Alternatives To Xanax

[girlx]

is CBT cognitive behavioral therapy or something else?

[mrtoad]

is CBT cognitive behavioral therapy or something else?

Yes, it is...and it can be very effective for those with anxiety disorders.

[girlx]

hmm i think it is the same concept in yoga or buddhist meditation.

[Sheryl]

In addition to the risks of addiction, another problem with self-prescribing a pyschotropic drug is that, in my experience, many people do not select the correct type of drug for the specific problem that they have. As with physical disease, emotional problems come in many forms and need to be correctly diagnosed before they can be appropriately treated. For example, I have seen many cases of people self-treating with xanax for what was realy a depressive disorder..for which xanax is contraindicated. Naturally they don't get the relief they seek from therapeutic doses but rather than realizing the remedy doesn't fit the ailment they up the dose....setting in motion the wheels of addiction and misuse. Of course, if enough is taken the person will be so zonked out that they'll feel almost nothing but that doesn't mean the depression has lifted.

Another common mistake is to take an anti-depressent for what is actually bipolar disorder, in turn triggering an episode of mania..or taking an anti-depressetn for what is actually anxiety...or a mixed depression-anxiety state.

Reaching the correct diagnosis for a psychological problem can be difficult even for trained professionals. The chances of the patient doing it correctly, and being able to accurately evaluate the response to the medication, aren't very good. For this reason, as well as the fact that not all problems warrant medication and even those that do will respond best if medication is combined with some type of therapy, it is highly advisable to get professional help rather than self-medicating.

If one insists on self-treating, at least make use of the various tools for self-diagnosis which are available online and do some serious reading up on the different medications and their indications.

Be sure to avoid addictive drugs if you have a history of substance abuse of any kind. Some people are intrinsically more susceptible to dependency than others.

And keep in mind that if the therapeutic dosage of a drug does not give the desired result, it is an indication that it is the wrong drug for you -- not that you need to up the dosage.

Edited July 10, 2007 by Sheryl

[Youbloodybeauty]

i have generalized anxiety disorder

Hi girlx,

If you are concerned about the "physical symptoms" of anxiety there are beta-blockers.

Propranolol (Inderal) helps with the physical side only.

These are OTC in Thailand but should be prescribed as they can especially effect people with asthma. Not addictive AFAIK.

Propranolol blocks adrenaline, and prevents it from increasing heart rate, blood pressure, and oxygen use. It effectively reduces autonomic nervous system arousal (e.g. anxiety symptoms, palpitations, hyperventilation, sweating, pounding heartbeat, nausea, shaking).

There are people who are against taking "drugs" but everyone is different finding their own way with this disorder.

Support

Myths About Benzodiazepines:

* "Benzodiazepines are addictive": FALSE for non drug addicts with anxiety disorders.

* "Benzodiazepines are hard to quit": FALSE (for SP, not GAD). Taper slow.

* "Benzodiazepine dose keeps escalating": FALSE. Dose stabilizes after a few months with continued efficacy.

from http://www.socialfear.com/

Edited July 10, 2007 by Youbloodybeauty

[Neeranam]

Myths About Benzodiazepines:

* "Benzodiazepines are addictive": FALSE for non drug addicts with anxiety disorders.

* "Benzodiazepines are hard to quit": FALSE (for SP, not GAD). Taper slow

Absolute, total bulls***!!

Unbelievable - do you actually believe this?

[mrtoad]

Myths About Benzodiazepines:

* "Benzodiazepines are addictive": FALSE for non drug addicts with anxiety disorders.

* "Benzodiazepines are hard to quit": FALSE (for SP, not GAD). Taper slow

Absolute, total bulls***!!

Unbelievable - do you actually believe this?

No, not from my 12 years experience as an RMN.

[Huw]

i have generalized anxiety disorder and was prescribed xanax about 5 years ago by my doctor at home. i rarely use it unless i am really stressed out, and still have a couple pills left from that time (which probably have expired now). recently i have been under more stress than usual and have been thinking of ways to treat it. i tried to get a new prescription of xanax from a clinic near me but they treated me like a drug addict, and i doubt i will find the real version at an pharmacy outside of the hospital. so i have been looking at alternatives... thus far i have tried passion flower capsules, which a pharmacist in malaysia recommended to me. it actually worked pretty well to calm me down but i bought a small bottle and haven't been able to find more around here. i have tried valerian as well (another herb) but that didn't really work at all. i have also tried yoga (been doing it for a year) and that works really well, when i have time to do it (which is rarely these days as i am overwhelmed by work and personal crises). any other suggestions? thanks for any help.

Sorry to dive into this so late.

generalised anxiety disorder that is intermittent?

I would be prepared to bet the answer is to be found elsewhere. I notice a couple of posters have recommended hypnotherapy but unless it is combined with psychotherapy, it may not be useful.

I have heard good things about passiflora in certain mild cases but it isn't something that would be a good option for severe anxiety. Also I have no idea where to get it in BKK. Can you not get it sent from UK or via internet?

H

[Sheryl]

Well now that we seem to be moving back to the OP's dilemma and away from bickering about Xanax...Girlx:

1) What dose of atarax did you try? The dosage can go as high as 100mg for acute anxiety. Be warned though that 100mg will knock you out unless you are in fact flooded with adrenaline. Many, many years ago after an attempted rape I was prescribed and took 100mg of Vistaril (essentially same thing as Atarax) every 4 hours for about a week. It worked well and did not overly sedate me but even 25mg now will make me very sleepy, as I am not in a severely anxious state. Anyhow you might try a higher dose, but don't do it before having to work or drive.

2) Anxiety is an alarm signal and I really think you would benefit from some short-term therapy, see resources posted here.

3) For Vipassana mediation, which will definitely help, see www.dhamma.org

Good luck

[Youbloodybeauty]

Myths About Benzodiazepines:

* "Benzodiazepines are addictive": FALSE for non drug addicts with anxiety disorders.

* "Benzodiazepines are hard to quit": FALSE (for SP, not GAD). Taper slow

Absolute, total bulls***!!

Unbelievable - do you actually believe this?

Ummm, maybe the abuse has effected something? I didn't type with the idea of not believing it

From my perspective, the first one above most definately. People CAN be responsible about taking them. Regularily is another story yes - notice above "for SP, not GAD".

No, not from my 12 years experience as an RMN.

Those who takes them responsibly, are they your experience? What's the ratio 100:1?

Cheers YBB

[mrtoad]

Myths About Benzodiazepines:

* "Benzodiazepines are addictive": FALSE for non drug addicts with anxiety disorders.

* "Benzodiazepines are hard to quit": FALSE (for SP, not GAD). Taper slow

Absolute, total bulls***!!

Unbelievable - do you actually believe this?

Ummm, maybe the abuse has effected something? I didn't type with the idea of not believing it

From my perspective, the first one above most definately. People CAN be responsible about taking them. Regularily is another story yes - notice above "for SP, not GAD".

No, not from my 12 years experience as an RMN.

Those who takes them responsibly, are they your experience? What's the ratio 100:1?

Cheers YBB

YBB,

That is part of the problem. More often than not people do not take them responsibily. They use the tablet to aleviate the symptoms, rather than learn to deal with causes of the symptoms.PRN prescribing is extremmely effective if used correctly, all to often patients in the community do not follow the guidelines. Hence, proactive therapy, i.e. building problem solving skills along with medication is a far more effective route.

I think though that we should also look at how different medications affect different people. There is some new research that has been undertaken in the past 12 months that suggests that within the next 2-3 years Dr's will be able to prescribe meds for MI based on information gained from taking blood, so that in the end will put an end to what can loosely be termed as general prescrbing. I would imagine from your post that you know most DR's follow a particullar prescribing plan until they find the most suitable medication. Hopefully, with these advancements DR's will be able to get it right at the beginning and alleviate a lot of the suffering that people with these disorders endure. (I apologise, that I haven't got the exact details of the research paper to quote as I'm not at home at present).

Sorry

for missing out on the note regarding GAD and SP, hence my rather brief initial post.

Edited July 11, 2007 by mrtoad

[Neeranam]

Myths About Benzodiazepines:

* "Benzodiazepines are addictive": FALSE for non drug addicts with anxiety disorders.

* "Benzodiazepines are hard to quit": FALSE (for SP, not GAD). Taper slow

Absolute, total bulls***!!

Unbelievable - do you actually believe this?

Ummm, maybe the abuse has effected something? I didn't type with the idea of not believing it

From my perspective, the first one above most definately. People CAN be responsible about taking them. Regularily is another story yes - notice above "for SP, not GAD".

No, not from my 12 years experience as an RMN.

Those who takes them responsibly, are they your experience? What's the ratio 100:1?

Cheers YBB

YBB, are you on drugs?

Benzos are addictive, period. Would you like me to give you some links to proper, medical websites?

[Youbloodybeauty]

YBB, are you on drugs?

Do you have the discipline not to become addicted? Compare it to alcohol Neeranam, some people can't get enough and other have a glass now and then without becoming addicted.

Benzos are addictive, period.

Yep, so are many things including gambling, doesn't mean everyone does not have the will/discipline/responsibilty to stick a coin in and walk away.

Would you like me to give you some links to proper, medical websites?

[Neeranam]

Do you have the discipline not to become addicted? Compare it to alcohol Neeranam, some people can't get enough and other have a glass now and then without becoming addicted.

Benzos are addictive, period.

Now you're saying alcoholism is lack of discipline or will-power?

The Committee on Safety of Medicines recommends that the use of benzodiazepines should be limited in the following ways:

USES

As Anxiolytics

Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling or subjecting the individual to unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic or psychotic illness.

The use of benzodiazepines to treat short-term 'mild' anxiety is inappropriate and unsuitable.

As Hypnotics

Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or subjecting the individual to extreme distress.

DOSE

The lowest dose which can control the symptoms should be used. It should not be continued beyond four weeks.

Long-term chronic use is not recommended.

Treatment should always be tapered off gradually.

Patients who have taken benzodiazepines for a long time may require a longer period during which doses are reduced.

When a benzodiazepine is used as a hypnotic, treatment should, if possible, be intermittent.

PRECAUTIONS

Benzodiazepines should not be used alone to treat depression or anxiety associated with depression. Suicide may be precipitated in such patients.

They should not be used for phobic or obsessional states.

They should not be used for the treatment of chronic psychosis.

In cases of loss or bereavement, psychological adjustment may be inhibited by benzodiazepines.

Disinhibiting effects may be manifested in various ways. Suicide may be precipitated in patients who are depressed, and aggressive behaviour towards self and others may be precipitated. Extreme caution should therefore be used in prescribing benzodiazepines in patients with personality disorders.

--------------------------------------------------------------------------------

[Youbloodybeauty]

Now you're saying alcoholism is lack of discipline or will-power?

Amongst others yes. Alcoholism points to concerns such as a preoccupation with or compulsion toward the consumption of alcohol, and/or an impaired ability to recognize the overall negative effects of excessive alcohol consumption.

USES, DOSE, PRECAUTIONS. - exactly.

* "Benzodiazepines are addictive": FALSE for non drug addicts with anxiety disorders.

drug addicts = "Long-term chronic use is not recommended"

* "Benzodiazepines are hard to quit": FALSE (for SP, not GAD). Taper slow.

for SP = "USES - As Anxiolytics".

Taper slow = "Patients who have taken benzodiazepines for a long time may require a longer period during which doses are reduced".

Agreed and seems you didn't comprehend those basic myths from the outset.

[Neeranam]

QUOTE(Neeranam @ 2007-07-13 22:20:36)

Now you're saying alcoholism is lack of discipline or will-power?

Amongst others yes. Alcoholism points to concerns such as a preoccupation with or compulsion toward the consumption of alcohol, and/or an impaired ability to recognize the overall negative effects of excessive alcohol consumption.

It seems that you know better than the The American Psychiatric , American Medical Association, American Public Health Association, the National Association of Social Workers, the World Health Organization and the American College of Physicians, who say alcoholism is a disease. Maybe you do, why not write to them and tell them to use will-power lessons to beat that disease.

[Neeranam]

* "Benzodiazepines are addictive": FALSE for non drug addicts with anxiety disorders.

Xanax is a highly addictive and dangerous drug, please don't say otherwise. This sttement is totally incorrect.

[Youbloodybeauty]

QUOTE(Neeranam @ 2007-07-13 22:20:36)

Now you're saying alcoholism is lack of discipline or will-power?

Amongst others yes. Alcoholism points to concerns such as a preoccupation with or compulsion toward the consumption of alcohol, and/or an impaired ability to recognize the overall negative effects of excessive alcohol consumption.

It seems that you know better than the The American Psychiatric , American Medical Association, American Public Health Association, the National Association of Social Workers, the World Health Organization and the American College of Physicians, who say alcoholism is a disease. Maybe you do, why not write to them and tell them to use will-power lessons to beat that disease.

Comprehension yet again? See highlighted words above. I said "amoungst others" such as: influenced by genetic, psychological, and social factors any of which may precipitate a persistent difficulty in controlling overall alcohol consumption.

Xanax is safe if prescribed and taken as directed.

Alcohol is safe in moderation.

[Neeranam]

QUOTE(Neeranam @ 2007-07-13 22:20:36)

Now you're saying alcoholism is lack of discipline or will-power?

Amongst others yes. Alcoholism points to concerns such as a preoccupation with or compulsion toward the consumption of alcohol, and/or an impaired ability to recognize the overall negative effects of excessive alcohol consumption.

It seems that you know better than the The American Psychiatric , American Medical Association, American Public Health Association, the National Association of Social Workers, the World Health Organization and the American College of Physicians, who say alcoholism is a disease. Maybe you do, why not write to them and tell them to use will-power lessons to beat that disease.

Comprehension yet again? See highlighted words above. I said "amoungst others" such as: influenced by genetic, psychological, and social factors any of which may precipitate a persistent difficulty in controlling overall alcohol consumption.Let's just agree to disagree on this matter.Xanax is safe if prescribed and taken as directed. So is heroin,and heroin doesn't have such a bad withdrawal.

Alcohol is safe in moderation.Not for alcoholics.

Do not take Xanax for more than 3 weeks.

Edited July 14, 2007 by Neeranam

[Youbloodybeauty]

Alcohol is safe in moderation.Not for alcoholics.

Xanax is safe. Not for drug addicts.

Back to your post, The Committee on Safety of Medicines recommendations.

Xanax is SAFE for SHORT TERM "continuous" use.

Re: "It should not be continued beyond four weeks".

Xanax is safe if used infrequently.

Re: "The lowest dose which can control the symptoms should be used."

Whether or not that is acceptable as the main treatment for anxiety isn't questioned. The answer is it can be used every now and then, infrequently, not often, occasionally, once in a while, periodically, sometimes. Not for long term continuous use.

[Neeranam]

Alcohol is safe in moderation.Not for alcoholics.

Xanax is safe. Not for drug addicts.

Back to your post, The Committee on Safety of Medicines recommendations.

Xanax is SAFE for SHORT TERM "continuous" use.

Re: "It should not be continued beyond four weeks".

Xanax is safe if used infrequently.

Re: "The lowest dose which can control the symptoms should be used."

Whether or not that is acceptable as the main treatment for anxiety isn't questioned. The answer is it can be used every now and then, infrequently, not often, occasionally, once in a while, periodically, sometimes. Not for long term continuous use.

Ok, we agree that you MAY not get addicted if you use it once in a while. The same could be said for heroin. You are playing with fire when taking either of these drugs.

Do you agree xanax is worse than heroin, forgetting the legal nature?

[Youbloodybeauty]

Ok, we agree that you MAY not get addicted if you use it once in a while. The same could be said for heroin. You are playing with fire when taking either of these drugs.

Do you agree xanax is worse than heroin, forgetting the legal nature?

Definately comparable - yes for "drug addicts".

Edit: BTW xanax is used by heroin users to increase the effects of heroin so the statistics may be slanted towards the "drug user" rather than the anxiety sufferer. Don't know.

Edited July 14, 2007 by Youbloodybeauty

[chemist]

Neeranam, I have followed this thread and your crusade against benzodiazepines for quite some time now. Although I am truly sorry that you personally have had bad experiences with these drugs, I don't think it is very wise of you to extrapolate these experiences to all individuals in need of anxiolytic treatment. Different people react differently to pharmacologic treatments, and therefore I think it is important to point out that sweeping generalizations based on one person's opinions should be avoided. Such (negative) generalizations can in fact be dangerous, as they have the potential to discourage people who could benefit greatly from drugs such as the benzodiazepines from seeking professional help.

Some important points:

1) There is a difference between "addiction" and "dependence". Dependence can occur with many classes of drugs (such as the benzodiazepines, but also with for example beta blockers such as propranolol) and is a result of the human body getting used to (adapting to) the drug in question. This adaptation often leads to dicontinuation symptons upon withdrawal and also in many cases (but far from all) tolerance to the drug. Addiction, although it often encompasses the characteristics of dependence, is defined as a state where a person compulsively craves the drug and will continue to take it (usually in increasing amounts) even if the use of it leads to serious harm to himself and/or others. In short, in the case of addiction the situation has spun out of control.

Tolerance, dependence and addiction can all occur with the use of benzodiazepines, but true addiction is far less common than tolerance and dependence. Furthermore, serious tolerance and dependence issues occur much less frequently with benzodiazepines (even with long-term use) than most people have been led to believe by reading sensationalist articles in the press. The typical long-term benzodiazepine user have used the same amount of for example Valium, Xanax or Klonopin for years (or even decades) without feeling the need to raise the dose significantly or that the drug has stopped working. Having said that, these long-term users mostly develop some degree of dependency to their medicine, and are strongly advised to taper the drug slowly when it is time to discontinue.

2) Some people (but far far from all) become addicted or strongly dependent to benzodiazepines. Especially abusers of other substances, such as alcohol, are at risk here. Extreme caution is adviced when prescribing benzodiazepines to alcoholics, for example. Of course you can have serious problems with benzodiazepines without being an alcoholic or crack smoker, but the risk increases if you are abusing something else.

3) As said above, the typical benzodiazepine user will not have serious problems with their medication (or often no problems at all), but this only holds true providing that the patient is monitored by a physician (through monthly/yearly/whatever visits to preferrably the same doctor all through the treatment period). The treating physician can then detect any beginning tolerance/dependence/addiction problems at an early stage and act accordingly.

4) The patents for virtually all benzodiazepines have run out many years ago, and still they are around (in fact, the first benzodiazepine, chlordiazepoxide (Librium), was discovered about 50 years ago). So why are they still prescribed, when so many new psychiatric drugs have emerged over the years? Well, because the benzos work! And they work quickly and with very few side effects. As a matter of fact, many people suffering from generalized anxiety, panic anxiety, social anxiety, sleep disorders etc etc don't get enough relief from the more modern (and much more expensive)antidepressants/anxiolytics (yes, antidepressants such as Zoloft, Prozac and Celexa are used to treat many anxiety disorders as well). Additionally, the side effects of the newer agents are often much more pronounced than the side effects of the benzodiazepines. So, in spite of the extreme pressure from the pharmaceutical companies (yes, I am in that business myself) to make the doctors throw the benzos away and replace them with the modern, expensive stuff, benzos are still relatively widely prescribed, because, as stated above, they are highly efficient with minimal side effects.

5) Yes, benzodiazepines have the potential to cause problems like tolerance/dependence/addiction for some people. However, for many individuals they can literally be life-savers. As always, the pros and cons should always be quantified in each individual case, and the importance of physician monitoring must be emphasized. Self-medicating is foolish, to say the least, in this case.

I hope I haven't bored you too much with the above .

Regards

[mrtoad]

As I am not going to get involved in a huge debate on this, I'd just like to say that both of you have valid points.

That is why it is so important when prescribing any type of medication for Anxiety, Depression, Schizophrenia, Bi - Polar etc that a full Mental Health Assessment is carried out to avoid future problems.

In the end I certainly do not advocate the use of benzo's over a long period of time or self medicating.

It is also worth noting that from my experience the majority of benzo abusers that I dealt with whilst working as a Crisis Resolution Nurse were normally drug and alcohol abusers.

As chemist has mentioned, and as I had mentioned previuosly all cases are unique so the affects can be greatly different depending on the circumstances. Hence the need for the Nurse or Doctor to conduct a thorough assessment.

Edited July 14, 2007 by mrtoad

[Youbloodybeauty]

However, for many individuals they can literally be life-savers. As always, the pros and cons should always be quantified in each individual case, and the importance of physician monitoring must be emphasized. Self-medicating is foolish, to say the least, in this case.

That comment is worth repeating in bold and yes, can be life-savers.

[jumnien]

and life-enders!!!

[chemist]

and life-enders!!!

I guess you are talking about people trying to end their lives by ingesting large amounts of benzos. The thing is that the benzodiazepines replaced the old barbiturates virtually overnight in the sixties due to the fact that benzos have a very large therapeutic window and a wide safety margin (which the barbs don't have), that is, it is rather difficult to end one's life by overdosing on benzodiazepines alone. However, if you combine benzos with...Well, we are not supposed to talk about this on ThaiVisa.

Some of the worst offenders when it comes to "life-ending" are, by the way, the old tricyclic antidepressants and a few of the new antidepressants as well.

I am sorry for discussing this banned topic , but I figured that the quote above deserved a comment .

Best regards

[Neeranam]

Neeranam, I have followed this thread and your crusade against benzodiazepines for quite some time now. Although I am truly sorry that you personally have had bad experiences with these drugs, I don't think it is very wise of you to extrapolate these experiences to all individuals in need of anxiolytic treatment. Different people react differently to pharmacologic treatments, and therefore I think it is important to point out that sweeping generalizations based on one person's opinions should be avoided. Such (negative) generalizations can in fact be dangerous, as they have the potential to discourage people who could benefit greatly from drugs such as the benzodiazepines from seeking professional help.

Personally, I had terrible time with these drugs. I've seen so many others have problems, death included, I have to speak out agaist the use of them. I've spent a lot of time in a drug treatment centre in Thailand and seen lots of victims of this drug, or rather the stupid doctors who prescribe it. I've even been to see "top" so-called specialists in Bangkok with friends with drink problems. Every time they were prescribed benzos. It's what most Thai doctors do, through not knowing about them. Benzos(long term use) is a real no no in the west, especially for those with history of alcohol/drug problems. Doctors in the West don't do this. In the West, I've known many "accidental adicts", including both my parents, who were told they were harmless. They both managed to get off them but had terrible times and they are not "drug addicts". Do you actualy know anyone who has taken this drug for any length of time and stopped?

Some important points:

1) There is a difference between "addiction" and "dependence". Dependence can occur with many classes of drugs (such as the benzodiazepines, but also with for example beta blockers such as propranolol) and is a result of the human body getting used to (adapting to) the drug in question. This adaptation often leads to dicontinuation symptons upon withdrawal and also in many cases (but far from all) tolerance to the drug. Tolerance to propanalol??You must have been in a different physiology/pharmacology class than me(I have a Medical Laboratory Scientific Officer HND). I took propanaol for many years and had absolutely NO withdrawal. Comparing this drug to benzos is ridiculous. Where did you get this info. from?. Addiction, although it often encompasses the characteristics of dependence, is defined as a state where a person compulsively craves the drug and will continue to take it (usually in increasing amounts) even if the use of it leads to serious harm to himself and/or others. In short, in the case of addiction the situation has spun out of control.Tolerance, dependence and addiction can all occur with the use of benzodiazepines, but true addiction is far less common than tolerance and dependence. Furthermore, serious tolerance and dependence issues occur much less frequently with benzodiazepines (even with long-term use) than most people have been led to believe by reading sensationalist articles in the press. The typical long-term benzodiazepine user have used the same amount of for example Valium, Xanax or Klonopin for years (or even decades) without feeling the need to raise the dose significantly or that the drug has stopped working. Having said that, these long-term users mostly develop some degree of dependency to their medicine, and are strongly advised to taper the drug slowly when it is time to discontinue. Agreed, and the ones who manage to come of it will tell you that they can't remember anything from the time they were on it- they were living like a zombie.,

2) Some people (but far far from all) become addicted or strongly dependent to benzodiazepines. Especially abusers of other substances, such as alcohol, are at risk here. Extreme caution is adviced when prescribing benzodiazepines to alcoholics, for example. Of course you can have serious problems with benzodiazepines without being an alcoholic or crack smoker, but the risk increases if you are abusing something else.

3) As said above, the typical benzodiazepine user will not have serious problems with their medication (or often no problems at all)until they try to stop, but this only holds true providing that the patient is monitored by a physician (through monthly/yearly/whatever visits to preferrably the same doctor all through the treatment period). The treating physician can then detect any beginning tolerance/dependence/addiction problems at an early stage and act accordingly.

4) The patents for virtually all benzodiazepines have run out many years ago, and still they are around (in fact, the first benzodiazepine, chlordiazepoxide (Librium), was discovered about 50 years ago). So why are they still prescribed, when so many new psychiatric drugs have emerged over the years? Well, because the benzos work! And they work quickly and with very few side effects. As a matter of fact, many people suffering from generalized anxiety, panic anxiety, social anxiety, sleep disorders etc etc don't get enough relief from the more modern (and much more expensive)antidepressants/anxiolytics (yes, antidepressants such as Zoloft, Prozac and Celexa are used to treat many anxiety disorders as well). Additionally, the side effects of the newer agents are often much more pronounced than the side effects of the benzodiazepines. So, in spite of the extreme pressure from the pharmaceutical companies (yes, I am in that business myself ) to make the doctors throw the benzos away and replace them with the modern, expensive stuff, benzos are still relatively widely prescribed, because, as stated above, highly efficient with minimal side effects.

5) Yes, benzodiazepines have the potential to cause problems like tolerance/dependence/addiction for some people. However, for many individuals they can literally be life-savers. they are turned into zombies because the doctors don't have the time to find out the real cuse of their anxietyAs always, the pros and cons should always be quantified in each individual case, and the importance of physician monitoring must be emphasized. Self-medicating is foolish, to say the least, in this case.

I hope I haven't bored you too much with the above Not at all.

Regards

Edited July 14, 2007 by Neeranam

[Neeranam]

and life-enders!!!

I guess you are talking about people trying to end their lives by ingesting large amounts of benzos. The thing is that the benzodiazepines replaced the old barbiturates virtually overnight in the sixties due to the fact that benzos have a very large therapeutic window and a wide safety margin (which the barbs don't have), that is, it is rather difficult to end one's life by overdosing on benzodiazepines alone. However, if you combine benzos with...Well, we are not supposed to talk about this on ThaiVisa.

Some of the worst offenders when it comes to "life-ending" are, by the way, the old tricyclic antidepressants and a few of the new antidepressants as well.

I am sorry for discussing this banned topic , but I figured that the quote above deserved a comment .

Best regards

It's hard to end your life with these drugs, as you say. My good friend was taking an average amount of diazepam daily for depression(prescribed in Thailand). He went back to the USA to come off these drugs in a treatment centre using phenol barbitol or something. He had a seizure and died during treatment. A coincedence?

[chemist]

Neeranam, I have followed this thread and your crusade against benzodiazepines for quite some time now. Although I am truly sorry that you personally have had bad experiences with these drugs, I don't think it is very wise of you to extrapolate these experiences to all individuals in need of anxiolytic treatment. Different people react differently to pharmacologic treatments, and therefore I think it is important to point out that sweeping generalizations based on one person's opinions should be avoided. Such (negative) generalizations can in fact be dangerous, as they have the potential to discourage people who could benefit greatly from drugs such as the benzodiazepines from seeking professional help.

Personally, I had terrible time with these drugs. I've seen so many others have problems, death included, I have to speak out agaist the use of them. I've spent a lot of time in a drug treatment centre in Thailand and seen lots of victims of this drug, or rather the stupid doctors who prescribe it. I've even been to see "top" so-called specialists in Bangkok with friends with drink problems. Every time they were prescribed benzos. It's what most Thai doctors do, through not knowing about them. Benzos(long term use) is a real no no in the west, especially for those with history of alcohol/drug problems. Doctors in the West don't do this. In the West, I've known many "accidental adicts", including both my parents, who were told they were harmless. They both managed to get off them but had terrible times and they are not "drug addicts". Do you actualy know anyone who has taken this drug for any length of time and stopped?

Some important points:

1) There is a difference between "addiction" and "dependence". Dependence can occur with many classes of drugs (such as the benzodiazepines, but also with for example beta blockers such as propranolol) and is a result of the human body getting used to (adapting to) the drug in question. This adaptation often leads to dicontinuation symptons upon withdrawal and also in many cases (but far from all) tolerance to the drug. Tolerance to propanalol??You must have been in a different physiology/pharmacology class than me(I have a Medical Laboratory Scientific Officer HND). I took propanaol for many years and had absolutely NO withdrawal. Comparing this drug to benzos is ridiculous. Where did you get this info. from?. Addiction, although it often encompasses the characteristics of dependence, is defined as a state where a person compulsively craves the drug and will continue to take it (usually in increasing amounts) even if the use of it leads to serious harm to himself and/or others. In short, in the case of addiction the situation has spun out of control.Tolerance, dependence and addiction can all occur with the use of benzodiazepines, but true addiction is far less common than tolerance and dependence. Furthermore, serious tolerance and dependence issues occur much less frequently with benzodiazepines (even with long-term use) than most people have been led to believe by reading sensationalist articles in the press. The typical long-term benzodiazepine user have used the same amount of for example Valium, Xanax or Klonopin for years (or even decades) without feeling the need to raise the dose significantly or that the drug has stopped working. Having said that, these long-term users mostly develop some degree of dependency to their medicine, and are strongly advised to taper the drug slowly when it is time to discontinue. Agreed, and the ones who manage to come of it will tell you that they can't remember anything from the time they were on it- they were living like a zombie.,

2) Some people (but far far from all) become addicted or strongly dependent to benzodiazepines. Especially abusers of other substances, such as alcohol, are at risk here. Extreme caution is adviced when prescribing benzodiazepines to alcoholics, for example. Of course you can have serious problems with benzodiazepines without being an alcoholic or crack smoker, but the risk increases if you are abusing something else.

3) As said above, the typical benzodiazepine user will not have serious problems with their medication (or often no problems at all)until they try to stop, but this only holds true providing that the patient is monitored by a physician (through monthly/yearly/whatever visits to preferrably the same doctor all through the treatment period). The treating physician can then detect any beginning tolerance/dependence/addiction problems at an early stage and act accordingly.

4) The patents for virtually all benzodiazepines have run out many years ago, and still they are around (in fact, the first benzodiazepine, chlordiazepoxide (Librium), was discovered about 50 years ago). So why are they still prescribed, when so many new psychiatric drugs have emerged over the years? Well, because the benzos work! And they work quickly and with very few side effects. As a matter of fact, many people suffering from generalized anxiety, panic anxiety, social anxiety, sleep disorders etc etc don't get enough relief from the more modern (and much more expensive)antidepressants/anxiolytics (yes, antidepressants such as Zoloft, Prozac and Celexa are used to treat many anxiety disorders as well). Additionally, the side effects of the newer agents are often much more pronounced than the side effects of the benzodiazepines. So, in spite of the extreme pressure from the pharmaceutical companies (yes, I am in that business myself ) to make the doctors throw the benzos away and replace them with the modern, expensive stuff, benzos are still relatively widely prescribed, because, as stated above, highly efficient with minimal side effects.

5) Yes, benzodiazepines have the potential to cause problems like tolerance/dependence/addiction for some people. However, for many individuals they can literally be life-savers. they are turned into zombies because the doctors don't have the time to find out the real cuse of their anxietyAs always, the pros and cons should always be quantified in each individual case, and the importance of physician monitoring must be emphasized. Self-medicating is foolish, to say the least, in this case.

I hope I haven't bored you too much with the above Not at all.

Regards

Dear Neeranam.

Thanks for your comments and replies . I will try to comment on your input as best as I can. The red passages below are quotes from you.

A) "Personally, I had terrible time with these drugs. I've seen so many others have problems, death included, I have to speak out agaist the use of them. I've spent a lot of time in a drug treatment centre in Thailand and seen lots of victims of this drug, or rather the stupid doctors who prescribe it. I've even been to see "top" so-called specialists in Bangkok with friends with drink problems. Every time they were prescribed benzos. It's what most Thai doctors do, through not knowing about them. Benzos(long term use) is a real no no in the west, especially for those with history of alcohol/drug problems. Doctors in the West don't do this. In the West, I've known many "accidental adicts", including both my parents, who were told they were harmless. They both managed to get off them but had terrible times and they are not "drug addicts". Do you actualy know anyone who has taken this drug for any length of time and stopped?"

Again, I am sincerely sorry that you had such a rough time when dealing with benzodiazepines. I note that you this time use the word "personally", though. As I said in my original post, extreme caution is advised when prescribing benzos to people with for example alchol problems. If I am not mistaken you said in some earlier posts that you were mixing diazepam (brand name: Valium) with alcohol. Am I correct here? Furthermore, I don't doubt that you have seen other people with benzo problems, but the question is: Why did they have these problems? Due to abuse of other drugs? Due to self-medication or irresponsible prescription by doctors? Please note that I in my original post stretched the importance of: 1) Physician monitoring, 2) extreme caution when prescribing benzos to drug abusers (sorry for repeating myself).

You say that some person that you know of died because of benzodiazepine use. Excuse me, but I highly doubt that benzodiazepine use per se causes deaths (and I read several medicine journals on a regular basis). However, abrupt discontinuation of a benzo after long-term use can in rare cases cause death (and so can abrupt discontinuation of many drugs, propranolol included) due to withdrawal-induced seizures. Is that what happened here? Or was some other factor involved? Again, note what I wrote in the original post: Long-term bensodiazepine users are strongly advised to taper the drug slowly. (This should be done mainly to minimize unpleasant withdrawal effects, but also to avoid the risk of seizures; I should have mentioned this in my original post.)

Furthermore, you claim that long-term use of benzos in the West is a no-no. That is simply not true (except for drug addicts, which you also point out). Granted, long-term benzodiazepine treatment is not the first choice for most doctors (but it still is for some) when it comes to treatment of chronic anxiety disorders. But what I talked about in my first post was persons for whom the the more modern antidepressants/anxiolytics are not efficient enough. Additionally, the side effects of these relatively new agents are too harsh for many people to bear. Common practice in the West is to try the new stuff first (because it is viewed as less habit forming), and then, if those treatments don't work, move on to for example benzos. Now, many are those who have tried countless modern drugs, only to discover (after years of trial and error) that the only thing that helps them is a drug from the benzo family. Should they be denied this tool that allows them to lead relatively normal lives, just because you and people you know have had bad experiences with benzodiazepines?

If your parents were told that benzodiazepines are harmless, they were simply victims of extremely bad medical practice (did this happen a long time ago, when most doctors just didn't know better?). Naturally, which I pointed out in the first post, responsible doctors who take the time to monitor their patients are a key element here.

Do I know anyone who has taken benzos for a long time (with good results) and then stopped? You bet I do, but more about this later.

"Tolerance to propanalol??You must have been in a different physiology/pharmacology class than me(I have a Medical Laboratory Scientific Officer HND). I took propanaol for many years and had absolutely NO withdrawal. Comparing this drug to benzos is ridiculous. Where did you get this info. from?"

Maybe I am ignorant, but I don't know what a Medical Laboratory Scientific Officer HND is. Personally i have a Ph D in medicinal/pharmacological chemistry. That means that I have studied pharmacology pretty much, and it also means that I know how to synthesize pharmacologically active compounds in the lab (I have mostly dealt with research and development of potential drug candidates during my career).

When it comes to the issue of propranolol, I think you misunderstood what I said. I brought up propranolol to illustrate the concept of dependence (I did not compare propranolol with benzos in any other way). It is a well known fact that propranolol, mainly used to lower blood pressure and to stabilize the rhythm of the heart, should be discontinued relatively slowly to avoid the risk of worsening of angina problems and, in the worst case, myocardial infarction. Thus, this example shows that the human body can adapt to a drug and that drug's pharmacodynamic effects. Furthermore, propranolol penetrates the blood-brain-barrier to some extent, and some people use propranolol as an anxiolytic (it calms down the body's fight-or-flight response to external stimuli via its beta receptor blocking properties, mainly outside of the brain, but to some degree also within the brain). Rebound anxiety has been reported during abrupt withdrawal, but that is not the main point here though.

C) "Agreed, and the ones who manage to come of it will tell you that they can't remember anything from the time they were on it- they were living like a zombie."

"they are turned into zombies because the doctors don't have the time to find out the real cuse of their anxiety"

Oh, please. Here you are implying that patients using benzodiazepines turn into virtually braindead zombies. (I am sure you can find examples of this "zombiefication" effect, but that effect is certainly not the norm.) This is a prime example of scaremongering. Now, if someone on a benzo turns into a zombie, then they: 1) Should lower the dose or 2) maybe try another benzo (or a completely different medication). You know as well as I do that the often (but not always, granted) only significant side effect when using a benzo is initial drowsiness that will diminish after a week or two. After this initial period the vast majority of people taking benzos feel essentially normal, minus the crippling anxiety. But, as I am sure you will point out to me, there are of course exceptions to this rule (perhaps people you know). I should add here that if one particular benzo doesn't agree with you, there is always the possibility to try another.

You earlier asked me if I knew any people who had been on a benzo and then stopped, and I anwered that I indeed did.

Example 1): A friend of mine who went to the same university as I to study chemistry was taking 6 mg of Xanax daily for many years (he was suffering from panic anxiety). Then he lowered the dose to 3 mg/day for a few years, and today he doesn't consume any benzo at all as he no longer needs to do that. He is doing just fine. He is a very smart guy, and if he hadn't told me I would never have known that he was on Xanax. Zombie? I don't think so.

Example 2): Another friend who works at a pharmaceutical company in Sweden was on 1 mg of Xanax daily for years (generalized anxiety disorder). Now he is Xanax-free and has started using Effexor (an antidepressant) instead. He too is just fine, and he was never any zombie while on Xanax (again, there was no way to tell that he was using Xanax, i e no zombie effect).

Example 3): Myself! Some years ago I was on the benzodiazepine clonazepam (brand name in America: Klonopin) for reasons I will not reveal here. The dose was 2 mg per day (0.5 mg in the morning, 0.5 mg at lunch and 1 mg in the evening) for approximately three years. I discontinued the drug over a period of three months (why hurry?), and only experienced some restlessness and mild insomnia for a couple of days following each dose adjustment. During these three years I finished my Ph D studies, and I also met the woman to whom I am married today. I assure you that I was not some kind of zombie during my Klonopin years, and my memories of that period are clear as crystal. In fact, my supervising professor at my university commended me for being the hardest working Ph D student he had come across for quite some time.

Please note that these success stories will not make me recommend all ThaiVisa members to run to the nearest pharmacy to buy bulk quantities of benzo tablets to be popped like M&Ms.

D) "As said above, the typical benzodiazepine user will not have serious problems with their medication (or often no problems at all)until they try to stop"

The text in red is a quote from you. Well, I think I have already covered this issue somewhat. Benzodiazepine treatment should be initiated, maintained and discontinued under a responsible physician's supervision. When it is time to stop the treatment, the patient should be informed that the taper should proceed slowly to avoid too unpleasant withdrawal effects. The key issues here are supervison and monitoring by a physician during the whole period of treatment. As indicated in my original post, withdrawal effects (due to dependency) are not uncommon during the discontinuation of long-term benzodiazepine treatments, but the intensity of these effects can almost always be controlled by manipulating the tapering scheme.

E) "I hope I haven't bored you too much with the above Not at all"

Again, the text in red is a quote from you. And my response? Thank you !

Finally (it is getting quite late, and I am tired as he1l), I would like to summarize my take on this subject. The question is not if some person (me included) knows some people who have had good or bad experiences with benzodiazepines. The question is rather: Are benzos (in spite of their shortcomings) a viable treatment option, given the fact that many of the new psychiatric drugs just don't cut it for many anxiety-plagued patients? My answer is yes, because what is the alternative? Should we deny these patients a highly effetive treatment option and just leave them in their misery? I am sure that most of you who read this are aware of the fact that anxiety (which, by the way, often leads to depression) is a strong risk factor when it comes to premature death (we are talking about cardiovascular diseases, strokes, cancer and suicide for example). The body of an anxiety-ridden person is constantly "on alert", and there are few moments during which the body of this person can relax and heal itself. So which is worse, taking a potentially dependence-inducing drug that lets you lead a relatively normal life, or living in an anxiety-controlled hel_l that ultimately probably will kill you prematurely? Take your pick.

Regards

Edited July 14, 2007 by chemist