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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by qbsbrown on August 25, 2006, at 0:34:58
I've seen that it has just as high as rating for anxiety on remedyfind.com, it's been around forever, has a very long half-life, and less affinity for depression like klonopin has, and less interdose withdrawals than xanax.
Is this just the case of a good old drug getting lost to the newer ones w/ more marketing money behind them?
I was depressed as hell on klonopin, and had horrible interdose withdrawals.
Opinions?
Brian
Posted by yxibow on August 25, 2006, at 3:28:35
In reply to why isn't Valium prescribed more???, posted by qbsbrown on August 25, 2006, at 0:34:58
> I've seen that it has just as high as rating for anxiety on remedyfind.com, it's been around forever, has a very long half-life, and less affinity for depression like klonopin has, and less interdose withdrawals than xanax.
>
> Is this just the case of a good old drug getting lost to the newer ones w/ more marketing money behind them?
>
> I was depressed as hell on klonopin, and had horrible interdose withdrawals.
>
> Opinions?
>
> Brian
Well there are a set of possible reasons -- one, for whatever reason psychiatrists have gotten used to prescribing clonazepam for anxiolytic relief because only small quantities are needed, it has a 16 hour + half life, so 1-2 times a day are all that are needed and its been ingrained in those who don't practice with other methods. The other possible reason is that it might carry a little extra anti-convulsant potential than Valium for use adjunctive to say Wellbutrin although thats debatable.But mainly I think that people, including doctors, have gotten the impression that Valium is the forever 60's "mother's little helper" that it was in the past. It has a higher street value and so some people are reluctant to prescribe it. But truthfully they're about the same in terms of long term use benzodiazepines, its just a question of how the patient reacts or prefers the medication. Myself, I think, Valium works better for my purposes but of course one could never say for sure, there are always placebo thoughts.
I'd weight in on the street value, and the old "mother's little helper" on why its not perhaps prescribed as much in some places. Otherwise, its a perfectly good long term benzodiazepine. In fact its excellent because it has 24+ hour half life and less likely for a patient to immediately withdraw and need supportive care thus, plus there isn't a "reward" factor for long term use being that once you accumulate it for several days basically or so, you've got a steady state in you.
- tidingsJay
Posted by UgottaHaveHope on August 25, 2006, at 3:43:24
In reply to Re: why isn't Valium prescribed more???, posted by yxibow on August 25, 2006, at 3:28:35
It is one of the benzos, which just about all have notorious reputations (unjustified) for abuse. It is wonderful drug for those who take it for medicinal reasons.
Posted by Phillipa on August 25, 2006, at 11:03:53
In reply to Re: Image problems, posted by UgottaHaveHope on August 25, 2006, at 3:43:24
Thank-you. I was made out to be a drug addict when I moved here the Phd that did psych testing on me said I was depressed from the valium. He sowed a seed and since I'm so suggestive I became depressed? So now I'm back to seeing my old pdoc 5 hours away. But at least she's not benzophobic. Love phillipa
Posted by ed_uk on August 25, 2006, at 13:37:03
In reply to why isn't Valium prescribed more???, posted by qbsbrown on August 25, 2006, at 0:34:58
Most UK doctors don't seem to prescribe any other benzos for anxiety apart from diazepam, it's certainly the most widely prescribed anxiolytic benzo by a very long way. Temazepam is the most popular benzo for sleep in the UK. Clonazepam is the current fashion in the US.
Ed
Posted by qbsbrown on August 25, 2006, at 14:03:50
In reply to Re: why isn't Valium prescribed more??? » qbsbrown, posted by ed_uk on August 25, 2006, at 13:37:03
That is interesting. My PDOC that i was seeing in china, is from spain, and diazepam was by far her top choice of benzo.
It's an obvious trend that here in american we always jump after the new and so called "better" things, instead of not messing w/ what's not broken. Also perhaps the newer generations of younger doctors, whom might see it as outdated.
I was just withdrawing from 12.5mgs of diazepam, and i was down to 3.5. I then foolishly decided to switch my ssri from celexa to lexapro, which threw the withdrawal through the roof. I'm now having to find that i need 15-20 to get back to the stablizaiton point to where i started.
that said, things have been amazingly better on lexapro. I have never been so active in years. I think it was also the fact that i am a lower dose responder. My PDOC wanted me on 20mgs lexapro, i was still shaking, obsessing, couldn't eat etc. then i drop to 15, then to 10, and i'm now playing baseball, eating in diners by myself, enjoying my coffee, food, paper, and daydreaming, whereas on higher doses i'd be freaking out and obsessing rampantly.
Brian
Posted by sdb on August 25, 2006, at 18:15:04
In reply to Re: why isn't Valium prescribed more???, posted by qbsbrown on August 25, 2006, at 14:03:50
I don't understand why there's no prazepam or ketazolam available in the US. Ketazolam has proven to be better than diazepam. The substance ketazolam itself has a longer half-life than diazepam, some ketazolam is metabolized in diazepam and at the end there are the active nordiazepam metabolites. Ketazolam could be a very good drug to come off from all benzos. Diazepam included. In would be a good maintenance treatment also. Ketazolam has very flat plasma-levels.
Prazepam is said to possess even antidepressant properties itself. Plasma-levels are flat because of slow resorption.
Benzodiazepines are actually very useful drugs. I don't understand all the discussions of addiction.
Benzos are used everyday in hospital. I don't think benzos cause much physical dependency (increased dopamine transmission in some areas in the brain, changes in plasticity).IMO every drug will cause dependency if the substance works. Furthermore one should differentiate of physical or mental dependency.
There was a discussion recently of great concern relating SSRI dependency in the news. I was only laughing.
It's a shame that somebody must have a bad conscience using a benzo if he only treats a problem.
Many docs treat panic attacks with imipramine. Imipramine is a good deal more dangerous for the body than a low dosage treatment with benzodiazepines.
It was no astonishment for me that I saw a woman with total noncompliance under imipramine, clomipramin coming in to the hospital every second week again and again.
The problem is that if a constant anxiety patient with failure of other treatments or pychotherapy has taken benzos, the patient will no more abandon because of its relieving effects.
But nevertheless there should be a clear diagnosis (!) before prescribing benzos.
Clonazepam is an effective drug for anxiety, panic attacks. But it makes absolutely no sense to prefer clonazepam over diazepam on principle only because of some studies done in Durham, N.C.
Opinions may vary.
Posted by Wildflower on August 25, 2006, at 18:44:45
In reply to why isn't Valium prescribed more???, posted by qbsbrown on August 25, 2006, at 0:34:58
> I've seen that it has just as high as rating for anxiety on remedyfind.com, it's been around forever, has a very long half-life, and less affinity for depression like klonopin has, and less interdose withdrawals than xanax.
I've been on and off meds for a few years and was recently prescribed Valium. I gasped when my doctor asked if I'd be willing to try it -- or should I say the generic equivilant. The stigma behind the name made me think of endless songs and movies that refer to the drug in such a negative way.
> Is this just the case of a good old drug getting lost to the newer ones w/ more marketing money behind them?
Could be. With a name like Valium, you don't need to run brand recognition campaigns like the newer drugs do. Everyone knows what Valium is and they also know that it was once a popular recreational drug. Once the generic versions of any drug come out, advertising for the original ceases.
> I was depressed as hell on klonopin, and had horrible interdose withdrawals.
I was taking Klonopin and I guess I never thought that it may be contributing to the depression. Isn't it ironic that certain ADs list anxiety as a SE and the anti-anxiety meds contribute to depression? No wonder no one's come up with a miracle cure for someone with both anxiety AND depression.
Posted by qbsbrown on August 25, 2006, at 19:18:15
In reply to Re: why isn't Valium prescribed more??? » qbsbrown, posted by Wildflower on August 25, 2006, at 18:44:45
I remember before i ever tried any psychotropic drugs, i took some valium for a MRI procedure. At it was fun!!! I felt drunk and funny. Now, I absolutely get no feelings of well being out of it. But the same holds true for the first time i drank alcohol to now, it's completely different feeling.
that said, if anything xanax causes by far the most feelings of well being, probably due to the dopamine involved. That and it's short half-life could be asking for bad withdrawals.
Withdrawal is real! I've tried 4 times to come off. Once cold turkey. 2 times the WD schedule was way too fast. And this last one i was down to 3.5, and switched to lexapro, which threw me for a loop.
I thought that i was only going to go back up to 7mgs, from 3.5. I have never ever felt such a physical and psychological craving and needing for more! I've even gone back to 15mgs, and still don't feel stablized.Typically i would feel do depressed and disappointed that i didn't make the WD, but this time round i really don't care, becuase lexapro is work so much better for depression.
Brian
Posted by ed_uk on August 26, 2006, at 15:07:57
In reply to Re: why isn't Valium prescribed more??? » qbsbrown, posted by Wildflower on August 25, 2006, at 18:44:45
>Everyone knows what Valium is and they also know that it was once a popular recreational drug.
Diazepam is only available as a generic in the UK. Valium has been discontinued here.
Now that Klonopin is prescribed much more frequently than Valium in the US, Klonopin will inevitably be taken (recreationally) far more frequently than Valium is. Klonopin and Valium have similar 'recreational value'.
>It's an obvious trend that here in american we always jump after the new and so called "better" things, instead of not messing w/ what's not broken. Also perhaps the newer generations of younger doctors, whom might see it as outdated.
That's very true. It's even got to the point where American doctors prescribe new (and usually very expensive) drugs to treat conditions which they have not been proven to treat in preference to prescribing well established older treatments eg. prescribing Topamax as a first line treatment for bipolar disorder instead of lithium or valproate.
Ed
Posted by ed_uk on August 26, 2006, at 15:09:59
In reply to Re: why isn't Valium prescribed more???, posted by qbsbrown on August 25, 2006, at 19:18:15
Hi Brian
I read your email! I think you should stay on 10mg Lexapro. Don't let your pdoc force you to take a higher dose if it's not necessary. 10mg is enough for most people.
Regards
Ed
Posted by qbsbrown on August 26, 2006, at 15:53:23
In reply to Re: why isn't Valium prescribed more??? » qbsbrown, posted by ed_uk on August 26, 2006, at 15:09:59
I guess that sometimes in the psychotropic world, sometimes less is more, isn't it?
Posted by finelinebob on August 26, 2006, at 16:26:45
In reply to Re: why isn't Valium prescribed more???, posted by yxibow on August 25, 2006, at 3:28:35
> But mainly I think that people, including doctors, have gotten the impression that Valium is the forever 60's "mother's little helper" that it was in the past.
Dang! I was gonna blame it on the Rolling Stones, but you beat me to it.
Posted by qbsbrown on August 26, 2006, at 16:32:47
In reply to Re: why isn't Valium prescribed more??? » yxibow, posted by finelinebob on August 26, 2006, at 16:26:45
LOL. Well, with all due respect to my elders, im only 28, so i really wasn't around to experience that stigma in full force. Although i do know the name valium carries much with it. But diazepam doesn't carry the same:)
I would imagine that when the new line of ADs hit the market, there will be the same move to scrutinize the SSRIs more than ever, such as the older drugs like benzos and TCAS, although they were beneficial to so many, an saved many lives.
Posted by ed_uk on August 26, 2006, at 18:33:01
In reply to Re: why isn't Valium prescribed more???, posted by qbsbrown on August 26, 2006, at 16:32:47
Xanax probably has more stigma these days anyway!
Ed
Posted by yxibow on August 27, 2006, at 5:50:50
In reply to Re: why isn't Valium prescribed more???, posted by sdb on August 25, 2006, at 18:15:04
> I don't understand why there's no prazepam or ketazolam available in the US. Ketazolam has proven to be better than diazepam. The substance ketazolam itself has a longer half-life than diazepam, some ketazolam is metabolized in diazepam and at the end there are the active nordiazepam metabolites. Ketazolam could be a very good drug to come off from all benzos. Diazepam included. In would be a good maintenance treatment also. Ketazolam has very flat plasma-levels.
>
> Prazepam is said to possess even antidepressant properties itself. Plasma-levels are flat because of slow resorption.
>
> Benzodiazepines are actually very useful drugs. I don't understand all the discussions of addiction.
> Benzos are used everyday in hospital. I don't think benzos cause much physical dependency (increased dopamine transmission in some areas in the brain, changes in plasticity).
>
> IMO every drug will cause dependency if the substance works. Furthermore one should differentiate of physical or mental dependency.
>
> There was a discussion recently of great concern relating SSRI dependency in the news. I was only laughing.
>
> It's a shame that somebody must have a bad conscience using a benzo if he only treats a problem.
>
> Many docs treat panic attacks with imipramine. Imipramine is a good deal more dangerous for the body than a low dosage treatment with benzodiazepines.
>
> It was no astonishment for me that I saw a woman with total noncompliance under imipramine, clomipramin coming in to the hospital every second week again and again.
>
> The problem is that if a constant anxiety patient with failure of other treatments or pychotherapy has taken benzos, the patient will no more abandon because of its relieving effects.
>
> But nevertheless there should be a clear diagnosis (!) before prescribing benzos.
>
> Clonazepam is an effective drug for anxiety, panic attacks. But it makes absolutely no sense to prefer clonazepam over diazepam on principle only because of some studies done in Durham, N.C.
>
> Opinions may vary.
Some of the more esoteric benzodiazepines were not bothered to be marketed here -- there are literally more than 2 dozen and some have been discontinued for years because the market is full with plentiful 1,4 benzodiazepines since they since they were first discovered in 1958.
Some are not here for good reason -- they discovered liver problems early on and were withdrawn from the US market or most likely entirely worldwide.
All benzodiazepines, with the exception of the esoteric clobazam (Canada and other countries), are 1,4 benzodiazepine derivatives. Clobazam is a 1,5 benzodiazepine and binds slightly differently to parts of GABA.
Its basically a marketing issue and general trends in prescribing that have determined what benzodiazepines (including some older, more esoteric ones) have remained on the US market. (And this is generic trends largely since the 80s with the exception of Xanax XR).
This is the end of the thread.
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