# Benzos revisited: last time for me.



## Guest (Sep 18, 2004)

And thank you terri for the heads about.

Here is a different perspective regarding Xanax its safety and withdrawal in answer or in response to the alarmist post by dakatajo.

I will lets the statement speak for it self:

"or the layperson --- 
Dr. Steve's Guidelines for Discontinuing Xanax (alprazolam)
Stephen Cox MD, Asst Clinical Professor of Psychiatry, UKMC
This article is written in lay terminology and with analogies to make complicated medical science understandable.
Return to NAF home page
You've no doubt heard negative things about Xanax. We have all read stories of some negative aspect of the use of Xanax. These stories are surprising. I, personally, have seldom experienced difficulty in tapering Xanax in patients with panic disorder. This may be a surprise to those who are not experienced in prescribing psychoactive medicants for anxiety disorders.

The fact is that Xanax works very well indeed in treating panic disorder. Tolerance develops to the initial dose. Dose increases are necessary in the first weeks of therapy. Why the tolerance? This is a very good question and should be answered before you start taking Xanax. You can't possibly know how to go off Xanax unless you understand what happens to your body as you are going on it.

There is a neurotransmitter in your brain called GABA. It stands for gamma amino butyric acid. GABA is your natural God-given tranquilizer. It is present at 80% of the nerve connections in your brain. When you are too nervous your brain cells release GABA which causes negatively charged chlorine atoms to stream into your nerve cells. That's good because it makes it harder for other stimulating neurotransmitters to trigger the firing of that nerve. If your brain were a car, anxiety might be like the car speeding down a hill toward a sharp curve. As it comes to a curve it must slow down. The car brakes are applied so that the car can negotiate the curve and not burst through the guard rail. The GABA molecules of your brain are like the brakes in your car. If you don't have enough GABA, your brain is going to be like the car speeding toward a curve with worn out brakes! Xanax acts by making what little GABA you do have work more strongly. This is sort of like applying stronger pressure on worn out brakes so that your car will negotiate a curve safely.

When you take Xanax for a couple of weeks it usually works great for panic disorder but then it does not seem to work as well as time goes on. This is to be expected. Why? This could be for two reasons. One possibility is that your brain cuts back on the release of GABA. It is sort of like your brain says, "Gosh, things are a lot calmer in here. I don't think I need to make as much GABA as I used to." Well, you likely didn't have enough GABA to begin with. And now your brain makes even less than it did before you started taking Xanax. Naturally, the Xanax wouldn't work as well once GABA is reduced.

A second reason for tolerance may be down in your liver. Your liver gets rid of Xanax ultimately by making enzymes which destroy Xanax. After you are on Xanax for awhile it is as if your liver says, "Hey we sure are getting a lot of Xanax these days. Let's make more Xanax-destoying enzymes." And so it does. Let's say your dose that you started out on was giving you a blood level of, say, 100 units. But after your liver makes more of this destroying enzyme you have a level of, say, 55 units of Xanax. No wonder you feel like the Xanax isn't working as well. It isn't! Even though you're taking the same dose, your blood level dropped. Remember, it does not really make any difference how many milligrams you swallow. What really matters is how much is running around in your bloodstream.

So, tolerance normally develops to Xanax and it may be due to either or both of the above reasons. If you didn't understand those two things, go back and read it again because what follows won't make much sense unless you understand those two ideas.

Now, let's say we have a 26 year old woman, Monica, who has been on 6 mg of Xanax for panic disorder for 3 years. She's doing great. She can drive anywhere she wants and no panic attacks have occurred for 2 years. She even flew from Cincinnati to Cancun Mexico without a problem. She asked her psychiatrist if it would OK if she went off the Xanax now to see if she still needed it. The psychiatrist said yes, 'but you must not do it faster than I order'. The patient was relieved to hear her psychiatrist was urging a gradual decline. You see, the patient's roommate, Suzy, had taken herself off Xanax from 6 mg per day to 3mg a day suddenly. And after only a week she stopped it completely. She thought she would die, she felt so bad; and, she blamed it on 'the addictive nature of Xanax'. Fortunately, Monica was told by her psychiatrist to cut her daily dose from 6.0 mg per day to 5.75 mg per day and to stay on that dose for two weeks. Then she was told to cut to 5.5 mg a day for another 2 weeks, and so on by 0.25 mg off her daily dose every 2 weeks. Monica's psychaitrist explained that there was no way to tell if she still had panic disorder or not and by going down that slowly, if Monica should experience any anxiety symptoms, it would be due to the reappearance of panic disorder symptoms that were inadequately treated by her lower dose of medicine. This would mean that Monica still was afflicted with panic disorder and needed continued treatment, at least for the time being. If, on the other hand, she gradually tapered the Xanax down to zero and had no panic attacks, she would officially be either well or in remission.

So, if you want to go off Xanax, ask your doctor how to do it. If there is a rush, it can be done faster than the above method. But usually there is no rush. And it is usually best to go slowly.

Now, let's review. Why didn't our patient Monica have any withdrawal when she tapered off Xanax, whereas her roommate, Suzy had severe withdrawal? The answer is that both women had a very, very low level of GABA production and a very high level of liver Xanax-destroying enzymes. When Suzy cut herself off over a week's time, she thought she was tapering off but it was actually much too fast. It takes a long time for the brain to figure out that it needs to make more GABA and to do so. It also takes a long time for the liver to quit making so much Xanax-destroying enzymes. Monica's psychiatrist wisely told her to make these tiny cuts in the Xanax dose that were barely perceptible to her as far as the way she felt. And equally wisely she had her go 2 weeks on that dose to let her brain GABA increase and liver enzymes decrease before cutting the dose further.

Dr. David Sheehan of the University of South Florida suggested this method to me at a meeting in Tampa years ago. I cannot recall any of my patients experiencing any bothersome withdrawal discomfort in going off Xanax by the above method. Any difficulties I witnessed were relapses of a clinically silent panic disorder that was previously adequately treated by the Xanax at the pre-taper dose.

You should never, never, never decide to go off Xanax on your own without your physician's counsel and guidance. Xanax is a remarkably safe medicine except for two things: overdosing on it can be extremely hazardous to driving safety. Sudden or rapid stopping Xanax at daily doses of 4 mg or more can cause moderate to severe withdrawal and, in very rare instances, a convulsion could occur.

You should carefully weigh the decision to go off Xanax with medical counsel. Is this a good time to go off it? Is this a stressful time? If so, you should wait until a calmer time. Are you being pressured into going off Xanax prematurely by well-meaning, but uninformed family or friends who value more your 'being off medicine' than they do the relief of your suffering with panic attacks and avoidance behavior. Panic disorder is not a trivial thing. It, untreated, is associated with the highest suicide attempt rate of all medical disorders. It, untreated, also has a higher mortality risk from cardiovascular cause than non-panic disorder persons. The general principles we have discussed with Xanax also holds true for other high potency benzodiazepines like lorazepam (Ativan) and clonazepam (Klonopin). The dosages however are all different and the mg reductions do not apply to these other medicants.

Despite popular beleif, it is my opinion that Xanax is under-utilized by clinicians in their patients. Such medicines are remarkably safe. Panic disorder patients seem rarely to abuse such medicine. Compliance problems (patients not following doctors orders) with panic disorder patients on Xanax are rare; and, when seen are most often a matter of the patient not taking as much medicine as is prescribed rather than taking too much.

Return to NAF home page.

http://www.xanaxxr.com/content.asp?ID=1


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## Guest (Sep 18, 2004)

And thank you terri for the heads about.

Here is a different perspective regarding Xanax its safety and withdrawal in answer or in response to the alarmist post by dakatajo.

I will lets the statement speak for it self:

"or the layperson --- 
Dr. Steve's Guidelines for Discontinuing Xanax (alprazolam)
Stephen Cox MD, Asst Clinical Professor of Psychiatry, UKMC
This article is written in lay terminology and with analogies to make complicated medical science understandable.
Return to NAF home page
You've no doubt heard negative things about Xanax. We have all read stories of some negative aspect of the use of Xanax. These stories are surprising. I, personally, have seldom experienced difficulty in tapering Xanax in patients with panic disorder. This may be a surprise to those who are not experienced in prescribing psychoactive medicants for anxiety disorders.

The fact is that Xanax works very well indeed in treating panic disorder. Tolerance develops to the initial dose. Dose increases are necessary in the first weeks of therapy. Why the tolerance? This is a very good question and should be answered before you start taking Xanax. You can't possibly know how to go off Xanax unless you understand what happens to your body as you are going on it.

There is a neurotransmitter in your brain called GABA. It stands for gamma amino butyric acid. GABA is your natural God-given tranquilizer. It is present at 80% of the nerve connections in your brain. When you are too nervous your brain cells release GABA which causes negatively charged chlorine atoms to stream into your nerve cells. That's good because it makes it harder for other stimulating neurotransmitters to trigger the firing of that nerve. If your brain were a car, anxiety might be like the car speeding down a hill toward a sharp curve. As it comes to a curve it must slow down. The car brakes are applied so that the car can negotiate the curve and not burst through the guard rail. The GABA molecules of your brain are like the brakes in your car. If you don't have enough GABA, your brain is going to be like the car speeding toward a curve with worn out brakes! Xanax acts by making what little GABA you do have work more strongly. This is sort of like applying stronger pressure on worn out brakes so that your car will negotiate a curve safely.

When you take Xanax for a couple of weeks it usually works great for panic disorder but then it does not seem to work as well as time goes on. This is to be expected. Why? This could be for two reasons. One possibility is that your brain cuts back on the release of GABA. It is sort of like your brain says, "Gosh, things are a lot calmer in here. I don't think I need to make as much GABA as I used to." Well, you likely didn't have enough GABA to begin with. And now your brain makes even less than it did before you started taking Xanax. Naturally, the Xanax wouldn't work as well once GABA is reduced.

A second reason for tolerance may be down in your liver. Your liver gets rid of Xanax ultimately by making enzymes which destroy Xanax. After you are on Xanax for awhile it is as if your liver says, "Hey we sure are getting a lot of Xanax these days. Let's make more Xanax-destoying enzymes." And so it does. Let's say your dose that you started out on was giving you a blood level of, say, 100 units. But after your liver makes more of this destroying enzyme you have a level of, say, 55 units of Xanax. No wonder you feel like the Xanax isn't working as well. It isn't! Even though you're taking the same dose, your blood level dropped. Remember, it does not really make any difference how many milligrams you swallow. What really matters is how much is running around in your bloodstream.

So, tolerance normally develops to Xanax and it may be due to either or both of the above reasons. If you didn't understand those two things, go back and read it again because what follows won't make much sense unless you understand those two ideas.

Now, let's say we have a 26 year old woman, Monica, who has been on 6 mg of Xanax for panic disorder for 3 years. She's doing great. She can drive anywhere she wants and no panic attacks have occurred for 2 years. She even flew from Cincinnati to Cancun Mexico without a problem. She asked her psychiatrist if it would OK if she went off the Xanax now to see if she still needed it. The psychiatrist said yes, 'but you must not do it faster than I order'. The patient was relieved to hear her psychiatrist was urging a gradual decline. You see, the patient's roommate, Suzy, had taken herself off Xanax from 6 mg per day to 3mg a day suddenly. And after only a week she stopped it completely. She thought she would die, she felt so bad; and, she blamed it on 'the addictive nature of Xanax'. Fortunately, Monica was told by her psychiatrist to cut her daily dose from 6.0 mg per day to 5.75 mg per day and to stay on that dose for two weeks. Then she was told to cut to 5.5 mg a day for another 2 weeks, and so on by 0.25 mg off her daily dose every 2 weeks. Monica's psychaitrist explained that there was no way to tell if she still had panic disorder or not and by going down that slowly, if Monica should experience any anxiety symptoms, it would be due to the reappearance of panic disorder symptoms that were inadequately treated by her lower dose of medicine. This would mean that Monica still was afflicted with panic disorder and needed continued treatment, at least for the time being. If, on the other hand, she gradually tapered the Xanax down to zero and had no panic attacks, she would officially be either well or in remission.

So, if you want to go off Xanax, ask your doctor how to do it. If there is a rush, it can be done faster than the above method. But usually there is no rush. And it is usually best to go slowly.

Now, let's review. Why didn't our patient Monica have any withdrawal when she tapered off Xanax, whereas her roommate, Suzy had severe withdrawal? The answer is that both women had a very, very low level of GABA production and a very high level of liver Xanax-destroying enzymes. When Suzy cut herself off over a week's time, she thought she was tapering off but it was actually much too fast. It takes a long time for the brain to figure out that it needs to make more GABA and to do so. It also takes a long time for the liver to quit making so much Xanax-destroying enzymes. Monica's psychiatrist wisely told her to make these tiny cuts in the Xanax dose that were barely perceptible to her as far as the way she felt. And equally wisely she had her go 2 weeks on that dose to let her brain GABA increase and liver enzymes decrease before cutting the dose further.

Dr. David Sheehan of the University of South Florida suggested this method to me at a meeting in Tampa years ago. I cannot recall any of my patients experiencing any bothersome withdrawal discomfort in going off Xanax by the above method. Any difficulties I witnessed were relapses of a clinically silent panic disorder that was previously adequately treated by the Xanax at the pre-taper dose.

You should never, never, never decide to go off Xanax on your own without your physician's counsel and guidance. Xanax is a remarkably safe medicine except for two things: overdosing on it can be extremely hazardous to driving safety. Sudden or rapid stopping Xanax at daily doses of 4 mg or more can cause moderate to severe withdrawal and, in very rare instances, a convulsion could occur.

You should carefully weigh the decision to go off Xanax with medical counsel. Is this a good time to go off it? Is this a stressful time? If so, you should wait until a calmer time. Are you being pressured into going off Xanax prematurely by well-meaning, but uninformed family or friends who value more your 'being off medicine' than they do the relief of your suffering with panic attacks and avoidance behavior. Panic disorder is not a trivial thing. It, untreated, is associated with the highest suicide attempt rate of all medical disorders. It, untreated, also has a higher mortality risk from cardiovascular cause than non-panic disorder persons. The general principles we have discussed with Xanax also holds true for other high potency benzodiazepines like lorazepam (Ativan) and clonazepam (Klonopin). The dosages however are all different and the mg reductions do not apply to these other medicants.

Despite popular beleif, it is my opinion that Xanax is under-utilized by clinicians in their patients. Such medicines are remarkably safe. Panic disorder patients seem rarely to abuse such medicine. Compliance problems (patients not following doctors orders) with panic disorder patients on Xanax are rare; and, when seen are most often a matter of the patient not taking as much medicine as is prescribed rather than taking too much.

Return to NAF home page.

http://www.xanaxxr.com/content.asp?ID=1


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## Guest (Sep 18, 2004)

xanax is a load of BS

it ruins people lives

http://www.benzo.org.uk


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## Guest (Sep 18, 2004)

xanax is a load of BS

it ruins people lives

http://www.benzo.org.uk


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## Guest (Sep 18, 2004)

Your an idiot.


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## Guest (Sep 18, 2004)

Your an idiot.


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## nemesis (Aug 10, 2004)

Benzos can give great relief to those suffering from brief periods of environmentally triggered chronic anxiety. Like any other meds debate, the choice to take a benzo along with its side effects has to be weighed up against your current state of functioning and how long you foresee the need to take the drug. Benzos are *not* intended to be used for long term treatment, so I see little harm in using them during times of extreme crisis provided theyre only used within the recommend dosage period and always under supervision. Any long term management of a pervasive anxiety disorder is probably better treated with an SSRI in combination with councilling.

Try and have some compassion Narc. The guys asking for honest insight from those that have had experience with the medication.


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## nemesis (Aug 10, 2004)

Benzos can give great relief to those suffering from brief periods of environmentally triggered chronic anxiety. Like any other meds debate, the choice to take a benzo along with its side effects has to be weighed up against your current state of functioning and how long you foresee the need to take the drug. Benzos are *not* intended to be used for long term treatment, so I see little harm in using them during times of extreme crisis provided theyre only used within the recommend dosage period and always under supervision. Any long term management of a pervasive anxiety disorder is probably better treated with an SSRI in combination with councilling.

Try and have some compassion Narc. The guys asking for honest insight from those that have had experience with the medication.


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## Guest (Sep 18, 2004)

I have plenty of experience with these so called wonder drugs. I wouldn't be posting on these subjects if I didn't. Trust me though, I have more experience than you could ever know.


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## Guest (Sep 18, 2004)

I have plenty of experience with these so called wonder drugs. I wouldn't be posting on these subjects if I didn't. Trust me though, I have more experience than you could ever know.


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## Guest (Sep 18, 2004)

And I apologize for calling you an idiot. It just shows how passionately I hate benzos. I truly think they are the drugs from hell.


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## Guest (Sep 18, 2004)

And I apologize for calling you an idiot. It just shows how passionately I hate benzos. I truly think they are the drugs from hell.


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## Blake (Aug 10, 2004)

John,
Thank you for your insight, as it is in line with every medical professional that I have ever spoken to. My doctor (who I hold in the highest regards) agrees with your post completely.

People react negatively because they have had horrible experiences with benzos...but you can mismanage a medication (any) and have a horrible experience.

Blake


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## Blake (Aug 10, 2004)

John,
Thank you for your insight, as it is in line with every medical professional that I have ever spoken to. My doctor (who I hold in the highest regards) agrees with your post completely.

People react negatively because they have had horrible experiences with benzos...but you can mismanage a medication (any) and have a horrible experience.

Blake


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## Guest (Sep 18, 2004)

I guess the "mismanaging" person must be me? Ok, well lets talk about "mismanaging." I never took more than 0.5 mgs of klonopin daily. Thats 6 times less benzo than mr. johnny boy is taking here. So you tell me who is the one mismanaging their medication? Benzo addiction, tolerance, withdrawal has nothing to do with mismanaging. You are sadly misinformed and unfortunately you'll be like thousands of others(including me) in finding out the hard way. Have fun smart one.


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## Guest (Sep 18, 2004)

I guess the "mismanaging" person must be me? Ok, well lets talk about "mismanaging." I never took more than 0.5 mgs of klonopin daily. Thats 6 times less benzo than mr. johnny boy is taking here. So you tell me who is the one mismanaging their medication? Benzo addiction, tolerance, withdrawal has nothing to do with mismanaging. You are sadly misinformed and unfortunately you'll be like thousands of others(including me) in finding out the hard way. Have fun smart one.


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## person3 (Aug 10, 2004)

I would just like to say that i love xanax with all my heart, body, and soul.

In another language!

Ik houd van Xanax met al mijn hartlichaam en ziel

And if I had a valium right now I would take it.

It doesn't help all things but being that i know where my problems came from and hating xanax and my mother and god won't get me nowhere.

You can say it's nasty stuff but I will be the dent in your theory that xanax universally ruins.

Thank you.

Melissa Van Xanax


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## person3 (Aug 10, 2004)

I would just like to say that i love xanax with all my heart, body, and soul.

In another language!

Ik houd van Xanax met al mijn hartlichaam en ziel

And if I had a valium right now I would take it.

It doesn't help all things but being that i know where my problems came from and hating xanax and my mother and god won't get me nowhere.

You can say it's nasty stuff but I will be the dent in your theory that xanax universally ruins.

Thank you.

Melissa Van Xanax


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## Guest (Sep 18, 2004)

Person3,

Your love of xanax will give you alot of problems in the future. You should've broken up with your love while you had the chance. Looks like xanax is the one who is going to be doing the heartbreaking now.


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## Guest (Sep 18, 2004)

Person3,

Your love of xanax will give you alot of problems in the future. You should've broken up with your love while you had the chance. Looks like xanax is the one who is going to be doing the heartbreaking now.


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## luke1979 (Aug 20, 2004)

ive never used xanax, but i used diazapan for all up about a month, actually, more like 6 weeks.
it helped me.
i had no problems at all when i started, or stopped taking it.
from the start i knew it was only to be used for a short period of time, so i was carefull as to how much, and how often i took it, at most id have a 5mg tablet twice a day.
im also using an anti-d which i think is helping my anxiety so i dont need the diazapan anymore.
i wont hesitate to take them again if needed and i carry a tablet with me to work and so on just in case, however i havnt taken one.
my personal experience with benzo's has been all positive, but i do know some people have problems with them, so i would only advise someone to take them if they are really needed and to only take them for a short period of time.


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## luke1979 (Aug 20, 2004)

ive never used xanax, but i used diazapan for all up about a month, actually, more like 6 weeks.
it helped me.
i had no problems at all when i started, or stopped taking it.
from the start i knew it was only to be used for a short period of time, so i was carefull as to how much, and how often i took it, at most id have a 5mg tablet twice a day.
im also using an anti-d which i think is helping my anxiety so i dont need the diazapan anymore.
i wont hesitate to take them again if needed and i carry a tablet with me to work and so on just in case, however i havnt taken one.
my personal experience with benzo's has been all positive, but i do know some people have problems with them, so i would only advise someone to take them if they are really needed and to only take them for a short period of time.


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## Guest (Sep 18, 2004)

Hi,

Just want to say that 0,5 mg of klonopin, withdrew in safe dosage, can't make your life a HELL, pure narcotic. It's too little for that.

Sincerely,

coucouc


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## Guest (Sep 18, 2004)

Hi,

Just want to say that 0,5 mg of klonopin, withdrew in safe dosage, can't make your life a HELL, pure narcotic. It's too little for that.

Sincerely,

coucouc


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## Guest (Sep 18, 2004)

Benzos don't kill people.
People kill people.

And that, just like the gun debate, is only a way of saying there are two sets of facts, and two Truths to every question. It depends on our personal experience and whether or not for us the hot potato in question proved dangerous or life-saving.

Peace,
Janine

p.s. for our Non-American friends, the above is a parody of a slogan from the American Rifle Assocation (arguing that we have the right to bear arms, to own guns, etc. and protesting those who say that if we allow our citizens to own handguns, more deaths will result. The actual slogan is: "guns don't kill people. PEOPLE kill people")


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## Guest (Sep 18, 2004)

Benzos don't kill people.
People kill people.

And that, just like the gun debate, is only a way of saying there are two sets of facts, and two Truths to every question. It depends on our personal experience and whether or not for us the hot potato in question proved dangerous or life-saving.

Peace,
Janine

p.s. for our Non-American friends, the above is a parody of a slogan from the American Rifle Assocation (arguing that we have the right to bear arms, to own guns, etc. and protesting those who say that if we allow our citizens to own handguns, more deaths will result. The actual slogan is: "guns don't kill people. PEOPLE kill people")


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## dakotajo (Aug 10, 2004)

PROTOCOL FOR TREATMENT OF XANAX WITHDRAWAL 
By: Ronald A. Gershman, M.D.

BACKGROUND

Xanax is a triazolobenzodiazepine that is very similar to other benzodiazepines in most of its properties, but does have some properties that distinguish it from the group in general, which are specifically its anti-panic an anti-depressant properties. As an anxiolytic or anti-anxiety agent, it functions more or less indistinguishably from other benzodiazepines. In that capacity, it is a relatively short-acting anti-anxiety agent 
with a half life of somewhere between 8 and 12 hours.

Xanax, when administered on a regular basis, will produce physiological dependence with a severe withdrawal syndrome that relates to both dose and duration of usage, with duration being more important than actual dosage. Higher doses will produce more rapid physiologic addiction than lower doses, but severe levels of physical addiction can occur in even the low therapeutic range of dosaging at 1 mg. or 2 mg. per day. Average length of time necessary to occur to the extent that the patient will clinically experience clearly noticeable symptoms of withdrawal is approximately four to six months at dosages between 2 mg. to 4 mg. If there is a history of addiction to benzodiazepines, an addiction can occur much more rapidly over a shorter period of time, with a more intense withdrawal.

Since Xanax is a relatively short-acting agent, the symptoms of withdrawal have a relatively rapid onset and rapidly accelerate, producing severe dysphoria and symptoms of withdrawal in the patient beginning at approximately six hours from the last dose and generally peaking at approximately 24 to 72 hours after discontinuation. What has become clinically apparent with Xanax which appears to be somewhat different than the other benzodiazepines is that the patients ability to self-detox or be able to be gradually tapered off of the medication is markedly more difficult. Thusly, once the physiologic dependence has occurred with Xanax, the ability of the patient to discontinue use successfully on their own is quite low, and medical assistance becomes of significant necessity in the majority of cases. THE WITHDRAWAL SYNDROME

The withdrawal syndrome from Xanax and other benzodiazepines are quite similar, with the exception that Xanax has a much higher incidence of panic attack and a bereavement type of emotional lability that is singularly more severe. Since the symptoms are almost all internal, with a few physical or objective manifestations, the diagnosis of it can be very difficult. Patients have a difficult time verbally describing what is occurring, and much of the descriptions often take on a quality or character reminiscent of the emotional or psychiatric problem for which they originally began taking Xanax, and is not understood or elucidated as withdrawal symptomology.

The withdrawal syndrome, though, is quite clearly different and can be easily diagnosed with a clear understanding of some of the more defining features. In the early stage of withdrawal, there is a presentation of a sense of anxiety and apprehension associated with increasing subjective sense of tremor and mild bifrontal headache. This rapidly progresses to feelings of panic-like anxiety with tachycardia and palpitations, as well as a rapidly progressing feeling of de-realization, which is an altered sense of reality, additionally associated with marked startle response and a general amplification of most sensory input. As the withdrawal syndrome progresses, there is a marked disturbance of proprioception, with difficulty in ambulation relative to feeling "dizzy" and "unsteady," needing to use reference and physical objects to steady oneself. With the proprioceptive problem increasing in severity simple acts such as swallowing, signing one's name, talking or even buttoning a shirt can become extremely difficult. many patients at this stage describe hot/cold sensations and generalized myalgia.

There is also a progession of extreme emotional lability with sudden outbursts of crying or near panic levels of anxiety and fearfulness which will have sudden onset without clear connection to external events. Associated with this are frequent hypochodriacal fears of morbid consequence from the sensations they are feeling, such as fear of heart attack or stroke. patients will also experience a type of emotional dysphoria which is very difficult for them to verbalize, but which come very close by cumulative description to a bereavement type of feeling that is very painful emotionally. Additionally, the amplification of almost all sensory information coming into the brain, other than that of taste, can produce many bizarre misinterpretation of sensory stimulation ranging from feeling one's teeth rotating in their sockets to parts of their bodies disassociating or "falling off".

As the withdrawal symptom further progresses, illusionary and hallucinatory phenomena, predominately of a visual nature, will begin to manifest themselves, initially with patterens and geometric shapes, and then into full-formed complex visual hallucinations. These also often will become associated with delusions of bodily dysfunction or discorporation. It is very frequent and common for the patient to conclude that he is having a nervous breakdown, or "going crazy" as an attempt to try to understand the process at hand, not understanding it as withdrawal phenomena. With further progression, disorientation to person and place will occur with full delirium, and eventually withdrawal will finalize with tonic-clonic major motor seizure activity, generally singular in nature, although several cases of status have been reported.

The last triad of symptoms--of hallucinosis, delirium and seizure--are classified as major symptoms of Xanax withdrawal, with the others classified as minor symptoms. The withdrawal syndrome can take from six months to two years to fully resolve and is well-documented in literature regarding this. Not all patients will experience withdrawal symptomology for that length of time, but most will have withdrawal for at least several months.

TREATMENT APPROACH

The treatment approach is focused primarily on the utilization of Tegretol, which has been shown to be extremely effective in preventing and of the major symptoms of Xanax withdrawal, as well as attenuating significantly most of the minor symptoms. The Tegretol is utilized along with Klonopin as a cross-over benzodiazepine to stabilize and to create control of withdrawal until adequate Tegretol blood levels have been achieved, then allowing one to discontinue the Klonopin. The total length of treatment will span somewhere between 10 to 30 days which, relative to the natural course of this withdrawal syndrome, actually represents a short period of time.

The first step is to estimate the total daily dose of Xanax and start the patient on an equivalent amount of Klonopin, which relates to Xanax on a ration of 2 mg. Klonopin to 1 mg. of Xanax. Thusly, a patient with a daily dose of 4 mg. of Xanax would be given a single bed time dose of Klonopin at 8 mg., which will quickly and effectively stabilize them and prevent further symptoms of withdrawal. Additionally, the patient is started on Tegretol at 50 mg. three times a day and is increased by 50 mg. increments until a total daily dose of 400 mg. daily, in divided doses q.i.d., is achieved, at which the first Tegretol blood level will be ascertained, It will generally take four to seven days to reach therapeutic blood levels.

Since Klonopin has an extremely long half life of 40 to 60 hours, the patient is well covered with a single bed time dosaging, and this benzodiazepine has shown little abuse potential for drug seeking behavior and provides smooth, steady serum levels during the course of treatment. Generally, beginning day 2 or 5, the dose of Klonopin is decreased as the dose of Tegretol being increased. Since therapeutic levels of Tegretol can often be achieved while the patient is being titrated to a therapeutic blood level of Tegretol, the Klonopin is reduced at a rate of approximately 1 mg. per day. generally, with doses in excess of 6 to 8 mg. per day of Klonopin, there is enough time with this rate of withdrawal to slowly establish a Tegretol level without neurotoxicity during the cross-over, and there is little probability of any breakthrough major symptoms of withdrawal due to Klonopins very long half life. Since both Klonopin and Tegretol are very potent anti-convulsants, the incidence of seizure has been essentially 0 in over 300 cases that we have treated so far. The Klonopin is thusly being decreased at 1 mg. daily until one reaches 1 mg., at which point decreases are then done by 0.25 mg. increments anywhere from once a day, on average, once a week.

It is important to understand that Tegretol has a significant impact on auto-induction of liver enzymes, and initially, for the first exposure to Tegretol, a dose as low as 200 mg. may produce a blood level in the therapeutic range of somewhere between 4 to 10 mcg/L necessary for control of seizure and withdrawal; but as liver enzymes are induced, increasing doses will be necessary over the necessary weeks to maintain an adequate blood level. The average dose eventually that is achieved in steady state with induction of liver enzymes is somewhere between 400 mg. and 800 mg. daily, with an average of approximately 600 mg. Additionally, the half life of Tegretol will be essentially 20 to 26 hours when initially used, but will progressively shorten as liver enzyme induction takes place, approaching a half life as short as six to eight hours and requiring multiple daily dosaging at that time.

The major complications with Tegretol are neurotoxic effects when blood level will be generally too high, or above the level of 10 mcg/L, or due to an accumulation of its first order epoxide metabolite. These complications of neurotoxicity present themselves as nauseousness and vomiting, significant sedation, dizziness and dyscoordination. Also frequently reported is a sense of significant gastric retention with delayed gastric emptying. Although the side effects of Tegretol can be successfully treated with Reglan, Tigan and/or Antivert, it is far better to slowly titrate the dose and avoid developing these side effects. The presense of them can be ascertained to represent blood levels that are unacceptably high and to slow the rate of increasing of the Tegretol dosage. There is a small percentage of the population of people who simply do not tolerate Tegretol because of the GI side effects.

As noted, Tegretol is almost 100% effective in controlling major symptoms of Xanax withdrawal, but will very in its effectiveness in attenuating the minor symptoms, thus requiring sometimes slower titration down off the Klonopin. It is infrequent that one needs to go slower than once a week in the 0.25 mg decreases, and often one can be decreased on a daily basis without symptoms of withdrawal, but at times the decrease may have to be as slow as once a month. Once the patient is off the Klonopin and on the Tegretol in a steady state basis, the patient is maintained on Tegretol for approximately one to two months after achieving this state, and then tapered off of the Tegretol over a four to five day period of time. Should there be a recurrence of withdrawal symptomology, then the Tegretol is reinstated for an additional month, and then the process repeated.

CBC and checks of white blood count should be done periodically while the patient is on Tegretol. There often will be mild leukopenia with white count at 3000 to 4000 found with Tegretol, which is benign. The incidence of agranulocytosis is extremely rare with tegretol, and there is support in the literature for the lack of need for rigorous routine white count testing while on this medication. Prudence, though, would require some periodic evaluation of white count while the patient is being maintained on the tegretol.

Once the patient has been successfully detoxed off Xanax and/or the Tegretol, the issues of underlying conditions, such as Agoraphobia, Panic Disorder, Generalized Anxiety Disorder, or Major Depressive Disorder, often must still be dealt with. Whereas Buspar is of no utility in managing Xanax withdrawal or Xanax-generated anxiety, it can be quite helpful for anxiety that is non-benzodiazepine withdrawal related, and patients, after completion of withdrawal, can be, and often have been, successfully maintained on Buspar at 40 to 60 mg. daily as a final dose with good control of underlying anxiety. Treatment of Panic Disorder and/or Agoraphobia will often require a tricyclic anti-depressant in conjunction with Buspar, with essentially good success. The introduction of the anti-depressant can be begun at the time withdrawal is started, or can be deferred to a later date, depending on the intensity and frequency of panic attacks that the patient may be having.

It should be kept in mind that a patient with underlying Agoraphobia or Panic Disorder will have a marked exacerbation of his/her pre-existing illness during the course of withdrawal.It is often then of necessity to start an anti-depressant to stop panic attacks in order to get the patient through the withdrawal process successfully. The presence of a tricyclic will not interfere materially in any way with the medications for withdrawal.

Patients having gone through this process will generally need a significant degree of emotional support and constant re-assurance during the withdrawal stage that they are indeed in withdrawal and are not suffering some morbid physical or psychiatric disorder other than the withdrawal process. Weekly visits with medication management, plus frequent phone consultation generally is what is required and generally produces a successful outcome on an outpatient basis. In more severe cases, and in situatioons where time or efficiency is paramount, then inpatient treatment is the most effective route to be travelled, and the detoxification can be accomplished much more rapidly in that modality.

It is critically important during the course of this that the patient refrain from use of all psychoactive drugs, particularly alcohol and stimulants, as well as over the counter preparations that contain pseudoephedrine and phenylpropanolamine. Lastly, caffeine must be avoided by the patient for a period of approximately six months to one year. Caffeine is a benzodiazepine antagonist and will occupy the receptor site, blocking Klonopin or other agents and intensify withdrawal markedly. Innocuous or inadvertant ingestion of high doses of caffeine is often a major complication to the withdrawal process, and patient education in this area is very important, as well as reassurance should it happen that it will wear offwithin a relatively short period of time.

Lastly, for patients who have severe symptoms of tachycardia or palpitations as an attendant withdrawal symptom, the addition of a beta blocker sich as Atenolol at 50 mg. q. day is highly effective in stopping this and generally does not need to be continued for more than 4 to 6 weeks.


----------



## dakotajo (Aug 10, 2004)

PROTOCOL FOR TREATMENT OF XANAX WITHDRAWAL 
By: Ronald A. Gershman, M.D.

BACKGROUND

Xanax is a triazolobenzodiazepine that is very similar to other benzodiazepines in most of its properties, but does have some properties that distinguish it from the group in general, which are specifically its anti-panic an anti-depressant properties. As an anxiolytic or anti-anxiety agent, it functions more or less indistinguishably from other benzodiazepines. In that capacity, it is a relatively short-acting anti-anxiety agent 
with a half life of somewhere between 8 and 12 hours.

Xanax, when administered on a regular basis, will produce physiological dependence with a severe withdrawal syndrome that relates to both dose and duration of usage, with duration being more important than actual dosage. Higher doses will produce more rapid physiologic addiction than lower doses, but severe levels of physical addiction can occur in even the low therapeutic range of dosaging at 1 mg. or 2 mg. per day. Average length of time necessary to occur to the extent that the patient will clinically experience clearly noticeable symptoms of withdrawal is approximately four to six months at dosages between 2 mg. to 4 mg. If there is a history of addiction to benzodiazepines, an addiction can occur much more rapidly over a shorter period of time, with a more intense withdrawal.

Since Xanax is a relatively short-acting agent, the symptoms of withdrawal have a relatively rapid onset and rapidly accelerate, producing severe dysphoria and symptoms of withdrawal in the patient beginning at approximately six hours from the last dose and generally peaking at approximately 24 to 72 hours after discontinuation. What has become clinically apparent with Xanax which appears to be somewhat different than the other benzodiazepines is that the patients ability to self-detox or be able to be gradually tapered off of the medication is markedly more difficult. Thusly, once the physiologic dependence has occurred with Xanax, the ability of the patient to discontinue use successfully on their own is quite low, and medical assistance becomes of significant necessity in the majority of cases. THE WITHDRAWAL SYNDROME

The withdrawal syndrome from Xanax and other benzodiazepines are quite similar, with the exception that Xanax has a much higher incidence of panic attack and a bereavement type of emotional lability that is singularly more severe. Since the symptoms are almost all internal, with a few physical or objective manifestations, the diagnosis of it can be very difficult. Patients have a difficult time verbally describing what is occurring, and much of the descriptions often take on a quality or character reminiscent of the emotional or psychiatric problem for which they originally began taking Xanax, and is not understood or elucidated as withdrawal symptomology.

The withdrawal syndrome, though, is quite clearly different and can be easily diagnosed with a clear understanding of some of the more defining features. In the early stage of withdrawal, there is a presentation of a sense of anxiety and apprehension associated with increasing subjective sense of tremor and mild bifrontal headache. This rapidly progresses to feelings of panic-like anxiety with tachycardia and palpitations, as well as a rapidly progressing feeling of de-realization, which is an altered sense of reality, additionally associated with marked startle response and a general amplification of most sensory input. As the withdrawal syndrome progresses, there is a marked disturbance of proprioception, with difficulty in ambulation relative to feeling "dizzy" and "unsteady," needing to use reference and physical objects to steady oneself. With the proprioceptive problem increasing in severity simple acts such as swallowing, signing one's name, talking or even buttoning a shirt can become extremely difficult. many patients at this stage describe hot/cold sensations and generalized myalgia.

There is also a progession of extreme emotional lability with sudden outbursts of crying or near panic levels of anxiety and fearfulness which will have sudden onset without clear connection to external events. Associated with this are frequent hypochodriacal fears of morbid consequence from the sensations they are feeling, such as fear of heart attack or stroke. patients will also experience a type of emotional dysphoria which is very difficult for them to verbalize, but which come very close by cumulative description to a bereavement type of feeling that is very painful emotionally. Additionally, the amplification of almost all sensory information coming into the brain, other than that of taste, can produce many bizarre misinterpretation of sensory stimulation ranging from feeling one's teeth rotating in their sockets to parts of their bodies disassociating or "falling off".

As the withdrawal symptom further progresses, illusionary and hallucinatory phenomena, predominately of a visual nature, will begin to manifest themselves, initially with patterens and geometric shapes, and then into full-formed complex visual hallucinations. These also often will become associated with delusions of bodily dysfunction or discorporation. It is very frequent and common for the patient to conclude that he is having a nervous breakdown, or "going crazy" as an attempt to try to understand the process at hand, not understanding it as withdrawal phenomena. With further progression, disorientation to person and place will occur with full delirium, and eventually withdrawal will finalize with tonic-clonic major motor seizure activity, generally singular in nature, although several cases of status have been reported.

The last triad of symptoms--of hallucinosis, delirium and seizure--are classified as major symptoms of Xanax withdrawal, with the others classified as minor symptoms. The withdrawal syndrome can take from six months to two years to fully resolve and is well-documented in literature regarding this. Not all patients will experience withdrawal symptomology for that length of time, but most will have withdrawal for at least several months.

TREATMENT APPROACH

The treatment approach is focused primarily on the utilization of Tegretol, which has been shown to be extremely effective in preventing and of the major symptoms of Xanax withdrawal, as well as attenuating significantly most of the minor symptoms. The Tegretol is utilized along with Klonopin as a cross-over benzodiazepine to stabilize and to create control of withdrawal until adequate Tegretol blood levels have been achieved, then allowing one to discontinue the Klonopin. The total length of treatment will span somewhere between 10 to 30 days which, relative to the natural course of this withdrawal syndrome, actually represents a short period of time.

The first step is to estimate the total daily dose of Xanax and start the patient on an equivalent amount of Klonopin, which relates to Xanax on a ration of 2 mg. Klonopin to 1 mg. of Xanax. Thusly, a patient with a daily dose of 4 mg. of Xanax would be given a single bed time dose of Klonopin at 8 mg., which will quickly and effectively stabilize them and prevent further symptoms of withdrawal. Additionally, the patient is started on Tegretol at 50 mg. three times a day and is increased by 50 mg. increments until a total daily dose of 400 mg. daily, in divided doses q.i.d., is achieved, at which the first Tegretol blood level will be ascertained, It will generally take four to seven days to reach therapeutic blood levels.

Since Klonopin has an extremely long half life of 40 to 60 hours, the patient is well covered with a single bed time dosaging, and this benzodiazepine has shown little abuse potential for drug seeking behavior and provides smooth, steady serum levels during the course of treatment. Generally, beginning day 2 or 5, the dose of Klonopin is decreased as the dose of Tegretol being increased. Since therapeutic levels of Tegretol can often be achieved while the patient is being titrated to a therapeutic blood level of Tegretol, the Klonopin is reduced at a rate of approximately 1 mg. per day. generally, with doses in excess of 6 to 8 mg. per day of Klonopin, there is enough time with this rate of withdrawal to slowly establish a Tegretol level without neurotoxicity during the cross-over, and there is little probability of any breakthrough major symptoms of withdrawal due to Klonopins very long half life. Since both Klonopin and Tegretol are very potent anti-convulsants, the incidence of seizure has been essentially 0 in over 300 cases that we have treated so far. The Klonopin is thusly being decreased at 1 mg. daily until one reaches 1 mg., at which point decreases are then done by 0.25 mg. increments anywhere from once a day, on average, once a week.

It is important to understand that Tegretol has a significant impact on auto-induction of liver enzymes, and initially, for the first exposure to Tegretol, a dose as low as 200 mg. may produce a blood level in the therapeutic range of somewhere between 4 to 10 mcg/L necessary for control of seizure and withdrawal; but as liver enzymes are induced, increasing doses will be necessary over the necessary weeks to maintain an adequate blood level. The average dose eventually that is achieved in steady state with induction of liver enzymes is somewhere between 400 mg. and 800 mg. daily, with an average of approximately 600 mg. Additionally, the half life of Tegretol will be essentially 20 to 26 hours when initially used, but will progressively shorten as liver enzyme induction takes place, approaching a half life as short as six to eight hours and requiring multiple daily dosaging at that time.

The major complications with Tegretol are neurotoxic effects when blood level will be generally too high, or above the level of 10 mcg/L, or due to an accumulation of its first order epoxide metabolite. These complications of neurotoxicity present themselves as nauseousness and vomiting, significant sedation, dizziness and dyscoordination. Also frequently reported is a sense of significant gastric retention with delayed gastric emptying. Although the side effects of Tegretol can be successfully treated with Reglan, Tigan and/or Antivert, it is far better to slowly titrate the dose and avoid developing these side effects. The presense of them can be ascertained to represent blood levels that are unacceptably high and to slow the rate of increasing of the Tegretol dosage. There is a small percentage of the population of people who simply do not tolerate Tegretol because of the GI side effects.

As noted, Tegretol is almost 100% effective in controlling major symptoms of Xanax withdrawal, but will very in its effectiveness in attenuating the minor symptoms, thus requiring sometimes slower titration down off the Klonopin. It is infrequent that one needs to go slower than once a week in the 0.25 mg decreases, and often one can be decreased on a daily basis without symptoms of withdrawal, but at times the decrease may have to be as slow as once a month. Once the patient is off the Klonopin and on the Tegretol in a steady state basis, the patient is maintained on Tegretol for approximately one to two months after achieving this state, and then tapered off of the Tegretol over a four to five day period of time. Should there be a recurrence of withdrawal symptomology, then the Tegretol is reinstated for an additional month, and then the process repeated.

CBC and checks of white blood count should be done periodically while the patient is on Tegretol. There often will be mild leukopenia with white count at 3000 to 4000 found with Tegretol, which is benign. The incidence of agranulocytosis is extremely rare with tegretol, and there is support in the literature for the lack of need for rigorous routine white count testing while on this medication. Prudence, though, would require some periodic evaluation of white count while the patient is being maintained on the tegretol.

Once the patient has been successfully detoxed off Xanax and/or the Tegretol, the issues of underlying conditions, such as Agoraphobia, Panic Disorder, Generalized Anxiety Disorder, or Major Depressive Disorder, often must still be dealt with. Whereas Buspar is of no utility in managing Xanax withdrawal or Xanax-generated anxiety, it can be quite helpful for anxiety that is non-benzodiazepine withdrawal related, and patients, after completion of withdrawal, can be, and often have been, successfully maintained on Buspar at 40 to 60 mg. daily as a final dose with good control of underlying anxiety. Treatment of Panic Disorder and/or Agoraphobia will often require a tricyclic anti-depressant in conjunction with Buspar, with essentially good success. The introduction of the anti-depressant can be begun at the time withdrawal is started, or can be deferred to a later date, depending on the intensity and frequency of panic attacks that the patient may be having.

It should be kept in mind that a patient with underlying Agoraphobia or Panic Disorder will have a marked exacerbation of his/her pre-existing illness during the course of withdrawal.It is often then of necessity to start an anti-depressant to stop panic attacks in order to get the patient through the withdrawal process successfully. The presence of a tricyclic will not interfere materially in any way with the medications for withdrawal.

Patients having gone through this process will generally need a significant degree of emotional support and constant re-assurance during the withdrawal stage that they are indeed in withdrawal and are not suffering some morbid physical or psychiatric disorder other than the withdrawal process. Weekly visits with medication management, plus frequent phone consultation generally is what is required and generally produces a successful outcome on an outpatient basis. In more severe cases, and in situatioons where time or efficiency is paramount, then inpatient treatment is the most effective route to be travelled, and the detoxification can be accomplished much more rapidly in that modality.

It is critically important during the course of this that the patient refrain from use of all psychoactive drugs, particularly alcohol and stimulants, as well as over the counter preparations that contain pseudoephedrine and phenylpropanolamine. Lastly, caffeine must be avoided by the patient for a period of approximately six months to one year. Caffeine is a benzodiazepine antagonist and will occupy the receptor site, blocking Klonopin or other agents and intensify withdrawal markedly. Innocuous or inadvertant ingestion of high doses of caffeine is often a major complication to the withdrawal process, and patient education in this area is very important, as well as reassurance should it happen that it will wear offwithin a relatively short period of time.

Lastly, for patients who have severe symptoms of tachycardia or palpitations as an attendant withdrawal symptom, the addition of a beta blocker sich as Atenolol at 50 mg. q. day is highly effective in stopping this and generally does not need to be continued for more than 4 to 6 weeks.


----------



## dakotajo (Aug 10, 2004)

XANAX - A VOYAGE INTO THE TWILIGHT ZONE

by Max Ricketts

Xanax Does Not Cure Anxiety
by Max Ricketts

Xanax - America's hottest selling tranquilizer - praised by some, condemned by many, has become one of the nation's most controversial drugs as a result of recent approval for use in the treatment of panic disorder - a severe, though not rare, form of anxiety state disorder.

Documents obtained from the Food and Drug Administration (FDA) by this writer under the Freedom of Information Act indicate that no evidence exists that Xanax (a benzodiazepine tranquilizer produced by Upjohn) cures anxiety or panic disorder, nor that it is even safe.

The product does have FDA approval for treating both conditions. However, serious adverse effects were reported even from the short-term clinical trials (less than 10 weeks) that XANAX (alprazolam) was subjected to by Upjohn in order to obtain approval. Panic disorder may be cured naturally without any hazard of adverse drug side effects. The condition is not life threatening, although it leaves its victims often severely disabled in that they often withdraw most activity and live in constant dread of the next panic attack.

Russian Roulette

Xanax is a "therapy" with a great potential for harm. The drug does not effectively resolve the underlying bio-chemical basis of anxiety state disorders. The "evidence" for the FDA approval was obtained from three very short-term studies. Several senior FDA officials have expressed concern that there is no data to suggest that Xanax is safe over a long period or at higher dosages - yet, there are many patients who are being prescribed this drug for months and even years!

Actually, there is compelling evidence that benzodiazepines, particularly XANAX, may be among the most addictive substances in the American drug marketplace. Thomas Temple M.D., Director of the FDA Office of Drug Evaluation, noted that the potential for XANAX withdrawal phenomena was "clearly the area of main concern for two principal reasons. First, there is the matter of seizures. In addition, there is the issue of life-long dependence, i.e. inability to discontinue therapy."

FDA Psychiatric Drug Products group leader Thomas Laughren M.D. agreed that much of Upjohn's information concerning withdrawal events was "often poorly organized and confusing." The official expressed "frustration that so little useful data have emerged".

Yet, the FDA has approved this drug in higher dosages (up to 10 mg per day) for the treatment of panic disorder without evidence that it is safe for long-term prescription! At the highest dosage level (6 mg per day), administered in the short-term studies, subjects were having considerable difficulties with adverse effects.

Unsafe At Any Speed

According to the FDA, applications for XANAX in panic disorder have been turned down by Denmark ("insufficient data to evaluate long term efficacy and safety"), Germany, and Norway "deficiency in long term data to support the safety of XANAX with regard to withdrawal phenomena").

What do quotes from the new XANAX (Upjohn) product labeling reveal? "Demonstrations of the effectiveness of XANAX by systematic clinical study are limited to four months duration for anxiety disorder and four to ten weeks duration for panic disorder."

One may well question the motive for not having longer-term scientific data available on a drug that has been aggressively marketed for a decade and that sells for over $800,000 per kilo.

Upjohn admits, "Certain adverse clinical events, some life-threatening, are a direct consequence of physical dependence to XANAX. These include a spectrum of withdrawal symptoms; the most important is seizure...studies of patients with panic disorder showed a higher rate of rebound and withdrawal symptoms with XANAX...Other symptoms, such as anxiety and insomnia, were frequently reported during discontinuation"

"The ability of patients to completely discontinue therapy with XANAX after long-term therapy has not been reliably determined...Withdrawal reactions may occur when dosage reduction occurs for any reason...withdrawal symptoms including seizures have been reported after only brief therapy with XANAX at doses within the recommended range for the treatment of anxiety...Death has been reported in association with overdoses in association with overdoses of alprazolam by itself"

Severe Side Effects

"XANAX has the potential to cause severe emotional and physical dependence in some patients and these patients may find it exceedingly difficult to terminate treatment...The following adverse events have been reported in association with the use of XANAX, seizures, hallucinations, depersonalization, taste alterations, diplopia, elevated bilirubin, elevated hepatic enzymes, and jaundice.

"The necessary duration of treatment for panic disorder victims responding to XANAX is unknown...a carefully supervised tapered discontinuation may be attempted, but there is evidence that this may often be difficult to accomplish without recurrence of symptoms and/or the manifestation of withdrawal phenomena."

A drug with unknown long-term consequences and potential for addiction has been approved by the FDA for a non-life threatening condition, which may be treated successfully by non-drug means!

XANAX has become a major economic success story for the Upjohn Company. Small wonder with its habituating potential and immediate appeal for sufferers of panic and anxiety disorders desperately seeking relief. In the end, the long benzodiazepine tranquilizer voyage is a journey into the darkest side of the twilight zone - another world's timeless hell for those that are lured there seeking calm, and yet finding unrelenting heightened anxiety and abject misery.


----------



## dakotajo (Aug 10, 2004)

XANAX - A VOYAGE INTO THE TWILIGHT ZONE

by Max Ricketts

Xanax Does Not Cure Anxiety
by Max Ricketts

Xanax - America's hottest selling tranquilizer - praised by some, condemned by many, has become one of the nation's most controversial drugs as a result of recent approval for use in the treatment of panic disorder - a severe, though not rare, form of anxiety state disorder.

Documents obtained from the Food and Drug Administration (FDA) by this writer under the Freedom of Information Act indicate that no evidence exists that Xanax (a benzodiazepine tranquilizer produced by Upjohn) cures anxiety or panic disorder, nor that it is even safe.

The product does have FDA approval for treating both conditions. However, serious adverse effects were reported even from the short-term clinical trials (less than 10 weeks) that XANAX (alprazolam) was subjected to by Upjohn in order to obtain approval. Panic disorder may be cured naturally without any hazard of adverse drug side effects. The condition is not life threatening, although it leaves its victims often severely disabled in that they often withdraw most activity and live in constant dread of the next panic attack.

Russian Roulette

Xanax is a "therapy" with a great potential for harm. The drug does not effectively resolve the underlying bio-chemical basis of anxiety state disorders. The "evidence" for the FDA approval was obtained from three very short-term studies. Several senior FDA officials have expressed concern that there is no data to suggest that Xanax is safe over a long period or at higher dosages - yet, there are many patients who are being prescribed this drug for months and even years!

Actually, there is compelling evidence that benzodiazepines, particularly XANAX, may be among the most addictive substances in the American drug marketplace. Thomas Temple M.D., Director of the FDA Office of Drug Evaluation, noted that the potential for XANAX withdrawal phenomena was "clearly the area of main concern for two principal reasons. First, there is the matter of seizures. In addition, there is the issue of life-long dependence, i.e. inability to discontinue therapy."

FDA Psychiatric Drug Products group leader Thomas Laughren M.D. agreed that much of Upjohn's information concerning withdrawal events was "often poorly organized and confusing." The official expressed "frustration that so little useful data have emerged".

Yet, the FDA has approved this drug in higher dosages (up to 10 mg per day) for the treatment of panic disorder without evidence that it is safe for long-term prescription! At the highest dosage level (6 mg per day), administered in the short-term studies, subjects were having considerable difficulties with adverse effects.

Unsafe At Any Speed

According to the FDA, applications for XANAX in panic disorder have been turned down by Denmark ("insufficient data to evaluate long term efficacy and safety"), Germany, and Norway "deficiency in long term data to support the safety of XANAX with regard to withdrawal phenomena").

What do quotes from the new XANAX (Upjohn) product labeling reveal? "Demonstrations of the effectiveness of XANAX by systematic clinical study are limited to four months duration for anxiety disorder and four to ten weeks duration for panic disorder."

One may well question the motive for not having longer-term scientific data available on a drug that has been aggressively marketed for a decade and that sells for over $800,000 per kilo.

Upjohn admits, "Certain adverse clinical events, some life-threatening, are a direct consequence of physical dependence to XANAX. These include a spectrum of withdrawal symptoms; the most important is seizure...studies of patients with panic disorder showed a higher rate of rebound and withdrawal symptoms with XANAX...Other symptoms, such as anxiety and insomnia, were frequently reported during discontinuation"

"The ability of patients to completely discontinue therapy with XANAX after long-term therapy has not been reliably determined...Withdrawal reactions may occur when dosage reduction occurs for any reason...withdrawal symptoms including seizures have been reported after only brief therapy with XANAX at doses within the recommended range for the treatment of anxiety...Death has been reported in association with overdoses in association with overdoses of alprazolam by itself"

Severe Side Effects

"XANAX has the potential to cause severe emotional and physical dependence in some patients and these patients may find it exceedingly difficult to terminate treatment...The following adverse events have been reported in association with the use of XANAX, seizures, hallucinations, depersonalization, taste alterations, diplopia, elevated bilirubin, elevated hepatic enzymes, and jaundice.

"The necessary duration of treatment for panic disorder victims responding to XANAX is unknown...a carefully supervised tapered discontinuation may be attempted, but there is evidence that this may often be difficult to accomplish without recurrence of symptoms and/or the manifestation of withdrawal phenomena."

A drug with unknown long-term consequences and potential for addiction has been approved by the FDA for a non-life threatening condition, which may be treated successfully by non-drug means!

XANAX has become a major economic success story for the Upjohn Company. Small wonder with its habituating potential and immediate appeal for sufferers of panic and anxiety disorders desperately seeking relief. In the end, the long benzodiazepine tranquilizer voyage is a journey into the darkest side of the twilight zone - another world's timeless hell for those that are lured there seeking calm, and yet finding unrelenting heightened anxiety and abject misery.


----------



## dakotajo (Aug 10, 2004)

XANAX - APPROVED FOR PANIC DISORDER

Excerpts from Toxic Psychiatry
Chapter 11
by Peter R. Breggin, M.D.

Xanax - Approved for Panic Disorder

The news was announced in 1990 in headlines in Upjohn's eight-page gaudy color advertisements in psychiatric journals: XANAX: THE FIRST AND ONLY MEDICATION INDICATED FOR PANIC DISORDER. Panic disorder (see chapter 10) was officially classified as a distinct psychiatric entity for the first time in 1980 by the APA's Diagnostic and Statistical Manual. The recent FDA approval of Xanax as the one and only treatment for this popular diagnosis will catapult the drug to even greater domination of the market.

Yet what is there to distinguish Xanax from the rest of the benzodiazepines? We've already found that there's little or no difference among these drugs in regard to their clinical impact. The same is true in regard to side effects - except that Xanax is short-acting and more tightly bound to its receptors, and therefore, as already discussed, more likely to cause severe withdrawal symptoms and addiction.

Xanax is one of the more dangerous minor tranquilizers. Joe Graedon and Teresa Graedon warn about Xanax in their October 1989 syndicated column "The People's Pharmacy":

Xanax, one of the most commonly prescribed medications in the country, has been associated with confusion, paranoia, depression, hostility and forgetfulness while a person is taking it. Sudden withdrawal from such antianxiety agents can be living hell for some people. We have received letters from readers reporting nerves "jumping," muscle twitching, feelings of disorientation, fear, insomnia, anxiety, agitation and even seizure.

Death from Xanax in combination with alcohol or other sedatives has been a special problem, as reported by Chad Carlton in 1990 in the Lexington Herald-Leader: "A commonly prescribed tranquilizer, introduced nearly a decade ago as a safer alternative to Valium, has become increasingly linked to overdose deaths, addiction and street-drug sales in Central Kentucky." It had played a role in ten deaths in a six-month period in Lexington alone. "Doctors are handing it out like candy," says Mark Hyatt, chief of psychiatry at the local Veterans Affairs Medical Center.

The Xanax Studies

On reading Upjohn's eight-page advertisements in psychiatric journals about its FDA studies, I was struck by something odd. At the top left of one page is a statement that drug evaluations were made at "weeks 1, 2, 3, 4, 6, and 8 of therapy." This gave the immediate impression that Xanax must have been proven effective at eight weeks. But the chart beneath this statement records only the first four weeks. Nowhere in the advertisement is there any discussion of the results after the full eight weeks. Then, at the bottom of the page, there is this explanation: "Because of the high rate of placebo dropouts, week 4 (the last evaluation point where the majority of patients remained in the placebo treatment group) was considered the study 'end point' for efficacy analyses."

In other words, Upjohn was counting only the first four weeks of the study and discarding the final results at eight weeks. Why would Upjohn want to do this?

I was shocked at what I found when I studied the original research report. By the end of the eight weeks, the sugar-pill patients were doing about as well as the drug patients. Indeed, the placebo patients were far better off, because they did not suffer the severe withdrawal and rebound reactions, including an increase in anxiety and in phobic responses, plus a 350 percent greater number of panic attacks.

In an unusually negative reaction to a highly touted study, an international group of eleven psychiatrists and psychologists, led by Isaac M. Marks from the Institute of Psychiatry in London, wrote a two-page letter in the July 1989 Archives of General Psychiatry criticizing and largely dismissing the Xanax study. They point out that "at the last week after taper [drug withdrawal], patients receiving alprazolam were in a worse state than patients receiving placebo, in terms of panic (350% worse, in table I of the article by Pecknold et al.), phobias and Hamilton anxiety (other measures were not reported)."

In summary, the FDA Xanax study really shows that most patients were better off if they had never taken the drug. None of this is obvious in reading the actual study by James C. Ballenger and his colleagues. In the introductory abstract, no mention is made of Xanax's effect beyond four weeks. And yet the abstract describes the drug as an unqualified success.

Faced with their own negative results, the Xanax investigators came up with statistical manipulations to show how the data really should have - but didn't - come out at eight weeks; but apparently they were embarrassed by these efforts, and they limited the summary and conclusion of their report to data from the first four weeks. As noted, the drug company, with whom they were working closely, followed suit.

In their lengthy critique of the study in the Archives of General Psychiatry, Marks and his colleagues point out that a few weeks of relief is hardly worth the consequences of withdrawal and worsening symptoms, especially when the patients had been suffering from anxiety problems for an average of nearly nine years.

Furthermore, they point out that any hoped-for benefit must be balanced against known and unknown dangers of long-term use, including the possibility (see above) of brain shrinkage from chronic benzodiazepine use.

Marks and his colleagues summarize, "The unqualified conclusions about efficacy based solely on short-term partial gains in a chronic condition seems biased and arguable."

More Problems with the Xanax Study

As discussed in chapter 8, most people think that FDA drug trials extend for many months or years rather than a few weeks. According to Ballenger and his colleagues, most psychiatrists were giving Xanax for a period of three months to a year before tapering or discontinuing it. Yet Upjohn itself limited its data analysis on efficacy to a mere four weeks. It merits reemphasis: FDA approval does not mean that the drug has been tested with controlled studies for anywhere near the length of time that it typically is prescribed by doctors.

The size of the sample is also a problem, especially in regard to testing for negative side effects. While most people think that FDA-approved drugs have been tested on thousands or tens of thousands of patients, the actual sample size is described in Upjohn advertisements as "more than 500 patients." In fact, only 226 patients took Xanax for the length of the main study. That is hardly a sufficient number to test for relatively infrequent but potentially serious side effects. For example, a side effect that causes death in 0.5 percent of drug patients could easily escape showing up in such a small sample, but it would kill five thousand of the first one million people to take the drug. And, of course, a side effect that doesn't appear until after eight weeks would be missed completely.

Xanax's addictive effects became a serious problem even during short, eight-week trials. J. C. Pecknold and his associates found that even a gradual four-week period of withdrawal did not prevent a "worsening of symptoms" and that "some, in fact most, patients experienced relapse." Thirty-five percent of the patients had "mild to moderate" withdrawal symptoms. Thus after only two months of treatment, a large percentage of the patients were becoming addicted to the drug.

The warning given by Upjohn for Xanax in the 1991 PDR states: "If benzodiazepines are used in large doses and/or for extended periods of time, they may produce habituation and emotional and physical dependence." However, the data actually indicate that physical dependence very frequently develops without "large doses" and before "extended" periods of treatment. Furthermore, there is no hint in the PDR that Xanax is especially addictive.

Writing in The New Harvard Guide to Psychiatry, George Vaillant indicates that the public is unaware of the addictive qualities of minor tranquilizers, including Xanax: "Contrary to popular belief, physical dependence on diazepam (Valium), chlordiazepoxide (Librium) and especially alprazolam (Xanax) does occur" (p. 711). Because the public is relatively ignorant of the problem and because Xanax is "especially" likely to addict, Upjohn should have made the danger as emphatically clear as possible.

Pecknold and his colleagues recommend that treatment with Xanax be routinely extended for six months, to be followed by very slow withdrawal. This adds up to a minimum period of treatment approaching one year. In short, the authors recommend many months of treatment for a drug whose beneficial effect over a placebo was shown to decline to nothing at eight weeks! Furthermore, as Pecknold and associates admit, the increased length of treatment could be expected to worsen the addiction and withdrawal problems. A genuine concern for the patients should have led these investigators to the opposite recommendation: that in order to avoid withdrawal and addiction, the drug should be used for very short periods of time (such as a few days) or not at all.

Xanax as Alcohol in a Pill

The similarity between Xanax and any other addictive sedative, including alcohol, was verified in the FDA studies. Russell Noyes, Jr., and his associates report that 61.7 percent of the subjects suffered from sedation during the first week and that by the last week 38.7 percent were still aware of the effect. At some time during the treatment, 77 percent reported "at least mild sedation." Clinical experience with alcoholism and drug addiction, as well as the Golombok study of minor tranquilizers, indicates that people taking sedatives tend to deny their drug-induced sedation. People who are sedated often do not appreciate that they are thinking more slowly, getting muddled, forgetting things, slurring their words, or losing their coordination. As almost everyone has noticed at parties where people get "drunk," or from TV and radio ads encouraging us to take the car keys away from our inebriated friends, denial of impairment is typical of people experiencing sedation. It is virtually certain that the patients on Xanax were far more sedated than they reported.

In addition to sedation, other "drunken" symptoms were commonly reported by the patients, including ataxia (muscular incoordination), fatigue, slurred speech, and amnesia.

One wonders how the drug would have compared to alcohol, rather than to an inactive placebo, in its "beneficial" and its toxic side effects.

In another study, after only six days' use, Xanax was found to cause sufficient memory problems to potentially impair educational learning. The investigators warned against taking Xanax before school examinations.

How did Xanax get such an edge on the other benzodiazepines, first by taking the lead in the market and then by becoming the first drug approved for panic disorder? Apparently not on the basis of scientific studies, which show that Xanax is ineffective beyond four weeks, frequently produces sedation and mental dysfunction, and often causes withdrawal problems. In chapter 15 we shall examine how Upjohn's financial support of the psychiatric profession may have influenced the drug's acceptance.

Is There Any "Therapeutic Role" for the Minor Tranquilizers?

Don't people have a right to escape anxiety at times? To use shortcuts if necessary, including sedative drugs? Yes, they surely do. But should doctors encourage this approach to life? I don't think so, except under the most limited circumstances. Because people cannot obtain minor tranquilizers without a doctor's prescription, I don't fault physicians who occasionally prescribe them to help patients get through a difficult few days or to get a good night's sleep; but their usefulness for more than a few days is highly questionable. Even the prodrug literature has not been able to show a beneficial impact beyond a few weeks, when tolerance and withdrawal symptoms develop.

Minor tranquilizers, like any sedative, can be harmful in the long run not only because they are habit-forming and addictive, but because they cover up anxiety by suppressing the capacity of the brain to generate feelings. The brain, as usual, tries to overcome the suppression and reacts in ways we cannot begin to predict or fully comprehend. As we have seen, drug-induced rebound anxiety is one common effect.

The drugged individual with a suppressed and confused anxiety signal system lives under a considerable handicap. At the least, feelings are pushed down, and with that, self-awareness is muted. More seriously, as the brain reacts against the drug, natural anxiety responses are muted but abnormal rebound anxiety reactions begin to flare up.

What about people who are so overwhelmed by anxiety that they cannot cope at all? The doctor who offers medication is likely to reinforce the patient's feelings of helplessness. If psychotherapy is being attempted, the drug induced insensitivity to self can inhibit progress. When a patient has an acute anxiety attack in the midst of a psychotherapy session, for example, it's prime time for understanding the problem and showing the patient various ways to handle it.

Without drugs, severely anxious patients often can be helped rather quickly to overcome the worst of their anguish (see chapter 10). Over a longer period they can learn new approaches to living relatively free of anxiety.

But success in psychotherapy is not guaranteed. Failure may result from a faulty delivery of therapy or from a poorly motivated client, or from a bad "chemistry" between client and therapist. Whatever the cause of the failure, what about drugs as an alternative?

I would rather urge a client to try another therapist, or several other therapists, as well as other approaches, such as group therapy, self-help groups, self-help books, self-hypnosis, relaxation techniques, deep massage, or meditation and other spiritual exercises, rather than to turn to drugs.

Improvement while on drugs is rarely a psychologically clean affair; the improvement almost always leaves an aftermath of persistent personal helplessness. The individual is unable to say with confidence, "I overcame my anxiety and I know how I did it." There is always the lingering suspicion that "the drugs did it."

Even prescribing medications on an occasional basis can interfere with and undermine the real work of psychotherapy.

After a session, a client called me in the evening to request a telephone prescription for a few minor tranquilizers.

"What's up?" I asked.

"Sorry to bother you, Peter. I can't sleep. I just want something to sleep for a few nights."

"How come you didn't bring it up in the session today'?" I asked.

"Hey, Doc, you were hardly listening to me today. You seemed in another world yourself"

In an instant I knew he was right. I'd received distressing news by telephone moments before his session, and without realizing it at the time, I hadn't shaken off the effect.

"Thanks for telling me," I said. "if you can come in tomorrow morning, I'll give you a free session to make up for it."

"It's a deal. And forget the drugs. Good-night."

If I had readily acquiesced to the request for a prescription, the patient's real feelings never would have surfaced. Giving drugs runs the risk of distracting from the work of psychotherapy, not only for the client but for the therapist.

Scientific Studies of Efficacy

By now, I hope, the reader will approach the question of "scientific studies" in psychiatry with a large measure of skepticism, and even cynicism. In regard to the minor tranquilizers, there are some blanket endorsements, such as this one from the American Psychiatric Press's Textbook of Psychiatry: "The efficacy of the benzodiazepines in the treatment of anxiety, including the symptoms of worry, psychic anxiety, and somatic symptoms (gastrointestinal and cardiovascular), has been clearly and repeatedly demonstrated in many well-controlled studies" (p. 810). On the other hand, there is a detailed review of the literature by Ronald Lipman in Seymour Fisher and Roger Greenberg's The Limits of Biological Treatments for Psychological Distress (1989). Lipman finds that, except for the very short-term treatment of generalized anxiety, there is little evidence for the efficacy of these medications. Most reviews suggest that use should be short term and that long-term use is generally dangerous and unwarranted.

Peter R. Breggin, M.D. founded The International Center for the Study of Psychiatry and Psychology (ICSPP) as a nonprofit research and educational network concerned with the impact of mental health theory and practices upon individual well-being, personal freedom, and family and community values. For 25 years ICSPP has been informing the professions, media and the public about the potential dangers of drugs, electroshock, psychosurgery, and the biological theories of psychiatry.

See also:

Peter R. Breggin M.D. & The International Center for the Study of Psychiatry & Psychology

Withdrawal Reactions from Benzodiazepines

Excerpts from Toxic Psychiatry, Chapter 11

Brain-Disabling Effects of Benzodiazepines

--------------------------------------------------------------------------------


----------



## dakotajo (Aug 10, 2004)

XANAX - APPROVED FOR PANIC DISORDER

Excerpts from Toxic Psychiatry
Chapter 11
by Peter R. Breggin, M.D.

Xanax - Approved for Panic Disorder

The news was announced in 1990 in headlines in Upjohn's eight-page gaudy color advertisements in psychiatric journals: XANAX: THE FIRST AND ONLY MEDICATION INDICATED FOR PANIC DISORDER. Panic disorder (see chapter 10) was officially classified as a distinct psychiatric entity for the first time in 1980 by the APA's Diagnostic and Statistical Manual. The recent FDA approval of Xanax as the one and only treatment for this popular diagnosis will catapult the drug to even greater domination of the market.

Yet what is there to distinguish Xanax from the rest of the benzodiazepines? We've already found that there's little or no difference among these drugs in regard to their clinical impact. The same is true in regard to side effects - except that Xanax is short-acting and more tightly bound to its receptors, and therefore, as already discussed, more likely to cause severe withdrawal symptoms and addiction.

Xanax is one of the more dangerous minor tranquilizers. Joe Graedon and Teresa Graedon warn about Xanax in their October 1989 syndicated column "The People's Pharmacy":

Xanax, one of the most commonly prescribed medications in the country, has been associated with confusion, paranoia, depression, hostility and forgetfulness while a person is taking it. Sudden withdrawal from such antianxiety agents can be living hell for some people. We have received letters from readers reporting nerves "jumping," muscle twitching, feelings of disorientation, fear, insomnia, anxiety, agitation and even seizure.

Death from Xanax in combination with alcohol or other sedatives has been a special problem, as reported by Chad Carlton in 1990 in the Lexington Herald-Leader: "A commonly prescribed tranquilizer, introduced nearly a decade ago as a safer alternative to Valium, has become increasingly linked to overdose deaths, addiction and street-drug sales in Central Kentucky." It had played a role in ten deaths in a six-month period in Lexington alone. "Doctors are handing it out like candy," says Mark Hyatt, chief of psychiatry at the local Veterans Affairs Medical Center.

The Xanax Studies

On reading Upjohn's eight-page advertisements in psychiatric journals about its FDA studies, I was struck by something odd. At the top left of one page is a statement that drug evaluations were made at "weeks 1, 2, 3, 4, 6, and 8 of therapy." This gave the immediate impression that Xanax must have been proven effective at eight weeks. But the chart beneath this statement records only the first four weeks. Nowhere in the advertisement is there any discussion of the results after the full eight weeks. Then, at the bottom of the page, there is this explanation: "Because of the high rate of placebo dropouts, week 4 (the last evaluation point where the majority of patients remained in the placebo treatment group) was considered the study 'end point' for efficacy analyses."

In other words, Upjohn was counting only the first four weeks of the study and discarding the final results at eight weeks. Why would Upjohn want to do this?

I was shocked at what I found when I studied the original research report. By the end of the eight weeks, the sugar-pill patients were doing about as well as the drug patients. Indeed, the placebo patients were far better off, because they did not suffer the severe withdrawal and rebound reactions, including an increase in anxiety and in phobic responses, plus a 350 percent greater number of panic attacks.

In an unusually negative reaction to a highly touted study, an international group of eleven psychiatrists and psychologists, led by Isaac M. Marks from the Institute of Psychiatry in London, wrote a two-page letter in the July 1989 Archives of General Psychiatry criticizing and largely dismissing the Xanax study. They point out that "at the last week after taper [drug withdrawal], patients receiving alprazolam were in a worse state than patients receiving placebo, in terms of panic (350% worse, in table I of the article by Pecknold et al.), phobias and Hamilton anxiety (other measures were not reported)."

In summary, the FDA Xanax study really shows that most patients were better off if they had never taken the drug. None of this is obvious in reading the actual study by James C. Ballenger and his colleagues. In the introductory abstract, no mention is made of Xanax's effect beyond four weeks. And yet the abstract describes the drug as an unqualified success.

Faced with their own negative results, the Xanax investigators came up with statistical manipulations to show how the data really should have - but didn't - come out at eight weeks; but apparently they were embarrassed by these efforts, and they limited the summary and conclusion of their report to data from the first four weeks. As noted, the drug company, with whom they were working closely, followed suit.

In their lengthy critique of the study in the Archives of General Psychiatry, Marks and his colleagues point out that a few weeks of relief is hardly worth the consequences of withdrawal and worsening symptoms, especially when the patients had been suffering from anxiety problems for an average of nearly nine years.

Furthermore, they point out that any hoped-for benefit must be balanced against known and unknown dangers of long-term use, including the possibility (see above) of brain shrinkage from chronic benzodiazepine use.

Marks and his colleagues summarize, "The unqualified conclusions about efficacy based solely on short-term partial gains in a chronic condition seems biased and arguable."

More Problems with the Xanax Study

As discussed in chapter 8, most people think that FDA drug trials extend for many months or years rather than a few weeks. According to Ballenger and his colleagues, most psychiatrists were giving Xanax for a period of three months to a year before tapering or discontinuing it. Yet Upjohn itself limited its data analysis on efficacy to a mere four weeks. It merits reemphasis: FDA approval does not mean that the drug has been tested with controlled studies for anywhere near the length of time that it typically is prescribed by doctors.

The size of the sample is also a problem, especially in regard to testing for negative side effects. While most people think that FDA-approved drugs have been tested on thousands or tens of thousands of patients, the actual sample size is described in Upjohn advertisements as "more than 500 patients." In fact, only 226 patients took Xanax for the length of the main study. That is hardly a sufficient number to test for relatively infrequent but potentially serious side effects. For example, a side effect that causes death in 0.5 percent of drug patients could easily escape showing up in such a small sample, but it would kill five thousand of the first one million people to take the drug. And, of course, a side effect that doesn't appear until after eight weeks would be missed completely.

Xanax's addictive effects became a serious problem even during short, eight-week trials. J. C. Pecknold and his associates found that even a gradual four-week period of withdrawal did not prevent a "worsening of symptoms" and that "some, in fact most, patients experienced relapse." Thirty-five percent of the patients had "mild to moderate" withdrawal symptoms. Thus after only two months of treatment, a large percentage of the patients were becoming addicted to the drug.

The warning given by Upjohn for Xanax in the 1991 PDR states: "If benzodiazepines are used in large doses and/or for extended periods of time, they may produce habituation and emotional and physical dependence." However, the data actually indicate that physical dependence very frequently develops without "large doses" and before "extended" periods of treatment. Furthermore, there is no hint in the PDR that Xanax is especially addictive.

Writing in The New Harvard Guide to Psychiatry, George Vaillant indicates that the public is unaware of the addictive qualities of minor tranquilizers, including Xanax: "Contrary to popular belief, physical dependence on diazepam (Valium), chlordiazepoxide (Librium) and especially alprazolam (Xanax) does occur" (p. 711). Because the public is relatively ignorant of the problem and because Xanax is "especially" likely to addict, Upjohn should have made the danger as emphatically clear as possible.

Pecknold and his colleagues recommend that treatment with Xanax be routinely extended for six months, to be followed by very slow withdrawal. This adds up to a minimum period of treatment approaching one year. In short, the authors recommend many months of treatment for a drug whose beneficial effect over a placebo was shown to decline to nothing at eight weeks! Furthermore, as Pecknold and associates admit, the increased length of treatment could be expected to worsen the addiction and withdrawal problems. A genuine concern for the patients should have led these investigators to the opposite recommendation: that in order to avoid withdrawal and addiction, the drug should be used for very short periods of time (such as a few days) or not at all.

Xanax as Alcohol in a Pill

The similarity between Xanax and any other addictive sedative, including alcohol, was verified in the FDA studies. Russell Noyes, Jr., and his associates report that 61.7 percent of the subjects suffered from sedation during the first week and that by the last week 38.7 percent were still aware of the effect. At some time during the treatment, 77 percent reported "at least mild sedation." Clinical experience with alcoholism and drug addiction, as well as the Golombok study of minor tranquilizers, indicates that people taking sedatives tend to deny their drug-induced sedation. People who are sedated often do not appreciate that they are thinking more slowly, getting muddled, forgetting things, slurring their words, or losing their coordination. As almost everyone has noticed at parties where people get "drunk," or from TV and radio ads encouraging us to take the car keys away from our inebriated friends, denial of impairment is typical of people experiencing sedation. It is virtually certain that the patients on Xanax were far more sedated than they reported.

In addition to sedation, other "drunken" symptoms were commonly reported by the patients, including ataxia (muscular incoordination), fatigue, slurred speech, and amnesia.

One wonders how the drug would have compared to alcohol, rather than to an inactive placebo, in its "beneficial" and its toxic side effects.

In another study, after only six days' use, Xanax was found to cause sufficient memory problems to potentially impair educational learning. The investigators warned against taking Xanax before school examinations.

How did Xanax get such an edge on the other benzodiazepines, first by taking the lead in the market and then by becoming the first drug approved for panic disorder? Apparently not on the basis of scientific studies, which show that Xanax is ineffective beyond four weeks, frequently produces sedation and mental dysfunction, and often causes withdrawal problems. In chapter 15 we shall examine how Upjohn's financial support of the psychiatric profession may have influenced the drug's acceptance.

Is There Any "Therapeutic Role" for the Minor Tranquilizers?

Don't people have a right to escape anxiety at times? To use shortcuts if necessary, including sedative drugs? Yes, they surely do. But should doctors encourage this approach to life? I don't think so, except under the most limited circumstances. Because people cannot obtain minor tranquilizers without a doctor's prescription, I don't fault physicians who occasionally prescribe them to help patients get through a difficult few days or to get a good night's sleep; but their usefulness for more than a few days is highly questionable. Even the prodrug literature has not been able to show a beneficial impact beyond a few weeks, when tolerance and withdrawal symptoms develop.

Minor tranquilizers, like any sedative, can be harmful in the long run not only because they are habit-forming and addictive, but because they cover up anxiety by suppressing the capacity of the brain to generate feelings. The brain, as usual, tries to overcome the suppression and reacts in ways we cannot begin to predict or fully comprehend. As we have seen, drug-induced rebound anxiety is one common effect.

The drugged individual with a suppressed and confused anxiety signal system lives under a considerable handicap. At the least, feelings are pushed down, and with that, self-awareness is muted. More seriously, as the brain reacts against the drug, natural anxiety responses are muted but abnormal rebound anxiety reactions begin to flare up.

What about people who are so overwhelmed by anxiety that they cannot cope at all? The doctor who offers medication is likely to reinforce the patient's feelings of helplessness. If psychotherapy is being attempted, the drug induced insensitivity to self can inhibit progress. When a patient has an acute anxiety attack in the midst of a psychotherapy session, for example, it's prime time for understanding the problem and showing the patient various ways to handle it.

Without drugs, severely anxious patients often can be helped rather quickly to overcome the worst of their anguish (see chapter 10). Over a longer period they can learn new approaches to living relatively free of anxiety.

But success in psychotherapy is not guaranteed. Failure may result from a faulty delivery of therapy or from a poorly motivated client, or from a bad "chemistry" between client and therapist. Whatever the cause of the failure, what about drugs as an alternative?

I would rather urge a client to try another therapist, or several other therapists, as well as other approaches, such as group therapy, self-help groups, self-help books, self-hypnosis, relaxation techniques, deep massage, or meditation and other spiritual exercises, rather than to turn to drugs.

Improvement while on drugs is rarely a psychologically clean affair; the improvement almost always leaves an aftermath of persistent personal helplessness. The individual is unable to say with confidence, "I overcame my anxiety and I know how I did it." There is always the lingering suspicion that "the drugs did it."

Even prescribing medications on an occasional basis can interfere with and undermine the real work of psychotherapy.

After a session, a client called me in the evening to request a telephone prescription for a few minor tranquilizers.

"What's up?" I asked.

"Sorry to bother you, Peter. I can't sleep. I just want something to sleep for a few nights."

"How come you didn't bring it up in the session today'?" I asked.

"Hey, Doc, you were hardly listening to me today. You seemed in another world yourself"

In an instant I knew he was right. I'd received distressing news by telephone moments before his session, and without realizing it at the time, I hadn't shaken off the effect.

"Thanks for telling me," I said. "if you can come in tomorrow morning, I'll give you a free session to make up for it."

"It's a deal. And forget the drugs. Good-night."

If I had readily acquiesced to the request for a prescription, the patient's real feelings never would have surfaced. Giving drugs runs the risk of distracting from the work of psychotherapy, not only for the client but for the therapist.

Scientific Studies of Efficacy

By now, I hope, the reader will approach the question of "scientific studies" in psychiatry with a large measure of skepticism, and even cynicism. In regard to the minor tranquilizers, there are some blanket endorsements, such as this one from the American Psychiatric Press's Textbook of Psychiatry: "The efficacy of the benzodiazepines in the treatment of anxiety, including the symptoms of worry, psychic anxiety, and somatic symptoms (gastrointestinal and cardiovascular), has been clearly and repeatedly demonstrated in many well-controlled studies" (p. 810). On the other hand, there is a detailed review of the literature by Ronald Lipman in Seymour Fisher and Roger Greenberg's The Limits of Biological Treatments for Psychological Distress (1989). Lipman finds that, except for the very short-term treatment of generalized anxiety, there is little evidence for the efficacy of these medications. Most reviews suggest that use should be short term and that long-term use is generally dangerous and unwarranted.

Peter R. Breggin, M.D. founded The International Center for the Study of Psychiatry and Psychology (ICSPP) as a nonprofit research and educational network concerned with the impact of mental health theory and practices upon individual well-being, personal freedom, and family and community values. For 25 years ICSPP has been informing the professions, media and the public about the potential dangers of drugs, electroshock, psychosurgery, and the biological theories of psychiatry.

See also:

Peter R. Breggin M.D. & The International Center for the Study of Psychiatry & Psychology

Withdrawal Reactions from Benzodiazepines

Excerpts from Toxic Psychiatry, Chapter 11

Brain-Disabling Effects of Benzodiazepines

--------------------------------------------------------------------------------


----------



## Guest (Sep 18, 2004)

Once you get Dakota Joe started, theres no stopping him.

Ive been taking 1 mg of Klonopin once a day, since umm last February, and ive had no symptoms of addiction or anything of that nature.

Just read Janines post & accept it.


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## Guest (Sep 18, 2004)

Once you get Dakota Joe started, theres no stopping him.

Ive been taking 1 mg of Klonopin once a day, since umm last February, and ive had no symptoms of addiction or anything of that nature.

Just read Janines post & accept it.


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## Guest (Sep 18, 2004)

I agree with soulbro.

Coucou xxx


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## Guest (Sep 18, 2004)

I agree with soulbro.

Coucou xxx


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## dakotajo (Aug 10, 2004)

Hey soul,

You wont know if you are dependent unless you reach tolerance or withdraw from this drug. Once the drug completely leaves your body, you will definitely find out if you are dependent or not.

Joe


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## dakotajo (Aug 10, 2004)

Hey soul,

You wont know if you are dependent unless you reach tolerance or withdraw from this drug. Once the drug completely leaves your body, you will definitely find out if you are dependent or not.

Joe


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## person3 (Aug 10, 2004)

Well man I love Xanax and Xanax loves me, but we know to only see each other in rare moments. It's a beautiful realationship.


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## person3 (Aug 10, 2004)

Well man I love Xanax and Xanax loves me, but we know to only see each other in rare moments. It's a beautiful realationship.


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## Dreamer (Aug 9, 2004)

I can't believe I'm getting involved in this thread, but one very important point.

NOONE has EVER said, that psychiatric medications CURE. Doctors, researchers, pharmaceutical companies have NEVER said that psychiatric medications CURE anything. They treat, they control symptoms.

This is like saying insulin cures a diabetic. Or that cholesterol medications cure genetically inherited high-colesterol.

What meds are available are yes, imperfect, and no one here want to be on meds. I certainly don't.

But simply to clarify.

And Joe, I thought you were having much success with Paxil now, where in the past you said Paxil wasn't helping? (Correct me if I'm wrong, but your Avatar used to say "Paxil Eater" early on, on the other board.). Do you have a positive story to tell now? Seems that would be helpful at this point.

*NO PSYCHIATRIC DRUG CURES A PSYCHIATRIC ILLNESS. IT HELPS CONTROL IT, OR IMPROVE FUNCTIONING AND IMPROVE QUALITY OF LIFE.*

D :shock:


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## Dreamer (Aug 9, 2004)

I can't believe I'm getting involved in this thread, but one very important point.

NOONE has EVER said, that psychiatric medications CURE. Doctors, researchers, pharmaceutical companies have NEVER said that psychiatric medications CURE anything. They treat, they control symptoms.

This is like saying insulin cures a diabetic. Or that cholesterol medications cure genetically inherited high-colesterol.

What meds are available are yes, imperfect, and no one here want to be on meds. I certainly don't.

But simply to clarify.

And Joe, I thought you were having much success with Paxil now, where in the past you said Paxil wasn't helping? (Correct me if I'm wrong, but your Avatar used to say "Paxil Eater" early on, on the other board.). Do you have a positive story to tell now? Seems that would be helpful at this point.

*NO PSYCHIATRIC DRUG CURES A PSYCHIATRIC ILLNESS. IT HELPS CONTROL IT, OR IMPROVE FUNCTIONING AND IMPROVE QUALITY OF LIFE.*

D :shock:


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## dakotajo (Aug 10, 2004)

I think if you bother taking a drug you might as well take a drug that helps correct the area of the brain thought to cause the problem. Benzos may minimize symptoms but thats all. In the end they have the potential to make your symptoms much worse than you originally had. Compare it to taking a narcotic pain killer to fix a dislocated shoulder? It may help with the pain but it doesnt fix the shoulder and if this is all you ever do then you will still have a bad shoulder plus you will be a junkie on top of it.

Joe


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## dakotajo (Aug 10, 2004)

I think if you bother taking a drug you might as well take a drug that helps correct the area of the brain thought to cause the problem. Benzos may minimize symptoms but thats all. In the end they have the potential to make your symptoms much worse than you originally had. Compare it to taking a narcotic pain killer to fix a dislocated shoulder? It may help with the pain but it doesnt fix the shoulder and if this is all you ever do then you will still have a bad shoulder plus you will be a junkie on top of it.

Joe


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## person3 (Aug 10, 2004)

Yeah but the thing with DP is that it is crucial to stay in touch with the world. If you need something to lessen your symptoms in order to do so, that is good because the ultimate cure lays in being with people and being in the world. If you sat at home b/c your symptoms were bad and you didn't take drugs to alleviate them, and you couldn't go out b/c they were so bad, you would be unable to take a step towards curing yourself.

Plus, you didn't answer Dreamer's question about the Paxil. Brilliant post BTW, Dreamer. 

It isn't like you're taking the drug for a more comfortable trip to recovery. Sometimes you are taking the drug to get you out of the house, in order to be ABLE to recover in the first place. The drug doesn't cure but without it people like Janine wouldn't have made it to the doctor to help discuss her life, as well as others on here (Janine being the first example that came to mind).

Sometimes I need to take trazodone to get to sleep, so I can wake up and be in class the next day. Because class isn't going to wait until I wake up after oversleeping, and I'm not going to make myself better by staying up all night ruminating.

See what I'm saying here?


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## person3 (Aug 10, 2004)

Yeah but the thing with DP is that it is crucial to stay in touch with the world. If you need something to lessen your symptoms in order to do so, that is good because the ultimate cure lays in being with people and being in the world. If you sat at home b/c your symptoms were bad and you didn't take drugs to alleviate them, and you couldn't go out b/c they were so bad, you would be unable to take a step towards curing yourself.

Plus, you didn't answer Dreamer's question about the Paxil. Brilliant post BTW, Dreamer. 

It isn't like you're taking the drug for a more comfortable trip to recovery. Sometimes you are taking the drug to get you out of the house, in order to be ABLE to recover in the first place. The drug doesn't cure but without it people like Janine wouldn't have made it to the doctor to help discuss her life, as well as others on here (Janine being the first example that came to mind).

Sometimes I need to take trazodone to get to sleep, so I can wake up and be in class the next day. Because class isn't going to wait until I wake up after oversleeping, and I'm not going to make myself better by staying up all night ruminating.

See what I'm saying here?


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## person3 (Aug 10, 2004)

Also joe I think it's freakin' hilarious that none of your documentation is truly scientific, peer-reviewed journal material. The above articles you ripped are based on sensationalism, they don't show controlled tests, they don't have conclusions drawn based on thoughtfully carried-out testing. Kind of like Marty talking about God here, but with medication there is no denial that you DO need actual science and logic to study the effects of it. Your documents are emotionally driven and try to persuade the reader that Xanax is a glamourous party drug that has negative connotations. It is not objective whatsoever.

What do you think about cocaine?

Bad, huh? Real bad.

Yet, workers who live in the high altitudes of the Andes Mountain range chew its natural source it to keep their body temperature higher in order to regulate their body temperatures in the harsh climate. And many in third world grow cocoa leaves that are going to be used for cocaine, but they do it so their families won't die of starvation because they don't have the stable economy we have in america.

Have you ever considered part of your DP is the habit of putting so much blame and hate on an outside source? The vigor and passion you pursue this subject with might point to something you're not admitting to yourself. Even if you are right that Xanax causes problems, it's the same as me fighting my mom: Yes, I have proof of what she has done wrong, but I lose some of myself every time I put so much energy into fighting with it instead of making my peace.

Everything is relative...


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## person3 (Aug 10, 2004)

Also joe I think it's freakin' hilarious that none of your documentation is truly scientific, peer-reviewed journal material. The above articles you ripped are based on sensationalism, they don't show controlled tests, they don't have conclusions drawn based on thoughtfully carried-out testing. Kind of like Marty talking about God here, but with medication there is no denial that you DO need actual science and logic to study the effects of it. Your documents are emotionally driven and try to persuade the reader that Xanax is a glamourous party drug that has negative connotations. It is not objective whatsoever.

What do you think about cocaine?

Bad, huh? Real bad.

Yet, workers who live in the high altitudes of the Andes Mountain range chew its natural source it to keep their body temperature higher in order to regulate their body temperatures in the harsh climate. And many in third world grow cocoa leaves that are going to be used for cocaine, but they do it so their families won't die of starvation because they don't have the stable economy we have in america.

Have you ever considered part of your DP is the habit of putting so much blame and hate on an outside source? The vigor and passion you pursue this subject with might point to something you're not admitting to yourself. Even if you are right that Xanax causes problems, it's the same as me fighting my mom: Yes, I have proof of what she has done wrong, but I lose some of myself every time I put so much energy into fighting with it instead of making my peace.

Everything is relative...


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## dakotajo (Aug 10, 2004)

So xanax is ok because it makes you able to live your life...What the fuck good is your life if your a fucking strung out junkie!! Most decent therapists dont want their patients intoxicated. Theres about as many(or more) documented studies on the negative effects of xanax as their is on the positve. I would post articles all day long on xanax but Im getting bored with it. I dont know shit about cocaine except ,like benzos, its highly addictive and if taken regularly it will eventually ruin your life. Tell your story to somebody who would give anything to get off xanax. I know of a member on this board on 30mg and their addiction started when they took xanax to ease them into therapy. what a joke.

Joe


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## dakotajo (Aug 10, 2004)

So xanax is ok because it makes you able to live your life...What the fuck good is your life if your a fucking strung out junkie!! Most decent therapists dont want their patients intoxicated. Theres about as many(or more) documented studies on the negative effects of xanax as their is on the positve. I would post articles all day long on xanax but Im getting bored with it. I dont know shit about cocaine except ,like benzos, its highly addictive and if taken regularly it will eventually ruin your life. Tell your story to somebody who would give anything to get off xanax. I know of a member on this board on 30mg and their addiction started when they took xanax to ease them into therapy. what a joke.

Joe


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## Guest (Sep 20, 2004)

The irony is that there are many more websites espousing the evils of Paxil. Some say it ruined their lives, some say they had loved ones who committed sucide when they had such severe withdrawal they thought they were going insane.

But we dont' currently have a Paxil Hater on board, so there's no one to threaten Joe with "you'll see, when you try to come off it, the agony will make your benzo withdrawal look like paradise."

life.
people.
in search of ONE ultimate truth.
So sad.

Peace,
J


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## Guest (Sep 20, 2004)

The irony is that there are many more websites espousing the evils of Paxil. Some say it ruined their lives, some say they had loved ones who committed sucide when they had such severe withdrawal they thought they were going insane.

But we dont' currently have a Paxil Hater on board, so there's no one to threaten Joe with "you'll see, when you try to come off it, the agony will make your benzo withdrawal look like paradise."

life.
people.
in search of ONE ultimate truth.
So sad.

Peace,
J


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## dakotajo (Aug 10, 2004)

Youre comparing apples to oranges. Dont compare paxil withdrawal to benzo withdrawal. They are not even in the same ballpark. Paxil wd may be miserable and make you want to die, but it cannot, I repeat, it cannot kill you. If dependent, xanax withdrawal can be life threatening. It can give continous grand mal seizures and can induce psychosis. Ive also read several well documented articles of people going into cardiac arrest during severe benzo withdrawal.

Joe


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## dakotajo (Aug 10, 2004)

Youre comparing apples to oranges. Dont compare paxil withdrawal to benzo withdrawal. They are not even in the same ballpark. Paxil wd may be miserable and make you want to die, but it cannot, I repeat, it cannot kill you. If dependent, xanax withdrawal can be life threatening. It can give continous grand mal seizures and can induce psychosis. Ive also read several well documented articles of people going into cardiac arrest during severe benzo withdrawal.

Joe


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## Guest (Sep 20, 2004)

http://www.diy-medical-knowledge.co...ithdrawal-symptoms-pulmonary-hypertension.htm


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## Guest (Sep 20, 2004)

http://www.diy-medical-knowledge.co...ithdrawal-symptoms-pulmonary-hypertension.htm


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## Guest (Sep 20, 2004)

http://www.paxil-side-effects-lawsuits.com/pages/lawsuits.html


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## Guest (Sep 20, 2004)

http://www.paxil-side-effects-lawsuits.com/pages/lawsuits.html


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## Guest (Sep 20, 2004)

http://www.paxil-side-effects-lawsuits.com/pages/withdrawals.html


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## Guest (Sep 20, 2004)

http://www.paxil-side-effects-lawsuits.com/pages/withdrawals.html


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## Guest (Sep 20, 2004)

http://www.prozactruth.com/sideeffects.htm


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## Guest (Sep 20, 2004)

http://www.prozactruth.com/sideeffects.htm


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## dakotajo (Aug 10, 2004)

Your not listening. I could care less about your link. Paxil has never, ever killed anyone. You may feel so bad that you will want to kill yourself but the drug ITSELF cannot kill you. Benzos and their withdrawal can be life threatening regardless of the mental circumstances.

Joe


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## dakotajo (Aug 10, 2004)

Your not listening. I could care less about your link. Paxil has never, ever killed anyone. You may feel so bad that you will want to kill yourself but the drug ITSELF cannot kill you. Benzos and their withdrawal can be life threatening regardless of the mental circumstances.

Joe


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## peacedove (Aug 15, 2004)

Like I said once before... different drugs work for different people. My boyfriend had severe withdrawal from weaning himself off paxil while I only got some headaches after stopping klonopin cold turkey. I used to go to the hospital once a month because of DP induced panic attacks. I used to pace around the house and cry uncontrollably. I was put on several meds that did nothing or made me feel worse so I self-medicated with alcohol every single day, which brought even more problems. Finally I got a new psychiatrist, one that actually gave a fuck and actually talked with me about my life and personality and he got me back on klonopin and gave me xanax. I love xanax. I only drink on weekends now and have not been to the hospital once since I've had it which has been over a year. I wonder where I'd be now without benzos. I know a lot of people are still suffering from having taken benzos, but everyone is different.


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## peacedove (Aug 15, 2004)

Like I said once before... different drugs work for different people. My boyfriend had severe withdrawal from weaning himself off paxil while I only got some headaches after stopping klonopin cold turkey. I used to go to the hospital once a month because of DP induced panic attacks. I used to pace around the house and cry uncontrollably. I was put on several meds that did nothing or made me feel worse so I self-medicated with alcohol every single day, which brought even more problems. Finally I got a new psychiatrist, one that actually gave a fuck and actually talked with me about my life and personality and he got me back on klonopin and gave me xanax. I love xanax. I only drink on weekends now and have not been to the hospital once since I've had it which has been over a year. I wonder where I'd be now without benzos. I know a lot of people are still suffering from having taken benzos, but everyone is different.


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## bat (Aug 18, 2004)

i dont have a personal bag with benzos but just wondering. when my gp gave me benzos he said that he didnt want to repeat the prescription because he only gives them for a max of 2 to 4 weeks. in the anxiety literature the surgery gave me it says that they are only given for short periods of time unless with panic disorder when they can be prescribed for 6 months to 1 year. are the rules different in places other than the uk?


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## bat (Aug 18, 2004)

i dont have a personal bag with benzos but just wondering. when my gp gave me benzos he said that he didnt want to repeat the prescription because he only gives them for a max of 2 to 4 weeks. in the anxiety literature the surgery gave me it says that they are only given for short periods of time unless with panic disorder when they can be prescribed for 6 months to 1 year. are the rules different in places other than the uk?


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## Guest (Sep 20, 2004)

Hi Joe,

Why this anger because of benzos? You had a bad experience, so? Why all people here would have a bad experience too? It's not true that benzos can kill people. Benzo can save people by calming their most bad panick attacks and DP/DR. It's NOT THAT BAD. You have to take what's better for you to heal.

You don't take benzos, right? :?: So why are you wasting your time taking all sensational stuff on the Internet, anti-benzo campaign, (you can always find it on EVERYTHING!!!!!!), and put it there, lots of writing, lots of pages... why? We ARE educated, we know the two sides of the medal. You are so obsessed by the benzos, I can't realize it.

Benzos doens't make Dp/DR. DP/DR can be brought by anything.

Benzos are not evil.

Stop to try to "educate" us, we already know all this stuff about benzos.

No matter what you are writing here, no people will stop benzos because of those anti-benzo's campain. They will stop by themselves. if they are ready. If they want to.

I know many people who take, or took benzos, and they never had any problems. So stop generalizing and scare people.

Anyway, I won't comment on those posts anymore. I just don't understand why all this anger.
:!:

Sorry but it was too much for me.

Cyn


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## Guest (Sep 20, 2004)

Hi Joe,

Why this anger because of benzos? You had a bad experience, so? Why all people here would have a bad experience too? It's not true that benzos can kill people. Benzo can save people by calming their most bad panick attacks and DP/DR. It's NOT THAT BAD. You have to take what's better for you to heal.

You don't take benzos, right? :?: So why are you wasting your time taking all sensational stuff on the Internet, anti-benzo campaign, (you can always find it on EVERYTHING!!!!!!), and put it there, lots of writing, lots of pages... why? We ARE educated, we know the two sides of the medal. You are so obsessed by the benzos, I can't realize it.

Benzos doens't make Dp/DR. DP/DR can be brought by anything.

Benzos are not evil.

Stop to try to "educate" us, we already know all this stuff about benzos.

No matter what you are writing here, no people will stop benzos because of those anti-benzo's campain. They will stop by themselves. if they are ready. If they want to.

I know many people who take, or took benzos, and they never had any problems. So stop generalizing and scare people.

Anyway, I won't comment on those posts anymore. I just don't understand why all this anger.
:!:

Sorry but it was too much for me.

Cyn


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## Guest (Sep 20, 2004)

Cynthia,

Benzos are the most addicting drugs in the world. You already know how addicting they are because you have tried to stop several times and have failed because the withdrawal symptoms were way too much for you to handle. Benzos take over the natural calming abilities of your brain. When you stop them, whether it be cold turkey or very slowly, your brain has no freaking idea how to calm itself down. Because of this you can experience symptoms that produce pain and suffering beyond your comprehension.

Heres the thing. We all have a natural calming system in our brains. It may not work perfect for some of us, but it works nonetheless. You may think benzos help the calming area of your brain, but they actually make it alot worse than it was to begin with. You will not believe this until you try coming off the drugs yourself. It is only then that you will realize what kind of damage benzos have done to you. And it is only then that you will realize that your situation you were in originally was a piece of cake compared to the one you are now in.

Until then, you will continue to believe that benzos are wonder drugs and you will continue to up your dosage because you will need more and more to produce the same "miracle drug" effect. I do not expect anybody on benzos to believe the horror stories until they either a.) try to withdrawal from them or b.) not up their dosage...Once you do those two things, you will realize that all the negativity regarding benzos was nothing but the truth. Believe me, I thought these drugs were miracle drugs too. Everyone did at some point. Even joe himself thought that klonopin was a miracle drug.


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## Guest (Sep 20, 2004)

Cynthia,

Benzos are the most addicting drugs in the world. You already know how addicting they are because you have tried to stop several times and have failed because the withdrawal symptoms were way too much for you to handle. Benzos take over the natural calming abilities of your brain. When you stop them, whether it be cold turkey or very slowly, your brain has no freaking idea how to calm itself down. Because of this you can experience symptoms that produce pain and suffering beyond your comprehension.

Heres the thing. We all have a natural calming system in our brains. It may not work perfect for some of us, but it works nonetheless. You may think benzos help the calming area of your brain, but they actually make it alot worse than it was to begin with. You will not believe this until you try coming off the drugs yourself. It is only then that you will realize what kind of damage benzos have done to you. And it is only then that you will realize that your situation you were in originally was a piece of cake compared to the one you are now in.

Until then, you will continue to believe that benzos are wonder drugs and you will continue to up your dosage because you will need more and more to produce the same "miracle drug" effect. I do not expect anybody on benzos to believe the horror stories until they either a.) try to withdrawal from them or b.) not up their dosage...Once you do those two things, you will realize that all the negativity regarding benzos was nothing but the truth. Believe me, I thought these drugs were miracle drugs too. Everyone did at some point. Even joe himself thought that klonopin was a miracle drug.


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## dakotajo (Aug 10, 2004)

Cynthia,

This is the internet and I have the right to my opinion as well as you do. I think this is a good board, but when I first came here it was running rampant with pro-benzo talk. The 2 main so called "experts" here were advising people to take benzos. I listened and I got myself in alot of trouble. Wether it causes trouble or not, both sides of the story have to be told so that people can make a proper, educated decision. Benzos are tolerance-producing, highly addictive drugs. It has been well documented for many years. They will always be a very contraversial subject and will be the cause of alot of heated debates no matter where you go.

Joe


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## dakotajo (Aug 10, 2004)

Cynthia,

This is the internet and I have the right to my opinion as well as you do. I think this is a good board, but when I first came here it was running rampant with pro-benzo talk. The 2 main so called "experts" here were advising people to take benzos. I listened and I got myself in alot of trouble. Wether it causes trouble or not, both sides of the story have to be told so that people can make a proper, educated decision. Benzos are tolerance-producing, highly addictive drugs. It has been well documented for many years. They will always be a very contraversial subject and will be the cause of alot of heated debates no matter where you go.

Joe


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## Guest (Sep 20, 2004)

Ok sorry I will not read your posts anymore.

We have our own opinions.

I forgot this was a free board.

But I keep my opinion.

Cyn

p.s. I dind't upgrade my benzo dosage since many many months.


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## Guest (Sep 20, 2004)

Ok sorry I will not read your posts anymore.

We have our own opinions.

I forgot this was a free board.

But I keep my opinion.

Cyn

p.s. I dind't upgrade my benzo dosage since many many months.


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## person3 (Aug 10, 2004)

Pure Narcotic...you think benzos are the most addictive thing in the world?

F*ck man, try taking some methadone and see how you feel the next day and TELL me it's not more addictive than Xanax. If you can get up to type on the computer that is. I can't describe the withdrawl of methadone to you, but if it's anything similar to what heroin users feel during withdrawl, I would wonder if once I started herion I would EVER stop!

I've personally never had a problem getting on or off benzos. I've found adderall to have more withdrawl sypmtoms than any other psych drug i've taken, and those symptoms last for maybe three days. That's it.

So um yeah.


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## person3 (Aug 10, 2004)

Pure Narcotic...you think benzos are the most addictive thing in the world?

F*ck man, try taking some methadone and see how you feel the next day and TELL me it's not more addictive than Xanax. If you can get up to type on the computer that is. I can't describe the withdrawl of methadone to you, but if it's anything similar to what heroin users feel during withdrawl, I would wonder if once I started herion I would EVER stop!

I've personally never had a problem getting on or off benzos. I've found adderall to have more withdrawl sypmtoms than any other psych drug i've taken, and those symptoms last for maybe three days. That's it.

So um yeah.


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## dakotajo (Aug 10, 2004)

P3,

I would consider myself lucky. Both Methadone and Heroin withdrawal are absolutely miserable and may make you want to hurl your head into a wall, but they are not life threatening. Severe Benzo withdrawal has the severe mental and physical symptoms and as a added bonus can have severe life threatening symptoms as well. Ive talked to people that have withdrawn from both heroin and benzos. They claim they will take the heroin withdrawal any day over benzo withdrawal because heroin withdrawl is no more intense and is usually over in a few weeks. If severely dependent, benzo withdrawl can keep you on your knees for months or even years.

Joe


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## dakotajo (Aug 10, 2004)

P3,

I would consider myself lucky. Both Methadone and Heroin withdrawal are absolutely miserable and may make you want to hurl your head into a wall, but they are not life threatening. Severe Benzo withdrawal has the severe mental and physical symptoms and as a added bonus can have severe life threatening symptoms as well. Ive talked to people that have withdrawn from both heroin and benzos. They claim they will take the heroin withdrawal any day over benzo withdrawal because heroin withdrawl is no more intense and is usually over in a few weeks. If severely dependent, benzo withdrawl can keep you on your knees for months or even years.

Joe


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## Guest (Sep 20, 2004)

Joe, if you'd continued to listen to the two "so called experts" you would have also heard that it is crucial to taper very very slowly when you withdraw from a benzo.

I'm very sorry you had the terrible experience you did - but my point is that Paxil has as many horror stories as benzos, despite what you will now scream back. Lawsuits have been paid, dear one...HUGE lawsuits by the makers of Paxil (the drug you're currently taking and raving about).

Please post a successful lawsuit against the makers of a benzo.

There are NO absolutes. Nobody is trying to stop you from telling your story and from saying that MANY people (your links/quotes) have had similar experiences.

But....you continue to say THIS IS HOW YOU WILL BE IF YOU STOP BENZOS - universally. It is not true. And that fact is why you are always getting flack and considered to be rageful and irrational.

J


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## Guest (Sep 20, 2004)

Joe, if you'd continued to listen to the two "so called experts" you would have also heard that it is crucial to taper very very slowly when you withdraw from a benzo.

I'm very sorry you had the terrible experience you did - but my point is that Paxil has as many horror stories as benzos, despite what you will now scream back. Lawsuits have been paid, dear one...HUGE lawsuits by the makers of Paxil (the drug you're currently taking and raving about).

Please post a successful lawsuit against the makers of a benzo.

There are NO absolutes. Nobody is trying to stop you from telling your story and from saying that MANY people (your links/quotes) have had similar experiences.

But....you continue to say THIS IS HOW YOU WILL BE IF YOU STOP BENZOS - universally. It is not true. And that fact is why you are always getting flack and considered to be rageful and irrational.

J


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## dakotajo (Aug 10, 2004)

Janine,

WHAT? What the hell are you talking about? Ive heard you give some of the worst and most dangerous benzo advice of anybody on this board. Ive read your posts advising people to take these drugs and Ive also read plenty of posts giving advice to people that they can taper over a few weeks or even quit cold turkey if they are only on a low dose. I dont care how many years you took them. I dont think you should be giving any advice on benzos.

You pick and choose what you want to respond to also. I honestly dont care what you have to say about Paxil. You bore me. I know what kind of drug paxil is and I know people DO suffer when they withdraw. Dont tell me, Ive been off and on ssris for the past 3 years for Gods sake. Im not denying that. The point Im trying to make(and what you continue to ignore) is that regardless of how much you suffer from ssri withdrawal, its usually short lived, and IT IS NOT DANGEROUS, I repeat, IT IS NOT DANGEROUS. Benzo withdrawal is another story. You can have seizures, you can experience psychosis, and you can even die in benzo withdrawal! These are all well documented symptoms in benzo and alcohol withdrawal. GET IT, GOT IT...GOOD!!!!!

Joe


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## dakotajo (Aug 10, 2004)

Janine,

WHAT? What the hell are you talking about? Ive heard you give some of the worst and most dangerous benzo advice of anybody on this board. Ive read your posts advising people to take these drugs and Ive also read plenty of posts giving advice to people that they can taper over a few weeks or even quit cold turkey if they are only on a low dose. I dont care how many years you took them. I dont think you should be giving any advice on benzos.

You pick and choose what you want to respond to also. I honestly dont care what you have to say about Paxil. You bore me. I know what kind of drug paxil is and I know people DO suffer when they withdraw. Dont tell me, Ive been off and on ssris for the past 3 years for Gods sake. Im not denying that. The point Im trying to make(and what you continue to ignore) is that regardless of how much you suffer from ssri withdrawal, its usually short lived, and IT IS NOT DANGEROUS, I repeat, IT IS NOT DANGEROUS. Benzo withdrawal is another story. You can have seizures, you can experience psychosis, and you can even die in benzo withdrawal! These are all well documented symptoms in benzo and alcohol withdrawal. GET IT, GOT IT...GOOD!!!!!

Joe


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## dakotajo (Aug 10, 2004)

Iatrogenic Benzodiazepine Addiction

FIRST MALPRACTICE JUDGMENT IN GERMANY

Report by Ralf Gerlach
Deputy Director of INDROeV
M?nster, Germany
January 24, 2004

For the first time in Germany, a patient has claimed damages from his family doctor for iatrogenic addiction to benzodiazepines. Over a period of 17 years the patient had been given 650 private prescriptions for Rohypnol (active substance: flunitrazepam), corresponding to a total of some 19,000 tablets. A medical arbitration board awarded 75,000 Euros, a relatively large sum for malpractice cases in Germany.

This is the first time a German arbitration board has recognised inappropriate medical care as the cause of addiction to prescription drugs.

The Board characterised the harm done to the patient as "avoidable and a consequence of egregiously inappropriate care." While the arbitration board's decision does not serve as a legal precedent, it paves the way for similar claims in the future. It is estimated that some 1,400,000 people are addicted to prescription drugs in Germany, a great number of whom became addicted through substandard medical treatment and prescribing practices.

The German Health Department has long sought ways to minimise injudicious prescribing of medications that can cause addiction, including improvement of physician training in the field of addiction medicine. The threat of successful claims for damages, however, and the attendant adverse publicity, may prove to be a more effective deterrent.


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## dakotajo (Aug 10, 2004)

Iatrogenic Benzodiazepine Addiction

FIRST MALPRACTICE JUDGMENT IN GERMANY

Report by Ralf Gerlach
Deputy Director of INDROeV
M?nster, Germany
January 24, 2004

For the first time in Germany, a patient has claimed damages from his family doctor for iatrogenic addiction to benzodiazepines. Over a period of 17 years the patient had been given 650 private prescriptions for Rohypnol (active substance: flunitrazepam), corresponding to a total of some 19,000 tablets. A medical arbitration board awarded 75,000 Euros, a relatively large sum for malpractice cases in Germany.

This is the first time a German arbitration board has recognised inappropriate medical care as the cause of addiction to prescription drugs.

The Board characterised the harm done to the patient as "avoidable and a consequence of egregiously inappropriate care." While the arbitration board's decision does not serve as a legal precedent, it paves the way for similar claims in the future. It is estimated that some 1,400,000 people are addicted to prescription drugs in Germany, a great number of whom became addicted through substandard medical treatment and prescribing practices.

The German Health Department has long sought ways to minimise injudicious prescribing of medications that can cause addiction, including improvement of physician training in the field of addiction medicine. The threat of successful claims for damages, however, and the attendant adverse publicity, may prove to be a more effective deterrent.


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## dakotajo (Aug 10, 2004)

ADDICTS OF PRESCRIPTION DRUGS
ARE NEEDED FOR LEGAL FIGHT

Lancashire Evening Telegraph
July 25, 2003

Thousands of East Lancashire residents with experience of addiction to prescription drugs are sought for a legal battle to stop others getting hooked.

Around 1.2 million people in Britain are long-term addicts of anxiety-suppressing benzodiazepines such as Valium, temazepam, Librium and Ativan, said by some experts to be more dangerous and addictive than heroin.

Working with Beat the Benzos, a charity dedicated to highlighting the plight of those who have suffered from the effects of addiction to the drugs, East Lancashire Liberal Democrat MEP Chris Davies has helped secure the backing of the European Parliament for action to be taken.

Now, the European Commission has agreed to draft guidelines for an EU-wide approach to the problem, and is asking for help from those with first-hand experience.

The aim is to produce best-practice recommendations on treatment and support for patients suffering from withdrawal symptoms or with permanent impairment.

Mr Davies said: "At last recognition is being paid to the thousands of silent addicts in this country and across Europe. Their shared experiences will be vital when compiling these guidelines."

Beat The Benzos' Barry Haslam is collating addict responses for the European Commission.

For further information contact him on 01457 876355 or write to him at 7 School Street, Uppermill, Oldham, OL3 6HB or email [email protected].

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Media Archive ? Beat The Benzos Campaign


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## dakotajo (Aug 10, 2004)

ADDICTS OF PRESCRIPTION DRUGS
ARE NEEDED FOR LEGAL FIGHT

Lancashire Evening Telegraph
July 25, 2003

Thousands of East Lancashire residents with experience of addiction to prescription drugs are sought for a legal battle to stop others getting hooked.

Around 1.2 million people in Britain are long-term addicts of anxiety-suppressing benzodiazepines such as Valium, temazepam, Librium and Ativan, said by some experts to be more dangerous and addictive than heroin.

Working with Beat the Benzos, a charity dedicated to highlighting the plight of those who have suffered from the effects of addiction to the drugs, East Lancashire Liberal Democrat MEP Chris Davies has helped secure the backing of the European Parliament for action to be taken.

Now, the European Commission has agreed to draft guidelines for an EU-wide approach to the problem, and is asking for help from those with first-hand experience.

The aim is to produce best-practice recommendations on treatment and support for patients suffering from withdrawal symptoms or with permanent impairment.

Mr Davies said: "At last recognition is being paid to the thousands of silent addicts in this country and across Europe. Their shared experiences will be vital when compiling these guidelines."

Beat The Benzos' Barry Haslam is collating addict responses for the European Commission.

For further information contact him on 01457 876355 or write to him at 7 School Street, Uppermill, Oldham, OL3 6HB or email [email protected].

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Media Archive ? Beat The Benzos Campaign


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## dakotajo (Aug 10, 2004)

KEEBLE HAWSON WINS ?40,000 SETTLEMENT

24th June 2002

Ray Nimmo
Claimant 
Caroline Moore
Solicitor

Yorkshire based law firm, Keeble Hawson is delighted to announce the success of Partner Caroline Moore in securing a ?40,000 settlement for former Valium addict Raymond Nimmo.

The strength of the case, the severity of the negligence and the perseverance of the legal team means that Mr Nimmo's case is the first of its kind to be reported to conclude in favour of the claimant and Keeble Hawson's Caroline Moore is extremely pleased with the outcome.

Partner and acting Solicitor in the case, Caroline Moore said:

"This case settled within 3 years which in itself is an achievement in matters of this kind. It is the first reported case successful against a prescriber negotiated out of court and as such represents real progress for those fighting for increased awareness of Benzodiazepine drugs including Valium. There is still a place for Benzodiazepines but people prescribed the drug should think carefully about the dosage they are on and the length of time they have been using it. Those with concerns should review their use with their GP and if still worried should speak to a specialist clinical negligence solicitor, regulated by AVMA and Law Society Panels."

Notes for Editors

Keeble Hawson is a premier Yorkshire law firm with over 170 staff and 25 partners working in 3 offices across Yorkshire.

The Keeble Hawson Clinical Negligence team is recognised as a leading team by the Legal 500 and Chambers and Partners.

The Keeble Hawson Clinical Negligence team is recognised by the Law Society as a specialist team and regulated by the Law Society and AVMA.

BACKGROUND

Mr Raymond Daniel Nimmo was 32 years old in 1984 when he consulted his GPs Drs Shambhulingappa and Ugargol (husband and wife), with a dental infection. He was prescribed an antibiotic and suffered an allergic reaction to it experiencing severe abdominal pains. He was told, however, that this pain was caused by a muscle spasm and was prescribed a powerful benzodiazepine tranquilliser called Xanax. The pain persisted and he was prescribed a variety of different tranquillisers and by early 1985 was taking high doses of diazepam (Valium). This drug was prescribed continuously until 1998 when Mr Nimmo changed doctors.

Mr Nimmo was told he needed the drug to alleviate the abdominal pain and he attended the surgery at least every 3 months to collect repeat prescriptions. In fact the drug caused many intense side-effects including suicidal depression, agoraphobia, insomnia and panic attacks as well as physical effects such as itching, sweating, dyspepsia and flu-like symptoms. Mr Nimmo was prescribed a wide variety of drugs including antidepressants to treat the side-effects which the doctors failed to recognise.

Mr Nimmo had jointly set up a scaffolding company but could not cope with this owing to the Valium, gave it up in 1986 and has not worked since despite a previous good employment record. The company continues to be run successfully to date by his fellow director.

He and his wife have one son and had planned to have more children but gave up these plans when because Mr Nimmo was diagnosed as "mentally ill" and he believed he was not fit to father more children.

It was in 1998 that Mr Nimmo was advised by a new GP, Dr Rizk, that diazepam was causing rather than treating his depression. Mr Nimmo came off the drug and his abdominal pain, depression, anxiety and various other symptoms resolved completely. Although it is now more than three and a half years since he withdrew from diazepam he continues to suffer distressing protracted physical withdrawal symptoms such as tinnitus, burning scalp sensations, muscular pains and numbness as well as continued memory and concentration problems.

Last December Mr Nimmo had an MRI scan which revealed two areas of brain damage. Although the specialist could not say what caused these he did conclude that the symptoms he is currently suffering from are consistent with the Protracted Benzodiazepine Withdrawal Syndrome.

For the last few years Mr Nimmo has been building a web site and runs a support forum for fellow sufferers across the world. His web site has become very popular and can be accessed at: http://www.benzo.org.uk.

PROGRESS OF LITIGATION

In 1999 Mr Nimmo started to pursue a claim of clinical negligence against his former GPs. Dr Shambhu vigorously denied the claim and passed the matter onto his indemnity insurers, the Medical Protection Society. After detailed correspondence the MPS admitted the GPs had been negligent in their prescribing of the diazepam which was over the levels recommended by the British National Formulary and that there were no reasonable or consistent attempts to reduce the drug but required Mr Nimmo to prove the extent of injury suffered as a result of the negligent prescribing.

The MPS initially indicated there would be no pay out because Mr Nimmo was out of time for bringing an action. However, after service of High Court proceedings the MPS was persuaded that Mr Nimmo might persuade a court to award damages despite the potential time issue and a reduced payout was negotiated in the sum of ?40,000 plus legal costs.

OTHER CLAIMANTS

Many have been put off pursuing prescribers of benzodiazepine drugs for various reasons. They may think they are out of time as the usual rule being that proceedings should be taken within 3 years of the negligent event. However, the courts do have discretion to allow awards in some strong cases of negligence, despite time problems and the circumstances of each case has to be looked at individually.

Also, there was much publicity when the manufacturers, largely of Ativan and Valium, were pursued in a group action in the late 1980s/early 1990s. The group action failed and consequently the group pursued the prescribers ie GPs and health authorities employing psychiatrists. The Court of Appeal disallowed the group action but this was in part owing to funding difficulties as well as difficulties in individual cases in proving the injury was caused by the drugs themselves. Three of the claims against prescribers were in fact allowed to proceed.

It is thought that there may be various cases against prescribers that have settled out of court but have not been reported to the public owing to the Defendants imposing non-publicity clauses as a term of any settlement. Generally legal advisers should try to protect their client and the public, as far as possible, from non-publicity clauses.

TEAM

Solicitor: Miss Caroline Moore LLB, is now with Taylor & Emmet Solicitors, 20 Arundel Gate, Sheffield S1 2PP. Telephone: 0114 290 2239. In the UK and interested in taking legal action against your prescriber? Email [email protected] for details.

Barrister: Miss Rachel Vickers LLB (Hons), 199 The Strand Chambers, 199 The Strand, London, WC2R IDR. Telephone: 0207-379-9779.

Causation: Professor Malcolm Lader OBE, DSc, PhD, MD, FRC Psych, FMedSci, Professor of Clinical Psychopharmacology, Institute of Psychiatry, London SE5 8AF. Telephone: 0207 848 0372.

GP Expert: Dr Ian Isaac MBBS, MRCGP, DRCOG, Fircroft, 26A Watford Road, Kings Langley, Hertfordshire, WD4 8DY. Telephone: 01923 266176.

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## dakotajo (Aug 10, 2004)

KEEBLE HAWSON WINS ?40,000 SETTLEMENT

24th June 2002

Ray Nimmo
Claimant 
Caroline Moore
Solicitor

Yorkshire based law firm, Keeble Hawson is delighted to announce the success of Partner Caroline Moore in securing a ?40,000 settlement for former Valium addict Raymond Nimmo.

The strength of the case, the severity of the negligence and the perseverance of the legal team means that Mr Nimmo's case is the first of its kind to be reported to conclude in favour of the claimant and Keeble Hawson's Caroline Moore is extremely pleased with the outcome.

Partner and acting Solicitor in the case, Caroline Moore said:

"This case settled within 3 years which in itself is an achievement in matters of this kind. It is the first reported case successful against a prescriber negotiated out of court and as such represents real progress for those fighting for increased awareness of Benzodiazepine drugs including Valium. There is still a place for Benzodiazepines but people prescribed the drug should think carefully about the dosage they are on and the length of time they have been using it. Those with concerns should review their use with their GP and if still worried should speak to a specialist clinical negligence solicitor, regulated by AVMA and Law Society Panels."

Notes for Editors

Keeble Hawson is a premier Yorkshire law firm with over 170 staff and 25 partners working in 3 offices across Yorkshire.

The Keeble Hawson Clinical Negligence team is recognised as a leading team by the Legal 500 and Chambers and Partners.

The Keeble Hawson Clinical Negligence team is recognised by the Law Society as a specialist team and regulated by the Law Society and AVMA.

BACKGROUND

Mr Raymond Daniel Nimmo was 32 years old in 1984 when he consulted his GPs Drs Shambhulingappa and Ugargol (husband and wife), with a dental infection. He was prescribed an antibiotic and suffered an allergic reaction to it experiencing severe abdominal pains. He was told, however, that this pain was caused by a muscle spasm and was prescribed a powerful benzodiazepine tranquilliser called Xanax. The pain persisted and he was prescribed a variety of different tranquillisers and by early 1985 was taking high doses of diazepam (Valium). This drug was prescribed continuously until 1998 when Mr Nimmo changed doctors.

Mr Nimmo was told he needed the drug to alleviate the abdominal pain and he attended the surgery at least every 3 months to collect repeat prescriptions. In fact the drug caused many intense side-effects including suicidal depression, agoraphobia, insomnia and panic attacks as well as physical effects such as itching, sweating, dyspepsia and flu-like symptoms. Mr Nimmo was prescribed a wide variety of drugs including antidepressants to treat the side-effects which the doctors failed to recognise.

Mr Nimmo had jointly set up a scaffolding company but could not cope with this owing to the Valium, gave it up in 1986 and has not worked since despite a previous good employment record. The company continues to be run successfully to date by his fellow director.

He and his wife have one son and had planned to have more children but gave up these plans when because Mr Nimmo was diagnosed as "mentally ill" and he believed he was not fit to father more children.

It was in 1998 that Mr Nimmo was advised by a new GP, Dr Rizk, that diazepam was causing rather than treating his depression. Mr Nimmo came off the drug and his abdominal pain, depression, anxiety and various other symptoms resolved completely. Although it is now more than three and a half years since he withdrew from diazepam he continues to suffer distressing protracted physical withdrawal symptoms such as tinnitus, burning scalp sensations, muscular pains and numbness as well as continued memory and concentration problems.

Last December Mr Nimmo had an MRI scan which revealed two areas of brain damage. Although the specialist could not say what caused these he did conclude that the symptoms he is currently suffering from are consistent with the Protracted Benzodiazepine Withdrawal Syndrome.

For the last few years Mr Nimmo has been building a web site and runs a support forum for fellow sufferers across the world. His web site has become very popular and can be accessed at: http://www.benzo.org.uk.

PROGRESS OF LITIGATION

In 1999 Mr Nimmo started to pursue a claim of clinical negligence against his former GPs. Dr Shambhu vigorously denied the claim and passed the matter onto his indemnity insurers, the Medical Protection Society. After detailed correspondence the MPS admitted the GPs had been negligent in their prescribing of the diazepam which was over the levels recommended by the British National Formulary and that there were no reasonable or consistent attempts to reduce the drug but required Mr Nimmo to prove the extent of injury suffered as a result of the negligent prescribing.

The MPS initially indicated there would be no pay out because Mr Nimmo was out of time for bringing an action. However, after service of High Court proceedings the MPS was persuaded that Mr Nimmo might persuade a court to award damages despite the potential time issue and a reduced payout was negotiated in the sum of ?40,000 plus legal costs.

OTHER CLAIMANTS

Many have been put off pursuing prescribers of benzodiazepine drugs for various reasons. They may think they are out of time as the usual rule being that proceedings should be taken within 3 years of the negligent event. However, the courts do have discretion to allow awards in some strong cases of negligence, despite time problems and the circumstances of each case has to be looked at individually.

Also, there was much publicity when the manufacturers, largely of Ativan and Valium, were pursued in a group action in the late 1980s/early 1990s. The group action failed and consequently the group pursued the prescribers ie GPs and health authorities employing psychiatrists. The Court of Appeal disallowed the group action but this was in part owing to funding difficulties as well as difficulties in individual cases in proving the injury was caused by the drugs themselves. Three of the claims against prescribers were in fact allowed to proceed.

It is thought that there may be various cases against prescribers that have settled out of court but have not been reported to the public owing to the Defendants imposing non-publicity clauses as a term of any settlement. Generally legal advisers should try to protect their client and the public, as far as possible, from non-publicity clauses.

TEAM

Solicitor: Miss Caroline Moore LLB, is now with Taylor & Emmet Solicitors, 20 Arundel Gate, Sheffield S1 2PP. Telephone: 0114 290 2239. In the UK and interested in taking legal action against your prescriber? Email [email protected] for details.

Barrister: Miss Rachel Vickers LLB (Hons), 199 The Strand Chambers, 199 The Strand, London, WC2R IDR. Telephone: 0207-379-9779.

Causation: Professor Malcolm Lader OBE, DSc, PhD, MD, FRC Psych, FMedSci, Professor of Clinical Psychopharmacology, Institute of Psychiatry, London SE5 8AF. Telephone: 0207 848 0372.

GP Expert: Dr Ian Isaac MBBS, MRCGP, DRCOG, Fircroft, 26A Watford Road, Kings Langley, Hertfordshire, WD4 8DY. Telephone: 01923 266176.

--------------------------------------------------------------------------------


----------



## dakotajo (Aug 10, 2004)

INVESTIGATION: FORTY YEARS OF VALIUM

Sunday Tribune, Ireland
March 2, 2003

The Background 
When the cure becomes more dangerous that the disease 
100,000 Irish addicted to tranquilliser drugs 
'Mother's Little Helper' - a global phenomenon 
Withdrawal can be worse than original symptoms 
"All I was doing was blocking out my life" 
The Background
by Harry McGee

The benzodiazepine guidelines announced in Britain and Ireland in 1988 led to a huge number of lawsuits in Britain. In all, 17,000 cases were taken alleging that manufacturers such as Roche, Wyeth and Upjohn had long been aware of the dangers of addic?tion and other side-effects but had not made this information available to prescribers and patients.

In particular, it was claimed that much higher levels of warn?ing were issued in Scandinavia, the US and Australia than in Britain and Ireland. The claims were initially backed by legal aid in Britain (eventually running up a bill of ?40m), but legal aid was withdrawn in 1994 after being challenged by the manufacturers. In the end, the number of cases was reduced from 17,000 to one, which was struck out two years ago. The litigant in that last case was Michael Behan, who was hooked on Ativan for seven years. "It destroyed my life," he told The Sunday Tribune. I quickly became addicted, after four weeks. I did not get proper warnings."

Behan is now acting as an expert advisor for a claim still being pursued by a Dublin solicitor, one of a number of such cases here. These tend to be David and Goliath-type strug?gles between a small solicitor's firm and a pharmaceutical giant. In the case that Behan is advis?ing on, there are over one million documents pertaining to the case and the company involved, Wyeth, is attempting to strike out the claim "for want of prose?cution".

When asked to comment on the case, Wyeth told The Sunday Tribune that "we are aware of three claims currently proceed?ing against us, all of which were originally filed in the early 1990s. Wyeth has always vigorously denied these claims."

When the cure becomes more dangerous that the disease
by Harry McGee and Kate O'Flaherty

Forty years ago, when Valium was first introduced as a 'wonder drug' it was hailed as a potential side-effects free cure for a whole range of psychological ailments. Four decades on, it is now clear that such enthusiasm was dangerously misguided.

Picture the typical Irish drug addict and you will probably be wrong. The immediate image that comes to most people's minds is the sad visible one, the skeletal heroin addict with pinhole eyes who floats through city streets. But there is a far larger and much less visible group made up of people who are chronic users of potent, addictive drugs, many, for decades rather than years or months. To try and characterise them is more tricky. You are, after all, describing your own community; neighbours, grandparents, parents, relatives - all leading normal lives bar the fact that they are hooked on a type of drug that a doctor has prescribed for them and that they have 'scored' legally across the counter of a pharmacy. The class of drug, to give it its pharmacological name, is benzodiazepines.

Widely prescribed in the 1960s and 1970s, benzodiazepines- such as Valium, Xanax, Rohypnol and Mogadon - were at first considered 'wonder drugs'. But something was amiss with this panacea which promised domestic bliss. During the '70s, articles began appearing in medical journals seriously questioning the assertion that benzodiazepines had few side effects. In particular, studies began to suggest that they were addictive.

In 1988, the UK Committee on Safety of Medicines (CSM) issued a warning that these drugs should only be used for short periods of time as there was a high risk of addiction, and a serious withdrawal syndrome after long-term use.

In 2000, our own Department of Health and Children established a Benzodiazepine Committee to examine the current use and prescribing of these drugs in Ireland, and it reported late last year.

The report observes that these drugs have a problem of "dependence when taken on a long-term basis, even in prescribed therapeutic doses", but that "in many cases, the prescribing of these drugs is excessive and perhaps has become a matter of routine". It further adds that "it would appear that these patients receive little support from their doctors, and generally it would appear that some medical practitioners are not well-informed about benzodiazepine withdrawal symptoms or methods of withdrawal.

But this problem is not confined to a small group of patients. Arriving at the number of long-term users of these drugs is notoriously difficult, but the committee's own findings reveal some startling statistics.

For one, the evidence suggests a continuing increase in the prescribing rate for these drugs to medical card-holders between 1995 and 2000, with one in 10 people with a medical card being prescribed benzodiazepines at any one time. More than two-thirds of these people are taking them for longer than four weeks, and when the figures are extrapolated, they suggest that as many 100,000 Irish people are taking these drugs, many of them for many years.

Campaigners say that the majority of these are addicts, whose reasons for taking the drug have nothing to do with their original symptoms. GPs renew their prescriptions almost as a matter of routine - sometimes on the basis that an elderly patient on a therapeutic dose for many years is better off left on the drug than being coerced to undergo the trauma of withdrawal.

Disturbingly, the report also highlights a small number of doctors who are "prescribing inappropriately - thereby putting their patients and others at risk". It also draws attention to the fact that benzodiazepines are often a second drug of abuse for heroin addicts - the most common type of drug involved in the 86 heroin-related deaths recorded by the Dublin City Coroner in 1999 was, in fact, benzodiazepines.

Limerick-based GP and author Dr Terry Lynch is well known for his concerns about the over-reliance of his profession on medications to treat the problem of mental distress.

"It's now 15 years since the Committee on Safety of Medicines gave its advice about prescribing benzodiazepines, and unfortunately the truth seems to be that they weren't followed," he says. "The problem was created by prescribing, and a considerable part of the problem was created by not paying sufficient attention to what patients were telling us. Historically, we have a problem recognising the addiction potential of medications and acting swiftly on the information - I mean, we had similar problems in the past with barbiturates and amphetamines, more recently with benzodiazepines, and I personally believe that in the future we will have a similar problem with the anti-depressants which are so enthusiastically prescribed at the moment.

"Twenty years ago, benzodiazepines were held as 'wonder drugs', so there is an eerie repetitiveness about this. Each drug that comes along gives doctors a new 'hope' to believe in and to prescribe, and prescribing is second nature to doctors, that is how they are trained. But many of them have a very basic understanding of anxiety and distress and what patients are going through, what is causing their pain."

Matthew Daly's story would be typical of tens of thousands of others who became addicted to these drugs. Daly (48) now counsels long-term users of the drugs.

"I started off on Valium in 1973 when I was 18." he says. "I had gone to the GP because I felt a bit shy and introverted. I was not a very outgoing fellow and there was some personal stuff in my childhood. I had anxiety, tension and stress. The doctor gave me Valium. I took it and felt that it was great. I felt very attached to it."

So attached that it was to dominate the next 14 years of his life. "For all that time, I was living in a haze. I lost my job and did not care. Once I had it I could float around. I stopped for a very short time and felt that the world was a frightening place."

Daly alternated in the early years between alcohol and benzodiazepines but by his late 20s, the pills had taken over completely. But giving them up became a prospect too horrible to contemplate. "I did not realise that this was worse than a heroin addiction. It's very secretive as well. It's like putting on a mask. Behind it all you are a shell, dying inside."

Daly finally stopped taking benzodiazepines at the age of 32 but, not until after he had taken two overdoses. The withdrawal process was a nightmare, he says, that took many months. He looks back on that 14-year period as a time when "my life was on hold and I was emotionally frozen".

Benzodiazepines are, of course, valuable drugs in the short-term treatment of extreme distress, anxiety and insomnia, and often the decision to prescribe or consume these drugs is not a simple one.

Dr John Fleetwood, a GP based in Dun Laoghaire feels that there are a number of reasons why these drugs are still over-prescribed. "Many people do not want to or are afraid to come off these drugs, and may become hostile when a doctor suggests that they need to wean themselves off them," he says. "And the increasing levels of stress and anxiety in our society affecting everyone from teenagers to the elderly, places enormous pressures of time and resources on our health services. And sometimes there is a certain blas? attitude towards drugs by too many people in society, who may want a 'quick fix' for their ills, rather than looking at these drugs as a last resort."

Dr Kieran Harkin, a Dublin-based GP who was a member of the Benzodiazepines Committee, argues that in some cases long-term prescribing may be necessary. "While it is good practice to limit therapy to two to four weeks, it doesn't necessarily mean that everybody being prescribed for more than four weeks is inappropriately prescribed," he says. "There are people who may have become addicted who started off buying tablets on the street or people who were initially prescribed while waiting for services such as methadone treatment. There are also a number of people with chronic anxiety who may benefit from long-term treatment, assuming that they appreciate issues such as dependence but are prepared to tolerate it because their life is so miserable. Sometimes there may be conflict between what a patient thinks and what the doctor thinks. A doctor may prefer not to prescribe, but if you are faced with an 80-year-old patient who cannot sleep, it's a very difficult situation. A doctor can't tell a patient 'I don't care what you think', there is a grey area there and a good caring doctor is going to respect a patient's opinion."

However, there is not full agreement with this approach within the medical profession.

"There is, of course, some truth in the argument that patients also have a responsibility here and doctors often come under pressure to prescribe," says Dr Lynch. "But I think this is often exaggerated as it tends to absolve doctors and merely passes the blame onto me patients. I do think more of the pressure comes from the doctor's side. As regards the somewhat plaintive comments from our profession about lack of time and resources, that's not the full story at all. I feel that if we don't have enough time, we should make more time or refer people to services such as counselling where they will get the time they need. But we don't hear many doctors out there really pushing for more counselling services. And it's important to realise that GPs are not the sole prescribers of these drugs, they are also prescribed by psychiatrists. I frequently encounter people who have been put on tranquillisers in psychiatric hospitals, and then released without any advice about addiction or any plan to come off their medication over time. Another factor in this debacle relates to the lack of external, independent monitoring and surveillance of the medical profession."

Ireland's problem with benzodiazepines, however, is not unique - it is a Europe-wide phenomenon - and the report's recommendations mirror those of European efforts, such as better collection of data relating to the use of these drugs, better training for doctors, manufacture of smaller pack sizes of these drugs, and a need for greater public awareness of the problems associated with the use of these drugs.

"Much of the current problem with benzodiazepines is an inherited problem," says Harkin, "and I believe that prescribing practice in general is becoming more consistent. The number of new long-term prescriptions is decreasing but there will be no great immediate effects. Very often, people start using benzodiazepines for psychological reasons and those reasons are still there to be dealt with, but the resources for psychological support are not there in the community I do believe there are serious moves afoot to deal with this issue and the report is an important first step, but unfortunately you do get people in every profession who don't practice to the highest standards."

100,000 Irish addicted to tranquilliser drugs
by Harry McGee and Kate O'Flaherty

As many as 100,000 Irish people may be unwittingly addicted to medications they have been prescribed for several months or even years, despite warnings issued 15 years ago that the drugs should not be used for longer than four weeks.

The drugs, known as benzodiazepines, include many common tranquillisers and sleeping tablets, such as Valium, Ativan, Mogadon and Rohypnol.

Benzodiazepines carry a high risk of addiction and other side effects, including a severe withdrawal syndrome that can last for several months after a person comes off the drugs.

A recent report by a government-appointed Benzodiazepine Committee concluded that "the prescribing of these drugs is excessive" and adds that "some medical practitioners are not well-informed about benzodiazepine withdrawal symptoms or methods of withdrawal".

In addition, the report expresses concern about a small number of rogue doctors who may be prescribing these drugs inappropriately, some even for financial gain, stating they are "putting their patients and others at risk".

As many as one in ten medical card holders are being prescribed these drugs at any one time, the majority of them for longer than the four weeks advised by the UK Committee on Safety of Medicines as far back as 1988. In fact, the prescribing rates of these drugs continued to rise in Ireland during the 1990s, despite increasing concerns worldwide about their safety.

During the 1990s, up to 17,000 claims were made in the UK against the manufacturers of these drugs, and there are currently a small number of claims still being pursued by Irish people, although none to date has been successful.

Later this month, the pharmaceutical company Wyeth, which vigorously denies such claims, will attempt to strike out one of these claims in the Irish courts for "want of prosecution".

'Mother's Little Helper' - a global phenomenon
by Harry McGee

Forty years ago this month, the first and most famous of the benzodiazepine group was launched. In March 1963, Valium (diazepam) was introduced amid claims that it was the new 'wonder drug'. The drug's precursor had been shown to have a significant calming effect on lions and tigers that were part of a circus act.

When developed for humans by the Swiss pharmaceutical company Hoffmann-La Roche, it was marketed as a revolution in the treatment of a variety of ailments including stress, anxiety, insomnia and other sleep disorders, safer and more effective than barbiturates, and with few serious side-effects and no addictive properties.

Valium and its sister-drug Librium catapulted Roche into the stratosphere, making it the biggest pharmaceutical company in the world.

The other major drug companies quickly followed suit, and began to produce and market their own benzodiazepines, including Wyeth's Ativan, and Upjohn's Xanax, while Roche developed others such as Rohypnol, Dalmane, Lexotan and Mogadon. Soon these names were as familiar to the ears of many families as Daz and Persil.

The impact of benzodiazepines was indeed massive. They were prescribed in their billions in the 1960s and 1970s - some three billion prescriptions were written worldwide in 1979 alone.

Valium achieved an iconic status as the drug of the suburban housewife - 'Mother's Little Helper' was how the Rolling Stones wryly described it in 1966.

Withdrawal can be worse than original symptoms
by Kate O'Flaherty

Most tranquillisers and sleeping tablets belong to a group of drugs known as benzodiazepines, which is the name of their general chemical structure.

They are used to treat severe anxiety and insomnia, and are valuable in the short-term treatment of these conditions. As these are sedative drugs, they can impair a person's judgement and memory and their ability to drive safely However, some people can have what is known as a paradoxical reaction to these drugs, and instead become hostile, aggressive or talkative.

In 1988, the UK Committee on Safety of Medicines (CSM) issued the advice that these drugs should be used only for the "short-term relief (two to four weeks only) of anxiety... and insomnia.., that is severe, disabling or subjecting the individual to unacceptable distress", that the use of benzodiazepines to treat short-term, "mild" anxiety is inappropriate and unsuitable".

As far back as 1980, doctors were advised that the effectiveness of these drugs after four months' use was not guaranteed.

Dependence or addiction is a major risk with benzodiazepines and this is why their use should be limited to a few weeks.

Anyone coming off these drugs is advised to gradually withdraw the drugs, as coming off them suddenly can cause confusion, convulsions or psychosis.

The benzodiazepine withdrawal syndrome can last for several weeks or months after a person comes off the drug.

The symptoms may be similar to the original complaint for which the drugs were prescribed, such as insomnia, anxiety and tremors. Often people may continue to take the drugs in the mistaken belief that they are treating these symptoms, when in fact they are relieving their physical withdrawal symptoms.

Detoxing from these drugs should be done slowly and under medical supervision as the withdrawal syndrome can be difficult to cope with, mentally and physically.

"All I was doing was blocking out my life"
by Kate O'Flaherty

Rosaleen Masterson found a way out of her cycle of dependency

The word that springs to mind when you meet Rosaleen Masterson is 'survivor'. One of 21 children, she was born and reared in Rialto, Dublin, and at the age of 21, married and moved to St Teresa's Gardens.

"I brought problems into my marriage that I wasn't even aware of, I never had the education," says Masterson.

"And that was because of where I came from. Like most people from those areas, I was put down, stigmatised, never offered chances. After I got married, I felt stuck, I felt I didn't really fit into the role I was in, but I couldn't explain what was wrong. I was empty inside, no self-confidence. I started drinking and labelling myself as an 'alcoholic'." After a few years, Masterson sought medical help for her problems.

"I went to the doctor and was prescribed Valium and Librium. That was about 1976, and I was treated for alcoholism and depression. I didn't take the tablets all the time because deep down somehow, I realised they weren't what I needed. And I heard other people talking about the problems they had with them. But when I did take them I was in a haze and a daze. You'd feel 'good' but all you were doing was blocking out your life. They blocked you from feeling and thinking, and I felt they made me even more depressed. But anytime I went to the doctor, he'd write a prescription and you felt that you had to take them because the doctor told you to. You didn't think you had any other options."

Despite having to cope with depression, alcohol abuse, and other problems, Masterson always felt there was a light at the end of the tunnel.

"I always had a strong faith, I used to go to Lourdes every year and my nickname was 'follow the novena' because I went to anything going. So I was always searching for help, but I was given the wrong directions. I knew my life wasn't good for me, and that it was damaging my children, but it was all I knew."

The combination of a diagnosis of breast cancer and the birth of her first grandchild was the unlikely catalyst that led to the start of her recovery.

"When my grandchild was born, I was in a treatment centre and I just thought, 'no more'. And then when I got the breast cancer it was actually a turning point for the better, because I came to believe more strongly in a higher power and I was determined to beat the cancer, that I was going to live. Since then, I have gone from strength to strength."

Masterson first approached Elah, a counselling and community training service in Hamilton Street, Dublin, for counselling, recalling that one psychiatrist had told her that what she needed was therapy, not medication. Named Elah after the place where David slew Goliath, its mission is to help people defeat their own particular giants or monsters.

'I knew my life wasn't good for me, and that it was damaging my children, but it was all I knew'

"I eventually ended up getting a job at Elah, and now I work on reception there. The first day, I couldn't even answer the phone because I hadn't a clue what I would say to anyone who called, that's how low my self-confidence was. Now I am a trained facilitator in parenting programmes and this summer, I will get my qualification in Reality Therapy. My goal then is to become a professional counsellor, and maybe even write a book about my Journey. I want to give something back, to give hope to other people who are stuck. What people need is someone to listen to them and believe them, and education is the key to help you reach your potential. I feel that I am one of the lucky ones that I've found these things myself."

Elah is at 48 Hamilton Street, Dublin 8, (01-4541278)

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## dakotajo (Aug 10, 2004)

INVESTIGATION: FORTY YEARS OF VALIUM

Sunday Tribune, Ireland
March 2, 2003

The Background 
When the cure becomes more dangerous that the disease 
100,000 Irish addicted to tranquilliser drugs 
'Mother's Little Helper' - a global phenomenon 
Withdrawal can be worse than original symptoms 
"All I was doing was blocking out my life" 
The Background
by Harry McGee

The benzodiazepine guidelines announced in Britain and Ireland in 1988 led to a huge number of lawsuits in Britain. In all, 17,000 cases were taken alleging that manufacturers such as Roche, Wyeth and Upjohn had long been aware of the dangers of addic?tion and other side-effects but had not made this information available to prescribers and patients.

In particular, it was claimed that much higher levels of warn?ing were issued in Scandinavia, the US and Australia than in Britain and Ireland. The claims were initially backed by legal aid in Britain (eventually running up a bill of ?40m), but legal aid was withdrawn in 1994 after being challenged by the manufacturers. In the end, the number of cases was reduced from 17,000 to one, which was struck out two years ago. The litigant in that last case was Michael Behan, who was hooked on Ativan for seven years. "It destroyed my life," he told The Sunday Tribune. I quickly became addicted, after four weeks. I did not get proper warnings."

Behan is now acting as an expert advisor for a claim still being pursued by a Dublin solicitor, one of a number of such cases here. These tend to be David and Goliath-type strug?gles between a small solicitor's firm and a pharmaceutical giant. In the case that Behan is advis?ing on, there are over one million documents pertaining to the case and the company involved, Wyeth, is attempting to strike out the claim "for want of prose?cution".

When asked to comment on the case, Wyeth told The Sunday Tribune that "we are aware of three claims currently proceed?ing against us, all of which were originally filed in the early 1990s. Wyeth has always vigorously denied these claims."

When the cure becomes more dangerous that the disease
by Harry McGee and Kate O'Flaherty

Forty years ago, when Valium was first introduced as a 'wonder drug' it was hailed as a potential side-effects free cure for a whole range of psychological ailments. Four decades on, it is now clear that such enthusiasm was dangerously misguided.

Picture the typical Irish drug addict and you will probably be wrong. The immediate image that comes to most people's minds is the sad visible one, the skeletal heroin addict with pinhole eyes who floats through city streets. But there is a far larger and much less visible group made up of people who are chronic users of potent, addictive drugs, many, for decades rather than years or months. To try and characterise them is more tricky. You are, after all, describing your own community; neighbours, grandparents, parents, relatives - all leading normal lives bar the fact that they are hooked on a type of drug that a doctor has prescribed for them and that they have 'scored' legally across the counter of a pharmacy. The class of drug, to give it its pharmacological name, is benzodiazepines.

Widely prescribed in the 1960s and 1970s, benzodiazepines- such as Valium, Xanax, Rohypnol and Mogadon - were at first considered 'wonder drugs'. But something was amiss with this panacea which promised domestic bliss. During the '70s, articles began appearing in medical journals seriously questioning the assertion that benzodiazepines had few side effects. In particular, studies began to suggest that they were addictive.

In 1988, the UK Committee on Safety of Medicines (CSM) issued a warning that these drugs should only be used for short periods of time as there was a high risk of addiction, and a serious withdrawal syndrome after long-term use.

In 2000, our own Department of Health and Children established a Benzodiazepine Committee to examine the current use and prescribing of these drugs in Ireland, and it reported late last year.

The report observes that these drugs have a problem of "dependence when taken on a long-term basis, even in prescribed therapeutic doses", but that "in many cases, the prescribing of these drugs is excessive and perhaps has become a matter of routine". It further adds that "it would appear that these patients receive little support from their doctors, and generally it would appear that some medical practitioners are not well-informed about benzodiazepine withdrawal symptoms or methods of withdrawal.

But this problem is not confined to a small group of patients. Arriving at the number of long-term users of these drugs is notoriously difficult, but the committee's own findings reveal some startling statistics.

For one, the evidence suggests a continuing increase in the prescribing rate for these drugs to medical card-holders between 1995 and 2000, with one in 10 people with a medical card being prescribed benzodiazepines at any one time. More than two-thirds of these people are taking them for longer than four weeks, and when the figures are extrapolated, they suggest that as many 100,000 Irish people are taking these drugs, many of them for many years.

Campaigners say that the majority of these are addicts, whose reasons for taking the drug have nothing to do with their original symptoms. GPs renew their prescriptions almost as a matter of routine - sometimes on the basis that an elderly patient on a therapeutic dose for many years is better off left on the drug than being coerced to undergo the trauma of withdrawal.

Disturbingly, the report also highlights a small number of doctors who are "prescribing inappropriately - thereby putting their patients and others at risk". It also draws attention to the fact that benzodiazepines are often a second drug of abuse for heroin addicts - the most common type of drug involved in the 86 heroin-related deaths recorded by the Dublin City Coroner in 1999 was, in fact, benzodiazepines.

Limerick-based GP and author Dr Terry Lynch is well known for his concerns about the over-reliance of his profession on medications to treat the problem of mental distress.

"It's now 15 years since the Committee on Safety of Medicines gave its advice about prescribing benzodiazepines, and unfortunately the truth seems to be that they weren't followed," he says. "The problem was created by prescribing, and a considerable part of the problem was created by not paying sufficient attention to what patients were telling us. Historically, we have a problem recognising the addiction potential of medications and acting swiftly on the information - I mean, we had similar problems in the past with barbiturates and amphetamines, more recently with benzodiazepines, and I personally believe that in the future we will have a similar problem with the anti-depressants which are so enthusiastically prescribed at the moment.

"Twenty years ago, benzodiazepines were held as 'wonder drugs', so there is an eerie repetitiveness about this. Each drug that comes along gives doctors a new 'hope' to believe in and to prescribe, and prescribing is second nature to doctors, that is how they are trained. But many of them have a very basic understanding of anxiety and distress and what patients are going through, what is causing their pain."

Matthew Daly's story would be typical of tens of thousands of others who became addicted to these drugs. Daly (48) now counsels long-term users of the drugs.

"I started off on Valium in 1973 when I was 18." he says. "I had gone to the GP because I felt a bit shy and introverted. I was not a very outgoing fellow and there was some personal stuff in my childhood. I had anxiety, tension and stress. The doctor gave me Valium. I took it and felt that it was great. I felt very attached to it."

So attached that it was to dominate the next 14 years of his life. "For all that time, I was living in a haze. I lost my job and did not care. Once I had it I could float around. I stopped for a very short time and felt that the world was a frightening place."

Daly alternated in the early years between alcohol and benzodiazepines but by his late 20s, the pills had taken over completely. But giving them up became a prospect too horrible to contemplate. "I did not realise that this was worse than a heroin addiction. It's very secretive as well. It's like putting on a mask. Behind it all you are a shell, dying inside."

Daly finally stopped taking benzodiazepines at the age of 32 but, not until after he had taken two overdoses. The withdrawal process was a nightmare, he says, that took many months. He looks back on that 14-year period as a time when "my life was on hold and I was emotionally frozen".

Benzodiazepines are, of course, valuable drugs in the short-term treatment of extreme distress, anxiety and insomnia, and often the decision to prescribe or consume these drugs is not a simple one.

Dr John Fleetwood, a GP based in Dun Laoghaire feels that there are a number of reasons why these drugs are still over-prescribed. "Many people do not want to or are afraid to come off these drugs, and may become hostile when a doctor suggests that they need to wean themselves off them," he says. "And the increasing levels of stress and anxiety in our society affecting everyone from teenagers to the elderly, places enormous pressures of time and resources on our health services. And sometimes there is a certain blas? attitude towards drugs by too many people in society, who may want a 'quick fix' for their ills, rather than looking at these drugs as a last resort."

Dr Kieran Harkin, a Dublin-based GP who was a member of the Benzodiazepines Committee, argues that in some cases long-term prescribing may be necessary. "While it is good practice to limit therapy to two to four weeks, it doesn't necessarily mean that everybody being prescribed for more than four weeks is inappropriately prescribed," he says. "There are people who may have become addicted who started off buying tablets on the street or people who were initially prescribed while waiting for services such as methadone treatment. There are also a number of people with chronic anxiety who may benefit from long-term treatment, assuming that they appreciate issues such as dependence but are prepared to tolerate it because their life is so miserable. Sometimes there may be conflict between what a patient thinks and what the doctor thinks. A doctor may prefer not to prescribe, but if you are faced with an 80-year-old patient who cannot sleep, it's a very difficult situation. A doctor can't tell a patient 'I don't care what you think', there is a grey area there and a good caring doctor is going to respect a patient's opinion."

However, there is not full agreement with this approach within the medical profession.

"There is, of course, some truth in the argument that patients also have a responsibility here and doctors often come under pressure to prescribe," says Dr Lynch. "But I think this is often exaggerated as it tends to absolve doctors and merely passes the blame onto me patients. I do think more of the pressure comes from the doctor's side. As regards the somewhat plaintive comments from our profession about lack of time and resources, that's not the full story at all. I feel that if we don't have enough time, we should make more time or refer people to services such as counselling where they will get the time they need. But we don't hear many doctors out there really pushing for more counselling services. And it's important to realise that GPs are not the sole prescribers of these drugs, they are also prescribed by psychiatrists. I frequently encounter people who have been put on tranquillisers in psychiatric hospitals, and then released without any advice about addiction or any plan to come off their medication over time. Another factor in this debacle relates to the lack of external, independent monitoring and surveillance of the medical profession."

Ireland's problem with benzodiazepines, however, is not unique - it is a Europe-wide phenomenon - and the report's recommendations mirror those of European efforts, such as better collection of data relating to the use of these drugs, better training for doctors, manufacture of smaller pack sizes of these drugs, and a need for greater public awareness of the problems associated with the use of these drugs.

"Much of the current problem with benzodiazepines is an inherited problem," says Harkin, "and I believe that prescribing practice in general is becoming more consistent. The number of new long-term prescriptions is decreasing but there will be no great immediate effects. Very often, people start using benzodiazepines for psychological reasons and those reasons are still there to be dealt with, but the resources for psychological support are not there in the community I do believe there are serious moves afoot to deal with this issue and the report is an important first step, but unfortunately you do get people in every profession who don't practice to the highest standards."

100,000 Irish addicted to tranquilliser drugs
by Harry McGee and Kate O'Flaherty

As many as 100,000 Irish people may be unwittingly addicted to medications they have been prescribed for several months or even years, despite warnings issued 15 years ago that the drugs should not be used for longer than four weeks.

The drugs, known as benzodiazepines, include many common tranquillisers and sleeping tablets, such as Valium, Ativan, Mogadon and Rohypnol.

Benzodiazepines carry a high risk of addiction and other side effects, including a severe withdrawal syndrome that can last for several months after a person comes off the drugs.

A recent report by a government-appointed Benzodiazepine Committee concluded that "the prescribing of these drugs is excessive" and adds that "some medical practitioners are not well-informed about benzodiazepine withdrawal symptoms or methods of withdrawal".

In addition, the report expresses concern about a small number of rogue doctors who may be prescribing these drugs inappropriately, some even for financial gain, stating they are "putting their patients and others at risk".

As many as one in ten medical card holders are being prescribed these drugs at any one time, the majority of them for longer than the four weeks advised by the UK Committee on Safety of Medicines as far back as 1988. In fact, the prescribing rates of these drugs continued to rise in Ireland during the 1990s, despite increasing concerns worldwide about their safety.

During the 1990s, up to 17,000 claims were made in the UK against the manufacturers of these drugs, and there are currently a small number of claims still being pursued by Irish people, although none to date has been successful.

Later this month, the pharmaceutical company Wyeth, which vigorously denies such claims, will attempt to strike out one of these claims in the Irish courts for "want of prosecution".

'Mother's Little Helper' - a global phenomenon
by Harry McGee

Forty years ago this month, the first and most famous of the benzodiazepine group was launched. In March 1963, Valium (diazepam) was introduced amid claims that it was the new 'wonder drug'. The drug's precursor had been shown to have a significant calming effect on lions and tigers that were part of a circus act.

When developed for humans by the Swiss pharmaceutical company Hoffmann-La Roche, it was marketed as a revolution in the treatment of a variety of ailments including stress, anxiety, insomnia and other sleep disorders, safer and more effective than barbiturates, and with few serious side-effects and no addictive properties.

Valium and its sister-drug Librium catapulted Roche into the stratosphere, making it the biggest pharmaceutical company in the world.

The other major drug companies quickly followed suit, and began to produce and market their own benzodiazepines, including Wyeth's Ativan, and Upjohn's Xanax, while Roche developed others such as Rohypnol, Dalmane, Lexotan and Mogadon. Soon these names were as familiar to the ears of many families as Daz and Persil.

The impact of benzodiazepines was indeed massive. They were prescribed in their billions in the 1960s and 1970s - some three billion prescriptions were written worldwide in 1979 alone.

Valium achieved an iconic status as the drug of the suburban housewife - 'Mother's Little Helper' was how the Rolling Stones wryly described it in 1966.

Withdrawal can be worse than original symptoms
by Kate O'Flaherty

Most tranquillisers and sleeping tablets belong to a group of drugs known as benzodiazepines, which is the name of their general chemical structure.

They are used to treat severe anxiety and insomnia, and are valuable in the short-term treatment of these conditions. As these are sedative drugs, they can impair a person's judgement and memory and their ability to drive safely However, some people can have what is known as a paradoxical reaction to these drugs, and instead become hostile, aggressive or talkative.

In 1988, the UK Committee on Safety of Medicines (CSM) issued the advice that these drugs should be used only for the "short-term relief (two to four weeks only) of anxiety... and insomnia.., that is severe, disabling or subjecting the individual to unacceptable distress", that the use of benzodiazepines to treat short-term, "mild" anxiety is inappropriate and unsuitable".

As far back as 1980, doctors were advised that the effectiveness of these drugs after four months' use was not guaranteed.

Dependence or addiction is a major risk with benzodiazepines and this is why their use should be limited to a few weeks.

Anyone coming off these drugs is advised to gradually withdraw the drugs, as coming off them suddenly can cause confusion, convulsions or psychosis.

The benzodiazepine withdrawal syndrome can last for several weeks or months after a person comes off the drug.

The symptoms may be similar to the original complaint for which the drugs were prescribed, such as insomnia, anxiety and tremors. Often people may continue to take the drugs in the mistaken belief that they are treating these symptoms, when in fact they are relieving their physical withdrawal symptoms.

Detoxing from these drugs should be done slowly and under medical supervision as the withdrawal syndrome can be difficult to cope with, mentally and physically.

"All I was doing was blocking out my life"
by Kate O'Flaherty

Rosaleen Masterson found a way out of her cycle of dependency

The word that springs to mind when you meet Rosaleen Masterson is 'survivor'. One of 21 children, she was born and reared in Rialto, Dublin, and at the age of 21, married and moved to St Teresa's Gardens.

"I brought problems into my marriage that I wasn't even aware of, I never had the education," says Masterson.

"And that was because of where I came from. Like most people from those areas, I was put down, stigmatised, never offered chances. After I got married, I felt stuck, I felt I didn't really fit into the role I was in, but I couldn't explain what was wrong. I was empty inside, no self-confidence. I started drinking and labelling myself as an 'alcoholic'." After a few years, Masterson sought medical help for her problems.

"I went to the doctor and was prescribed Valium and Librium. That was about 1976, and I was treated for alcoholism and depression. I didn't take the tablets all the time because deep down somehow, I realised they weren't what I needed. And I heard other people talking about the problems they had with them. But when I did take them I was in a haze and a daze. You'd feel 'good' but all you were doing was blocking out your life. They blocked you from feeling and thinking, and I felt they made me even more depressed. But anytime I went to the doctor, he'd write a prescription and you felt that you had to take them because the doctor told you to. You didn't think you had any other options."

Despite having to cope with depression, alcohol abuse, and other problems, Masterson always felt there was a light at the end of the tunnel.

"I always had a strong faith, I used to go to Lourdes every year and my nickname was 'follow the novena' because I went to anything going. So I was always searching for help, but I was given the wrong directions. I knew my life wasn't good for me, and that it was damaging my children, but it was all I knew."

The combination of a diagnosis of breast cancer and the birth of her first grandchild was the unlikely catalyst that led to the start of her recovery.

"When my grandchild was born, I was in a treatment centre and I just thought, 'no more'. And then when I got the breast cancer it was actually a turning point for the better, because I came to believe more strongly in a higher power and I was determined to beat the cancer, that I was going to live. Since then, I have gone from strength to strength."

Masterson first approached Elah, a counselling and community training service in Hamilton Street, Dublin, for counselling, recalling that one psychiatrist had told her that what she needed was therapy, not medication. Named Elah after the place where David slew Goliath, its mission is to help people defeat their own particular giants or monsters.

'I knew my life wasn't good for me, and that it was damaging my children, but it was all I knew'

"I eventually ended up getting a job at Elah, and now I work on reception there. The first day, I couldn't even answer the phone because I hadn't a clue what I would say to anyone who called, that's how low my self-confidence was. Now I am a trained facilitator in parenting programmes and this summer, I will get my qualification in Reality Therapy. My goal then is to become a professional counsellor, and maybe even write a book about my Journey. I want to give something back, to give hope to other people who are stuck. What people need is someone to listen to them and believe them, and education is the key to help you reach your potential. I feel that I am one of the lucky ones that I've found these things myself."

Elah is at 48 Hamilton Street, Dublin 8, (01-4541278)

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## Guest (Sep 20, 2004)

While interesting, those are lawsuits against the prescribing physician, not against the makers of the drugs (hence, showing irresponsible "useage prescriptions" by the doctor, not showing dangerous properties of the existing medication itself - as if true for manufacturers of Paxil).


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## Guest (Sep 20, 2004)

While interesting, those are lawsuits against the prescribing physician, not against the makers of the drugs (hence, showing irresponsible "useage prescriptions" by the doctor, not showing dangerous properties of the existing medication itself - as if true for manufacturers of Paxil).


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## person3 (Aug 10, 2004)

Joe, you so obviously have never taken methadone or heroin. You don't know the withdrawl. That's all I can say. I took a small amount and was incapacitated for 2 or 3 days. I took a small enough amount for one night. If I had taken it for a week I would have been down for weeks and yes you can die from that stuff.


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## person3 (Aug 10, 2004)

Joe, you so obviously have never taken methadone or heroin. You don't know the withdrawl. That's all I can say. I took a small amount and was incapacitated for 2 or 3 days. I took a small enough amount for one night. If I had taken it for a week I would have been down for weeks and yes you can die from that stuff.


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## dakotajo (Aug 10, 2004)

Oh good God!!


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## dakotajo (Aug 10, 2004)

Oh good God!!


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## person3 (Aug 10, 2004)

btw it wasnt the benzos that killed the heroin addicts, it was the combination of opiates and benzos that killed them. I know someone who died that way. You don't combine depressants, that is what kills.


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## person3 (Aug 10, 2004)

btw it wasnt the benzos that killed the heroin addicts, it was the combination of opiates and benzos that killed them. I know someone who died that way. You don't combine depressants, that is what kills.


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## Homeskooled (Aug 10, 2004)

Dear Dakota Joe, 
Oh my...Why do these threads always have to devolve into these pedantic mud-slinging fests? Why? I had a real good day today, but at the risk of adding fuel to the fire, I'm going to add a comment or two.

I like you. I really do. You're stubborn, opinionated, and crabby, but a good portion of the time I like you're posts. But you have tunnel-vision. Youre on a merry go-round of hatred. You post incredibly long articles on the nature and effects of benzo-withdrawal, which I often read, but have the gall to tell Janine that she bores you....Honestly...Its a cheap unintelligent shot to make when you're trying to make scholarly points about the dangers of benzo withdrawal. And I agree with you. In severe withdrawal cases, they CAN cause death. BUT YOU ARENT DEAD. This is not the most convincing anti-benzo argument. Very few deaths come through my local ER from benzo withdrawal. Although many deaths have occurred in it from heroin withdrawal. Seizures, psychosis, death....these can all occur from opiate dependency. Yes, you've had a bad withdrawal experience and it has lasted well over a year. Well, this may occur with many antidepressants. I've read several stories of people who say Paxil did a number on them years ago that they have not recovered from. Personally, I think that psychiatry is an inexact, underdeveloped branch of medicine where psychiatric drugs are over-prescribed. Its not good that the fish in our rivers have detectable levels of Prozac in them from being in contact with run-off water from our sewers. Frankly, its scary. In many respects, I agree with you DakotaJoe. People should be much more skeptical of their doctors than they are. But you have a ruminating, angry personality, and if you don't ease off of your benzo obsession, it will continue to consume you until long after the effects of Klonopin have worn off, or until you find another issue to take its place and express your anger through.

Homeskooled


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## Homeskooled (Aug 10, 2004)

Dear Dakota Joe, 
Oh my...Why do these threads always have to devolve into these pedantic mud-slinging fests? Why? I had a real good day today, but at the risk of adding fuel to the fire, I'm going to add a comment or two.

I like you. I really do. You're stubborn, opinionated, and crabby, but a good portion of the time I like you're posts. But you have tunnel-vision. Youre on a merry go-round of hatred. You post incredibly long articles on the nature and effects of benzo-withdrawal, which I often read, but have the gall to tell Janine that she bores you....Honestly...Its a cheap unintelligent shot to make when you're trying to make scholarly points about the dangers of benzo withdrawal. And I agree with you. In severe withdrawal cases, they CAN cause death. BUT YOU ARENT DEAD. This is not the most convincing anti-benzo argument. Very few deaths come through my local ER from benzo withdrawal. Although many deaths have occurred in it from heroin withdrawal. Seizures, psychosis, death....these can all occur from opiate dependency. Yes, you've had a bad withdrawal experience and it has lasted well over a year. Well, this may occur with many antidepressants. I've read several stories of people who say Paxil did a number on them years ago that they have not recovered from. Personally, I think that psychiatry is an inexact, underdeveloped branch of medicine where psychiatric drugs are over-prescribed. Its not good that the fish in our rivers have detectable levels of Prozac in them from being in contact with run-off water from our sewers. Frankly, its scary. In many respects, I agree with you DakotaJoe. People should be much more skeptical of their doctors than they are. But you have a ruminating, angry personality, and if you don't ease off of your benzo obsession, it will continue to consume you until long after the effects of Klonopin have worn off, or until you find another issue to take its place and express your anger through.

Homeskooled


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## dakotajo (Aug 10, 2004)

It takes 2 people to argue.


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## dakotajo (Aug 10, 2004)

It takes 2 people to argue.


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## sleepingbeauty (Aug 18, 2004)

and some people argue for the sake of arguement. give it a rest.

perhaps someone with a magic want should kill this one. make it dissappear. this has been rehashed so many times that its become BEYOND boring. enough already. we hear you. we get the picture. its a dead issue. put it to rest.

*HERE LIES OUR DEAREST FRIEND, THE BENZO. HE CAME INTO THIS WORLD WITH THE INTENT TO HEAL. TO SOME HE WAS A SUCCESS, AND TO OTHERS A CURSE. BUT ALL IN ALL, HE GAVE US YEARS OF FANTASTIC INTERNET BRAWLS AND ENDLESS DEBATE. MAY HIS LEGACY LIVE ON IN MIND-NUMBING WITHDRAWL. *

FAREWELL!


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## sleepingbeauty (Aug 18, 2004)

and some people argue for the sake of arguement. give it a rest.

perhaps someone with a magic want should kill this one. make it dissappear. this has been rehashed so many times that its become BEYOND boring. enough already. we hear you. we get the picture. its a dead issue. put it to rest.

*HERE LIES OUR DEAREST FRIEND, THE BENZO. HE CAME INTO THIS WORLD WITH THE INTENT TO HEAL. TO SOME HE WAS A SUCCESS, AND TO OTHERS A CURSE. BUT ALL IN ALL, HE GAVE US YEARS OF FANTASTIC INTERNET BRAWLS AND ENDLESS DEBATE. MAY HIS LEGACY LIVE ON IN MIND-NUMBING WITHDRAWL. *

FAREWELL!


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## dakotajo (Aug 10, 2004)

I agree. I will leave it alone if those that promote these drugs will also.

Joe


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## dakotajo (Aug 10, 2004)

I agree. I will leave it alone if those that promote these drugs will also.

Joe


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## JasonFar (Aug 13, 2004)

I agree, Homeskooled put it pretty well...

I'm not taking sides, but the mere energy DakotaJoe has been giving off lately is just a total negative one, a downer.

And I myself would personally NEVER go on benzo's. Yet I still feel this way about his output.


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## JasonFar (Aug 13, 2004)

I agree, Homeskooled put it pretty well...

I'm not taking sides, but the mere energy DakotaJoe has been giving off lately is just a total negative one, a downer.

And I myself would personally NEVER go on benzo's. Yet I still feel this way about his output.


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## Guest (Sep 21, 2004)

If that negative energy can keep just a few people from taking these drugs then I say its worth it. Its funny how you people are so easy to accept drug promotion here, but when someone speaks against drugs you all yell "bloody murder." Yeah, I realize that Joe has been bashing benzos for a very long time and that some of you may be getting sick of it. Well then, you should also be getting sick of the people promoting these freakin drugs non stop. I wont name names, but there are many members here who mine as well be pharamaceutical reps.


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## Guest (Sep 21, 2004)

If that negative energy can keep just a few people from taking these drugs then I say its worth it. Its funny how you people are so easy to accept drug promotion here, but when someone speaks against drugs you all yell "bloody murder." Yeah, I realize that Joe has been bashing benzos for a very long time and that some of you may be getting sick of it. Well then, you should also be getting sick of the people promoting these freakin drugs non stop. I wont name names, but there are many members here who mine as well be pharamaceutical reps.


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## Guest (Sep 21, 2004)

I am sorry Pure Narcotic, But I don't know people here who do the _promotion_ of those meds. Me, I don't promote those meds. I just think they are not evil, point.

Seriously nobody say : take benzo! take this one, etc. I just think some people take it here and some had great results with?

Thanks

Cyn xxx


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## Guest (Sep 21, 2004)

I am sorry Pure Narcotic, But I don't know people here who do the _promotion_ of those meds. Me, I don't promote those meds. I just think they are not evil, point.

Seriously nobody say : take benzo! take this one, etc. I just think some people take it here and some had great results with?

Thanks

Cyn xxx


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## Guest (Sep 21, 2004)

I couldn't care less if Joe wants to state his claim over and over.

But....he should not promote Paxil then - just because HE hasn't had a horrible time, that does not stop the other facts from being true. Lawsuits, settlement claims paid by THE DRUG COMPANY - something he cannot say is true for any benzo.

My only point is that he is adamant about what happened to HIM, but makes it universal. If someone else brings in information about a drug he LIKES (so far), then he gets just as furious as those of us who have successfully used and stopped benzos get.

Joe can post all he likes. But the hypocrisy will be pointed out every single post. count on it.


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## Guest (Sep 21, 2004)

I couldn't care less if Joe wants to state his claim over and over.

But....he should not promote Paxil then - just because HE hasn't had a horrible time, that does not stop the other facts from being true. Lawsuits, settlement claims paid by THE DRUG COMPANY - something he cannot say is true for any benzo.

My only point is that he is adamant about what happened to HIM, but makes it universal. If someone else brings in information about a drug he LIKES (so far), then he gets just as furious as those of us who have successfully used and stopped benzos get.

Joe can post all he likes. But the hypocrisy will be pointed out every single post. count on it.


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## dakotajo (Aug 10, 2004)

Janine,

Just for you sweety, Im going to stop talking about ssris all together. I couldnt give a shit wether people take these drugs anyway. Dont worry tho, I will also point it out every time you give your ridiculous and dangerous advice advocating the use of benzodiazepene drugs...


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## dakotajo (Aug 10, 2004)

Janine,

Just for you sweety, Im going to stop talking about ssris all together. I couldnt give a shit wether people take these drugs anyway. Dont worry tho, I will also point it out every time you give your ridiculous and dangerous advice advocating the use of benzodiazepene drugs...


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