Expecting Recovery (Healing)?

The authors state, “These results are indeed significant, for they challenge earlier findings that benzodiazepine users who are successful in withdrawing from benzodiazepine can expect recovery in cognitive functioning.”

 

An article re: the meta-analytic study (which I don't have access to)

 

https://www.madinamerica.com/2018/01/cognitive-impairment-long-term-benzodiazepine-use-remains-even-drug-withdrawal/

Is it better for individuals to withdraw from these drugs & suffer life-long physical & mental distress or is it better for them to remain on the drugs for as long as they are providing some comfort? I know, it's different for everyone. If that's true, why are governments, doctors & others suggesting, persuading & coercing most patients to withdraw? Is it in the best interest of the patients? I can more easily prepare for the future when I learn the facts of the past & present. The mantra of "you will heal in time" does not appear to be supported by facts.

Perhaps I can add my thoughts here.  I was prescribed a benzodiazepine for almost 40 years for myoclonic jerks.  When it was first prescribed I immediately had an adverse reaction which was unrecognised.  This led to 35 years of antidepressant prescribing for depression as well as the Nitrazepam.  My cognition was badly affected from the start but gradually deteriorated over  the years.  I tapered off Nitrazepam at age 59 and the effect on my physical health and cognition has been catastrophic.  When I came to these groups I was advised that everyone heals, that seemed to be generally accepted, I never really believed it, perhaps because I already knew a great deal about the harmful effects of these drugs. I had been aware of the UK campaign on benzos from the 1980s onwards. For me it would have been far better to have stayed on the drug, I was independent and functional before tapering, though not in good health.  I have lost my independence and am no longer functional,  and my cognition is very much worse. I think it very much depends on the individual patient as to what the best course of action might be.  I had no idea that by following my doctor's advice in 2013, my health would be destroyed.

lookingforward, exactly! i wasn't provided informed consent when i was first prescribed benzodiazepine and i wasn't provided informed consent when my doctor suggested that i try cutting back "just a tad". once i cut back a little, i was thrust into full blown withdrawal. from there, my doctor's advise was to withdraw at 25% per week for 4 weeks. others of course have advised much slower withdraws. but, as you said, i too was highly functional prior to experiencing withdrawal and now, i am very concerned about losing independence & the ability to function. that is why i am searching & advocating for truthful facts. thank you for responding.

I am sorry you have been badly advised by your doctor and adversely affected.  I do hope you will recover well as many people do.

Hey Fi,

Something to keep in mind: One of the possible effects of taking benzos is brutal dizziness, because they're known as "vestibular suppressants". They interfere with proper balance, and that can hit at any time. For me, it was in year four, but I had no idea what the hell was going on and what the cause was.

 

I can tell you from vast experience that one cannot continue to take a medication that makes them dizzy. The only possible chance of healing is to get off it, because there's no other logical route. So, for those who decide to stay on the meds, they have to understand that that is a possible outcome.

 

I don't wish it on anyone. It makes you housebound and completely incapacitated, and you may even break bones (like I did). It's hellish.

 

Just something to consider.

 

 

They didn't follow people beyond 3.5 years post-withdrawal.  We know people continue to make improvements after 3.5 years.

 

The reviewed studies suggest that cognitive deficits persist after recent and long-standing benzodiazepine withdrawal (up to 3.5 years).

Oh, this is a scary finding!!

Is it better for individuals to withdraw from these drugs & suffer life-long physical & mental distress or is it better for them to remain on the drugs for as long as they are providing some comfort?

 

These are the same sorts of thoughts people have when they quit smoking (or otherwise quit nicotine). "I can just have one." "I'll use the patch/gum for the rest of my life. It's better than smoking."

 

In fact, it's the same thought many people have when they are physically dependent on a drug and are trying to quit using the drug.

 

Xanax is the 4th drug that I am quitting.

troller

I'm just trying to obtain as much factual information as I can so that I can make informed decisions regarding my future & the futures of those involved in my life. I don't think 'troller' is a helpful accusation.

I'm just trying to obtain as much factual information as I can so that I can make informed decisions regarding my future & the futures of those involved in my life. I don't think 'troller' is a helpful accusation.

 

I am not sure that the accusation was aimed at you.  You are correct to gather as much factual information as you can.  I knew a fair bit about these drugs before tapering, I had no symptoms as I tapered off, I had no indication that I would have any difficulty getting off the drug, I had no way of knowing what the end result would be and that is really a huge problem.  We can only take the course of action that seems best at the time with whatever knowledge we happen to have.  I had huge hopes of recovery for the first three years but it hasn't happened.  And of course I can now look back with the benefit of hindsight and wish I had made different choices.  I hope you can complete your taper and recover well. 

Cognitive Impairment was my main side effect from taking benzos that I felt from the first pill.  I didn't realize it and even when I complained about it, the doctors seemed to know very little and it was blamed on "my anxiety".  This would make me very sad if my brain won't repair at all; however, I do hope this information can help people who notice a cognitive defect while on the meds, and maybe convince some not to go on at all. 

Thank you lookingforward, and I wish the best for you as well. I'm curious how the UK campaign is turning out? I also wonder if similar campaigns will take place around the globe? I would very much like to see documented factual evidence that permanent damage from long-term benzodiazepine use does not likely lead to an inability to live an independent and functioning life. The most recent peer reviewed publication, which I referenced above, seems to point the other way: "The results of the study are important in that they corroborate the mounting evidence that a range of neuropsychological functions are impaired as a result of long-term benzodiazepine use, and that these are likely to persist even following withdrawal." I find this site helpful but, I wonder if the posters have unrealistic confirmation bias in perpetuating anonymous non-documented statements of 'healing'?  If that is the case, no matter how useful the information on tapering is, the perpetuation of misinformation may be causing more long-term harm than benefit to those that frequent this site? Greencup, I agree, my experience with the medical profession is that it dismisses serious symptoms as 'anxiety' to the detriment of patients.

Bear in mind that cognitive impairment -- and even Alzheimer's Disease -- has been associated with the long-term use of benzodiazepines. We've seen numerous studies on that topic already, although there has yet to be a definitive cause-effect established for Alzheimer's. The side effects are well-known and easily found through the many, many, many studies that already exist.

 

It's a crap shoot. If you choose to take benzos and you know all of the possible side effects and long-term effects, then you know that those things may happen to you. However, most of us didn't know at the time we started taking them.

 

Hi Fi A

As i read the study they followed people for six months after long term benzo use, which as we all know here, unfortunately, is far too short a time frame. Many people continue to improve once they are off these meds -- provided they have done a slow sxs based taper.  Yes I said many -- I know there are many who do not and I am bereft by the suffering that these meds create..

 

I know that for me my memory and cognitive functioning have improved ten-fold since i started my taper -- whew.

AND that my doc said she would help me withdraw or "go down as low as I wanted to." 

When I sped down I was in hell and that hell stayed with me through many months as I cut a wee bit and held. Really I've been at a similar dose for almost a year now.  Yes I monkeyed with some cuts but added more Valium in a bonehead move.

 

So my strategy atm is to continue tapering after a 3 month hold, in some ways to mostly make sure I don't reach any kind of tolerance.  If it tales me years to get off then so be it.  This is what I have learned in my 18 months of tapering.... a taper that I thought would take 4 months at the longest...

 

I am truly outraged by the people who lives are in tatters due to these meds and the misinformation that is offered.  It's crazy.

If this was any kind of "Street drug" that caused this much harm to people, the people who provided these meds would be in jail...

 

But my long-winded post here is to say that my cognition has improved as I taper off -- and I expect it to continue to improve.... only time will tell.

 

thanks of starting these important threads....

SS

Thank you SS, your comments are always useful & usually inspiring.  The only item from your post that I question is that this most recent study appears to extend the review to 36 months rather than 6 months after cessation of benzodiazepines. "The reviewed studies suggest that cognitive deficits persist after recent and long-standing benzodiazepine withdrawal (up to 3.5 years)." As I said, I don't have access to the source documents, only the reporting of the study. The futures of millions of people are on the line, what a tragedy that more factual data isn't readily available for those effected.

 

 

Thank you SS, your comments are always useful & usually inspiring.  The only item from your post that I question is that this most recent study appears to extend the review to 36 months rather than 6 months after cessation of benzodiazepines. "The reviewed studies suggest that cognitive deficits persist after recent and long-standing benzodiazepine withdrawal (up to 3.5 years)." As I said, I don't have access to the source documents, only the reporting of the study. The futures of millions of people are on the line, what a tragedy that more factual data isn't readily available for those effected.

 

Oh I had read that as 3.5 years of usage.... my misreading....  Although I wonder how they decided what people's cognition was like before benzos, thus how they decided that cognition was worse than before the start of benozs.

 

I guess it's good I started this thing fairly smart! :laugh:.... so some cognitive decline is .... well again I'll say let's wait and see.

 

No disrespect meant to anyone who is facing more serious issues with these meds.... I am all to aware of the horrors they offer to many.

 

I just have to laugh when I can as other times I am  :'(.....

SS

Hi All,

It's best to read the study to really understand what the researchers have found. Here's the beginning of it, plus a link so that you can read the rest. Please note the reference to the CYP450 enzymes, which play a large role in how a given individual responds to a medication.

 

Introduction

 

The benzodiazepines were introduced in the latter half of the 20th century to treat anxiety, insomnia, and panic disorders (Coleman, 1985). While these medications are useful in the short-term, the published evidence indicates that when they are used for longer periods, they often culminate in significant harm. This is of particular concern, as they continue to be amongst the most widely prescribed psychotropic medications across the globe (Crowe & Barker, 2007). The short-term cognitive

effects of these agents include decreased alertness, impaired psychomotor performance, and memory dysfunction (Deckersbach, Moshier, Tuschen-Caffier, & Otto, 2011).

 

Barker, Greenwood, Jackson, and Crowe (2004a,2004b,2005) conducted a series of meta-analyses and an empirical study examining the longer-term affect of these agents. The results indicated that current long-term benzodiazepine users were significantly impaired in all of the cognitive domains measured (Barker et al., 2004a) including sensory processing, psychomotor speed, non-verbal memory, visuospatial processing, speed of processing, problem-solving, attention/concentration, verbal memory, general intelligence, motor control/performance, working memory, and verbal reasoning.

 

A subsequent meta-analysis (Barker et al., 2004b) investigated whether the cognitive function of long-term users would improve following their withdrawal and whether previous long-term users would still be impaired at follow-up as compared to controls or normative data. The findings indicated that long-term benzodiazepine users significantly improved in many cognitive areas when they discontinued (i.e., visuospatial, attention/concentration, general intelligence, psychomotor speed, and non-verbal memory). However following withdrawal, significant impairment in many areas of cognition (i.e., verbal memory, psychomotor speed, speed of processing, motor control/performance, visuospatial processing, general intelligence, attention/concentration, and non-verbal memory (Barker et al., 2004b), persisted.

 

Definitively characterizing the residual effects of benzodiazepine use has been complicated however, as the effects of these agents are confounded by the presence of the clinical condition for which the drug had originally been prescribed (Deckersbach et al., 2011). In the context of these methodological issues, our group conducted an empirical evaluation of the functioning of previous long-term benzodiazepine users (Barker et al., 2005). Five of the cognitive areas identified in the follow-up meta-analysis as having moderate to large effect sizes (i.e., attention/concentration, motor control/performance,non-verbal memory, verbal memory, and visuospatial skills) were chosen for further assessment. Twenty previous long-term benzodiazepine users of more than 1 year’s duration, who had remained abstinent for over 6 months, were each matched closely to two control groups (with and without anxiety) for age, sex, and education.

 

The results indicated that after at least 6 months of abstinence, previous long-term benzodiazepine users, continued to display cognitive deficits as compared to matched controls with moderate to large effect sizes for verbal memory, motor control/performance and non-verbal memory when comparing the previous benzodiazepine users and the normal controls. Significant differences were also found on these measures between previous benzodiazepine users and the anxious control group.

 

The observation that the anxious control group and the normal control group performed similarly on most measures and both groups performed significantly better than did the previous benzodiazepine users, implicates long-term benzodiazepine use as the most plausible explanation for these differences. Since the publications of these studies, there has been considerably more research into the cognitive effects of benzodiazepines.

 

In addition to the effects of these agents on the index condition as indicated earlier, their pharmacokinetic properties, such as their half-life are also important determinants of the residual effects of these drugs on cognitive functioning (Greenblatt, Shader, Divoll, & Harmatz, 1981). Helmes and Østbye (2015) examined the association between benzodiazepine use and neuropsychological test scores in older adults and found that the short half-life benzodiazepines were not associated with

neuropsychological impairment, whereas the intermediate and long half-life benzodiazepines were both associated with deficits on the Token test. In addition, the participants who took intermediate half-life benzodiazepines were more likely to exhibit impairments on comprehension tests, and long half-life benzodiazepine use was associated with impaired performance on a word recall test (Helmes & Østbye, 2015). When the chronically benzodiazepine-medicated patients were compared to patients with panic disorder who were not chronically medicated as well as normal controls, it was found that the impairments observed in the domains of non-verbal memory and visuoconstruction performance was larger for the chronically medicated participants (Helmes & Østbye, 2015).

 

The variability in the drug response for patients is multifaceted, and is influenced by environmental, genetic, and disease determinants that can each affect the absorption, distribution, metabolism, and excretion of a given drug (Wilkinson, 2005). Pharmacogenomics is concerned with how genes can influence responses to drugs and is considered to be one of the most immediate clinical applications of the Human Genome Project with its potential to reduce adverse drug reactions (Phillips, Veenstra, Oren, Lee, & Sadee, 2001). Specifically, “adverse drug reactions could be reduced by modifying drug

selection or dosing in patients with poor ability to metabolize a drug because of genetic variation in their drug metabolizing enzymes or by developing drugs a priori that will avoid metabolic pathways with adverse genetic variability”(Phillips et al., 2001, p. 2270).

 

Within the benzodiazepines grouping, large differences exist with regard to their pharmacokinetic properties and metabolism (Breimer, Jochemsen, & Von Albert, 1979). Some are eliminated from the body at a relatively slow rate (e.g., diazepam) while others are metabolized rather rapidly (e.g., oxazepam, temazepam, triazolam) (Breimer et al., 1979). The Cytochrome P450 (CYP) enzymes (which are predominantly expressed in the liver but also produced in the small intestine, placenta, and

kidneys) are essential for the metabolism of many medications, including benzodiazepines (Lynch & Price, 2007;Slaughter & Edwards, 1995). This class has more than 50 enzymes, with the most significant ones being CYP3A4 and CYP2D6, of which over 40 allelic variants have been discovered thus far (Bradford, 2002;Lynch & Price, 2007). Variability in these enzymes may directly influence a patient’s responses to certain drugs (Lynch & Price, 2007, p. 391). More specifically, CYP enzymes can be inhibited or induced by drugs, resulting in clinically significant drug interactions that can cause unanticipated adverse sequelae (Lynch & Price, 2007). The CYP2D6 is the enzyme that has been the most studied. While this particular enzyme accounts for <2% of the total CYP liver enzyme content, it is involved in the metabolism of a large number ofpsychotropic medications, including many antipsychotics and antidepressant, β-blockers, anti-arrhythmic agents, opiates, and most benzodiazepines (Bradford, 2002).

 

Indeed, research suggests that there are also ethnic differences with respect to the response to medications such as benzodiazepines due to the relative activity levels of the CYP enzymes, which are typically categorized into functional, non-functional, and reduced function groups (Bradford, 2002). A specific gene encodes the CYP enzymes, with single genetic alleles being inherited from each parent (Lynch & Price, 2007). Alleles are classified either as “wild type”(the most commonly occurring in the

general population) or “variant,”(Lynch & Price, 2007). An individual is considered to be an “extensive”(normal) metabolizer if they inherit two copies of wild type alleles, whereas “poor”metabolizers are those individuals who have inherited two copies of the variant alleles (Lynch & Price, 2007). The proportion of people who are poor metabolizers differs in different ethnic groups. For example, 5%–10% of Caucasians are reported to be poor metabolizers whereas on only 2%–7% of African

Americans and Asians are poor metabolizers (Lynch & Price, 2007).

 

The rationale for undertaking this updated meta-analysis was to incorporate studies published since the previous meta-analyses to provide an up to date review of the residual cognitive effects of the benzodiazepines in current users, those who have recently withdrawn and characterizing the long-term residual effects of those who have successfully abstained following withdrawal taking into consideration the unique features of the drug class itself as well as of that of the patients who are prescribed these agents.

 

The link to the study is here:

 

https://www.researchgate.net/publication/321856301_The_Residual_Medium_and_Long-term_Cognitive_Effects_of_Benzodiazepine_Use_An_Updated_Meta-analysis

 

Thanks for this Lapis.

For me one of the take aways is that for most of my usage I was on a short acting benzo..... bodes a bit better than for long acting, although with so many variable who knows what will be the absolute outcome for any of us.

 

I guess the answer is to continue to taper with a sxs based slow taper and to keep in mind that being on benzos is also implicated in Alzheimer's...

 

 

Darn right, SS! There's little in the way of good news studies when it comes to long-term benzodiazepine use. Proving a causal connection between benzos and Alzheimer's is rather difficult, since there are many factors at play, but which one of us wants to knowingly take that chance?

 

If I'd known how dangerous these meds are, I never would have taken them at all. Thankfully, we can access A LOT of info now online, so we don't need to rely on others to provide it to us. However, doctors SHOULD be providing comprehensive info to patients BEFORE they start any potentially dangerous medications. 

Thank you Lapis for posting a link to the study.

You're welcome, Fi. It's not light reading, but I always find that it's much more enlightening to read the study itself rather than an article about it. The writer interprets the findings but may miss important details that some of us need or want to know.

 

As an example, I didn't see any mention of the CYP450 enzymes in the MAD article, and that's an important detail. We all metabolize meds differently, and much of it depends on our genetics. Which medication we took, for how long, any concurrent meds or health issues, etc. can all play into it as well. SO many factors are involved.

By the way, lookingforward shared this study with everyone back in December 2017. I was pretty sure we'd seen it before. Here's the link to the thread:

 

http://www.benzobuddies.org/forum/index.php?topic=194068.10

Did they establish what is considered long-term use? Certainly one can feel an impairment in brain function with shorter use.