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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 34. Go back in thread:
Posted by Quintal on April 5, 2007, at 16:47:56
In reply to Re: Doctors irresponsible with Xanax » Cynthia_Greene, posted by Fivefires on April 5, 2007, at 16:19:03
Everybody varies in their response to meds, so charts like that can only be a general guideline. I found the same thing re: Xanax only working at very high (unacceptably high for my GP) doses outside the normal therapeutic range.
Q
Posted by TheMeanReds on April 5, 2007, at 16:53:30
In reply to Doctors irresponsible with Xanax, posted by Cynthia_Greene on April 5, 2007, at 13:04:32
Warning rarely if ever helped me. I started klonopin at .5 and ended it at 2mg. I started Xanax at 2mg and ended at 4mg.
I knew they would be addictive. Anything that gives me an 'eu-phooooooo-riiiii-aaaaaa' response relief against anxiety, is like that for me.
I really dont mind the addictiveness, as long as I can keep my scripts. It's the only thing that makes me feel that I'm not going to get 'The Mean Reds'. Being horribly afraid of everything, and not knowing why.
Posted by bassman on April 5, 2007, at 19:06:19
In reply to Doctors irresponsible with Xanax, posted by Cynthia_Greene on April 5, 2007, at 13:04:32
I guess that's the other side of the benzo story. The usual story is that docs hold onto control of benzo use like it was heroin. That's often scares people that don't need to be more fearful. Xanax isn't "addictive" (I think you mean "causes dependence")at all to some people. And for some people, like myself, I don't seem to get dependent on any benzo-in the sense that I experience no withdrawal. The psychoactive drugs that scare me are the atypicals with their diabetes/extreme weight gain and Effexor (see the Withdrawal board at this site).
I do agree that any competent doc would say something like, "if you take this benzo long enough and regularly enough, you'll have to taper off the med; and for some people, that can be unpleasant". I personally side with the "stop the patient suffering now, worry about dependence later" school of thought.
Posted by valene on April 5, 2007, at 19:25:49
In reply to Re: Doctors irresponsible with Xanax » Cynthia_Greene, posted by bassman on April 5, 2007, at 19:06:19
Posted by Phillipa on April 5, 2007, at 20:24:23
In reply to Re: Doctors irresponsible with Xanax » Cynthia_Greene, posted by bassman on April 5, 2007, at 19:06:19
I agree. But raising a dose like mine did and ripping me off luvox and introducing what he has has made much worse. I seriously afraid as I'm weak and unreal now. Love Phillipa
Posted by linkadge on April 5, 2007, at 21:15:24
In reply to Doctors irresponsible with Xanax, posted by Cynthia_Greene on April 5, 2007, at 13:04:32
>I just realized how many people out there who >don't know anything about benzos are being >prescribed Xanax without being told that it's >addictive.
Not everybody has problems of dependance with benzos. I suppose the doctor thinks that a patient wouldn't take it if they thought it was unsafe for some reason. The same could be said for AD's as well.
For instance, if my doctor told me that I would get addicted to klonazepam, I would never have taken it. But he didn't and it really helped. I didn't have too much problem getting off of it.
What you are saying is true, but I wouldn't necessarily call it irresponsable.
Linkadge
Posted by linkadge on April 5, 2007, at 21:17:26
In reply to Re: Doctors irresponsible with Xanax » Cynthia_Greene, posted by Fivefires on April 5, 2007, at 16:19:03
>I'm not sure if you're in the US CG, but >the 'county system' here has a big crackdown on >prescribing benzos.
How about a crackdown on SSRI prescriptions? I never had a problem getting off benzos. I could go on and off them no problem. SSRI's withdrawl was what made me want to jump off a bridge.
Posted by linkadge on April 5, 2007, at 21:18:31
In reply to Re: Doctors irresponsible with Xanax, posted by TheMeanReds on April 5, 2007, at 16:53:30
I've never had a benzo give me a high, infact they make me depressed.
Linkadge
Posted by Quintal on April 5, 2007, at 21:33:02
In reply to Re: Doctors irresponsible with Xanax, posted by linkadge on April 5, 2007, at 21:15:24
My first script for benzos was 4mg Ativan - a huge dose for someone with no tolerance. I'd taken in a printout from the http://www.socialfear.com/ website which was a passionate advocate of the 'benzos do not produce dependence and addiction except in addicts' stance. My GP admitted she'd never heard of that one before and told me after reading the article "I was just going to say they're addictive but I'd better not........". This was the same doctor who later told me every time I went for a refill "you can't stay on these drugs forever you know, they're very addictive and have lots of side effects".
I did go on to develop dependence and later, addiction to benzos. So I suppose that goes to show doctors even in a supposedly benzophobic country can be irresponsible, and addiction can develop even where both patient and doctor are aware of the addictive potential from the outset (I'd read the benzo.org website and dismissed it in favour of the more optimistic SocialFear view).
Q
Posted by Franz on April 5, 2007, at 21:50:42
In reply to Doctors irresponsible with Xanax, posted by Cynthia_Greene on April 5, 2007, at 13:04:32
Don´t you get the packet insert with your drugs?. All is there.
Why a person will take anything not knowing what it is for?. I don´t understand your friends.
Can´t people choose another doctor or health insurance limit your choices?.
Posted by rjlockhart on April 5, 2007, at 22:52:54
In reply to Re: Doctors irresponsible with Xanax, posted by Quintal on April 5, 2007, at 21:33:02
I am prescribed a high dosage of Xanax, because of years and years of gonig through SSRI's, panic attacks, then we finally went to clonazepam, stayed on that for a 2 years, then went to Ativan at 6mg daily! for 1 year. Didnt work either, finally Xanax.
Its helped, i've been so nervous i cant even type, im just zoned in fear.
rj
Posted by Cynthia_Greene on April 5, 2007, at 23:01:04
In reply to Re: Doctors irresponsible with Xanax, posted by linkadge on April 5, 2007, at 21:18:31
> I've never had a benzo give me a high, infact they make me depressed.
>
> Linkadge
Same here; in fact, that's why I stopped taking Xanax during the day and only using it at night. Until one night when I had taken it and gone to sleep, then was woken up by a friend who wanted me to drive him somewhere. I was embarassingly depressed, emotional, and disoriented. That experience alone convinced me to never touch the stuff again.I started taking Valium again last week in an effort to get rid of a horrible week long tension headache, but it also made me depressed for no reason. I immediately felt much better when I stopped taking it.
Posted by greywolf on April 6, 2007, at 5:04:30
In reply to Doctors irresponsible with Xanax, posted by Cynthia_Greene on April 5, 2007, at 13:04:32
Coincidentally, I just wrote to someone about a similar topic regarding benzos.I'm not anti-benzo. In fact, I think benzos work great--particularly if the person taking them is careful to use them only when really necessary. I've never had any problem getting off Xanax, and I've had valium, but never to an extent that you would worry about an addiction developing. I've also never experienced any high with a benzo.
My concern about benzos is not addictiveness, it's dependency. There's a HUGE difference between those two situations. Many people have come to rely heavily on benzos at the same time many doctors are becoming more reluctant to prescribe them long-term.
So, what do you do if you've been taking Xanax responsibly for a long time--never taking it just as a matter of habit, but on a carefully regulated, as-needed basis--and your doctor suddenly decides that simply on the basis of the length of time you've been on Xanax, it's time to take you off? What do you do then if you've relied on a benzo to "treat" anxiety?
I tend to favor use of a med like Xanax as an adjunct to a primary med, not as the primary itself. That way, the dependency factor isn't as threatening. Of course, the addiction risk could still be there, but that's more of an individual concern.
Greywolf
Posted by linkadge on April 6, 2007, at 14:26:12
In reply to Re: Doctors irresponsible with Xanax, posted by greywolf on April 6, 2007, at 5:04:30
Anxiety disorders for some people are a long term issue requiring long term treatment.
Of course discontinuing benzo's can be difficult, but the same thing goes for SSRI's. Non drug alternatives may work for some people, but if somebody needs a med for anxiety, I don't see that an SSRI is any better than a benzo.
I would tend to think that doctors have been irresponsable with SSRI's. I am not the only person who has had more problems with SSRI's then benzo's, so I don't know.
Linkadge
Posted by Fivefires on April 6, 2007, at 18:33:13
In reply to Re: Doctors irresponsible with Xanax, posted by greywolf on April 6, 2007, at 5:04:30
If this were to occur in my lifetime, and, I'd not found anything which offers near the relief or supports it (FLOBW), I'm confident I would be one of thousands of peeps who would suffer and raise a an argument of misconduct of prescribing and its resultant damage to myself.
I'll present this ? to my P next month.
Tks, 5f
Posted by Fivefires on April 6, 2007, at 18:34:04
In reply to Re: Doctors irresponsible with Xanax, posted by greywolf on April 6, 2007, at 5:04:30
Yikes ... I accidentally jumped ahead a day.
Sorry about that.
5f
Posted by mattye on April 6, 2007, at 19:07:39
In reply to Doctors irresponsible with Xanax, posted by Cynthia_Greene on April 5, 2007, at 13:04:32
Taking a benzo as directed without continually escalating the dose is a very therapeutic and effective way for a lot of people to mitigate the suffering of panic and anxiety. For some people an SSRI just doesn't cut it. They need something more . . . so why let them suffer?
Furthermore, I don't think benzos are as addictive as some people make them out to be. If you are responsible with benzos and don't escalate the dosage, then tapering off your prescribed amount shouldn't be so horrible. I'm steady on 1 milligram of Klonopin, and when I'm ready, I will go down to .75, then .5, and so on.
I mean, they give adderall and ritalin to little kids like Pez, and those meds act directly on dopamine and require tapering as well. They can stunt your growth and cause heart problems. My sister takes adderall and Xyrem (GHB) for narcolepsy and she doesn't have a problem with addiction. So why are benzos made out to be such an evil drug.
I have my own theories . . . I think drug companies don't make much money off them anymore so they push the new SSRI's and the neuroleptics.
> I'm nowhere near being one of those anti benzo zealots who thinks they should all be banned, but I'm really concerned about something.
>
> The other week when I went to get a prescription for Valium, my doctor lectured me for a long time about how addictive it is and dangerous the withdrawel is, etc.
> This is the same doctor who once gave me an unbelievable amount of Xanax without telling me once that it was addictive at all.
>
> Luckily I already knew how addictive Xanax is because I've had to study anxiety meds in psychology classes before and have already heard all the addiction horror stories, but I just realized how many people out there who don't know anything about benzos are being prescribed Xanax without being told that it's addictive.
>
> I know a lot of people taking benzos every day that don't even know what class of drugs they belong to. When I ask my friends on Xanax what they're taking it for, a lot of them don't even know why it was prescribed and didn't even ask the doctor why before taking it.
>
> Sorry if my post offends anyone, but I just think the whole Xanax thing is really scary and there would be less people addicted to it if the doctors or pharmacists would actually warn them first.
Posted by bassman on April 6, 2007, at 19:22:49
In reply to Re: dependence vs. addiction, posted by mattye on April 6, 2007, at 19:07:39
That's my theory, too. When benzos were all brand name, they were prescribed without question. They came off patent and then it was "an SSRI is the drug of choice". Now most of the SSRI's are off patent. So everyone was then declared bipolar and given atypicals off label.
Posted by Quintal on April 6, 2007, at 19:25:23
In reply to Re: dependence vs. addiction, posted by mattye on April 6, 2007, at 19:07:39
I thnk plenty of people do make out that SSRIs, Adderall, GHB and Ritalin are 'evil' drugs (isn't there a whole movement against prescribing Ritalin for kids?), maybe those people had bad experiences with those meds that colors their perception?
Q
Posted by Declan on April 6, 2007, at 21:00:31
In reply to Re: dependence vs. addiction » mattye, posted by Quintal on April 6, 2007, at 19:25:23
The trouble with 'addiction' and 'dependance' is that every 30 years we have to learn new definitions supporting current policies relating to drugs of the legal and illegal sort.
I learned mine in the 70s and see no reason to do it all again, although, on reflection, the definitions from the 40s might be more to my taste.
Posted by greywolf on April 7, 2007, at 1:18:28
In reply to Re: Doctors irresponsible with Xanax » greywolf, posted by Fivefires on April 6, 2007, at 18:33:13
> If this were to occur in my lifetime, and, I'd not found anything which offers near the relief or supports it (FLOBW), I'm confident I would be one of thousands of peeps who would suffer and raise a an argument of misconduct of prescribing and its resultant damage to myself.
>
> I'll present this ? to my P next month.
>
> Tks, 5f
I'm not sure that this is directly responsive to your post, but take a look at this old memo that's on Dr. Bob's pharmacology tips page:
Date: Fri, 22 Dec 1995 09:34:27 -0800 (PST)
From: "H. Westley Clark" <carter@itsa.ucsf.EDU>
Subject: Long-term treatment with benzodiazepinesLong term benzodiazepine treatment may be indicated in select patients. You, of course, must have a strict treatment plan--ideally, written and signed by the patient.
The patient must be apprised of the dependency syndrome associated with even low dose chronic benzodiazepines. The patient should be made aware of tolerance and withdrawal syndromes. Even if the stress is time limited, e.g., a new job, the issues of physiological dependence must be carefully explained.
If you choose to proceed, prescriptions should be regulated carefully. Refills should not be automatically granted. The prescription should be re-evaluated every 30 days. You should agree on an initial fixed time period for the prescription. You should agree on a maximum time period for the prescription.
You should have a toxicology screen for illicit substances performed before initiating the prescription. You should verify through the interview and contact with other physicians whether there is a history of alcohol or drug abuse.
You should require the patient to use one and only one pharmacy. Every 6 months, you should contact the pharmacist and review the prescribing history and detail the prescribing plan.
If you prescribe for more than a year, you should recommend that a case conference occur, with all involved practitioners (or their representatives) attending.
The reluctance of physicians to prescribe for long periods of time is not surprising, given that the Medical Board, the DEA, and the patient may seek recourse for inappropriate prescribing.
The medical rationale for the use of chronic benzos should be carefully established and documented. The fact of medical benefit from the benzos should be carefully established and documented. By involving all parties, even the patient's signficant other (if there is one), the physician can establish a medical purpose for the prescribing.
Periodic physical examinations by the prescribing physician or at least by the treatment team is also critical.
This sounds like a lot. It is. However, if the flak comes, it is best to be covered.
__________________________________
I don't think those views have disappeared.
Posted by Phillipa on April 7, 2007, at 19:52:48
In reply to Re: Doctors irresponsible with Xanax, posted by greywolf on April 7, 2007, at 1:18:28
Well over the years not once with many pdocs have I ever signed a treatment plan or been advised of long term use. In my case it's been so long that I guess they know I will need them for life. And never have I been questioned about which pharmacy I use. I'm usually the one questioning the pharmacists about any side effects of any meds I take. Strange but true. You know when I started valium in the 70's I had an open ended prescription and didn't see the pdoc for years as I was doing well. The truth. Love Phillipa nor have I had a physical required of me. It's usually me just getting one
Posted by greywolf on April 7, 2007, at 21:55:20
In reply to Re: Doctors irresponsible with Xanax » greywolf, posted by Phillipa on April 7, 2007, at 19:52:48
Well, maybe the psychiatrists in my area tend to conservatism. I've had two doctors mention concerns regarding long-term use of benzos, and my current doctor refuses to give more than 30 day prescriptions. Of course, I'm BP, and you can't use benzos in my situation like you can with GAD.My point is not that there is anything wrong with long-term use of benzos from a properly-managed care perspective. I'm concerned about dependency not in the sense of addictiveness, but in the context of a patient who relies primarily on benzos over a long period of time, and then runs into a doctor who does not subscribe to that philosophy. It's not like anyone can guarantee how long their relationship with a psychiatrist will last, so my only point is to suggest that thought be given to whether another approach would be more protective.
Also, what happens if there's a full review of this Anna Nicole Smith situation and the psychiatrists come under heavy criticism for their handling of benzo scrips? A couple weeks of Entertainment Tonight and CNN and Nancy Grace hammering the medical profession for laxity in prescribing benzos (which will inevitably be called "tranquilizers") is all it will take for our politicians to jump all over the issue. If something like that happens, I can't imagine that the response of the psychiatric profession will be to be more liberal in prescribing Xanax.
Greywolf
Posted by Phillipa on April 7, 2007, at 22:00:09
In reply to Re: Doctors irresponsible with Xanax » Phillipa, posted by greywolf on April 7, 2007, at 21:55:20
What exactly was she on? As people magazine said chloral hydrate and a mix of benzos and IV ativan. Come on that's ridiculous. I had thought she also was on SSRI's? and meth? Thanks Phillipa
Posted by greywolf on April 7, 2007, at 22:25:38
In reply to Re: Doctors irresponsible with Xanax » greywolf, posted by Phillipa on April 7, 2007, at 22:00:09
I think the question is, what wasn't she on?I really don't know the full story. I just heard that multiple benzos were involved.
Greywolf
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