2010 Pysch. Debate: "...Guidelines for Responsible Prescription of Benzo...."

This 2010 Canadian Journal of Psychiatry article contains the following four sections in which different doctors look at various pros and cons of prescribing benzodiazepines. The link to the article follows.

"The Prevalence of Prescriptions and Their Indications"

"BDZs Should Be Considered in the Long-Term Treatment of Mood and Anxiety Disorders"

Rebuttals:

"Should the Prescription of BDZs Be Based on an Act of Faith?"

"Emerging Evidence That Risk of Fractures Is Not Only Associated With BDZs But Also Other Psychotropic Medications in the Elderly"

http://publications.cpa-apc.org/media.php?mid=1061

Lapis,

I know this is not your intent, but after reading this article, I am almost tempted to reinstate use of benzodiazepines after 1 year off tomorrow.  While I am functional, I am sick and tired of the chemical anxiety I deal with most days. I am tired of sleeping poorly waking every two hours throughout the night and never getting into deep slow wave sleep. I am tired of constantly having to use "strategies" to manage anxiety vs. just being able to live in the moment. At six months off, I was much more positive since I had hope that, with time, the nervousness and sleep issues would continue to improve. They have not.

This article actually gave me hope that I could reinstate some benzo at a low dose on an as needed basis and potentially avoid tolerance. I know that many here think this is a major risk, but I know of many people who take benzos with no problems. I may have sensitized my nervous system in some way, but then again I think I just may have a sensitive nervous system. None of the theories about continued downregulated GABA receptors after one year off a small dose of Klonopin make any sense to me. It makes more sense to me that I have a mood disorder that I must deal with. I hope I can do this without medication, but I am very tired of constantly having to manage the few symtoms I have. I would like to have an occasional day when I can act and sleep effortlessly. I may not remember exactly how I felt before my use of benzo medication, but I am fairly certain that I did not have to deal with anxiety, nervousness and poor sleep every day of my life. Maybe the medical profession is right about this  stuff. If you need a medication and you are not at risk of abusing it, just take and stop worrying about the negative consequences.

Sincerely,

WW

Hi WW,

My intent when sharing articles and information is really just to offer to others what I've come across in my online research. In my opinion, we are better equipped to make decisions about our health when we have information upon which to base those decisions. Also, I think it decreases some of the anxiety we might feel, and the guessing we might do, if (hopefully) solid information is available.

Thanks for sharing your thoughts and experiences, WW. To me, these articles give more of a 360-degree view of the issue, and I find it helpful to understand where the doctors are coming from. When I read these articles, I was nodding at times and shaking my head at other times. From what you've written, perhaps we did those things at opposite times!

In the end, we all have to make our own decisions, and I think the mandate here at BB isn't to tell others what to do, but to offer support and share the experiences. I wasn't doing well AT ALL on these drugs, and they have greatly affected my balance, quality of sleep, quality of life, etc. I'm paying a high price for having taken these medications, and I can only hope that my balance and quality of life will be restored with time.

Aside from the fall risk, there are new risks we recently learned about. That is, there's a possible connection with Alzheimers disease. I don't think it's definitive, but for me, it's a risk I don't want to take. From my other reading, I understand that these meds affect the stages of sleep, and hence, quality and depth of sleep. Again, it's not something I'm comfortable with, but I think it's up to everyone to make his/her own decision.

You've come very far already, and although 1 year is a long time, it's not likely enough time to be able to say with clarity what it is you're dealing with. The British National Formulary suggests it takes 6-18 months after the last dose (on average only) to be done with withdrawal. For some of us, it takes longer. I'm counting on the amazing recuperative capacity of the brain to bring me to better health. I'm reading the Success Stories from time to time, sharing with BBs here, and trying to stay informed.

Whatever you decide, WW, I wish you well! I wish everyone well.

Lapis

"Maybe the medical profession is right about this  stuff. If you need a medication and you are not at risk of abusing it, just take and stop worrying about the negative consequences."

It seems like the Medical Profession is split on this - and the trend "seems" to be letting the patient decide whether to quit or stay on forever.

It is tempting I know. I just keep in mind how lousy I felt, getting tested for cancer, MS, sarcoidosis, early dementia, PET scans, CATR scans, ultrasounds, etc. In the dementia test, it showed that my IQ dropped 15 points. I guess that's what they mean by cognitive decline. And now it is looking like we have a 50% greater chance of developing Alzheimer's or Dementia. I can't accpet either.

I saw the long, slow crash and burn of my life, over 10 years, and all of my investigations point to Klonopin.

I have a buddy who tried quitting as an in-patient and was so horrified by the C/T that he has decided it's Benzo's for Life for him.

I haven't had many windows, but when I do they are indescribably awesome - that's what I'm shooting for.

So, whatever is right for you. It's not an easy decision - good luck, and let us know how it all goes.

Hey Lapis,

Thanks for your reply! I absolutely agree that it is important to be informed and I appreciate any information posted. Yes, I think it is interesting/amusing that 2 or more of us may read or hear the same information and come away with very different perspectives.

I wish you the best as well and hope that you continue to feel better. No matter what the outcome, this is certainly a challenging journey. I wish everyone well.

Take care,

WW

"Maybe the medical profession is right about this  stuff. If you need a medication and you are not at risk of abusing it, just take and stop worrying about the negative consequences."

It seems like the Medical Profession is split on this - and the trend "seems" to be letting the patient decide whether to quit or stay on forever.

It is tempting I know. I just keep in mind how lousy I felt, getting tested for cancer, MS, sarcoidosis, early dementia, PET scans, CAT scans, ultrasounds, etc. In the dementia test, it showed that my IQ dropped 15 points. I guess that's what they mean by cognitive decline. And now it is looking like we have a 50% greater chance of developing Alzheimer's or Dementia. I can't accpet either.

I saw the long, slow crash and burn of my life, over 10 years, and all of my investigations point to Klonopin.

I have a buddy who tried quitting as an in-patient and was so horrified by the C/T that he has decided it's Benzo's for Life for him.

I haven't had many windows, but when I do they are indescribably awesome - that's what I'm shooting for.

So, whatever is right for you. It's not an easy decision - good luck, and let us know how it all goes.

Hey WW,

I just wanted to follow up on the effects of benzos on sleep. Here's an excerpt from the Wikipedia entry about slow-wave sleep:

"Certain substances, such as benzodiazepines (e.g. Ativan, Valium, Klonopin), seem to have the reverse effect on the time spent in SWS.[citation needed] Instead of lengthening SWS (as do the substances mentioned above), they are known to shorten the time. While these sedatives can increase sleep duration or shorten the time it takes before sleep-onset occurs, they tend to deprive patients of deep sleep."

Here's the link, if you want a bit more info:

http://en.wikipedia.org/wiki/Slow-wave_sleep

And here's a study that looks at using valerian for sleep after benzo withdrawal:

http://www.ncbi.nlm.nih.gov/pubmed/11999905

And here's another study that includes info on how benzos affect sleep quality:

http://www.medscape.com/viewarticle/723907_2

There's a key phrase in that last one: "restorative properties of physiologic sleep". That's what we're all looking for! Ah, the elusive restorative sleep!

Take care and sweet dreams,

Lapis

Lapis,

Thanks for this information on sleep. I have read some similar studies regarding the effects of benzodiazepines on sleep architecture. The article on Valerian is interesting and I will search for additional information regarding its use.

Dec. 11th is my one year anniversary free from benzos. I will probably not make any decisions regarding reinstatement right away. I am just so tired of having to deal with the increased anxiety, insomnia and hyperarousal on a daily basis. It is manageable and I can function, but I feel like my quality of life suffers.

If I believed that these issues would definitely resolve with more time, I would be able to hang in there. Unfortunately, I have not heard or read anything that persuades me this is the case. I don't think I am "damaged" permanently. I just think I have a mood disorder that has been both helped and harmed by use of psychotropic medications.

Again, thanks for your responses and best wishes to you.

WW

Well, WW, I must wish you Happy One Year Anniversary today! I'm not sure if you feel like celebrating, but I have to congratulate you anyway. I see from what you're saying that you're feeling unsure and somewhat conflicted, not to mention unwell, so that's no fun. But good for you for coming so far and for asking the tough questions that everyone should ask when taking medication of any kind. What is it for? What are the side effects? What are the long-term effects? How safe is it? Do the benefits outweigh the risks for me?

Do take your time to make the decision, and don't forget to read some Success Stories as well. Those amazing recollections of time spent in the Benzo Trenches have helped many of us put this experience into a bit of perspective.

All the best,

Lapis

Well, WW, I must wish you Happy One Year Anniversary today! I'm not sure if you feel like celebrating, but I have to congratulate you anyway. I see from what you're saying that you're feeling unsure and somewhat conflicted, not to mention unwell, so that's no fun. But good for you for coming so far and for asking the tough questions that everyone should ask when taking medication of any kind. What is it for? What are the side effects? What are the long-term effects? How safe is it? Do the benefits outweigh the risks for me?

 

Do take your time to make the decision, and don't forget to read some Success Stories as well. Those amazing recollections of time spent in the Benzo Trenches have helped many of us put this experience into a bit of perspective.

 

All the best,

Lapis

Lapis,

I don't post here much, but I must admit that it does feel good to have someone respond with care and concern. I really appreciate your responses and congratulations on my one year anniversary today. I can see that you spend a lot of time researching the effects of psychotropic medications and encouraging others on their journey to discontinue them. I am very impressed.

You are right- I am very conflicted and will try to take my time to decide how I want to proceed. I am particularly confused because I am doing relatively well. I just struggle with ongoing physical anxiety which is not accompanied by thoughts of doom and gloom or hypochondria. Just muscle tension, lightheadedness, heart racing etc. I can manage it. It's just frustrating on top of my pre-existing depression and generally poor, but adequate sleep. At one year off, I feel like enough is enough. I wish I had faith that my body would actually achieve homeostasis at some point. Just not sure that my personal biochemistry is not somehow off balance. I've read Robert Whitaker's book Anatomy of an Epidemic. It's excellent if you have not read it yet. It presents a persuasive case for staying off of psychotropic medications. But, there's always another side of the story.  I have many friends and acquaintances who take medications with minimal negative consequences. They are currently enjoying their lives, traveling, working, spending time with friends, family, grandbabies etc.  It's not that I can't do these things. I just struggle with depression and anxiety and have to push myself. Often, there is no enjoyment in any of it.

You don't need to respond to this post. I am just venting. I have not previously used this forum to do this. Maybe getting my frustrations out and on paper so to speak will allow me to celebrate the achievement of being benzo free for a year.

Thanks again for your compassionate and wise words.

WW

For WW and anyone else considering whether to go back on the medication, there's been a discussion elsewhere on BB on this topic that might be of interest:

http://www.benzobuddies.org/forum/index.php?topic=122926.0