![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by Mr. Scott on February 15, 2002, at 19:38:39
Certain elements about benzos scare me because I like to be in control, but someone who sees the whole picture would surely see that Effexor and Paxil are just as bad if not worse in all respects. You can't go on a trip and forget to take your Effexor just like you can't forget to take your Klonopin. Someone please correct me, but what is the difference? Just because Monkeys and Rats don't self administor Effexor when locked in a cage? Maybe it's because the Rats and Monkeys are smarter than we are. Because the label calls them "discontinuation symptoms" instead of "withdrawal Symptoms".However, The reason newer drugs aren't being trashed (except by us, the people who take them) is because they are "on Label" while benzos are "off Label". Off label=generic=no marketing dollars. On label=branded=14 years to get richer=FAT marketing budget to drive sales. I'm still a capitalist all they way, but patients need to know what is going on behind the scenes, and I would hope doctors would realize that reps have no real interest in the docs other than to persuade them to SELL THEIR DRUGS.
Drug Companies with their FAT marketing budgets and tentacles of dissemination try to bad mouth generic competitors even if WE don't hear about it, you can bet Wyeth and GSK reps trash benzos every chance they get so they will prescribe their drugs instead. Handing out studies funded through "Unrestricted Educational Grants" that highlight the merits of shitty SSRI's and knocking benzo's down. Unrestricted Educational Grants are a myth in case you want to know. Even the most reputable journals "will work with their clients" especially now when the advertising dollars are down.I know factually that BMS reps leveraged MASSIVE campaigns against benzos to doc's when Buspar turned out to be a disapointment in clinical practice.
So stick that in yer pipe and smoke it!
Scott
Posted by Alan on February 15, 2002, at 23:22:03
In reply to Trashing Benzos, posted by Mr. Scott on February 15, 2002, at 19:38:39
>
> Certain elements about benzos scare me because I like to be in control, but someone who sees the whole picture would surely see that Effexor and Paxil are just as bad if not worse in all respects. You can't go on a trip and forget to take your Effexor just like you can't forget to take your Klonopin. Someone please correct me, but what is the difference? Just because Monkeys and Rats don't self administor Effexor when locked in a cage? Maybe it's because the Rats and Monkeys are smarter than we are. Because the label calls them "discontinuation symptoms" instead of "withdrawal Symptoms".
> Scott
************************************************
The demonisation of this entire class of medications is also motivated by other factors - mainly the misunderstanding of undereducated docs that don't understand your first paragraph (above) which is really the issue about the medical distinction between "addiction" and "medical dependence".When one loosely tosses out the term "addictive" they are ignoring the medical communities' definitions for PRESCRIBED MEDICATIONS for valid reasons.
The term used when someone is on long term treatment for a medication is MEDICALLY DEPENDENT. And yes, there is a huge distinction.
The continual refusal to accept this may inhibit someone from seeking treatment for unneccessary fear of "addiction.""Needing medication for many years -- even over a lifetime -- to function normally is not drug abuse or drug addiction but rather medical dependence." -- William D. Kernodle, Panic Disorder: The Medical Point of View."
Addiction vs. Dependency:
Benzodiazepines & Anxiety DisordersXanax is one of several benzodiazepines. The alleged addictiveness of Xanax and other benzodiazepines is a hot topic among people with anxiety disorders and the professionals who treat us. The issue is often discussed on online support groups, sometimes resulting in heated debate.
"Needing medication for many years -- even over a lifetime -- to function normally is not drug abuse or drug addiction but rather medical dependence." -- William D. Kernodle, Panic Disorder: The Medical Point of View
Why This is Important
RESEARCH
"In patients without histories of substance abuse, who are prescribed benzodiazepines under medical supervision . . . benzodiazepines almost never induce behavior that satisfies any reasonable definition of addiction" (Piper, Jr., A. "Addiction to Benzodiazepines -- How Common?" Archives of Family Medicine 4.11 (1995): 964-970)."Long-term users of alprazolam/lorazepam . . . used a constant or decreasing dose of medication . . . Persistant use of alprazolam/lorazepam for therapeutic purposes did not represent abuse or addiction as the terms are usually understood" (Romach, M., et. al. "Clinical Aspects of Chronic Use of Alprazolam and Lorazepam." American Journal of Psychiatry 152.8 (1995): 1161-1170).
"The vast majority of the use of benzodiazepines is appropriate. Problems of nonmedical use arise nearly exclusively among people who abuse other drugs" (Woods, J.H. and G. Winger. "Current Benzodiazepine Issues." Psychopharmacology 118.2 (1995): 107-115).
"With panic/agoraphobia patients there is no evidence of abuse. Chronic use is justified in these patients; risk must be weighed against benefit, dependence against relief . . . Potential abusers are those with personality disorders, dysphoria (mood disturbance) and current or previous substance abuse . . . there is no epidemic of misuse. Abuse seems to be limited to substance abusers . . . chronic use is justified in chronic anxiety patients. Chronic use does not usually lead to abuse" (American Psychiatric Association. Benzodiazepine Task Force on Use, Dependence, Toxicity and Abuse. May 1990).
William D. Kernodle's Panic Disorder: The Medical Point of View....If you want to truly understand (or begin to understand) the biology of panic disorder as well as the function of medications, then do read this book.
The Definitions:
The term addiction is often equated with abuse. Addiction is generally marked by tolerance and/or psychological dependence. With tolerance, a person needs to increase the dosage of a medication over time in order to receive the same therapeutic benefits. Studies show that the majority of people with anxiety disorders do not increase their benzodiazepine dosages over time; in fact, most lower their dosages.
When we think of addiction we are often thinking of psychological dependence. With psychological dependence, a person continues to take a medication no matter what the consequences. The person will also seek out the medication no matter what the consequences. Again, as with tolerance, most studies show that people with anxiety disorders do not become psychologically dependent on benzodiazepines.
The exceptions to the studies mentioned above are people who have a history of addiction to other drugs. People with such a history are possibly at risk for becoming addicted to benzodiazepines, too.
A condition which does occur with long-term, regular use of benzodiazepines is physical dependence. After using benzodiazepines regularly for a few months (and the time varies for each individual), a person's body will usually adapt to the drug. If the medication is stopped abruptly, the person will experience withdrawal symptoms. These symptoms may be lessened (or even eliminated) by slowly tapering off the medication, if one chooses to stop taking it. Benzodiazepines should be discontinued only with the supervision of a qualified physician.
People who are on medication for an illness for a long time are not addicted to the medication; they are medically dependent on it. They need to keep taking the medication in order to keep the symptoms of the illness away. The majority of anxiety disorders patients who take benzodiazepines over the long term fall into the category of medical dependence."
Alan
Posted by Alan on February 15, 2002, at 23:27:59
In reply to Trashing Benzos, posted by Mr. Scott on February 15, 2002, at 19:38:39
One Doesn't have to feel defective if they find that they do best on the benzodiazepine alone. That actually makes you part of the discreet majority.
Your doctor probably doesn't know it, but one of the best-kept secrets in this field is that the majority of people who achieve long-term pharmaceutical control of their anxiety disorder are on benzodiazepines rather than antidepressants. This has been so for many, many years, both before and after the introduction of SSRIs, and was most recently reiterated in a study presented at the 2001 conference of the Anxiety Disorders Association of America (an organization that generally does not favor pharmaceutical treatment of any kind).
Significant numbers of people do achieve such control on antidepressants alone or with an antidepressants as the primary pharmaceutical treatment and a benzodiazepine as backup. But a larger group of people get started out on antidepressants and eventually have to be switched to benzodiazepines, or they get started on an antidepressant and a benzodiazepine and eventually quit the antidepressant but stay on the benzodiazepine -- either officially or without telling their doctor. And of course some people "graduate" from antidepressant treatment, benzodiazepine treatment, or combination treatment and maintain equilibrium without medication. I haven't seen any convincing evidence that either class of medication leads to more "graduations" than the other, although many doctors are under the misimpression that antidepressants are superior in that respect. The thing is, if you push such docs, they usually discover they can't provide any independent evidence to back that up -- they've always heard it from people around them (especially sales reps) but never gone looking at the evidence for themselves.
Alan
Posted by Bob on February 15, 2002, at 23:30:59
In reply to Re: Trashing Benzos - Re: addiction. » Mr. Scott, posted by Alan on February 15, 2002, at 23:22:03
Well... I guess I'm medically and/or physically dependent on both benzos and SSRIs. I can't seem to come close to getting off of either one. The rebound anxiety, muscle tension, and mood destabilization is absolutely horrific. I really can't see ever getting off of either class of drug unless a replacement treatment comes along.
Posted by jay on February 15, 2002, at 23:41:33
In reply to Trashing Benzos, posted by Mr. Scott on February 15, 2002, at 19:38:39
Scott, thanks, and I thought I would add in some of my other thoughts also, and in particular to your situation. I don't really like giving a lot of med advice, but I can honestly say, and will put money on this, that benzos, for me in particular, have been *the only* lifesaver especially in difficult times.Here in Canada, there is anti-benzo sentiment, but I don't think it is as harsh as some places in the U.S. (In particular, with the DEA and their Big Brother scare tactics.) I also think it is sad that folks don't get a chance to try a maintenance dose of not one, but a couple benzo's. I have a friend in Europe who is on a good dose of Clonazepam, and takes a small dose of Xanax with that for "breakthrough" anxiety. Interesting but he is also on a small dose of a tricyclic, which are far more popular in Europe than here in North America. I don't honestly think the problem with tricyclics has been their side-effects, I think it is their 'cost-effects'. I have only ever found the closest to complete remission of my depression on the tricyclic nortriptyline with a benzo, and given all the designer drugs I have been on, nothing comes close to touching my depression and anxiety like those two do.
All of these stories we see on here, and especially the horrid pain of side-effects and concern about meds in everything from Lithium to antipsychotics, and how doctors are pushing these as "maintenance" treatment, is just downright pathetic. If a person's anxiety and depression can be well treated with a low eminence dose of both a benzo and a tricyclic, what the heck are they doing on a combo of expensive meds like Remeron or Effexor often with very, very heavy medication like an antipsychotic? Antipsychotics are not indicated for generalized anxiety, and I think cause more problems and put people in danger when they don't have to be. The same goes for the anti-convulsants, as some folks seem to think they act the same way benzo's do, which is not true. Anti-convulsants are powerful medications that *still* haven't made the grade the way benzos do. They tried it with Buspar, and even my old pdoc claimed it was "garbage".
If you can/and/or/do have a benzo to take, don't be afraid to fall back on it, and if it is the only thing that helps you, assertively tell your pdoc. I went through a couple of years of hell thinking I could combine anti-convulsants, with powerful new a.d's and antipsychotics. All's that ended up happening was that I felt very drugged, tired, anxious, and of course just as 'depressed'. As of a few days ago, I am off my Effexor, chucked the antipsychotics down the toilet, and my pdoc got me back on eminence benzo doses. I have 9 or so years experience with the benzos, and they still work just as amazing and great AND quick, and I can start/stop as needed. Last time I was on benzos alone, I found an amazing girlfriend and got into a relationship, got working again, felt much lighter. Then my pdoc put me on Effexor without benzos, and that is when my major problems began. Anyhow...just my story/ IMHO. I hope this can help somehow.
This is a great thread...I hope we can keep it up. Take good care...
Jay
>
> Certain elements about benzos scare me because I like to be in control, but someone who sees the whole picture would surely see that Effexor and Paxil are just as bad if not worse in all respects. You can't go on a trip and forget to take your Effexor just like you can't forget to take your Klonopin. Someone please correct me, but what is the difference? Just because Monkeys and Rats don't self administor Effexor when locked in a cage? Maybe it's because the Rats and Monkeys are smarter than we are. Because the label calls them "discontinuation symptoms" instead of "withdrawal Symptoms".
>
> However, The reason newer drugs aren't being trashed (except by us, the people who take them) is because they are "on Label" while benzos are "off Label". Off label=generic=no marketing dollars. On label=branded=14 years to get richer=FAT marketing budget to drive sales. I'm still a capitalist all they way, but patients need to know what is going on behind the scenes, and I would hope doctors would realize that reps have no real interest in the docs other than to persuade them to SELL THEIR DRUGS.
> Drug Companies with their FAT marketing budgets and tentacles of dissemination try to bad mouth generic competitors even if WE don't hear about it, you can bet Wyeth and GSK reps trash benzos every chance they get so they will prescribe their drugs instead. Handing out studies funded through "Unrestricted Educational Grants" that highlight the merits of shitty SSRI's and knocking benzo's down. Unrestricted Educational Grants are a myth in case you want to know. Even the most reputable journals "will work with their clients" especially now when the advertising dollars are down.
>
> I know factually that BMS reps leveraged MASSIVE campaigns against benzos to doc's when Buspar turned out to be a disapointment in clinical practice.
>
> So stick that in yer pipe and smoke it!
>
> Scott
Posted by Alan on February 15, 2002, at 23:41:37
In reply to Re: Trashing Benzos - Re: addiction. » Alan, posted by Bob on February 15, 2002, at 23:30:59
> Well... I guess I'm medically and/or physically dependent on both benzos and SSRIs. I can't seem to come close to getting off of either one. The rebound anxiety, muscle tension, and mood destabilization is absolutely horrific. I really can't see ever getting off of either class of drug unless a replacement treatment comes along.
*********************************************
Well then read:http://bearpaw8.tripod.com/pd.html#SSRI
especially as it relates to Dr. Scott's original post in this thread. You may want scroll down to the next informational review of the benzodiazapines too! Great website for panic disorder if you take the time to read the whole thing.
Alan
Posted by Alan on February 15, 2002, at 23:55:48
In reply to Re: Trashing Benzos. » Mr. Scott, posted by jay on February 15, 2002, at 23:41:33
>
> Scott, thanks, and I thought I would add in some of my other thoughts also, and in particular to your situation. I don't really like giving a lot of med advice, but I can honestly say, and will put money on this, that benzos, for me in particular, have been *the only* lifesaver especially in difficult times.
>
> This is a great thread...I hope we can keep it up. Take good care...
>
> Jay
******************************************Jay. I had a similar experience and have been on BZD monotherapy for several years now having lost much of the last 15 or so years trying to "make" every conceiveable form of AD or combo ssri and BZD, or anticonvulsant/AD/BZD , etc, work for me. I ended up feeling like a square peg trying to be put into a round hole.
Many docs feel that a patient is simply "unresponsive" or "atypical" if the patient doesn't fit their own criteria for what they perrceive as a diagnosing through the technique of "Listening to the Drug" (as so well described iny Peter Kramer's best seller, "Listening to Prozac").
PLEASE read this fantastic website I came accross about PD and anxiety in general....especially medicine therapy such as ssri's and the BZD's. My doc specialising in the treatment of anxiety disorders read it and passed out copies to their entire staff as reference to well written, patient accessable information:
http://bearpaw8.tripod.com/pd.html
It's longish but worth every drop!!!
Alan
Posted by jay on February 16, 2002, at 0:56:49
In reply to Re: Trashing Benzos - Re: addiction. » Mr. Scott, posted by Alan on February 15, 2002, at 23:22:03
Thanks Alan...your resources really put good light on the "true" benefit and "risk" ratio of using benzos. Two points about them really, to me, make them a superior psych med.
One is their safety. I am a living experiment with medications, as many of us are. I have used benzos for many years, on and off, and have *never* had any problems with them in all factors, and especially in contrast to the other massive powerful and often negative effects of antipsychotics and even antidepressants. Each of those meds pose a very, very high side-effect profile in contrast to benzos.
Two is their strength and efficacy without "brute force". They work faster, and seem to be the most effective for treatment of anxiety, which I think is keenly tied into depression.
My old pdoc, whom I may be going back to, used benzos + and a.d. for any depression/anxiety condition. He had me on just benzos for awhile. I also think benzos have much potential in bipolar disorder, in particular 2 and 3.
These are cost-effective, cheap, and widely available meds, and I hope the field of psychiatry wakes up and realizes many don't benefit from the newer, very high priced drugs, and this in fact is even shown in research. The only problem is, I think as Scott said, that the drug companies are trying to make the benzos look "evil" because they want to push their designer million-dollar drugs on people instead.
Anyhow..just IMHO..
Jay
> >
> > Certain elements about benzos scare me because I like to be in control, but someone who sees the whole picture would surely see that Effexor and Paxil are just as bad if not worse in all respects. You can't go on a trip and forget to take your Effexor just like you can't forget to take your Klonopin. Someone please correct me, but what is the difference? Just because Monkeys and Rats don't self administor Effexor when locked in a cage? Maybe it's because the Rats and Monkeys are smarter than we are. Because the label calls them "discontinuation symptoms" instead of "withdrawal Symptoms".
> > Scott
> ************************************************
>
>
> The demonisation of this entire class of medications is also motivated by other factors - mainly the misunderstanding of undereducated docs that don't understand your first paragraph (above) which is really the issue about the medical distinction between "addiction" and "medical dependence".
>
> When one loosely tosses out the term "addictive" they are ignoring the medical communities' definitions for PRESCRIBED MEDICATIONS for valid reasons.
>
> The term used when someone is on long term treatment for a medication is MEDICALLY DEPENDENT. And yes, there is a huge distinction.
> The continual refusal to accept this may inhibit someone from seeking treatment for unneccessary fear of "addiction."
>
> "Needing medication for many years -- even over a lifetime -- to function normally is not drug abuse or drug addiction but rather medical dependence." -- William D. Kernodle, Panic Disorder: The Medical Point of View."
>
> Addiction vs. Dependency:
> Benzodiazepines & Anxiety Disorders
>
> Xanax is one of several benzodiazepines. The alleged addictiveness of Xanax and other benzodiazepines is a hot topic among people with anxiety disorders and the professionals who treat us. The issue is often discussed on online support groups, sometimes resulting in heated debate.
>
> "Needing medication for many years -- even over a lifetime -- to function normally is not drug abuse or drug addiction but rather medical dependence." -- William D. Kernodle, Panic Disorder: The Medical Point of View
>
> Why This is Important
>
> RESEARCH
> "In patients without histories of substance abuse, who are prescribed benzodiazepines under medical supervision . . . benzodiazepines almost never induce behavior that satisfies any reasonable definition of addiction" (Piper, Jr., A. "Addiction to Benzodiazepines -- How Common?" Archives of Family Medicine 4.11 (1995): 964-970).
>
> "Long-term users of alprazolam/lorazepam . . . used a constant or decreasing dose of medication . . . Persistant use of alprazolam/lorazepam for therapeutic purposes did not represent abuse or addiction as the terms are usually understood" (Romach, M., et. al. "Clinical Aspects of Chronic Use of Alprazolam and Lorazepam." American Journal of Psychiatry 152.8 (1995): 1161-1170).
>
> "The vast majority of the use of benzodiazepines is appropriate. Problems of nonmedical use arise nearly exclusively among people who abuse other drugs" (Woods, J.H. and G. Winger. "Current Benzodiazepine Issues." Psychopharmacology 118.2 (1995): 107-115).
>
> "With panic/agoraphobia patients there is no evidence of abuse. Chronic use is justified in these patients; risk must be weighed against benefit, dependence against relief . . . Potential abusers are those with personality disorders, dysphoria (mood disturbance) and current or previous substance abuse . . . there is no epidemic of misuse. Abuse seems to be limited to substance abusers . . . chronic use is justified in chronic anxiety patients. Chronic use does not usually lead to abuse" (American Psychiatric Association. Benzodiazepine Task Force on Use, Dependence, Toxicity and Abuse. May 1990).
>
> William D. Kernodle's Panic Disorder: The Medical Point of View....If you want to truly understand (or begin to understand) the biology of panic disorder as well as the function of medications, then do read this book.
>
> The Definitions:
>
> The term addiction is often equated with abuse. Addiction is generally marked by tolerance and/or psychological dependence. With tolerance, a person needs to increase the dosage of a medication over time in order to receive the same therapeutic benefits. Studies show that the majority of people with anxiety disorders do not increase their benzodiazepine dosages over time; in fact, most lower their dosages.
>
> When we think of addiction we are often thinking of psychological dependence. With psychological dependence, a person continues to take a medication no matter what the consequences. The person will also seek out the medication no matter what the consequences. Again, as with tolerance, most studies show that people with anxiety disorders do not become psychologically dependent on benzodiazepines.
>
> The exceptions to the studies mentioned above are people who have a history of addiction to other drugs. People with such a history are possibly at risk for becoming addicted to benzodiazepines, too.
>
> A condition which does occur with long-term, regular use of benzodiazepines is physical dependence. After using benzodiazepines regularly for a few months (and the time varies for each individual), a person's body will usually adapt to the drug. If the medication is stopped abruptly, the person will experience withdrawal symptoms. These symptoms may be lessened (or even eliminated) by slowly tapering off the medication, if one chooses to stop taking it. Benzodiazepines should be discontinued only with the supervision of a qualified physician.
>
> People who are on medication for an illness for a long time are not addicted to the medication; they are medically dependent on it. They need to keep taking the medication in order to keep the symptoms of the illness away. The majority of anxiety disorders patients who take benzodiazepines over the long term fall into the category of medical dependence."
>
> Alan
Posted by jay on February 16, 2002, at 1:00:57
In reply to Re: Trashing Benzos. » jay, posted by Alan on February 15, 2002, at 23:55:48
Thanks again Alan! I am going to print this up, and take it to my pdoc at my next appointment. I added some other comments in last message, and I hope maybe we can get some good info to pass around. Just curious...what benzo are you on? I am on a benzo on available in Canada, called Lectopam (bromazepam). I find it great, because it hase a longer life than Ativan, but still has a good strong punch to it.I will get back with more comments on the website you posted.
Thanks again! Take care..
Jay
> >
> > Scott, thanks, and I thought I would add in some of my other thoughts also, and in particular to your situation. I don't really like giving a lot of med advice, but I can honestly say, and will put money on this, that benzos, for me in particular, have been *the only* lifesaver especially in difficult times.
> >
> > This is a great thread...I hope we can keep it up. Take good care...
> >
> > Jay
> ******************************************
>
> Jay. I had a similar experience and have been on BZD monotherapy for several years now having lost much of the last 15 or so years trying to "make" every conceiveable form of AD or combo ssri and BZD, or anticonvulsant/AD/BZD , etc, work for me. I ended up feeling like a square peg trying to be put into a round hole.
>
> Many docs feel that a patient is simply "unresponsive" or "atypical" if the patient doesn't fit their own criteria for what they perrceive as a diagnosing through the technique of "Listening to the Drug" (as so well described iny Peter Kramer's best seller, "Listening to Prozac").
>
> PLEASE read this fantastic website I came accross about PD and anxiety in general....especially medicine therapy such as ssri's and the BZD's. My doc specialising in the treatment of anxiety disorders read it and passed out copies to their entire staff as reference to well written, patient accessable information:
>
> http://bearpaw8.tripod.com/pd.html
>
> It's longish but worth every drop!!!
>
>
> Alan
Posted by jimmygold70 on February 16, 2002, at 2:13:49
In reply to Trashing Benzos, posted by Mr. Scott on February 15, 2002, at 19:38:39
The real big question about a drug is if you get ADDICTED to it. There are three elements of addiction:
1) Dependence
2) Tolerance
3) Drug-seeking behaviorTolerance (increasing the dose all the time) and drug-seeking behavior (spending time and effort getting the drug) does occur with benzos but not with Effexor. People suffering from anxiety does not have those symptoms while on either Benzos or Effexor, but others do (see Bush's daughter). Tolerance does develop in anxiety patients but it is generally limited.
The dependence on Benzos compared to Effexor is much stronger. People have much harder time stopping Benzos related to Effexor albeit both have withdrawal symptoms.
That is why Effexor is less addicting than Benzos. Period.
Jimmy
Posted by Dr. Bob on February 16, 2002, at 2:31:36
In reply to Trashing Benzos, posted by Mr. Scott on February 15, 2002, at 19:38:39
> However, The reason newer drugs aren't being trashed (except by us, the people who take them) is because they are "on Label" while benzos are "off Label". Off label=generic=no marketing dollars. On label=branded=14 years to get richer=FAT marketing budget to drive sales.
Discussion about drug companies, rather than drugs, should take place at Psycho-Social-Babble:
http://www.dr-bob.org/babble/social/20020214/msgs/18395.html
Thanks,
Bob
PS: And discussion about posting policies should take place at Psycho-Babble Administration.
Posted by Alan on February 16, 2002, at 2:43:23
In reply to Elements of addiction » Mr. Scott, posted by jimmygold70 on February 16, 2002, at 2:13:49
> The dependence on Benzos compared to Effexor is much stronger. People have much harder time stopping Benzos related to Effexor albeit both have withdrawal symptoms.
>
> That is why Effexor is less addicting than Benzos. Period.
>
> Jimmy
************************************************
And this is exactly what I mean. There is no credible evidence to back this up. There is no control for those misdiagnosed, misprescribed, mis-supervised tapering BZD's fit into the equation. There is no credible evidence even that the above statement is true in the least. If you read the definition of "addiction" vs. medical dependency that I posted earlier it makes this point very clear. Personally, I see more complaints about withdrawl effects from ssri's than any benzo - especially on this bboard. It's a constant title to threads one after another here when I visit.If you read the website that I posted earlier perhaps it will help in understanding the idea of withdrawl from ANY drug including non-psychotropics, let alone PROPER, slow tapering of BZD's (assuming they should be tapered off of them in the first place). Many require long term treatment which after reviewing all of the studies for decades, the prestigious World Health Organisation - hardly a drug pushing group of CEO's from the major pharmecuticals - has deemed BZD's not only safe, but preferable and advantageous long OR short term.
There are no "periods" in blanket statements about BZD's or the concept of "addiction". That is the misnomer that drives the hesitency of patients and non-specialist doctors alike to fear prescribing BZD monotherapy on an equal footing with any ssri - giving the patient freedom of choice to determine for themselves the effecacy of either drug. Misinforming the general population of patients with the corporate line that *BZD's "addicting"/ssri's not* is taking away the patient's freedom of choice. It is "wordsmithing" and "euphemising" at the expense of the health and well being of vulnerable anxiety sufferers and their underinformed docs.
Alan
Posted by jay on February 16, 2002, at 6:48:01
In reply to Elements of addiction » Mr. Scott, posted by jimmygold70 on February 16, 2002, at 2:13:49
Sorry, I think you are wrong, period. You have shown no citations or evidence to back up your claims. As Alan pointed out, this is VERY much the same, if not WORSE, for current antidepressants. There is now a large database in Europe containing all of the withdrawl 'hells' people have had in coming off everything from Effexor to Paxil. Ask the people on here about their Effexor and Paxil withdrawl stories.
It seems you and so many have fallen prey to the garbage that big Drug companies use as propaganda. Second, there is no way you can tell me that antidepressants, especially the newer ones, touch anywhere near anxiety and GAD.
Last, but not least, it ALSO appears people build up quite a tolerance to antidepressants, the newer ones in particular, and people seem to go to the max dose possible, and then just fall to pieces. Do a search on benzos, and people tend to take *less* over time. What I don't understand is why people want this torture of horrid side effects from a.d's, with very, very little good response (again, especially the newer ones), when a bezo does a clean, good, safe, and effective job. What about how the antidepressants kill your sex drive, turns off your most basic and beautiful desire and ability to enjoy a healthy sex life? Never mind the side effects AND the costs. People being sexually shut-off by a drug, raises some MAJOR moral and ethical questions, yet people believe it because and doctors dish these new "wonderdrugs" out.
Simple: Add it all up, and newer antidepressants are often anything but. Unless someone is into self-torture, there is no reason, NIL, to avoid benzodiazepines.
/rant
Jay
> The real big question about a drug is if you get ADDICTED to it. There are three elements of addiction:
> 1) Dependence
> 2) Tolerance
> 3) Drug-seeking behavior
>
> Tolerance (increasing the dose all the time) and drug-seeking behavior (spending time and effort getting the drug) does occur with benzos but not with Effexor. People suffering from anxiety does not have those symptoms while on either Benzos or Effexor, but others do (see Bush's daughter). Tolerance does develop in anxiety patients but it is generally limited.
>
> The dependence on Benzos compared to Effexor is much stronger. People have much harder time stopping Benzos related to Effexor albeit both have withdrawal symptoms.
>
> That is why Effexor is less addicting than Benzos. Period.
>
> Jimmy
Posted by Bob on February 16, 2002, at 12:04:39
In reply to Re: Elements of addiction » jimmygold70, posted by jay on February 16, 2002, at 6:48:01
What about how the antidepressants kill your sex drive, turns off your most basic and beautiful desire and ability to enjoy a healthy sex life? Never mind the side effects AND the costs. People being sexually shut-off by a drug, raises some MAJOR moral and ethical questions, yet people believe it because and doctors dish these new "wonderdrugs" out.
==================================================Benzodiazepines are fine for pure anxiety disorders, but if a person has significant depression along with that, benzos don't have antidepressant effects as far as I know.
Posted by Alan on February 16, 2002, at 13:12:15
In reply to Re: Elements of addiction » jay, posted by Bob on February 16, 2002, at 12:04:39
> What about how the antidepressants kill your sex drive, turns off your most basic and beautiful desire and ability to enjoy a healthy sex life? Never mind the side effects AND the costs. People being sexually shut-off by a drug, raises some MAJOR moral and ethical questions, yet people believe it because and doctors dish these new "wonderdrugs" out.
> ==================================================
>
> Benzodiazepines are fine for pure anxiety disorders, but if a person has significant depression along with that, benzos don't have antidepressant effects as far as I know.
*******************************************
Actually, there have been several studies that show xanax hasa mild antidepressant effect.But more importantly I think is whether anxiety is causing the depression or the other way around. This sounds simplistic and is in a way but many find that the chronic symptoms of anxiety depress them. When the anx. is releived, the depression is alleviated soon afterwards.
This is one of the problems of treating with ssri's. One is less likely be able to diagnose by "listening to the drug" (or one's reaction to it) if it is designed to treat both at once. That's why those that have chronic, more pronounced symptoms of anxiety usually end up on an equal amount of BZD's to take away the remaining anxiety or panic that ssri's don't cover but unfortunately, with all of the side effects that go with the ssri too.
BZD monotherapy for those with mixed anx/depress. often works wonders. I personally came to the conclusion that after years of combos that included both types of drugs to just tell my doc, "hey - you'd be depressed too if you were under the thumb of so much constant anxiety!".
Being the pragmatist that he was thankfully, we went with BZD monotherapy for a month and the depression (which was quite sever at times) simply vanished.
Alan
Posted by Mr. Scott on February 16, 2002, at 14:34:07
In reply to Re: Trashing Benzos - Re: addiction., posted by Alan on February 15, 2002, at 23:41:37
Posted by Mr. Scott on February 16, 2002, at 14:37:06
In reply to Elements of addiction » Mr. Scott, posted by jimmygold70 on February 16, 2002, at 2:13:49
Jimmy I see your points, but my dependence on effexor seems much harder to break then was my dependence on Benzos which I had for many years (many good years). I don't take them now, and sure it was unpleasant to withdraw, but Effexor...If I skip a day or two I want to kill myself!!
Thats pretty Bad in my opinion.
Posted by Bob on February 16, 2002, at 15:16:48
In reply to Re: Elements of addiction » jimmygold70, posted by Mr. Scott on February 16, 2002, at 14:37:06
> Jimmy I see your points, but my dependence on effexor seems much harder to break then was my dependence on Benzos which I had for many years (many good years). I don't take them now, and sure it was unpleasant to withdraw, but Effexor...If I skip a day or two I want to kill myself!!
>
> Thats pretty Bad in my opinion.==================================================
I think that everybody's different and the ability to wean one's self off of either class, benzos or ADs, depends on the individuals underlying biology and symptoms. I know people who are able to come on and off antidepressants with just minor discomfort (if any at all), and I know myself: it's not a pretty picture. It has come to the point with me where any change is dosage of any med I take affects me adversely. The only question left for me is to what degree of severity.
Posted by christophrejmc on February 16, 2002, at 16:18:49
In reply to Re: Elements of addiction » jimmygold70, posted by Mr. Scott on February 16, 2002, at 14:37:06
Can anyone explain to me why people abuse benzodiazepines? The only reason I've ever heard was to "space out." If that's the main reason, why wouldn't there be more cases of neuroleptic abuse?
Is it just that benzos work too well? Many drug abusers are simply self-medicating and anxiety is one of most common psychiatric disorders.
Some antidepressants have suffered the same fate -- amineptine and nomifensine were removed from the U.S. market for what a lot of people think to be because of abuse potential (i.e. they worked too well, too fast). (This may be one of the reasons why no-one is interested in developing any more substantially dopaminergic ADs.) Also, as a result of several reports of Parnate abuse, some parts of the world (at least Italy and perhaps Germany) combine tranylcypromine with a phenothiazine neuroleptic.
Few opioid analgesics are available without the addition of another drug (usually one that is dangerous in large amounts (perhaps in any amount)) to thwart abuse. If this trend continues, will we see the release of Xanaxcet?I'll save my rant about the anti-benzo groups for a later time, but I think we should start an anti-benzo-prohibition ("pro-benzo" might give people the wrong idea) group -- I don't deny that people have had real problems with benzos (some even truly addicted) but there's no reason to throw the baby...
-Christophre
Posted by Alan on February 16, 2002, at 18:17:33
In reply to Re: Elements of addiction, posted by christophrejmc on February 16, 2002, at 16:18:49
Posted by skills on February 20, 2002, at 15:03:10
In reply to Trashing Benzos, posted by Mr. Scott on February 15, 2002, at 19:38:39
I do agree that Benzo's are useful in some cases but overtime tolerance builds up and a succesful dosage may need to be increased. Withdrawal from acute withdrawal from chronic benzo use is extremely unpleasant. Apart from the muscle cramps, minor visual illusions, shaking, sickness, depression, rebound insomnia ( which can last for months ( incurable by traditional benzo and antipyscotic hypnotic drugs, except for the 130 year old dangerous choral hydrate) and confusion, pyschosis inducing both auditory and visual hallucinations is unplesant and deppressing. Having experienced both an opiod and benzodiazepine withdrawal the latter effected me far worse in acute physical symptoms and these lasted for much long than those associated with opiod dextox. These addictions were not formed through abuse, rather through prescribed medication. The extreme reality of a benzo detox is what the doctors want to avoid as well as the other physiological impairments resulting from benzo's high addicton potential. Belive me if a benzo addict could not get their prescription or required dosage in the case of street users, drug seeking behaviour becomes apparant. Addmitedly new benzo's including Ouzepam have lower addicton potential are extremly useful in the treatment of anxiety.
Posted by OldSchool on February 20, 2002, at 18:27:24
In reply to Trashing Benzos, posted by Mr. Scott on February 15, 2002, at 19:38:39
I dont worry about this stuff much. I just take the drugs and am glad I have them. I do get irritated when I read about drug companies developing more "me too" serotonin drugs however. There are already enough SSRI type drugs on the market. As far as benzos go, I just get an rx for them and take them...which is not very often BTW. Whether they are generic, the real deal "label" drug or whatever doesnt really concern me.
Posted by Alan on February 20, 2002, at 22:29:12
In reply to Re: Trashing Benzos, posted by skills on February 20, 2002, at 15:03:10
> I do agree that Benzo's are useful in some cases but overtime tolerance builds up and a succesful dosage may need to be increased. Withdrawal from acute withdrawal from chronic benzo use is extremely unpleasant. Apart from the muscle cramps, minor visual illusions, shaking, sickness, depression, rebound insomnia ( which can last for months ( incurable by traditional benzo and antipyscotic hypnotic drugs, except for the 130 year old dangerous choral hydrate) and confusion, pyschosis inducing both auditory and visual hallucinations is unplesant and deppressing. Having experienced both an opiod and benzodiazepine withdrawal the latter effected me far worse in acute physical symptoms and these lasted for much long than those associated with opiod dextox. These addictions were not formed through abuse, rather through prescribed medication. The extreme reality of a benzo detox is what the doctors want to avoid as well as the other physiological impairments resulting from benzo's high addicton potential. Belive me if a benzo addict could not get their prescription or required dosage in the case of street users, drug seeking behaviour becomes apparant. Addmitedly new benzo's including Ouzepam have lower addicton potential are extremly useful in the treatment of anxiety.
*************************************************
Most of this may be your own unusual, personal experience, but the vast majority of properly diagnosed, managed, and followed up anxiety disorders respond to BZD's without all of the phenomenon you suggest - especially "high addiction potential". This is statistically true speaking for the majority of the general population, not just for some as you state.You are obviously one of those that fit into a different catagory. But fitting into a different catagory can apply to ANY drug. It's the exclusive use of BZD's to compare with narcotics and using loaded terms like "detox" that give away bias in the direction from which is spoken here. Using the term "chronic use" implies that the drug is at fault but the reality is that anxiety is the chronic part of the equation. So keeping symptoms at bay does not constitute "chronic use".
I've posted several links here about this if you read this thread. Here is another that addresses the "addiction" vs "medical dependence" distinction:
http://panicdisorder.about.com/library/weekly/aa031997.htm
If the perpetual stigmitisation of this drug were not so insisted on by a strident minority, patients and some misinformed docs would not have choices taken from them to decide for themselves. Rather, vulnerable anxiety sufferers are being discouraged to even venture a try. Truly unfortunate.
Alan
Posted by gilbert on February 21, 2002, at 17:22:15
In reply to Re: Trashing Benzos, posted by Alan on February 20, 2002, at 22:29:12
I have always been pro benzo use but have had the most terrible thing happen this past winter. My xanax after 3 years of use became completely ineffective. My maintenance dose was 2mg per day and when I upped the dose to 4mg began to get paradoxical symptomolgy. I am now tapering off xanax after 3 years which is no picnic. I am going slow but have had most of my panic symptoms return worse than before. Each of us is different and I pray you guys and gals don't have this happen but suddenly I would need elephant size doses of xanax or klonopin to stay panic free. I am currently on low dose prozac while I taper and it is helping somewhat. I have no idea what I will do or how I will be functional again without the benzos but they simply stopped working. I am a sober alcoholic....maybe I am just prone to develope tolerance to downer type drugs. I guess I will have to wait for pagloclone to come out or just endure through a dose of antidepressants....who knows now thAT i AM FORCED TO ACTUALLY STAY ON PROZAC MAYBE IT WILL work in the long run.
Best of luck to all you lucky benzo users....
Gil
Posted by Alan on February 23, 2002, at 15:36:05
In reply to Re: Trashing Benzos, posted by gilbert on February 21, 2002, at 17:22:15
> I have always been pro benzo use but have had the most terrible thing happen this past winter. My xanax after 3 years of use became completely ineffective. My maintenance dose was 2mg per day and when I upped the dose to 4mg began to get paradoxical symptomolgy. I am now tapering off xanax after 3 years which is no picnic. I am going slow but have had most of my panic symptoms return worse than before. Each of us is different and I pray you guys and gals don't have this happen but suddenly I would need elephant size doses of xanax or klonopin to stay panic free. I am currently on low dose prozac while I taper and it is helping somewhat. I have no idea what I will do or how I will be functional again without the benzos but they simply stopped working. I am a sober alcoholic....maybe I am just prone to develope tolerance to downer type drugs. I guess I will have to wait for pagloclone to come out or just endure through a dose of antidepressants....who knows now thAT i AM FORCED TO ACTUALLY STAY ON PROZAC MAYBE IT WILL work in the long run.
>
> Best of luck to all you lucky benzo users....
>
> Gil
************************************************
Sorry that you are having trouble Gil. Perhaps some of past history w/alchohol has something to do with it - I don't know. There is also a very small population that have a genetic "predisposition" to becoming addicted that figures into the equation...Read:
http://panicdisorder.about.com/library/weekly/aa031997.htm
AND:
http://bearpaw8.tripod.com/pd.html
They will help answer alot of the questions you and others may have by the info in your post.
Alan
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