Informal Poll - Long Terrm Treatment With Benzodiazepines

[debaser23]

I'm interested in hearing about the experiences of people who've been on benzos long term (more than a year).

How long have you been using them?
Which drug?
At what doses have you taken it?
What is your opinion, overall (efficacy, side effects, tolerance are of particular concern to me)?

Please note that I'm not interested in this turning into a pro- or anti-benzo debate.  I'd like to hear only from people who've taken them for around a year or more.

[suzi-q]

I have been taken clorzanepam (klonopin) for approx. 10 years.  However, I do not take it daily...I take it as needed.  So, there may be a time when I may take one every day for about a week and then months when I take none.  I would say that maybe I take about 30 in an entire year.  I only take it when I cannot sleep or have a high anxiety day and my heart is pounding.  I do take Paxil and buspar, however, on a daily basis.

Clorzanepam has helped me when I get severe anxiety...It takes about 1/2 to1 hour for it to kick in for me and then I get a sleepy feeling for about an hour...then it just helps to keep me calm for many hours to follow. I am very happy with the results of my benzo!!!

[Hoody62]

I took Xanax off and on for one year at the .25 mg level. I took it only when an anxiety attack occured, which was maybe once every few weeks. Xanax worked well for me, becuase it untightened my chest; however, I never experienced that "calm, don't worry feeling" that others say they get from it. My brain never knew I was taking it, but other parts of my body affected by the anxiety attack did. After one year my body told me when it had enough of the Xanax. I began having the opposite of an anxiety attack--I would get muscles that felt like jelly, and no urge to breath whatsoever. So, I stopped taking Xanax and low and behold, 5 weeks later withdrawals kicked in. Neither of my doctors believed me. They said I hadn't been taking enough of it. I found it amazing that I could look up the symptoms of Xanax withdrawals and find my symptoms among them and still be disbelieved by 2 doctors. I think they just didn't want to have to deal with me going through withdrawals. Withdrawas lasted off and on for 3 weeks and were unpleasant, but I made it.

[debaser23]

Thanks for your responses.  I was hoping for more, but maybe there just aren't many people here how have been on them for that long.  

I'm mainly curious about tolerance.  I've read a lot about the subject and have found that tolerance to anxiotic properties of benzos is pretty rare.  As I think RCA said, many people appear to develop tolerance to the sedative properties and mistake that for the "tolerance" that leads to higher and higher doses.

So I guess the question I'm ultimately seeking to answer is, why aren't benzodiazepines more popular for treating anxiety and panic for the long term?  What's the draw back?  Assuming patients don't just take the pill and forget about working on themselves, what's the problem?  Why fool around with SSRIs?

I know I'm just one person and I haven't even been on Klonopin that long, but it has made such an incredible difference in my life that I'm just really impressed with it.  I don't feel just great 100 percent of the time or anything, but it's a night and day difference and I'm not exaggerating at all.

Others' mileage may vary.  I realize that, so I don't want to just sound completely pro-benzo.  I think if you have the wrong doctor they could ultimately do more harm than good, and I think benzo patients should educate themselves thoroughly.  They're quite potent.

Anyway, I'm just talking to talk, I guess.

Hope everyone has a good night.

[Raine9]

Hey there, kinda new to the forum.  Was thinking about meds to treat my anxiety but worried about possible long term effects.  I am a health nut and hypochondriac.  Don't even take Tylenol.  I read on Wikipedia, the following:

'In long term and high dosage therapy, periodic liver function tests should be administered and the dosage of any benzodiazepine should be carefully titrated in patients with impaired hepatic function and renal clearance. While liver damage may be limited when these drugs are prescribed at the recommended dosage, the possibility of such harm should be considered in all individuals; especially individuals utilizing other medications including over the counter analgesics and/or alcohol.'

Do you know anything about this? Is this something I should even worry about?
I tried asking Dr. Gould but he just kinda ignored that part of my question.

BTW: are you a doctor, pharmacist? How do you know so much?

Much appreciated...

[debaser23]

Well, it could just be that not many people have been on them that long.  

I actually talked to my doctor today as I had a "refill appointment".  It so happens that I asked him about the liver stuff, and he said it's exceedingly rare with normal dosing, but he didn't go into many details.  Maybe it tends to happen more when people take them in combination with other drugs.  I wouldn't have known I couldn't take Zantac with my Klonopin if RCA had told me, for example.  That will screw with the liver, apparently.

If you take a benzo regularly, you'll become dependent.  But does it really matter?  I only have experience with Klonopin and maybe others are different, but I don't understand how anyone could abuse them.  You notice a huge difference, but it's nothing like a high or anything remotely like that.  If you're dependent on a therapeutic dose and it helps you, there's nothing wrong with that.

I'd suggest that anyone who decides to use benzodiazepines as part of their recovery trust their doctor.  Get a good one and trust him or her.  Don't ever increase doses on your own.  Never.  And research the drug you're taking so you know all about it and what to expect.  

I was scared shitless of drugs before I took my Klonopin, but I finally did and it worked amazingly well.  Best decision I ever made in my life was the day I finally took the stuff.

[debaser23]

By the way, if I had my guess "long term and high dosage therapy" would likely apply to patients who take benzos for seizures.  There are people on really large doses of Klonopin for that...much more than you would EVER take for anxiety disorders.

[RCA7591]

Correct. The Liver Function Testing is important in folks who are taking Benzodiazepines for seizure disorder. Often times, massive doses are needed to control them.

It is not at all unusual for an epileptic to take between 10-20 mg of Klonopin daily. Obviously, the higher the dose, the higher the risk of liver complications.

Generally speaking,doses less than 1 mg aren't going to effect a normal person's liver, unless he has a predisposition to a liver disorder, or he abuses other drugs (namely, alcohol and pain killers).

Raine, Benzodiazepines are no good for true depression, they can make it worse. If you are unsure of the difference between anxiety and depression, I'd recommend scheduling an appointment to see a Psychiatrist so you can be evaluated.

If you have a combination of depression and anxiety (the anxiety being "somatic", ie: thoughts over your health), A Tricyclic antidepressant would probably work better for you. Elavil and Sinequan are both very good choices. There are some others as well.

-Ryan

[RCA7591]

"So I guess the question I'm ultimately seeking to answer is, why aren't benzodiazepines more popular for treating anxiety and panic for the long term? What's the draw back? Assuming patients don't just take the pill and forget about working on themselves, what's the problem? Why fool around with SSRIs?"

(1) Benzo's were overprescribed in the 70's (mainly Valium and Serax), and they got a "bad rap". GP's handed them out like candy for even the slightest complaint. Notice now that all prescribing literature clearly states "Stress associated with daily living does not usually require treatment with an anxiolytic"

(2) SSRI pushers: The manufacturers push SSRI's as Benzodiazepine replacements, even though they are largely ineffective. Most are still patented, which means MAD MONEY for the manufacturer. Benzo's are older drugs, and none of them are patented. They are cheap to make, the revenue is far less. In the end, it's all about the money, sadly.
Care for some Prozac weekly?

As if the SSRI's were bad enough. Now "they" are pushing newer SNRI's and "atypical antipsychotics" for the treatment of anxiety.

(3) Liability: Largely a non-issue with the true anxiety patient, but a select few will "drug seek". Xanax or Valium are the drugs of choice and abuse. Some docs are "apprehensive" about dispensing them. Many are "benzophobic" (especially the younger doctors). Those who abuse Benzo's usually abuse other drugs as well (especially alcohol).

Some shrinks (ie: my aunt), require that the patient sign a contract, a type of "informed consent" before any Benzo is dispensed. This clears the issue of liability. Likewise, she has forms for other drugs as well. Any side effect or other important material is fully disclosed to the patient *prior* to the initiation of therapy.

What's the drawback? There is none, other than the abuse potential. Benzo's are schedule IV controlled substances (low potential for abuse).

As you say, Benzo's rarely lose their anxiolytic effect. Tolerance is rare, and even more rare for long-acting Benzo's.

No other class of drugs in the history of Psychiatry have been proven to be more effective than Benzodiazepines for anxiety states. Tolerance and abuse potential is almost a non-issue when the drugs are used correctly.

There are many opinions on this subject, and the above material is one opinion only. I am "pro-benzo".

-Ryan

[debaser23]

What's going on...I can't see the rest of the posts?

[Raine9]

I wished more people would have responded to your poll.  I'm was also interested in what they had to say.

I'm contemplating going on some type of drug to help me with my anxiety/depression.  I have an appointment next Monday.  I'm not big on meds.  I'm worried about the long-term effects.  A lot of people on this forum rely on their meds and I understand why, anxiety sucks!  However, I read posts in the addiction/substance abuse forum and I get worreid cuz a lot of people in THAT forum wish they never went on any "anti-anxiety", "anti-depressant" drugs.      

[Raine9]

depression or anxiety...hmmm good question.  I think both depending on the day. maybe the anxiety is causing the depression. cuz honestly, i have a lot to be happy about and am pretty content with the way my life turned out.

i do have an appointment to see a psychiatrist on monday.  i will ask him about Tricyclic antidepressants. THANKS!!

so you are not gonna tell me what your profession is?  hmmm...

[Raine9]

I forgot, thanks for clarifying the liver damage stuff.  Like duh...it's so apparent to me now.  (And I graduated from college with honors??? Sometimes I don't know how i pulled that one off!)  Anyway, I'm not so worried about it anymore.  Thanks a bunch.  

Have a good weekend.  

[RCA7591]

Raine,

The first step in making a clear-cut diagnosis would be to differentiate between anxiety and depression. Below are two *limited* examples, both appear to have depressive qualities, but only one actuallly does (the depressed patient):

The Anxiety Patient Conversation:

"The traffic is very heavy this morning.
I hope my wife won't have an accident"

"I suppose you see a lot of nerve cases.
Some very bad ones.
Some like me.
Some that don't get better"

The Depressed Patient Conversation:

"The traffic is very heavy this morning.
I really don't deserve to have a car."

"I suppose you see a lot of nerve cases.
Some very bad ones.
They deserve to get better.
But I don't."

Two totally different trains of thought, each with a specific treatment modality.

In example #1 (the apprehensive anxious patient), the most common treatment modalities would include Benzodiazepines or Tricyclic antidepressants.

Example #2 is a more extreme type of depressive state, which shows "self-worthlessness". Here, depending on the severity of the depressive disorder, the treatment modalities could include Tricyclic antidepressants, SSRI's, SNRI's, or MAOI inhibitors for extreme cases.

Essentially, there is a fine line as to what these drugs will target in specific (with the possible exception of the Tricyclics and SSRI's, as they have indications for both), therefore, the correct diagnosis is needed. You wouldn't want to give an anxious person "stimulating" drugs like Tofranil, as they would only further increase his anxiety. Likewise, you wouldn't want to give a depressed patient a CNS depressant like Ativan, as the depression would only worsen. Of course, it may take some "trial and error" to find the appropriate drug treatment for you.

The examples given above are non-specific, they merely show the contrast between anxiety and depression states.

-Ryan

[Raine9]

Oh my god, thank you for that.  I definitely follow the "anxiety patient" train of thought.  I will discuss this with the psych on monday.  I have seen other psychs and therapists in the past but they never explained it to me like that.  They never explained medications to me like that either.  This is an eye opener.

Thank you so much.