![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 28. Go back in thread:
Posted by Else on July 22, 2001, at 10:56:12
In reply to Re: clonazepam+depression, posted by sar on July 22, 2001, at 10:28:34
I concur. And those doctors are a bit anal-retentive aren't they?
> my own personal, unprofessional view/experience:
>
> i think klonopin is like magic! perhaps so much anxiety was one of the thicker roots of my depression. i take prozac as well. i still consider myself depressed (but i always have been) but klonopin makes is so much easier for me to actually enjoy and appreciate things. it (along with prozac), have annihilated mmmm 70% of my nihilism.
>
> i've heard that some docs hesitate to prescribe klonopin because of its addictive properties.
>
> sar
Posted by Elizabeth on July 22, 2001, at 13:01:51
In reply to clonazepam+depression, posted by PaulB on July 22, 2001, at 7:28:20
> One of the pdocs I saw said that he didnt tend to use Clonazepam so often in persons with anxiety AND depression because with too regular frequency he had seen in people with depression, not only did Clonazepam make the depression worse but also make the depression resistant to treatment.
I think this is variable. It is true that some depressed people get more depressed on Klonopin (although I think it's reversible by stopping the Klonopin), but many people don't have any problems with it. I'm taking Klonopin now (with desipramine and buprenorphine), and I think it's very helpful. I've never had a problem with it.
Xanax is probably the benzo of choice if benzos have caused worsening of your depression in the past but you need one for anxiety. Xanax seems to be less likely than other benzos to cause or exacerbate depression, and it can have an antidepressant effect for some people.
-elizabeth
Posted by JohnL on July 22, 2001, at 17:34:28
In reply to clonazepam+depression, posted by PaulB on July 22, 2001, at 7:28:20
> One of the pdocs I saw said that he didnt tend to use Clonazepam so often in persons with anxiety AND depression because with too regular frequency he had seen in people with depression, not only did Clonazepam make the depression worse but also make the depression resistant to treatment.
>
> My personal experience is that the SSRI's are more lilely to worsen my depression than the benzodiazepines. Can anyone relate to this? Is this unusual? Views.......
>
>I think they both have about the same potential to actually cause depression rather than fix it. For example, if someone is just got that blahs kind of depression where they are withdrawn, can't find fun in anything, blah, I think SSRIs just make that worse. SSRIs are much better I think for the crying despair type of depression. Dittos for the benzos. I think the chances are about the same.
According to most clinical studies, both strategies are effective in treating depression. But of course if you dig deep into the details of those studies, there is a certain percentage of patients that get worse instead of better.
John
Posted by terra miller on July 22, 2001, at 18:30:20
In reply to Re: clonazepam+depression, posted by JohnL on July 22, 2001, at 17:34:28
John et. al.,
I am one of those that doesn't seem to respond to meds with antidepressant effects. They either dull my emotions or send me into suicidal thinking. When I stop the trial, everything returns to normal. I've found ativan and buspar to dull my emotions; and zoloft nearly did me in (thank goodness my pdoc took me seriously and got me off of it.) Only wellbutrin has not enduced depressed thinking. I just can't find anything (yet) to just take the edge off the anxiety.... and that's what I've been trying to find for the last year. < sigh > I don't want to be numbed out or I can't do therapy (and I certainly don't want to prolong therapy!); neither do I want to be jumping out of my seat and irritable and panicky, blablabla. SOOOOO, what's suggested? Klonopin? (or will that just numb me again) or something else (that won't send me into depression)?? Everything just seems to be overpowering and seems to treat anxiety, yes, but also a host of other symptoms that I don't have. Then I end up worse than where I was when I started. Thanks. -Terra
> I think they both have about the same potential to actually cause depression rather than fix it. For example, if someone is just got that blahs kind of depression where they are withdrawn, can't find fun in anything, blah, I think SSRIs just make that worse. SSRIs are much better I think for the crying despair type of depression. Dittos for the benzos. I think the chances are about the same.
>
> According to most clinical studies, both strategies are effective in treating depression. But of course if you dig deep into the details of those studies, there is a certain percentage of patients that get worse instead of better.
> John
Posted by judy1 on July 22, 2001, at 19:46:09
In reply to clonazepam+depression, posted by PaulB on July 22, 2001, at 7:28:20
Dear Paul,
My pdoc, the anxiety specialist, feels that in people with primary anxiety klonopin helps the anxiety which in turn reduces depressive symptoms. It should be fairly easy for you to think which symptom was first. Again in people with primary anxiety, SSRI's tend to worsen symptoms of anxiety- which in turn worsen depression. (Personally, SSRI's just make me manic and klonopin is the magic bullet) Hope you're doing better- judy
Posted by PaulB on July 23, 2001, at 12:33:30
In reply to Re: clonazepam+depression » PaulB, posted by judy1 on July 22, 2001, at 19:46:09
> Dear Paul,
> My pdoc, the anxiety specialist, feels that in people with primary anxiety klonopin helps the anxiety which in turn reduces depressive symptoms. It should be fairly easy for you to think which symptom was first. Again in people with primary anxiety, SSRI's tend to worsen symptoms of anxiety- which in turn worsen depression. (Personally, SSRI's just make me manic and klonopin is the magic bullet) Hope you're doing better- judyThanks for the replys. It just recently occured to me that the benzodiazepines may not actually worsen my depression. I think it was that I expected the 'pams' to worsen mt depression and I didnt expect it with the SSRI's I tried. The former are depressants after all. The idea that anxiety can precipitate and cause depression and therefore treating the anxiety alone is a interesting topic but Im not sure where I stand on it.
The writer of an article which drew on the topic says:
'My own view is that the notion that benzodiazepines "cause" or "precipitate" depression may be an interpretive error. That is, people with anxiety disorders like social phobia and generalised anxiety disorder are at a higher than average risk of depressive illness across their life span. If someone receives a benzodiazepine, typically they have more severe symptoms, which increases risk. Since benzodiazepines have no maintenance preventative effect for subsequent depressive episodes, and since they are typically taken long-term, the association between benzodiazepines and depression may actually be population at risk effect(i.e. it is the group of people, not the drug, that increases relative risk)
Elizabeth, you mentioned Xanax which is a good option I hear. Recalling that particular pdoc I mentioned he added, specifically, that people who are unable to tolerate Clonazepam do much better when switched to Lorazepam.
PaulB
Posted by kid_A on July 23, 2001, at 13:21:24
In reply to Re: clonazepam+depression, posted by sar on July 22, 2001, at 10:28:34
>
> i've heard that some docs hesitate to prescribe klonopin because of its addictive properties.
>I've actually been given the advice (by a friend, not the pdoc) to try to -never- take the benzos... because they are so addicting... I just hate being 'addicted' to something that lessons my overall anxiety and residual side effects...
** Please note intended sarcasm **
/end rant.
Posted by Georgie Geordie on July 24, 2001, at 1:23:25
In reply to Re: clonazepam+depression, posted by kid_A on July 23, 2001, at 13:21:24
the problem that you have to keep upping the dose..
> >
> > i've heard that some docs hesitate to prescribe klonopin because of its addictive properties.
> >
>
> I've actually been given the advice (by a friend, not the pdoc) to try to -never- take the benzos... because they are so addicting... I just hate being 'addicted' to something that lessons my overall anxiety and residual side effects...
>
> ** Please note intended sarcasm **
>
> /end rant.
Posted by kid_A on July 24, 2001, at 11:15:46
In reply to Re: clonazepam+depression, posted by Georgie Geordie on July 24, 2001, at 1:23:25
> the problem that you have to keep upping the dose..
>Not if you don't take them preemtively, or habitually... I try to take them in response to a problem, not proactive to one... Plus it helps if you can take a little medication holiday when possible... People get in the habit of taking them every day if they need them or not... Of course that will build tollerance and addiction...
Of course either way its give and take, it all comes with a cost, you have to weigh those costs to see if its worth the risk of taking (any) medication...
Posted by Zo on July 24, 2001, at 19:43:15
In reply to Re: clonazepam+depression, posted by Georgie Geordie on July 24, 2001, at 1:23:25
> the problem that you have to keep upping the dose..
I wonder how atypical my experience is. . .I never had to increase the dose more really minimal amounts, like 1/4 or 1/2 a tab, of *any* benzo I've used over the years.
Zo
Posted by Elizabeth on July 26, 2001, at 23:42:41
In reply to Re: clonazepam+depression » Georgie Geordie, posted by Zo on July 24, 2001, at 19:43:15
> I wonder how atypical my experience is. . .I never had to increase the dose more really minimal amounts, like 1/4 or 1/2 a tab, of *any* benzo I've used over the years.
That is typical of anxiety patients. They tend not to overuse medication, and tolerance usually does not develop to the anxiolytic effects of benzodiazepines.
-elizabeth
Posted by sar on July 27, 2001, at 4:45:34
In reply to Re: clonazepam+depression » Zo, posted by Elizabeth on July 26, 2001, at 23:42:41
i'm supposed to take .5 mg klonopin twice daily, bit i usually only take it once becaise i drink.
HOWEVER, i do find myself in certain stressful situations (usually at work) in which i crave klonopin.
klonopin really mellows me out and extroverts me. Without it, I am nearly silent, catatonic. With it, I am a giggly talkative person.
so i like it.
addictive, whatevahs...if you take iy forever, why should that matter?
(i've always been a social phobic and believe i always would be without klonopin; however, MENTALLY i am quite outspoken, etc--i don't care if it's addictive...i like it...)
it does not make me more depressed. it makes me yawn and sleep and bit more, but being able to smile + laugh w/ others outweighs its negative side-effects.
sar
Posted by Elizabeth on July 27, 2001, at 20:30:23
In reply to Re: clonazepam+depression, posted by sar on July 27, 2001, at 4:45:34
> i'm supposed to take .5 mg klonopin twice daily, bit i usually only take it once becaise i drink.
How much do you drink, and how often? Alcohol is a much dirtier, more dangerous drug than Klonopin (and yet for some reason, you need a prescription for Klonopin while any adult can buy as much alcohol as they like).
> HOWEVER, i do find myself in certain stressful situations (usually at work) in which i crave klonopin.
I'm not sure that's the same kind of craving that addicts feel in protracted withdrawal (a phenomenon that can happen, at least, with opioids).
> klonopin really mellows me out and extroverts me. Without it, I am nearly silent, catatonic. With it, I am a giggly talkative person.
>
> so i like it.Understood. On the occasions when I've taken too much Klonopin (the amount I need for anxiety is variable, and sometimes I have overshot), all it did was make me sleepy.
> addictive, whatevahs...if you take iy forever, why should that matter?
An excellent point. The problem is that tolerance often develops with respect to the disinhibiting and euphoric effects of "addictive" drugs.
> (i've always been a social phobic and believe i always would be without klonopin; however, MENTALLY i am quite outspoken, etc--i don't care if it's addictive...i like it...)
Klonopin is a fine treatment for social phobia, yes.
> it does not make me more depressed. it makes me yawn and sleep and bit more, but being able to smile + laugh w/ others outweighs its negative side-effects.
I don't have problems with depression on benzos either. I've been considering taking it regularly in the long term; I'm not sure whether that would be good or not.
-elizabeth
Posted by Benzobuster on July 27, 2001, at 22:12:18
In reply to Re: clonazepam+depression, posted by PaulB on July 23, 2001, at 12:33:30
> > Dear Paul,
> > My pdoc, the anxiety specialist, feels that in people with primary anxiety klonopin helps the anxiety which in turn reduces depressive symptoms. It should be fairly easy for you to think which symptom was first. Again in people with primary anxiety, SSRI's tend to worsen symptoms of anxiety- which in turn worsen depression. (Personally, SSRI's just make me manic and klonopin is the magic bullet) Hope you're doing better- judy
>
> Thanks for the replys. It just recently occured to me that the benzodiazepines may not actually worsen my depression. I think it was that I expected the 'pams' to worsen mt depression and I didnt expect it with the SSRI's I tried. The former are depressants after all. The idea that anxiety can precipitate and cause depression and therefore treating the anxiety alone is a interesting topic but Im not sure where I stand on it.
>
> The writer of an article which drew on the topic says:
>
> 'My own view is that the notion that benzodiazepines "cause" or "precipitate" depression may be an interpretive error. That is, people with anxiety disorders like social phobia and generalised anxiety disorder are at a higher than average risk of depressive illness across their life span. If someone receives a benzodiazepine, typically they have more severe symptoms, which increases risk. Since benzodiazepines have no maintenance preventative effect for subsequent depressive episodes, and since they are typically taken long-term, the association between benzodiazepines and depression may actually be population at risk effect(i.e. it is the group of people, not the drug, that increases relative risk)
>
> Elizabeth, you mentioned Xanax which is a good option I hear. Recalling that particular pdoc I mentioned he added, specifically, that people who are unable to tolerate Clonazepam do much better when switched to Lorazepam.> PaulB
Paul, Excuse me but the information you just gave out will have the opposite effect as what you think. One does not switch from a medium half life benzo to a short half life benzo and expect it to reduce anxiety. This will cause more problems.
Then you wrote:
"and since they are typically taken long-term,"You give the impression that the drug companies endorse long term usage. This is not true. Benzos should not be used for more than 2 to 4 weeks for anxiety or insomnia. Depression ? Just where di anyone here get the idea that a tranquilizer is an anti-depressant. Tranquilizers are depressants and do not lift a persons mood. It may seem that they do because they actually take the edge off and dull the CNS.
There is a web page that was just rated 5/5 by Clinnix. This web page is the best in the world on the subject of benzos.
Dr James Cave reviews medical websites (REF: Clinnix)
The site of the benzodiazepine addiction, withdrawal and recovery group.
Reviewing the site, Dr Cave said: "Possibly the most comprehensive site on benzodiazepines and addiction, this is not a sight for the sensitive doctor! And that is my only criticism of this otherwise great site. Ray Nimmo, the creator, has somehow made it almost addictive with wonderful little back streets, humour and punchy personal stories. I would recommend all GPs and pharmacists visit this site."
Star Rating 5/5
Website address: http://www.benzo.org.uk
Source:
http://www.clinnixpro.net/news/archive/010521*****PLEASE NOTE*****
The Heather Ashton Manual on How to Withdraw From Benzodiazepines
http://members.dencity.com/ashtonpapers/manual.htm
News and Articles on Benzodiazepine Issues
http://www.geocities.com/benzodebate
Link to All Known Benzo Related Web Sites
http://www.geocities.com/benzowebsites
Benzobusters Site of Withdrawal Symptom Lists & The Accidental Addict
http://members.dencity.com/BenzoBusters
""The worst of the withdrawals should be over in about three days. If you're no better in a week, see your GP and he'll give you something. In the meantime get some sleep - you look terrible." (Some young UK Casualty doctor)
Posted by Else on July 28, 2001, at 2:02:25
In reply to Re: clonazepam+depression, posted by Benzobuster on July 27, 2001, at 22:12:18
Whatever
> > > Dear Paul,
> > > My pdoc, the anxiety specialist, feels that in people with primary anxiety klonopin helps the anxiety which in turn reduces depressive symptoms. It should be fairly easy for you to think which symptom was first. Again in people with primary anxiety, SSRI's tend to worsen symptoms of anxiety- which in turn worsen depression. (Personally, SSRI's just make me manic and klonopin is the magic bullet) Hope you're doing better- judy
> >
> > Thanks for the replys. It just recently occured to me that the benzodiazepines may not actually worsen my depression. I think it was that I expected the 'pams' to worsen mt depression and I didnt expect it with the SSRI's I tried. The former are depressants after all. The idea that anxiety can precipitate and cause depression and therefore treating the anxiety alone is a interesting topic but Im not sure where I stand on it.
> >
> > The writer of an article which drew on the topic says:
> >
> > 'My own view is that the notion that benzodiazepines "cause" or "precipitate" depression may be an interpretive error. That is, people with anxiety disorders like social phobia and generalised anxiety disorder are at a higher than average risk of depressive illness across their life span. If someone receives a benzodiazepine, typically they have more severe symptoms, which increases risk. Since benzodiazepines have no maintenance preventative effect for subsequent depressive episodes, and since they are typically taken long-term, the association between benzodiazepines and depression may actually be population at risk effect(i.e. it is the group of people, not the drug, that increases relative risk)
> >
> > Elizabeth, you mentioned Xanax which is a good option I hear. Recalling that particular pdoc I mentioned he added, specifically, that people who are unable to tolerate Clonazepam do much better when switched to Lorazepam.
>
> > PaulB
>
> Paul, Excuse me but the information you just gave out will have the opposite effect as what you think. One does not switch from a medium half life benzo to a short half life benzo and expect it to reduce anxiety. This will cause more problems.
>
> Then you wrote:
> "and since they are typically taken long-term,"
>
> You give the impression that the drug companies endorse long term usage. This is not true. Benzos should not be used for more than 2 to 4 weeks for anxiety or insomnia. Depression ? Just where di anyone here get the idea that a tranquilizer is an anti-depressant. Tranquilizers are depressants and do not lift a persons mood. It may seem that they do because they actually take the edge off and dull the CNS.
>
> There is a web page that was just rated 5/5 by Clinnix. This web page is the best in the world on the subject of benzos.
>
> Dr James Cave reviews medical websites (REF: Clinnix)
>
> The site of the benzodiazepine addiction, withdrawal and recovery group.
>
> Reviewing the site, Dr Cave said: "Possibly the most comprehensive site on benzodiazepines and addiction, this is not a sight for the sensitive doctor! And that is my only criticism of this otherwise great site. Ray Nimmo, the creator, has somehow made it almost addictive with wonderful little back streets, humour and punchy personal stories. I would recommend all GPs and pharmacists visit this site."
>
> Star Rating 5/5
>
> Website address: http://www.benzo.org.uk
>
>
> Source:
> http://www.clinnixpro.net/news/archive/010521
>
> *****PLEASE NOTE*****
> The Heather Ashton Manual on How to Withdraw From Benzodiazepines
> http://members.dencity.com/ashtonpapers/manual.htm
>
>
> News and Articles on Benzodiazepine Issues
> http://www.geocities.com/benzodebate
> Link to All Known Benzo Related Web Sites
> http://www.geocities.com/benzowebsites
> Benzobusters Site of Withdrawal Symptom Lists & The Accidental Addict
> http://members.dencity.com/BenzoBusters
> ""The worst of the withdrawals should be over in about three days. If you're no better in a week, see your GP and he'll give you something. In the meantime get some sleep - you look terrible." (Some young UK Casualty doctor)
Posted by PaulB on July 28, 2001, at 6:21:12
In reply to Re: clonazepam+depression, posted by Benzobuster on July 27, 2001, at 22:12:18
> > > Dear Paul,
> > > My pdoc, the anxiety specialist, feels that in people with primary anxiety klonopin helps the anxiety which in turn reduces depressive symptoms. It should be fairly easy for you to think which symptom was first. Again in people with primary anxiety, SSRI's tend to worsen symptoms of anxiety- which in turn worsen depression. (Personally, SSRI's just make me manic and klonopin is the magic bullet) Hope you're doing better- judy
> >
> > Thanks for the replys. It just recently occured to me that the benzodiazepines may not actually worsen my depression. I think it was that I expected the 'pams' to worsen mt depression and I didnt expect it with the SSRI's I tried. The former are depressants after all. The idea that anxiety can precipitate and cause depression and therefore treating the anxiety alone is a interesting topic but Im not sure where I stand on it.
> >
> > The writer of an article which drew on the topic says:
> >
> > 'My own view is that the notion that benzodiazepines "cause" or "precipitate" depression may be an interpretive error. That is, people with anxiety disorders like social phobia and generalised anxiety disorder are at a higher than average risk of depressive illness across their life span. If someone receives a benzodiazepine, typically they have more severe symptoms, which increases risk. Since benzodiazepines have no maintenance preventative effect for subsequent depressive episodes, and since they are typically taken long-term, the association between benzodiazepines and depression may actually be population at risk effect(i.e. it is the group of people, not the drug, that increases relative risk)
> >
> > Elizabeth, you mentioned Xanax which is a good option I hear. Recalling that particular pdoc I mentioned he added, specifically, that people who are unable to tolerate Clonazepam do much better when switched to Lorazepam.
>
> > PaulB
>
> Paul, Excuse me but the information you just gave out will have the opposite effect as what you think. One does not switch from a medium half life benzo to a short half life benzo and expect it to reduce anxiety. This will cause more problems.
>
> Then you wrote:
> "and since they are typically taken long-term,"
>
> You give the impression that the drug companies endorse long term usage. This is not true. Benzos should not be used for more than 2 to 4 weeks for anxiety or insomnia. Depression ? Just where di anyone here get the idea that a tranquilizer is an anti-depressant. Tranquilizers are depressants and do not lift a persons mood. It may seem that they do because they actually take the edge off and dull the CNS.
>
> There is a web page that was just rated 5/5 by Clinnix. This web page is the best in the world on the subject of benzos.
>
> Dr James Cave reviews medical websites (REF: Clinnix)
>
> The site of the benzodiazepine addiction, withdrawal and recovery group.
>
> Reviewing the site, Dr Cave said: "Possibly the most comprehensive site on benzodiazepines and addiction, this is not a sight for the sensitive doctor! And that is my only criticism of this otherwise great site. Ray Nimmo, the creator, has somehow made it almost addictive with wonderful little back streets, humour and punchy personal stories. I would recommend all GPs and pharmacists visit this site."
>
> Star Rating 5/5
>
> Website address: http://www.benzo.org.uk
>
>
> Source:
> http://www.clinnixpro.net/news/archive/010521
>
> *****PLEASE NOTE*****
> The Heather Ashton Manual on How to Withdraw From Benzodiazepines
> http://members.dencity.com/ashtonpapers/manual.htm
>
>
> News and Articles on Benzodiazepine Issues
> http://www.geocities.com/benzodebate
> Link to All Known Benzo Related Web Sites
> http://www.geocities.com/benzowebsites
> Benzobusters Site of Withdrawal Symptom Lists & The Accidental Addict
> http://members.dencity.com/BenzoBusters
> ""The worst of the withdrawals should be over in about three days. If you're no better in a week, see your GP and he'll give you something. In the meantime get some sleep - you look terrible." (Some young UK Casualty doctor)PaulB says
Not to disagree with you. Everyone has their own views and I believe that you are right in that the benzodiazepines are certainly not anti-depressants. But I would like to clear up a couple of things where I think you may have misunderstood me.You wrote that one does not switch from a medium half-life benzo(Clonazepam)to a short half-life benzo(Lorazepam)and expect it to reduce anxiety but in fact this causes more problems. In reference to the pdoc I was taliking about I wanted to highlight that those who couldnt tolerate Clonazepam may do better on Lorazepam because it 'may' be less likely to cause/worsen depression. Lorazepam and other 'shorter-acting benzo's' may well be inferior in terms of their potential for addiction which is where we got our wires crossed.
Secondly, I dont personally think benzodiazepines are anti-depressants. However, in some cases if a person with an anxiety disorder takes a benzodiazepine their depression may lessen because their anxiety disorder made them more susceptible to depression. Although I said I didnt know where I stand on this issue.
Thirdly, you said I wrote
"and since benzodiazepines are typically taken long-term". I didnt write this. I quoted this, unfortunately from a cut-out so I cannot provide the source. So it wasnt me who would be implying that the drug companies endorse benzodiazepines for long-term usage. Your right, the drug companies do not approve of longer periods of usage than you mentioned.
Posted by Elizabeth on July 29, 2001, at 14:46:47
In reply to Re: clonazepam+depression, posted by Benzobuster on July 27, 2001, at 22:12:18
> You give the impression that the drug companies endorse long term usage. This is not true. Benzos should not be used for more than 2 to 4 weeks for anxiety or insomnia.
Research has shown that they can be used long-term for panic disorder without tolerance or loss of efficacy. This has been known for some time. They generally don't work very well for chronic insomnia.
> Depression? Just where did anyone here get the idea that a tranquilizer is an anti-depressant.
There is evidence to support the use of alprazolam as an AD. Adinazolam (brand name Deracyn), another triazolobenzodiazepine, is available in some countries for use as an AD. (It's not marketed in the US; I'm guessing it's not in the UK either. It is in clinical use -- as an antidepressant -- in Germany and France and probably a few other places.)
> Tranquilizers are depressants and do not lift a persons mood. It may seem that they do because they actually take the edge off and dull the CNS.
It's a common misunderstanding that CNS depressants are drugs that cause "depression." Some people do become more depressed on benzodiazepines (and some probably mistake sedation for depression), but this is relatively rare (barbiturates were much more of a problem). As mentioned, alprazolam may be less likely to trigger or exacerbate [affective] depression.
If you are interested, I can refer you to some articles relating to the use of adinazolam and alprazolam as antidepressants, and to the use of benzodiazepines for chronic anxiety disorders such as panic disorder.
-elizabeth
Posted by Alan on July 29, 2001, at 18:21:43
In reply to misunderstandings about benzodiazepines » Benzobuster, posted by Elizabeth on July 29, 2001, at 14:46:47
> > You give the impression that the drug companies endorse long term usage. This is not true. Benzos should not be used for more than 2 to 4 weeks for anxiety or insomnia.
>
> Research has shown that they can be used long-term for panic disorder without tolerance or loss of efficacy. This has been known for some time. They generally don't work very well for chronic insomnia.
>
> > Depression? Just where did anyone here get the idea that a tranquilizer is an anti-depressant.
>
> There is evidence to support the use of alprazolam as an AD. Adinazolam (brand name Deracyn), another triazolobenzodiazepine, is available in some countries for use as an AD. (It's not marketed in the US; I'm guessing it's not in the UK either. It is in clinical use -- as an antidepressant -- in Germany and France and probably a few other places.)
>
> > Tranquilizers are depressants and do not lift a persons mood. It may seem that they do because they actually take the edge off and dull the CNS.
>
> It's a common misunderstanding that CNS depressants are drugs that cause "depression." Some people do become more depressed on benzodiazepines (and some probably mistake sedation for depression), but this is relatively rare (barbiturates were much more of a problem). As mentioned, alprazolam may be less likely to trigger or exacerbate [affective] depression.
>
> If you are interested, I can refer you to some articles relating to the use of adinazolam and alprazolam as antidepressants, and to the use of benzodiazepines for chronic anxiety disorders such as panic disorder.
>
> -elizabeth
*****************************************Yes, elizabeth. Those articles would be most informative if you can provide links or relevant passages to treat anxiety or panic disorders.
These "facts" sound like the mantra for the anti-benzo lobby - mostly based in the U.K.. The World Heath Organisation sees no problem with short and long term benzodiazapine therapy after all of the 40 or so years that they've been available.
It's also perplexing that there is so much misinformation out there about the drug in light of its huge success rate for the general population of chronic anxiety sufferers. I think the fact that benzos are off brand and ssri's for the most part haven't been, the "one size fit all" pitch for dep. AND anx. to family docs and internists (non-specialists) over the years from the companies have muddied the waters about how one goes about seeking full releif from the symptoms of disorders that are anxiety driven.
Also, I don't know how many posts I've read here about "withdrawl" symptoms from ssri's - a supposedly "non-addictive" alternative to benzos.
I could go on and on.
But I won't.
Alan
Posted by Elizabeth on July 30, 2001, at 16:30:28
In reply to Re: misunderstandings about benzodiazepines » Elizabeth, posted by Alan on July 29, 2001, at 18:21:43
> Yes, elizabeth. Those articles would be most informative if you can provide links or relevant passages to treat anxiety or panic disorders.
OK. You can get loads of references with a cursory Medline search. Here's what a current mainstream textbook (_American Psychiatric Association Textbook of Psychopharmacology_, Schatzberg & Nemeroff eds. 1998) has to say:
"The controversy surrounding benzodiazepine administration and potential abuse or addiction in routine patient use is generally not supported by the available scientific evidence. (See Shader and Greenblatt 1993 [1] for an excellent review of this complex area.) In a large community study of long-term alprazolam users, Romach and colleagues (1992) [2] found that dosage did not escalate over prolonged use and that most patients used the benzodiazepines as prescribed. In fact, if deviations occurred, it was generally that a patient took less than the prescribed dosage. This area has been more controversial than warranted in part because of confusion over the meanings of addiction, dependence, and abuse. Recent efforts to clear up this confusion, especially differentiating abused from withdrawal symptom liability, have been helpful (Ballenger 1993 [3]; Linsen et al. 1995 [4]; N.S. Miller 1995 [5]; N.S. Miller et al. 1995 [6]).
"... Numerous groups, including some medical professionals, have perpetuated the idea that if benzodiazepines are used long term, patients become `addicted' to the benzodiazepines, implying that they will abuse them or have an extreme withdrawal syndrome when the medication is discontinued. Actually, what occurs with benzodiazepines is similar to the effects of other medications used for long-term treatment of a medical and/or psychiatric condition and can be compared to what happens when a patient's cardiovascular medication (e.g., propranolol, methyldopa) is suddenly discontinued (Garbus et al. 1979 [7]). In essence, the body goes through an adaptational process to the drug, and if medication is discontinued too abruptly, the patient can have withdrawal symptoms. The patient may also experience a transient recurrence of anxiety symptoms at levels more intense than those experienced before treatment; this is called rebound. The patient may also experience a return of symptoms that were present before treatment (relapse). However, if dosage is adjusted and gradually titrated downward, and if patients and their families are educated about what to expect during the discontinuation process, most patients can manage the transient withdrawal symptoms without much difficulty (see Ballenger et al. 1993 [8] and Shader and Greenblatt 1993 [1] for review), this area remains somewhat controversial (Ashton 1995 [9]; Lader 1995 [10] [note that these are both by British authors])."
1. Shader RI, Greenblatt DJ: Use of benzodiazepines in anxiety disorders. N Engl J Med 328:1398-1405, 1993.
2. Romach MK, Somer GR, Sobell LC, et al.: Characteristics of long-term alprazolam users in the community. J Clin Psychopharmacol 12:316-332, 1992.
3. Here, the citation is ambiguous (there is no reference listed that matches the citation). It could be one of the following:
Ballenger JC, Fyer AJ: Examining criteria for panic disorder. Hosp Community Psychiatry 44:226-228, 1993
Ballenger JC: Long-term pharmacologic treatment of panic disorder. J Clin Psychiatry 52:18-23, 1991.
Ballenger JC, Pecknold J, Rickels K, et al.: Medication discontinuation in panic disorder. J Clin Psychiatry 54 (10 suppl):15-21, 1993.4. Linsen SM, Zitman JG, Breteler MHM: Defining benzodiazepine dependence: the confusion persists. European Psychiatry 10:306-311, 1995.
5. Miller NS: Liability and efficacy from long-term use of benzodiazepines: documentation and interpretation. Psychiatric Annals 25:166-173, 1995.
6. Miller NS, Gold MS, Stennie K: Benzodiazepines: the dissociation of addiction from pharmacological dependence/withdrawal. Psychiatric Annals 25:149-152, 1995.
7. Garbus SB, Weber MS, Priest RT, et al.: The abrupt discontinuation of antihypertensive treatment. J Clin Pharmacol 19:476-486, 1979.
8. again, ambiguous: could be
Ballenger JC, Fyer AJ: Examining criteria for panic disorder. Hosp Community Psychiatry 44:226-228, 1993, or
Ballenger JC, Pecknold J, Rickels K, et al.: Medication discontinuation in panic disorder. J Clin Psychiatry 54 (10 suppl):15-21, 1993.9. Ashton H: Protracted withdrawal from benzodiazepines: the post-withdrawal syndrome. Psychiatric Annals 25:174-179, 1995.
10. Lader M: Clinical pharmacology of anxiolytic drugs: past, present, and future, in _GABA Receptors and Anxiety: From Neurobiology to Treatment_. Edited by Biggio G, Sanna E, Costa E. New York, Raven, 1995, pp. 135-153.
In a later chapter, the authors do note that patients with a history of drug or alcohol abuse may be at increased risk for benzodiazepine abuse, but they add that: "Such a history is not an absolute contraindication to benzodiazepine use, but these drugs should be used with particular caution in this population." A history of substance abuse may be indicative of self-medication rather than any special propensity for abusing drugs in general.
I could go on, but you get the idea.
Some references regarding the use of adinazolam and alprazolam as antidepressants:
Kennedy SH, de Groot J, Ralevski E, Reed K: A comparison of adinazolam and desipramine in the treatment of major depression. Int Clin Psychopharmacol 1991 Summer;6(2):65-76.
Feighner JP, Boyer WF, Hendrickson GG, Pambakian RA, Doroski VS: A controlled trial of adinazolam versus desipramine in geriatric depression. Int Clin Psychopharmacol 1990 Jul;5(3):227-232.
Dunner D, Myers J, Khan A, Avery D, Ishiki D, Pyke R: Adinazolam--a new antidepressant: findings of a placebo-controlled, double-blind study in outpatients with major depression. J Clin Psychopharmacol. 1987 Jun;7(3):170-172.
Ansseau M, Devoitille JM, Papart P, Vanbrabant E, Mantanus H, Timsit-Berthier M: Comparison of adinazolam, amitriptyline, and diazepam in endogenous depressive inpatients exhibiting DST nonsuppression or abnormal contingent negative variation. J Clin Psychopharmacol 1991 Jun;11(3):160-165.
Smith WT, Glaudin V: Double-blind efficacy and safety study comparing adinazolam mesylate and placebo in depressed inpatients.
Cohn JB, Pyke RE, Wilcox CS: Adinazolam mesylate and placebo in depressed outpatients: a 6-week, double-blind comparison. J Clin Psychiatry. 1988 Apr;49(4):142-147.
Amsterdam JD, Kaplan M, Potter L, Bloom L, Rickels K: Adinazolam, a new triazolobenzodiazepine, and imipramine in the treatment of major depressive disorder. Psychopharmacology (Berl). 1986;88(4):484-488.
Weissman MM, Prusoff B, Sholomskas AJ, Greenwald S: A double-blind clinical trial of alprazolam, imipramine, or placebo in the depressed elderly.
J Clin Psychopharmacol. 1992 Jun;12(3):175-182.Hicks F, Robins E, Murphy GE: Comparison of adinazolam, amitriptyline, and placebo in the treatment of melancholic depression. Psychiatry Res. 1988 Feb;23(2):221-227.
Rickels K, Chung HR, Csanalosi IB, Hurowitz AM, London J, Wiseman K, Kaplan M, Amsterdam JD: Alprazolam, diazepam, imipramine, and placebo in outpatients with major depression. Arch Gen Psychiatry. 1987 Oct;44(10):862-866.
Eriksson B, Nagy A, Starmark JE, Thelander U: Alprazolam compared to amitriptyline in the treatment of major depression. Acta Psychiatr Scand. 1987 Jun;75(6):656-663.
...and many others.
These results seem to suggest that triazolobenzodiazepines may be less efficacious than tricyclics for severe depression, but may be helpful for milder depression or in conjunction with other antidepressants.
> These "facts" sound like the mantra for the anti-benzo lobby - mostly based in the U.K.
Yes, British doctors do seem to be much more conservative/benzophobic than doctors in other parts of the world (even the U.S.).
> Also, I don't know how many posts I've read here about "withdrawl" symptoms from ssri's - a supposedly "non-addictive" alternative to benzos.
I think this view results from an outdated and misleading idea of what constitutes "addiction." Pharmacologic dependence (i.e., the occurrence of a characteristic withdrawal syndrome upon discontinuation of the drug) isn't sufficient by itself to merit a diagnosis of addiction.
-elizabeth
Posted by Alan on July 30, 2001, at 22:18:11
In reply to Re: misunderstandings about benzodiazepines » Alan, posted by Elizabeth on July 30, 2001, at 16:30:28
"....... > I think this view results from an outdated and misleading idea of what constitutes "addiction." Pharmacologic dependence (i.e., the occurrence of a characteristic withdrawal syndrome upon discontinuation of the drug) isn't sufficient by itself to merit a diagnosis of addiction."
>
> -elizabeth
===========================================Wow! this is terrific - you're a wizard. I appreciate it very much....
Best,
Alan
Posted by sar on July 30, 2001, at 22:26:47
In reply to Re: clonazepam+depression » sar, posted by Elizabeth on July 27, 2001, at 20:30:23
Maybe try it for a bit and see how it goes? Give it a few weeks. I think it's greeeeaaaattt...howvere, the last pdoc I spoke with seemed concerned that i would grow a tolerance to it and require higher dosages...any opinions?
Posted by Daveman on July 31, 2001, at 2:13:02
In reply to misunderstandings about benzodiazepines » Benzobuster, posted by Elizabeth on July 29, 2001, at 14:46:47
Elizabeth:
As his "name" indicates, "Benzobuster" is one of those who oppose all but the most short-term uses of benzos. All of the websites he "points" to are part of the anti-benzo movement. Of course, he has every right to his opinion, I just think its a waste of time to try to persuade him otherwise:)
Dave
Posted by Elizabeth on July 31, 2001, at 18:27:24
In reply to Re: misunderstandings about benzodiazepines » Elizabeth, posted by Daveman on July 31, 2001, at 2:13:02
> As his "name" indicates, "Benzobuster" is one of those who oppose all but the most short-term uses of benzos. All of the websites he "points" to are part of the anti-benzo movement. Of course, he has every right to his opinion, I just think its a waste of time to try to persuade him otherwise:)
Yup, I can tell whether someone is interested in a balanced point of view or not, and Benzobuster is pretty obviously a person with an agenda. I just figured it would be nice to offer a counterpoint to BB's opinions -- not for him so much as for anyone else who might be reading.
-elizabeth
Posted by Alan on July 31, 2001, at 20:13:19
In reply to Re: misunderstandings about benzodiazepines » Daveman, posted by Elizabeth on July 31, 2001, at 18:27:24
> > As his "name" indicates, "Benzobuster" is one of those who oppose all but the most short-term uses of benzos. All of the websites he "points" to are part of the anti-benzo movement. Of course, he has every right to his opinion, I just think its a waste of time to try to persuade him otherwise:)
>
> Yup, I can tell whether someone is interested in a balanced point of view or not, and Benzobuster is pretty obviously a person with an agenda. I just figured it would be nice to offer a counterpoint to BB's opinions -- not for him so much as for anyone else who might be reading.
>
> -elizabeth
========================================Any guesses or insights as to how this movement got started and keeps going - and is based in the UK? Does it have to do with the "addictiveness" issue in general, the drug war on narcotics or just anything associated with "addiction" and all of the misunderstandings and stigma that you posted about?
Or is it additionally related to something else? The prospect of being on a med for a chronic condition for a long period, thinking they'll end up an addict?Why isn't there an eqivalently strident anti-ssri movement - an anti-anticonvulsant movement? They have a discontinuation syndrome associated with them. I find the anti-benzo zealotry and scare tactics particularly disturbing and puzzling (it actually had me fooled for a long time) in view of the many that are suffering needlessly while going under or untreated with the very drug that will help relieve their suffering.....
Looking forward to your insights.
Best,
Alan
Posted by Daveman on July 31, 2001, at 23:57:27
In reply to Re: misunderstandings about benzodiazepines » Elizabeth, posted by Alan on July 31, 2001, at 20:13:19
>
> Any guesses or insights as to how this movement got started and keeps going - and is based in the UK? Does it have to do with the "addictiveness" issue in general, the drug war on narcotics or just anything associated with "addiction" and all of the misunderstandings and stigma that you posted about?
> Or is it additionally related to something else? The prospect of being on a med for a chronic condition for a long period, thinking they'll end up an addict?
>
> Why isn't there an eqivalently strident anti-ssri movement - an anti-anticonvulsant movement? They have a discontinuation syndrome associated with them. I find the anti-benzo zealotry and scare tactics particularly disturbing and puzzling (it actually had me fooled for a long time) in view of the many that are suffering needlessly while going under or untreated with the very drug that will help relieve their suffering.....
>
> Looking forward to your insights.
>
> Best,
>
> AlanOkay, here's my two cents:
Any drug is going to have adverse reactions. In the case of the benzos, there have been many millions of prescriptions filled, especially during their "wonder drug" phase (see my earlier post re: Hegelian Logic and Benzos). With so many benzos scripted over the years, there are bound to be more adverse reactions than to many other drugs. Many of those that suffered such reactions have found each other and formed a support community.
Also, I think many benzos- valium in particular- were wildly overprescribed without any forewarnings of the potential problems this might cause. There is no doubt that if you take benzos in high enough doses for long enough, you will form a physiological dependency (which is hypothesized to be due to the "down-regulating" of the natural production of Gamma Amino Butyric Acid (GABA) by the brain. Most of those who are taking benzos long term while under the care of a knowledgeable psychopharmacologist understand this and accept the "trade" of physiologic dependency for effective control of debilitating anxiety.
I actually think that the anti-benzo folks have performed a valuable service in counteracting the overprescription of benzos where not properly monitored or medically indicated. But like any zealots, they go way too far in claiming that long term use of benzos is NEVER appropriate.
As to Great Britain, I don't really know, but I think it may be due to the prevelance of valium as the benzo of choice. Valium is probably the benzo most susceptible to addiction.
Finally, as to the SSRI's- you are wrong to say there is no anti-SSRI hysteria. Do a web search and you will find numerous anti-SSRI websites. SSRI's have also IMHO been wildly overprescribed. I do think there is a big difference between SSRI's and benzos in that benzos are "immediate response" drugs and thus are more susceptible to true addiction. I doubt they'll ever be a "street" market for Celexa like there is for Xanax; you can't get a buzz off Celexa no matter how much you take (unless you consider Serotonin Syndrome a "buzz":)) But with lawyers blaming SSRI's for suicides and murderous rampages, the anti-SSRI hysteria is definitely out there.
Dave
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.