![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 92 to 116 of 175. Go back in thread:
Posted by hiba on October 27, 2002, at 0:49:33
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » hiba, posted by Squiggles on October 26, 2002, at 10:32:44
Hello Squiggles,
I got a "Please be civil" warning from Dr.Bob and I am sorry if I made any personal offence.
((Once again, what kind of evidence would you like?
Statistical evidence can only be gathered by
testimonials of people who have taken these drugs
for a long time. Would you rather rely on the
behaviour of rats over a period of 3 months, under
the supervision of Hoffman LaRoche or Eli Lilly's
white-coats?))I was asking for a scientific evidence for "Protracted withdrawal syndrome" which you attributed to benzos in your thread. After carefully reading your reply, still I couldn't find any. "Protracted withdrawal" is quite strange to medical professionals. And my common sense doesn't allow me to take biased views of anti-benzo groups and their testimonials without a grain of salt. Meanwhile I had named some references in my message. And "Pharmacological basis of therapeutics" was one of them. Can you show me a single instance of "Protracted withdrawal syndrome" in that book which describes therapeutic pros and cons of medications?
I don't advocate for any drug. I believe all drugs have their pros and cons. But I could sense your attempt to project benzos as the most dangerous drugs in psychiatric practice. Labelling them as addictive will make matters much easier, as the term "addictive" is terrorizing to an already overanxious patient.
I was not mentioning rats or any other reptiles. I know what makes patients complain benzos are addictive. In most cases it is "patient awkwardness". Using a powerful drug for years and stopping it abruptly will cause more than enough discomforts to an individual. And most testimonials of withdrawal symptoms are the fruits of this kind of awkwardness. I have mentioned this matter many times in my threads. Why benzos alone?? If you are using beta-blockers for a long period of time and stopping it abruptly, there is a chance of fatal myocardial infarction.
((I have quoted the Merck before here and
The American Family Physician, and Goodman and Gillman's
Pharmaceutical Therapeutics on the addictive nature and need
for caution in benzo withdrawal, which also mention the
risk of seizure upon sudden discontinuation.))Where in the "Goodman and Gilman's Pharmacological basis of therapeutics" mention benzos are ADDICTIVE ? CAN YOU PLEASE SHOW ME THAT TERM "ADDICTIVE" IN IT ?? I have the latest edition (10th edition) in my hand. Just refer that page in your response. Note: If you have the same edition with you I recommend to read the page 628 carefully. It talks about dependence. (PHARMACOLOGICAL DEPENDENCE)but not addiction.
Unfortunately, I don't have access to "AMERICAN FAMILY PHYSICIAN". But I think PDR is the most authentic therapeutic guide used worldwide. MARTINDALE comes next to it. Nowhere in those guides I see the term "addictive". And if I see it in American Family Physician or Merck manual, I will definitely consider it as an "EXCEPTION". Why? Because I have more authentic source in my hand to refer.Dr. Ashton may be running the clinic for years. But I like to know what kind of patients and she used to treat. Those who stopped their benzo intake abruptly will surely have a majority there. And those multiple drug users who uses benzos for recreational purpose do not represent the ideal benzo users. I am talking about those patients who use benzos under medical supervision, where abuse and withdrawal complications never occur. But if you want to abuse a drug, no matter what kind of drug that may be, you can abuse antihistamines and can have withdrawal symptoms. Periactin is being abused by underweight patients who like to utilize its appetite stimulating properties. Phenergan is also being abused because of its sedative properties. Phenergan, if combined with alcohol can be fatal sometimes.
So my initial question still remains. Can you show me an instance of "Protracted withdrawal syndrome"in any reputed therapeutic guides ? Can you show me the term "addictive" attributed to benzos in PDR, or MRTINDALE, or GOODMAN AND GILMAN'S...THERAPEUTICS ?
Good luck Squiggles, take care
HIBA
Posted by viridis on October 27, 2002, at 1:00:20
In reply to Re: Evidence Please!! Squiggles,,, posted by hiba on October 27, 2002, at 0:49:33
Hi Hiba, Squiggles and co.,
I had an interesting experience a few months ago. I decided to go off Klonopin for a day after having taken it for several months. As the day progressed, I got more and more anxious -- not unbearably so, but it was very unpleasant. Finally, I took some Klonopin and felt normal again.
I was still in the "don't want to get hooked" phase, and reported this to my psychiatrist the next time I saw him. He asked me a simple question -- was the anxiety worse than what you experienced before taking Klonopin? I said no, it was about like what I'd often felt before, but it was very disturbing. His response was that of course it was disturbing, but he asked me again, was it worse or different than what you've experienced before? Again I said no, quite honestly. And I realized (without him having to tell me this, although he did) that I'm an anxious person who doesn't like being anxious. Did I experience withdrawal? I'm not sure, but it brought home the point that I'm much better with Klonopin than without -- I'd just forgotten how awful anxiety can be.
I wonder how many people in "withdrawal" are just returning to their pre-benzo state and find it very upsetting.
That being said, my pdoc definitely believes that these drugs can cause medical dependency, and advocates a slow, supervised taper if one chooses to discontinue their use. But it did make me question just how common or severe "withdrawal" from benzos is, and how to distinguish it from a return to an intolerable condition. I have no doubt that for some people, withdrawal from benzos (and ADs etc.) is very serious and creates effects that are worse than the initial condition. But what proportion of people on the anti-benzo sites are just going back to an intolerable "ground state"?
By the way (Squiggles) -- your posts to me have been very reasonable, helpful, and understanding, so I don't mean this as an attack on you. It sounds like you're someone who really did have a bad reaction, and you have much longer-term experience with benzos than I do. I just wonder about the points I've raised above.
Posted by Alan on October 27, 2002, at 1:06:49
In reply to Re: Evidence Please!! Squiggles,,, posted by hiba on October 27, 2002, at 0:49:33
You are quite right Hiba. Our own elizabeth has posted about this very issue some time back and refers to exactly that text in her last paragraph. Although redundant, it might be of some benefit for those that are following this thread to review the entire content of her post:
http://www.dr-bob.org/babble/20010618/msgs/67768.html
There are serious consequences as the result of not making the distinction between the two which she points out in a rather eloquent fashion.
Alan
Posted by hiba on October 27, 2002, at 2:08:59
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » hiba, posted by Squiggles on October 26, 2002, at 10:32:44
Hello Everyone,
I searched online for American Family Physician and Merck Manual with success. I have found something interesting."Benzodiazepines are effective in treating panic disorder; they are also used to treat generalized anxiety disorder and social phobia, two common comorbidities of panic disorder. In contrast to antidepressants, benzodiazepines relieve anxiety within hours,7 can prevent panic attacks within a few days to a few weeks,5 and are free of troublesome activating effects.7 Nevertheless, benzodiazepine use in treating panic disorder can be complicated by abuse, physiologic and psychologic dependence, and sedative and neurocognitive side effects.7,8
(AMERICAN FAMILY PHYSICIAN)
The term "ADDICTION" is nowhere here.Secondly I post a link where viewers can have access to Merck Manual. Please check this link
http://www.merck.com/pubs/mmanual_home/sec7/92.htm
Contrary to my anticipation, Merck scientists are emphasizing on benzodiazepine's safety and effectiveness over Alcohol, barbiturates and chloral hydrate. The term "Addictive" is still lacking, although in a title I can see it. But it is not directly attributed to benzos. Rather it can be seen directly attributed to narcotics.What do these mean? Aren't these reputed scientists aware of the difference between Addiction and dependence??
Oh! it is only a linguistic squabble !!
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
Posted by Squiggles on October 27, 2002, at 8:29:09
In reply to True extent of benzo withdrawal? » hiba, posted by viridis on October 27, 2002, at 1:00:20
Yes, thank for being so understanding. I
got off Klonopin or did not take it many
times in the early years of taking and did
not have serious problems at all. It was
after MANY years of taking it that it became
so incredibly difficult.I appreciate your note very much; i confess
that this conversation with people who seem
to be studying perhaps, but have little experience,
reminds me of that classic painting of the
examination of the wounds, by poking at the guy
to see if it *really* hurts.Squiggles
Posted by Squiggles on October 27, 2002, at 8:37:36
In reply to Re: Evidence Please!! » hiba, posted by Alan on October 27, 2002, at 1:06:49
Very nice--I agree with Gilman and Goodman;
As a physician or scientist,
i would be embarrassed to confuse addiction
(or in pragmatic terms what happens when
a drug is withdrawn) with cultural and
pulp fiction associations of dens of inequity,
and heavily made up harlots, shooting up
addictive drugs so they can get high.Squiggles
Posted by Dr. Bob on October 27, 2002, at 9:31:08
In reply to Re: RATIONAL USE OF BENZODIAZAPINES (5.) » Squiggles, posted by Alan on October 26, 2002, at 23:17:11
> Anyone that does not, but indeed outright refuses to make the medical distinction between "addiction" (which appears too many times to count on the websites of this nature) and "pharmcological dependence" is using it out of ignorance or as a pejorative.
Please be sensitive to the feelings of others, respect their views even if you think they're wrong, and neither jump to conclusions about them nor post anything that could lead them to feel accused or put down. I've asked you before to be civil, so now I'm going to block you from posting for a week.
Bob
PS: Follow-ups regarding posting policies, and complaints about posts, should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by Squiggles on October 27, 2002, at 9:38:02
In reply to Re: please be civil » Alan, posted by Dr. Bob on October 27, 2002, at 9:27:52
How could I forget Dr. David Healy?
Here is something on the squabble on the
term "addiction" (i hope this will be my
last word on it), from his book:"The Creation of Psychopharmacology"
Harvard U. Press, 2002, pp. 169-170:"Using the ease with which an animal can be
induced to crave a drug as a yardstick, researchers
found the abuse liability of the benzodiazepines
was low to ninexistent. [122]. Consequently,
in the 1980s it made perfect sense for an addiction
specialist to state that physical dependence on
the benzodiazepines was possible but that they
caused neither addiction nor drug dependence.
This was a semantic step too far not just for
the public but for most of the medical profession.
In the laboratory the benzodiazepines might not
be seen to be drugs of addiction, but saying that
they were not drugs of addiction did not solve
what had become a pressing public problem."I have not read the whole chapter, so i hope i am
not misinterpreting Dr. Healy's words; he does
seem to emphasize the comparable addiction to
SSRIs. I think that one feature that is common
to both AD withdrawal problems as well as
benzos is the lack of CRAVING which we associate
with the opiates. but though there is lack of
craving for the drugs, there is certainly relief
upon reinstating them.Squiggles
Posted by Rick on October 27, 2002, at 10:52:55
In reply to Klonopin as a dumb drug, posted by viridis on October 27, 2002, at 0:14:29
For me it's not so much a cognitive dulling problem on Klonopin as memory problems, especially short-term (including VERY short term). But I think AD's, and even a purported memory-booster like Provigil, have exacerbated this annoyance. In terms of many other aspects of mental agility, I find as you do that I'm actually sharper than pre-Klonopin.
Word-finding is one interesting aspect, however. At times my brain can't summons up even the simplest words to save my life , but at other times the words just flow, much better than pre-Klonopin. It seems as if the problems are more in extemporaneous speaking than in writing. One theory I have is that, despite my greatly reduced "fear of people", I can still feel inhibitory pressure to come up with the right things to say when someone's staring at me and waiting for me to speak (or worse yet if I feel I need to organize and express my thoughts quickly to keep their attention). OTOH, I can certainly have the word-finding difficulties when I'm just thinking to myself, too. I could go on here with other thoughts related to this topic, but I think you get the general idea.
Getting back to your original topic and summarizing, other than amnesic effects I don't consider Klonopin a dumb drug either. Since you didn't mention memory issues, I assume you don't experience them.
Rick
P.S. One reason as-needed Xanax bombed out for my SP is that it *did* cause cognitive dulling, maybe related in part to the physical dulling sensations I felt. Klonopin never made me feel so physically slow, not even the first dose. I was amazed to feel so much more calm with nothing more than a smidge of fatigue, an effect which soon went away -- especially after I determined that "less" worked *better* for my SP than "more."
> It's interesting how differently people react, even to different drugs within the same class. Klonopin hasn't dulled me out at all (except a bit in first 1-2 weeks that I took it). In contrast, my thinking became much sharper and more focused -- maybe because I wasn't constantly agonizing over trivial details, sleeping 2-3 hours a night, and so on. It's not just my imagination either, since friends, family, and co-workers commented on how I'd suddenly become so "on target" and enthusiastic.
>
> On the other hand, Valium really is a "dumb drug" for me -- when I take even a small amount, it puts me in a haze (and not pleasant, just a general stupid/drugged feeling).
Posted by Rick on October 27, 2002, at 11:02:18
In reply to Re: True extent of benzo withdrawal? » viridis, posted by Squiggles on October 27, 2002, at 8:29:09
>It was
> after MANY years of taking it that it became
> so incredibly difficult.Squiggles -
My aplogies if you've already said this somewhere else in this mammoth thread, but how much Klonopin were you taking, and at what time(s) of day?
Thanks,
Rick
Posted by viridis on October 27, 2002, at 12:42:21
In reply to Re: True extent of benzo withdrawal? » viridis, posted by Squiggles on October 27, 2002, at 8:29:09
Hi Squiggles,
I can certainly believe that the longer you take a drug like Klonopin, the harder it will be to get off. After all, these drugs do induce changes in brain pathways and neurotransmitter release/response, so it makes sense that this would become more pronounced over time. But this isn't necessarily bad, if the changes make your brain function like that of a normal person.
And yes, I am relatively naive, having only taken K for 1 1/4 years or so. I still wonder, though, when I read reports from people who say they've had severe withdrawal and/or permanent damage from benzos (especially after relatively short-term use), whether they've returned to their "ground state" and didn't realize just how bad it was. This is just speculation on my part, but it seems logical to me in at least some cases.
A friend of mine who's a dentist told me about one of his patients, a woman in her 70s who had been on the same dose of Valium for around 30 years with no measurable negative effects. Then she saw a new doctor, who refused to prescribe it because she was "addicted". She had a severe reaction that required hospitalization, and the end result was a new doctor who reinstated the Valium. Apparently, she's doing fine, will probably continue to take Valium for the rest of her life, and (I expect) will have a higher quality of life because of it. So, why did the doctor discontinue it (abruptly), and what's the harm in her using it if it helps her live a normal life?
I'm curious (you've probably addressed this here already, but it's hard to keep track in this thread) -- why did you want to get off Klonopin after taking it for so long? Was it no longer working, causing problems, did your doctor want you off it, or were you just tired of being dependent on a medication? I ask because for now at least, K is helping so much that I'd just as soon stay on it, yet I'd like to know what to expect in the long term.
Thanks again,
Viridis
Posted by Squiggles on October 27, 2002, at 13:16:43
In reply to Re: True extent of benzo withdrawal? » Squiggles, posted by Rick on October 27, 2002, at 11:02:18
For about 7 years 0.50mg K, then i started
getting severe dyspnea, especially when
taking the K close to lithium--i had to
crouch on all fours on the bed to be able
to draw in a breath; at this point my dr.
raised it to 1.0mg and if my memory is not
too awful that was for 5 years on.I can't remember when i took it - i experimented
with times of day.Presently i take 1.5 mg because after the
seizure, i seemed to need more.Squiggles
Posted by Squiggles on October 27, 2002, at 13:54:59
In reply to Re: True extent of benzo withdrawal? » Squiggles, posted by viridis on October 27, 2002, at 12:42:21
Viridis,
You raise some good points; given the severe
withdrawals from benzos (and here we are speaking
of long-life benzos - Valium and and medium-life
Klonopin) it seems to me unwise to withdraw,
unless the side effects are undesirable, or
the dose has not been raised enough to avoid
withdrawal.Regarding the 70-yr old woman who had severe
withdrawal, upon discontinuation from her dr.,
i would say the dr. did not know how to get
her off, whatever the reason she was gotten off
(perhaps respiratory problems), and she was
darn lucky to be hospitalized for withdrawals.As for my case, i would not have tried to get
off Klonopin had i known what it would entail.
My problem is that I sincerely do not know WHY
I was put on it. Also, the fact that i finally
was able to live without 2-5 panic attacks a
day from the Xanax dose for so many years (which
was really destructive), encouraged me towards
better health. I did not know it would be so hard.One more thing: I am still not sure if my diagnosis
of bipolar was ever correct. And the reason for that
is that when i was dx'd as bipolar i was prescribed
Valium, but since it was such a popular drug then,
(20 yrs ago), it was neither monitored nor withdrawn
with any program. So, as far as i remember, i just
took the stuff whenever, and very haphazardly. It was
a time of great stress at school, and socially, and
personally (marriage, moving, thesis, harrassment at
university, overload of academic work) and i had
a kind of nervous breakdown.The symptoms (like severe anxiety, panic, temper
outbursts, blood pressure changes, progressing
to severe depression, depersonalization, and 5-day
insomnia) were very abrupt symptoms. And though
lithium got rid of the depression in 5 days, i still
do not know if the lithium treated Valium-withdrawal
or bipolar depression.And so, I tried to get off these drugs. But it
seems to me that whether there was an incorrect
diagnosis or not, it is now too late - too late
because these drugs have actually changed my
brain; nor do i know of any doctor who would undertake
this challenge to see if indeed there was no endogenous
mental disorder in the first place.Squiggles
Posted by Squiggles on October 27, 2002, at 18:23:26
In reply to Re: True extent of benzo withdrawal? » viridis, posted by Squiggles on October 27, 2002, at 13:54:59
P.S. Just wanted to add that I may be
wrong after all about the Valium withdrawal;
I do recall reading my pre-Valium and lithium
diary, and it is full of descriptions of
dark days of depression. Since taking lithium
I have not been depressed. I think it is
safe to conclude that whether I am bipolar
or not, lithium has prevented depression on
a daily, chronic basis.Just want to present both sides.
Squiggles
Posted by viridis on October 27, 2002, at 22:10:55
In reply to Re: Klonopin as a dumb drug » viridis, posted by Rick on October 27, 2002, at 10:52:55
Hi Rick,
Actually, I did notice some short-term memory loss early on (maybe for a couple of weeks), but it seemed to diminish pretty quickly. It's hard for me to accurately assess the memory issue, because I've always been prone to short-term forgetfulness (although my long-term recall is excellent).
Pre-K, when I was experiencing severe anxiety or (especially) depression, my short-term memory was terrible. In a deep depression, I could completely forget something someone said a few minutes earlier, even if we'd discussed it in detail.
So in summary -- I've always experienced short-term forgetfulness. K seemed to make this worse at first, then this disappeared, or at least went back to what I think is my normal state, and this is much better than when I'm anxious and/or depressed.
By the way, I've always been awful with names. I can run into someone I've met before and remember all sorts of details except the person's name -- where we met, what the person does, what we discussed previously, etc. My wife is very aware of this, and always asks a person's name before I'm obligated to introduce her to them, to avoid any awkwardness. It's always been this way, so I don't think K has much to do with it, except maybe briefly.
Posted by hiba on October 27, 2002, at 23:33:11
In reply to Re: Evidence Please!! Squiggles, ok » hiba, posted by Squiggles on October 27, 2002, at 8:11:10
Hello Squiggles,
Thank you for responding to my input. You are referring the sixth edition of Goodman and Gilman, which is slightly different from what I have in my hand. But I was referring the most updated version of it.
Even after reading those sentences, I don't see any instance of "Protracted withdrawal syndrome". It only says "withdrawal syndrome may not occur for week after abrupt discontinuation". Still fails to note a "Protracted withdrawal syndrome". PROTRACTED" means "lasting longer than expected or longer than usual". Does the book mention such a phenomenon? NO
The links which you provided took me to the anti-benzo group. I am sorry, I can't take their words without a grain of salt.
Then, interestingly if you read in your own response, there are a lot of points which I can use for my argument. "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."
This is an instance.I think you will allow me to reproduce some sentences in your message with a slight change in fonts.
"Benzodiazepine MAY cause paradoxical effects.Anticonvulsant benzodiazepines SOMETIMES inducemotor 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 OCCASSIONALLY accompany the use of antianxiety benzodiazepines".Note this "May, Sometimes, Some Users, Occassionally". It is sufficient to make this statement inconclusive.
Again let me quote from your own message.
"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)"Does this sentence help your arguments ? I don't think so. After reading it carefully, I think I can use it to argue. Mr. Alan will also benefit from it.
I have posted a link to Merck manual in one of my thread, assuming that will help benzo defenders. Still what you took from Merck is inconclusive.
"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, nauseahypertension, 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]."What is defined in this sentence is mainly the complication of an ABRUPT withdrawal. Did I ever argue Benzos can be abruptly stopped?? Rather I was insisting abrupt discontinuation from any psychoactive drug will cause complications.
And the last part of this sentence is not an evidence of "Protracted withdrawal syndrome". Longer than unusual withdrawal symptom is not mentioned here. Rather it makes a confusion over withdrawal symptom and underlying disorder.
((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.))
How can a patient stop benzos abruptly if he or she is under medical supervision ? Weren't we discussing about medically supervised benzo users? Besides Dear Squiggles, Benzos are here for over 40 years. And I was referring the drug manuals which published after the year of 2000. I wonder when they are going to find "BENZOS ARE ADDICTIVE AND THEY WILL CAUSE PROTRACTED WITHDRAWAL SYNDROME"? If 40 years are not enough to make a remarkable finding, I don't think another 40 years or more will make any difference.Lastly I should reveal why I am more allegic to anti-benzo group: I have seen a number of patients in my experience who gave up their benzos for the sake of this group and suffered. Now what is common in psychiatric practice is "If a medication works for a patient, DON'T change it." Because psychiatry has come upto realize how complicated psychiatric disorders are. So do you think I should back those benzophobics ??
Good luck Squiggles, Take care
HIBA
Posted by hiba on October 27, 2002, at 23:37:12
In reply to Re: Klonopin as a dumb drug » viridis, posted by Rick on October 27, 2002, at 10:52:55
Dear Rick,
You are right. Low doses of klonopin improves cognitive function. Improved concentration, sharpened memory.. all are the benefits. There is a website which emphasize this property of klonopin. I will post it later.
HIBA
Posted by hiba on October 28, 2002, at 3:55:41
In reply to Re: Klonopin as a dumb drug » Rick, posted by viridis on October 27, 2002, at 22:10:55
Hello Everyone,
Here is that missing link which describes klonopin's unique properties. Please check this.
http://www.immunesupport.com/library/showarticle.cfm/id/3154
Thanks
HIBA
Posted by Squiggles on October 28, 2002, at 6:39:44
In reply to Re: Not a Convincing Evidence at alll..Squiggles,, posted by hiba on October 27, 2002, at 23:33:11
I anticipated these objectionss; possibly the
maybes, some, etc' is a reflection of a lack
of accurate statistic taking, or possibly you
are right, they are rare.I agree that the protracted syndrome is not mentioned.
I don't know why.I would like to know why you think the articles
I sent you on Protracted Withdrawal syndrome
from the Benzo group are to be taken with a grain
of salt. They are after all articles from
doctors and addictionologists, not Benzo undercover
agents.Squiggles
Posted by Squiggles on October 28, 2002, at 6:47:16
In reply to Re: A Link For the Klonopin Users, posted by hiba on October 28, 2002, at 3:55:41
Regarding Dr. Cheney's inclusion of KAVA
as a neuroprotective agent, the FDA and the
AMA has recently pronounced extremely toxic
to the liver.Dr. Cheney sounds like he has some nutrition
experience. He omits Lithium as not only
a neuroprotective but neurogenerative agent.Squiggles
Posted by Dr. Bob on October 28, 2002, at 8:13:16
In reply to Re: please be civil (Dr. Healy) » Dr. Bob, posted by Squiggles on October 27, 2002, at 9:38:02
> "The Creation of Psychopharmacology"
> Harvard U. Press, 2002I'd just like to plug the new double double quote feature. But I don't mean to be pushy. Did you deliberately not use it to link to Amazon? If so, I'd be interested in why, over at PBA:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks,
Bob
Posted by hiba on October 28, 2002, at 9:12:00
In reply to Re: Not a Convincing Evidence at alll..Squiggles, » hiba, posted by Squiggles on October 28, 2002, at 6:39:44
Dear Squiggles,
<<I would like to know why you think the articles
I sent you on Protracted Withdrawal syndrome
from the Benzo group are to be taken with a grain
of salt. They are after all articles from
doctors and addictionologists, not Benzo undercover agents.>>Because all of those articles have failed in final clinical evaluation and couldn't make any impact in clinical settings. That is why "Protracted withdrawal syndrome" is not yet mentioned in much updated pharmaceutical manuals. Benzo.org is notorious for their biased views. And as a rule of debate it is not acceptable to refer such a controversial source. I could have posted you a lot of links which encourage the use of benzos freely. (prepared by medical professionals). But I didn't do it due to the controversies surrounding them. Those pharmaceutical manuals which I referred in my message is commonly accepted in clinical practice without any exception at all.
Good luck Squiggles, Thank you for responding, Take care
HIBA
Posted by Squiggles on October 28, 2002, at 9:18:45
In reply to Re: Not a Convincing Evidence at alll..Squiggles,, posted by hiba on October 28, 2002, at 9:12:00
You mean the protracted syndrome has actually
been tested? One of the problems would be
that it take some time after the fact, i.e.
after the withdrawal and some months to years
to actually record these effects.I'm not trying to be contrary for the hell of
it... i really am concerned with the facts
being discovered.It is very disconcerting to deal with medical
controversies. Where there is doubt, there
is ignorance, and where there is ignorance there
is malpractice.Anyway, i'm not asking for more on this as it
has probably run its course. Anyone interested
CAN look at these articles on the benzo group.I'm still curious about why you refer to it
as somehow unworthy of consideration; i don't see
this reaction to other similar groups so
understandably it makes me suspicious of something
sinister going on. But if it is, I can't see it.Squiggles
Posted by Franz on October 28, 2002, at 20:18:38
In reply to Klonopin as a dumb drug, posted by viridis on October 27, 2002, at 0:14:29
Thanks for your post viridis, you give hope.
Coincidentally, I received a similar comment from a friend who is on klono. It surprised me she told me she felt NO sedation or numbness at a small dose 2/3 times/day.
I have postponed for years the regular use of a benzo, but I think it is time to consider it.
Today I felt bad most of the day. I finally took 1/4 alprazolam 0.5mg. I went to bed and had a nap. I woke up and could go out to buy something to eat (I often crave carbos after a benzo, plus I had almost no food today). Then I could go to the gym. many times I can do more when the benzo worked good.
I read all your posts in this thread -you are in my read list now :-). Good to see there are not big problems with memory. Sure anxiety and depression kill your memory.
You have a good doctor it shows. I wonder why he chose klonopin and not alprazolam, maybe for the longer effect?.
> It's interesting how differently people react, even to different drugs within the same class. Klonopin hasn't dulled me out at all (except a bit in first 1-2 weeks that I took it). In contrast, my thinking became much sharper and more focused -- maybe because I wasn't constantly agonizing over trivial details, sleeping 2-3 hours a night, and so on. It's not just my imagination either, since friends, family, and co-workers commented on how I'd suddenly become so "on target" and enthusiastic.
>
> On the other hand, Valium really is a "dumb drug" for me -- when I take even a small amount, it puts me in a haze (and not pleasant, just a general stupid/drugged feeling).
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.