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/