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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by jlo820 on February 17, 2004, at 8:38:17
Why is Valium (Diazepam) the only benzo that is used as a muscle relaxer? How is it diferent from the others - Klonopin, Xanax, Ativan, etc.
Posted by c ubbybear on February 18, 2004, at 2:43:27
In reply to Valium Question, posted by jlo820 on February 17, 2004, at 8:38:17
> Why is Valium (Diazepam) the only benzo that is used as a muscle relaxer? How is it diferent from the others - Klonopin, Xanax, Ativan, etc.
I'm not an expert on what makes Valium a muscle relaxer but it differs from the other benzos in having a much longer half-life (stays in body cells longer) than the other meds commonly prescribed for anxiety and panic. Perhaps it's the half-life that makes it a better bet for muscle relaxation. It's also used as a substitute benzo for people who are weaning off Xanax, Klonopin, Ativan or the benzos with shorter half life. (This is exactly what I've been doing, i.e. I recently substituted Valium when I got to the tail-end of my Klonopin taper.)
If tense muscles are your sole problem, keep in mind that there are many alternative methods you can try other than (or in conjunction with) Valium: warm Jacuzzi, massage, acupuncture, etc.
Posted by Chairman_MAO on February 18, 2004, at 7:53:12
In reply to Valium Question, posted by jlo820 on February 17, 2004, at 8:38:17
I do not know why exactly, but having tried alprazolam, lorazepam, clonazepam, nitrazepam, and diazepam, I can tell you that diazepam had by far the strongest muscle relaxant effects. In my experience, the order of strength from weakest to strongest was:
alprazolam < clonazepam < lorazepam < nitrazepam < diazepam
Nitrazepam has the best buzz, by far (if you can call it a buzz).
Perhaps the reason it works so well as a muscle relaxant is that YOUR BRAIN MAKES ITS OWN DIAZEPAM. Most people do not know this. It should be sold in health food stores as a supplement along with GHB and morphine, both of which your brain makes itself as well.
Posted by Sad Panda on February 18, 2004, at 7:57:15
In reply to Re: Valium Question » jlo820, posted by c ubbybear on February 18, 2004, at 2:43:27
Benzos all have a similar function, but everyone seems to have a prefered one. Biggest difference is how long they stay in the system & it's Diazepam that lasts the longest because of all it's active metabolites. Temazepam & Oxazepam are two of Diazepam's metabolites. The first is a benzo used for sleep & the second is a benzo used for anxiety.
Cheers,
Panda.
Posted by Sad Panda on February 18, 2004, at 8:08:52
In reply to Re: Valium Question » jlo820, posted by Chairman_MAO on February 18, 2004, at 7:53:12
> I do not know why exactly, but having tried alprazolam, lorazepam, clonazepam, nitrazepam, and diazepam, I can tell you that diazepam had by far the strongest muscle relaxant effects. In my experience, the order of strength from weakest to strongest was:
>
> alprazolam < clonazepam < lorazepam < nitrazepam < diazepam
>
> Nitrazepam has the best buzz, by far (if you can call it a buzz).
>
> Perhaps the reason it works so well as a muscle relaxant is that YOUR BRAIN MAKES ITS OWN DIAZEPAM. Most people do not know this. It should be sold in health food stores as a supplement along with GHB and morphine, both of which your brain makes itself as well.
>
>My mother swears by her Valium, she has osteoporosis in the neck & upper back part of her spine & just 2&1/2mg per day keeps her neck muscles relaxed & her panic disorder under control all day.
Cheers,
Panda.
Posted by cubbybear on February 19, 2004, at 3:39:29
In reply to Re: Valium Question » jlo820, posted by Sad Panda on February 18, 2004, at 7:57:15
> Benzos all have a similar function, but everyone seems to have a prefered one. Biggest difference is how long they stay in the system & it's Diazepam that lasts the longest because of all it's active metabolites. Temazepam & Oxazepam are two of Diazepam's metabolites. The first is a benzo used for sleep & the second is a benzo used for anxiety.
>
> Cheers,
> Panda.You sound like an expert on these meds. Can you or anyone else provide a link so I can read up on the history and development of benzos (starting way back with Librium)?
>
Posted by Sad Panda on February 20, 2004, at 10:01:51
In reply to Re: Valium Question » Sad Panda, posted by cubbybear on February 19, 2004, at 3:39:29
> > Benzos all have a similar function, but everyone seems to have a prefered one. Biggest difference is how long they stay in the system & it's Diazepam that lasts the longest because of all it's active metabolites. Temazepam & Oxazepam are two of Diazepam's metabolites. The first is a benzo used for sleep & the second is a benzo used for anxiety.
> >
> > Cheers,
> > Panda.
>
> You sound like an expert on these meds. Can you or anyone else provide a link so I can read up on the history and development of benzos (starting way back with Librium)?
> >
>
>Nooo! I'm not an expert, I just know how to operate google effectively. :)
When you are looking for drug info with google it helps to add -buy -online so you avoid 100000 hits for online phamacys.
I'll try & find something for you to read on benzo development.
Cheers,
Panda.
Posted by Chairman_MAO on February 21, 2004, at 8:05:03
In reply to Re: Valium Question » Sad Panda, posted by cubbybear on February 19, 2004, at 3:39:29
> You sound like an expert on these meds. Can you or anyone else provide a link so I can read up on the history and development of benzos (starting way back with Librium)?
http://www.etfrc.com/benzos1.htm
This is an excellent overview of the benzodiazepines.
Posted by cubbybear on February 22, 2004, at 2:29:10
In reply to Re: Valium Question » Sad Panda » cubbybear, posted by Chairman_MAO on February 21, 2004, at 8:05:03
Posted by Sad Panda on February 22, 2004, at 10:05:08
In reply to Re: Valium Question » Sad Panda » cubbybear, posted by Chairman_MAO on February 21, 2004, at 8:05:03
> > You sound like an expert on these meds. Can you or anyone else provide a link so I can read up on the history and development of benzos (starting way back with Librium)?
>
> http://www.etfrc.com/benzos1.htm
>
> This is an excellent overview of the benzodiazepines.Good read. :)
Have you got a similar link for TCA's?
I understand that Imipramine was the original & the rest are variations.
eg.
Desipramine is Desmethyl-Imipramine.
Clomipramine is Imipramine with a Clorine atom attached.
Doxepin is Amitriptyline with an Oxygen atom attached.
Dothepin is Amitriptyline with a Sulphur atom attached.
Nortiptyline is Desmethyl-Amitriptyline.Do you know what was done to Imipramine to make Amitriptyline?
Cheers,
Panda.
Posted by BobS, on February 23, 2004, at 19:51:14
In reply to Re: Valium Question » Chairman_MAO, posted by Sad Panda on February 22, 2004, at 10:05:08
Chairman, et al,
The link you posted was as nice read. In my case, a skim, because of age and no chemistry in my background.
However, the author makes several comments about memory problems with BZDs, but never documents them. My own Medline inquiries have found many articles that state as part of the abstract, "the well known problem with memory" when discussing BZDs, but I have not many articles that actually discuss tests on memory. Those that discuss memory, generally, cite stuff similar to what the author ridicules in his article, like one I ran across using something called a "flicker test" to document memory problem.
Any thoughts on the memory issue would be greatly appreciated. I have been anxious for 62 years and have to keep taking my BZDs for a reasonable quality of life.
Regards,
BobS.
Posted by Chairman_MAO on February 23, 2004, at 20:59:41
In reply to Re: Valium Question Article Memory, posted by BobS, on February 23, 2004, at 19:51:14
Benzodiazepines *MAY* cause (I only have one, old Russian study abstract on this) a dose-dependent inhibition of acetylcholine release in certain areas of the brain integral to memory formation/storage. Undoubtedly the real picture is more complex than this, but I have personal experience using galantamine to counteract the sedation and cognitive problems from using Klonopin or Valium. Talk to your doctor about trying low-dose galantamine to see if it helps your clarity of thought--assuming you feel it's impaired at all in the first place.
They did a lot of Research in the former Soviet Union about using galantamine + high-dose clonazepam to treat all sorts of mental disorders, from schizophrenia to panic attacks. This research cannot be found on medline and will likely never see the light of day in the US. However, you can find evidence of it in the US Patent database, as enterprising Americans have patented these methods which they've pirated from the work of Eastern European/Russian scientists. Search the Patent Database for "galantamine AND clonazepam" and see what you find.
Here's a study to back me up. Ketalar, mentioned in the article, is the "dissociative anesthetic" ketamine, which produces massive cognitive impairment. "Nivaline" is their brand of galantamine, now "Nivalin", which can be ordered from www.nivalin.com:
Akush Ginekol (Sofiia). 1987;26(3):28-31.[Attempt to eliminate residual somnolence and disorientation with nivaline after anesthesia with ketalar and diazepam for minor obstetrical and gynecologic surgery]
[Article in Bulgarian]
Chakalova E, Marinova M, Srebreva M, Anastasov D, Ploskov K.
PIP: Effectiveness of the anticholinergic agent nivaline to prevent side-effects of anesthetics ketalar and diazepam was studied in 40 pregnant women (15- 40 years old) undergoing induced abortion during the 1st trimester. The patients were divided into two groups. Group 1 included 20 patients who received anesthesia with diazepam (10 mg) and ketalar (50-70 mg) alone. Group 2 included 20 patients undergoing anesthesia under diazepam-ketalar in combination with nivaline (10 mg, iv) during an early postoperative period. The degree of somnolence and disorientation was assessed immediately after anesthesia, and 5, 10, 15, 30 and 60 min after surgery using a scale of 1 to 4 (from response to verbal commands and pain stimulus to complete absence of response). The patients in group 2 were more alert than the patients in group 1 only 5, 10 and 15 min after surgery.
Posted by BobS, on February 24, 2004, at 19:29:22
In reply to Re: Valium Question Article Memory » BobS,, posted by Chairman_MAO on February 23, 2004, at 20:59:41
I take it you agree that the memory issue with BZDs may be overstated. Generally, the studies say something like 24 healthy adults (medication naive) were given 2mg alprazolam and two hours later they scored xyz on these memory tests. I would like to see a test of 100 panic/agoraphobics (bridges let's say) take the same test while sitting on a bridge and, naturally, without access to alprazolam PRN.
Anyway, what is your diagnosis and what do you do you take for it? What is your experience with any other meds? You're clearly a bright young man and while I am interested for myself, I also have two children in college who may have picked up some of my genetic propensity for anxiety. I am looking to help them live a long and happy life. Lastly, where do you get galantamine and what are the upside and downside of it? Is it doctor prescribed or secured otherwise? I need further info to discuss that compound with my doctor, especially, if it has any anxiolytic properties.
Regards,
BobS.
Posted by Chairman_MAO on February 25, 2004, at 18:21:36
In reply to Chairman - TX reply What's your dx and rx, posted by BobS, on February 24, 2004, at 19:29:22
> I take it you agree that the memory issue with BZDs may be overstated. Generally, the studies say something like 24 healthy adults (medication naive) were given 2mg alprazolam and two hours later they scored xyz on these memory tests. I would like to see a test of 100 panic/agoraphobics (bridges let's say) take the same test while sitting on a bridge and, naturally, without access to alprazolam PRN.
Doctors mainly use the memory issue as an excuse for not giving benzodiazepines, rather than admitting that you can give drugs to help/ameliorate it. If they had to suffer crippling anxiety, social phobia, panic, etc., they'd realize that there is no use for a good memory if you're too anxious to use it.
I'm positive that I would score better on some exams/tests and certainly in oral interviews/exams if I had a small amount of a BZD in my system because I wouldn't be second-guessing myself to death. And even in the unlikely event that I didn't, what the hell does it matter? I could care less if my memory was impaired a little; saying that we should all have high-powered memories is a paternalistic value judgement on the part of doctors/researchers. Many psychologists would say, "So what about quality of life and other things that we can only PRETEND to quantify--at best?" It is telling that BZD antagonists/inverse agonists IMPROVE memory, as does strychnine in lab animals.
And I honestly do not care how researchers want to spin their data: benzodiazepines blow all other drugs away where anxiolysis is concerned. The main problem with them that nobody seems to admit directly is that they're TOO EFFECTIVE. Two friends of mine and I once took a moderate dose of LSD along with 2mg of Klonopin and experienced NO ANXIETY WHATSOEVER walking through the middle of Times Square, staring head-to-head with 5 lanes of technicolored oncoming traffic. It's hard for a psyche to grow when it experiences no distress. For people with anxiety disorders, however, life padded by benzodiazepines is a lot more rewarding than life with psyche-splitting anxiety.
>
> Anyway, what is your diagnosis and what do you do you take for it? What is your experience with any other meds?I am BP2 (cyclothymia) with inattentive ADD and social phobia. It's quite a combination, let me tell you, although, as Bob Marley said, "Every man think his burden is the heaviest". I have all too much experience with a slew of drugs; there was a time that I thought they were the sole answer to my problems.
Which of my experiences would you like to know about? I already articulated one earlier, but I'll bet you were asking about drugs I've used in TREATMENT of myself. :)
>You're clearly a bright young man
Thank you. Scores of people have been telling me this for years; I'm trying to internalize it.
>and while I am interested for myself, I also have two children in college who may have picked up some of my genetic propensity for anxiety. I am looking to help them live a long and happy life.
As Baba Ram Dass wrote, "Good parents provide the external things". That is, a safe place with food, water, and a place to flourish, a refuge without constant harsh judgements. If you've done this, you've done pretty much all you can do. If they want to take meds, you'd do well to tell them what you've gotten good results from. This could save them some wasted time in trying to find the right drug(s). In a psychological vein, if you see similarities in their experience of anxiety and yours, you could tell them so. My somewhat narcissistic mother to this day condemns in me what she cannot tolerate in/does not want to happen to herself.
>Lastly, where do you get galantamine and what are the upside and downside of it? Is it doctor prescribed or secured otherwise? I need further info to discuss that compound with my doctor, especially, if it has any anxiolytic properties.
It is anti-manic (people who need this effect really should give a cholinesterase inhibitor a try) and can be mood darkening, can make anxiety worse, may cause sleep disturbances, and has some physical side effects. At the right dosage, however, it really boosts cognition/memory/attention and strengthens erections, among other things--with a low side effect profile. Look up Reminyl on www.rxlist.com. You may also check out www.nivalin.com or Google for information. You may have your doctor prescribe it for you, but if you do not have insurance, Reminyl is EXPENSIVE. It is somewhat cheaper if ordered directly from the Nivalin web site, and although it's impossible to know for sure, the quality is probably just as good as the US brand. It sure worked like a charm for me.
If you want to know anything else more specific, I will try to help you.
Best wishes!
Posted by zeugma on February 25, 2004, at 19:22:51
In reply to Re: Chairman - TX reply What's your dx and rx » BobS,, posted by Chairman_MAO on February 25, 2004, at 18:21:36
For people with anxiety disorders, however, life padded by benzodiazepines is a lot more rewarding than life with psyche-splitting anxiety.
I don't feel 'padded' at all on a tiny dose of clonazepam. I feel like an anxious, but passably normal-anxious, person. I was used recently as an illustration of the word 'anxiety' by a person who knows me well, explaining the term to a non-native English speaker. That is how anxious I am without meds.
I am BP2 (cyclothymia) with inattentive ADD and social phobia. It's quite a combination, let me tell you, although, as Bob Marley said, "Every man think his burden is the heaviest". I have all too much experience with a slew of drugs; there was a time that I thought they were the sole answer to my problems
Inattentive ADD is a lot more crippling than a lot of people imagine. Severe ADD is typically comorbid with a slew of other disorders, in my case: endogeneous depression, social anxiety, so-called 'generalized anxiety disorder' (the disorder that Buspar, ahem, is supposed to treat), narcolepsy.
It wasn't until i went all out in researching my conditions, and finding people who would believe me about the symptoms I have (my therapist recently commented that many of my symptoms are so bizarre that she could understand why trained observers would conclude that I suffered from simple 'psychosis' rather than the amalgamation of disorders that tons of meds are more or less effectively treating. But as I said, comorbidities are the rule with severe ADD), that things got better. And I am on a slew of drugs, mostly noradrenergic enhancers (the TCA nortriptyline and Strattera, plus buspirone, which works through every neuroreceptor and to seemingly so little effect for most, but it helps me sleep). NE is in many ways acetchyholine's opposite number, interestingly enough.
>Lastly, where do you get galantamine and what are the upside and downside of it? Is it doctor prescribed or secured otherwise? I need further info to discuss that compound with my doctor, especially, if it has any anxiolytic properties.
It is anti-manic (people who need this effect really should give a cholinesterase inhibitor a try) and can be mood darkening, can make anxiety worse, may cause sleep disturbances, and has some physical side effects. At the right dosage, however, it really boosts cognition/memory/attention and strengthens erections, among other things--with a low side effect profile. Look up Reminyl on www.rxlist.com. You may also check out www.nivalin.com or Google for information. You may have your doctor prescribe it for you, but if you do not have insurance, Reminyl is EXPENSIVE. It is somewhat cheaper if ordered directly from the Nivalin web site, and although it's impossible to know for sure, the quality is probably just as good as the US brand. It sure worked like a charm for me.
This is totally in line what what I've been learning about the interactions of the cholinergic/ monoaminergic systems. That cholinergic enhancer would be anti-manic makes perfect sense, considering that many potent antidepressants have either direct or indirect anti-cholinergic effects, and that cholinergic enhancers shorten REM latency dramatically (they are the most potent REM enhancers known), while all known AD's (with the interesting exception of Wellbutrin- maybe you could shed some light on this?- I sure didn't last long on Wellbutrin) are REM latency prolongers and general REM suppressants.
That cholinergic enhancers improve memory and cognition, while potentially darkening mood for already REM-bombarded depressives, makes an interesting echo to the finding that BZD inverse agonists/antagonists improve memory, but cause similar disruptions in the sphere of anxiety.
The puzzle is beginning to fit together.
>
This is the end of the thread.
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