Posted by yxibow on November 23, 2006, at 20:02:07
In reply to Re: Buprenorphine-Advice Please, posted by blueberry on November 23, 2006, at 7:16:41
> When was the last time you heard someone say, "I started on 20mg prozac 4 years ago and I am still doing great on the same dose"? Probably never. More likely it is something like, "20mg prozac worked sort of for a little while and then I had to go to 40mg and when that stopped working I went to 60mg and now 4 years later it doesn't seem to hardly work at all anymore."
>
> Why do they single out the benzos and opiates for tolerance issues, when in fact every single psychiatric med I can think of is equally guilty? The only exception might be lithium or a rare situation.
An SSRI "not working" because its "pooped out" is not the same as the real dangers of respiratory depression definately from barbiturates, somewhat benzodiazepines, and especially hardcore opiates.
They're singled out because they're frequent drugs of diversion. Generic prozac is not a drug you see sold frequently on the street corner. But high abuse of Oxycontin and forged prescriptions for Xanax and diversion of Valium are things that are unfortunately out there.
That doesn't mean that benzodiazepines shouldn't be used for what they are meant for -- anxiety, hypnotic, antispasmotic, and antiepileptic applications. They're especially abhorred it seems in England.I think the trust between one and a competent psychopharmacologist should be enough to obtain benzodiazepines for what they are best used for -- anxiolytics that are far less dangerous than barbiturates or opiates.
And I agree, they are singled out and there are doctors who won't prescribe them, including a past one I had in college who would use propranolol instead of benzodiazepines. That can be dangerous in itself if one stops a beta blocker midway and doesn't taper, blood pressure becomes misregulated.
But doctors also are concerned for themselves, and malpractice, and so essentially some CYA (cover your *ss) and don't prescribe benzodiazepines all that often when in fact a modest dose of a long acting benzodiazepine like Valium is actually probably one of the safest psychiatric drugs out there just because of their near 50 year history. Tolerance and habituation of course can still develop, but its this concept that one will become addicted to benzodiazepines is more than an issue of semantics.
-- Jay
poster:yxibow
thread:706244
URL: http://www.dr-bob.org/babble/20061123/msgs/706543.html