To Mike and EVERYONE about Benzos

Discussion in 'Fibromyalgia Main Forum' started by AC77, May 12, 2003.

  1. AC77

    AC77 New Member

    I apologize in advance as i am in a major 'fog' as its called. so i am going to disregard spelling , grammar, etc. cuz i cant concentrate! please bear with me.
    I have always advocated that benzos were ok to take short-term and even long-term, in low dose. after some research I think i am going to have to change my mind. after talking to a few drs...no er ones, as they know little about such things usually. i have come across some sites and books written (mostly in the UK) that advocate against them largely!

    The articles and info are very convicing. what benzos am i talking about? all of them! including, klonopin, xanax, restoril, ativan, valium, serax, and also the semi-benzos such as ambien and sonata! they appear to be more addictive than at first glance and long term use has been shown to cause symptoms of apathy and MS!!! the researche was well backed up and I was a little upset. I take klonopin myself and plan on reducing the dose to a minimum.

    I cant get into all the details, but believe me..I dont convince easily and dont listen to web-site cures, as a rule. Unforintaly much of the research has been published in the British Lancet and our U.S. eqiv medical journal, The New England Journal of Medicine. Do a search on google with Pro Benzo as a key word. Over in the UK, apparently, either there is a larger desire for people to stop these meds for fear of addiction, imagined or otherwise or we in the US are ignorant of the fact. I think the UK journals might be overdramtazing the whole picture. Benzos have been around for about 50 years, so any new findings aren't really new, just being brought to light to either inform others in good-faith or less fortunatly, witch hunt

    I know benzos can be life savers but we should all be a little more careful of thier use and keep it intermitment and PRN at least. I myself am going to adivise the following Rx for patients who need these meds (talk to doc first, of course :)...
    Klonopin 0.25mg BID up to 0.5mg BID
    Ativan 0.5mgs up to TID
    Serax 7.5mgs no more than TID
    Ambien no more than 10mgs HS
    Sonata max 10mgs HS, prefer 5mgs HS
    Valium 2.5mgs up to 15mgs a day

    These are very conservative doses. But should be helpful, none-the-less. I currently take 2mgs klonopin but am Rx'd up 3mgs/d. (I get a script for #90 1mgs tabs) I plan on going down to no more more than 1mgs a day over the long haul. Even in the PDR, it states that anxiety states were best helped with doses of 1mgs MAX NOT anymore--of course they didnt take into mind tolerance and the need for mild dose escalation.

    Seizures/epilepsy is an exception, but even now there are many many many new anticonvulsants out there and benzos are not the sole therapy but adjunctive. I always thought them to be miracles. I can't tell you how many times I have seen in the capacity as a Paramedic and to a lesser extent in the ER (because I am new) how a shot of Ativan or Valium (IV or rarely IM) gave relief to tonic-clonic seizures! Especially ones induced by other drugs of known origin and other states.

    FMS is believed by many here and elsewhere to be a slight seizure state. I wont comment on that, but suffice it to say, that it is not epilepsy (unless of course you have that too) and so, hence should not be treated AS aggresively as such. You may be in this 'slight seizure' state but because you arent having seizures, at least at any known magnitude, you dont want to overtreat, epecially with this info in mind. Evidence sometime is contrary sometimes..experts always disagree. Just as some are going to disagree with what I am saying. And this I understand

    What they appear to be doing is making GABA in the brain, less and less available overtime (i tried to cut and paste a diagram but couldnt). I think this is what leads to apathy and the false MS syndrome and depession. It is true I have noticed an increase in depression as of restarting klonopin. As i taper I hope this stops. For some people it may help thier depression initially as the anxiety decreases--as in my cases and i believe almost everyone elses.

    On the Pro-side it appears that as Dr Cheney points out, that benzos can protect the brain also. and have been shown to decrease the onset of other neurological diseases. I am going to have to say that these meds are safe, if taken cautiously. All meds even asprin, tylenol advil and so forth are dangerous if taken for years. My biggest fear is that coming off them for many...but not all people can be HELL and even dangerous.

    To sum it up. I think that psychiatrists...some at least, are Rxing too high a dose initially. One study showed Klonopin 0.5mgs was equiv too 10mgs diazepam (valium) which means that someone on .5mgs TID, (3xs a day) is on equiv. of 30mgs of valium. .5 TID of klonopin is the most popular starting dose per, many psychiatrists. This is scary, as I am Rx'd 3mgs of klonopin a day. If I take it, then it is equiv to 60mgs of Valium. That is a HEFTY dose. I can't attest to the accuracy of this chart as NO one is really to sure of benzo equivalancy. I do know Klonopin, Xanax, Ativan and Restoril are the most potent benzos available in the U.S. and also most likely second only to rophyonal (sp) ie, roofies or the 'date rape drug' made by Roche. It is also a benzo! Just more potent and quicker acting with a short half-life! In reality it is probally no stronger than Restoril. Scary!

    For now I am going to say for me, at least, to stay low and use PRN, please do your own researcha and DONT ever just stop taking a benzo without proper medical consultation. Most drs dont even know how to taper. This is especially true if you have been on one for more than 2 years. Which many of us have.
    I am sorry to be the harbinger of bad tidings. If I find out more I will let you know.

    I know this information is not new to many of us. Take it as a grain of salt for now. I aplogize for the length of this post :-( AC

    ALSO: I would love to hear Madwolf and Sudjays take on all this, as they have much more expereience with this than I. Also ...any other prescribers M.D. PA-C, or APRN who has any knowledge.[This Message was Edited on 05/12/2003]
  2. Shirl

    Shirl New Member

    Sorry news for sure. I have been taking Xanax now off and on for 15 years.
    I take 0.25 milligrams at night only(for racing brain syndrome), unless I have a panic attack, then I take half that dosage only now and then during the day, or if I have severe muscle spasms, then I will take half plus an OTC Advil gel cap together. (Which I have not needed in a longtime).

    Is this alright to take (you did not mention the Xanax in safe dosage)?
    I have never taken as 'prescribed', which would be 'three times a day'! I truly don't need to be sedated all day long.

    Is it possible to replace the Xanax with GABA (gamma-animobutyric acid???), just a thought from a layman!

    By the way, would you know the medical name for 'Racing brain syndrome?', I was told once, but can't remeber now.

    I hope you are feeling better soon.

    Shalom, Shirl

  3. klutzo

    klutzo New Member

    I was prescribed .25 mg. of Xanax, TID, when I first got Fibro and it became clear that anti-deps. would not work for me.
    I slowly worked my way down to dividing one .25 mg. tablet into 4 pieces, taking one in am, one in pm and half at bedtime.
    Now that I'm on Guai, the pain is so much more, that I am back up to a whole tab at bedtime, and 1/2 tabs in am and pm or 2 tabs per day appx.
    When I get killer headaches I must have 30 mgs. Restoril and 50 mgs. Phenergan or my blood pressure will soar to 210/110, even though I take BP meds....that's how bad the pain is.
    So, what am I to do? I agree they are awful. The 4 times I have weaned myself off completely (takes at least 3 months even at my low dose), I have had more energy, more ambition, and more color in my life, but I also had panic attacks every time I physcially exerted myself even a little bit, and my FMS pain was horrific,with spasms causing loss of balance and insomnia, which was why I was put on it in the first place.
    I try to keep my dosage low by taking the max. dose of GABA itself(750 mgs. BID).
    Besides the physical problems, I am a super-sensitive person with very high ethical standards, and I think as long as I live in an insensitve society full of "anything I can get away with is OK" people, I will probably need Xanax. It's cheaper than therapy, and when Itried to get therapy...guess what...they just offered me even more Xanax!
    Klutzo
  4. AC77

    AC77 New Member

    I dont know the dose of xanax that would be safest. I venture a guess of no more than 1mg a day? As for racing brain....it depends, is it a psychiatric or nurological diagnosis? I guess it doesn't matter, as the treatment is the same. I really am not advocating anyone quitting just being 'mindful' I think I want to stop or at least reduce my dose, as I have stated. I am sure it is worsening my depression. As always, weigh the pros and cons. Most people on these meds say the pros outweigh the cons but not realize long-term they may not! I think your dose of xananx is safe and after 15 years, it may be quite hard to stop...no matter how low. Xanax is supposedly one of the most addictive in this class...I dont see any logic in what it would be anymore than the others. In equal doses all benzos are more alike than not alike. Some can only tolerate or be helped by one and not another.

    I know a person who said that kicking her klonopin habit (6mgs a day) was harder than her cocaine habit. I was pretty awed at this analogy.

    What one addiction specialist said is that, benzo should be used in the follow conditions:

    abscense seizures and some adjuctive (with other meds) provided it is the only one that helps.

    Severe panic, not caused by other cause, ie: thyroid disorders. Low dose, not daily use.

    Not for muscle spasms, except in cases of MS, tetanus and a few others

    For presurgical anethesia.

    I don't know how well I agee. Many drs will start a pt on say klonopoin (clonazepam) and later the pt gets depression or it worsens, not knowing the benzo is the cause and Rx's an antidepressant along with it....a vicious cycle. I think xanax is supposed to cause less depression than most of the others as it has something to do with it's effect on platlet serotonin aggregation? Serax (oxazepam) is supposed to cause less dependance and cognitive disability.

  5. sb439

    sb439 New Member

    I'm on Klonopin 0.25mg per night, with the very occasional upping to 0.5, and the occasional extra daytime dose of 0.125. I rely on Klonopin's synergistic properties, if taken with a soporific antihistamine (of which I also take a very small amount every night).
    QUESTION: I was thinking of substituting on a trial basis some or all of the Klonopin with GABA. But from what you say about the research in Britain, perhaps taking GABA will have the same effect of interfering with the brains own GABA production, so this move would be pointless - did they say anything about that?
    Many thanks,
    Susanne
  6. Shirl

    Shirl New Member

    The racing brain thing was diagnosed as nurological by my Gyno!
    Never have been to a psychiatrist, but did have a few for friends. On a friendly basic, they always told me I was saner then they were:).

    They did agree that my doctor was correct with the diagnosis and the Xanax, but was advised to limit it to nights only, or if I felt a panic attack coming on. Which is what I have been doing all these years.

    A few times I could not get the doctors to prescribe the Xanax, so I had no choice but to quit them cold turkey, sometimes for years.
    At the time the only side effect I had was I didn't sleep anymore, back to the racing brain at nightime.

    But I have been taking them again for the past two years this time around. I always have extra as I don't take them as prescribled (3 times a day), just in the evening (or emergencies).

    When I try to go to sleep, my mind simply races to all kinds of subjects, and I can't relax enough to fall asleep.

    The Xanax calms this down. Then I take ZMA, and Melatonin and will sleep for 7-8 hours a night. I have not tried the supplements without the Xanax 'yet'. Have been thinking about it, but will take your advice and wean myself down to a lower dose of the Xanax this time.

    I am getting older, so maybe I won't be able to just stop without a problem like before.

    Thank you so very much for all your information, even though I seldom respond to your posts, I always read them!

    Shalom, Shirl
  7. Mikie

    Mikie Moderator

    I have always been concerned about long-term use of the benzos. I know that taking too much can make a person feel "flat." I take less than prescribed. I'm supposed to take 1 mg. at night and .5 mg during the day. I started out with .5 mg at night and increased to the ideal dose of .75 mg. I usually only take .25 mg during the day in two separate doses of 1/4 tablet under the tongue. If I took any more during the day, it would make me sleepy. As I take it now, it helps me stay calm and allows me to concentrate better.

    Without the Klonopin, my brain races, I cannot sleep, I suffer sensory overload and tinnitus and I have panic attacks. I know Mel has taken Klonopin for longer than 10 years and is till on the same dose; however, when he tried to wean off, he had a seizure.

    I don't like using the term, slight seizure state, either because it brings visions of grand mal fits. That is why I usually suggest people read Cheney's article on Klonopin. He does a really good job of explaining the seizure/coma continuim. I think that the benzos, if taken responsibly, do protect a brain which misfires and/or overfires. Neurons will die an early death if allowed to continue doing this.

    Perhaps going too far the other direction, using too large a dose of benzos for too long a period of time, will also kill neurons. Is the MS true MS or MS-like symptoms? I know a lot of drugs cause Parkinsonism but not Parkinson's Disease and go away when the offending drug is stopped.

    Again, thanks. Seems we are always damned if we do and damned if we don't. I guess moderation is the key here.

    Love, Mikie
  8. AC77

    AC77 New Member

    you had a paradoxical reaction... fairly common with ativan, it has strong amnesic qualities and if it was given to you IV then that made it all the more strong. It caused disinhibation. They should have stopped giving it to you ASAP and that was thier fault.

    Addition: Well, 6gs is not uncommon. The PDR (physcian's bible) states for epilepsy doses of up to 18 or 20mgs can be used!!!!! I cant believe it myself. I have never seen anyone, legally taking more than 8mgs. 20mgs of Klonpoin is = 400mgs of Valium. People take Benzos with cocaine and other uppers to 'bring them down' or reduce withdrawl...it's very common. They also take them with heroin and opiods to supposedly enhance the high! In England it appears, Dalmane is used by dope addicts mixed with thier heroin to make it more potent; I read that in the Lancet. In the ER, if someone is having an amphetamine induced psychosis, it is not uncommon to give ativan or valium to bring them down and reduce seizure risk/tachycardia/increased B/P. It's actually safe, if monitored--such as in a hospital environment. Otherwise it could be DEADLY!
    [This Message was Edited on 05/13/2003]
  9. Mikie

    Mikie Moderator

    Did they say whether the MS symptoms disappeared when benzos are stopped?

    Love, Mikie
  10. AC77

    AC77 New Member

    They did, after complete withdrawl. During the withdrawl experience, no matter how slow, thier memory actually became worse for a while and eventually got better. Benzos don't cause brain injury like phenothiazines, like thorazine, compazine and mellaril. They just kinda shut you down...which is far safer than activating you. It kinda like keeping something refrigrated to make it last longer in comparison to leaving it out in the heat. Bad analogy but all I can think of.
  11. sb439

    sb439 New Member

    I'm on Klonopin 0.25mg per night, with the very occasional upping to 0.5, and the occasional extra daytime dose of 0.125. I rely on Klonopin's synergistic properties, if taken with a soporific antihistamine (of which I also take a very small amount every night).
    QUESTION: I was thinking of substituting on a trial basis some or all of the Klonopin with GABA. But from what you say about the research in Britain, perhaps taking GABA will have the same effect of interfering with the brains own GABA production, so this move would be pointless - did they say anything about that?
    Many thanks,
    Susanne

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