![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 23 to 47 of 47. Go back in thread:
Posted by Squiggles on August 24, 2002, at 8:20:31
In reply to Re: To...Addiction vs. Medical dependence » Squiggles, posted by alan on August 22, 2002, at 20:43:50
A description of the effects, withdrawals, and
dependence/addiction of benzos from a physician's
reference manual - about as MOR as you can get:http://www.aafp.org/afp/20000401/2121.html
Squiggles
Posted by alan on August 24, 2002, at 11:07:06
In reply to Re: Addiction- benzos ( American Family Physician) » alan, posted by Squiggles on August 24, 2002, at 8:20:31
These references are all well and good (with several points that are self-admittedly speculative and inconclusive) but these references do not address the theme of my original interjection about the difference between "addiction" and "medical dependence".
Alan
Posted by Squiggles on August 24, 2002, at 11:46:36
In reply to Re: Addiction- benzos ( American Family Physician) » Squiggles, posted by alan on August 24, 2002, at 11:07:06
Here is the reason for the distinction:
Straight from a very intelligent horses's mouth:
infact if you wish to read anything really good
on this topic i recommend Charles Medawar -http://www.socialaudit.org.uk/4200peha.htm
Squiggles
Posted by alan on August 24, 2002, at 16:27:53
In reply to Re: To...Addiction vs. Medical dependence, posted by Squiggles on August 22, 2002, at 16:07:36
I've read throughly the link that you have provided. I see much reference to "discontinuation syndrome" as used (or misused) by the pharmecutical co's appropos AD's and do not see but an oblique reference in passing to bzds - one that didn't directly address the distinction as far as I am aware of.
Perhaps you will quote from what section of this link that directly addresses the issue of addiction vs. medical dependence as it relates to bzds.
Alan
Posted by Squiggles on August 24, 2002, at 16:56:11
In reply to Re: To...Addiction vs. Medical dependence » Squiggles, posted by alan on August 24, 2002, at 16:27:53
Right,
You remind me of some profs i had:
ok - here is something hopefully more pertinent:
"Benzodiazepines were classified as drugs of dependence, in the early to mid 1980s, essentially because of their tendency
to cause withdrawal reactions, even when taken at the usual recommended dosage, though especially after long-term use.
This point is underlined in the 1990 report of the American Psychiatric Association's Task Force report on Benzodiazepine
Dependency:"The presence of a predictable abstinence syndrome following abrupt discontinuance of benzodiazepines is
evidence of the development of physiological dependence" ..."Historically, long-term, high-dose, physiological dependence has been called addiction, a term that implies
recreational use. In recent years, however, it has become apparent that physiological adaptation develops and
discontinuance symptoms can appear after regular daily therapeutic dose administration ... in some cases after a
few days or weeks of administration. Since therapeutic prescribing is clearly not recreational abuse, the term
dependence is preferred to addiction, and the abstinence syndrome is called a discontinuance syndrome." (APA,
1990)Essentially the same point is made in the College's report, Benzodiazepines: risks, benefits or dependence (1997):
"Dependence on benzodiazepines is mainly manifest by withdrawal symptoms on cessation", and "Dependence is now
recognised as a significant risk in patients receiving treatment for longer than one month..."
taken fromhttp://www.socialaudit.org.uk/4400rcp.htm
I would like to know a little more about you since
you are drilling me so hard. :-)Squiggles
Posted by alan on August 24, 2002, at 18:58:29
In reply to Re: To...Addiction vs. Medical dependence » alan, posted by Squiggles on August 24, 2002, at 16:56:11
> Right,
>
> You remind me of some profs i had:
>
> ok - here is something hopefully more pertinent:
>
>
> "Benzodiazepines were classified as drugs of dependence, in the early to mid 1980s, essentially because of their tendency
> to cause withdrawal reactions, even when taken at the usual recommended dosage, though especially after long-term use.
> This point is underlined in the 1990 report of the American Psychiatric Association's Task Force report on Benzodiazepine
> Dependency:
>
> "The presence of a predictable abstinence syndrome following abrupt discontinuance of benzodiazepines is
> evidence of the development of physiological dependence" ...
>
> "Historically, long-term, high-dose, physiological dependence has been called addiction, a term that implies
> recreational use. In recent years, however, it has become apparent that physiological adaptation develops and
> discontinuance symptoms can appear after regular daily therapeutic dose administration ... in some cases after a
> few days or weeks of administration. Since therapeutic prescribing is clearly not recreational abuse, the term
> dependence is preferred to addiction, and the abstinence syndrome is called a discontinuance syndrome." (APA,
> 1990)
>
> Essentially the same point is made in the College's report, Benzodiazepines: risks, benefits or dependence (1997):
> "Dependence on benzodiazepines is mainly manifest by withdrawal symptoms on cessation", and "Dependence is now
> recognised as a significant risk in patients receiving treatment for longer than one month..."
>
>
> taken from
>
> http://www.socialaudit.org.uk/4400rcp.htm
>
> I would like to know a little more about you since
> you are drilling me so hard. :-)
>
> Squiggles
------------------------------------------------
Well, firstly I have taken bzds in short and long term therapy off and on for twenty years now - but only after research about the risks involved in doing so after having AD's (commercially motivated), pushed upon me for my anxiety disorder when they clearly were not in my case working for anxiety.In the many posts to you I have tried to convey my dismay at having not been offered bzds on an equal footing with the AD's and have told you why I think things progressed in this manner.
Well I, as well as many others I was reading about, were scared to death of taking an "addictive" drug, after hearing them related to heroin or cocaine and being totally unacceptable for prescription as told to me by my corporate-line psychopharmacologists.
Come to find out, the anti-benzo movement that I and others were falling for hook, line, and sinker, were exaggerating risk to the point that they were scaring away patientws from the very drug that would help them. No end to hassles and haranguing from AD corporate-line docs about the addictiveness of bzds kept me from the very med that changed my life around.
The real irony is that the co's promoting AD's that have a somewhat similar profile as to withdrawl effects, have, in order to gain cometitive advantage over the bzds, witheld information that AD's indeed have the need to be monitored for tolerance and withdrawl just like the bzd's.
There is no literature claiming "significant risks" to long or short bzd monotherapy as your link describes. In fact the latest and most comprehensive report on the saftey of bzd therapy appears in the amalgamated synopsis of
ALL studies about bzds summarised by the World Health Organisation in their recent report on "THE RATIONAL USE OF BENZODIAZAPINES".My point is that the use of the word "addiction", while in sterile definition is correct due strictly to the phenomenon of tolerance/withdrawl, in CONTEXT the more appropriate usage that is adopted for obvious reasons is medical dependence as outlined in this link:
http://panicdisorder.about.com/library/weekly/aa031997.htm
"Addiction" is reserved in the medical community to describe in a pragmatic usage, those drugs that are not appropriate for medical use. To use the word inappropriately for the general public, for which little or no distinction is made, is scaring them unnecessarily into thinking that they will be no different than drug addicts on heroin or cocaine and most assuredly will suffer the same consequences as the addict that is addicted to illicit drugs.
Of course this is rarely the case - contrary to what these anti-benzo websites irresponsibly convey.
If this were indeed the case, bzds would have been jerked off of the market worldwide long ago - that is, if the risks were eqivalent to the hype surrounding them.
alan
Alan
Posted by Squiggles on August 24, 2002, at 19:39:29
In reply to Re: To...Addiction vs. Medical dependence » Squiggles, posted by alan on August 24, 2002, at 18:58:29
Alan,
I don't think you or anyone else should
be intimidated into not taking benzos -
i think that each benzo has its "rational"
use, and if given according to the prescriptions
and guidelines of experts in this area,
the chances of addiction are not ubiquitous;
i believe that the short life ones are more
prone to that; personally i have not have
the same experience with Rivotril (thought my
doctor did raise it once or twice due to
tolerance - but this is over many years.)Having said that, i believe that withdrawal
is a much more dangerous experience and fraught
with unexpected symptoms which may be confused
with another illness by a novice doctor.As for the status of the drugs themselves, i
believe that in Canada and Britain they have
been raised to a higher level of narcotic
substances due to the testimonials and reports
from the medical community.The pharmaceutical brochures also warn of
habituation.With the growing awareness on how these drugs
affect people after 25 yrs of consumption (they
are relatively new) i think you can rest assured
that your doctor will now be more informed than
he or she was say 7 years ago.Squiggles
Posted by CLS on August 24, 2002, at 23:47:26
In reply to Re: To...Addiction vs. Medical dependence CLS, posted by hiba on August 24, 2002, at 3:51:16
Dear HIBA --
Thanks for your response. I'm taking 4 tablets daily (.5mg) each of Xanax. I had increased it becasue I have just started taking Geodon. Geodon works fime except that after it wears off a bit I get really nervous, which adds to my already parinoid state. I guess I can get caught up in the media bliz about how bad they are and feel guilty for taking them. I am going to talk to my pdoc when he comes back from vacation (which is today). Hopefully he will answer my e-mail. I guess I was pretty stupid in substituting Seqruel with Xanax. I should stick with the regime and not miss a dose. But I have to admit I have not been fully functional mentally. But hopefully the Geodon will do the trick to that.
CLS
> Dear CLS,
>
> You didn't mention the strength of xanax you were on and simply calling it addictive doesn't make any sense. If you are on a high dosage of an antihypertensive medication and stopping or cutting the dosage to half abruptly, you will feel horrible withdrawal symptoms. Does this mean that the drug is addictive?
> It is always patient's awkwardness that makes them moan benzos are addictive. You will have to taper the medication and your doc and pharmacist will surely have warned you over stopping or cutting the xanax dosage abruptly. Doing it without consulting with your doc or pharmacist and complaining the drug is addictive is not making enough fun. If you are on a medication especially on a psychotropic for a long time, your brain will need some time to adjust to the lack of that substance. It is quite rational. Again I like to quote great Shakespeare. 'THE FAULT DEAR BRUTUS IS NOT IN OUR STARS; BUT IN OURSELVES"
> Thank you and hoping you will see your doc and taper the dose of xanax. But if it is working well, why should you quit it?
> HIBA
Posted by hiba on August 25, 2002, at 1:11:29
In reply to Re: To...Addiction vs. Medical dependence » alan, posted by Squiggles on August 24, 2002, at 19:39:29
Dear Squiggles,
I don't want to mess up with you and Mr. Alan and your war of words. But let me point something which will definitely be helpful to both of you.I have seen many links and quotings in both of your postings. And it is obvious both of you are speaking with the backing of personal experiences. I do have experiences with benzos and have used them. I definitely back Mr. Alan, he seems more rational and writes with a lot of sense. It doesn't mean you are senseless. You too have your liberty to express your findings.
Now let me also quote something."Although benzodiazepines are widely prescribed and used, most of this use is intermittent, brief, and for purposes of smptom relief. Research survey data indicate that long-term use of benzodiazepines is limited to a relatively small population of patients who take the drugs for legitimate, medically supervised symptom reduction. These patients tend to be older, to have chronic physical as well as psychiatric illness, and to have psychological distress, and these patients report that the drug use is therapeutic. THERE IS NO DATA TO SUGGEST THAT LONG-TERM THERAPEUTIC USE OF BENZODIAZEPINES BY PATIENTS COMMONLY LEADS TO DOSE ESCALATION OR TO RECREATIONAL USE.(Benzodiazepine: dependence, toxicity, and abuse. A task force report of the American Psychiatric Association p.55)
"There are significant differences between dependence in therapeutic use and abuse for socio-recreational purposes. Therapeutic dependence only very rarely leads on to abuse with dose escalation."(John Marks/ The benzodiazepines Use, overuse, misuse, abuse? p.114)
"People who receive prescriptions for benzodiazepines to treat medical problems rarely take more of the medication than their doctors recommend and do not often take it for periods longer than those required to treat their problems. There are certainly cases of benzodiazepine abuse, but considering the number of people who have taken this medication, THE NUMBER OF PEOPLE WHO HAVE ABUSED IT IS QUITE SMALL." (The encyclopedia of psychoactive drugs. Vol. 16 p.99-100)
"Because of the long half-lives and conversion to active metabolites with long durations of action, withdrawal or abstinence symptoms after prolonged use may not appear for a week or more after abrupt discontinuation of the drug and are likely to be mild. In most instances after tapered withdrawal of usual doses of long-acting agents, no abstinence syndrome occurs. (Goodman and Gilman's The Pharmacological basis of therapeutics vol.1 p.427)Instead of exchanging words and links I suggest you should read these books which are much reliable. There are many more to refer, but I only quote a few. Nowhere I could find the term "ADDICTION". Does it mean all these great psychiatists and scientists are misleading us with a linguistic squabble?
Okay, leave all these behind. Use common sense. We depend on a lot of things in our life. Air, water, food, relationships.... This table will be much longer. But do you ever think you are addicted to oxygen, water? or your spouse? What makes the difference here is depending on a true necessity is not an addiction, but depending on a created necessity is definitely an addiction. For those overanxious, panic patients, benzos are not a created necessity, but a true necessity. And depending on these substances can never be regarded as an addiction.
Good luck Squiggles, I am waiting for a level headed reply.
HIBA
Posted by alan on August 25, 2002, at 2:01:25
In reply to Re: To...Addiction vs. Medical dependence » alan, posted by Squiggles on August 24, 2002, at 19:39:29
> Alan,
>
> I don't think you or anyone else should
> be intimidated into not taking benzos -
> i think that each benzo has its "rational"
> use, and if given according to the prescriptions
> and guidelines of experts in this area,
> the chances of addiction are not ubiquitous;
> i believe that the short life ones are more
> prone to that; personally i have not have
> the same experience with Rivotril (thought my
> doctor did raise it once or twice due to
> tolerance - but this is over many years.)
>
> Having said that, i believe that withdrawal
> is a much more dangerous experience and fraught
> with unexpected symptoms which may be confused
> with another illness by a novice doctor.
>
> As for the status of the drugs themselves, i
> believe that in Canada and Britain they have
> been raised to a higher level of narcotic
> substances due to the testimonials and reports
> from the medical community.
>
> The pharmaceutical brochures also warn of
> habituation.
>
> With the growing awareness on how these drugs
> affect people after 25 yrs of consumption (they
> are relatively new) i think you can rest assured
> that your doctor will now be more informed than
> he or she was say 7 years ago.
>
> Squiggles
----------------------------------------------
Yes, and that is why they are being prescribed now more than ever. If any trend is to be seen with prescribing habits of specialists that know and understand these medications, it is that the initial backlash to overprescribing when they first were introduced over 40 years ago (sound familiar - as in ssri's?) is now being supplanted by knowledgeable use of these drugs - despite the stigma that cult groups such as the backward looking benzo.org continue to attempt to inflict on these perfectly and overall safe drugs and the vulnerable med-phobic chronic anxiety sufferers that are in need of them.I've already debunked the big bad benzo monster in my mind...and after years of being deprived the medication by a couple of ill-informed, or just plain old idealogue benzophobic docs...but many others new to this pathetic game carried on by anti-benzo zealotry, don't stand a chance of escaping the same zeal of these highly political and moralistic organisations.
It's alright though. Websites such as this (psycobabble) where people can make up their own minds will eventually educate those that would otherwise fall victim to these far-from-medical, indeed unethical organisations.
There are enough obstacles standing between doctor and patient including commercialism, simple misinformation, and medical ideology. It's too bad that benzophobic evangilists have to further muddy the waters with politically motivated websites that mistakenly believe that scaremongering to make the end justify the means are somehow "legitimate" obstacles.
Pathetic.
Alan
Posted by Squiggles on August 25, 2002, at 8:28:07
In reply to Re: To...Addiction vs. Medical dependence, posted by hiba on August 25, 2002, at 1:11:29
Hiba,
Well, I am very sorry that the American Psychiatric
Association lacks data on this issue - perhaps with
future case reports they will acquire it.
Actually, it was not my dr. who got the information
about he addictive nature of Xanax given on a daily
basis that was troublesome - it was the pharmacist
who warned her that they are addictive given under
such circumstances.It was at that point that i realized i was addicted
and that he took measures from the Chief of Psychiatry
to change the situation.Squiggles
Posted by hiba on August 25, 2002, at 23:59:52
In reply to Re: To...Addiction vs. Medical dependence » hiba, posted by Squiggles on August 25, 2002, at 8:28:07
Dear Squiggles,
It is amazing, that you, your pdoc and pharmacist still possess the data which APA lacks.
I saw the term "addiction" attributed to benzos only on the net. And I have enough reason to believe it is a creation of patient awkwardness.Physicians have no other options than to believe their patients.So at least some of them are forced to assume the term "addictive"(that is why you can see in some websites physicians use this term to dub benzos.) Did you see the posting of CLS above? It is an ideal example of patient awkwardness. Consuming a psychotropic drug for years and insisting on abrupt withdrawal is not much reasonable.Most of those horror stories of benzo withdrawal I read on the net are definitely the results of inappropriate use and abrupt withdrawal.
There is no doubt benzos cause physiological and psychological dependence. But "sometimes to understand the evil, you will have to go evil in details." So if you go in details without a biased outlook you can make yourself sure that this dependence is much, much better than leading a hellish life. When there are no safer alternatives to calm agitation, what do you suggest to do? Should we go back to the primitive way of handcuffing the patient and fixing him or her in chains?
Once again, I emphasize benzos are much safer than alcohol, tobacco and Antidepressants(newer and older ones). Because benzos don't cause any long term damage as alcohol and tobacco do. They don't have nasty side effects like sexual dysfunction attributable to antidepressants.Take care Squiggles,
HIBA
Posted by Dinah on August 26, 2002, at 0:16:56
In reply to Re: Oh ! Not again Squiggles, posted by hiba on August 25, 2002, at 23:59:52
Hi. Dinah here, filling in for Dr. Bob while he's out.
I wanted to remind you that while it's fine to have different opinions, the rules of this site require that debate be carried on with a certain amount of civility and respect for the other poster.
I'm going to post a link to the civility guidelines of the site, and ask that you please keep the discussion to ideas rather than personalities.
http://www.dr-bob.org/babble/faq.html#civil
I really appreciate your cooperation in taking extra care of the site while Dr. Bob is away.
Thanks,
Dinah
Posted by Dinah on August 26, 2002, at 0:21:53
In reply to Re: To...Addiction vs. Medical dependence » hiba, posted by Squiggles on August 25, 2002, at 8:28:07
It makes my job filling in for Dr. Bob a lot easier. And I really do appreciate your measured response.
Thanks,
Dinah
Posted by hiba on August 26, 2002, at 1:16:09
In reply to Re: Please be careful... » hiba, posted by Dinah on August 26, 2002, at 0:16:56
Dear Dinah,
I don't what made my message offensive. Could you please specify it? Is it the title? If so I apologize
HIBA
Posted by Dinah on August 26, 2002, at 1:48:38
In reply to Re: Please be careful..., posted by hiba on August 26, 2002, at 1:16:09
Hello Hiba,
That wasn't an official Please Be Civil, just a gentle reminder. I'm just being extra careful I suppose. And since I'm not a regular on the meds board, I wasn't sure how long you had been here, or how familiar you were with the civility guidelines.
It was based on the title coupled with a couple of sentences from your prior post.
"I definitely back Mr. Alan, he seems more rational and writes with a lot of sense. It doesn't mean you are senseless. You too have your liberty to express your findings."
"Good luck Squiggles, I am waiting for a level headed reply."
And I guess those sentences would have been fine had they said "His position makes more sense to me" rather than "He seems more rational". A subtle difference, but one refers to the ideas expressed while the other refers to the poster.
Nothing uncivil, but perhaps a bit challenging especially in light of the title to your later post? So I suppose I was just afraid that the discussion was getting more personal.
Perhaps I'm reading into it a bit more than was intended, and if so I apologize for overreacting. I want to make clear that it was not an official Please Be Civil. I just hate giving official Please Be Civils and so was trying to keep this thread from getting contentious. :)
Again, I'm sorry if I misunderstood.
Dinah
P.S. Dr. Bob prefers that posts about administrative matters be discussed on Psycho-Babble Administration. There are links at the top of the page.
Posted by hiba on August 26, 2002, at 2:50:31
In reply to Re: Please be careful... » hiba, posted by Dinah on August 26, 2002, at 1:48:38
Dear Dinah,
Thank you for the specification. I am sorry for using such phrases. I owe this board and especially Squiggles an apology. I didn't mean to hurt anybody. I know the value of this support group and messages this board contain. I shouldn't have used such words. Once again I sincerely apologize to Squiggles and all in this forum
HIBA
Posted by Dinah on August 26, 2002, at 4:42:23
In reply to Re: Sorry, Squiggles, Dinah and Others..., posted by hiba on August 26, 2002, at 2:50:31
I am sorry Hiba. I certainly didn't want to make you feel bad about it. I always quake in fear of a PBC myself, and I don't want to make anyone else feel bad.
Perhaps I was just trying too hard to ward off trouble, and ended up causing it. :(
Please don't take it too much to heart. As I said before, it wasn't a Please Be Civil, just an expression of concern on my part, and perhaps unwarranted. This isn't my regular job you know. :)
So, how about we agree. I won't beat myself up too much over it, if you don't either. And I am sorry if I misunderstood.
Deal?
(And we really shouldn't discuss it any further here or I'm going to be in trouble with Dr. Bob for not redirecting this to Admin. :) )
Posted by Squiggles on August 26, 2002, at 7:20:27
In reply to Re: Oh ! Not again Squiggles, posted by hiba on August 25, 2002, at 23:59:52
I did not see the word "addiction" myself,
over the counter, just heard it - perhaps
it was loosely used.Squiggles
Posted by Squiggles on August 26, 2002, at 7:23:04
In reply to Re: Sorry, Squiggles, Dinah and Others..., posted by hiba on August 26, 2002, at 2:50:31
I didn't notice or take any offense, maybe
it was the clonazepam :-)Squiggles
Posted by Guy on August 26, 2002, at 23:57:48
In reply to Re: Sorry, Squiggles, Dinah and Others... » hiba, posted by Squiggles on August 26, 2002, at 7:23:04
Squiggles, I note that you aren't too critical of clonazepam. Are you still taking this med? What dose are you at and is it still effective? Also, for how long have you been taking it? I am trying to decide whether or not to start this med...many others posters seem to have had a good experience.
Posted by hiba on August 27, 2002, at 5:03:30
In reply to Re: Sorry, Squiggles, Dinah and Others..., posted by Guy on August 26, 2002, at 23:57:48
Dear Guy,
Actually your question is directed to Squiggles, but may I take some liberty to answer on my own?
I have taken klonopin continuously for eighteen months. The strength of dosage was 1.5 mg daily(0.5 mg three times) I began to take it as 2 mg daily and kept on that dosage for a month and then reduced myself to 1.5 mg and kept on it for seventeen months. It never lost its effectiveness. There is almost a universal agreement, sedative effects diminish over time, but anxioltic effects remains. But in my case both remained same (There was no tolerance either to anxiolytic or sedative effects) and it was much beneficial. And most importantly I could come off it with the help of a slow tapering procedure and the only withdrawal symptom was a mild dysphoria which only lasted a month. If you need more information I am ready to share
HIBA
Posted by Squiggles on August 27, 2002, at 8:00:45
In reply to Re: Sorry, Squiggles, Dinah and Others..., posted by Guy on August 26, 2002, at 23:57:48
Hi Guy,
I've been taking it for about 15 or more yrs.
I think it was prescribed for GAD but i can't
remember - it may have been for bipolar - because
it was prescribed so much later than lithium
(5-7 yrs) i think it was for GAD.I don't feel it taking it - but i do feel its
absence - the withdrawals were near fatal. So
i think that your brain may change if you take
a long time and you should continue taking it.My dose was never raised more than once or twice
in the duration of taking it (0.50 - 1.0 - to
post withdrawal necessity - 1.50 mg); In this
respect - i.e. that you can go a long time
without reaching tolerance it is a very good and
potent benzo.Squiggles
Posted by alan on August 27, 2002, at 12:16:05
In reply to Re: Sorry, Squiggles, Dinah and Others..., posted by Squiggles on August 27, 2002, at 8:00:45
> Hi Guy,
>
> I've been taking it for about 15 or more yrs.
> I think it was prescribed for GAD but i can't
> remember - it may have been for bipolar - because
> it was prescribed so much later than lithium
> (5-7 yrs) i think it was for GAD.
>
> I don't feel it taking it - but i do feel its
> absence - the withdrawals were near fatal. So
> i think that your brain may change if you take
> a long time and you should continue taking it.
>
> My dose was never raised more than once or twice
> in the duration of taking it (0.50 - 1.0 - to
> post withdrawal necessity - 1.50 mg); In this
> respect - i.e. that you can go a long time
> without reaching tolerance it is a very good and
> potent benzo.
>
> Squiggles
------------------------------------------------
I've taken klon for 10 years - both in short periods and for the last 5 years as maintainence.Two of the common misperceptions that kept me from taking it full time were:
1)That the drug was "addictive" and that I would develop ever increasing tolerance with no way out.
If I did discontinue after a period of extended therapy that I would suffer dire consequences such as seizures and withdrawl the likes of heroin and cocaine. These were of course wild exaggeration of risk - not only for me, but the vast majority of the population.2)That my brain would adapt to these medications in some way causing permanent damage. I would be caught up in the spiraling escallation of dosage increases and be forced to withdraw only to have to be put back on therapy.
These seem to be the most widely held beliefs by those that are considering bzd monotherapy.
If one understands the difference between "addiction" and "medical dependence" as practiced and applied to all drugs by the medical profession, then these fears immediately go out the window. There is no "permanent adaptation" phenomenon nor is the general population of anxiety sufferers "hooked" on ever increasing doses of any bzd.
The standard profile is that of dosages remaining constant (after a theraputic dose is found, one not arrived at arbitrarily) with the overall dose many times decreasing over a period of months or years. That is certainly what mine has done also.
I took 2mgs at first and over a period of time have been hovering at 1 to 1.5mgs depending on how the underlying anxiety fluctuates.
It may be worth reading the following short article if you have not seen it:
http://panicdisorder.about.com/library/weekly/aa031997.htm
Otherwise, what can one tell you other than their own individual experiences? Its always hard to remember that one can't extrapolate for the entire population based on an individual case...but that for the vast majority of sufferers, bzds are by far effective and safe.
The World Health Organisation has reviewed all of the 40+ years of studies on the subject and report in their "Rational Use of Benzodiazapines" that both long and short term bzd monotherapy for anxiety disorders is one of the safest treatments available.
alan
Posted by Squiggles on August 27, 2002, at 13:04:34
In reply to Re: Sorry, Squiggles, Dinah and Others..., posted by alan on August 27, 2002, at 12:16:05
Guy,
I had none of these benzo-phobic ideas before
my dr. raised the dose because of tolerance;
infact i never had any serious problems (such
as panic with Xanax) with K. I was content
to just keep taking it; but i was convinced
that i might feel better if i got off by the
benzo group.Again, i had no idea or fear of this drug until
a. my dr. raised it for tolerance
b. i had a stroke/seizure that left me severely
disabled for a month.Now i grant you, I was not monitored, and b.
may have actually been something like
drug displacement, with the lithium kicking in
and giving a seizure. But my dr. said it was
withdrawal. I confess it felt nothing like the
long withdrawal i had during K decrements - it
felt like a stroke - i have described it many times.
It happened last summer and the temperature must
have been 100 Farenheit after 3 months in the 90s.On the other hand, my husband forced me to reinstate
the whole dose and my dr. said take as much as
is required to stabilize to pre-stroke status.So it is a complicated picture with the lithium.
Squiggles
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.