![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 4 to 28 of 71. Go back in thread:
Posted by lorie on July 26, 1999, at 10:44:48
In reply to Re: Lorazapam, posted by saintjames on July 24, 1999, at 15:04:06
> > > How can I find out what a lethal dosage of Lorazapam is?
> >
> > Why do you ask?
> >
> > Bob
>
> James here....
>
> There is an ez answer to this, but I would like you to answer Dr. Bobs question first !
> I just started taking lorazapam for anxiety and am wondering how much I could take before I need to worry about phycological addition or overdose. I notice in some articles doeses of up to 10mg, while my persecription is for 1mg tablets, and I sometime take tables. but, I've noticed the effect continues to diminish.
> james
Posted by GS on August 4, 1999, at 0:47:30
In reply to Re: Lorazapam, posted by lorie on July 26, 1999, at 10:44:48
> > > > How can I find out what a lethal dosage of Lorazapam is?
> > >
> > > Why do you ask?
> > >
> > > Bob
> >
> > James here....
> >
> > There is an ez answer to this, but I would like you to answer Dr. Bobs question first !
> > I just started taking lorazapam for anxiety and am wondering how much I could take before I need to worry about phycological addition or overdose. I notice in some articles doeses of up to 10mg, while my persecription is for 1mg tablets, and I sometime take tables. but, I've noticed the effect continues to diminish.
> > james
________________________________________________
The dosage needed depends on how bad the anxiety is that you are experiencing. First, there seems to be 2 schools of thought in the psychiatric profession about benzodiazapines. To generalize, 1) Benzodiazapines are not good for long term treatment of any anxiety disorder - cognitave therapy in combo with a sedating anti-depressant(such as Serzone)should be all that is about necessary. 2)Benzos are good for long term treatment of anxiety disorders because that is what they are....anti-anxiety agents made specifically for that purpose. Just keep it well managed...especially with a short half-life benzo like Xanax or Ativan. Supplement with cognitive therapy.
THE PROBLEM IS:The 1st group are in my opinion overrating the tolerance and dependence issues surrounding this class of drugs because of lack of understanding in prescribing and managing them. Also, misinterpretation of the PDR as well as listening to other psychiatrists with similar prejudice telling of THEIR OWN prejudice and ignorance concerning the side effects of benzos.
It is a semantic argument actually. What is dependence? That if you stop taking benzos you'll become anxious again? Yes there is withdrawl involved in abruptly stopping benzos rather than tapering but does that constitute dependence? No. Yes, one can build up a tolerance to dosage but not something that can't be managed (unless they are being abused or not being taken as instructed).
For instance, it doesn't take alot of imagination to know that Ativan can be managed with an augmentation of a small amount of the low or no side effect mood stabilizer Neurontin (900 - 1200mg)to help with Ativan going in and out of
the system therefore aleviating the drug induced anxiety.
Also, keep the Ativan at a constant level whether it is 2 or 6 or I've read up to 10 mgs. daily...whatever allows you to function the way you need to without the affliction of an anxiety disorder! That is the whole point! So what if you take 3 -4 mgs or 5 -6 mgs. a day! Does it in conjunction with cognative therapy techniques alleviate your anxiety disorder?
Don't be scared off by the argument that you are addicted to benzos when benzos are what stops the disease that you're afflicted with! A non -prejudicial psychopharmacologist will help manage your suffering and allay your unfounded fears of addiction that are imposed upon you by the first group of psychiatrists mentioned above. The point is, get the ball in the hole. Until these prejudiced doctors stop heaping these needlessly anxiety - provoking "facts" there will continue to be your type of sad questions worried about by many, many patients in need of relief.If you have an anxiety disorder, you take inti-anxiety drugs (until the purists come up with something THAT WORKS for you with less side effects).
Am I pretty much on target Dr. Bob? (assuming that she has a properly diagnosed anxiety disorder).
GS
Posted by Susan on August 4, 1999, at 6:32:49
In reply to Re: Lorazapam - Br. Bob,am I right?, posted by GS on August 4, 1999, at 0:47:30
I don't know if Dr. Bob will agree but my pdoc agrees and I have been looking for collaborative documentation to alleviate the fears of family members re. benzos for insomnia and anxiety.
Posted by GS on August 4, 1999, at 18:05:27
In reply to Re: Benzos - Dr. Bob, is GS right?, posted by Susan on August 4, 1999, at 6:32:49
> I don't know if Dr. Bob will agree but my pdoc agrees and I have been looking for collaborative documentation to alleviate the fears of family members re. benzos for insomnia and anxiety.
--------------------------------------------------
Susan,For short term insomnia benzos are OK but long term not so OK. Also, higher dosages of Benzos can interfere with sleep architecture or QUALITY of sleep, not the quantity. This is one of the larger problems that I find with benzos - not the dependence or tolerance threshold problem.
Again, a mood stabilizer such as Gabapentin (Neurontin) helps in this department a little. Actually for insomnia, Trazadone, an antidepressant, works well alone without benzos at lower than theraputic doses ...25 - 50mgs for instance at bedtime. Or a low dosage of the other sedating antidepressants such as Elavil, or for some people Serzone or Remron.
Dr. Bob?
GS
Posted by GS on August 5, 1999, at 21:08:15
In reply to Re: Benzos - Dr. Bob, is GS right?, posted by GS on August 4, 1999, at 18:05:27
> > I don't know if Dr. Bob will agree but my pdoc agrees and I have been looking for collaborative documentation to alleviate the fears of family members re. benzos for insomnia and anxiety.
> --------------------------------------------------
> Susan,
>
> For short term insomnia benzos are OK but long term not so OK. Also, higher dosages of Benzos can interfere with sleep architecture or QUALITY of sleep, not the quantity. This is one of the larger problems that I find with benzos - not the dependence or tolerance threshold problem.
>
> Again, a mood stabilizer such as Gabapentin (Neurontin) helps in this department a little. Actually for insomnia, Trazadone, an antidepressant, works well alone without benzos at lower than theraputic doses ...25 - 50mgs for instance at bedtime. Or a low dosage of the other sedating antidepressants such as Elavil, or for some people Serzone or Remron.
>
> Dr. Bob?
>
> GSControversial subject in the profession Dr. Bob?
GS
Posted by me on August 8, 1999, at 11:10:20
In reply to Re: Benzos - Dr. Bob - too contoversial ?, posted by GS on August 5, 1999, at 21:08:15
I've taken low doses of benzo's for sleep for years without any problems.
> > > I don't know if Dr. Bob will agree but my pdoc agrees and I have been looking for collaborative documentation to alleviate the fears of family members re. benzos for insomnia and anxiety.
> > --------------------------------------------------
> > Susan,
> >
> > For short term insomnia benzos are OK but long term not so OK. Also, higher dosages of Benzos can interfere with sleep architecture or QUALITY of sleep, not the quantity. This is one of the larger problems that I find with benzos - not the dependence or tolerance threshold problem.
> >
> > Again, a mood stabilizer such as Gabapentin (Neurontin) helps in this department a little. Actually for insomnia, Trazadone, an antidepressant, works well alone without benzos at lower than theraputic doses ...25 - 50mgs for instance at bedtime. Or a low dosage of the other sedating antidepressants such as Elavil, or for some people Serzone or Remron.
> >
> > Dr. Bob?
> >
> > GS
>
> Controversial subject in the profession Dr. Bob?
>
> GS
Posted by GS on August 8, 1999, at 21:27:09
In reply to Re: Benzos - Dr. Bob - too contoversial ?, posted by me on August 8, 1999, at 11:10:20
> I've taken low doses of benzo's for sleep for years without any problems.
>
>
> > > > I don't know if Dr. Bob will agree but my pdoc agrees and I have been looking for collaborative documentation to alleviate the fears of family members re. benzos for insomnia and anxiety.
> > > --------------------------------------------------
> > > Susan,
> > >
> > > For short term insomnia benzos are OK but long term not so OK. Also, higher dosages of Benzos can interfere with sleep architecture or QUALITY of sleep, not the quantity. This is one of the larger problems that I find with benzos - not the dependence or tolerance threshold problem.
> > >
> > > Again, a mood stabilizer such as Gabapentin (Neurontin) helps in this department a little. Actually for insomnia, Trazadone, an antidepressant, works well alone without benzos at lower than theraputic doses ...25 - 50mgs for instance at bedtime. Or a low dosage of the other sedating antidepressants such as Elavil, or for some people Serzone or Remron.
> > >
> > > Dr. Bob?
> > >
> > > GS
> >
> > Controversial subject in the profession Dr. Bob?
> >
> > GS
***************************************************************************************************
LOW dosages of course wouldn't disrupt the natural sleep archetecture but when treating anxiety disorders at higher dosages, it can. Treating sleep disorders with low dosages of benzos is safe and common as I understand it...as long as there is not another underlying problem causing the insomnia - either psychological or physiological.GS
Posted by Susan on August 8, 1999, at 21:50:14
In reply to Re: Benzos - Dr. Bob - too contoversial ?, posted by GS on August 8, 1999, at 21:27:09
> LOW dosages of course wouldn't disrupt the natural sleep archetecture but when treating anxiety disorders at higher dosages, it can. Treating sleep disorders with low dosages of benzos is safe and common as I understand it...as long as there is not another underlying problem causing the insomnia - either psychological or physiological.
>
> GSWhat do you consider a low dose? Is .50 mg Xanax a low dose?
Susan
Posted by Greg on August 9, 1999, at 21:47:53
In reply to Re: low dose benzos controversy, posted by Susan on August 8, 1999, at 21:50:14
>
> > LOW dosages of course wouldn't disrupt the natural sleep archetecture but when treating anxiety disorders at higher dosages, it can. Treating sleep disorders with low dosages of benzos is safe and common as I understand it...as long as there is not another underlying problem causing the insomnia - either psychological or physiological.
> >
> > GS
>
> What do you consider a low dose? Is .50 mg Xanax a low dose?
> Susan
***********************************************
Heavens Yes! You would have to be up over 2 or more mg to disrupt sleep to the point that you would notice "sleep deprivation" during the middle of the day (due to poor sleep archetechture).The problem is that 1 mg to me would't equate to 1 mg. to you. It's a highly variable thing from person to person. Just look at a table of half-lifes for just one single type of benzo and you begin to understand that the range is ENORMOUS because they are processed by each person differently.
For instance, my doc told me that 1 = 1 generally Xanax to Ativan....but when I took them it was more like .5 Xanax = 1 Ativan TO ME. I know of a friend with stage fright and is a top artist in their field that takes 5 - 6 Xanax before a performance for performance anxiety. So you see how awful a disease they have...and that's on top of a healthy dose of the sedating antidepressant Imipramine!! If I took that much, I'd probably sleep for a week. So it's by trial and error for each individual for benzos.
I think that is why it is almost an art form unto itself to prescribe and manage these things successfully...that is why they seem so "dangerous" to so many docs I think. The controversy is not at the dose and purpose for which you take them - at the higher dosages for treatment of anxiety disorders - yes there is as I mentioned in my first post on 8/4/99.
Am I making any sense Susan?GS
Posted by Paul on August 10, 1999, at 2:44:07
In reply to Re: low dose benzos controversy, posted by Greg on August 9, 1999, at 21:47:53
> >
> > > LOW dosages of course wouldn't disrupt the natural sleep archetecture but when treating anxiety disorders at higher dosages, it can. Treating sleep disorders with low dosages of benzos is safe and common as I understand it...as long as there is not another underlying problem causing the insomnia - either psychological or physiological.
> > >
> > > GS
> >
> > What do you consider a low dose? Is .50 mg Xanax a low dose?
> > Susan
> ***********************************************
> Heavens Yes! You would have to be up over 2 or more mg to disrupt sleep to the point that you would notice "sleep deprivation" during the middle of the day (due to poor sleep archetechture).
>
> The problem is that 1 mg to me would't equate to 1 mg. to you. It's a highly variable thing from person to person. Just look at a table of half-lifes for just one single type of benzo and you begin to understand that the range is ENORMOUS because they are processed by each person differently.
>
> For instance, my doc told me that 1 = 1 generally Xanax to Ativan....but when I took them it was more like .5 Xanax = 1 Ativan TO ME. I know of a friend with stage fright and is a top artist in their field that takes 5 - 6 Xanax before a performance for performance anxiety. So you see how awful a disease they have...and that's on top of a healthy dose of the sedating antidepressant Imipramine!! If I took that much, I'd probably sleep for a week. So it's by trial and error for each individual for benzos.
>
> I think that is why it is almost an art form unto itself to prescribe and manage these things successfully...that is why they seem so "dangerous" to so many docs I think. The controversy is not at the dose and purpose for which you take them - at the higher dosages for treatment of anxiety disorders - yes there is as I mentioned in my first post on 8/4/99.
> Am I making any sense Susan?
>
> GSTo GS: Thanks for your benzo. related posts. Where do you get your info. on benzos disrupting sleep quality? I'm not disputing your info., just wondering where you found it. I'm having a hell of a time taking Klonopin to function "out in the world" then crashing when I get home. It seems that Prozac may accentuate this, whereas Zoloft may not? (At least according to the info. I've read. I'd be interested in your source for sleep & benzo info & if this disruption would show up in a sleep study. Thanks, Paul
Posted by Phil on August 10, 1999, at 6:41:36
In reply to Re: low dose benzos controversy, posted by Greg on August 9, 1999, at 21:47:53
> >
> > > LOW dosages of course wouldn't disrupt the natural sleep archetecture but when treating anxiety disorders at higher dosages, it can. Treating sleep disorders with low dosages of benzos is safe and common as I understand it...as long as there is not another underlying problem causing the insomnia - either psychological or physiological.
> > >
> > > GS
> >
> > What do you consider a low dose? Is .50 mg Xanax a low dose?
> > Susan
> ***********************************************
> Heavens Yes! You would have to be up over 2 or more mg to disrupt sleep to the point that you would notice "sleep deprivation" during the middle of the day (due to poor sleep archetechture).
>
> The problem is that 1 mg to me would't equate to 1 mg. to you. It's a highly variable thing from person to person. Just look at a table of half-lifes for just one single type of benzo and you begin to understand that the range is ENORMOUS because they are processed by each person differently.
>
> For instance, my doc told me that 1 = 1 generally Xanax to Ativan....but when I took them it was more like .5 Xanax = 1 Ativan TO ME. I know of a friend with stage fright and is a top artist in their field that takes 5 - 6 Xanax before a performance for performance anxiety. So you see how awful a disease they have...and that's on top of a healthy dose of the sedating antidepressant Imipramine!! If I took that much, I'd probably sleep for a week. So it's by trial and error for each individual for benzos.
>
> I think that is why it is almost an art form unto itself to prescribe and manage these things successfully...that is why they seem so "dangerous" to so many docs I think. The controversy is not at the dose and purpose for which you take them - at the higher dosages for treatment of anxiety disorders - yes there is as I mentioned in my first post on 8/4/99.
> Am I making any sense Susan?
>
> GSHey Greg,
That artist wouldn't be Tom Waites would it? He sounds like he has taken 5 or 6 Xanax before recording, too!! Just a little humor...Phil
Posted by GS on August 12, 1999, at 20:21:17
In reply to Re: Questions for GS (Greg?), posted by Paul on August 10, 1999, at 2:44:07
> > >
> > > > LOW dosages of course wouldn't disrupt the natural sleep archetecture but when treating anxiety disorders at higher dosages, it can. Treating sleep disorders with low dosages of benzos is safe and common as I understand it...as long as there is not another underlying problem causing the insomnia - either psychological or physiological.
> > > >
> > > > GS
> > >
> > > What do you consider a low dose? Is .50 mg Xanax a low dose?
> > > Susan
> > ***********************************************
> > Heavens Yes! You would have to be up over 2 or more mg to disrupt sleep to the point that you would notice "sleep deprivation" during the middle of the day (due to poor sleep archetechture).
> >
> > The problem is that 1 mg to me would't equate to 1 mg. to you. It's a highly variable thing from person to person. Just look at a table of half-lifes for just one single type of benzo and you begin to understand that the range is ENORMOUS because they are processed by each person differently.
> >
> > For instance, my doc told me that 1 = 1 generally Xanax to Ativan....but when I took them it was more like .5 Xanax = 1 Ativan TO ME. I know of a friend with stage fright and is a top artist in their field that takes 5 - 6 Xanax before a performance for performance anxiety. So you see how awful a disease they have...and that's on top of a healthy dose of the sedating antidepressant Imipramine!! If I took that much, I'd probably sleep for a week. So it's by trial and error for each individual for benzos.
> >
> > I think that is why it is almost an art form unto itself to prescribe and manage these things successfully...that is why they seem so "dangerous" to so many docs I think. The controversy is not at the dose and purpose for which you take them - at the higher dosages for treatment of anxiety disorders - yes there is as I mentioned in my first post on 8/4/99.
> > Am I making any sense Susan?
> >
> > GS
>
> To GS: Thanks for your benzo. related posts. Where do you get your info. on benzos disrupting sleep quality? I'm not disputing your info., just wondering where you found it. I'm having a hell of a time taking Klonopin to function "out in the world" then crashing when I get home. It seems that Prozac may accentuate this, whereas Zoloft may not? (At least according to the info. I've read. I'd be interested in your source for sleep & benzo info & if this disruption would show up in a sleep study. Thanks, Paul
*************************************************A Dr. at Rush St. Lukes, a leader in psy. med. research told me of the disruption caused by benzos. Results would probably show up in a sleep study, yes. Not enough of a certain stage of sleep will cause the brain to try to "compensate" by making up for lost time so to speak. Benzos throw out of proportion these stages so I imagine that this would show up on a COMPLETE NIGHTS sleep study.
GS
Posted by GS on August 12, 1999, at 23:40:52
In reply to Re: Lorazapam - Br. Bob,am I right?, posted by GS on August 4, 1999, at 0:47:30
> > > > > How can I find out what a lethal dosage of Lorazapam is?
> > > >
> > > > Why do you ask?
> > > >
> > > > Bob
> > >
> > > James here....
> > >
> > > There is an ez answer to this, but I would like you to answer Dr. Bobs question first !
> > > I just started taking lorazapam for anxiety and am wondering how much I could take before I need to worry about phycological addition or overdose. I notice in some articles doeses of up to 10mg, while my persecription is for 1mg tablets, and I sometime take tables. but, I've noticed the effect continues to diminish.
> > > james
> ________________________________________________
> The dosage needed depends on how bad the anxiety is that you are experiencing. First, there seems to be 2 schools of thought in the psychiatric profession about benzodiazapines. To generalize, 1) Benzodiazapines are not good for long term treatment of any anxiety disorder - cognitave therapy in combo with a sedating anti-depressant(such as Serzone)should be all that is about necessary. 2)Benzos are good for long term treatment of anxiety disorders because that is what they are....anti-anxiety agents made specifically for that purpose. Just keep it well managed...especially with a short half-life benzo like Xanax or Ativan. Supplement with cognitive therapy.
> THE PROBLEM IS:
>
> The 1st group are in my opinion overrating the tolerance and dependence issues surrounding this class of drugs because of lack of understanding in prescribing and managing them. Also, misinterpretation of the PDR as well as listening to other psychiatrists with similar prejudice telling of THEIR OWN prejudice and ignorance concerning the side effects of benzos.
>
> It is a semantic argument actually. What is dependence? That if you stop taking benzos you'll become anxious again? Yes there is withdrawl involved in abruptly stopping benzos rather than tapering but does that constitute dependence? No. Yes, one can build up a tolerance to dosage but not something that can't be managed (unless they are being abused or not being taken as instructed).
>
> For instance, it doesn't take alot of imagination to know that Ativan can be managed with an augmentation of a small amount of the low or no side effect mood stabilizer Neurontin (900 - 1200mg)to help with Ativan going in and out of
> the system therefore aleviating the drug induced anxiety.
> Also, keep the Ativan at a constant level whether it is 2 or 6 or I've read up to 10 mgs. daily...whatever allows you to function the way you need to without the affliction of an anxiety disorder! That is the whole point! So what if you take 3 -4 mgs or 5 -6 mgs. a day! Does it in conjunction with cognative therapy techniques alleviate your anxiety disorder?
> Don't be scared off by the argument that you are addicted to benzos when benzos are what stops the disease that you're afflicted with! A non -prejudicial psychopharmacologist will help manage your suffering and allay your unfounded fears of addiction that are imposed upon you by the first group of psychiatrists mentioned above. The point is, get the ball in the hole. Until these prejudiced doctors stop heaping these needlessly anxiety - provoking "facts" there will continue to be your type of sad questions worried about by many, many patients in need of relief.
>
> If you have an anxiety disorder, you take inti-anxiety drugs (until the purists come up with something THAT WORKS for you with less side effects).
>
> Am I pretty much on target Dr. Bob? (assuming that she has a properly diagnosed anxiety disorder).
>
> GS
*******************************************Well Dr. Bob, what do you think about my above post regarding the 2 schools of thought re: treatment of anxiety disorders with benzos??????????
Posted by Paul on August 14, 1999, at 1:55:14
In reply to Re: Questions for GS , posted by GS on August 12, 1999, at 20:21:17
> > > >
> > > > > LOW dosages of course wouldn't disrupt the natural sleep archetecture but when treating anxiety disorders at higher dosages, it can. Treating sleep disorders with low dosages of benzos is safe and common as I understand it...as long as there is not another underlying problem causing the insomnia - either psychological or physiological.
> > > > >
> > > > > GS
> > > >
> > > > What do you consider a low dose? Is .50 mg Xanax a low dose?
> > > > Susan
> > > ***********************************************
> > > Heavens Yes! You would have to be up over 2 or more mg to disrupt sleep to the point that you would notice "sleep deprivation" during the middle of the day (due to poor sleep archetechture).
> > >
> > > The problem is that 1 mg to me would't equate to 1 mg. to you. It's a highly variable thing from person to person. Just look at a table of half-lifes for just one single type of benzo and you begin to understand that the range is ENORMOUS because they are processed by each person differently.
> > >
> > > For instance, my doc told me that 1 = 1 generally Xanax to Ativan....but when I took them it was more like .5 Xanax = 1 Ativan TO ME. I know of a friend with stage fright and is a top artist in their field that takes 5 - 6 Xanax before a performance for performance anxiety. So you see how awful a disease they have...and that's on top of a healthy dose of the sedating antidepressant Imipramine!! If I took that much, I'd probably sleep for a week. So it's by trial and error for each individual for benzos.
> > >
> > > I think that is why it is almost an art form unto itself to prescribe and manage these things successfully...that is why they seem so "dangerous" to so many docs I think. The controversy is not at the dose and purpose for which you take them - at the higher dosages for treatment of anxiety disorders - yes there is as I mentioned in my first post on 8/4/99.
> > > Am I making any sense Susan?
> > >
> > > GS
> >
> > To GS: Thanks for your benzo. related posts. Where do you get your info. on benzos disrupting sleep quality? I'm not disputing your info., just wondering where you found it. I'm having a hell of a time taking Klonopin to function "out in the world" then crashing when I get home. It seems that Prozac may accentuate this, whereas Zoloft may not? (At least according to the info. I've read. I'd be interested in your source for sleep & benzo info & if this disruption would show up in a sleep study. Thanks, Paul
> *************************************************
>
> A Dr. at Rush St. Lukes, a leader in psy. med. research told me of the disruption caused by benzos. Results would probably show up in a sleep study, yes. Not enough of a certain stage of sleep will cause the brain to try to "compensate" by making up for lost time so to speak. Benzos throw out of proportion these stages so I imagine that this would show up on a COMPLETE NIGHTS sleep study.
>
> GSThanks a lot for the info GS. I'm going to get on Medline tomorrow and try to find some research articles. I've been on Prozac and Klonopin for 10+ years now, and have had great problems with fatigue, especially after my doc. added Effexor. This effect of the benzos seems strange seeing that many seem to be successfully prescribed for sleep disorders. I'm only recently learning of the SSRI's disruption/elimination of REM stage sleep. Could this be the reason that so many people experience fatigue, memory, and word finding difficulties on these meds? But then again, many experience increased energy. I wish I could find a site where patients could get knowledgeable answers from docs online. I realize that Dr. Bob will occasionally answer a question on this site, but only about 10%. I'm sure he's barely got time to answer these. It seems that psychiatry is the toughest specialty to find a competent practitioner in. I think lower pay, managed care probably explains that. I've found many professionals hesitant to give an online opinion because of the possibility of a lawsuit, but hell, I'll sign a waiver. Thanks again GS, and all other contributors for their helpful advice. I'll try to pass on any more info. I find on this topic. Paul
Posted by Paul on August 14, 1999, at 2:11:20
In reply to Re: Lorazapam - Br. Bob, Please comment, posted by GS on August 12, 1999, at 23:40:52
> > > > > > How can I find out what a lethal dosage of Lorazapam is?
> > > > >
> > > > > Why do you ask?
> > > > >
> > > > > Bob
> > > >
> > > > James here....
> > > >
> > > > There is an ez answer to this, but I would like you to answer Dr. Bobs question first !
> > > > I just started taking lorazapam for anxiety and am wondering how much I could take before I need to worry about phycological addition or overdose. I notice in some articles doeses of up to 10mg, while my persecription is for 1mg tablets, and I sometime take tables. but, I've noticed the effect continues to diminish.
> > > > james
> > ________________________________________________
> > The dosage needed depends on how bad the anxiety is that you are experiencing. First, there seems to be 2 schools of thought in the psychiatric profession about benzodiazapines. To generalize, 1) Benzodiazapines are not good for long term treatment of any anxiety disorder - cognitave therapy in combo with a sedating anti-depressant(such as Serzone)should be all that is about necessary. 2)Benzos are good for long term treatment of anxiety disorders because that is what they are....anti-anxiety agents made specifically for that purpose. Just keep it well managed...especially with a short half-life benzo like Xanax or Ativan. Supplement with cognitive therapy.
> > THE PROBLEM IS:
> >
> > The 1st group are in my opinion overrating the tolerance and dependence issues surrounding this class of drugs because of lack of understanding in prescribing and managing them. Also, misinterpretation of the PDR as well as listening to other psychiatrists with similar prejudice telling of THEIR OWN prejudice and ignorance concerning the side effects of benzos.
> >
> > It is a semantic argument actually. What is dependence? That if you stop taking benzos you'll become anxious again? Yes there is withdrawl involved in abruptly stopping benzos rather than tapering but does that constitute dependence? No. Yes, one can build up a tolerance to dosage but not something that can't be managed (unless they are being abused or not being taken as instructed).
> >
> > For instance, it doesn't take alot of imagination to know that Ativan can be managed with an augmentation of a small amount of the low or no side effect mood stabilizer Neurontin (900 - 1200mg)to help with Ativan going in and out of
> > the system therefore aleviating the drug induced anxiety.
> > Also, keep the Ativan at a constant level whether it is 2 or 6 or I've read up to 10 mgs. daily...whatever allows you to function the way you need to without the affliction of an anxiety disorder! That is the whole point! So what if you take 3 -4 mgs or 5 -6 mgs. a day! Does it in conjunction with cognative therapy techniques alleviate your anxiety disorder?
> > Don't be scared off by the argument that you are addicted to benzos when benzos are what stops the disease that you're afflicted with! A non -prejudicial psychopharmacologist will help manage your suffering and allay your unfounded fears of addiction that are imposed upon you by the first group of psychiatrists mentioned above. The point is, get the ball in the hole. Until these prejudiced doctors stop heaping these needlessly anxiety - provoking "facts" there will continue to be your type of sad questions worried about by many, many patients in need of relief.
> >
> > If you have an anxiety disorder, you take inti-anxiety drugs (until the purists come up with something THAT WORKS for you with less side effects).
> >
> > Am I pretty much on target Dr. Bob? (assuming that she has a properly diagnosed anxiety disorder).
> >
> > GS
> *******************************************
>
> Well Dr. Bob, what do you think about my above post regarding the 2 schools of thought re: treatment of anxiety disorders with benzos??????????All your info seems to be confirmed in a book I just picked up Panic Disorder, The Medical Point of View by William Kernodle. He cites an APA Task Force study from 1990 which basically denounces this benzodiazepene stigma. It seems similar to deriding a diabetic for becoming "addicted" to insulin. At least in GA. this ignorance is fueled by our state medical board which monitors benzos and stimulant prescriptions like they're crack. Seems like many docs are running scared, i.e. reluctant to prescribe benzos and/or stimulants because of this oversight. I too would like to hear what Dr. Bob's opinion on this issue is. Thanks for the post. Paul
Posted by Dr. Bob on August 14, 1999, at 11:56:14
In reply to Re: Lorazapam - Br. Bob,am I right?, posted by GS on August 4, 1999, at 0:47:30
> there seems to be 2 schools of thought in the psychiatric profession about benzodiazapines. To generalize, 1) Benzodiazapines are not good for long term treatment of any anxiety disorder
> 2)Benzos are good for long term treatment of anxiety disorders
> THE PROBLEM IS:
>
> The 1st group are in my opinion overrating the tolerance and dependence issues surrounding this class of drugs because of lack of understanding in prescribing and managing them.Yes, those are two sides of the benzodiazepine issue, and the 1st group may sometimes overestimate the risks. OTOH, the 2nd group may sometimes underestimate the risks, too...
Bob
Posted by GS on August 14, 1999, at 14:33:26
In reply to Re: Lorazapam - right enough, posted by Dr. Bob on August 14, 1999, at 11:56:14
> > there seems to be 2 schools of thought in the psychiatric profession about benzodiazapines. To generalize, 1) Benzodiazapines are not good for long term treatment of any anxiety disorder
>
> > 2)Benzos are good for long term treatment of anxiety disorders
>
> > THE PROBLEM IS:
> >
> > The 1st group are in my opinion overrating the tolerance and dependence issues surrounding this class of drugs because of lack of understanding in prescribing and managing them.
>
> Yes, those are two sides of the benzodiazepine issue, and the 1st group may sometimes overestimate the risks. OTOH, the 2nd group may sometimes underestimate the risks, too...
>
> Bob
************************************************The underestimation of risk would be from the ill informed
practitioners from the first group (the under educated, biased, and poor managers) not the second! If not for the skill and knowledge of group two, there wouldn't even be a debate about the issue. They're the ones battling ignorance and underestimation!
If a psychopharmacologist is worth their salt, they will have taken TIME to manage and oversee benzos properly (looking for drug seeking behaivors, quizzing the patient about QUALITY of sleep, having them keep mood/sleep logs, knowing whether or not there is an accurate diagnosis in the first place, etc.)
I don't understand your post frankly. My FULL POSTED description of group 2 did not include doctors that irresponsibly prescribe - underestimating benzos problems....quite the opposite!GS
Posted by Paul on August 14, 1999, at 16:21:12
In reply to Re: Lorazapam - Sorry but you're wrong, posted by GS on August 14, 1999, at 14:33:26
> > > there seems to be 2 schools of thought in the psychiatric profession about benzodiazapines. To generalize, 1) Benzodiazapines are not good for long term treatment of any anxiety disorder
> >
> > > 2)Benzos are good for long term treatment of anxiety disorders
> >
> > > THE PROBLEM IS:
> > >
> > > The 1st group are in my opinion overrating the tolerance and dependence issues surrounding this class of drugs because of lack of understanding in prescribing and managing them.
> >
> > Yes, those are two sides of the benzodiazepine issue, and the 1st group may sometimes overestimate the risks. OTOH, the 2nd group may sometimes underestimate the risks, too...
> >
> > Bob
> ************************************************
>
> The underestimation of risk would be from the ill informed
> practitioners from the first group (the under educated, biased, and poor managers) not the second! If not for the skill and knowledge of group two, there wouldn't even be a debate about the issue. They're the ones battling ignorance and underestimation!
> If a psychopharmacologist is worth their salt, they will have taken TIME to manage and oversee benzos properly (looking for drug seeking behaivors, quizzing the patient about QUALITY of sleep, having them keep mood/sleep logs, knowing whether or not there is an accurate diagnosis in the first place, etc.)
> I don't understand your post frankly. My FULL POSTED description of group 2 did not include doctors that irresponsibly prescribe - underestimating benzos problems....quite the opposite!
>
> GS
Sounds like this one was a little too controversial for Dr. Bob to give us an opinion on. But quoting Dr. Robert Dupont, former director of the National Institute of Alcoholism and Drug Abuse,he states:"I have yet to see a patient become addicted to benzodiazepenes without a history of substance abuse. Dr. Dupont suggests "the concept of using the lowest possible dose of a benzodiazepine for the shortest period of time is inconsistent with sound clinical practice. This concept needs to include the important qualification that our goal is to maximize the patient's ability to function well and to enjoy life. Benzodiazepenes are among the safest and most effective treatments in all of medicine, including their role in the treatment of anxiety disorder." Amen
Posted by GS on August 14, 1999, at 18:26:42
In reply to Re: Lorazapam - Sorry but you're wrong, posted by Paul on August 14, 1999, at 16:21:12
> > > > there seems to be 2 schools of thought in the psychiatric profession about benzodiazapines. To generalize, 1) Benzodiazapines are not good for long term treatment of any anxiety disorder
> > >
> > > > 2)Benzos are good for long term treatment of anxiety disorders
> > >
> > > > THE PROBLEM IS:
> > > >
> > > > The 1st group are in my opinion overrating the tolerance and dependence issues surrounding this class of drugs because of lack of understanding in prescribing and managing them.
> > >
> > > Yes, those are two sides of the benzodiazepine issue, and the 1st group may sometimes overestimate the risks. OTOH, the 2nd group may sometimes underestimate the risks, too...
> > >
> > > Bob
> > ************************************************
> >
> > The underestimation of risk would be from the ill informed
> > practitioners from the first group (the under educated, biased, and poor managers) not the second! If not for the skill and knowledge of group two, there wouldn't even be a debate about the issue. They're the ones battling ignorance and underestimation!
> > If a psychopharmacologist is worth their salt, they will have taken TIME to manage and oversee benzos properly (looking for drug seeking behaivors, quizzing the patient about QUALITY of sleep, having them keep mood/sleep logs, knowing whether or not there is an accurate diagnosis in the first place, etc.)
> > I don't understand your post frankly. My FULL POSTED description of group 2 did not include doctors that irresponsibly prescribe - underestimating benzos problems....quite the opposite!
> >
> > GS
> Sounds like this one was a little too controversial for Dr. Bob to give us an opinion on. But quoting Dr. Robert Dupont, former director of the National Institute of Alcoholism and Drug Abuse,he states:"I have yet to see a patient become addicted to benzodiazepenes without a history of substance abuse. Dr. Dupont suggests "the concept of using the lowest possible dose of a benzodiazepine for the shortest period of time is inconsistent with sound clinical practice. This concept needs to include the important qualification that our goal is to maximize the patient's ability to function well and to enjoy life. Benzodiazepenes are among the safest and most effective treatments in all of medicine, including their role in the treatment of anxiety disorder." Amen
**********************************************
Of course. When I was being scared half to death from a psy doc who kept refusing to treat me properly, creating more anxiety about the drug than the actual disorder, it created needless suffering for years! And he was a well respected head of a major university's psy program having recently graduated from the very institution that is at the forefront of psy drug research - Rush St. Lukes! Shows it can happen anywhere.
I now am being treated with respect and care by another doc that knows what's going on because I feel better and function better than ever. As he says, just get the ball in the hole!He trusts my self evaluations.
This is my 3rd Psy doc and we finally have it right. As you may be able to tell, I have alot of resentment for the needless suffering and lost happiness over those years.
If you read my original post of 8/4 about the subject, it is the one that is complete and not cut and pasted out of context.GS
Posted by Paul on August 14, 1999, at 22:37:51
In reply to Re: Lorazapam - Sorry but you're wrong, posted by GS on August 14, 1999, at 18:26:42
> > > > > there seems to be 2 schools of thought in the psychiatric profession about benzodiazapines. To generalize, 1) Benzodiazapines are not good for long term treatment of any anxiety disorder
> > > >
> > > > > 2)Benzos are good for long term treatment of anxiety disorders
> > > >
> > > > > THE PROBLEM IS:
> > > > >
> > > > > The 1st group are in my opinion overrating the tolerance and dependence issues surrounding this class of drugs because of lack of understanding in prescribing and managing them.
> > > >
> > > > Yes, those are two sides of the benzodiazepine issue, and the 1st group may sometimes overestimate the risks. OTOH, the 2nd group may sometimes underestimate the risks, too...
> > > >
> > > > Bob
> > > ************************************************
> > >
> > > The underestimation of risk would be from the ill informed
> > > practitioners from the first group (the under educated, biased, and poor managers) not the second! If not for the skill and knowledge of group two, there wouldn't even be a debate about the issue. They're the ones battling ignorance and underestimation!
> > > If a psychopharmacologist is worth their salt, they will have taken TIME to manage and oversee benzos properly (looking for drug seeking behaivors, quizzing the patient about QUALITY of sleep, having them keep mood/sleep logs, knowing whether or not there is an accurate diagnosis in the first place, etc.)
> > > I don't understand your post frankly. My FULL POSTED description of group 2 did not include doctors that irresponsibly prescribe - underestimating benzos problems....quite the opposite!
> > >
> > > GS
> > Sounds like this one was a little too controversial for Dr. Bob to give us an opinion on. But quoting Dr. Robert Dupont, former director of the National Institute of Alcoholism and Drug Abuse,he states:"I have yet to see a patient become addicted to benzodiazepenes without a history of substance abuse. Dr. Dupont suggests "the concept of using the lowest possible dose of a benzodiazepine for the shortest period of time is inconsistent with sound clinical practice. This concept needs to include the important qualification that our goal is to maximize the patient's ability to function well and to enjoy life. Benzodiazepenes are among the safest and most effective treatments in all of medicine, including their role in the treatment of anxiety disorder." Amen
> **********************************************
> Of course. When I was being scared half to death from a psy doc who kept refusing to treat me properly, creating more anxiety about the drug than the actual disorder, it created needless suffering for years! And he was a well respected head of a major university's psy program having recently graduated from the very institution that is at the forefront of psy drug research - Rush St. Lukes! Shows it can happen anywhere.
> I now am being treated with respect and care by another doc that knows what's going on because I feel better and function better than ever. As he says, just get the ball in the hole!He trusts my self evaluations.
> This is my 3rd Psy doc and we finally have it right. As you may be able to tell, I have alot of resentment for the needless suffering and lost happiness over those years.
> If you read my original post of 8/4 about the subject, it is the one that is complete and not cut and pasted out of context.
>
> GS
Glad that you were able to find adequate help. I had a visit with my current doc. last week and he didn't even know what I was taking! I had sent him a fax two weeks before our appointment to express some concerns about side effects, and he informed me that he didn't read any faxes that are over a page! My fax was like a page and a half. And this guy is board certified, and a UCLA med school grad. I'm definitely changing docs, but I feel that I have the moral obligation to report this guy to the APA, or do something before he kills somebody. I could have had a suicide/homicicidal threat in the faxes he received, but didn't have 3-5 minutes(max) to read.I also have no insurance currently. It seems that prisoners get far better psychiatric care, and other medical care than the uninsured. I'm currently in grad. school, and don't have the $$ for insurance. Well, I've got modest coverage, but psych. care would be considered "pre-existing". Perhaps the only good thing to come out of this summer of violence, may be increased funding for community mental health. GA plans to cut our gutted system by another 20% next year. Something's gotta give!
Thanks for all your knowledgeable, informative posts. Paul
Posted by alan on August 15, 1999, at 4:33:06
In reply to Re: Lorazapam - right enough, posted by Dr. Bob on August 14, 1999, at 11:56:14
With some trepidation:
It must be borne in mind that our society has for many years been in the grip of a drug hysteria
which hinders rational thought about any drug with with abuse potential. It has been extreme enough to prevent terminal patients from geting adequate pain relief! Physicians are not immune.
Because of said hystria, physicians must protect themselves, sometimes at cost to the patient.
Finally, the 'recovery community' has had a great deal of influence. But it is dominated by people who have little interest in science, and often downright hostility. It seems to largely derive from AA which is basically a cult, tho a cult that seems to work for many people, perhaps precisely because it is a cult.
Posted by Susan on August 15, 1999, at 19:20:22
In reply to Re: Lorazapam - right enough, posted by alan on August 15, 1999, at 4:33:06
> With some trepidation:
> It must be borne in mind that our society has for many years been in the grip of a drug hysteria
> which hinders rational thought about any drug with with abuse potential. It has been extreme enough to prevent terminal patients from geting adequate pain relief! Physicians are not immune.
> Because of said hystria, physicians must protect themselves, sometimes at cost to the patient.
> Finally, the 'recovery community' has had a great deal of influence. But it is dominated by people who have little interest in science, and often downright hostility. It seems to largely derive from AA which is basically a cult, tho a cult that seems to work for many people, perhaps precisely because it is a cult.Alan, are you referring to Alcoholics Anonymous as a cult?
Posted by GS on August 16, 1999, at 10:43:11
In reply to Re: Lorazapam - Br. Bob,am I right?, posted by GS on August 4, 1999, at 0:47:30
> > > > > How can I find out what a lethal dosage of Lorazapam is?
> > > >
> > > > Why do you ask?
> > > >
> > > > Bob
> > >
> > > James here....
> > >
> > > There is an ez answer to this, but I would like you to answer Dr. Bobs question first !
> > > I just started taking lorazapam for anxiety and am wondering how much I could take before I need to worry about phycological addition or overdose. I notice in some articles doeses of up to 10mg, while my persecription is for 1mg tablets, and I sometime take tables. but, I've noticed the effect continues to diminish.
> > > james
> ________________________________________________
> The dosage needed depends on how bad the anxiety is that you are experiencing. First, there seems to be 2 schools of thought in the psychiatric profession about benzodiazapines. To generalize, 1) Benzodiazapines are not good for long term treatment of any anxiety disorder - cognitave therapy in combo with a sedating anti-depressant(such as Serzone)should be all that is about necessary. 2)Benzos are good for long term treatment of anxiety disorders because that is what they are....anti-anxiety agents made specifically for that purpose. Just keep it well managed...especially with a short half-life benzo like Xanax or Ativan. Supplement with cognitive therapy.
> THE PROBLEM IS:
>
> The 1st group are in my opinion overrating the tolerance and dependence issues surrounding this class of drugs because of lack of understanding in prescribing and managing them. Also, misinterpretation of the PDR as well as listening to other psychiatrists with similar prejudice telling of THEIR OWN prejudice and ignorance concerning the side effects of benzos.
>
> It is a semantic argument actually. What is dependence? That if you stop taking benzos you'll become anxious again? Yes there is withdrawl involved in abruptly stopping benzos rather than tapering but does that constitute dependence? No. Yes, one can build up a tolerance to dosage but not something that can't be managed (unless they are being abused or not being taken as instructed).
>
> For instance, it doesn't take alot of imagination to know that Ativan can be managed with an augmentation of a small amount of the low or no side effect mood stabilizer Neurontin (900 - 1200mg)to help with Ativan going in and out of
> the system therefore aleviating the drug induced anxiety.
> Also, keep the Ativan at a constant level whether it is 2 or 6 or I've read up to 10 mgs. daily...whatever allows you to function the way you need to without the affliction of an anxiety disorder! That is the whole point! So what if you take 3 -4 mgs or 5 -6 mgs. a day! Does it in conjunction with cognative therapy techniques alleviate your anxiety disorder?
> Don't be scared off by the argument that you are addicted to benzos when benzos are what stops the disease that you're afflicted with! A non -prejudicial psychopharmacologist will help manage your suffering and allay your unfounded fears of addiction that are imposed upon you by the first group of psychiatrists mentioned above. The point is, get the ball in the hole. Until these prejudiced doctors stop heaping these needlessly anxiety - provoking "facts" there will continue to be your type of sad questions worried about by many, many patients in need of relief.
>
> If you have an anxiety disorder, you take inti-anxiety drugs (until the purists come up with something THAT WORKS for you with less side effects).
>
> Am I pretty much on target Dr. Bob? (assuming that she has a properly diagnosed anxiety disorder).
>
> GS
*******************************************************
Any comments, similar experiences with this issue surrounding benzos.....Dr.s , patients??GS
Posted by Elizabeth on August 16, 1999, at 20:34:34
In reply to Re: Lorazapam - right enough, posted by Dr. Bob on August 14, 1999, at 11:56:14
> Yes, those are two sides of the benzodiazepine issue, and the 1st group may sometimes overestimate the risks. OTOH, the 2nd group may sometimes underestimate the risks, too...
I have a question, Dr. Bob: have you ever seen any problems with the long-term use of benzodiazepines for anxiety disorders (as opposed to, say, insomnia)?
According to the studies I've seen, patients treated for anxiety disorders with benzos rarely, if ever, abuse their medication, so that's why I'm asking.
Posted by Dr. Bob on August 17, 1999, at 21:07:54
In reply to bzd risks - q for Dr. Bob, posted by Elizabeth on August 16, 1999, at 20:34:34
> > Yes, those are two sides of the benzodiazepine issue, and the 1st group may sometimes overestimate the risks. OTOH, the 2nd group may sometimes underestimate the risks, too...
>
> I have a question, Dr. Bob: have you ever seen any problems with the long-term use of benzodiazepines for anxiety disorders (as opposed to, say, insomnia)?
>
> According to the studies I've seen, patients treated for anxiety disorders with benzos rarely, if ever, abuse their medication, so that's why I'm asking.There have been times when I've wondered, but there haven't (yet) been any when I've been sure. Of course, that doesn't mean there aren't any risks. Maybe I've just been lucky.
Bob
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