Is it safe to use a benzodiazepine for withdrawal symptoms?

[Brandy]

In fact I disagree with what is said about Clonazempan because it is actually a very long acting benzo, with a half life of 30-50 hours.

Half-life figures vary considerably on different sources. The Ashton Manual lists clonazepam half-life as 18-50, with a footnote re half-lives that states:

Half-life: time taken for blood concentration to fall to half its peak value after a single dose. Half-life of active metabolite shown in square brackets. This time may vary considerably between individuals.

 

URL for that is: Benzodiazepine Equivalence Table

 

I think most sites consider clonazepam more a medium-range half-life med, with xanax and ativan etc. short-acting, and valium and tranxene etc. long-acting.

 

As for how quickly one becomes physically habituated (or addicted, the phrase used for convenience - readily understandable to laymen - and brevity), I have a theory that factors such as previous med use are also factors, even if they're not actually psychotropic meds and even if a person has been off them some time. Just a theory on my part, but I'm seeing patterns that suggest this.

 

Re semantics of addiction - I didn't like how I felt on benzos and on paxil when I went on them (at very different times) and told my doctors so (it's in my medical records in doctors' notes), but I was urged to stay on them (for medical reasons, not psychiatric effects), and although I never liked how I felt on them, my body was definitely addicted in terms of not functioning properly without them - to say the least - after having physically adapted to them. Again, a matter of semantics, but that's the popular use on many sites re these meds.

[Brandy]

Just now saw that there's a second page to this thread!

 

Hope my reply just now didn't cause any confusion. I'll read the thread in its entirety (second page also!) as soon as I can!

 

(btw, Whatever, I read your story late - very late - last night, and was blown away at your strength and determination. Truly inspiring!)

 

Back to our regularly scheduled programming...

[Barbarannamated]

Very interesting equivalence table Brandy - I'll have to look at that more closely on a non mobile device -

Would be interesting to see the onset of action also - looks like Xanax has shorter half life than some of the sleepers/sedative hypnotics (Doral - Dalmane) -

Q: Are Tranxene and Halcion still on market - Halcion is a scary drug - relatively speaking of course -

[Skyler]

Very interesting equivalence table Brandy - I'll have to look at that more closely on a non mobile device -

Would be interesting to see the onset of action also - looks like Xanax has shorter half life than some of the sleepers/sedative hypnotics (Doral - Dalmane) -

Q: Are Tranxene and Halcion still on market - Halcion is a scary drug - relatively speaking of course -

 

The availability of drugs depends to some extent on the country... Halcion is off the market in the US.. but last I knew still prescribed in Australia. I have not run into anyone who is taking Tanxene in in my benzo forum travels, so it is either unpopular, or unavailable. Also, Valium is now off the market so people need to rely on generic diazepam.

 

The main concerns for benzos are the half life, and from that you can see how even a couple of doses of valium a week can get people in trouble. The shorter the half life, the greater the potential for addiction. This of course goes with Brandy's provisos that individual differences (age, genetic makeup, history...) come into play.

 

Alternate Equivalent Table

 

Why Cross Taper to Diazepam

 

Benzodiazepine Withdrawal Guide

 

Withdrawal from Diazepam

 

Guide to rates of reduction

 

Benzo FAQS

 

Protracted Withdrawal Symptoms

 

 

Following is a suggested handout I wrote up for people who want to withdraw to take to their Doc. Everything was reviewed by a former administrator at TRAP.

Tips on how to approach a doctor

 

1. Take a taper schedule with you (you can get help developing one at the Benzo forums*). You might want to ask your doctor for help. Or just say you want to “try” this approach, so she/he does not need to commit outright.

2. Write down the way benzodiazepines are affecting you, be specific about the reasons you want to stop taking them.

3. Be tactful. Doctors don’t usually don’t like to think you may know more than they do. (Even if you do!)

4. Print out supporting information for purposes of reference.(See below)

5. If you need a guide for yourself, for the doctor or for both of you, you can use the one written below. Edit as you feel necessary. (You will need to use your judgment as some doctors are more receptive than others).

 

Benzo Withdrawal Guide for you and Your Doctor

 

It can take considerable time to withdraw from benzodiazepines. The amount of time needed is affected by several variables; including age, drug history, dose, the length of time you have been on the drug, and genetics. It takes longer to taper off benzodiazepines than other classes of drugs because GABA receptors need time to reset.

 

Drug companies advocate a much faster taper, but this usually comes with a cost of devastating withdrawal symptoms, including severe and protracted insomnia, and the success rate is very low.

 

There is disagreement about how rapidly people should withdraw even among those who follow Doctor Ashton’s equivalencies and cross taper guidelines. (See Professor Heather C. Ashton DM, FRCP; The Ashton Manual ) Some believe it is better to come off faster and try to bear the symptoms. Others advocate a much slower taper. This allows for fewer withdrawal symptoms and a greater possibility of success.

 

Transitioning to diazepam is suggested by Doctor Ashton because the half life is 20 to 100 hours. By comparison, the half life of Xanax is 6 to 12 hours, Klonopin is 18 to 50 hours, and Zolpidem (Ambien) is 2 hours.The longer half life makes it possible to take a single daily dose, as opposed 2 or 3 doses. Also, diazepam tablets come in small quantities (2mg) and in liquid form which make taper cuts easier.

 

A minimum of a month is suggested for the cross taper from the current benzodiazepine to diazepam. It takes that long for diazepam to be 90% absorbed, and the body needs time to adjust to the difference between half lives. Equivalencies between different benzodiazepines were established by Dr. Ashton based on her experience running a withdrawal clinic in the UK for 12 years.

 

People who taper too fast often "hit the wall" at some point. Many end up reinstating (somewhere near 80%). When benzodiazepines are reinstated, tapering becomes more difficult. This is because of a brain process called "kindling", or a sensitization to the tapering process. Those making a second or third attempt should not be discouraged, but will need to take previous attempts into consideration and adjust the pace accordingly.

 

Just remember that the rate of withdrawal may need to be adjusted as the dose gets smaller. But there always needs to be some forward momentum. If withdrawal symptoms seem too prominent at any one cut, do not go back but hold the cut longer to stabilize.

 

Forums where you can get support for withdrawal.:

BenzoBuddies http://www.benzobuddies.org/

 

The following links can be used to printout information that has been used as a reference in the guide above. Having printouts with you may lend credibility.

 

For complete information

The Ashton Manual http://www.benzo.org.uk/manual/index.htm

Benzodiazepine and Z drug information http://www.bcnc.org.uk/

 

For specific information:

Role of GABA and GABA Receptors in Benzodiazepine WithdrawalWhy Valium http://www.bcnc.org.uk/whyvalium.html

 

For those who are dependent on Z-Drugs (Ambien, Sonata, Lunesta). Diazepam can be used to taper off Z-Drugs. In the event you are taking both a benzodiazepine and a Z-Drug, it is best to do a cross taper that involves both simultaneously.

 

http://www.non-benzodiazepines.org.uk/z-drugs.html

http://www.non-benzodiazepines.org.uk/eszopiclone.html

http://www.non-benzodiazepines.org.uk/zolpidem.html

http://www.non-benzodiazepines.org.uk/zopiclone.html

 

Schuyler

 

PS.. Alto, could a 'Benzo Corner' be setup with a stickie for gathering the info needed to help people learn about tapering?

[blue]

Just adding something I learned... benzos in general exacerbate or cause depression. Many people complain about feeling down and lethargic after benzo use. Clonazepam and valium are pretty common ones that cause depression. However, xanax is one benzo that has bit of anti-depressant effects.

 

So, if you do NEED benzo, only use it AS NEEDED basis never more than 2-3 times a week otherwise, tolerance and withdrawal can be quite brutal.

[Altostrata]

Very true, blue. Thank you.

[Barbarannamated]

Just adding something I learned... benzos in general exacerbate or cause depression. Many people complain about feeling down and lethargic after benzo use. Clonazepam and valium are pretty common ones that cause depression. However, xanax is one benzo that has bit of anti-depressant effects.

 

So, if you do NEED benzo, only use it AS NEEDED basis never more than 2-3 times a week otherwise, tolerance and withdrawal can be quite brutal.

 

I'm once again struck by the similarities of benzos and SSRIs... both now shown to cause depression ("blue again...perturbational effects of antidepressants").

[Barbarannamated]

Bump. Very good discussion.

 

Most importantly, IMHO... every case is different.

[basildev]

Thanks for this topic.

 

I'm now seriously reconsidering my previous decision to take valium for my body jerking.

 

I do notice that I feel terribly depressed the following day when I take it.

 

I guess I'm just absolutely petrified of having a whole night with no sleep.

[b305m]

Is it okay to take a benzo like an Ativan during extreme panic times, let's say like maybe once a month during SSRI withdrawal ?? I don't know see what harm it would cause

[Kelmo137]

the problem with addiction is its still not very well studied.  most of the population will not be addicts. addiction and dependency are not the same. because genetic testing is not so easy to obtain no one will know if they are an addict until its too late. these psychitric drugs cause dependence not addiction. both cause withdrawl. i took klonopin on and off a few times and i never had an issue stopping it. so for me personally i think a benzo during withdrawl will benefit me greatly. if someone takes  a benzo daily and has withdrwal when stopped it doesnt always mean addiction.its a topic that most people are oblivious about because mainstream pushes addiction in our faces especially with pain meds. most take them with no abuse problems. same with benzos. 

 

[ChessieCat]

49 minutes ago, Kelmo137 said:

so for me personally i think a benzo during withdrawl will benefit me greatly.

 

SA does not recommend starting a benzo in order to taper a different drug.  SA recommends tapering slowly to keep withdrawal symptoms to a minimum.  Which also means reducing by less and/or holding for longer when needed, not continuing to taper "through the withdrawal symptoms".  If a member tapers carefully by listening to their body/symptoms then taking a benzo should not be needed.  And it means that you will not have added another drug which will require tapering.

[Onmyway]

4 hours ago, Kelmo137 said:

the problem with addiction is its still not very well studied.  most of the population will not be addicts. addiction and dependency are not the same. because genetic testing is not so easy to obtain no one will know if they are an addict until its too late. these psychitric drugs cause dependence not addiction. both cause withdrawl. i took klonopin on and off a few times and i never had an issue stopping it. so for me personally i think a benzo during withdrawl will benefit me greatly. if someone takes  a benzo daily and has withdrwal when stopped it doesnt always mean addiction.its a topic that most people are oblivious about because mainstream pushes addiction in our faces especially with pain meds. most take them with no abuse problems. same with benzos. 

 

Before withdrawal I used Xanax quite successfully in extreme anxiety episodes (up to a couple of weeks at a time) at very low doses of 0.25 mg once a day to break the morning anxiety. This would be very rare - once every five years for a week or two and once a month after. I was extremely careful not to do it for a long time and never more than a week or two and never more than 0.25 mg a day. It was sort of my safety blanket. Xanax used to lift my mood. Every other benzo, depressed me immensely with dizziness, sadness, lethargy and nausea.

 

However, in withdrawal this changed. I tried to relieve some symptoms with Xanax in the very beginning before I found SA and it caused a strange brain fog and nausea and dizziness like the others. I then tried clonazepam at very low doses (despite the generosity of my GP who prescribed a lot) and it made things quite worse for me with extreme nausea and crying spells and lethargy.

 

Then I found SA and now I know better so wouldn't touch any of these. 

 

But I do agree that if I had used Xanax judiciously for a day or two every couple of months I could have avoided SSRIs in the very beginning. But who knows maybe I would have been addicted to Xanax. These things are insidious. No more of either for me. I recently refused a benzo for surgery. Was just fine without it.

[Marta]

Question for whom wasn't able to sleep at all several days. How did it end?

Will the brain finally knock out at some point?

Did you go to hospital?

Did you started a benzodiazepine (which?)?

 

Please let me know how the outcomes were.

Thanks

[chrona]

Gaba+theanine.   A lot of Gaba, to the point where you feel really strange and you might have a heart attack.  It only lasts for a few seconds then you conk out.  I never remember what happened,  had the computer in my lap, or whatever.  One gets used to the strange feeling.