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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by qbsbrown on September 12, 2006, at 12:56:52
I just came back from China, where i was seeing Euro PDOCS. They all prescribe Valium, and hate xanax and ativan, seeing them more abused and on the black market.
I just arrived back to the staes, come to fine, no docs prescribe it, except surgeons for patients going in to surgery.
So the doc i just saw prefers ativan. I'm confused as which to take. I was under the impression that valium is typically used to come off of benzos, due to the longer half life. That too seems like Euro thought, here they think u can come off ativan or klonopin just as easily.
Experience and advice appreciated.
PS- I've noticed that with the longer acting ones, klonopin and valium, i think induces more depression in me. I'm in the midst of finding the right AD. But w/ the shorter acting ones, xanax and ativan, i NEED them more often.
Brian
Posted by ed_uk on September 12, 2006, at 15:50:29
In reply to BENZO Preferences? one easier to WD????, posted by qbsbrown on September 12, 2006, at 12:56:52
Hi Brian
American pdocs don't like diazepam. It's the opposite to the UK.
I'm suprised your doc didn't suggest clonazepam.
Ed
Posted by qbsbrown on September 12, 2006, at 18:30:38
In reply to Re: BENZO Preferences? one easier to WD???? » qbsbrown, posted by ed_uk on September 12, 2006, at 15:50:29
I was on clonazepam for 1.5 years. I really didn't like it, and think it induced much depression.
It was a GP here that prescribed it, although he knew my PDOC in China (from Spain) prescribed Diazepam.
She emailed me back saying she wouldn't do it, and that she hates ativan and xanax.
I can still get Diazepam, it's not a problem, but i can't see a PDOC here until i get insurance.
So basically it's a personal choice.
Brian
Posted by Phillipa on September 12, 2006, at 19:02:26
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 12, 2006, at 18:30:38
My suggestion is to go to a mental health clinic I have a friend on medicaid. Apply for that. All your appointments will be based on ability to pay. And meds are free. Here they prescribe xanax I have a presription for it . And my Son has Ativan. I'm taking valium now. And Daughter-in=law on klonopin and xanax and an ad. Make some calls or google the state and city. Get some names and make some calls. Love Phillipa
Posted by tizza on September 12, 2006, at 20:20:53
In reply to Re: BENZO Preferences? one easier to WD???? » qbsbrown, posted by Phillipa on September 12, 2006, at 19:02:26
I'd go for valium too, it's worked better for me than any other benzo on the market, I have tried oxazepam, alprazolam, clonazepam, lorazepam, nitrazepam, temazepam and flunitrazepam, the latter 3 are hypnotics though.
Posted by nolegirl23 on September 12, 2006, at 21:56:37
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 12, 2006, at 18:30:38
I have been on clonazapam (Klonopin) and it really didn't do much for my anxiety. My new pdoc prescribed Xanax XR, (alprazolam XR), and I am having great success. From what my pdoc tells me, and from the research I have conducted on my own, Xanax is difficult to come off of, but it can be done in a relatively painless manner if tapered correctly. I love this drug, it works wonders for my panic attacks and general anxiety.
Good luck to you!
Posted by qbsbrown on September 12, 2006, at 22:47:03
In reply to Re: BENZO Preferences? one easier to WD????, posted by nolegirl23 on September 12, 2006, at 21:56:37
Thanks for the advice on the insurance.
I haven't found much relief from the benzos either, if anything only worsening depression. I'd my AD that's gotten me out the door.
Now i am playing baseball, and the diazepam makes all the lights blurry, and my reactions are slow, so i wonder if a shorter acting one would be better for me.
Advice?
Posted by yxibow on September 13, 2006, at 1:26:29
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 12, 2006, at 22:47:03
> Thanks for the advice on the insurance.
>
> I haven't found much relief from the benzos either, if anything only worsening depression. I'd my AD that's gotten me out the door.
>
> Now i am playing baseball, and the diazepam makes all the lights blurry, and my reactions are slow, so i wonder if a shorter acting one would be better for me.
>
> Advice?I'd continue with the Valium -- its probably a transient reaction to an introduction of a benzodiazepine. All benzodiazepines have the potential to increase reaction time (hence watching your driving patterns until you get used to them). They relax most smooth muscle tissue in the body including your lungs so it is not surprising that you are experiencing some blurry vision. This all, despite a slight discomfort seems perfectly normal to me.
If it is a phenomenon that carries on for a month or something then I would say maybe you have a sensitivity to Valium and could try another benzodiazepine such as Serax (dosage would have to be much higher) or Ativan.
Posted by qbsbrown on September 13, 2006, at 2:08:07
In reply to Re: BENZO Preferences? one easier to WD???? » qbsbrown, posted by yxibow on September 13, 2006, at 1:26:29
Actually Jay, i've been on diazepam for about 8-9 months.
My only concern is that ativan would be more difficult to come off of than valium.
Brian
Posted by sdb on September 13, 2006, at 8:37:47
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 13, 2006, at 2:08:07
do you take valium once a day and how much is the dosage? I've heard that a benzo eg. valium can increase anxiety after one single dosage.
Posted by qbsbrown on September 13, 2006, at 9:49:11
In reply to Re: BENZO Preferences? one easier to WD????, posted by sdb on September 13, 2006, at 8:37:47
twice daily, 5 and 7.5mgs, morning-night.
the odd thing is that all the literature i look at can't pin down the conversion from valium to ativan.
half says 5mg valium=1mg ativan
the other half says 10mg=1mg ativan
I love when there's billion's of dollars involved, and people's health at stage, and we can't know simple questions like that, eg lexapro=celexa equivalence.
Brian
Brian
Posted by yxibow on September 13, 2006, at 15:59:28
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 13, 2006, at 9:49:11
> twice daily, 5 and 7.5mgs, morning-night.
>
> the odd thing is that all the literature i look at can't pin down the conversion from valium to ativan.
>
> half says 5mg valium=1mg ativan
>
> the other half says 10mg=1mg ativan
>
> I love when there's billion's of dollars involved, and people's health at stage, and we can't know simple questions like that, eg lexapro=celexa equivalence.
>
> Brian
>
> Brian
There's no exact science, especially in the second one, the SSRI equivalence, but the first chart you speak of, I think you're talking about the one on Dr bob's list, is accurate. I know, because I transferred a **load of Klonopin over stages to a **load of Valium and its correct. 1mg Lorazepam is approximately 5mg Valium, a 10mg Valium tablet is approximately a half milligram Klonopin tablet.
I take Valium twice daily even though it has a 24+ hour half life, bulk in the evening.
Posted by yxibow on September 13, 2006, at 16:03:02
In reply to Re: BENZO Preferences? one easier to WD???? » qbsbrown, posted by yxibow on September 13, 2006, at 15:59:28
> There's no exact science, especially in the second one, the SSRI equivalence, but the first chart you speak of, I think you're talking about the one on Dr bob's list, is accurate.
That there's no exact science has the whole load of genetics and then theres the fact that SSRIs target 4 or 5 serotonin subtransmitters and except in lab observations, benzodiazepines primarily hit GABA-A with only slight to obvious variations in how much hypnotic-sedative, anxiolytic, and anticonvulsant activity they have.
Posted by qbsbrown on September 13, 2006, at 16:22:46
In reply to Re: BENZO Preferences? one easier to WD????, posted by yxibow on September 13, 2006, at 16:03:02
Could you cite that conversion talbe for me, or send a link please.
I'm at a loss of what to do. it seems the longer acting benzos give me more depression and irritability, but seem like valium is the easiest to come off of, right?
Brian
Posted by Phillipa on September 13, 2006, at 18:17:39
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 13, 2006, at 16:22:46
5mg of valium=lmg of ativan or .5 of xanax or .5 klonopin=l0mg of valium. Klonopin is the most potent one. The two long acting are valium longest and klonopin not as long. The short acting ones are xanax and ativan. I believe from my experience with all of them that xanax is the shortest. And maybe you just need it as needed? So then a shor term would make sence since the long acting build up in the body valium lasts for more than a day at least the half-life and klonopin too. I think that chart is on the homepage. Love Phillipa
Posted by qbsbrown on September 13, 2006, at 19:48:37
In reply to Re: BENZO Preferences? one easier to WD???? » qbsbrown, posted by Phillipa on September 13, 2006, at 18:17:39
Taking it as needed does sound good, but i've already failed at 3-4 withdrawals because, one was cold turkey, 2-3 were WAY to fast, and 4 i messed w/ my AD in the final weeks.
I do notice the benzo WD significantly, so i think it has to be a long continuous process, correct me if i'm wrong, cause i'd love to try as needed.
Brian
Posted by Phillipa on September 13, 2006, at 21:12:14
In reply to correc me if i'm wrong, posted by qbsbrown on September 13, 2006, at 19:48:37
No you're right. Most definitely right. Love Phillipa
Posted by yxibow on September 13, 2006, at 22:52:56
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 13, 2006, at 16:22:46
> Could you cite that conversion talbe for me, or send a link please.
>
> I'm at a loss of what to do. it seems the longer acting benzos give me more depression and irritability, but seem like valium is the easiest to come off of, right?
>
> BrianCertainly
http://www.dr-bob.org/tips/bzd.html
The first one is quoted elsewhere on the net and my layman's sense, sensed it was pretty much on the dot. As they say, your miles may vary.
Longer acting benzodiazepines (Valium here you mention specifically) are easier to come off of, but all if you have become habituated are a long process (I know personally, I am probably somewhat habituated but there is a special evidence-based reason in my case why I have a high dosage. Nonetheless a smaller one is always better.)Some will quote the "Ashton" (its not actually) her site -- I dont want to get into a PBC about it as I find the nonlinearity and oddness of withdrawal methods there not to what I consider complete scientific standards.
But anyhow, yes, if you have become very habituated it is a long process. One thing to remember though, as long as you don't have something rare like end stage liver disease, is that there is always another day, and being among the safest of psychiatric medications, it will still be there tomorrow.
So if you feel you're going too fast, just hold it steady for another day or week. Then start going down. You can practice other tricks like alternating days when you remove a bit and return a bit the next day, as well. That sometimes works too. You'll get there. Just never cold turkey.
And with Valium, you have the luxury, if there is such a word of doing all these tricks because the half life in your body, specifically only unto you, is bound to be some value above 24 hours. The problems people get into is long use of things like Xanax, because it is sometimes taken 4x a day with a half life as little as 4-6 hours in most people. Then there's the nightmare of shaving off quantities of 4 pills. People have to eventually crush entire tablets at the end, dunk them in orange juice or something and drink a specified milliliter, per day. So you're in a much better place to reduce to what you need to.
-- tidings
Jay
Posted by qbsbrown on September 13, 2006, at 23:26:32
In reply to Re: BENZO Preferences? one easier to WD???? » qbsbrown, posted by yxibow on September 13, 2006, at 22:52:56
So basically you're saying if i want off of benzos, and i'm only at 12.5 mgs valium, that im in a pretty good place, and to forget about the burry vision etc? That switching over to ativan would in fact make the situation more difficult. I believe that ativan and xanax bind to the GABA like 4 times more potent than valium.
I would love to hear and understand your arguments against Ashton. I have read her work, and seen some of her cult followings, whom somewhat scare me, and many are pissed at the psychiatric community as a whole.
I did however notice, although she ran a benzo WD clinic for 10 or so years (and considered the forefront expert on benzo WD) there was only an average of about 10-12 patients treated per year, most of whom were severe cases. So that intrigued me.
Also tell me what is more of a scientific approach to WD. 10% weekly every 1-2 weeks?
Thanks Jay,
Brian
Posted by dbc on September 13, 2006, at 23:47:15
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 13, 2006, at 23:26:32
While valium does in theory have the longest half life its not particularly active in comparison to say klonopin though. Valium in true active half life is more comparable to ativan, its about the middle of the road. Back when i had severe SAD/GAD problems i took somewhere around 5mg daily. When i finally decided i didnt need to be sedated all day everyday i moved over to xanax and slowly lowered the dose down to about .5 a day. I prefer xanax now simply due to the potency of the anxiolyic effects and its short half life.
Posted by qbsbrown on September 14, 2006, at 2:06:33
In reply to Re: BENZO Preferences? one easier to WD????, posted by dbc on September 13, 2006, at 23:47:15
That is somewhat what i feel, is that the longer half life benzos (valium, and klonopin), is that i'm sedated all day, and i feel is holding me back personally and personality wise. I'm only affriad of the tolerance issue w/ Ativan, as where i don't really feel it on Valium.
Is it true that with only 75mgs Effexor, you're not really receiving any of the Norepinephrine benefits? This is what my PDOC is saying, that it will only act as an SSRI at 75mgs. This is what Cymbalta was supposed to improve upon, but the verdict is still out, right?
Posted by dbc on September 14, 2006, at 2:51:02
In reply to quick Effexor question, posted by qbsbrown on September 14, 2006, at 2:06:33
Its generally thought that the norepinephrine action doesnt start kicking in untill the 120ish area and you dont start seeing dopamine action untill 300. I never went beyond 150 and im glad of that because withdrawing is a long and crappy process with effexor.
Posted by yxibow on September 15, 2006, at 3:31:29
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 13, 2006, at 23:26:32
> So basically you're saying if i want off of benzos, and i'm only at 12.5 mgs valium, that im in a pretty good place, and to forget about the burry vision etc? That switching over to ativan would in fact make the situation more difficult. I believe that ativan and xanax bind to the GABA like 4 times more potent than valium.
I'm not saying that one should ignore the blurry vision if you're really worried -- as in an opthamologic issue rather than just a side effect one can live with whilst one is reducing medication. If it doesn't interfere with your daily activities, driving, reading, and is not seeming to be degenerative (progressing any more than status quo), then it probably is not a red flag issue. But that is up to your comfortability.
And you're right, you would create two taper scenarios.
I'm not sure about binding, one would have to read things like Stahl and other sources, but if you mean that Xanax is 10 times more potent by equivalency and Ativan is 5 times more potent by milligram equivalency then that is the case.
All benzodiazepines bind to GABA-A, at subreceptors that are responsible for anaesthesia, sedative-hypnotic, anxiolytic, and anti-convulsant. Each has submetabolites, some of which are other benzodiazepines, e.g. Restoril is a smaller non-main metabolite of Valium. Each binds to those subreceptors in varying degrees but they all bind to them to some degree. Versed, a preoperative anaesthetic, binds strongly to the anaesthesia angle, while Halcion, Dalmane, Restoril, and Rohypnol bind to the sedative-hypnotic side more strongly. Dalmane is quite strong on that angle. Clonazepam and Valium bind varyingly to the anxiolytic and anti-convulsant parts more strongly than other benzodiazepines.GABA-B agents, such as baclofen, operate somewhat differently.
>
> I would love to hear and understand your arguments against Ashton. I have read her work, and seen some of her cult followings, whom somewhat scare me, and many are pissed at the psychiatric community as a whole.
I don't know if its about Ashton per se or the person (unrelated to her) who creates that site. I just prefer to stay away from it, and comments that I have posted in the past equating it to both quackery and a dangerous idea to get all people (including those who have evidence based psychiatric need for benzodiazepines) off benzodiazepines have just resulted in "please be civil" issues so I would just leave it there. One can believe what they choose.
> I did however notice, although she ran a benzo WD clinic for 10 or so years (and considered the forefront expert on benzo WD) there was only an average of about 10-12 patients treated per year, most of whom were severe cases. So that intrigued me.
>
> Also tell me what is more of a scientific approach to WD. 10% weekly every 1-2 weeks?
A scientific approach is whatever works for you and your doctor. But yes, 10% weekly every 1-2 weeks sounds rational if you are having moderately bad withdrawal issues, thats about on par what I am doing at the moment as an experimental test against using less medication to cover the same issues with more clarity of mind.
But you are on a much smaller portion than I, so nonlinearity may prove more positive at some point because it could take 30 weeks and tablet sizes that don't exist to come off of 12.5mg of Valium at that calculation. So I'm not completely against nonlinearity, at some point dose reductions become a matter of a placeboid.
>
>
> Thanks Jay,
>
> Brian
Posted by qbsbrown on September 15, 2006, at 10:06:23
In reply to Re: BENZO Preferences? one easier to WD???? » qbsbrown, posted by yxibow on September 15, 2006, at 3:31:29
Actually the Docs want me to hold steady on the benzo, while im going up on effexor, so i guess i'll continuing the taper when i'm ready. I was angry at benzos for a while. I've never had such bad anxiety since beginning them, and blaming them for so many other issues, i could most definatly be wrong (i was listening to the "benzo island" people for a little while, had i followed them, i'd be dead), probably lack of the other neurotransmitters.
To me, ativan does represent being more clean and clear, not so muggy and muffled like valium, so yes it sounds more attractive.
Brian
Posted by qbsbrown on September 15, 2006, at 18:07:05
In reply to Re: BENZO Preferences? one easier to WD????, posted by qbsbrown on September 15, 2006, at 10:06:23
I have experienced this with both klonopin and valium. I vaguely remember experiencing interdose withdrawals from klonopin, thus me being affraid to switch from valium to ativan, although remaining on valium doesn't sound like much fun either.
Brian
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