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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by sdb on March 12, 2006, at 16:50:10
It's an old question but I am not completely sure apart from all common pharmacology knowledge.
How are your personal experiences with benzos?
Did you have tolerance to benzodiazepines (which bz, how long, how much, for what)
thus the need to elevate the dosage from time to time for the same effect or did you have no problems with tolerance?Did you have dependence (which bz, how long, how much, for what)
, you were not or almost not able to taper down the benzodiazepine or did you have no or almost
no problems with dependence?There are possible differences between benzos metabolizing in nordazepam eg. Valium
and other benzos like Xanax xr (alprazolam), Klonopin (clonazepam).Thanks for every personal experience, response, thought, knowledge...
~sdb
Short list of benzodiazpines from wikipedia:
Triazolam (Halcion®) - 2 hours
Midazolam (Versed®, Hypnovel®) - 3 hours (1.8-6 hours)
Oxazepam (Serax®) - 4-15 hours
Chlordiazepoxide (Librium®) - 5-25 hours
Alprazolam (Xanax®) - 6-12 hours
Temazepam (Restoril®) 8-20 hours
Lorazepam (Ativan®) 10-20 hours
Loprazolam (Dormonoct®) 10-20 hours
Bromazepam (Lexotan®) 10-20 hours
Estazolam (ProSom®) 10-24 hours
Clobazam (Frisium®) 18 hours
Flunitrazepam (Rohypnol®) 18-26 hours. Withdrawn from the market in some countries; considered a "date-rape drug"
Clonazepam (Klonopin®, Rivotril®) 18-50 hours
Nitrazepam (Mogadon®) 20-40 hours
Quazepam (Doral®) 25-100 hours
Clorazepate (Tranxene®) 36-100 hours
Medazepam (Nobrium®) 36-150 hours
Nordazepam (Madar®, Stilny®) 50-120 hours
Prazepam (Centrax®) 36-200 hours
Diazepam (Valium®) 36-200 hours
Flurazepam (Dalmane®) 40-250 hours
Posted by yxibow on March 12, 2006, at 17:50:35
In reply to Benzodiazepines, does it mean tolerance/dependence, posted by sdb on March 12, 2006, at 16:50:10
> It's an old question but I am not completely sure apart from all common pharmacology knowledge.
>
> How are your personal experiences with benzos?
>
> Did you have tolerance to benzodiazepines (which bz, how long, how much, for what)
> thus the need to elevate the dosage from time to time for the same effect or did you have no problems with tolerance?
>
> Did you have dependence (which bz, how long, how much, for what)
> , you were not or almost not able to taper down the benzodiazepine or did you have no or almost
> no problems with dependence?
>
> There are possible differences between benzos metabolizing in nordazepam eg. Valium
> and other benzos like Xanax xr (alprazolam), Klonopin (clonazepam).
>
> Thanks for every personal experience, response, thought, knowledge...
>
> ~sdb
>
> Short list of benzodiazpines from wikipedia:
>
> Triazolam (Halcion®) - 2 hours
> Midazolam (Versed®, Hypnovel®) - 3 hours (1.8-6 hours)
> Oxazepam (Serax®) - 4-15 hours
> Chlordiazepoxide (Librium®) - 5-25 hours
> Alprazolam (Xanax®) - 6-12 hours
> Temazepam (Restoril®) 8-20 hours
> Lorazepam (Ativan®) 10-20 hours
> Loprazolam (Dormonoct®) 10-20 hours
> Bromazepam (Lexotan®) 10-20 hours
> Estazolam (ProSom®) 10-24 hours
> Clobazam (Frisium®) 18 hours
> Flunitrazepam (Rohypnol®) 18-26 hours. Withdrawn from the market in some countries; considered a "date-rape drug"
> Clonazepam (Klonopin®, Rivotril®) 18-50 hours
> Nitrazepam (Mogadon®) 20-40 hours
> Quazepam (Doral®) 25-100 hours
> Clorazepate (Tranxene®) 36-100 hours
> Medazepam (Nobrium®) 36-150 hours
> Nordazepam (Madar®, Stilny®) 50-120 hours
> Prazepam (Centrax®) 36-200 hours
> Diazepam (Valium®) 36-200 hours
> Flurazepam (Dalmane®) 40-250 hoursIts actually a fairly recent question on the board and we keep beating it with a dead horse. Not that you dont have a right to ask it.
Personally, I categorize most all benzodiazepines alike, since they invariably touch sedative, hypnotic, anxiolytic, and convulsion factors in varying degrees, in varying persons.
I currently take high dosage diazepam, which I believe is not due to dosage escalation but rather both a necessity for the condition, and now slightly higher because of interaction with Trileptal.
Is it tolerance ? I dont think so... I don't have any cravings for it, but then it is a long acting agent.
In general I would describe the short acting agents such as Xanax and Tranxene as potentially possible in some people to cause habituation.
Here's where we get into semantics -- there are probably a certain percentage of the population who have true addiction -- faked prescriptions, somewhat unaware of the amount of the particular benzodiazepine they're taking until it gets into a situation they need to deal with.
Largely though I believe that there is a population that is perfectly capable of taking a set dose of a medication for a long period of time, even as long as the medication was on the market.
And then there is the group, genetics or whatever, that habituate to a particular agent, and must withdraw, or go through withdraw, vacation, and restore cycles.
Finally, I'll add that withdrawal effects can be mitigated by slow tapering of a benzodiazepine. Don't drop it cold turkey -- I did that with Tranxene, and then the * of a college psych doc gave me only part of it back when it should have all been restored and slowly tapered down. All sorts of unpleasant things can happen, which are completely unnecessary. I think I'm writing this for the second or third time, but if one is experiencing "withdrawal" symptoms, they are going too fast. And I don't ascribe to the benzo.org.uk site about their taper schedule and the whole spectrum of things found there -- maybe some people do, that is their perogative.
Also, not all of those benzodiazepines, and there are at least one or two more that may have been on the market outside of the US for a short period of time, are available in the US. They may be available in other countries, and some countries may not have some of those, vise versa.
So that's my 2c. I'm sure this will be a lively discussion
Tidings
-- Jay
Posted by gardenergirl on March 12, 2006, at 18:30:57
In reply to Re: Benzodiazepines -- here we go again... » sdb, posted by yxibow on March 12, 2006, at 17:50:35
> > Its actually a fairly recent question on the board and we keep beating it with a dead horse. Not that you dont have a right to ask it.
That poor horse! Put it down and try a club!
;)
gg
Posted by Phillipa on March 12, 2006, at 19:08:36
In reply to Put the horse down and step away! :^) » yxibow, posted by gardenergirl on March 12, 2006, at 18:30:57
Loaded topic. Some say they are addictive I say tolerance can be a factor. But why should benzos be any different than an antidepressant. Some people can never go off of them. But xanax is short acting and a long acting benzo like valium is used to get off of it. Fondly, Phillipa
Posted by yxibow on March 13, 2006, at 2:50:04
In reply to Put the horse down and step away! :^) » yxibow, posted by gardenergirl on March 12, 2006, at 18:30:57
> > > Its actually a fairly recent question on the board and we keep beating it with a dead horse. Not that you dont have a right to ask it.
>
> That poor horse! Put it down and try a club!
>
> ;)
>
> gg..like a dead horse I meant. Grammar, gramma. This board needs humour, because this is a loaded topic....
Posted by gardenergirl on March 13, 2006, at 8:01:37
In reply to Re: Put the horse down and step away! :^) » gardenergirl, posted by yxibow on March 13, 2006, at 2:50:04
Yeah, I knew right away what you meant. I just couldn't resist. The visual image in my brain was much too compelling.
Thanks for making me giggle. :)
And I agree, this topic can get heated.
gg
Posted by sdb on March 13, 2006, at 19:46:09
In reply to Re: Put the horse down and step away! :^) » yxibow, posted by gardenergirl on March 13, 2006, at 8:01:37
Thanks for the responses above and for the horses too :-)
in some books of anesthesia and pharmacology is written that benzodiazepines influence the transmission of dopamine in the area tegmentalis ventralis (VTA) in the brain, changes of plasticity and following tolerance. But these changes could variable from person to person. I am not sure how strong this effect is compared to other drugs in reality. We need some true statistics.
~sdb
Posted by Declan on March 15, 2006, at 19:35:48
In reply to Re: Put the horse down and step away! :^), posted by sdb on March 13, 2006, at 19:46:09
What benzos did to me was that they aggravated the condition they simultaneously relieved. Eventually the experience of benzo reduction made my original problems seem quite handleable. I wish I'd been given something else; I wish I hadn't gone to a shrink. A herbalist would have been much better for me in the long run. But I was subject to the prescribing patterns of the 70s, and young and reckless. Still taking 10 or so mg Valium a day. I don't think they are as benign as they feel. That's my 2 bob's worth.
Declan
Posted by yxibow on March 16, 2006, at 2:40:10
In reply to Re: Put the horse down and step away! :^), posted by Declan on March 15, 2006, at 19:35:48
> What benzos did to me was that they aggravated the condition they simultaneously relieved. Eventually the experience of benzo reduction made my original problems seem quite handleable. I wish I'd been given something else; I wish I hadn't gone to a shrink. A herbalist would have been much better for me in the long run. But I was subject to the prescribing patterns of the 70s, and young and reckless. Still taking 10 or so mg Valium a day. I don't think they are as benign as they feel. That's my 2 bob's worth.
> Declan
Does the 10mg give you any respite from your problems? Its only .5mg of Klonopin more or less, which is a very low dose (believe me). But your miles may very as they say and you're entitled to your feelings obviously.-- tidings
Jay
Posted by Declan on March 16, 2006, at 18:24:58
In reply to Re: Put the horse down and step away! :^) » Declan, posted by yxibow on March 16, 2006, at 2:40:10
Hi Yxbow
Respite from my problems? I feel better after taking it, of course. And I think I'd be better without it, my memory would be, anyway. I have taken a lot more than 10mg. I think the higher doses made me agoraphobic, meaning that I had to stay indoors because the business of meeting people became too much to handle. So, ultimately, no, no respite. But when I was Rxd it I was a mess. Whether a benzo was the most sensible thing to suggest is debateable. The shrink said I lacked a sense of identity (Erickson, I suppose). Does that imply I needed some life experiences? I'm not very good at conceptualising my problems, actually.
Declan
Posted by sdb on March 16, 2006, at 18:31:37
In reply to Re: Put the horse down and step away! :^) » Declan, posted by yxibow on March 16, 2006, at 2:40:10
There are two studies which I think are interesting see below (full text babble me). One positive aspect is that you dont have any hard sideffects with benzodiazepines. I am not sure if they're beneficial in the longterm, there are not many studies available. But apart from studies, in the babble and elsewhere are longterm bz users who swear by their bz. They dont seem to have tolerance symptoms to the antianxiety effect, probably more to the antiseizure properties. Prazepam is a benzo I have taken myself and I agree with the study concerning the antidepressive action. When I tested some bz's (ketazolam indicated for spasticity) they were usefully to diminish a muscle spasticity in the under extremities. I am now looking for an other treatment option. I surrendered because of popular bz concerns and some other reasons.
~sdb
------------------------------------------------
Compared efficacy of prazepam and clomipramine in major depression with anxiety: a multicenter controlled study.Lemoine P, Boulenger JP, Caillard V, Tanne N, Bonnet D.
Unite Clinique de Psychiatrie Biologique, C.H.S. Le Vinatier, Lyon Bron, France.
The efficacy of antidepressants is well established in major depressions, especially those with melancholic features. However, some anxiolytics also appear to have antidepressant properties at least for outpatients. 118 outpatients (25 males, 93 females, age: 18-60) with major depression according to DSM-III criteria, neither melancholic nor suicidal, reaching at least 27 on Montgomery and Asberg depression rating scale (MADRS) and 19 on Hamilton anxiety rating scale (HARS) accepted to participate this double blind study carried out by 15 G.P.s coordinated by 3 psychiatrists. After a one week placebo wash-out-single-blind period, they were randomly, double blind, assigned to one of the two following groups: PR treated with prazepam (30-60 mg), a benzodiazepine anxiolytic or CL treated clomipramine, an imipramine antidepressant (75-150 mg). Patients were evaluated at days 0, 7, 14, and 28, using MADRS, HARS, Clinical Global Impression and Hopkins symptoms check list 58. In addition, G.P.s had to meet monthly for a case discussion group. Results: groups were comparable at day 0. A highly significant improvement of MADRS and HARS scores (p less than 0.001) was observed in the total population. For the completer population evolution was also significantly positive in all the parameters studied but, considering MADRS and HSCL scores, a difference in favor of CL is observed.(ABSTRACT TRUNCATED AT 250 WORDS)
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled TrialPMID: 1775523 [PubMed - indexed for MEDLINE]
J Int Med Res. 1981;9(3):191-8. Related Articles, Links
Comparison of the therapeutic effect, tolerance and safety of ketazolam and diazepam administered for six months to out-patients with chronic anxiety neurosis.Fabre LF, McLendon DM, Stephens AG.
Recently, it has been argued that benzodiazepines may not be safe or efficacious beyond 3 months continuous dosage. This study was designed to provide data regarding efficacy, safety, possible tolerance development, and possible withdrawal effects of administering ketazolam and diazepam for a 6-month period. Chronic anxiety patients were screened for participation according to specific inclusion and exclusion criteria. Of 139 patients, forty-four terminated prematurely for non-drug related reasons and are not included in the analysis. Of the ninety-five patients remaining, sixty-three were on ketazolam, and thirty-two on diazepam. Efficacy parameters included the Hamilton Anxiety Rating Scale, Physician's Global Impressions, Target Symptoms, Self-Rating Symptom Scale, and Patient's Global Impressions. Patients were evaluated weekly for the first month except for Week 3, and then seen bi-weekly and rated monthly. The results of the study showed that ketazolam was as efficacious as diazepam in treating anxiety and resulted in fewer side-effects. No adverse effects were noted in either group. Both benzodiazepines were safe and well-tolerated. No tolerance or withdrawal effects were noted. The average doses were ketazolam Week 4 (50.0 mg), Week 24 (66.14 mg) and diazepam Week 4 (26.33 mg) and Week 24 (33.0 mg). An increase in anxiety occurred in a significant number of patients after termination of either drug. By 2 weeks after the last dose many patients were free of anxiety and did not require further treatment. These results demonstrate that benzodiazepines are safe and efficacious for at least 6 months of continuous dosage.
This is the end of the thread.
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