Online Psychiatry - benzos a versatile tool

Won't post the article because the equivalency tables and taper recommendations will not translate well.

 

This is worth reading. This let's us know what the psychiatrists are reading. And maybe the regular doctors.  Someone is wrong. It could be us. It could be them. I think it's good to be informed about what we can expect at the doctors office.

 

http://www.currentpsychiatry.com/article_Pages.asp?AID=10354

WOW!!!  All I can say to that is WHF??!!??!!??!!?? (am I allowed to use that here?)

It's interesting to me that the equivalency table says 5 mg V = .25 mg - .5 mg K and 1 mg X.

 

This seems to say that K and X are not considered of equal strength, as well as being way off the Ashton Tables.

 

Thanks Pianogirl for the move. I wasn't sure where to put it. 

And this is recent!  I hoped we were making progress in educating doctors and patients about benzodiazepines...

Argh...

Challis

Well Flip,

 

I will be the first to say that for me, K and X arent equivalent, but I don't know much more about this article as I havent read it fully other than to say it appears to be a ringing endorsement of the use of benzos.

 

I'm still not feeling well, so I take myself with a grain of salt here. Plus I've been doing a lot of rather "theoretical posting" yesterday and today and when I do that, I think it shows my "odd" state of mind.

 

Nevertheless, when I think that there would be doctors who would refuse to Rx benzos w/o some appropriate ( and I do mean appropriate) treatment for those already locked into years of use, I actually get scared. Because right now the standard treatment is rapid taper, rapid detox, or just plain c/t detox. Getting benzowise and even unbenzowise docs can be real "hit and miss" for many people.

 

So if we're all gonna be upset the lack of progress in the education of docs these days, we should also be very concerned about the lack of treatment options that lack also does not provide. Of course, hopefully that part of the educational process, but really who knows?

 

I have hope for humanity just likebothers do, I'm also concerned about me.

 

Intend

 

 

I don't see anything here that ruffles my feathers. For the most part they advocate short term use of benzos, caution that long term use will need to be tapered, and caution that long-acting benzos will bioaccumulate making them more difficult to come off of.

 

This is in line with my own thinking. Long term use of benzos invariably creates problems, but in the short term they definitely have a lot of uses, and also have a much better safety profile than any of the earlier classes of sedatives. The equivalence tables are questionable, but a lot of that comes down to duration of use and accumulation.

 

Right from the article:

Benzodiazepine use should be short-term; use exceeding 2 to 4 weeks increases the risk for dependence and withdrawal.

 

There are very infrequent cases of people running into problems from 4 week use, but there are also very infrequent cases of people having life-threatening reactions to penicillin. It's a risk:benefit analysis.

 

Benzos are a versatile tool. They have muscle-relaxing properties, create sleepiness, stop seizures, stop acute alcohol withdrawal, stop psychotic episodes, etc. The problems arise when they are prescribed long-term, or prescribed to people who do not have the risks adequately explained to them. Benzos aren't going anywhere because they remain the safest clinical tools to combat a wide variety of conditions. Even with my extreme issues coming off Valium, my spouse continues to take the same drug for very occasional insomnia. She probably takes it eight times a year. That kind of use can be maintained indefinitely without tolerance or problems.

Nicely said, spengler. I read the article and thought it was well written, balanced,  and echoed my thoughts. Personally, I am tapering because I have pre-existing major depressive disorder, and while Klonopin has helped some other conditions I have, it exacerbates my depression, so the cost outweighs the benefit, for me.

 

My husband gets severe panic attacks in certain situations. He has to use Xanax PRN, maybe 15 times a year. It helps him and he has no problems with it. Different people respond differently, and for him the benefit is great for his situation.

My main issues with this article are recommended taper rates and equivalencies.

 

To me it seems if you've been on a benzo for a more than a year, you have up to 4 months to taper. And the equivalent comparison to diazepam is off from the Ashton manual. They do say these equivalents have been challenged but what doctor is going to look up an outside source.

Gotcha, Flip. I don't strongly disagree, but I do think there are probably a lot of people who would do fine at those rates. I think the way I would change the article would just be to highlight the idea that some people have a much more difficult time coming off benzos than others, and if you're working with someone having difficulty the best thing to do is to go as slowly as necessary.

 

Equivilencies are kind of a crap-shoot, it's sort of hard for me to gauge how they mean them. Since they are mostly talking about short-term use, the eqiv tables may be meant in that context. The xanax equivalency seems low overall in terms of anxiolytic properties, but more reasonable in terms of sedation (with no benzo tolerance, 5-10mg V knocks me out as well as 1-2mg X). So, it's just a little hard for me to know what to make of that. Ashton's eqiv tables are firmly geared at looking for crossover equivalency, which is different than therapeutic equivalency for specific problems.

 

Pharmacology is a boondoggle!

I found interesting the new guidelines about prescribing benzodiazepines for PTSD.  I was first given Klonopin just days after my husband's suicide.  Prior to the event I had been a productive, outgoing person, living my life to the fullest.  At first it worked like a charm, and month after month I saw my psychiatrist for a refill.  The months ran into years, and during that period of time I was hospitalized multiple times, and each time my medications were changed around, but the Klonopin was always kept in place.  I was eventually diagnosed with just about every psychiatric condition in the DSM.  In the end I would guess I was given approximately 20 different psychiatric drugs.  Of course, I saw improvement with none of them and the cycle continued.  It just amazes me that not one of the many psychiatrists who treated me in those 6 years ever realized that my problems were due to the Klonopin.  I do not think that PTSD should be treated with benzodiazepines.  In retrospect, had I been offered alternative therapy I certainly would have considered it.  However, that was not the case at the time.

http://www.currentpsychiatry.com/article_Pages.asp?AID=10354

 

Thanks for posting this, Flip. Just printed it (rare treat). Looks interesting. Will read at leisure. If these are revised equivalencies, maybe my taper wasn't so drastic at the beginning as I thought! 

 

It's interesting to me that the equivalency table says 5 mg V = .25 mg - .5 mg K and 1 mg X.

 

I'm looking at the chart - to me it reads .5mg for Xanax = 5mg Valium. Am I misreading something?

 

Spengler and Cherryblossom: Thanks for your well thought out responses. I have sort of become accustomed to hysterical responses in some places here! 

 

jrvmc: So sorry to read about the tragic loss of your husband and what you have been through. It takes a long time to find out about the suffering some people here have endured.

 

Xana x

Ut oh, No Xana, my mistake. I frequently get the generics confused as I did this time. I was mistaking lorazepam for alprozalam. Still, they are "off" from what we know in the Ashton manual.

 

In many ways, this article is an improvement over current practices. I mean, I don't agree that a 6-8 week user would not need tapering. But it's better than a 5 day taper my doctor decided on based on something he looked up.

 

I also read your link to reviews of Whitaker's books on your blog. I haven't read Mad in America. And I read Anatomy of an Epidemic in 2010. It was my very first inking that benzos were addictive and pretty difficult to come off of. I had been to doctor after doctor, hunting a reason why I felt so wretched. Xanax, klonipin, Valium were never questioned.  So at least I'm grateful to Whitaker for including a chapter about benzos. It changed how I thought of them. They were no longer benign.

 

And when I presented myself to a free state run detox the attending doctor was incredulous I was on both Klonopin and Valium. He called it criminal. And when I left 9 days later, he told me his success rate with getting people off benzos was zero. That it was the hardest drug to come off of. I learned a lot in those nine days: chiefly, never under any circumstances go to a lock up facility. I think I still need trauma counseling. 

 

Flip xxxx

Hey Flip,

 

I found this particularly interesting as at my last visit to the shrink, when I did my big confession of going back to the beloved X, he was most nonchalant and seemed to think I was making a big deal about it. He said that .75mg Xanax which I am taking MOST days  was equivalent to 2mg Valium approximately (I know I am boringly repeating myself here to you but someone else might want to chime in). I protested that according to all online equivalency charts I'd seen (about TWO  ) would say 15mg Valium. He said that 2 different drugs can not be exactly measured like that. I said that I FELT like I was taking about 15mg Valium.

 

I am hoping this latest article is right as that would mean that I am only taking approximately 7.5mg Valium equivalent.

 

Another thing on the chart that I found interesting was that the onset of action for Xanax was listed as 'Intermediate', while Valium is 'Very Fast'. I would have put them around the other way. Xanax seems to work in about half an hour. Another strange thing I noticed is the difference in half life times between 'immediate release' and 'extended release' Xanax. I would have thought the extended release would have a much longer half life but it is much less.

 

I have been trying to get my mitts on the XR version for years but they don't sell it here in Australia for some reason.

 

The Valium half life is 20-100hrs. I don't understand this huge variation at all. Does anyone out there? Might have to take this stuff to the shrink. My husband sometimes helps me out with these things. He was an industrial chemist before he became a chem and physics teacher. Somehow he knows all about half lives etc but he is asleep. (Shame because I was going to clean up the kitchen before I went to bed but it would make too much noise.  )

 

Xana

Lol. I use that noise excuse, too, Xana.  works for me.

 

As far as the widely varying half life, I've read it is due to individual metabolism. For example, the elderly do not metabolize as rapidly as the young. And no, I'm not calling you elderly! 

 

Here's all I know of the Xanax XR - my Pdoc said she only used it in emergency situations and never prescribed it for continued use because it makes "clock watchers" out of people.

 

I am beginning to understand why she is "letting" me taper so slowly. She's unconvinced I need to, but since she has seen me completely wig out in her office with the 5 mg per week reduction rate she set up for me, she now is just grateful I'm continuing to go down, regardless of speed. She has been with me through every single step of this 18 month ordeal (and it's not over). She calls me "sensitive" to meds.  And that could be true. She says if I believe I need to taper so slowly, it is true for me. I'm just glad she is openminded and not stuck on one set way.

 

Flip xxx

Interesting link to response from the APA - American Family of Physicians - regarding ratio of Valium to Xanax.

 

http://www.benzobuddies.org/forum/index.php?topic=53468.20

 

See post 29 on page 3

I saw the magazine with this article in it on my psychiatrist's table in the waiting room! Didn't have time to read it, and it was gone the next time, so glad to see it here.

 

Interesting note re: relatively short rating of Valium half-life as per this article. When I brought up (for the first time) getting off K-pin by switching over to Valium gradually because of its "longer half-life," he insisted that K had a longer half life than Valium and that the only reason to switch to valium was because it had a more sedative effect which would take care of any irritation caused by withdrawing from the K.

 

Obviously to him cutting down, getting off even strong benzos was no problem....