![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 53 to 77 of 133. Go back in thread:
Posted by Quintal on February 5, 2007, at 14:28:42
In reply to Re: Ashton Rocks!, posted by notfred on February 5, 2007, at 14:22:30
I posted this further up the thread:
Here are some quotes that I think give a summary of her advice for long-term benzodiazepine users:
__________________________________________________The advantages of discontinuing benzodiazepines do not necessarily mean that every long-term user should withdraw. Nobody should be forced or persuaded to withdraw against his or her will. In fact, people who are unwillingly pushed into withdrawal often do badly. On the other hand, the chances of success are very high for those sufficiently motivated. As mentioned before, almost anyone who really wants to come off can come off benzodiazepines. The option is up to you.
http://www.benzo.org.uk/manual/bzcha02.htm
__________________________________________________The major clinical advantages of benzodiazepines are high efficacy, rapid onset of action and low toxicity. Adverse effects include psychomotor impairment, especially in the elderly, and occasionally paradoxical excitement. With long term use, tolerance, dependence and withdrawal effects can become major disadvantages. Unwanted effects can largely be prevented by keeping dosages minimal and courses short (ideally 4 weeks maximum, and by careful patient selection. ***Long term prescription is occasionally required for certain patients.***
http://www.benzo.org.uk/asgr.htm
__________________________________________________I think those quotes are a good enough antidote to this:
"Then there are those like me that do not use black and white thinking. benzos are good options for some and bad options for others."
>I am free, just as anyone else, to engage in threads as I like.
You are welcome to post on this thread if you have fresh information or some new perspective to add. You are not welcome here however, if you come to annoy and disrupt, no matter how free you may be to do so.
Q
Posted by notfred on February 5, 2007, at 14:31:35
In reply to Re: Ashton Rocks! » notfred, posted by Quintal on February 5, 2007, at 14:28:42
>
> You are welcome to post on this thread if you have fresh information or some new perspective to add. You are not welcome here however, if you come to annoy and disrupt, no matter how free you may be to do so.
>
> QYou are not in control of who is welcome or not.
Do not read my posts if you are bothered by them.
Posted by Quintal on February 5, 2007, at 14:35:03
In reply to Re: Ashton Rocks!, posted by notfred on February 5, 2007, at 14:25:56
>This means that when one only works with one group of people the tendancy is to generalize across all groups.
I don't think Heather Ashton is prone to generalization. She is far too experienced a scientist for that and I've seen no evidence of it myself. You may be able to isolate certain quotes from restricted passages to give that effect, but on the whole, the vast body of her work is very thorough in weighing up the subtleties of the problem.
Q
Posted by Quintal on February 5, 2007, at 14:35:55
In reply to Re: Ashton Rocks!, posted by Squiggles on February 5, 2007, at 14:28:10
In what way do you think clonazepam is unique Squiggles?
Q
Posted by Squiggles on February 5, 2007, at 14:41:43
In reply to Re: Ashton Rocks! » Squiggles, posted by Quintal on February 5, 2007, at 14:35:55
As I have said before, you can take 0.5mg
for 10 years and not have to raise it
for tolerance. It is also very difficult
and in some cases impossible to withdraw from.I don't know of any other benzos that have
those properties.Squiggles
Posted by Quintal on February 5, 2007, at 14:44:03
In reply to Re: Ashton Rocks!, posted by notfred on February 5, 2007, at 14:31:35
>You are not in control of who is welcome or not.
I am indeed in control of who I welcome and who I do not, though as you have said, I can't stop you posting.
This seems to be getting extremely childish and off-topic and that's the reason I don't welcome you to this thread I started. If you have something significant and insightful to add then please do so. Your opinion on this topic has been noted, thank you for providing it. However, your continued sniping is starting to seem to me like a wilful and malicious attempt to disrupt this thread.
>Do not read my posts if you are bothered by them.
Likewise.
Q
Posted by Meri-Tuuli on February 5, 2007, at 14:44:21
In reply to Re: Just a question » Meri-Tuuli, posted by Quintal on February 5, 2007, at 12:43:50
I didn't know that! I was only born in 1980. Although I do remember watching 'thats life'!
But surely a programme like that can't influence public policy like that? I mean, its one thing that sort of stuff appearing on a show, an other well, I dunno, influencing GPs and NHS policy and that.
Or I don't know? Can it? Perhaps it can.
Posted by Quintal on February 5, 2007, at 14:48:39
In reply to Re: Ashton Rocks!, posted by Squiggles on February 5, 2007, at 14:41:43
Many people have already posted of their experience taking other benzos like Xanax for decades with out raising the dose (and sometimes lowering it).
I became addicted to clonazepam in the truest sense - compulsively raising the dose until at its height I was taking 20mg a day. It's always possible to withdraw from benzos though it may be very hard.
Q
Posted by Quintal on February 5, 2007, at 14:54:50
In reply to Re: Just a question » Quintal, posted by Meri-Tuuli on February 5, 2007, at 14:44:21
>I didn't know that! I was only born in 1980. Although I do remember watching 'thats life'!
I was born in 1982 but don't remember watching it either!
I think it was the wave of public feeling against benzos that the programme generated which made the government revise it's policy. It was a form of investigative journalism and the government has to be seen respond to new evidence if it's very serious (which it was) along with the demands of irate voters.
Q
Posted by Squiggles on February 5, 2007, at 14:57:48
In reply to Re: Ashton Rocks! » Squiggles, posted by Quintal on February 5, 2007, at 14:48:39
> Many people have already posted of their experience taking other benzos like Xanax for decades with out raising the dose (and sometimes lowering it).
>
Then there must have been another factor
influencing my need to raise the Xanax-- possibly
the Synthroid was too high.
> I became addicted to clonazepam in the truest sense - compulsively raising the dose until at its height I was taking 20mg a day. It's always possible to withdraw from benzos though it may be very hard.This too is strange. I took clonazepam for
7-10 yrs with no need to raise it; then my dr.
raised by .50 totalling to 1.0mg and I was fine.
I could have stayed there indefinitely, except
for my ill-considered attempt to withdraw from
that given my success with Xanax. It was that
horrible attempt that led to the necessity for raising it even more just to stabilize.Curiouser and curiouser -- but I don't expect you
to unravel this -- it just remains a mystery for me. I have other mysteries too; i've read a lot of books and still, they remain. :-)I hope you feel better coming off.
Tx.
Posted by Quintal on February 5, 2007, at 14:59:43
In reply to Re: Just a question » Meri-Tuuli, posted by Quintal on February 5, 2007, at 14:54:50
>I was born in 1982 but don't remember watching it either!
I think I meant:
I was born in 1982 but don't remember watching it though!
Q
(:-0)
Posted by Quintal on February 5, 2007, at 15:14:04
In reply to Re: Ashton Rocks!, posted by Squiggles on February 5, 2007, at 14:57:48
>Then there must have been another factor
influencing my need to raise the Xanax-- possibly
the Synthroid was too highThat could be true. I know myself how it can cause hellish anxiety to raise your thyroid hormone too high.
>This too is strange. I took clonazepam for
7-10 yrs with no need to raise it; then my dr.
raised by .50 totalling to 1.0mg and I was fine.
I could have stayed there indefinitely, except
for my ill-considered attempt to withdraw from
that given my success with Xanax. It was that
horrible attempt that led to the necessity for raising it even more just to stabilize.I felt no need to raise my dose above 4mg for over a year. I think I was actually seeking oblivion, just trying to forget, by raising the dose that high. It's wasn't really a therapeutic dose.
>I hope you feel better coming off.
Thank you. I do feel mentally sharper, though at the expense of being a little frail in the face of stress. I think I'll find a way around that with time. It's a shame my GP won't follow Heather Ashton's recommendations and give recovered addicts more time to heal emotionally after an abrupt withdrawal - she expected me to be ready for work two weeks after my last (20mg!)dose of clonazepam. I think that's the type of ignorance Heather was trying to address in her letter to Rosie Winterton and I'm very grateful to her for doing that.
Q
Posted by Squiggles on February 5, 2007, at 15:22:24
In reply to Re: Ashton Rocks! » Squiggles, posted by Quintal on February 5, 2007, at 15:14:04
20mg is what they give to epileptics -- that
is so high; on the other hand you heard of
heroin addicts taking huge amounts, simply
because they have habituated to the dose.
Problems accumulate with higher dosages because
even though you can tolerate the amount, your
body takes the hit of the side effects of such
a dose.Coming off such a high amount though, must
take a long time to do and to recover. Yes,
absolutely, we need more specialists in this
area such as Professor Ashton. I think that
addiction specialists who help addicts of illegal drugs may actually be of assistance.Squiggles
Posted by Meri-Tuuli on February 5, 2007, at 15:54:11
In reply to Re: Just a question » Meri-Tuuli, posted by Quintal on February 5, 2007, at 14:54:50
I didn't know I was older than you!! I always imagined you to be older (alot?) than me. Its strange the misconceptions we get in our heads.
Well. I don't really know what to say about the benzo thing. I don't know enough thats for sure! I suppose a similar thing is going on re: suicides in young people and SSRIs? Perhaps. Anyway.
To be fair, and in my opinion, it seems abit harsh that a potentially useful drug is withheld from people who need it. I mean, I know Ashton says that you can get benzos for no more than 4 weeks, but in reality GPs won't really presribe them, if you see what I mean. Isn't it up to the indivdual to make these sort of choices about their lives? I mean, I'm in Finland now and got a prescription for some oxazepam with no problems from the pdoc - but I don't take them, I dunno. I mean, some people have crippling anxiety and that could just as much ruin their life as, say, taking a benzo and whatever that happens that is bad then you take them. To me, they don't seem to be as bad as the anti-benzo group seem to make out, if you see what I mean. Lots of things are addictive -- and you get withdrawal syptoms etc like coffee, cigarettes etc, but that doesn't nesscarily mean that they're banned or whatever.
I personally can't see what all the hatred for benzos is about, although I do realise I don't know much about them or their ill-effects.
How did that guys life get wrecked by benzos? I'm sure alot of people could say the same thing about say, alcohol, an addiction to sex/gambling/chatlines/whatever. But I guess benzos induce a physiological dependance...?
I don't know I'm just trying to get a clearer picture of whats going on.
And another thing, I'm just curious, how does a taper from a benzo differ in the suffering caused that from an AD for instance? For me, withdrawal from celexa and venlafaxine was no fun, it was miserable in fact. And was pretty much unsupervised by any GP. In fact, I don't think they offered any withdrawal advice whatsoever. I've never withdrawn from a benzo, so I have no comparison.
Kind regards
Meri
Posted by valene on February 5, 2007, at 17:02:41
In reply to Re: Ashton Rocks! » valene, posted by Quintal on February 5, 2007, at 13:36:29
> >Yes, when I joined the opening statement before you join is "you must believe........created in the depths of hell, etc." Not lying. I cannot say for certain that the owner made this statement but had to be endorsed by him.
>
> I'm curious why you, as a seemingly vehement supporter of long-term benzodiazepine use, decided to join a benzo withdrawal support group?******The answer, Quintal, not that I wish to publish my personal history here, but I will tell you a couple years ago my doctor suggested that I might want to taper off my xanax; hence I came home and did a web search, came up with benzo-uk-org, saw how "harmful" benzos were, and got scared, so joined the forum. I got sucked into the hype that any benzodiazepine use is absolutely uncalled for and extremely harmful. This is what the forum says, that and much worse. Every person on that forum has "extreme withdrawal symptoms" and is "dying". The headings on the posts say "I'm calling 911", I can't take it one more minute", "I'm dying " from withdrawals, etc. I actually saved a copy of the forum headings and each and every one said those things. Since then I have come to realize that benzos are not "evil" and they can be very beneficial for certain people.
>
> Which support forum did you join specifically valene? It appears there are several independent of benzo.org, though the website contains links to those sites for interested parties: http://www.benzo.org.uk/support.htm*******Quintal I don't like your condescending attitude toward me. There have been several "versions" of the forum on benzo-uk-org.....the one I joined is now called Benzo Island. Every time they make a sweep of the board and clean out the undesirables, such as anyone who questions their method of tapering off benzos, they rename the forum it seems. So forgive me if I don't recall the exact name of the forum, but it was the previous iteration of Benzo Island. They clean the boards periodically to get rid of anyone who might suggest that they take any other drug, such as an aspirin or I have seen people chastised for taking magnesium.
> I've searched through the site just now valene and I see no religious fundamentalism there. There is the symbol of the cross and the fish of course, but I think that's a harmless symbol of the faith that helped Ray Nimmo through the hardship of withdrawal. There is no pressure to conform to any particular belief system that I can see there.
******Quintal, I never said anything about "religious fundamentalism". You are putting words in my mouth!
I myself am a Christian. I merely quoted the words that were used "you must believe that Benzos were created by the very devil himself and distributed here on earth by his demons" - in order to join the forum. To me this is not any "religious" statement whatsoever. What pressure to conform to a belief system? Huh? He is being sarcastic and stressing the fact that "benzos are evil" , hence created by the devil.
Posted by Phillipa on February 5, 2007, at 17:26:36
In reply to Re: Ashton Rocks!, posted by Squiggles on February 5, 2007, at 14:41:43
Squiggles you can take up to 20mg of clonazepam as it is also used for seizure patients. And the t med you were trying to remember has one less oxygen ion and is trileptal taken from tegretol. Love Phillipa
Posted by Squiggles on February 5, 2007, at 17:31:55
In reply to Re: Ashton Rocks! » Squiggles, posted by Phillipa on February 5, 2007, at 17:26:36
> Squiggles you can take up to 20mg of clonazepam as it is also used for seizure patients. And the t med you were trying to remember has one less oxygen ion and is trileptal taken from tegretol. Love Phillipa
Thanks. About 20mg clonazepam-- I would be
worried about respiratory depression. I think
that if you suffer from epilepsy, you don't take
such an amount everyday right?Squiggles
p.s. has anyone noticed that everytime the
benzo topic appears the thread runs into
eternity? Why is that, and where is Dr. Bob
to put it into the dark hole where all matter
eventually disappears.
Posted by Phillipa on February 5, 2007, at 17:32:15
In reply to Re: Ashton Rocks!, posted by Squiggles on February 5, 2007, at 14:57:48
Squiggles that happened to me too but my TSH all of sudden elevated when synthroid got it back to normal I deceased the xanax didn' need the higher dose anymore. The thyroid if hasimotos destroys itself. Love Phillipa ps it's an autoimmune disease.
Posted by Quintal on February 5, 2007, at 17:55:40
In reply to Re: Ashton Rocks!, posted by valene on February 5, 2007, at 17:02:41
>Since then I have come to realize that benzos are not "evil" and they can be very beneficial for certain people.
Do you really expect me to believe your own basic intelligence didn't tell you this in the first place? (!)
>Quintal I don't like your condescending attitude toward me.
Likewise. Maybe it has something to do with the tone of your introductory post to this thread? I am none too taken myself by, what seems to me, your ebullient aggression toward myself and the work of Heather Ashton.
> So forgive me if I don't recall the exact name of the forum, but it was the previous iteration of Benzo Island. They clean the boards periodically to get rid of anyone who might suggest that they take any other drug, such as an aspirin or I have seen people chastised for taking magnesium.
Benzo Island still exists today. The activity of these groups has nothing to do with myself nor the work of Heather Ashton, other than they may try to misquote her for their own purposes. I don't see why you bring it up here.
>To me this is not any "religious" statement whatsoever.
Earlier you posted this:
>"When you join the forum, you must agree and I quote "benzodiazepines were created in the depths of hell by the very devil himself, and distributed freely here on earth by his demons". Hope that answers some questions about the origins of benzo.uk or whatever. I refuse to ever go back there, as it scared the daylights out of me with the extreme notions that *any* and all psych. meds are horrendous and people got thrown off the forum for taking a vitamin (not kidding)."
Which to me, sounds as though you are insinuating some sort of religious cult or fundamentalism, which also seems to be in line with the sentiments of other posters with their veiled accusations of scientology and cultism. You have not identified the author of those words with any certainty. If he (whoever he is, and if it is a 'he') really is being sarcastic it seems the quote was taken out of context - a real danger then that it may be misunderstood. Please try to give a fair representation of the facts when quoting other people. Also, in that post you claim that this explains the origins of benzo.org.
Q
Posted by Quintal on February 5, 2007, at 18:44:51
In reply to Re: Just a question » Quintal, posted by Meri-Tuuli on February 5, 2007, at 15:54:11
>I didn't know I was older than you!! I always imagined you to be older (alot?) than me.
Hmmm.......I'm pretty sure you wouldn't if you met me in real life :-)
>Its strange the misconceptions we get in our heads.
It is indeed!
>To be fair, and in my opinion, it seems abit harsh that a potentially useful drug is withheld from people who need it. I mean, I know Ashton says that you can get benzos for no more than 4 weeks, but in reality GPs won't really presribe them, if you see what I mean.
GP's do prescribe them - that's how I became addicted to benzos myself.
>Isn't it up to the indivdual to make these sort of choices about their lives?
Up to a point, but medicine is not yet a utilitarian service. Doctors and pdocs et al certainly need to learn to do their homework become healers if they are to avoid that.
>Lots of things are addictive -- and you get withdrawal syptoms etc like coffee, cigarettes etc, but that doesn't nesscarily mean that they're banned or whatever.
As I've said before, benzos aren't banned. Almost all powerfully addicting drugs are controlled though. The incongruences of alcohol and tobacco annoy me - especially since most people addicted to those drugs don't usually consider themselves to be addicts in the same way as those addicted to other drugs of abuse, despite the fact they have a damaging and potentially fatal habit. My own mother was one of them. I mean, she died of lung cancer, which to my mind was the direct result of her drug addiction - tobacco, yet we don't think of her death in the same way you might someone dying of a heroin overdose.
>How did that guys life get wrecked by benzos?
I'm not sure, but this has nothing to do with Heather Ashton's work. People like that often seem to exaggerate their problems, and I suspect benzo addicts tend to understate or deny the extent to which they're impaired as well - I know I did. Six and two threes! I might post my old rating of clonazepam from RemedyFind and let you see just how strongly pro-benzo I was at one point and how much I despised Heather Ashton.
>I'm sure alot of people could say the same thing about say, alcohol, an addiction to sex/gambling/chatlines/whatever.
Yes, they could. Look, I think there's some confusion about what exactly I am saying and Heather Ashton's motives. When she says that these drugs are not good for you - that you may be healthier without them - she's simply telling the truth. I've seen no judgement from her about people who do choose to take benzos long term, but as a scientist she must report facts, and that's all she's doing. In fact she has gone to considerable lengths to defend people who might have their benzos withdrawn against their will, as shown by the letter in my original post. Maybe it's because she's so terse and formal that to some 'ears' (especially American ears) she might sound militant and uncompromising. But she isn't. Really, just have a good look at a broad section of her work (not just on benzos) without prejudice and I think you'll see what I mean.
>And another thing, I'm just curious, how does a taper from a benzo differ in the suffering caused that from an AD for instance? For me, withdrawal from celexa and venlafaxine was no fun, it was miserable in fact. And was pretty much unsupervised by any GP. In fact, I don't think they offered any withdrawal advice whatsoever. I've never withdrawn from a benzo, so I have no comparison.
I've withdrawn from both benzos and venlafaxine cold turkey. As you say, neither of them were fun. It's hard to compare them because there's a different quality of awfulness between them. They are in the same ballpark, except with benzos there's the seizure risk of course. Heather Ashton has also provided some good work on tapering off SSRIs and she gives some advice on them here: http://www.benzo.org.uk/ssri.htm. Please try to see it for what it is - a very terse and dense appraisal of the facts by an experienced psychopharmacologist, and not as though she has some hidden agenda.
Heather Ashton was a qualified doctor before Valium was even a twinkle in Leo Sternbach's eye, she saw these things coming into being and has most likely a more thorough, balanced and reasonable view of benzos than any of us posting here. Many people have no problem with slagging SSRIs for causing awful withdrawal syndrome (and bloody awful side effects too during treatment), yet it's almost as though benzos can do no wrong here. As you'll see, Heather takes the same approach to antidepressants as she does to benzos. If she seems to be obsessed with them that's because they were the most widely used (and therefore most widely problematic) psych drugs during her career, and she devoted a large part of her career to helping people who had problems with them. Would we really feel so strongly about her if she was quoted saying the same things about SSRIs as she does about benzos? Yes - most likely some would, but since you have experience with antidepressants yourself maybe you'll be better able to judge her position when you've read her article: 'SSRIs, Drug Withdrawal and Abuse: Problem or Treatment?'.
You might recall that I encouraged you to take the oxazepam when you posted here asking for advice?
http://www.dr-bob.org/babble/20061123/msgs/707905.htmlI am not anti-benzo though for most of this thread I seem to have spent a lot of time and energy probably seeming that way for defending Heather Ashton against malicious snipers (and I don't mean you, Phillipa or Squiggles).
Q
Posted by Quintal on February 5, 2007, at 18:55:22
In reply to Re: Just a question » Meri-Tuuli, posted by Quintal on February 5, 2007, at 18:44:51
I can't help noticing a certain befuddledness about most of the posts here written by benzo users. Almost as if they were slightly impaired in some way that made organising information difficult......
Q
Posted by Quintal on February 5, 2007, at 19:08:57
In reply to Re: Ashton Rocks!, posted by Squiggles on February 5, 2007, at 15:22:24
>20mg is what they give to epileptics -- that
is so high;The most my doctor prescribed was 8mg (in addition to some other benzo-like sleeping tablets). I was buying clonazepam from online pharmacies by the time I was taking 20mg - and for a short while only. It did indeed cause respiratory depression - I seemed to be choking at one point though I was taking it with tramadol for euphoria too which would have contributed of course.
>Coming off such a high amount though, must
take a long time to do and to recover.I was forced by circumstances (and my GP) to quit cold turkey - no taper for me, yet the Heroin addicts at the clinic they sent me to were given disability benefit and free methadone prescriptions for as long as they needed(!).
Again that's what Heather was saying about drug detox clinics not being suitable for benzo addicts. The counsellors there had no idea how to go about helping me with my underlying anxiety disorder, they were used to easing people back into a normal life not treating psychiatric problems.
Q
Posted by Phillipa on February 5, 2007, at 19:15:19
In reply to Re: Just a question » Meri-Tuuli, posted by Quintal on February 5, 2007, at 18:44:51
Quintal thanks and I think ad's are too often prescribed for the sadness we all have in life it things don't go exactly the way we would like. Love Phillipa
Posted by Phillipa on February 5, 2007, at 19:17:40
In reply to Re: Ashton Rocks! » Squiggles, posted by Quintal on February 5, 2007, at 19:08:57
Quintal do you know why they use clonazapam for seizure patients? I don't. Love Phillipa
Posted by bassman on February 5, 2007, at 19:28:17
In reply to Re: Just a question » Meri-Tuuli, posted by Quintal on February 5, 2007, at 18:44:51
Schweizer et al. (58) have conducted an 8-month, placebo-controlled study of continuation therapy for panic disorder with alprazolam and imipramine that found sustained efficacy for both compounds with no dose escalation, suggesting an absence of tolerance to the therapeutic effect
Preliminary evidence for the efficacy of continuation therapy of GAD comes from two studies (43, 47). In both studies the benzodiazepine therapy achieved sustained remission of anxious symptomatology with no tolerance and no dose escalation over a 6-month period.
http://www.acnp.org/G4/GN401000129/CH127.html
A total of 136 patients received clonazepam nightly for a mean 3.5 (+/- 2.4) years, with no significant difference in initial versus final mean dose: 0.77 mg (+/- 0.46) versus 1.10 mg (+/- 0.96). Similar results were obtained with chronic alprazolam treatment and with other benzodiazepine treatments. CONCLUSION: Long-term, nightly benzodiazepine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep resulted in sustained efficacy in most cases, with low risk of dosage tolerance, adverse effects, or abuse.
Fifty-nine panic disorder patients originally randomized to treatment in a controlled trial comparing alprazolam, clonazepam, and placebo were reevaluated in a follow-up study. At a mean follow-up of 1.5 years, 78% of patients remained on medication and the mean dosage of alprazolam and clonazepam did not increase.A 15 year study:
Maintenance medication was common. No benzodiazepine abuse was reported. CONCLUSION: PD has a favourable outcome in a substantial proportion of patients. However, the illness is chronic and needs treatment. The short-term treatment given in the drug trial had no influence on the long-term outcome.I think this is interesting because it basically says the physicians are quite prejudiced concerning benzo use, even when it comes to outcome. Who knows the benefits better, the physician or the patient? That’ s easy.
The participants were 93 patients over 60 years of age using a benzodiazepine for insomnia and 25 physicians comprising sleep specialists, family physicians, and family medicine residents. The main outcome measure was perception of benefit and risk scores calculated from the mean of responses (on a Likert scale of 1 to 5) to various items on the survey. RESULTS: The mean perception of benefit score was significantly higher in patients than physicians (3.85 vs. 2.84, p < 0.001, 95% CI 0.69, 1.32). The mean perception of risk score was significantly lower in patients than physicians (2.21 vs. 3.63, p < 0.001, 95% CI 1.07, 1.77). CONCLUSIONS: There is a significant discordance between older patients and their physicians regarding the perceptions of benefits and risks of using benzodiazepines for insomnia on a long term basis. The challenge is to openly discuss these perceptions in the context of the available evidence to make collaborative and informed decisions.
The Task Force Report, although over 10 years old, is still a standard reference for benzodiazepine use. Its points—that there is undue reluctance to use minor tranquillizers, and that many people are under treated—still hold, and are borne out by the Roy-Byrne study. Other relevant literature includes a review of 2719 adult out-patient charts2 (medical and psychiatric) for evidence of benzodiazepine abuse that found no patients meeting the criteria. Another study, of long-term alprazolam users, found no dose escalation with long-term use.3 Tyrer’s 19884 paper on minor tranquillizers notes an absence of evidence that benzodiazepine dependence leads to dangerous long-term sequellae, and blames "excessive media attention" for distortion of scientific attitudes.
http://fampra.oxfordjournals.org/cgi/content/full/20/3/347
Benzodiazepines are relatively safe drugs that are probably under- rather than overprescribed. Periodic reassessment of chronic users is appropriate, although generalized anxiety disorder and panic disorder are chronic conditions for which long-term treatment may be necessary. In the more recent era of safer antidepressants, these agents may be able to supplant minor tranquillizers for the control of chronic anxiety in many patients. Long-term benzodiazepine use is appropriate for some patients.
http://fampra.oxfordjournals.org/cgi/content/full/20/3/347
Tolerance is the need to increase the dose of a drug to maintain the desired effects. Tolerance to the anxiety-relieving effects of benzodiazepines is uncommon and most individuals do not increase their benzodiazepine dose
http://www.daap.ca/factsonbenzodiazepines.html
http://www.psychservices.psychiatryonline.org/cgi/content/full/54/7/1006
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Dr. Bob is Robert Hsiung, MD,
[email protected]
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