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  1. #16
    metamorphosis's Avatar
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    Ah, the good old benzodiazepines!!!

    Link to a list of Benzos. and their properties and potential dangers:


    ‡There has been an ongoing debate about the length of use and potency factors of benzodiazepines in the UK. For this reason, The Ashton Manual should not be used for Wikipedia, as it does not present a worldwide view on this subject. The Ashton Manual keeps switching the potency of Alprazolam and Clonazepam to 0.5 mgs (equivalent to 10 mgs of Diazepam) , when they have long been known to be 1 mg. The UK is attempting to get a 2-4 week prescribing maximum on benzodiazepines. See http://www.benzo.org.uk/appg.htm
    for more information. Also compare the UK's Ashton chart with the chart athttp://www.psychresidentonline.com/B...Comparison.htm
    and you can see how the Ashton chart does not represent a worldwide view on this topic.
    ‡See also http://www.csam-asam.org/sites/defau...isc/TIP_45.pdf
    , Page 76. US Department of Health and Human Services, 2006. States that 10 mg Valium= 1 mg Xanax, 2 mg of Klonopin, and 2 mg of Ativan. (United States Department of Health guidelines)
    ‡See also https://docs.google.com/viewer?a=v&q...wOxivtqUfjbS_Q
    ; Table 11, Section 5.8. It notes that 10 mg of Valium is equivalent to 1mg of Xanax and .50-1 mg of Klonopin. (Australian view)


    If used everyday for over a month or two, there is a strong chance of tolerance and addiction.
    The consensus is if someone has addiction issues; then benzos. should not be prescribed. Cross-addiction is a reality with benzo use.
    http://link.springer.com/article/10....9220-8?LI=true
    http://ijpbs.mazums.ac.ir/browse.php...=1&slc_lang=en[/QUOTE]
    http://en.wikipedia.org/wiki/List_of_benzodiazepines
    http://en.wikipedia.org/wiki/Benzodiazepine

    I am not anti-benzo. I think they must be used with care and caution because they do work.
    Benzodiazepines have an important place in a pdocs armetarium. There are always different cases and issues. If someone has a severe anxiety disorder-agoraphobia . Then benzos. are a major candidate for longterm use. Even with tolerance of daily use the main concern would be the quality of life and possibly using benzos daily and indefinitely.

    Most pdocs today will use benzos daily only for a short time if possible unless a persons Sa, GAD, Panic Disorder, Agor. is moderate to severe. Using a low dose so that tapering off will be an easier task.
    If you do take a benzo. everyday, Never stop the med. cold turkey.The side effects can range from sleep issues, extreme paranoia, depersonalization, akathisia, dyskinesias, and at worst grand-mal seizures.
    A competent pdoc will slowly reduce the dosage and probably use another non-benzo anxiolytic for less discomfort. He/she may also add an anti-seizure medication if the person is in the higher echelon of use. An example would be a patient on 4 mg clonazepam.

    Here is an abstract that not only goes over guidelines for a taper, but also the use of benzodiazepines for short term, prn vs. longterm:
    http://onlinelibrary.wiley.com/doi/10.1002/psb.893/pdf

    This study is an interesting and often brought up topic. The use of pregabalin/Lyrica to titrate of benzodiazepines. The results are at least halfway promising:

    In this study, we demonstrated that after starting with pregabalin or gabapentin, 15–29% of the patients stopped using benzodiazepines. Stoppers consumed, on average, fewer benzodiazepines than the continuers, indicating that the use of smaller amounts was more easily stopped. Among continuers, the psychiatric patients starting pregabalin treatment reduced the consumption of benzodiazepines by 48% while the reduction among the non-specified users was 39%. For all the other groups, the reductions in benzodiazepine consumption were smaller. A possible interpretation would be that pregabalin, but not gabapentin, might have a benzodiazepine sparing effect in patients with anxiety disorders, as indicated by others [9,10]. However, some patients started using benzodiazepines after initiating pregabalin or gabapentin treatment, diluting the benzodiazepine sparing effect somewhat


    .
    http://onlinelibrary.wiley.com/doi/10.1111/j.1742-7843.2010.00590.x/full
    http://jop.sagepub.com/content/26/4/461.short

    So, many have success using this class of meds. prn. I know of people who use Klonopin, Xanax etc. 1-3 times a week for yrs with great results. The key being is that they never start using a higher dose of the drug or using it more often. They use it for certain high anxiety situations- a debate or speech class, family gatherings, riding the bus, grocery shopping etc. and they keep their use and dose to a minimum, without daily use. In this way the drug does not start to downregulate GABA over time. The result is basically, no tolerance to the drug and it's desired therapeutic effects stay constant. The results are unbelievable for their daily functioning. Remember, a drug like clonazepam, which is prescribed for SA.. It has a half-life of around 46 hrs depending on the persons metabolism.

    Again I believe many people with moderately high to severe anxiety need a daily fixed dose for whatever period of time a pdoc. He/she should also be implementing other meds. and therapies to hopefully get a lot of patients of the med.
    Benzo. withdrawal can last for months, up to a year and past. It has been shown that longterm use of benzos. cause cognitive impairment and short and longterm memory loss. It is still a question in neuropsychiatry how long after discontinuation the neurodegenerative side-effects will last and how much of atrophy can be regenerated by the brain.
    Here are some studies and findings on this topic:
    http://espace.library.uq.edu.au/view/UQ:206008
    http://link.springer.com/article/10....0344-1?LI=true
    http://download.springer.com/static/...3754e&ext=.pdf
    http://onlinelibrary.wiley.com/doi/1...563.x/abstract

    Again, I see the importance in the use of this class of meds., especially in the anxiety disorder spectrum. They need to be used with understanding, caution and care. Evaluating each individual. Pdocs need to take responsibility for the practice of over prescribing benzodiazepines and not thoroughly explaining to the patient the facts about this class of drugs and it's possible dangers.
    I see to many people on the boards who have just been scripted alprazolam, clonazepam, lorazepam, all the other 'pams and know nothing about this type of drug and, not out of ignorance, but because a doc or pdoc didn't take the 1/2 hr. to explain. So, that is why many benzo. users past and present on these forums try to give accurate, non-biased, straight up facts before some idiot tells them to swallow more, if it works and feels good.

    I'll finish with a huge meta-analysis on the topic. You cant beat a meta-analysis, yo!.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162180/

  2. #17
    UltraShy's Avatar
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    Quote Equinox View Post
    This part would be my guess. Big Pharma is a bit like a political party in the sense that they will sometimes run a smear campaign against their opponents (or in this case 'defenseless' old generic meds) rather than citing any actual statistical advantage which may not be there. The SSRI/SNRI and atypical antipsychotic markets in particular will bash benzos, tricyclics, MAOIs and the like.
    In part it's smear, but to a large extent it's having a massive team of cheerleaders from big pharma out every business day tirelessly promoting their company's "wonder drugs" to any MD who hasn't banned them from the office.

    I'd note that some medical groups have taken the controversial move of banned free samples and the cheerleaders who bring them, feeling that they do more harm than good. As a recipient of free samples, I fully understand their allure, though I also clearly see the downside. A doctor who has a spare room filled with expensive free samples is likely to start a patient out on a free sample of X, where X is some expensive new brand name med. Some medical practices view this as detrimental to patient care and to society overall. Instead of prescribing what you have in the back room, they feel a doctor should determine free of all outside influences what's the best choice for that patient. In some cases the best option will be an inexpensive generic that's as good or better than a pricey brand name product.

    Generic drugs will be older meds and they have an advantage in that all possible side effects are likely known. It's hard to imagine that there's any yet-to-be-discovered side effect of benzos after half a century of extensive world-wide use. Totally unlike new drugs where the FDA has pulled some after finding they cause things like death (e.g. Celebrex, Serzone).

    Quote Equinox View Post
    All that said, these same doctors who are vehemently against benzos will likely still hand out Ambien and Lunesta scripts, despite the fact that at a pharmacological level they work basically the same as a benzo, but hey their still on patent so they can't be bad right!?
    Perfect example. The z-drugs are essentially benzos that are more targeted, though according to some reports they target the ability to drive & eat while sleeping. Well, Ambien can now be evil as it's generic and Lunesta will soon be evil -- I mean generic -- too.

    Quote Equinox View Post
    I've heard similar notions with doctors who are against Dexedrine or Adderall IR but are perfectly fine with Vyvanse, because of some lingo about how it has less abuse potential due to having the lysine amino acid attached.
    Having used all of them, I can assure everyone that Vyvanse feels exactly the same as dextroamphetamine, which is what it's metabolized into. It's effectively just an extended release version of dex. It only has less abuse potential for the relative few patients who are going to snort or inject it. For those who take excess amounts by mouth to stay up all night it's going to do the same damn thing as Dexedrine or Adderall IR, and I'd assume of those who abuse stimulants the vast majority are simply swallowing pills in excess. Consider: do you know anybody who snorts or injects stimulants? I sure don't and a whole lot would never inject as needle phobia is quite common.

    Here in the US shortages of generic dex & Adderall in the last couple years drove many (including me) to use Vyvanse. Generic dex that in 2011 cost $40 now goes for $400, which makes Vyvanse a vastly cheaper alternative at a mere $200!!!

  3. #18
    JaneDoe's Avatar My So-Called Self
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    In a bit of a reference to what you guys are talking about, I believe it's very hard for a person to get addicted to benzos, even if they are taken every day. I was on 1mg of Klonopin every single day for over a year and, not only did it barely help when I was taking it that frequently, it definitely did not cause any sort of addictiveness or dependency in me. If without the meds, due to not being able to afford them, or not being able to get to the pharmacy, etc. I had no side effects. And when I was finally put on Celexa and dropped down to using Klonopin only occasionsally, as needed, that was very easy to do. I now take 1-2 mg's 1-3 times per month, usually. In my case, I didn't even experience withdrawal symptoms. If I had been chemically dependent or addicted, I definitely would have.

  4. #19
    YFS's Avatar Burning in Hell
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    I can't get much out of Klonopin at any dose.

    Several days ago I took 6 mg of Klonopin prior to going into a gun store. It had no noticable effect whatsoever.

    My dumbass ex pdoc wouldn't let me switch to Valium or Xanax, as I requested. He went on about how Klonopin was better for me since it's longer lasting than Xanax. Well, that'd be great if it had an effect to last in the first place. I've tried Ativan and Klonopin, so I figure it's time to try the other two to see if I respond any better. I tend to lean Valium over Xanax first since Valium has a longer duration of action, but either one would be fine.

  5. #20
    Lost Control Again's Avatar
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    I'm an addict! I can't function without it!

    I won't mention the drug because I know it's illegal in a lot of countries.

  6. #21
    UltraShy's Avatar
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    Quote YFS View Post
    Several days ago I took 6 mg of Klonopin prior to going into a gun store. It had no noticable effect whatsoever.
    What would you be doing in a gun store? I hear guns are dangerous.

  7. #22
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    I am not totally opposed to benzos but I will say that I got anxiety from stopping benzos. I was given loads of benzos post op to "help me sleep" and again after a reaction to steroids. I started feeling anxious as soon as the dose would wear off. I had my first panic attacks ever when I quit Klonopin (which was given to me btw to stop my ativan withdrawal). I do not have an addictive personality and never had anxiety prior to these meds.

    Do they help some people? Sure! But can they also be dangerous to others? Yes! I have friends that have quit them no problem. I think it just depends on your chemical make up. In fact I have heard from a pdoc that they are trying to come up with a blood test to determine which people would be likely to have trouble with benzos.

    Being a person who has protracted benzo withdrawal, let me tell you that it is absolutely no joke. I wouldn't wish it on anyone. I was not informed about these meds at all. I had no idea they were a psyche med or in the same class as xanax. I was ill informed. I was also not told to taper. I am an example of all the things that can go wrong with benzos.

    So my best suggestions are, go into it informed. Make wise choices. Take the lowest dose as infrequently as possible. For those of you that have no problemms with it, boy do I wish I was like you!

  8. #23
    metamorphosis's Avatar
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    @JaneDoe
    In a bit of a reference to what you guys are talking about, I believe it's very hard for a person to get addicted to benzos, even if they are taken every day.
    That is completely off. Everyone's physiology is different. Just because you had no problem going straight off 1mg clonazepam after a yr; That does not mean another daily user will be able to do that without some withdrawal. Usually, if someone is on 1mg for a long time,then it is wise to reduce to 1/2mg for a week or two,Then completely come off the clonazepam.
    Making a blanket statement that it's hard for daily user to get addicted to benzos. is not true.I posted about this above. Did you check any of my links to papers and double and triple blind studies on benzo tolerance and the issues with cognition and memory from long term use?
    http://anxietyspace.com/forums/showt...l=1#post196361

    I also believe some people need to be on benzos for a while and hopefully other meds./therapy will eventually get the person off as many meds as possible. Those with the most severe anxiety disorders, agoraphobia, may need to be on benzos indefinitely, yo!

    It is not just addiction. It's also tolerance over time. The med. isn't as therapeutic, as the GABA receptors down regulate over awhile . This is the case with daily use and not prn. There are ways to help regulate the med. and the receptors with daily use. Lowering the dose for a time. Possibly use prn, if other meds/therapies are working. Pregabalin is an anxiolytic that has helped people reduce or come off benzos..,If desired
    If ya don't want to read all the scientific stuff. Jump down to the conclusion. Pregabalin +
    http://www.nature.com/npp/journal/v3...pp201132a.html
    They often take in the cognitive and memory degeneration over long term benzo use. Again, the benzodozapines have their place in the armamentarium of pdocs and psychopharmacologists.
    Many people want off the drug after they feel better and other meds. and/or therapies are working

    Show me some current studies, 2006 and beyond, that proves your claim.
    Until then, I will say that your comment on benzos being a completely safe and not physiologically addictive or tolerance inducing; Is pure B.S> that is an irresponsible comment. You are stating inaccurate info. just from your own experience. Do your homework and get the facts straight!!!

    I am not anti-benzo. They have their place with anxiety disorders. They just have to be used correctly.

  9. #24
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    Thank you Metamorphosis. YES! Everyone's physiology is different. I have met people that have had a horrible time with benzos after being on them for a very short time. My body became physically addicted very quickly. I didn't have anxiety beforehand, I really truly did not. Then as my benzo dose would start to wear off I would feel weird and anxious. When I came off of Klonopin it was like the gates of Hell opened and I was sucked inside. I am still dealing with anxiety on a regular basis. I am 18 months post benzo. I won't even go into details about all of the physical things that came with the withdrawal. It was, and in some ways, still is horrific.

    Before you say I had an underlying condition, believe me I wondered the same. I have seen numerous doctors, had blood work done, etc. Other than the benzo withdrawal and occasional acid reflux and pms sometimes I am very healthy. I eat very clean and have been going for therapy to deal with this ordeal. I am one of the few that gets affected by benzos in this fashion. I have met others. I know personally lots of people that went through hell getting off benzos but it was much shorter than my experience. But I have also encountered others that said it took 2 to 3 years to heal completely all the damage that was done to the CNS.

    Again, each person is different. There are so many things that go in to the equation...genetics, lifestyle, diet, health and other meds. Just be sure to do your research when deciding to take any medicine. I wish I had. I was given this med in the hospital post op and written a script for loads of ativan and told to "take every 4 to 6 hrs" and it would help me sleep. I was not told it could be addictive. I was not told it was a benzo. I was not told you should taper off this medication.

    I am not trying to dissuade anyone from taking them. I know people that have been helped by them. Just make sure you know what you are getting into and weigh the pros and cons. I wish I had. I never would have taken them.

    Oh and the steroid I reacted to was Prednisone given for pneumonia that I got post op. They didn't taper me off and I went into mania. They gave me 3 mg of ativan in my IV and sent me home with more. I was taking 3 to 8mg a day. When I quit it wasn't pretty, and they gave me Klonopin to deal with the ativan withdrawal.

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