![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Frankie on March 7, 2002, at 21:44:17
Hello,
As I went back and read a few links that were written to me last week, I must admit, I had to laugh. It seems that a few will argue with me until doomsday about the fact that it is more practical to use a benzo. by itself to treat an anxiety disorder, or even a multiple anxiety condition, instead of using a combo of an antidepressant, along with a small dose of a benzo. Well, tell you guys what. I will argue until hell freezes over that it is much more effective, and there is much less of a chance to build a tolerance, if the antidepressant is the first line of treatment, with the benzo second. This is fact. period! End of story. Common sense, along with many, many, many sources will tell you this. If you know anything at all about human physiology, it is very well known that the human body adjusts to anything at all. It does not matter whether it is alcohol, environment, medication, excercise, etc... I could go on and on all night long! I used alcohol as an example when I compared it to klonopin and Xanax. I realize very well that they are not one in the same. But, on the other hand, both act on the GABA system. Albeit, in different ways.
The human body is complex. The most complex organism on earth. It will adjust to an antidepressant, antianxiety, antipsychotic, etc... over a period of time. I have never seen or heard, of anyone that remained on the same antidepressant for their entire life, at the same dosage, without ever changing, and receiving optimal benefits from it. For that matter, I have never seen a person on the same antidepressant for their entire life that has elevated the dosage to it's maximum potency, and received optimal benefits from it until the day they died. I have seen people kept on one for 5-10 years, but guess what? Eventually, no matter how long they take the medication with success, it poops out and they try something different. Maybe only for a year, then they go back to the med. that did so well for them all along, with success all over again. But, the body eventually became stale to this medication. So, they needed a switch for a while. It is absolutely no different with benzodiazepines. Period! In fact, the body will likely tolerate those much faster than an antidepressant. They are shorter acting. They are a short term treatment, but can be prescribed for long term use. A person needs to take 3 dosages daily to receive full benefits all day long. With an antidepressant, most only require one dosage at night. However, they can be dosed twice. And most have a half-life of 24 hours minimum.
Anyway, here is the main point. This person and that person try to say that they know more than I do about the benzodiazepines. Well, I am sure there are many that do. This does not impress me at all! I am willing to bet that I realize quite a bit more about the reaction of the human body to stimuli than most. And, plain and simple, the more variables one has to adjust, the better the chances they will have to correct their problems. I have always took the approach of using an antidepressant as first line of treatment, with the antianxiety med. second. I realize that many people place importance on their sex life, as do I, but there are ways to negate the sexual side effects of about 95% of antidepressants. Simple Vitamin E, Vitamin C, Ginko Biloba, or Yohimbe, will all do the trick. This has alway been my way around it. I also realize that many people gain success from a Klonopin, or Ativan, for years. I am not questioning that. I am questioning the validity of the statements made by those implying that the human body does not adapt. It does. Believe me. So, that being, most will develop a tolerance to a benzo., antidepressant, antibiotic, etc... It is how we are. Period. And there are absolutely no experts on any medications. Not even liscenced practitioners. I have seen that first hand too! I believe to have made my point now. All comments welcome and encouraged!
Frankie.
Posted by Thrud on March 8, 2002, at 0:03:31
In reply to No experts on Benzodiazipines!, posted by Frankie on March 7, 2002, at 21:44:17
Hi Frankie.
You might have a vast knowledge of benzos and ADs BUT.....
If someone happens to feel better on benzo monotherapy than with an AD, what of it? It is their happiness and not conformity to outcomes of studies that is important.
Thrud
Posted by Alan on March 8, 2002, at 10:03:19
In reply to No experts on Benzodiazipines!, posted by Frankie on March 7, 2002, at 21:44:17
> Hello,
>
> As I went back and read a few links that were written to me last week, I must admit, I had to laugh. It seems that a few will argue with me until doomsday about the fact that it is more practical to use a benzo. by itself to treat an anxiety disorder, or even a multiple anxiety condition, instead of using a combo of an antidepressant, along with a small dose of a benzo. Well, tell you guys what. I will argue until hell freezes over that it is much more effective, and there is much less of a chance to build a tolerance, if the antidepressant is the first line of treatment, with the benzo second. This is fact. period! End of story. Common sense, along with many, many, many sources will tell you this. If you know anything at all about human physiology, it is very well known that the human body adjusts to anything at all. It does not matter whether it is alcohol, environment, medication, excercise, etc... I could go on and on all night long! I used alcohol as an example when I compared it to klonopin and Xanax. I realize very well that they are not one in the same. But, on the other hand, both act on the GABA system. Albeit, in different ways.
>
> The human body is complex. The most complex organism on earth. It will adjust to an antidepressant, antianxiety, antipsychotic, etc... over a period of time. I have never seen or heard, of anyone that remained on the same antidepressant for their entire life, at the same dosage, without ever changing, and receiving optimal benefits from it. For that matter, I have never seen a person on the same antidepressant for their entire life that has elevated the dosage to it's maximum potency, and received optimal benefits from it until the day they died. I have seen people kept on one for 5-10 years, but guess what? Eventually, no matter how long they take the medication with success, it poops out and they try something different. Maybe only for a year, then they go back to the med. that did so well for them all along, with success all over again. But, the body eventually became stale to this medication. So, they needed a switch for a while. It is absolutely no different with benzodiazepines. Period! In fact, the body will likely tolerate those much faster than an antidepressant. They are shorter acting. They are a short term treatment, but can be prescribed for long term use. A person needs to take 3 dosages daily to receive full benefits all day long. With an antidepressant, most only require one dosage at night. However, they can be dosed twice. And most have a half-life of 24 hours minimum.
>
> Anyway, here is the main point. This person and that person try to say that they know more than I do about the benzodiazepines. Well, I am sure there are many that do. This does not impress me at all! I am willing to bet that I realize quite a bit more about the reaction of the human body to stimuli than most. And, plain and simple, the more variables one has to adjust, the better the chances they will have to correct their problems. I have always took the approach of using an antidepressant as first line of treatment, with the antianxiety med. second. I realize that many people place importance on their sex life, as do I, but there are ways to negate the sexual side effects of about 95% of antidepressants. Simple Vitamin E, Vitamin C, Ginko Biloba, or Yohimbe, will all do the trick. This has alway been my way around it. I also realize that many people gain success from a Klonopin, or Ativan, for years. I am not questioning that. I am questioning the validity of the statements made by those implying that the human body does not adapt. It does. Believe me. So, that being, most will develop a tolerance to a benzo., antidepressant, antibiotic, etc... It is how we are. Period. And there are absolutely no experts on any medications. Not even liscenced practitioners. I have seen that first hand too! I believe to have made my point now. All comments welcome and encouraged!
>
>
> Frankie.**********************************************
I'm certainly not here to argue Frankie.You posted earlier that you had at least 10 credible websites to bolster your assertions that would take them out of the realm of anecdotal experience into the realm of scientific and clinical evidence, that's all. I and others have waited but have not received anything - including your last post which is all opinion with no evidence except to ask that you simply be trusted.
As a veteran of working with BZD's, AD's, anticonvulsants, etc,etc, I've had to do my own research to come to informed decisions about which chemicals to put into my body to alter my brain and thinking. I have seen the plethora of credible information during my research and, yes, am well aware of the findings.
I'm all ears.
Alan
Posted by andyboy on March 8, 2002, at 10:18:11
In reply to No experts on Benzodiazipines!, posted by Frankie on March 7, 2002, at 21:44:17
> Hello,
>
> As I went back and read a few links that were written to me last week, I must admit, I had to laugh. It seems that a few will argue with me until doomsday about the fact that it is more practical to use a benzo. by itself to treat an anxiety disorder, or even a multiple anxiety condition, instead of using a combo of an antidepressant, along with a small dose of a benzo. Well, tell you guys what. I will argue until hell freezes over that it is much more effective, and there is much less of a chance to build a tolerance, if the antidepressant is the first line of treatment, with the benzo second. This is fact. period! End of story. Common sense, along with many, many, many sources will tell you this. If you know anything at all about human physiology, it is very well known that the human body adjusts to anything at all. It does not matter whether it is alcohol, environment, medication, excercise, etc... I could go on and on all night long! I used alcohol as an example when I compared it to klonopin and Xanax. I realize very well that they are not one in the same. But, on the other hand, both act on the GABA system. Albeit, in different ways.
>
> The human body is complex. The most complex organism on earth. It will adjust to an antidepressant, antianxiety, antipsychotic, etc... over a period of time. I have never seen or heard, of anyone that remained on the same antidepressant for their entire life, at the same dosage, without ever changing, and receiving optimal benefits from it. For that matter, I have never seen a person on the same antidepressant for their entire life that has elevated the dosage to it's maximum potency, and received optimal benefits from it until the day they died. I have seen people kept on one for 5-10 years, but guess what? Eventually, no matter how long they take the medication with success, it poops out and they try something different. Maybe only for a year, then they go back to the med. that did so well for them all along, with success all over again. But, the body eventually became stale to this medication. So, they needed a switch for a while. It is absolutely no different with benzodiazepines. Period! In fact, the body will likely tolerate those much faster than an antidepressant. They are shorter acting. They are a short term treatment, but can be prescribed for long term use. A person needs to take 3 dosages daily to receive full benefits all day long. With an antidepressant, most only require one dosage at night. However, they can be dosed twice. And most have a half-life of 24 hours minimum.
>
> Anyway, here is the main point. This person and that person try to say that they know more than I do about the benzodiazepines. Well, I am sure there are many that do. This does not impress me at all! I am willing to bet that I realize quite a bit more about the reaction of the human body to stimuli than most. And, plain and simple, the more variables one has to adjust, the better the chances they will have to correct their problems. I have always took the approach of using an antidepressant as first line of treatment, with the antianxiety med. second. I realize that many people place importance on their sex life, as do I, but there are ways to negate the sexual side effects of about 95% of antidepressants. Simple Vitamin E, Vitamin C, Ginko Biloba, or Yohimbe, will all do the trick. This has alway been my way around it. I also realize that many people gain success from a Klonopin, or Ativan, for years. I am not questioning that. I am questioning the validity of the statements made by those implying that the human body does not adapt. It does. Believe me. So, that being, most will develop a tolerance to a benzo., antidepressant, antibiotic, etc... It is how we are. Period. And there are absolutely no experts on any medications. Not even liscenced practitioners. I have seen that first hand too! I believe to have made my point now. All comments welcome and encouraged!
>
>
> Frankie.
Okay, myself nor Alan nor anyone else is doubting the fact that you are indeed knowledgable regarding the ins and outs of benzos-but how can an individual base what they feel or what they should do based solely on a report they read in a medical journal??? Alan for instance-says that he has been using benzos for 20 years and they are still effective-what would he have to gain by fabricating this? Each person is different, and yes, its true-we DO adapt over time, but we cant look into the future. We are guaranteed nothing. If you live day by day, you do only what is right in front of you, and what is going to help you feel better that day and that day alone. Because the next morning, you do it all over again. Forget concerns of long term use and its debate. If a certain benzo works and makes you feel better alone without a AD (like myself) then go for it. And if by chance over time, it does not seem to work as well, then you deal with it then. I am biased. Klono has done wonders for me over the last year. I havent felt this good since the early '90s. My God, if eating dog s**t made me feel this good, I'd do that! Frank-you have some solid arguments, but there are also many solid arguments against your "findings".
Absolutelt nothing personal. We're all in this together bro.
Posted by Alan on March 8, 2002, at 11:42:48
In reply to No experts on Benzodiazipines!, posted by Frankie on March 7, 2002, at 21:44:17
Of course stastics don't mean a thing in individual cases if you're the one that something works or doesn't work for.
I'm simply saying that the assertion that AD's first, BZD's second is a catagorical and polemic statement having no basis in actuality re: safety, efficacy or otherwise. They both should be given equal consideration through clinical trial for the individual, that's all. Not doing this takes away an individuals freedom to choose what works best for them.
The current *general* practice of prescribing ssri's for anxiety disorders (not that of the top specialists treating anxiety disorders exclusively) is predicated on the whole "addiction" stigma surrounding BZD's that is one old myth that seems to want to die hard.
If you haven't already, perhaps you may want to read:http://bearpaw8.tripod.com/pd.html
and:
http://panicdisorder.about.com/library/weekly/aa031997.htm
Alan
Posted by Frankie on March 8, 2002, at 14:50:36
In reply to Re: No experts on Benzodiazipines! » Frankie, posted by Alan on March 8, 2002, at 11:42:48
> Of course stastics don't mean a thing in individual cases if you're the one that something works or doesn't work for.
>
> I'm simply saying that the assertion that AD's first, BZD's second is a catagorical and polemic statement having no basis in actuality re: safety, efficacy or otherwise. They both should be given equal consideration through clinical trial for the individual, that's all. Not doing this takes away an individuals freedom to choose what works best for them.
>
> The current *general* practice of prescribing ssri's for anxiety disorders (not that of the top specialists treating anxiety disorders exclusively) is predicated on the whole "addiction" stigma surrounding BZD's that is one old myth that seems to want to die hard.
>
> If you haven't already, perhaps you may want to read:
>
> http://bearpaw8.tripod.com/pd.html
>
Hi guys,I greatly appreciate your responses, and the above links Alan. I am sure, as I said, that I am not the most knowledgeable person about the benzo's on this site. I do, however, know most of the in's and out's. I am only attempting to help those find a faster, and possibly more effective approach to treating, and inevitably curing, their anxiety problems. I will say this guys. I love my Xanax! Period. I only dose a .25 mg. at night, especially before going out, just to make me feel confident in a crowded social situation. I take that dose each night, and I love it. I never feel more in control of myself, or the things around me. Period. But, I have eliminated the A/D before for a period of no longer than a month, and the Xanax was not effective in giving me this level of euphoria. I realize that this is a baby dose too. I suffer from OCD and ADHD problems, so too high of a level of a benzo. will worsen my ADHD especially, since this needs a stimulant of some kind. But, I also suffer social anxiety and GAD problems too. That constitutes a multiple anxiety problem with attention defecit disorder! It is dificult to treat this combination because one requires an upper, which makes each of the anxiety problems worse. The anxiety problems require mainly an A/d and a downer, but this inevitably worsens the ADHD, by shutting down the frontal lobe. It is tricky. So for me the A/D is very essential. I feel that most can benefit from the SSRI's in particular, especailly in combo with the benzo's, no matter what the anxiety problem may be. But, to each his own. I realize, like I said, that the SSRI's have side effects. I try to research ways around them and ways to combat them. I will talk to you guys later! Thanks for the input on my post.
Frankie.
Posted by gilbert on March 9, 2002, at 0:10:06
In reply to Re: No experts on Benzodiazipines!, posted by Frankie on March 8, 2002, at 14:50:36
With all due respect The bearpaw site and data is simply a collection of opinions of patients and prationers......we are not sure how the data was similated, what methods were used etc. Almost everything on the web is opinion originated I know Alan you like or would like everyone to site sources but the sources you list ae not scientific stuies done with random sampling but just a collection of observations well written and organized to support your particular belief. Simplty read the preface to The bearpaw site it pretty much says it all.
I did show my pdoc the data from the ste it does go a bit ovberboard on comorbid illnesses his words"the only thing left off the list of comorbids was world hunger". Now I am not saying all the dta is garbage but is is loaded with opinion much of which again is not backed up by pure scientific methodology. If you want anti benzo studies and sources you not travel any
further the International mental health site look up xanax or generic apr. and look up adverse effects. There you will find an array of tolerance and addiction studies. Or look up xanax addiction under a google search and browse all of the different dta there...some is garbage, some is not. To take the attitude that because you can site the berapaw site or Dr shipko or the Tapir site all very pro benzo anxiety sites doesn't mean a hill of benas to the individual like myself who becomes addicted to xanax.Yes addicted....not dependent, I came off coke and vodka easier than this.
I am happy that a certain dose of klonopin or whatever has worked well for you and that is great. I strongly advocate the use of benzos but every time some one brings up an opinion different then yours you keep siting web sites as if they prove something.....They prove nothing....If they did we would visit here once get the one answer we needed and shut off our computers for good.
Sincererly,
Gil
P.S. I do enjoy your posts so please take this in the spirit it was meant....a simple difference of opinions.
Posted by trouble on March 9, 2002, at 2:03:14
In reply to No experts on Benzodiazipines!, posted by Frankie on March 7, 2002, at 21:44:17
Hi Franki,
We haven't met yet cause I'm usually over on PSB. This board is generally beyond me, but I'm learning as fast as I can.
My question is about your assertion that the body builds a tolerance to everything including Anti-depressants. Is this why my meds stop working all of a sudden? It would be nice if I had a crisp reply for my pdoc when he puts that vibe out, like I've done something to make my meds go haywire. Sometimes I start getting crazy side effects 2 or 3 months after having been on the same meds and my doc is like, these can't be side effects, it's too late, it may be psychological, let's look at that instead. BTW my psychological testings are excruciatingly detailed and up-to-date, and totally non-committal about the cause of my problems, but strongly suggest they are psychological, not biological in nature. It's all so complicated.
Thanks for reading,
trouble
Posted by Alan on March 9, 2002, at 10:07:06
In reply to Re: No experts on Benzodiazipines! Alan, posted by gilbert on March 9, 2002, at 0:10:06
> With all due respect The bearpaw site and data >is simply a collection of opinions of patients >and prationers......we are not sure how the data >was similated, what methods were used etc. >Almost everything on the web is opinion >originated I know Alan you like or would like >everyone to site sources but the sources you >list are not scientific stuies done with random >sampling but just a collection of observations >well written and organized to support your >particular belief. Simplty read the preface to >The bearpaw site it pretty much says it all.
Then how would you explain in particular the cited conclusions of the World Health Organisation in the section on BZD's for example -one of several used as particularly relevant information on the site. This is not about opinion and in particular, not about my own personal belief at all.
> I did show my pdoc the data from the ste it >does go a bit ovberboard on comorbid illnesses >his words"the only thing left off the list of >comorbids was world hunger". Now I am not >saying all the dta is garbage but is is loaded >with opinion much of which again is not backed >up by pure scientific methodology.The opinion IS backed up with evidence from a plethora of scientific studies all of which you can email the author about if you like, they're just not footnoted. They have been posted ad nauseum on the site for all to read if one visits the tAPir site regularly enough since they are not archived to the extent they are here.
>not travel any further the International mental >health site look up xanax or generic apr. and >look up adverse effects. There you will find an >array of tolerance and addiction studies. Or >look up xanax addiction under a google search >and browse all of the different dta there...some >is garbage, some is not. To take the attitude >that because you can site the berapaw site or Dr >shipko or the Tapir site all very pro benzo >anxiety sites doesn't mean a hill of benas to >the individual like myself who becomes addicted >to xanax.
True, one has to seperate the wheat from the chaff. That's why critical thinking is so important. These sites are not "pro-benzo". They are "pro-treatment" sites - or ANTI "anti-benzo" sites designed to get ALL of the facts and evidence into play so that the patient can be informed so that they aren't scared into complacency (or to go off their med that are working for no good reason) by the claims of exaggerated risk with the BZD's exclusively. Inumberable studies and personal experiences have been cited and posted on the sites you mention that overwhelm the board about studies that provide evidence to what I and the bearpaw site advocate.
>Yes addicted....not dependent, I came off coke >and vodka easier than this.
And this is a prime example of reason not to take BZD's. History of a predisposition to or history of poly-drug abuse is, respectfully, a contraindication for BZD use in many cases.
> I am happy that a certain dose of klonopin or >whatever has worked well for you and that is >great. I strongly advocate the use of benzos >but every time some one brings up an opinion >different then yours you keep siting web sites >as if they prove something.....They prove >nothing....If they did we would visit here once >get the one answer we needed and shut off our >computers for good.
>
> Sincererly,
>
> Gil
>
> P.S. I do enjoy your posts so please take this >in the spirit it was meant....a simple >difference of opinions.
Thanks. I'm not so sure we're in so much disagreement.I've mentioned the websites (with their corollary reliance on scientific evidence) in response to the some misunderstandings stated about these medications on this board. If you view that as contradicting someone simply because of my personal beliefs, you've possibly misunderstood my reason for posting. I'm not posting to prove anything, only to provide evidence about ALL sides of the issue. Evidence is not proof - especially in the realm of psychotropic medications or psychiatric medicine in general - but credible and overwhelming evidence is a good start for the assertions that have been made, that's all.
I would ask that you visit tAPir and pose some of these same assertions in the "debate" forum of the site and see what happens. The scientific evidence is overwhelming and will be cited to you individually if you ask - I do not have it in my computer power to store such information but others there do.
When in the realm of statistics, one has to realise that statistics mean nothing in individual cases. So studies admittedly are only useful up to a point. Treatment must be individualised.
BUT, to not give the patient freedom of choice with ALL of the information about BZD's is poor medicine and continues the stimatisation of these perfectly legitimate medications - a story heard repeatedly at the tAPir site and here as I'm finding. For proerly diagnosed chronic anxiety disorders, the overwhelming evidence demonstrates that BZD's should be considered on equal footing with any other medication vis-a-vis the risks involved.
Please visit the tAPir site in the "debate" forum and ask "Jilly" or "Alden" (the author of the bearpaw site) to cite the medical studies that I've mentioned and the studies that the World Health Organisation has amalgamated over decades and passed judgement on concerning the efficacy and safety of these medications in short AND long term treatment.
Alan
Posted by andyboy on March 9, 2002, at 10:34:13
In reply to Re: No experts on Benzodiazipines! Alan, posted by gilbert on March 9, 2002, at 0:10:06
"The vast majority of the use of benzodiazepines is appropriate. Problems of nonmedical use arise nearly exclusively among people who abuse other drugs" (Woods, J.H. and G. Winger. "Current Benzodiazepine Issues." Psychopharmacology 118.2 (1995): 107-115)
Okay, Gil, by no means am I taking a shot at you or any difficulty with substance abuse in the past, but the general rule is that benzos should not be prescribed for patients with a past history of addiction. I do apologize, I am just trying to reiterrate(sp?) the point that generalizations CANNOT be made in med use. Each individual reacts differently and thats the bottom line. I mean-for instance, some people cant be around cats for more than 2 minutes without having an asthma attack, whereas others own 5, 6, 7 or so cats. Do you see what I'm getting at? Unfortunately, you consider yourself addicted to Xanax, but this does NOT mean that used responsibly, everyone else will too....
Again, we're all in this together and everythings going to be alright for all of us.
Andy
Posted by Elizabeth on March 9, 2002, at 12:34:32
In reply to No experts on Benzodiazipines!, posted by Frankie on March 7, 2002, at 21:44:17
> It seems that a few will argue with me until doomsday about the fact that it is more practical to use a benzo. by itself to treat an anxiety disorder, or even a multiple anxiety condition, instead of using a combo of an antidepressant, along with a small dose of a benzo.
As with all things in clinical psychiatry, it depends on the individual patient's response to and tolerance of the two types of medication.
Of course, benzodiazepines aren't likely to be helpful for comorbid conditions such as depression (except, perhaps, if the depression is secondary to the anxiety disorder). I can't recall seeing anyone here claiming that benzodiazepines alone will be effective for comorbid (primary) depression and anxiety. I think that your impression that many people on this board believe that is mistaken.
> Well, tell you guys what. I will argue until hell freezes over that it is much more effective, and there is much less of a chance to build a tolerance, if the antidepressant is the first line of treatment, with the benzo second. This is fact. period! End of story. Common sense, along with many, many, many sources will tell you this.
Can you cite any of these putative "sources?" That would be much more convincing than your "common sense" argument (which is flawed in several ways) or your appeal to your own supposed authority.
BTW, all the credible authorities I've encountered (including standard psychiatry and pharmacology textbooks as well as clinical studies) have provided convincing evidence that persons who take benzodiazepines long-term for anxiety disorders do not, as a rule, develop tolerance (contrary to your "theory," which does not constitute "convincing evidence"). So you have a big hurdle to overcome.
I myself have no personal reason to believe one way or the other. I take antidepressants on a daily basis, and benzodiazepines only occasionally (for breakthrough anxiety or panic attacks). I just think it's irresponsible and inconsiderate of you to put forth your personal opinions and speculations as though they were facts.
-elizabeth
Posted by gilbert on March 9, 2002, at 12:57:39
In reply to Re: No experts on Benzodiazipines! Alan » gilbert, posted by andyboy on March 9, 2002, at 10:34:13
As I have posted in many of my earlier statements I am not against benzo use or properly prescribed benzo use. I do think that every time there has been anti benzo sentiment or problems then the same sited material gets posted over and over to substantiate there uses. I used xanax successfully as a a recovering addict for 2 years.....it was not until my third year that the drug took hold of me for lack of a better word. There are numerous studies even some original FDA studies siting the potential abuse of benzos...I am begging the question is this all there is. The SSRI's were not and are not near as effective for me as benzos. The benzos have pooped out and I have become very hooked on them. Now the ssri's are showing withdrawal syndromes. Are we willing to settle for these as our options. Nobody who continues to take benzos complains about them until they run out or have to go off. Look at all of my earlier posts....very pro benzo, How is one to tell that for 2 years the drug will be effective and then bam it does not work. Then you need more and more. I am not saying that everyone who takes benzos will turn out like me I am saying it is more prevalent than most on this board would have you think. In my personal realm of family and friends I know of many people simply unable to quit their valium or xanax, most of these people are not addicts. Should I trust data off the internet or what I see in front of my own 2 eyes. My mom who has never been addicted to anything has spent 3 years trying to ramp down off valium. I could give many, many real life examples. All of these people started on low doses, needed more and then could not quit. I have dropped from 4mg xanax to 3 mg this has taken 2 months. I have tried the old klonopin switch it did not work. I think the medical community would prefer most panic patients on ssri's...with this I do not agree....but simply put the benzos can pose some serious problems and you don't have to be an ex addict like me for this to occur. Sleep disturbances, prolactin levels, I mean it's not like these meds are innocous to the body mind and soul. I am not asking for everyone to quit their benzos but a little dose of reality about their use would be nice once in a while. IT is not just junkies who have problems with these drugs. I would hope a viable substitute appears within the next few years for the sake of all of us.
Gil
Posted by andyboy on March 9, 2002, at 15:24:59
In reply to Re: No experts on Benzodiazipines! , posted by gilbert on March 9, 2002, at 12:57:39
Posted by gilbert on March 9, 2002, at 17:19:11
In reply to Re: benzodiazEpines, posted by Elizabeth on March 9, 2002, at 12:34:32
Elizabeth I aways love your posts but you get 2 minutes in the penalty box for this one below.................
> BTW, all the credible authorities I've encountered (including standard psychiatry and pharmacology textbooks as well as clinical studies) have provided convincing evidence that persons who take benzodiazepines long-term for anxiety disorders do not, as a rule, develop tolerance (contrary to your "theory," which does not constitute "convincing evidence"). So you have a big hurdle to overcome.
There are huge amounts of data clinical and standard pyschiactric practice that would say otherwise then your statement above....in fact the last 4 pyschiatrists I have seen have been anti benzo, and tell me all about all of their patients that develope a tolerance to these drugs and need to raise doses to be effective. The DMV and most standrrd PDR's specify to use these drugs prn or less than 4 weeks due to dependence problems. I would say those big hurdles amount to nothing more than speed bumps in some cases. I would venture to say that a minority of patients can stay on the same dose year in and out unless like you they are prn. I would say your statement that "all the credible sources" is from a personal bias rather than a scientific point of view for God's sake even the FDA studies on xanax showed addiction and tolerance problems. I don't think the entire medical establishment is gun shy because the patients have run out or because valium took a bad rap in the 70's. They have personal experience with patients running into problems with these meds. Even my internest tells me stories about patients who always need higher doses...so I do not consider the PDR, any pdoc I have seen and my Internest non credible sources. This was the point of my post earlier. There are loads of studies showing tolerance and abuse just look them up even like I stated before the Internet Mental Health site shows adverse effects from long term benzo use, the PDR warns against it, My own doc has experienced it with patients and I myself have experienced it in my own life so am I now to deem all of these real life experiences non-credible...........that would be incredible....I love your posts, inteligence and writing skills but I think I have to part ways with you on this one.....and it isn't often I part ways with you.
Gil
Posted by Zo on March 9, 2002, at 19:01:09
In reply to Re: benzodiazEpines, posted by gilbert on March 9, 2002, at 17:19:11
. . .And then there's boring types like me who cannot get addicted to save their lives (sorry, just my mordant humor.) Who have been plugging along on various benzos since 1985 and never had to increase any. Some just plumb didn't work, but that's another, possibly related story. The serious point being, why is it so different for some; how could someone in my lifelong chemical desperation not have become addicted to anything, even when I needed it, if you understand. When the pain and suicidality was unbearable---I have siblings, just as ill and with the same wretched parents and wretched genes, who did self-medicate, and who became addicts. I couldn't find even that kind of relief, then--and it wasn't long ago that meds were few and choices almost nil--and in fact my chemical imbalance has proved far more stubborn than theirs, in our various recoveries.I haven't medical theories. I know I will likely, barring medical breakthough, need benzos to fall asleep for the rest of my life--and thank god for that. You see my point? I do have great compassion for both sides of the coin, and think there's some kind of cautionary in my tale. . .sorry, too muddled today to think further. . .
Zo
Posted by gilbert on March 9, 2002, at 20:42:06
In reply to Re: benzos as a necessary good » gilbert, posted by Zo on March 9, 2002, at 19:01:09
I hear ya zo.....I think in some ways drinking may have saved my life....I certainly don't want to give the impression benzos are evil. The comfort and relief I got for 2 yeras on xanax was wonderfull....I am just so sad it had to change.
Gil;
Posted by Elizabeth on March 12, 2002, at 20:31:58
In reply to Re: benzodiazEpines, posted by gilbert on March 9, 2002, at 17:19:11
> There are huge amounts of data clinical and standard pyschiactric practice that would say otherwise then your statement above....
I should have been more specific. Some clinical practitioners may have the impression that benzo tolerance is common. And in fact, it is, if the benzo is being used for *insomnia* (not anxiety). I think it's a bad idea to get in the habit of taking benzos for insomnia. But anyway, an opinion is not necessarily right just because it's held by some psychiatrists. Physicians can be vulnerable to being influenced by their emotions, by propaganda, etc., just like the rest of us can.
I was referring to data derived from well-designed, rigorous clinical research. This research is described in articles that I've read and/or that are cited in standard textbooks in relevant fields. I'm not going to make a claim based solely on what a psychiatrist (or a few of them) believes; that's what is called an "appeal to authority" and is very often misleading. You know four psychiatrists who think benzos should never be used long-term? I know plenty (definitely more than four) who do use them long term with success. It is true that patients who are abusing benzos tend to have to increase the dose a lot. Patients who take benzos for anxiety seldom abuse them, though. As I've said before, it's important for a pdoc to keep a close eye on a patient with a drug abuse history if it becomes necessary to treat such a patient with benzos.
Anyway, I prefer to look at the facts themselves in forming my own opinion, rather than let the "experts" (those I know, or those you know) tell me what opinion to have. I think everyone here is aware that doctors sometimes get things wrong.
It's important to realize that the drug monographs in the PDR are put together by pharmaceutical companies, not disinterested academics or clinicians. The drug companies tend to make conservative recommendations in order to cover their own butts.
But anyway, the product monographs say not to use *sleeping pills* more than a couple weeks. Insomnia is not an anxiety disorder. People who take benzos as sedative-hypnotics for too long will most likely start needing to raise the dose at some point.
In contrast, if you read the Xanax monograph, you'll find that it's well accepted that people with anxiety disorders require longer treatment than just a month or so. "Demonstrations of the effectiveness of XANAX by systematic clinical study are limited to four months duration for anxiety disorder [GAD] and four to ten weeks for panic disorder; however, patients with panic disorder have been treated on an open basis for up to eight months without apparent loss of benefit." This doesn't sound to me like a recommendation against long-term treatment. (Note: this is from the 1999 PDR.)
I'm out of town and don't have Schatzberg & Nemeroff's psychiatry text here, but they go into the subject in some depth. I think I've probaly cited them in the past.
> I would say your statement that "all the credible sources" is from a personal bias rather than a scientific point of view
I think you should be more careful before making accusations of bias. That's not a very nice thing to say.
Some people do abuse prescribed benzos, and these people often take much more than the prescribed dose. (Most anxiety disordered patients taking benzos do *not* abuse them; those who do are almost unfailingly people who also abuse other drugs.) Every now and then a person taking a benzodiazepine for anxiety, and not abusing it, may nonetheless become tolerant to the drug's anxiolytic effects, but the available evidence clearly shows that this is exceptional.
-elizabeth
p.s. I'm not sure what you mean by "the DMV." (Where I come from, that's the Division of Motor Vehicles.) If you mean "DSM-IV," that's a set of diagnostic guidelines, *not* prescription information.
Posted by Frankie on March 12, 2002, at 21:48:03
In reply to Re: No experts on Benzodiazipines!, posted by trouble on March 9, 2002, at 2:03:14
> Hi Franki,
> We haven't met yet cause I'm usually over on PSB. This board is generally beyond me, but I'm learning as fast as I can.
> My question is about your assertion that the body builds a tolerance to everything including Anti-depressants. Is this why my meds stop working all of a sudden? It would be nice if I had a crisp reply for my pdoc when he puts that vibe out, like I've done something to make my meds go haywire. Sometimes I start getting crazy side effects 2 or 3 months after having been on the same meds and my doc is like, these can't be side effects, it's too late, it may be psychological, let's look at that instead. BTW my psychological testings are excruciatingly detailed and up-to-date, and totally non-committal about the cause of my problems, but strongly suggest they are psychological, not biological in nature. It's all so complicated.
> Thanks for reading,
> trouble
Hello Trouble,I like the name! I have read and seen first hand that the body will learn to tolerate almost anything that is put into it. Period. This means drugs, alcohol, the same foods over and over, etc... It is in the human nature to adapt to our surroundings, from way back in the days of the cavemen. I enjoy doing some bodybuilding in my spare time, and the way I continue to make good gains is to frequently change up my workouts. It keeps the progress going well. The body will adjust to about anything. And, also, it takes much, much punishment to kill a human being. I am talking physically. That is because of the adaptation factor to even punishment. As far as your question, you need to use an antidepressant for a good while. The human system will adapt and tolerate these most likely, but not for a good amount of time. I took St. John's Wort with good success for about 3 years, then it became quite ineffective. It depends on the strength of the medication, method of action, dosage, etc... My advice is this. Ask your doctor about the possibility of being tolerant to a certain type of antidepressant. For instance, if you have only ever taken Paxil or Prozac or Luvox, then you are likely defecient in something other than serotonin. Ask to try out Wellbutrin, or Effexor, or an older Tricyclic. Something with an affinity for norepinephrine or dopamine. Or a combination. Good luck to you.
Frankie.
Posted by Alan on March 12, 2002, at 22:07:29
In reply to Re: No experts on Benzodiazipines!, posted by Frankie on March 12, 2002, at 21:48:03
> > Hi Franki,
> > We haven't met yet cause I'm usually over on PSB. This board is generally beyond me, but I'm learning as fast as I can.
> > My question is about your assertion that the body builds a tolerance to everything including Anti-depressants. Is this why my meds stop working all of a sudden? It would be nice if I had a crisp reply for my pdoc when he puts that vibe out, like I've done something to make my meds go haywire. Sometimes I start getting crazy side effects 2 or 3 months after having been on the same meds and my doc is like, these can't be side effects, it's too late, it may be psychological, let's look at that instead. BTW my psychological testings are excruciatingly detailed and up-to-date, and totally non-committal about the cause of my problems, but strongly suggest they are psychological, not biological in nature. It's all so complicated.
> > Thanks for reading,
> > trouble
>
>
> Hello Trouble,
>
> I like the name! I have read and seen first hand that the body will learn to tolerate almost anything that is put into it. Period. This means drugs, alcohol, the same foods over and over, etc... It is in the human nature to adapt to our surroundings, from way back in the days of the cavemen. I enjoy doing some bodybuilding in my spare time, and the way I continue to make good gains is to frequently change up my workouts. It keeps the progress going well. The body will adjust to about anything. And, also, it takes much, much punishment to kill a human being. I am talking physically. That is because of the adaptation factor to even punishment. As far as your question, you need to use an antidepressant for a good while. The human system will adapt and tolerate these most likely, but not for a good amount of time. I took St. John's Wort with good success for about 3 years, then it became quite ineffective. It depends on the strength of the medication, method of action, dosage, etc... My advice is this. Ask your doctor about the possibility of being tolerant to a certain type of antidepressant. For instance, if you have only ever taken Paxil or Prozac or Luvox, then you are likely defecient in something other than serotonin. Ask to try out Wellbutrin, or Effexor, or an older Tricyclic. Something with an affinity for norepinephrine or dopamine. Or a combination. Good luck to you.
>
> Frankie.
_______________________________________________What does any of this have to do with mine and Elizabeth's response to your assertions about BZD's?
Alan
Posted by Frankie on March 13, 2002, at 21:13:24
In reply to Re: No experts on Benzodiazipines! » Frankie, posted by Alan on March 12, 2002, at 22:07:29
> > > Hi Franki,
> > > We haven't met yet cause I'm usually over on PSB. This board is generally beyond me, but I'm learning as fast as I can.
> > > My question is about your assertion that the body builds a tolerance to everything including Anti-depressants. Is this why my meds stop working all of a sudden? It would be nice if I had a crisp reply for my pdoc when he puts that vibe out, like I've done something to make my meds go haywire. Sometimes I start getting crazy side effects 2 or 3 months after having been on the same meds and my doc is like, these can't be side effects, it's too late, it may be psychological, let's look at that instead. BTW my psychological testings are excruciatingly detailed and up-to-date, and totally non-committal about the cause of my problems, but strongly suggest they are psychological, not biological in nature. It's all so complicated.
> > > Thanks for reading,
> > > trouble
> >
> >
> > Hello Trouble,
> >
> > I like the name! I have read and seen first hand that the body will learn to tolerate almost anything that is put into it. Period. This means drugs, alcohol, the same foods over and over, etc... It is in the human nature to adapt to our surroundings, from way back in the days of the cavemen. I enjoy doing some bodybuilding in my spare time, and the way I continue to make good gains is to frequently change up my workouts. It keeps the progress going well. The body will adjust to about anything. And, also, it takes much, much punishment to kill a human being. I am talking physically. That is because of the adaptation factor to even punishment. As far as your question, you need to use an antidepressant for a good while. The human system will adapt and tolerate these most likely, but not for a good amount of time. I took St. John's Wort with good success for about 3 years, then it became quite ineffective. It depends on the strength of the medication, method of action, dosage, etc... My advice is this. Ask your doctor about the possibility of being tolerant to a certain type of antidepressant. For instance, if you have only ever taken Paxil or Prozac or Luvox, then you are likely defecient in something other than serotonin. Ask to try out Wellbutrin, or Effexor, or an older Tricyclic. Something with an affinity for norepinephrine or dopamine. Or a combination. Good luck to you.
> >
> > Frankie.
> _______________________________________________
>
> What does any of this have to do with mine and Elizabeth's response to your assertions about BZD's?
>
> Alan
Alan,As to your question. I was simply replying to Trouble's question to me about the human body tolerating medications over time. I used a few examples off the topic, but the point was to him/her only. I probably should have posted it at a different location. My fault. But, in reality, my examples do tie in with the topic anyway. Just a variation.
Frankie.
Posted by lostsailor on January 7, 2008, at 4:38:49
In reply to Re: No experts on Benzodiazipines! » Frankie, posted by andyboy on March 8, 2002, at 10:18:11
.....AD's come out all time and tons are in the 'pipeline" Brand names =MONEY. Personally I have been on all the bz's written most often (klonopin, ativan, valium, and the dreaded xanax.) In fact, i began with xanax 13 years ago with one complaint--the short half-life. I was eating 2mg tabs three to four times a day...three were for "maintenance" preventing withdrawal symptoms< BUT once xanax er came out, i often take just the 3mg pills in the am and maybe, on a bad day 2 2mgs...3 if im losing it.
klonopin, esp for bi poler's, can bring on depression. valium, has a great half life but doesn't do a ton for a full blow them anytimeover the newn panic attack and ativan weak unless you are in a hospital and given it iv.
I take sssri's too, and lamictal as a mood deflector, but given the time that benzo's have been around and the research, I'll choose them anytime over the the newest med with little research andyears of use in practice.
~tony
Posted by yxibow on January 10, 2008, at 4:35:25
In reply to Re: benzos as a necessary good zo, posted by gilbert on March 9, 2002, at 20:42:06
I've been on a high dosage of Valium for some years -- in the beginning it did rather good things for me. It was in part a journal and practice theory (I'm not psychotic by the way, no offensive meant to those who are diagnosed primary)
that it aids in helping psychosis
(I have a rare visual somatiform disorder -- anyone out there with one speak up..... anyhow)
but as the amount piled up over the years, I ceased to get any "aahhh" from it.Oh its still doing something, I know, because its at least a double if not a triple edged necessary agent, but when we go down on it, theres an adjustment period and odd visual symptoms come back, dissociation comes back. The target is to mostly eliminate it (I may go Seroquel->Clozaril but thats a different issue) but it may take a long time of up and down to get away from it. Diarrhea, etc (just had to put that in, sorry).
Anyway my final point is that as noted from someone else we've been using them since 1962, and the last one (Xanax) came out around 1985. Due caution is certainly a prudent thing, but if Xanax works for you long term, then the benefit outweighs risks.Others habituate (I prefer that term because addiction is more needless craving of pharmaceuticals, e.g. Valium on the streets -- now there are cases where addiction and habituation can occur at the same time) very quickly and should only take them for around 4 weeks.
The best strategy is to take long acting (and not immediate response) benzodiazepines with in mind to trade off to some other non-benzodiazepine agent, as long half life benzodiazepines are easier to withdraw from (e.g. Valium, Klonopin) rather than Xanax or Ativan -- but then its an individual thing just like all case reports here.
So there's my dissertation :) on benzodiazepines -- with a warning that if you start to notice there's no "aaahh" at all to them (we're talking hours), you may be starting to habituate, in part, depending on your situation. Just personal experience unfortunately.-- Jay
Posted by pstrait on January 11, 2008, at 5:51:08
In reply to Re: benzos as a necessary good, posted by yxibow on January 10, 2008, at 4:35:25
For what it's worth -- I was basically addicted to Xanax for a couple years, first acquired illegally, and then through a script from my p-doc. Recently, I noticed that I was almost out, and checked the bottle and realized I hadn't refilled my prescription since early October. And yet I haven't felt less anxiety in years, and haven't had a panic attack in months!
I have no idea what to attribute this to -- I have been on Trileptal for over a year; I recently changed from zoloft+strattera+seroquel to just mirtazapine (and a seroquel now and then when I feel like im going hypomanic). I also switched from Focalin to Adderall, which definately helped. Weekly talk-therapy hasn't revealed any specific insights or breakthroughs, but I think has had a non-specific good benefit. Before I was in any treatment, I was straight up addicted to xanax, and now I'm not. It was probably a combination of things, but its amazing. Just a few months ago, if i ever had less than 7 mg of xanax in my possession at any time, pangs of anxiety started to fill my chest, and now, I don't even think twice about leaving my pills at home.
Everyone's mileage may vary of course. My experience with mirtazapine has been wonderful, and it was totally by luck that I found it -- I had read something about it, asked my doctor if I could try it, and we went from there.
Paul
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