with an anxiety disorder seemed pretty courageous to me. Then more schooling and a residency? Sheesh! Way to go, dude!

> Background: I've taken clonazepam for 8 years. Overall it has been a tremendous med. Seven years on 1.0 mg bid, over the last year I decreased to 0.5 mg bid. Everything else didn't work or had unacceptable side-effects. (e.g. SSRIs --> tremor, sweating, both very bad in my trade)
> To my questions:
> 1. How well do you think cognitive impairment (memory) and depression secondary to chronic benzodiazepines is supported by the literature. I've seen some small n studies involving older folks cited to back this claim but not much else (I'm young(er), and I want to know about me :) ).
> It's hard to judge yourself. Maybe there has been a slow memory decline that I'm not aware of. Perhaps some of my lingering depression could be from long-term benzos.

I got news for you. You're aging. No faster and no slower than the rest of us, though. I'm more concerned that a high stress lifestyle might be cumulatively burdensome. I'm big on coping strategies such as regular sleep, exercise, good nutrition, social supports, indulging in hobbies.

> 2. What about the risk of *chronic anxiety itself* on memory and depression? I find it odd that the studies I looked at didn't consider this.

I saw that you brought this up, so I didn't add it to what I said already. Absolutely, a predisposition to anxiety has got to be a risk factor for cognitive problems, poor memory, depression, perhaps comorbid with other contributing factors.

> It would be hard if not impossible to say whether my memory and persistent low-grade depression would have been better or worse without benzos. I am quite certain that my depression improved significanly in the short term from where I originally was in 2001.

I really think you've answered your own question.

> Some of my attention might have even been freed up when my anxiety and ruminating thoughts decreased. I'm positive unchecked anxiety precipitates severe depression for me.

So, why is it you're cutting back on the clonazepam? Not enough risk in your life? <teasing, but seriously teasing>

> It almost seems like meds like clonazepam should be neuroprotective in the same way SSRIs and ADs have been shown to be.

I would think so. There is a realm of adaptation to the environment that changes gene regulation (epigenetics), so we never stop changing. But limiting the intensity of a chronic stressor has got to be sparing in some way.

> 3. I worry that some of the literature sort of suggests that memory loss from chronic benzos doesn't come back, or comes back slowly and incompletely.

I would think that there's no way to test that hypothesis.

I would describe medication for mental illness as generally being an incomplete treatment. If it helps subjectively, that does not mean that it entirely normalizes the underlying disorder which led to treatment in the first place. In other words, there are aspects of the progression of the disorder that are later attributed to the medication, despite the obvious passage of time since treatment began. Yes, there may well have been long term exposure to drugs, but the longer the term, the more other things that have changed also. There's no going back in time to start over.

> This makes me wonder why Ashton and her followers have developed these beautiful protocols to withdraw. What's the point of a hellish prolonged withdrawal if it doesn't get that much better? I don't believe in extra cool points for being "drug free" for the hell of it (although it would be nice not to have to see a psychiatrist periodically and re-explain my whole situation).

I don't have any relevant experience to guide me. I don't know what the motives are.

> I remember the hope I had years ago for novel medications like Lyrica and the novel CRH antagonists. But Lyrica is not what we hoped and CRH antagonists...what happened there? I hoped clonazepam would bridge the gap while they developed the good stuff, haha.

Well, you got me looking. Phase III clinical trials (one for GAD, one for depression) have wound up for Pexacerfont, a CRF-1 antagonist drug. They only recruited females, though. Nothing published yet.

And there is another one called antalarmin. Doesn't work well as a standalone drug, apparently. If they could come up with a CRF-2g antagonist, that might be great, as those receptors are only in the amygdala.

Good to see you, Matt.





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