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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 35. Go back in thread:
Posted by FredPotter on November 30, 2007, at 22:39:15
In reply to Re: Stopping Benzodiazepines - Please Help » sonic_gb, posted by Sigismund on November 29, 2007, at 21:23:16
I think the Dr should be unfrocked if he is unaware of the necessity for gradual tapering and the possible dangers of going too fast eg seizures. I agree that you shouldn't tell the Dr then you can go at your own pace, unharangued. We don't need Drs to tell us how to taper surely
Fred
Posted by sonic_gb on November 30, 2007, at 22:39:15
In reply to Re: Stopping Benzodiazepines - Please Help, posted by FredPotter on November 29, 2007, at 21:48:01
Good idea, Sigismund, Fred, I'll take on the tapering project myself and let my doctor prescribe as if business is as usual. Why didn't I think of that? Thanks!
Posted by DStupid on November 30, 2007, at 22:39:15
In reply to Stopping Benzodiazepines - Please Help, posted by sonic_gb on November 29, 2007, at 13:28:12
I'd not convert both benzos into diazepam at the same time. Oxazepam, I think, is a metabolite of diazepam, but clonazepam is not. I'd keep clonazepam as is without converting it. I'd also gradually taper oxazepam without converting it into diazepam. Once you sufficiently reduce oxazepam, then I'd start reducing clonazepam, again without converting it into diazepam.
My dad, who has taken Xanax (alprazolam) for years and is now taking a reduced dose of Xanax plus some Klonopin (clonazepam), has a lot of experience with benzos. I live with him and I've picked up a lot of things from him about that stuff. He is a retired scientist. He wanted to get off Xanax completely and I found for him the Ashton method, and he tried it for Xanax 4-6 mg daily withdrawal. According to his experience which I witnessed, Ashton's method worked only in the beginning, but then he couldn't get enough of diazepam, meaning it was much weaker than Xanax and couldn't replace it. Worse yet, diazepam stayed in his body for a long time (I think the half-life of diazepam is 100 hours), causing him problems with ground control. So he tapered Xanax slowly on his own to about 2 mg for the night and added Klonopin about 4 mg for the day time. He did everything on his own. The p-doc couldn't tolerate his meticulous and slow taper. Most importantly, you must build up an emergency supply of both drugs (clonazepam and oxazepam) in case you need to take a full dose for a while. Very important.
If you tell your p-doc that you're tapering, you won't get a full prescription ever. As other posters have said, always fill a full prescription.
Posted by Sigismund on November 30, 2007, at 22:39:16
In reply to Re: Stopping Benzodiazepines - Please Help » sonic_gb, posted by DStupid on November 29, 2007, at 22:39:03
> Most importantly, you must build up an emergency supply of both drugs (clonazepam and oxazepam) in case you need to take a full dose for a while. Very important.
>If you tell your p-doc that you're tapering, you won't get a full prescription ever. As other posters have said, always fill a full prescription.
Posted by yxibow on November 30, 2007, at 22:39:16
In reply to Re: Stopping Benzodiazepines - Please Help, posted by Sigismund on November 30, 2007, at 1:03:44
> > Most importantly, you must build up an emergency supply of both drugs (clonazepam and oxazepam) in case you need to take a full dose for a while. Very important.
>
> >If you tell your p-doc that you're tapering, you won't get a full prescription ever. As other posters have said, always fill a full prescription.
>If you have a reasonable psychiatrist, he'll keep his license, write your prescriptions legally and if the two of you notice signs of overwithdrawal, a new prescription with different directions can be written and faxed into (C-IV) just about every pharmacy around. There's no need even though I have that temptation, to have tons of moldering generic prescriptions around, unless you have a sadist for a doctor in which case I'm not sure why one would see one.
It doesn't take 30 weeks at your dose. I would say about 10% per week, depending on how long you've been on it and how you can stand it. As you get down lower, you may have to slow this level of taper. Propranolol, clonidine, Neurontin and other tricks can be used to temporarily substitute.The one thing you obviously don't want to do is dump it (any benzodiazepine) out the window. I had a not so nice doctor and I have permanent spinal and scalp muscle effects 10 years later. This isn't to scare you, proper clinically proven tapers work and are effective and one can choose to go by the "Ashton" method but it is not particularily scientifically accurate in my opinion.
Posted by Dinah on November 30, 2007, at 22:39:16
In reply to Re: Stopping Benzodiazepines - Please Help, posted by Sigismund on November 30, 2007, at 1:03:44
My pdoc gave me the exact same prescription even though he knew I'd worked my way down to 1/2 mg of klonopin. I doubt he'd have a problem if I said I was back at the full dose, even though I've now tapered off it completely after ten years of at least 1 mg a day.
I thought I'd have physical effects when I cut that last 1/2 tablet, but all I've noticed is a mild return of the middle of the night anxiety and insomnia that I first took it for.
Maybe the key is that he didn't ask me to reduce my klonopin. I'd been getting an average of 1 1/2 per day for the entire ten years with no increase. I doubt he'd have minded my taking it forever. I'm getting off it because the sleep neurologist said something about sleep stages, or cycles, and apnea, and suggested I go off it. I'm sure if it had been my pdoc who suggested it, he might not have been as unconcerned.
Posted by Zyprexa on November 30, 2007, at 22:39:16
In reply to Stopping Benzodiazepines - Please Help, posted by sonic_gb on November 29, 2007, at 13:28:12
First of all, I would tell my doctor exactly what I think. Don't leave any info out. Say that you don't know what will happen, and for the doctors support. Don't just say you want off it. Or that is what they will do, in support of that idea.
Posted by Sigismund on November 30, 2007, at 22:39:17
In reply to Re: Stopping Benzodiazepines - Please Help » Sigismund, posted by yxibow on November 30, 2007, at 5:30:47
The reason I felt strongly about this Yxi is that I've been on methadone maintenance, and everything said here about benzos is doubly true when it comes to that.
I've seen some punishing tapers.
Posted by sonic_gb on November 30, 2007, at 22:39:17
In reply to Re: Stopping Benzodiazepines - Please Help » yxibow, posted by Sigismund on November 30, 2007, at 12:20:23
OK, so I'm obviously not too smart about this whole thing. I met with my Doctor, and tried to subtly imply that I want to think about stopping benzo's slowly as I was concerned about dependence and side effects. He's tapering me off 2mg of clonazepam over 1 week, and then 30mg of oxazepam over the following week. This is going to be a brutal, punishing taper for me, and I told him that, but he thinks "it's in my best interest". He doesn't believe in slow tapers or diazepam conversions, as he thinks they just prolong the withdrawal period.
I'm starting to learn that you need to be really manipulative with Doctors to get satisfactory care. It makes me feel like a slimy "drug seeker". It's unfortunate that honesty results in punishment, because it reinforces dishonesty. I'm starting to have a lot more sympathy for manipulative "drug seekers" than I used to. Being in Canada, getting a steady pdoc is very difficult due to doctor shortages. Basically my alternative is to dump this guy and go to a walk in clinic, where the standard of care is even lower. I'm on a long wait list to see a psychiatrist, so maybe things will improve when I see him, but in the mean time I'm going to be in pretty rough shape. I imagine the withdrawal will worsen my depression, which is already not controlled at all by AD's. His only suggestion was that I go to an emergency room if I wasn't handling things well. I'm sure they will have loads of sympathy for someone asking for a controlled substance. Sigh... Not having a good day.
Sonic
> The reason I felt strongly about this Yxi is that I've been on methadone maintenance, and everything said here about benzos is doubly true when it comes to that.
>
> I've seen some punishing tapers.
Posted by yxibow on November 30, 2007, at 22:39:17
In reply to Re: Stopping Benzodiazepines - Please Help » yxibow, posted by Sigismund on November 30, 2007, at 12:20:23
> The reason I felt strongly about this Yxi is that I've been on methadone maintenance, and everything said here about benzos is doubly true when it comes to that.
>
> I've seen some punishing tapers.A taper isn't meant to "punish" -- its to get a patient's life back and their functionality. Now I'm sure there are some biased doctors, I can't control that. But heroin is much easier to get off ironically than benzodiazepines. It's not a pleasant ride, if you've seen Trainspotting, but it is largely over with in a rapid fashion. Diarrhea may persist and other nasty stuff for some time. No sane psychiatrist is going to dump your benzo like heroin.
Posted by Phillipa on November 30, 2007, at 22:39:17
In reply to Re: Stopping Benzodiazepines - Please Help, posted by sonic_gb on November 30, 2007, at 12:49:30
Sonic what about seizures is he not concerned about them as you could have a seizure withdrawing so fast from two meds. Years ago when my 33 year old was born was in the hospital for two weeks as she had problems. Me being in my 20's knowing nothing about meds cold turked l5mg of valium, two seconals barbituates at night and a half bottle of wine prescribed by both a pdoc and ob-gyn. I felt as If I was on a rocking ship and lay on the couch for two weeks. Then started taking 5mg of valium again and my beer three then at night. So it's not safe for a fast taper. Also the pdoc have now has never heard of Ashton and she specialized in addiction and wrote for Jama for may years. Phillipa
Posted by Phillipa on November 30, 2007, at 22:39:18
In reply to Re: Stopping Benzodiazepines - Please Help » Sigismund, posted by yxibow on November 30, 2007, at 12:52:19
Not all sane in NC as the one I saw was going to stopped seeing him. Phillipa
Posted by DStupid on November 30, 2007, at 22:39:18
In reply to Re: Stopping Benzodiazepines - Please Help, posted by Dinah on November 30, 2007, at 8:53:51
Benzos definitely worsen the sleep apnea.
Posted by DStupid on November 30, 2007, at 22:39:19
In reply to Re: Stopping Benzodiazepines - Please Help, posted by sonic_gb on November 30, 2007, at 12:49:30
<< He's tapering me off 2mg of clonazepam over 1 week, and then 30mg of oxazepam over the following week. This is going to be a brutal, punishing taper for me, and I told him that, but he thinks "it's in my best interest". He doesn't believe in slow tapers or diazepam conversions, as he thinks they just prolong the withdrawal period.>>
<<His only suggestion was that I go to an emergency room if I wasn't handling things well.>>
His advice borders on malpractice; you can't follow it, you may wind up in an emergency room where they'll give you lorazepam (Ativan) if you're lucky to get there.
Can an internist (a non-psychiatrist) write you a prescription for a benzo in Canada? If s/he can, get them and get them filled ASAP. Can you buy your benzos over the internet in Canada? Can you complain to the medical board to put pressure on him? I mean the guy is throwing you to the dogs.
Posted by Phillipa on November 30, 2007, at 23:35:41
In reply to Re: Stopping Benzodiazepines - Please Help, posted by DStupid on November 30, 2007, at 22:39:19
To follow the post have to post on withdrawal Phillipa
Posted by yxibow on December 2, 2007, at 16:43:13
In reply to Re: Stopping Benzodiazepines - Please Help, posted by sonic_gb on November 30, 2007, at 22:39:17
> OK, so I'm obviously not too smart about this whole thing. I met with my Doctor, and tried to subtly imply that I want to think about stopping benzo's slowly as I was concerned about dependence and side effects. He's tapering me off 2mg of clonazepam over 1 week, and then 30mg of oxazepam over the following week. This is going to be a brutal, punishing taper for me, and I told him that, but he thinks "it's in my best interest". He doesn't believe in slow tapers or diazepam conversions, as he thinks they just prolong the withdrawal period.
Depends how long you've been on the Klonopin. A week is a wee too much for 2mg but 2-3 weeks wouldn't harm you. Serax is a very weak agent and you're not going to feel a lot of difference, but again I would say 2-3 weeks.
And yes, there's something to be said about prolonging things. If you're going allright on it (remember you've already got a subconscious placebo effect just by knowing you're on less of the medication) then there shouldn't be anything wrong. Why climb the walls for 10 weeks when you could do it shorter (not quite as short as I said that he suggested) and get it over with. There's obviously a reason he's being a little over the top -- maybe he's observed the effects from behind the scenes so to speak as you being a former drug user and what benzodiazepines have done to you in the the long term.
>
> I'm starting to learn that you need to be really manipulative with Doctors to get satisfactory care. It makes me feel like a slimy "drug seeker". It's unfortunate that honesty results in punishment, because it reinforces dishonesty.
That's a feeling, not necessarily a reality. And as the saying goes, not trying to be harsh, but if you hire a dog, why bark yourself ? What is the purpose of true "manipulative" behaviour? Now I admit this tapering may seem and may be a bit over the top.I'm starting to have a lot more sympathy for manipulative "drug seekers" than I used to. Being in Canada, getting a steady pdoc is very difficult due to doctor shortages.
I love your system north of 49 but you're right, you get triages and people take out American insurance just to get special procedures.
Basically my alternative is to dump this guy and go to a walk in clinic, where the standard of care is even lower. I'm on a long wait list to see a psychiatrist, so maybe things will improve when I see him, but in the mean time I'm going to be in pretty rough shape. I imagine the withdrawal will worsen my depression, which is already not controlled at all by AD's.
His only suggestion was that I go to an emergency room if I wasn't handling things well. I'm sure they will have loads of sympathy for someone asking for a controlled substance. Sigh... Not having a good day.
>
> Sonic
>
> > The reason I felt strongly about this Yxi is that I've been on methadone maintenance, and everything said here about benzos is doubly true when it comes to that.Perhaps because you've been a former drug user is why the doctor is being cautious now that you have controlled substances in your system, albeit a small amount. This isn't a blanket statement on drugs -- if you want to go smoke pot, go ahead, if you want to smoke cigarettes, go ahead but accept the taxation which funds cancer treatments in your health system. If you want to shoot heroin, go down Hasting St but remember, you can get uncurable forms of hepatitis.
Posted by yxibow on December 2, 2007, at 16:47:29
In reply to Re: Stopping Benzodiazepines - Please Help » yxibow, posted by Phillipa on November 30, 2007, at 22:39:18
> Not all sane in NC as the one I saw was going to stopped seeing him. Phillipa
There are doctors and then there are doctors. You get what you pay for unfortunately sometimes and if you don't get a sense of collaboration -- please, don't sit passive in a chair in a psychiatrist's office
Write some stuff down to discuss so you might get things going your way as much as the doctor wants to handle things their way.
If you get a sense that the doctor slept through psychiatric residency then its pretty much time to seek a new doctor and I know there aren't as many in smaller towns, I sympathize, but doctors do network and it may be surprising who your GP turns up.
Posted by maxime on December 2, 2007, at 21:54:37
In reply to Benzo Withdrawal, posted by sonic_gb on November 26, 2007, at 15:34:17
Hi
I was taking 3.5 mg of clonazepam for over 10 years. I just spent a month in the hospital for my depression and they took me off the clonazepam COLD TURKEY. I did go though withdrawal but it wasn't as bad as it was when I tried before. I am now taking 200 mg of Seroquel and I think that is holding me together. I am sure it's the Seroquel that made my withdrawal almost painless.
Maxime
Posted by Phillipa on December 2, 2007, at 22:12:25
In reply to Re: Benzo Withdrawal » sonic_gb, posted by maxime on December 2, 2007, at 21:54:37
Maxie didn't know you could do that. Phillipa
Posted by sonic_gb on December 3, 2007, at 8:35:22
In reply to Re: Stopping Benzodiazepines - Please Help » sonic_gb, posted by yxibow on December 2, 2007, at 16:43:13
Just one point. I was not a former drug user. I never claimed to be, never have been. There was another poster in the thread who mentioned methadone tapering. I think you might be confusing him with me or combining our two posts somehow. Or maybe I'm just confused. Not that I'm saying drug abuse is something to be ashamed of or to hide from, but this isn't in my history. I only stated that I was concerned that my benzo usage was becoming a problem.
Posted by sonic_gb on December 3, 2007, at 8:41:23
In reply to Re: Stopping Benzodiazepines - Please Help, posted by DStupid on November 30, 2007, at 22:39:19
Hi DStupid,
This is an internist that's doing the taper. I'm on a long waiting list to see a psychiatrist, by which point the taper will be complete. Pdocs/internists here seem much more hesitant and conservative about prescribing and especially _maintaining_ benzo prescriptions than pdocs in the US. I guess we're sort of like the UK where they are a little benzo-phobic too. I can't import or buy benzos over the internet without a prescription from a Canadian Dr. I'll end up in the ER if worst comes to worst. I'd rather just avoid the 6 hour wait and then being accused of being a drug seeking addict. I'll try to stick to the taper and see how it goes. Thanks for your support.
sONIC
Posted by yxibow on December 3, 2007, at 19:52:47
In reply to Re: Stopping Benzodiazepines - Please Help » yxibow, posted by sonic_gb on December 3, 2007, at 8:35:22
> Just one point. I was not a former drug user. I never claimed to be, never have been. There was another poster in the thread who mentioned methadone tapering. I think you might be confusing him with me or combining our two posts somehow. Or maybe I'm just confused. Not that I'm saying drug abuse is something to be ashamed of or to hide from, but this isn't in my history. I only stated that I was concerned that my benzo usage was becoming a problem.
I apologize, I retract what may have been his observations then.But I still stand by the fact that a) Serax is a weak agent, b) You're not sky high yet on Klonopin, and c) This can be done over 2-3, maybe 4 weeks depending how sensitive you are and its done and over with. Try to persuade somehow your doctor over this and if you really can't get anywhere maybe you -- I can't suggest this, I hate this, because people make blanket statements like dump your doctor and all not knowing the person and their history and all that has gone on inbetween -- should think of a second consultation if that exists in the Canadian system. It ought to anyhow
Posted by Maxime on December 3, 2007, at 21:18:54
In reply to Re: Benzo Withdrawal » maxime, posted by Phillipa on December 2, 2007, at 22:12:25
> Maxie didn't know you could do that. Phillipa
Neither did I. And was taken off two anti-convulsants: clonazepam and trileptal. I am surprised I didn't have a seizure!
Maxie
Posted by Phillipa on December 3, 2007, at 21:42:57
In reply to Re: Benzo Withdrawal » Phillipa, posted by Maxime on December 3, 2007, at 21:18:54
Maxie what did you feel like seriously. Love Phillipa
Posted by yxibow on December 4, 2007, at 0:50:43
In reply to Re: Stopping Benzodiazepines - Please Help » sonic_gb, posted by Phillipa on November 30, 2007, at 22:39:17
It actually apparently is safe over a week -- Clonazepam has such a long half life that it apparently literally stops on its own. Now is it humane if the patient has a nervous breakdown, panic attacks, intestinal complaints, no. And really rare things can happen. So would I advocate it, as before, no, I'd wait a little longer.
This is the end of the thread.
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