![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 33 to 57 of 71. Go back in thread:
Posted by Amy II on September 14, 1999, at 13:03:25
In reply to Re: Lorazapam-inviting all comments about benzos, posted by GS on August 16, 1999, at 10:43:11
> > > > > > How can I find out what a lethal dosage of Lorazapam is?
> > > > >
> > > > > Why do you ask?
> > > > >
> > > > > Bob
> > > >
> > > > James here....
> > > >
> > > > There is an ez answer to this, but I would like you to answer Dr. Bobs question first !
> > > > I just started taking lorazapam for anxiety and am wondering how much I could take before I need to worry about phycological addition or overdose. I notice in some articles doeses of up to 10mg, while my persecription is for 1mg tablets, and I sometime take tables. but, I've noticed the effect continues to diminish.
> > > > james
> > ________________________________________________
> > The dosage needed depends on how bad the anxiety is that you are experiencing. First, there seems to be 2 schools of thought in the psychiatric profession about benzodiazapines. To generalize, 1) Benzodiazapines are not good for long term treatment of any anxiety disorder - cognitave therapy in combo with a sedating anti-depressant(such as Serzone)should be all that is about necessary. 2)Benzos are good for long term treatment of anxiety disorders because that is what they are....anti-anxiety agents made specifically for that purpose. Just keep it well managed...especially with a short half-life benzo like Xanax or Ativan. Supplement with cognitive therapy.
> > THE PROBLEM IS:
> >
> > The 1st group are in my opinion overrating the tolerance and dependence issues surrounding this class of drugs because of lack of understanding in prescribing and managing them. Also, misinterpretation of the PDR as well as listening to other psychiatrists with similar prejudice telling of THEIR OWN prejudice and ignorance concerning the side effects of benzos.
> >
> > It is a semantic argument actually. What is dependence? That if you stop taking benzos you'll become anxious again? Yes there is withdrawl involved in abruptly stopping benzos rather than tapering but does that constitute dependence? No. Yes, one can build up a tolerance to dosage but not something that can't be managed (unless they are being abused or not being taken as instructed).
> >
> > For instance, it doesn't take alot of imagination to know that Ativan can be managed with an augmentation of a small amount of the low or no side effect mood stabilizer Neurontin (900 - 1200mg)to help with Ativan going in and out of
> > the system therefore aleviating the drug induced anxiety.
> > Also, keep the Ativan at a constant level whether it is 2 or 6 or I've read up to 10 mgs. daily...whatever allows you to function the way you need to without the affliction of an anxiety disorder! That is the whole point! So what if you take 3 -4 mgs or 5 -6 mgs. a day! Does it in conjunction with cognative therapy techniques alleviate your anxiety disorder?
> > Don't be scared off by the argument that you are addicted to benzos when benzos are what stops the disease that you're afflicted with! A non -prejudicial psychopharmacologist will help manage your suffering and allay your unfounded fears of addiction that are imposed upon you by the first group of psychiatrists mentioned above. The point is, get the ball in the hole. Until these prejudiced doctors stop heaping these needlessly anxiety - provoking "facts" there will continue to be your type of sad questions worried about by many, many patients in need of relief.
> >
> > If you have an anxiety disorder, you take inti-anxiety drugs (until the purists come up with something THAT WORKS for you with less side effects).
> >
> > Am I pretty much on target Dr. Bob? (assuming that she has a properly diagnosed anxiety disorder).
> >
> > GS
> *******************************************************
> Any comments, similar experiences with this issue surrounding benzos.....Dr.s , patients??
>
> GS
Hey there. I can tell you that I have had 3 psychiatrists and not a one of them agrees with ativan. they say it is addicting and it is only good for short term.. I mean come on if it helps you what the hell is the problem.. I had three medical doctors that i have seen go ahead and prescribe it but only a small subscription and said go see your psychiatrist. Well everytime i go to see him he won't even listen to me about the ativan. That is the only thing htat has really helped me with my SEVERE anxiety disorder but he would rather have me suffering every night and every day until the "normal" medicine he has put me on, celexa kicks in.. I don't understand why i can't take 2 mgs a day for a couple of months unti the effects of celexa kicks in this is torture. I have state funded insurance so i have no choice about what psych i go see. I hate this my life is nightnare. I find something that f---ing works for me and the guy looks at me like i am stupid for asking him to please put me on it.. I swear they sometimes don't even understand the pain and horror this disease is. Do they really care. He gets frusterated with m e when i try to give him info thati find on the web.. I feel like i will never get any relieve imean this is bad.. what do i do. ?? Help? AmyII
Posted by Sean on September 14, 1999, at 15:56:41
In reply to Re: Lorazapam-inviting all comments about benzos, posted by Amy II on September 14, 1999, at 13:03:25
> > > > > > > How can I find out what a lethal dosage of Lorazapam is?
> > > > > >
> > > > > > Why do you ask?
> > > > > >
> > > > > > Bob
> > > > >
> > > > > James here....
> > > > >
> > > > > There is an ez answer to this, but I would like you to answer Dr. Bobs question first !
> > > > > I just started taking lorazapam for anxiety and am wondering how much I could take before I need to worry about phycological addition or overdose. I notice in some articles doeses of up to 10mg, while my persecription is for 1mg tablets, and I sometime take tables. but, I've noticed the effect continues to diminish.
> > > > > james
> > > ________________________________________________
> > > The dosage needed depends on how bad the anxiety is that you are experiencing. First, there seems to be 2 schools of thought in the psychiatric profession about benzodiazapines. To generalize, 1) Benzodiazapines are not good for long term treatment of any anxiety disorder - cognitave therapy in combo with a sedating anti-depressant(such as Serzone)should be all that is about necessary. 2)Benzos are good for long term treatment of anxiety disorders because that is what they are....anti-anxiety agents made specifically for that purpose. Just keep it well managed...especially with a short half-life benzo like Xanax or Ativan. Supplement with cognitive therapy.
> > > THE PROBLEM IS:
> > >
> > > The 1st group are in my opinion overrating the tolerance and dependence issues surrounding this class of drugs because of lack of understanding in prescribing and managing them. Also, misinterpretation of the PDR as well as listening to other psychiatrists with similar prejudice telling of THEIR OWN prejudice and ignorance concerning the side effects of benzos.
> > >
> > > It is a semantic argument actually. What is dependence? That if you stop taking benzos you'll become anxious again? Yes there is withdrawl involved in abruptly stopping benzos rather than tapering but does that constitute dependence? No. Yes, one can build up a tolerance to dosage but not something that can't be managed (unless they are being abused or not being taken as instructed).
> > >
> > > For instance, it doesn't take alot of imagination to know that Ativan can be managed with an augmentation of a small amount of the low or no side effect mood stabilizer Neurontin (900 - 1200mg)to help with Ativan going in and out of
> > > the system therefore aleviating the drug induced anxiety.
> > > Also, keep the Ativan at a constant level whether it is 2 or 6 or I've read up to 10 mgs. daily...whatever allows you to function the way you need to without the affliction of an anxiety disorder! That is the whole point! So what if you take 3 -4 mgs or 5 -6 mgs. a day! Does it in conjunction with cognative therapy techniques alleviate your anxiety disorder?
> > > Don't be scared off by the argument that you are addicted to benzos when benzos are what stops the disease that you're afflicted with! A non -prejudicial psychopharmacologist will help manage your suffering and allay your unfounded fears of addiction that are imposed upon you by the first group of psychiatrists mentioned above. The point is, get the ball in the hole. Until these prejudiced doctors stop heaping these needlessly anxiety - provoking "facts" there will continue to be your type of sad questions worried about by many, many patients in need of relief.
> > >
> > > If you have an anxiety disorder, you take inti-anxiety drugs (until the purists come up with something THAT WORKS for you with less side effects).
> > >
> > > Am I pretty much on target Dr. Bob? (assuming that she has a properly diagnosed anxiety disorder).
> > >
> > > GS
> > *******************************************************
> > Any comments, similar experiences with this issue surrounding benzos.....Dr.s , patients??
> >
> > GS
> Hey there. I can tell you that I have had 3 psychiatrists and not a one of them agrees with ativan. they say it is addicting and it is only good for short term.. I mean come on if it helps you what the hell is the problem.. I had three medical doctors that i have seen go ahead and prescribe it but only a small subscription and said go see your psychiatrist. Well everytime i go to see him he won't even listen to me about the ativan. That is the only thing htat has really helped me with my SEVERE anxiety disorder but he would rather have me suffering every night and every day until the "normal" medicine he has put me on, celexa kicks in.. I don't understand why i can't take 2 mgs a day for a couple of months unti the effects of celexa kicks in this is torture. I have state funded insurance so i have no choice about what psych i go see. I hate this my life is nightnare. I find something that f---ing works for me and the guy looks at me like i am stupid for asking him to please put me on it.. I swear they sometimes don't even understand the pain and horror this disease is. Do they really care. He gets frusterated with m e when i try to give him info thati find on the web.. I feel like i will never get any relieve imean this is bad.. what do i do. ?? Help? AmyIIRight on Amy. Of course when I had lightening bolts
zapping through my body, etc..., my doc was having
problems with me *staying* on xanax because in my
fear-based world, I was convinced he was going to
addict me.How about Neurontin? It may help and satisfy your
doctor's problems with prescribing ativan.Good luck,
Sean.
Posted by Amy II on September 14, 1999, at 18:50:27
In reply to Re: Lorazapam-inviting all comments about benzos, posted by Sean on September 14, 1999, at 15:56:41
> > > > > > > > How can I find out what a lethal dosage of Lorazapam is?
> > > > > > >
> > > > > > > Why do you ask?
> > > > > > >
> > > > > > > Bob
> > > > > >
> > > > > > James here....
> > > > > >
> > > > > > There is an ez answer to this, but I would like you to answer Dr. Bobs question first !
> > > > > > I just started taking lorazapam for anxiety and am wondering how much I could take before I need to worry about phycological addition or overdose. I notice in some articles doeses of up to 10mg, while my persecription is for 1mg tablets, and I sometime take tables. but, I've noticed the effect continues to diminish.
> > > > > > james
> > > > ________________________________________________
> > > > The dosage needed depends on how bad the anxiety is that you are experiencing. First, there seems to be 2 schools of thought in the psychiatric profession about benzodiazapines. To generalize, 1) Benzodiazapines are not good for long term treatment of any anxiety disorder - cognitave therapy in combo with a sedating anti-depressant(such as Serzone)should be all that is about necessary. 2)Benzos are good for long term treatment of anxiety disorders because that is what they are....anti-anxiety agents made specifically for that purpose. Just keep it well managed...especially with a short half-life benzo like Xanax or Ativan. Supplement with cognitive therapy.
> > > > THE PROBLEM IS:
> > > >
> > > > The 1st group are in my opinion overrating the tolerance and dependence issues surrounding this class of drugs because of lack of understanding in prescribing and managing them. Also, misinterpretation of the PDR as well as listening to other psychiatrists with similar prejudice telling of THEIR OWN prejudice and ignorance concerning the side effects of benzos.
> > > >
> > > > It is a semantic argument actually. What is dependence? That if you stop taking benzos you'll become anxious again? Yes there is withdrawl involved in abruptly stopping benzos rather than tapering but does that constitute dependence? No. Yes, one can build up a tolerance to dosage but not something that can't be managed (unless they are being abused or not being taken as instructed).
> > > >
> > > > For instance, it doesn't take alot of imagination to know that Ativan can be managed with an augmentation of a small amount of the low or no side effect mood stabilizer Neurontin (900 - 1200mg)to help with Ativan going in and out of
> > > > the system therefore aleviating the drug induced anxiety.
> > > > Also, keep the Ativan at a constant level whether it is 2 or 6 or I've read up to 10 mgs. daily...whatever allows you to function the way you need to without the affliction of an anxiety disorder! That is the whole point! So what if you take 3 -4 mgs or 5 -6 mgs. a day! Does it in conjunction with cognative therapy techniques alleviate your anxiety disorder?
> > > > Don't be scared off by the argument that you are addicted to benzos when benzos are what stops the disease that you're afflicted with! A non -prejudicial psychopharmacologist will help manage your suffering and allay your unfounded fears of addiction that are imposed upon you by the first group of psychiatrists mentioned above. The point is, get the ball in the hole. Until these prejudiced doctors stop heaping these needlessly anxiety - provoking "facts" there will continue to be your type of sad questions worried about by many, many patients in need of relief.
> > > >
> > > > If you have an anxiety disorder, you take inti-anxiety drugs (until the purists come up with something THAT WORKS for you with less side effects).
> > > >
> > > > Am I pretty much on target Dr. Bob? (assuming that she has a properly diagnosed anxiety disorder).
> > > >
> > > > GS
> > > *******************************************************
> > > Any comments, similar experiences with this issue surrounding benzos.....Dr.s , patients??
> > >
> > > GS
> > Hey there. I can tell you that I have had 3 psychiatrists and not a one of them agrees with ativan. they say it is addicting and it is only good for short term.. I mean come on if it helps you what the hell is the problem.. I had three medical doctors that i have seen go ahead and prescribe it but only a small subscription and said go see your psychiatrist. Well everytime i go to see him he won't even listen to me about the ativan. That is the only thing htat has really helped me with my SEVERE anxiety disorder but he would rather have me suffering every night and every day until the "normal" medicine he has put me on, celexa kicks in.. I don't understand why i can't take 2 mgs a day for a couple of months unti the effects of celexa kicks in this is torture. I have state funded insurance so i have no choice about what psych i go see. I hate this my life is nightnare. I find something that f---ing works for me and the guy looks at me like i am stupid for asking him to please put me on it.. I swear they sometimes don't even understand the pain and horror this disease is. Do they really care. He gets frusterated with m e when i try to give him info thati find on the web.. I feel like i will never get any relieve imean this is bad.. what do i do. ?? Help? AmyII
>
> Right on Amy. Of course when I had lightening bolts
> zapping through my body, etc..., my doc was having
> problems with me *staying* on xanax because in my
> fear-based world, I was convinced he was going to
> addict me.
>
> How about Neurontin? It may help and satisfy your
> doctor's problems with prescribing ativan.
>
> Good luck,
>
> Sean.Hey Sean.. You won't believe this but i went to see my psychiatrist today and he prescibed neurontin. told me he wanted me to take a half a milligram at night and 1 mg if i needed it but try to stay away from it. I don't know anything about it. Any info. Is it like Ativan. he also wants em to stay on 10 mg of celexa for a few eeks then up dose to 20 mg with half mg of Neurontin. I hope this helps me. I am so sick of trying to get docs to listen to me.
AmyII
Posted by Ian on September 15, 1999, at 8:36:58
In reply to Re: Lorazapam-inviting all comments about benzos, posted by Amy II on September 14, 1999, at 18:50:27
It appears to me that the benzo thing is a bit of a lottery.I've met one or two people who claim benzodiazpines have mad a real mess of there lives listing every concievable side effect and claiming they have lost years of there lives on them. On the other side I've met plenty of sprightly little old ladies who have been taking 10mg of Temazepam or 5mg of Nitrazepam to get them off to sleep for the last ten fifteen years with no ill effects.
Realy the benzo's in that sense are very similar to alcohol in the way people use them. The cross over of CNS suppressing effects is quite clear,benzos are used to lessen the effects of alcohol withdrawal and personally I've used them (or chlormetiazole) when confronted with post op orthopaedic patients beginning to lose it when their system hasn't had the rather generous Scotch nightcaps that they are used to.
This is another amiguous answer but I suppose it highlights the fact that the person the drug is given to or the reason for giving it are often the determinates of whether a drug is deamed good or bad, addictive or non addictive.
Posted by Amy II on September 15, 1999, at 11:53:11
In reply to Re: Lorazapam-inviting all comments about benzos, posted by Ian on September 15, 1999, at 8:36:58
> It appears to me that the benzo thing is a bit of a lottery.I've met one or two people who claim benzodiazpines have mad a real mess of there lives listing every concievable side effect and claiming they have lost years of there lives on them. On the other side I've met plenty of sprightly little old ladies who have been taking 10mg of Temazepam or 5mg of Nitrazepam to get them off to sleep for the last ten fifteen years with no ill effects.
> Realy the benzo's in that sense are very similar to alcohol in the way people use them. The cross over of CNS suppressing effects is quite clear,benzos are used to lessen the effects of alcohol withdrawal and personally I've used them (or chlormetiazole) when confronted with post op orthopaedic patients beginning to lose it when their system hasn't had the rather generous Scotch nightcaps that they are used to.
> This is another amiguous answer but I suppose it highlights the fact that the person the drug is given to or the reason for giving it are often the determinates of whether a drug is deamed good or bad, addictive or non addictive.Well the doctor prescribed klonopin not Neurontin. My mistake. :) I have looked this thing up and i don't know if i want to take it there are some really harsh i mean harsh side effectrs if there is anybody out there that has taken this drug ofr anxiety please let me know i don't want ot start taking it until i hear some experiences.
Posted by Bob on September 15, 1999, at 12:09:53
In reply to Re: Lorazapam-inviting all comments about benzos, posted by Amy II on September 15, 1999, at 11:53:11
> I have looked this thing up and i don't know if i want to take it there are some really harsh i mean harsh side effectrs if there is anybody out there that has taken this drug ofr anxiety please let me know i don't want ot start taking it until i hear some experiences.
Someone, I can't recall who, just talked about her horror story in being forced to switch from klonopin to its generic "equivalent", clonazepam. Apparently, there's a much bigger difference between the brand-name and the generic than you'd think.
On the other hand, I've been taking clonazepam for a little over a year now, and its effects for me are so basic and subtle that I'm tempted to include it at the base of my personal hierarchy of needs, right along with food, water, shelter, and whatever else Maslow put in there. I've been going through some extremely stressful times at work, and its been rock steady for me.
... besides, my copay for generics is half ($5) my copay for brand-names, so I got that extra 5 bucks a month to spend on the more important things in life, like playing the lotto (you can't win if you don't play ;^)
Cheers
Bob
Posted by Sean on September 15, 1999, at 16:45:03
In reply to klonopin vs clonazepam, posted by Bob on September 15, 1999, at 12:09:53
> > I have looked this thing up and i don't know if i want to take it there are some really harsh i mean harsh side effectrs if there is anybody out there that has taken this drug ofr anxiety please let me know i don't want ot start taking it until i hear some experiences.
>
> Someone, I can't recall who, just talked about her horror story in being forced to switch from klonopin to its generic "equivalent", clonazepam. Apparently, there's a much bigger difference between the brand-name and the generic than you'd think.
>
> On the other hand, I've been taking clonazepam for a little over a year now, and its effects for me are so basic and subtle that I'm tempted to include it at the base of my personal hierarchy of needs, right along with food, water, shelter, and whatever else Maslow put in there. I've been going through some extremely stressful times at work, and its been rock steady for me.
>
> ... besides, my copay for generics is half ($5) my copay for brand-names, so I got that extra 5 bucks a month to spend on the more important things in life, like playing the lotto (you can't win if you don't play ;^)
>
> Cheers
> Bob
I think the benzo risk may depend on an individuals
sensitivity to changes in the GABA-ergic system.
GABA is generally thought to confer an inhibitory
effect on the CNS which helps explain why benzos
work so well for anxiety which, subjectively, feels
like errant electricity in the brain and body, or
at least in the "fear" centers.From long personal experience with benzos, I
have found them irreplacable for acute anxiety.
They can be life savers in that sense: an evil
dose of anxiety on top of major depression puts
one at a high risk for suicide. Being hopless and
low energy is bad enough. Being hopeless and
anxious out of your mind to the point of total
derealization etc... is a recipe for disaster.I think (personal opinion here) that the brain
is rather malleable in some ways; the more anxiety
you get used to, the more you have - kind of like
kindling. By turning this signal down for say, 2
weeks, the nervous system has a chance to get back
into the swing of things.But, if you heavily down-regulate you GABA with acute
doses of benzos for a year, there will likely be
problems when coming off. A close friend of mine
found that his siezure threshold had been lowered
and the rate at which he slowed his medication
intake was critical.It is interesting to me that Gabapentin (Neuronten)
is also used for anti-siezure (epilepsy) which
is quite clearly a neurological storm in the brain.I wonder if people on Neuronten find that when they
come off that drug their siezure threshold is
lower?ANyway, I'm rambling on. Benzo are great acute
therapy. They save lives, are relatively safe, and
most people don't abuse them...Sean.
Posted by GS on September 15, 1999, at 22:40:51
In reply to Benzo Risks, posted by Sean on September 15, 1999, at 16:45:03
> I think the benzo risk may depend on an individuals
> sensitivity to changes in the GABA-ergic system.
> GABA is generally thought to confer an inhibitory
> effect on the CNS which helps explain why benzos
> work so well for anxiety which, subjectively, feels
> like errant electricity in the brain and body, or
> at least in the "fear" centers.
>
> From long personal experience with benzos, I
> have found them irreplacable for acute anxiety.
> They can be life savers in that sense: an evil
> dose of anxiety on top of major depression puts
> one at a high risk for suicide. Being hopless and
> low energy is bad enough. Being hopeless and
> anxious out of your mind to the point of total
> derealization etc... is a recipe for disaster.
>
> I think (personal opinion here) that the brain
> is rather malleable in some ways; the more anxiety
> you get used to, the more you have - kind of like
> kindling. By turning this signal down for say, 2
> weeks, the nervous system has a chance to get back
> into the swing of things.
>
> But, if you heavily down-regulate you GABA with acute
> doses of benzos for a year, there will likely be
> problems when coming off. A close friend of mine
> found that his siezure threshold had been lowered
> and the rate at which he slowed his medication
> intake was critical.
>
> It is interesting to me that Gabapentin (Neuronten)
> is also used for anti-siezure (epilepsy) which
> is quite clearly a neurological storm in the brain.
>
> I wonder if people on Neuronten find that when they
> come off that drug their siezure threshold is
> lower?
>
> ANyway, I'm rambling on. Benzo are great acute
> therapy. They save lives, are relatively safe, and
> most people don't abuse them...
>
> Sean.
************************************************Yeah Sean...
Gabapentin was intended as and is listed as an anti-siezure drug and mood stabilizer whose claim to fame is a low side effect profile. As I mentioned in an earlier post, prescribed in a relatively low dose in conjunction with ativan or similar benzo (for a legitimate anxiety disorder), the side effect of the shorter half life benzo going in and out of the system is then minimized.
You know looking at the last few posts about the unwillingness of an uninformed group of doctors to prescribe benzos for the long term treatment of anxiety disorders is exactly what motivated me to start contributing to this list in the first place (posts on 8/4 and 8/14).
My psychopharmacologist tells me that Gabapentin is used to help stop the withdrawl symptoms of alcohol and an overdose of benzos in the psyc unit at the hospital. I take several mgs of ativan on a daily basis and have for a couple of years and lead a high functioning existence now that my anxiety disorder is under control...this after the previous 5 years of trying every antidepressant and mood stabilizer known to man with another doc who refused to give me the relief that I needed with benzos for fear that I would become "addicted". I believe that the Gabapentin helps mediate the receptors in the brain that you mention - the ones that are also so influenced by ativan.
I'm interested to know what you mean by "seizure threshold" - as in epileptic seizure? - or as in drug induced seizure? I have no experience in this....
As far as going through withdrawl after a year on benzos, sure it would be hard - but alot easier than putting up with chronic anxiety instead. That is why there is no need to go off of them in the first place for a chronic condition (in both my and my docs opinion).
GS
**************************************************
Posted by Jeff on September 16, 1999, at 10:18:20
In reply to klonopin vs clonazepam, posted by Bob on September 15, 1999, at 12:09:53
Ivan Goldberg made a big point of telling me that there's a difference between generic lorazepam and brand name Ativan -and that his patients have better results. Even though insurance co's love the cheap generic I tried the brand and he was right. This wasn't a huge difference, nor one that would suggest risk in going the other direction - but it seemed to work better.
Posted by Sean on September 17, 1999, at 13:05:56
In reply to Re: Benzo Risks - To Sean, posted by GS on September 15, 1999, at 22:40:51
> > I think the benzo risk may depend on an individuals
> > sensitivity to changes in the GABA-ergic system.
> > GABA is generally thought to confer an inhibitory
> > effect on the CNS which helps explain why benzos
> > work so well for anxiety which, subjectively, feels
> > like errant electricity in the brain and body, or
> > at least in the "fear" centers.
> >
> > From long personal experience with benzos, I
> > have found them irreplacable for acute anxiety.
> > They can be life savers in that sense: an evil
> > dose of anxiety on top of major depression puts
> > one at a high risk for suicide. Being hopless and
> > low energy is bad enough. Being hopeless and
> > anxious out of your mind to the point of total
> > derealization etc... is a recipe for disaster.
> >
> > I think (personal opinion here) that the brain
> > is rather malleable in some ways; the more anxiety
> > you get used to, the more you have - kind of like
> > kindling. By turning this signal down for say, 2
> > weeks, the nervous system has a chance to get back
> > into the swing of things.
> >
> > But, if you heavily down-regulate you GABA with acute
> > doses of benzos for a year, there will likely be
> > problems when coming off. A close friend of mine
> > found that his siezure threshold had been lowered
> > and the rate at which he slowed his medication
> > intake was critical.
> >
> > It is interesting to me that Gabapentin (Neuronten)
> > is also used for anti-siezure (epilepsy) which
> > is quite clearly a neurological storm in the brain.
> >
> > I wonder if people on Neuronten find that when they
> > come off that drug their siezure threshold is
> > lower?
> >
> > ANyway, I'm rambling on. Benzo are great acute
> > therapy. They save lives, are relatively safe, and
> > most people don't abuse them...
> >
> > Sean.
> ************************************************
>
> Yeah Sean...
>
> Gabapentin was intended as and is listed as an anti-siezure drug and mood stabilizer whose claim to fame is a low side effect profile. As I mentioned in an earlier post, prescribed in a relatively low dose in conjunction with ativan or similar benzo (for a legitimate anxiety disorder), the side effect of the shorter half life benzo going in and out of the system is then minimized.
>
> You know looking at the last few posts about the unwillingness of an uninformed group of doctors to prescribe benzos for the long term treatment of anxiety disorders is exactly what motivated me to start contributing to this list in the first place (posts on 8/4 and 8/14).
>
> My psychopharmacologist tells me that Gabapentin is used to help stop the withdrawl symptoms of alcohol and an overdose of benzos in the psyc unit at the hospital. I take several mgs of ativan on a daily basis and have for a couple of years and lead a high functioning existence now that my anxiety disorder is under control...this after the previous 5 years of trying every antidepressant and mood stabilizer known to man with another doc who refused to give me the relief that I needed with benzos for fear that I would become "addicted". I believe that the Gabapentin helps mediate the receptors in the brain that you mention - the ones that are also so influenced by ativan.
>
> I'm interested to know what you mean by "seizure threshold" - as in epileptic seizure? - or as in drug induced seizure? I have no experience in this....
>
> As far as going through withdrawl after a year on benzos, sure it would be hard - but alot easier than putting up with chronic anxiety instead. That is why there is no need to go off of them in the first place for a chronic condition (in both my and my docs opinion).
>
> GS
> **************************************************GS -
Agreed on the chronic condition aspect of treatment.
I have an incredible addiction to - food. Man,
if I don't have it for few days I become shaky,
depressed, crabby, and I can think clearly...
Total withdrawl syndrome mang.Sean.
Posted by Michael on November 23, 1999, at 14:37:59
In reply to Re: Benzo Risks - To Sean, posted by Sean on September 17, 1999, at 13:05:56
> > > I think the benzo risk may depend on an individuals
> > > sensitivity to changes in the GABA-ergic system.
> > > GABA is generally thought to confer an inhibitory
> > > effect on the CNS which helps explain why benzos
> > > work so well for anxiety which, subjectively, feels
> > > like errant electricity in the brain and body, or
> > > at least in the "fear" centers.
> > >
> > > From long personal experience with benzos, I
> > > have found them irreplacable for acute anxiety.
> > > They can be life savers in that sense: an evil
> > > dose of anxiety on top of major depression puts
> > > one at a high risk for suicide. Being hopless and
> > > low energy is bad enough. Being hopeless and
> > > anxious out of your mind to the point of total
> > > derealization etc... is a recipe for disaster.
> > >
> > > I think (personal opinion here) that the brain
> > > is rather malleable in some ways; the more anxiety
> > > you get used to, the more you have - kind of like
> > > kindling. By turning this signal down for say, 2
> > > weeks, the nervous system has a chance to get back
> > > into the swing of things.
> > >
> > > But, if you heavily down-regulate you GABA with acute
> > > doses of benzos for a year, there will likely be
> > > problems when coming off. A close friend of mine
> > > found that his siezure threshold had been lowered
> > > and the rate at which he slowed his medication
> > > intake was critical.
> > >
> > > It is interesting to me that Gabapentin (Neuronten)
> > > is also used for anti-siezure (epilepsy) which
> > > is quite clearly a neurological storm in the brain.
> > >
> > > I wonder if people on Neuronten find that when they
> > > come off that drug their siezure threshold is
> > > lower?
> > >
> > > ANyway, I'm rambling on. Benzo are great acute
> > > therapy. They save lives, are relatively safe, and
> > > most people don't abuse them...
> > >
> > > Sean.
> > ************************************************
> >
> > Yeah Sean...
> >
> > Gabapentin was intended as and is listed as an anti-siezure drug and mood stabilizer whose claim to fame is a low side effect profile. As I mentioned in an earlier post, prescribed in a relatively low dose in conjunction with ativan or similar benzo (for a legitimate anxiety disorder), the side effect of the shorter half life benzo going in and out of the system is then minimized.
> >
> > You know looking at the last few posts about the unwillingness of an uninformed group of doctors to prescribe benzos for the long term treatment of anxiety disorders is exactly what motivated me to start contributing to this list in the first place (posts on 8/4 and 8/14).
> >
> > My psychopharmacologist tells me that Gabapentin is used to help stop the withdrawl symptoms of alcohol and an overdose of benzos in the psyc unit at the hospital. I take several mgs of ativan on a daily basis and have for a couple of years and lead a high functioning existence now that my anxiety disorder is under control...this after the previous 5 years of trying every antidepressant and mood stabilizer known to man with another doc who refused to give me the relief that I needed with benzos for fear that I would become "addicted". I believe that the Gabapentin helps mediate the receptors in the brain that you mention - the ones that are also so influenced by ativan.
> >
> > I'm interested to know what you mean by "seizure threshold" - as in epileptic seizure? - or as in drug induced seizure? I have no experience in this....
> >
> > As far as going through withdrawl after a year on benzos, sure it would be hard - but alot easier than putting up with chronic anxiety instead. That is why there is no need to go off of them in the first place for a chronic condition (in both my and my docs opinion).
> >
> > GS
> > **************************************************
>
> GS -
>
> Agreed on the chronic condition aspect of treatment.
> I have an incredible addiction to - food. Man,
> if I don't have it for few days I become shaky,
> depressed, crabby, and I can think clearly...
> Total withdrawl syndrome mang.
>
> Sean.I'm new here--so be kind. Had to add my 3 cents. Quess I've been a Klonopin "addict" fot almost ten years. That's ten years with "reasonable" control of my fears, too numerous to get into. Well--Klonopin 8 mg. in 1991 and for the coming few years, people wondered just how I could stay awke !! Well that just proves my point a dependence I have, not addiction. Need the drug, its helps me function and my p doc is in total agreement. Down to four mg. these days--did it on my own--no problems, Neurontin recently added up to 400 mg. three times a day. Takes a bit of getting use to...but when you do you feel that "fire" in your belly is gone, and you're off to a 'normal" day. Klonopin, I feel saved my life....now Neurontin just helps me live it to the fullest ever. Thanks for listening peoples. Hello all !!
Posted by Sue Mohler on November 14, 2000, at 19:20:28
In reply to Re: Benzo Risks - To Sean, posted by Michael on November 23, 1999, at 14:37:59
Hi
I am new to this thread but after a head injury I have been on up to 3 -4 mg. of Clonazepam for the past 4 1/2 years. I have been pretty fuzzy headed on this stuff and recently, I have had problems breathing after taking my dose...seems like the anxiety on a feeling level goes away but physically the elephant is on my chest. Recently I have convinced this really conservative Psych to give me 1 mg. of Lorazepam for PRN and this has helped me reduce the amount of Clonazepam and there are no side effects. He is concerned as he feels the Lorazepam is highly addictive (like 4 1/2 years of the other isn't :) I am interested in others experiences on these 2 and also used in combination with Wellbutrin....I have been at 250 mg for about 3 mos and am going to 300 mg...This has helped my cognitive functions. I have also been on Neurontin but didn't notice much benefit....any comments?
Thanks> > > > I think the benzo risk may depend on an individuals
> > > > sensitivity to changes in the GABA-ergic system.
> > > > GABA is generally thought to confer an inhibitory
> > > > effect on the CNS which helps explain why benzos
> > > > work so well for anxiety which, subjectively, feels
> > > > like errant electricity in the brain and body, or
> > > > at least in the "fear" centers.
> > > >
> > > > From long personal experience with benzos, I
> > > > have found them irreplacable for acute anxiety.
> > > > They can be life savers in that sense: an evil
> > > > dose of anxiety on top of major depression puts
> > > > one at a high risk for suicide. Being hopless and
> > > > low energy is bad enough. Being hopeless and
> > > > anxious out of your mind to the point of total
> > > > derealization etc... is a recipe for disaster.
> > > >
> > > > I think (personal opinion here) that the brain
> > > > is rather malleable in some ways; the more anxiety
> > > > you get used to, the more you have - kind of like
> > > > kindling. By turning this signal down for say, 2
> > > > weeks, the nervous system has a chance to get back
> > > > into the swing of things.
> > > >
> > > > But, if you heavily down-regulate you GABA with acute
> > > > doses of benzos for a year, there will likely be
> > > > problems when coming off. A close friend of mine
> > > > found that his siezure threshold had been lowered
> > > > and the rate at which he slowed his medication
> > > > intake was critical.
> > > >
> > > > It is interesting to me that Gabapentin (Neuronten)
> > > > is also used for anti-siezure (epilepsy) which
> > > > is quite clearly a neurological storm in the brain.
> > > >
> > > > I wonder if people on Neuronten find that when they
> > > > come off that drug their siezure threshold is
> > > > lower?
> > > >
> > > > ANyway, I'm rambling on. Benzo are great acute
> > > > therapy. They save lives, are relatively safe, and
> > > > most people don't abuse them...
> > > >
> > > > Sean.
> > > ************************************************
> > >
> > > Yeah Sean...
> > >
> > > Gabapentin was intended as and is listed as an anti-siezure drug and mood stabilizer whose claim to fame is a low side effect profile. As I mentioned in an earlier post, prescribed in a relatively low dose in conjunction with ativan or similar benzo (for a legitimate anxiety disorder), the side effect of the shorter half life benzo going in and out of the system is then minimized.
> > >
> > > You know looking at the last few posts about the unwillingness of an uninformed group of doctors to prescribe benzos for the long term treatment of anxiety disorders is exactly what motivated me to start contributing to this list in the first place (posts on 8/4 and 8/14).
> > >
> > > My psychopharmacologist tells me that Gabapentin is used to help stop the withdrawl symptoms of alcohol and an overdose of benzos in the psyc unit at the hospital. I take several mgs of ativan on a daily basis and have for a couple of years and lead a high functioning existence now that my anxiety disorder is under control...this after the previous 5 years of trying every antidepressant and mood stabilizer known to man with another doc who refused to give me the relief that I needed with benzos for fear that I would become "addicted". I believe that the Gabapentin helps mediate the receptors in the brain that you mention - the ones that are also so influenced by ativan.
> > >
> > > I'm interested to know what you mean by "seizure threshold" - as in epileptic seizure? - or as in drug induced seizure? I have no experience in this....
> > >
> > > As far as going through withdrawl after a year on benzos, sure it would be hard - but alot easier than putting up with chronic anxiety instead. That is why there is no need to go off of them in the first place for a chronic condition (in both my and my docs opinion).
> > >
> > > GS
> > > **************************************************
> >
> > GS -
> >
> > Agreed on the chronic condition aspect of treatment.
> > I have an incredible addiction to - food. Man,
> > if I don't have it for few days I become shaky,
> > depressed, crabby, and I can think clearly...
> > Total withdrawl syndrome mang.
> >
> > Sean.
>
> I'm new here--so be kind. Had to add my 3 cents. Quess I've been a Klonopin "addict" fot almost ten years. That's ten years with "reasonable" control of my fears, too numerous to get into. Well--Klonopin 8 mg. in 1991 and for the coming few years, people wondered just how I could stay awke !! Well that just proves my point a dependence I have, not addiction. Need the drug, its helps me function and my p doc is in total agreement. Down to four mg. these days--did it on my own--no problems, Neurontin recently added up to 400 mg. three times a day. Takes a bit of getting use to...but when you do you feel that "fire" in your belly is gone, and you're off to a 'normal" day. Klonopin, I feel saved my life....now Neurontin just helps me live it to the fullest ever. Thanks for listening peoples. Hello all !!
Posted by proud mary on January 15, 2003, at 15:56:14
In reply to klonopin vs clonazepam, posted by Bob on September 15, 1999, at 12:09:53
Bob,
I have taken both, I think, but I've been taking Clonazapam for a long, long time and have not had any trouble with it. I initially took it for severe GAD and then tapered off within about two years. I was off of it for years (while taking zoloft) but started taking it again a couple of years ago after having an exercise induced panic attack. Since then, sometimes it's the ONLY thing that gets me through...some days I don't even feel like I need it. part of the problem is that the zoloft has stopped being as effective for me and so I have switched to Lexapro and am in transition.
I don't understand why anyone is taking xanax in the long term when all of the doctors I have dealt with acted as if it was a street-drug, but seem to think an endless perscription of clonazapam is just fine...
I haven't noticed it bothering my sleep, either. If I don't sleep well, I don't. If I do sleep well, I do. All while taking .5-1 mg of it a night. Is that a low dose?
Any advice is appreciated...you seem really knowledgable!
Mary
Posted by utopizen on January 15, 2003, at 21:05:05
In reply to klonopin vs clonazepam, posted by Bob on September 15, 1999, at 12:09:53
I don't care, the K looks cute, and I want it. I'm asking for the K. I've really fought to get a new psychopharmacologist to get K-PAX, and I''ll be darned if I don't get that big K on the pill. The blank scored tablet is boring. $5 more, it's worth it, I'm like that. Besides, I'd just waste that money on another BK veggie anyway =P
Posted by comftnumb on January 16, 2003, at 2:07:51
In reply to Re: klonopin vs clonazepam » Bob, posted by proud mary on January 15, 2003, at 15:56:14
I'm not sure exactly why doctors would prefer klonopin to xanax but here is a possible reason:
Xanax has a much shorter average half-life (12hrs) than Klonopin (34hours). Xanax is considered a short-acting benzo while Klonopin is considered long-acting. Short-acting benzos are associated with more rebound anxiety and withdrawal reaction, therefore harder to get off of.
For a list of benzos, see http://www.sdh.sk.ca/rxfiles/acrobat/Cht-Psyc-Benzodiazepines.pdf
PS Make sure you have adobe acrobat reader installed. It's freeware.
Posted by lostsailor on January 16, 2003, at 10:44:45
In reply to Re: klonopin vs xanax » proud mary, posted by comftnumb on January 16, 2003, at 2:07:51
I think I can help a bit here. I am a person that has suffered from GAD and Panic Disorder now for about 7 years and has remained on benzodiazapines virtually continuously for all of those years.
Basically, the family of this medication can be broken down into three main categories depending on the "half-life " of the medication and are at times divided even further. 1) Short acting benzos--xanax and ativan are decent examples. 2) mid-length--Klonopin and 3)long-lasting--valium.
During the past years the ssris and newer meds have not totally alleviated my panic and anxiety prob, though they have helped. Also, while marketed as a salvation and alternative to benzos there is now evidence of a withdrawal syndrome
similar to the benzo family.
I began taking a Prozac and a low dose of xanax as needed in the mid 1990s as directed by my primary care doc. While somewhat helpful I needed a dose that my doc thought indicated a referral to a psychiatrist for work up and consult was in order.
It was then that the words Panic Disorder changed from my description of just the attacks.Dr M (e.g., my shrink), explained that while xanax is a great med for short-term issues klonopin was a better choice b/c it lasts in your body longer, produces less of a "euphoric" feeling and in general is more politically correct to prescribe. I was also started on paxil and stopped prozac.
While klonopin did help it was not as effective as xanax and it "seemed" that it intensified depressive feelings so we agreed that xnanx was perhaps the better choice for me at the time.
A year or two later, I began to despise carrying xanax everywhere I went. When a "short-acting" benzo wears off, you know it (xanax is like the american express card of the benzo family "don't leave home without it") and asked to go back on klonopin again. And again klonopin "seemed" to cause an increase in feelings of depression but did lessen the amount of daily doses I required.
Being sick of carrying xanax and not having great results with klonopin, doc suggested trying Valium, which proved to be effective.
During the interim, doc and I discussed benzo addiction (which I was terrified of) and Dependence. Doc emphatically emphasized that the distinction is made by the method of use and "drug seeking behavior" in the eyes of the clinician. While it was true that I was physically dependent on benzos he stressed, to help minimize my fears, that addiction--per say--would mean A) using the drug in a fashion to get high B) elevation in the dose required C) the method of obtaining the drug...calling for refills with the excuse of losing them, dog eating, finding other docs to write duplicate scripts, ect or buying them in the street.
I now switch for valium when doing "well" with panic and needing to take it only twice a day which is great and switch to xanax (taken 3 or 4 times a day) when panic is very elevated until it is back in control for a while and then switch back to valium again.
I also take an ssri or ssnri at all times and a mood stabilizer. For many, esp. those with prior or coexisting abuse of drugs or alcohol, the benzo family can be tragic if misused. For others, myself inc, they are a blessing that I cant describe for I would rather be dependent on a benzo than have panic attacks galore. I guess I feel bad that there are such stereotypes involved with this medication family and feel sorry for those who have docs that withhold an effective treatment option due to political corrective ness
Posted by proud mary on January 20, 2003, at 15:29:00
In reply to Re: klonopin vs xanax, posted by lostsailor on January 16, 2003, at 10:44:45
No, I agree with you completely, Lost. I can relate to the politically correct deal because I have no trouble whatsoever getting klonopin (clonazapam) from my pdoc (even when I was in the public health system, although they did screen a bit better than my private pdoc does) but asking about xanax seemed to set off bells of alarm and terror in the whole department. my Klonopin has worked well for me and I even got to the point where I didn't carry it with me all the time (a fact that impressed my therapist). But in the old days, I wouldn't have gotten caught DEAD without it (or I guess I thought I WOULD die)...it's SO WONDERFUL to find people who understand what it's like and what I have gone through/am going through! I am still having a bit of trouble navigating the whole message board thing, so if my messages turn up in odd places, that's why....
keep writing so I can keep reading....Mary
Posted by lostsailor on January 22, 2003, at 10:27:31
In reply to Re: klonopin vs xanax » lostsailor, posted by proud mary on January 20, 2003, at 15:29:00
Congrads, my friend.
Like your therapist, I am happy for you, too. Being back on xanax is a bit of a drag but also part of the ebb and flow. I am just so thankful for a doc that works with me not mostly for my insur company. Our goal is to get me back on Valium as soon as the panic waves break and might even try Librium for the first time. What is funny, though, is when first giving me valium he said "boy it's been a while since I wrote for this"...with the Librium, he said I'm not sure if I have ever written this other that for acute alcohol withdrawal...(he's only prop. in his mid forties...lol)
Post back when you have some time. You seem to have it down. I found this right away.
"See you soon"
~Tony
Posted by cares4 on October 12, 2003, at 22:54:59
In reply to Re: Benzos - Dr. Bob - too contoversial ?, posted by me on August 8, 1999, at 11:10:20
I had my first panic attack 2 1/2 years ago, since then I still have daily anxiety and usually full panic attacks at least twice a week. I take Lexapro 1.5 tab at night, and ativan as needed, which I need one every night just to sleep. On bad days i take them twice a day, some days only at bed time. My question is I am 32, have a stressful life, but will I suffer from this anxiety forever? I have tried several different antidepressents and usually they caused me anxiety, so this Lexapro seems to be the best. I can't do anything without having a panic attack, I can't go out w/friend, to school plays, to concerts, anything where I feel I can't get out without being obvious, just there mere thought of having an attack, seems to cause one. I am 32 and I can't stand this anymore. I feel one coming on now. I can't afford psychotherapy, I tried it once and it didn't do anything for my anxiety anyway. Do you think me taking ativan for this long is safe? I have heart palpations, chest pains, daily headaches, and dizziness, I have to wonder if the medicine is doing this, or if the stress I am under is causing it. The doctor says I am probably stressed, but I think the extreme stress for 3 years could be damaging to my body. I dont' know, I just wish I understood, what has happened to make me have panic attacks, and will they ever stop?
Posted by Pattisun on October 13, 2003, at 15:03:53
In reply to Re: low dose benzos controversy, posted by Greg on August 9, 1999, at 21:47:53
I have been taking Klonopin (generic) since 1995. I get terrible panic attacks. Initially my dose was 3-4mg/day but I've lived quite normally on a dosage of 2-3 .50 mg per day. Cognitive therapy was very helpful and got me out in the world and stopped all the emergency room trips, but it did not get rid of my attacks. I've had doctors insist that I get off the Klonopin and it's not been bad--actually nothing at all compared to what I went through getting off of Paxil for instance--however, when I'm off the panic attacks return.
For me, to live a normal life and be able to get out and live life like the majority of people, I have to have something to keep my panic attacks at bay.
I am thankful for the majority of my doctors who have been merciful and understanding and let me continue on this medication.
Pattisun
Posted by hockeygirlcanada on October 14, 2003, at 5:36:21
In reply to Re: Benzos since 95, living a full life, posted by Pattisun on October 13, 2003, at 15:03:53
Hi,
I have been on Klonopin as well since 97 and have been through over 10 anti-depressants (currently starting parnate) but klonopin was the only thing that has allowed me to get through life since then. Even childbirth! And yes, I was allowed to take it during pregnancy, my son was not addicted, and is very healthy. I too have had to use more at certain times, especially while changing meds, but I have always been able to return to an as needed dose of up to 2 mg a day.
My doctors said if you weigh the negatives against the positives, there is no need to stop taking it. THere is no significant scientifically evidence that it is physically harmful to your body, according to my psychiatrist. So, I would not worry about using it, unless you find that you keep needing more and build up a tolerance, but from reading here, and my own personal experiences, the chances of that are unlikely,
all the best, good luck..
Posted by MamaB on October 14, 2003, at 13:56:58
In reply to Re: Benzos since 95, living a full life, posted by hockeygirlcanada on October 14, 2003, at 5:36:21
No, benzodiazapines are not physically harmful. However you are right about the tolerance. However both doctor and patient walk a fine line with benzos. The physicians that I know generally will generally allow only ONE increase in dose.
I struggle with the whole issue as I am a healed/reformed alcoholic (AA does not like me, nor me them!) I have not had a drink for 24 years, but you just go to a new physician, and tell him/her that and you are an ex-alcoholic! You had better NEVER try and get a prescription for a benzo (or painkillers for that matter!!
I have excellent rapport with a fine doctor who knows my history well. On two occasions in the past 24 years it has been neccessary for me to take painkillers, and once a benzo for a pre-op. I was given 6 tablets of the pain killer both times and my husband kept the pills. I had no problems taking the benzo pre-op.
So I guess it depends on the individual and how well he or she works with the physician.
Posted by MamaB on October 14, 2003, at 14:18:42
In reply to Re: Benzos since 95, living a full life, posted by MamaB on October 14, 2003, at 13:56:58
If you doubt the addiction problem or if you just want to be informed, check out this site:
Posted by ian24 on October 14, 2003, at 16:39:13
In reply to Re: Benzos since 95, living a full life, posted by Pattisun on October 13, 2003, at 15:03:53
I agree I have taken Klonopin and it means the difference between being able to or not being able to deal with people at work. I am also in AA. I have 6 years sobriety and the big book says we are not doctors! That is what anyone in AA must learn before they dispense opinion on meds. The book says mind your own beeswax on that , it's between Me and God. Also I have taken zanaz for a year, stopped it then a year later too Klonopin. I never had a drink nor did I abuse my meds .
Posted by Pattisun on October 14, 2003, at 18:30:38
In reply to Re: Benzos since 95, living a full life, posted by MamaB on October 14, 2003, at 14:18:42
> If you doubt the addiction problem or if you just want to be informed, check out this site:
>
> http://www.xanaxaddiction.info/news-1.htmThanks for the info. I don't doubt the addition problem. I graduated HS in 74 and grew up in the pill popping, dope smoking crowd. I have 15 & 19 yr old sons. I keep my medications under tight control and would NEVER give them out to anyone. I have a lot of pain meds too but I don't like to take them (except the Ibuprofen) because I am scared of the potential addiction. But some days I just can't make it through without the meds. I mostly depend on my epidural and trigger point injection at the pain clinic and try my best to stay pill free. It's a scary thing and it's a shame, I guess it's human nature to want to get "stoned"????????
Take care....
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