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Message Board > Other Prescription Drugs > Xanax, Ativan, Klonopin, Valium, Great Info Here

Posted by: RUNVS February 9, 2006, 12:09 AM

XANAX, ATIVAN, KLONOPIN, VALIUM, great info here I m going to give you some real good info links. Please take the time to read them. http://www.geocities.com/BenzoBusters/rocheUKwithdrawal.htm http://www.breggin.com/benzodiazepine.pdf http://www.benzo.org.uk/manual/index.htm http://www.tlctx.com/ar_pages/paw_part1.htm remember knowledge is power in beating this You can do it

Posted by: hermom February 11, 2006, 2:10 AM

Thanks!

Posted by: RUNVS March 4, 2006, 5:16 AM

To understand the efficacy of the benzodiazepine drugs as tranquillisers and sleeping pills it is necessary to know how these drugs work on the brain. And to understand benzodiazepine addiction and withdrawal, it is necessary to understand the body's compensatory reaction to that action. Throughout the brain and spinal cord there are GABA receptors, which both inhibit neural activity and, indirectly, alter the production of neurotransmitters, such as noradrenaline, serotonin, dopamine and acetylcholine. The benzodiazepines act on these receptors to increase their inhibitory activity and reduce the flow of some of these neurotransmitters and so induce, among other things, calm, sleep, lack of emotion, and relaxed muscles; and they begin to act in minutes. After about two weeks of the continuous presence of these chemicals, the brain begins to compensate for this increased inhibition by reducing the intrinsic inhibitory action of the GABA receptors, and increasing the production of some neurotransmitters, thereby producing the state of neuroadaption known as tolerance; and this state of tolerance takes, at least, one year and often two or three, in the absence of the drug, to reverse back to normality. So what does tolerance mean for everyday behaviour and experience? It means that the only way the person involved can limit their excitability and alertness - their readiness for "flight or fight", the fundamental survival mechanism, is by taking the drug. Between doses, as the level of the chemical in the brain decreases, they have only their weakened GABA receptors to modify their experience, and at the same time, an increased flow of noradrenaline etc. This is an intolerable state to be in, and the only solution is to take more of the drug, because the person's natural ability to modify neural activity has been weakened and there is nothing else which will do that job. That is the basis of the chemical addiction to a benzodiazepine. Under these circumstances the benzodiazepine addicts know they cannot manage without the drug, and they are right. They are as right as diabetics who know they cannot manage without insulin. However, benzodiazepine addicts do not know why. They usually assume, with the support of most professionals involved, that this is a weakness of character, if not full-blown mental illness. This is the nature of psychological dependence. At the same time it seems that there is no compensatory reaction in the areas mediating emotion, memory or sensory experience; they remain anaesthetised as long the drug is present, and for some time after it is stopped. It is also necessary to understand that after the drug is stopped the initial detoxification period takes between six to eight weeks compared to five to ten days for heroin or alcohol, and neurophysiological recovery takes years. Recovery is interspersed with periods of intense withdrawal symptoms. This is not fully understood but is probably connected with the fat-soluble nature of the drug, its long-term storage in the body's fat cells and its cyclical release into the blood stream over many years. Victims of Tranquillisers Newsletter (1995) Issue 1, VOT, Dr R F Peart, 9 Vale Lodge, Vale Road, Bournemouth BH1 3SY

Posted by: kafo March 4, 2006, 12:55 PM

Thanks. Very nicely stated and will provide many here with great info.

Posted by: RUNVS March 6, 2006, 9:24 PM

PROTRACTED BENZODIAZEPINE WITHDRAWAL SYMPTOMS ------------------------------------------------------------------------------- A number of people are expressing fears that some benzodiazepine withdrawal symptoms last for ever, and that they can never completely recover. Particular concerns have been raised about impairment of cognitive functions (such as memory and reasoning) and other lingering problems such as muscle pains and gastrointestinal disturbances. People with such worries can be reassured. All the evidence shows that a steady decline in symptoms almost invariably continues after withdrawal, though it can take a long time - even several years in some cases. Most people experience a definite improvement over time so that symptoms gradually decrease to levels nowhere near as intense as in the early days of withdrawal, and eventually almost entirely disappear. All the studies show steady, if slow, improvement in cognitive ability and physical symptoms. Although most studies have not extended beyond a year after withdrawal, the results suggest that improvement continues beyond this time. There is absolutely no evidence that benzodiazepines cause permanent damage to the brain, nervous system or body. People bothered by long-term symptoms can do a lot to help themselves. For example: (1) Exercise your body. Physical exercise improves the circulation and function of both brain and body. Find an exercise that you enjoy: start at low level, work up gradually and keep it up regularly. Exercise also helps depression, decrease fatigue and increases general fitness. (2) Exercise your brain. Use your brain to devise methods to improve its efficacy: make lists, do crossword puzzles, find out what bothers you most - there is always a way round it. Cognitive retraining helps people to find ways around their temporary impairment. (3) Increase your interests. Finding an outside interest which you have to work at employs the brain, increases motivation, diverts attention away from your own symptoms and may even help others. (4) Calm your emotions. Above all, stop worrying. Worry, fear and anxiety increase all withdrawal symptoms. Many of these symptoms are actually due to anxiety and not signs of brain or nervous system damage. People who fear withdrawal have much more intense symptoms than those who just take it as it comes and think positively and confidently about recovery. (copied from Ashton's Manual)

Posted by: RUNVS March 14, 2006, 10:49 PM

Heres a story that really helped me http://www.benzo.org.uk/corey.htm Hope this helps someone else. Heres an update on Corey's story he just emailed me today. "I am fine now, took awhile though. It took about 3 years before I was completely symptom free." Corey

Posted by: RUNVS March 19, 2006, 9:03 AM

Hope this Info Helps others. http://benzobuddies.org/community/

Posted by: RUNVS April 9, 2006, 2:05 AM

Valium (Diazepam) vs. Klonopin (Clonazepam) in Benzodiazepine Withdrawal -------------------------------------------------------------------------------- Valium (Diazepam) vs. Klonopin (Clonazepam) in Benzodiazepine Withdrawal by Dr. Reg Peart Victims of Tranquilizers About 20 different drugs, including diazepam, clonazepam, barbiturates and other non-benzodiazepine drugs have been used for treating benzodiazepine withdrawals with varying degrees of success or failure. Diazepam is the most commonly used drug and has the highest success rate for the reasons given below, but because of the large inter-individual variability of response to benzodiazepines, there is no “one size fits all” solution to the withdrawal problem. Diazepam and clonazepam, like all benzodiazepine drugs, were found to have five therapeutic actions, i.e. anxiolytic, muscle relaxant, anticonvulsant, amnesic and hypnotic. Diazepam was marketed in the mid 1960’s for all five therapeutic actions; while clonazepam was developed and researched in the late 1960’s and early 1970’s and marketed in the mid 1970’s primarily as an anxiolytic and anticonvulsant. Any drug with similar therapeutic spectrum to the above will be both cross tolerate and cross dependent with the benzodiazepines and in principle will be of some help in benzodiazepine withdrawal. As well as the therapeutic actions, drugs with long half-lives are essential to prevent interdose withdrawals and to produce a helpful accumulation of the parent drug. In a few benzodiazepines the metabolites of the parent drug are also therapeutically active with the same five therapeutic actions. Of these only diazepam and chlordiazepoxide (Librium) have long half-lives for the parent drug and for the active metabolites. Librium is most commonly used for alcohol withdrawal and diazepam for a range of drug withdrawal problems. The active metabolites of diazepam are: 1) Desmethyldiazepam – marketed as clorazepate (Tranxene) and prazepam (Centrax). 2) Oxazepam – marketed as Serenid 3) Temazepam – marketed as Normison/Euhypnos The combined half-life of diazepam and its active metabolites is over 200 hours and this produces an accumulation of 5-7 times the therapeutic action of diazepam. It takes up to eight weeks for most of the accumulated drugs to be eliminated from the body. This "umbrella" of the benzodiazepinesa is the main reason for the success of diazepam tapering. The high accumulation levels produced by the diazepam active metabolites also reduces the probability of tolerance problems during tapering. There is no obvious reason why about 10% of the people have problems with diazepam tapering, but it is sometimes due to one or more of the following: 1) Incorrect equivalent dose – the values quoted by Ashton, et. al. are those found to be effective in benzodiazepine withdrawal and should in principle compensate for any difference in binding of the benzodiazepines to either the same or different benzodiazepine receptors. There values are not necessarily the same as therapeutically effective doses, but sometimes are. 2) Poorly planned or too short a period for the exchange from another benzodiazepine to diazepam. Mild daytime sedation at the end of a 2-3 weeks exchange suggests the equivalent dose is correct. 3) Failure to maximize accumulation of diazepam used and its metabolites – it takes about four weeks to achieve 90% accumulation, i.e. four weeks after exchange. 4) Tapering too fast. Each person should find the rate suitable to themselves. A good starting guide is 2 ˝ % of the initial dose/week. The rate for the last 1/3 of the taper should be reduced to ˝ of that for the first 2/3. Clonazepam is one of the nitro-benzodiazepines series, i.e. nitrazepam, flunitrazepam, clonazepam, and nimetazepam. It has a half-life of 20-50 hours and accumulates from 1.5 to 3 times the daily dose level. Most of it is eliminated from the body in 5–10 days. Along with triazolam, clonazepam has the highest incidence of side effects/adverse reactions of the benzodiazepines. An important difference between diazepam and clonazepam is that clonazepam does not produce active metabolites. Withdrawal symptoms increase markedly with accumulation of clonzepam, much of which is due to action of the inactive metabolites as well as the parent drug. This withdrawal symptom problem can be minimized at dose levels below 3 mg/day. In most countries, diazepam is marketed in 2 mg, 5 mg, and 10mg tablets and solution yielding 0.1 mgs or less. Clonazepam is marketed only as 0.5 mg. and 2 mg. (in the US it is produced as 0.125 mg, 0.25 mg, 0.50 mg, 1.0 mg, and 2.0 mg tablets). Hence for many, the option of using clonazepam will not be available for practical reasons. Very few papers have been published on the use of clonazepam in benzodiazepine withdrawals compared with many on the use of diazepam; hence it is not possible to make an assessment of their relative merits. Clonazepam meets three out of four of the criteria (1. The five therapeutic actions, 2. A long half-life, and 3. Accumulation) and it may well be suitable for a minority – it’s a “black art” not a science. N.B. It has been reported that diazepam produced by generic suppliers can vary by as much as 20% of the stated dose from batch to batch. If so, in order to avoid possible dose variations, Valium as produced by Roche should be used in diazepam tapering – it is more expensive

Posted by: RUNVS April 14, 2006, 12:07 AM

this is not me but a fellow benzo victim a success story that may help other long term sufferers I am 47 years old and have been a successful attorney for over 20 years. I am divorced with 3 daughters, the youngest 12, who I have full custody of. I guess I was always "anxious", which maybe is not the best thing for a lawyer to be, but anyway I guess my first problem arose when I developed a intestinal disease (which I am sure was caused by stress!) when I was in my late 20's, which led to some major abdominal surgery when I was 33. For whatever reason, after that surgery, I was even more anxious and started having real trouble sleeping. My HMO doctor tried me on Prozac but I got so wired from it that I discontinued that and tried various over the counter sleeping aids for a couple years until I went to a HMO psychiatrist who, after a 5 minute consultation, diagnosed me as having "situational anxiety" and put me on 3 mg klonopin and 150 mg Trazadone. While I guess I looked up on a PDR to see that Trazadone was an anti-depressant, I don't remember even looking up about Klonopin, certainly I never thought it was a powerful drug and never understood that it was in the same class as Valium, which I had taken off and on over the years to relax. I never really thought about the long term consequences of taking these pills, as I was just so happy to find some immediate relief since I started sleeping better and feeling better during the day, without any real side-effects. I reduced my dose of klonopin to 1 mg after about one year, and my HMO doctor continued to prescribe these drugs to me over the years, without much discussion. Fast forward to mid-2003, when I just started getting very tired and unfocused and, while I could perform my job ok, I just was not motivated or very happy. I thought my problem was from drinking too much, as I had a brother who went into rehab and had been sober a couple years and was convinced everyones problems were rooted in alcholism, so I decided in early 2004 to take a leave of absence from my job and go into an out-patient treatment facility for a 30 day program. My assumption was that I would be "all better" in a month and everything would be back to normal! Boy was I wrong! The rehab center sent me to a hospital for a 3 day detox. Without telling me why, they took me off the klonopin and while I was in the hospital I was on a small amount of phenobarbital. The whole detox scene was a joke: here I was with major heroin addicts, people taking 30 vicodin a day, people who were drinking a gallon of alcohol a day. They were all being pumped with all these meds (gorilla pills, they called them) and I was the only one who wasn't all druged up. It seemed like there was a competition going on as to who was the worst addict, and here I was trying to fit in, but my "addiction" paled compared to the others: I maybe drank a couple drinks at night, and had no idea at that point that my problem lay in that little pill I was taking every night to sleep! I was so happy to get out of there after 3 days and was actually feeling pretty good, and right when I was leaving the detox center director cautioned me that he just looked at my record (probably for the first time!) and realized I was on klonopin and that "that stuff is tough to withdraw from" and he urged me to stay there for a while longer. My conclusion was that he was just trying to tap my insurance for some more money (which I am sure was at least partly right) and I was actually feeling ok, so I left the hospital and went to the rehab facility. Well the long and short of it is that after a couple weeks of "treatment" (12 step) I was feeling worse than ever, whereas some heavy duty alcoholics and heroin addicts were doing fine. I could barely focus or function, and the director of the rehab facility sent me in for blood tests, which came out normal, and then started pumping me with vitamins, etc. The "addiction specialist" doctor who was associated with the center concluded I was "depressed" and put me on neurontin, which barely helped me sleep at all and had unacceptable side-effects such as groggiess. (When I told him it was not working, he doubled the dose!, which led me to a month of diarehea which he thought was caused by a parasite and had my stools tested, etc, until I discovered on my own through talking to my pharmacist that it was the neurontin, and the problem went away within one day!) There was no way I could even think about going back to work, and still thinking I was just recovering from alcohol withdrawals, and not knowing what else to do, I extended my treatment for another 30 days. Around 2 months into my recovery, someone mentioned something that made me wonder about klonopin, and when I typed that word into my search engine, I found the Ashton Manual which answered all my questions. I couldn't believe that the symptoms I was experiencing: brain fog, incredible insomnia, congnitive dysfunction, head pressure, incredible anxiety, electric shock experiences, unbearable fatigue, total lack of joy, body pain at night (especially in my legs), emotional blunting, were almost identical to the symptoms of benzo withdrawal. Hell, I didn't even know what a benzodiazapine was, let alone that klonopin was in the same class of drugs as valium or xanax, or that that little 1mg pill I was taking for the last 9 years was equivalent to 20 mg of valium! Nor was I aware that I should be tapering off the klonopin, and here I was c/ted for the last 2+ months...what could I do? I found this site and asked what should I do and basically I was told that I was too far along to reinstate without some major problems, so I was stuck in a cold-turkey recovery. But still, how long could this last...it would have to be over soon? I went to my "addiction specialist" doctor and brought him the Ashton Manual. He told me there was no way I was experiencing klonopin withdrawal and denied that I should have slowly tapered off the 1 mg I was on. (A real addiction specialist who probably never dealt with benzo problems in his career!) He continued to assert I was depressed, and that was why I was so tired and unfocused, and tried to get me to go on Wellbutrin. Well this doctor had lost all his credibility, and I knew I was on the right track following the advice of the Ashton Manual, so I largely bid him goodbye at that point. Over the next 9 months I explored many treatments: yoga (which I found to be incredibly beneficial in that it got me out of the house and some exercise and some relaxation and some socialization), sufi treatment involving healing and meditation (of course I was so zoned out that I could not clear my mind to meditate, but it was a nice diversion), detox fasting, various therapists; unfortunately nothing really worked: where some symptoms seemed to fade, others took their place, but the primary symptoms never waned for more than one day! And of course my friends and my family didn't understand. They all thought I was either suffering a mid-life crisis, or that I was depressed, or that I was just "weak". That was probably the worst, that several of my friends said what I was experiencing was the same as they go through ("I have trouble sleeping too" or "I get tired in the afternoon" or "I have trouble focusing" or "I am not interested in reading the newspaper either"), but that they were somehow tougher than me or that I was just being a baby! And of course my ex-wife just used my illness to her advantage: since I was not working, I was a convenient driver and baby-sitter fot the kids 24-7. I think you all know how difficult it was driving the kids around in my condition--hell I didn't have the energy to walk around the block, or open mail, or change a light bulb, or water a plant--yet I had no choice but to deal with my kids. At the end of the day I must be grateful for what my ex did to me: it forced me to go on living my life, despite the fact that what I was living was pure hell! Thankfully my youngest daughter, Carly, who has been with me throughout this hellatious experience, was the only person who understood that I was really sick: and while she needed me more than anyone, I could count on her not to be judgemental. Then there were my parents! Without whom I would be bankrupt. I would certainly have lost my house and tapped into all my retirement. But, my dad was impatient and, even after I let them know what I was going and provided him a copy of the Ashton manual, never really bought into my illness. (The same with my brother, who is a prominent doctor: it is like no one wants to educate themselves about what is really going on, which is understandable since they have their own lives, but is very frustrating when they try to offer "advice" which disregards everything you try to tell them!) So my dad tells me I have to get a job or he will cut me off around one year into my recovery: so I decide I will try to go back to school, since there was no way I could go back to work. So I take a couple classes at a local college, can barely muster the energy to go to classes, certainly cannot read a book, and drop out after a couple weeks. Here I was, having breezed through college and lawshool with pretty much straight A's, and I can't even handle a junior college class!

Posted by: RUNVS April 14, 2006, 12:08 AM

ONLY ONE THING SAVED ME during the first year of recovery: that was my guitar. I have played guitar all my life, and picked up my guitar around 3 months into my recovery, and where nothing else gave me any relief, be it food, tv, companionship, I found that I found total relief from playing my guitar. Furthermore, where I may have written a handful of songs over the 30 plus years I played, all of a sudden, I had a burst of creative energy which led, and continues to lead, me to compose over 50 songs over the last year! Some of my religious friends say "what god takes, he gives something in return if you know where to look." For me it was my music! I don't think I was ever suicidal, but many lonely nights and days were spent playing songs and finding some level of contentment, even at the height of panic attacks with my heart beating a mile a minute, my guitar was there for me! Then I hooked up with an attorney to explore a disability case. I am not going into the details (since this is still in litigation), but I hate disability insurance carriers: they are evil! It was such an unbearable ordeal, at the height of my withdrawal symptoms, dealing with these devils who would demean me, question my honesty and integrity, call me out of the blue and hassle me to try to get me to drop my claim. But my attorney referred me to a neuro-psychologist who performed some IQ type tests on me in 2/05 and concluded my brain was not functioning right. For the first time I had my illness validated by someone in the medical profession. She referred me to a neurologist who performed a series of tests on my brain, all of which came out normal, except the sleep study, which determined that I was suffering from periodic movement of legs syndrome and restless legs syndrome. No wonder I couldn't sleep and why I was suffering from "cognitive dysfunction"...so finally I had a medical validation for my disability: of course none of the doctors believe it was caused by klonopin withdrawal, but isn't it ironic that the treatment of choice for this disorder is, you guessed it, benzodiazapines! Of course, short of going on benzos again, or some sleeping pill, there is no real treatment for this sleep disorder. Aroung this same time my momma died. She was 85 and had a good life, and thankfully I was there for her and my dad at the end. Unlike my brothers and sisters, however, I realized that despite my symptoms, which were still quite severe, I could cope with her dying and was in many ways much stronger than anyone else. Whether by coincidence or not, around this time (the 13th month of my recovery) is the first improvement in my condition. The brain fog and head pressure seemed to fade, out of the blue. I was still suffering extreme anxiety attacks and was getting no more than 3 hours sleep a night, etc. but I gradually noticed this one area of improvement and later realized that it happened at 13 months, just like vetarans in this group predict. Shortly after this, Paul Thornton of this group posted his "success story", which happened to mirror my experience, and I found renewed hope that I would recover! Thanks Paul! I provided his story to my family and for the first time they seemed to understand what I was going through! For the next 6 months I cannot say I was doing much better though. I would still only sleep a couple hours, wake up with major anxiety attacks and extreme leg pain (which my neurologist claimed was due to my leg movements and which I have found has been significantly reduced by a small amount of codeine), and have incredible problems focusing or socializing, get extremely tired in the early afternoon, but if I tried to nap, would wake up with electric shock impulses and incredible anxiety which would ruin the rest of my day! I sold my house 4 months ago, which was way too big for me to keep up and which I couldn't afford, and therefore got in a position where I had enough cash on hand to keep me going comfortably until I got better, and found that even though moving was incredibly hard and stressful, I mustered enough energy to get it done and it relieved me of a lof of pressure. This may have helped more than I realized since now I am renting and nothing bothers me as much anymore! But then, I swear, it was out of the blue around 2 1/2 months ago, one day I was down in Palm Springs doing a project for my sister--manual labor scraping a patio deck--I swear I did not think I could do it, either pysically or mentally, I was there all by myself and was worried as afternoon approached I would face the daily fatigue that beset me and it didn't come! The next day it didn't come, nor the next! And my leg pain started diminishing and I started sleeping a couple more hours every once in a while at night. (I am convinced that my neuroglical condition has improved and will ultimately go away: klonopin withdrawal caused it and eventually once I have fully healed I will prove the neurolgist wrong since I will be the one who beat an incurable neurological condition!) But most importantly, the anxiety attacks have almost entirely disappeared: I swear, nothing major has changed in my life...I am still lonely (I have not been "well enough" to date much over the last 2 years) and none of my other personal issues have improved much either, yet all of sudden, I don't irrationally freak out and work myself up over nothing! And this all happened around the 22nd month, just like those crusty old veterans predicted! I can't say I am all better, but I think you all can attest that if you can be free of the symptoms I have beaten: brain fog, anxiety, incrdible panic attacks, etc. you would consider it a success story too! I don't know if I am going to be able practice law again, but I can assure you that my whole perspective of things has changed for the better having lived through this ordeal. I also realize how much I lost while I was numbed by klonopin: all these life events occured, my kids were growing up and s*** happened, but I basically did not experience highs or lows, and I was sucked dry of creativity or passion. Not that this realization made my recovery any easier: while I am stronger and wiser and more courageous than ever, there were many days over the last 23 months when I did not think I could make it, but I did--I am a survivor; I am a warrior! My heart goes out to all of you who are suffering, and I can only hope that my story gives hope to someone out there who can find some similarities in our stories, who are in the depths of despair from withdrawal, are lonely, are in pain, and are looking for a way out! I swear that I was in all of your shoes and now I can be a witness to what the oldtimers say: only time will heal the wounds caused by benzos and that we all can recover. I pray that each of you who are in need have the strength and courage to survive. It is far from easy, as I had the family support and resources to help me make it through, and I have such incredible sympathy for those who in the throes of withdrawals without the help I had, but the doctors and therapists and drugs that are available mean very little in this battle. Just bear in mind that you will recover, hopefully much sooner than I! I never thought I would be writing a success story, and it is ongoing! But I am full of hope and optimism, which 6 months ago were not even within my furthest reaches. Hopefully my story will give some hope and optimism to others! Take care and my thoughts are with all of you! Richard B*****

Posted by: RUNVS April 17, 2006, 6:51 AM

Paul’s Success Story Dear Group, Most of you don't know me......I joined the group back around Sept. 2001. I'm posting this success story as my way of giving back to the group. I owe much of my recovery to Geraldine Burns who started this group, Yvonne Day who talked to me every week on the phone for over 1 1/2 years, Hillary Noppinger who befriended me early on and others who helped me intermittently like Eva Sapi, Sheila from NH, Tom in Wisconsin, Kim in St. Louis and numerous others. I can't exhaust the litany of symptoms and ALL the horror I went thru, it would take volumes, but I'll relate what I can as best as I can. I can tell you what eventually worked for me and how I succeeded. It took me 3 1/2 years to get to where I am today, but if you read on, you'll see that I was one of the worst. The first year was all survival and that was it, and I will tell you that at some point you have to take control and do some things to make yourself better, but if you were as bad as I was, there was not much I could do except what you have all heard before.......TIME.....it will heal you...... I was on Klonopin, just 1 mg for 12 years after some situational panic attacks. I moved around a lot in those days so the doctors just kept me on the stuff.......you know the routine.......I was a successful Investment Broker, natural bodybuilder, mountain biked, roller bladed and many other things, I had a pretty full life, and then it started to come crashing down. Somewhere around the 8th year though I'm sure it started to effect me before that, I started to get sick more often, handled stress not as well, ran out of energy more often and didn't seem to have the postive outlook on life like I once had......since this crap is so insideous, it took several more years for the s*** to hit the fan... Let me tell you right now so as not to concern those that have struggled, or those who symptoms are troublesome but they can still kind of function, and anyone knowing Geraldine, Yvonne or Hilliary can attest to, I was in the top 5% of the worst cases you will ever see. I don't say that lightly cause I know we all think we are the worst......But I really really was........so here is how it went for me, and then I'll tell you what I did to finally get well......pull up a chair.... When I came off in Sept of 2001 and since I didn't know of this site, I went to a detox center instead of tapering......WRONG THING TO DO my friends, especially if like us, you are susceptible to protracted WD but of course, you would never know it until you got off. Suffice it to say that as hard as tapering is, cold turkey is the epitome of hell on earth.......hundreds of times more painful than the tapering process.... The first two months off were terrible but then like many, in the third month, hell opened up and invited me in.....I had over 75 symptoms and though I never did get the dp/dr like many, believe me, I had almost all the rest....for me, the head pressure was horrific, first exploding outwards for the first year, then crushing my brain like an orange the 2nd and part of the 3rd year....I did not sleep at night for onver two years.....I could not open my mail for a year, cook for myself, answer the phone, hell I couldn't even change the clocks during the change time....I was debilitated beyond belief. I was in bed 90% of the time for the first year, my central nervous system blown to hell.....even looking at tv or the computer was too much to bear, felt like my head would explode, my brain actaully vibrated and I was helpless.......my folks saved my life and took care of me.......they had too and I thought of suicide every day for at least 4 months until I could actually leave my bedroom and go into the front room.....all hope of even a small existence was gone and I thought would never ever return....... Sorry I can't relate more of the misery, but just know that I suffered more than the majority.......my good friends Geraldine, Yvonne and Hilliary will tell you..... Around 6 months off I first spoke with Geraldine and Yvonne. They both said I should go see a naturopath.....I have a background in health and supplements but never heard of candida......well, you may or may not believe in it but whatever I had, it was just like it. I went on a special diet mostly like an Atkins diet cause any sugar even natural would destroy me, and any wheat products the same thing...I stay on this type of diet for at least a year and maybe relaxed a little after 1 1/2 years off Klonopin. At 10 months off I finally could walk around the block.....but only 3 days a week cause it would take me two days to recover from just walking a mile.....this is the part where I decided to try and take charge a bit.......but for those of you who say, "I just can't do it", I understand totally.....but you have to try at some point.....if you can't.....try again in a week....if I walked to the mailbox in the first 10 months, that is all I could do for the day....and most of the time I didn't cause I couldn't handle the stress....I could only walk at night cause daytime would hurt sooooo much..... I walked further and further but still only 3 days a week until about 18 months off....remember, I was a weight trainer and jock, but I couldn't mangage more than this. I was still bad but improving a little.....I finally went back to the gym at 18 months but let me tell you...before all this at 6'1", I was 200 lbs of muscle and 12% body fat.....now I was 230, lost all my muscle and was probably 35% bodyfat.....I started to lift and resistence exercise seemed to help more but it killed me later cause my brain and body were so revved up, pressurized etc that my ears would ring all night, not that I slept anyway, and would be in agony most of that time... anyway, I did this routine for another year, I still couldn't handle any stress......any........maybe going to the store but that was it...but I persevered......and let me tell you......TIME still is the major healing force, but my exercise, while painful, exhausting was helping me strengthen my nervous system and adrenal glands....but very slowly..... OK.....that is just a small part of the hell I went thru...again, there is much much more but I know it is just too much to write....but HERE IS THE GOOD NEWS........I am 95% and going back to work now after 3 1/2 years....I weight train with more weight than before and in fact have gained back all my muscle, lost most of the fat. I can handle most stress now actually better than before and I am calmer now than ever in my whole life.... I was transformed into a better me.....when you hear people say that you will forget most of your symptoms they are right.....when you hear them say, "it was worth it"......I know you don't believe it now, but it was.....the keys for me were keeping my diet simple, progressively exercising more but you have to go slow on that, and when you start to see some daylight and feel almost healed, it was best for me to get back into my meditation, and read books like "Mind Power" by John Kehoe, Total Self Confidence by Dr. Robert Anthony. What worked for me may work for you.......most of you will heal long before I did and thank God you will....most will never see the extreme nature of protracted hell like I did....bless your fortune and as bad as it is now.........it will heal itself provided you assist it along the way....when you can.....never reinstate after you have been off for a few months....or even years, it will reverse any progress...... But YOU GUYS and GALS will heal......it will go away.....and it will get better and better......it even know is getting better and better and even when I feel, well, maybe I"m done healing.......it continues to heal.......hell, know I lift weights 4 times a week, do interval cardio twice a week and long distance cardio twice a week....two years ago.......no way.........and now I"m going to work.....my adrenals were the last to heal and are still healing....my energy is still not back to par but at 48 yrs old, I'm exercise more than most my age and most even 10 years younger... I'm living proof that you do heal from this torture, you really do, and I know some just can't or don't believe it.....don't worry about it, I didn't either.......but it happened if you just take any measures you can WHEN you can.....either way though, you will return to your self and in some ways be even better, cause after going thru this torment, nothing bothers me much anymore......how could it, nothing including war, divorce, other illness, etc could ever be as bad as what I had to endure......... So my friends.......there is light at the end of the tunnel, there is salvation from benzo WD.....the healed ones have told you and know I'm telling you......one of the worst has no blossomed into someone even better.......if you can't smile now......you will......faith is hard but you must dig down deep and know that what I tell you is true...I have never posted much on this site cause I as too sick.. But I found my mentors and did what they said.......I forever will love Geraldine and Yvonne for their care, nurture and guidance, their knowledge and empathy......they saved my life....literally.....and I still talk with them to this day......but about good stuff, not bad....thanks to Hilliary who helped me thru the worst 4 months and though she is still mending......she gave me hope early on....and all the others that took time to lead me down the path of healing...

Posted by: RUNVS April 17, 2006, 6:51 AM

........and to all of you that are still symptomatic and hurting or even being tormented, your day will come....I promise......the sun will shine upon you, the Lord (or your God) will lift you up from the despair and misery......I know I have said alot, but you have heard it from others before........and one day perhaps soon, you will be writing your own success story.......COUNT ON IT........ God Bless you all.....you are all in my prayers each and every day....and know that good things will happen.... Paul.....

Posted by: joy7866 April 17, 2006, 7:09 AM

Runvs: I am a little confused. Although I think your success story is awesome, I don't know if you are Paul or Richard B. I noticed one was signed Richard B and then some Paul. I am new to this message board so I don't really know how it works. Are you Richard B telling Pauls success story or are you Paul? Joy

Posted by: RUNVS April 18, 2006, 7:00 AM

Yes these are Real Stories I know the people in these stories. Remeber this is only a few examples of what can happen they're are many people that have little or no problems with benzos. But I think its important for people to understand there can be down falls to benzo use. The Makers of Benzos like Roche state that benzos are for short term only no longer then 4 weeks is recomended. Also, I share these story to give people hope that want off benzos. I am personally 9 months off benzos and still healing I do not feel that good but am getting better. But keep in mind I abused alcohol before benzos and this might be a reason for my slow recovery. I am almost a year off alcohol now. Thank you so much for asking about me. How are you doing now?

Posted by: RUNVS May 2, 2006, 10:58 AM

TABLE OF CONTENTS: 1. WHAT IS A BENZODIAZEPINE? 2. HOW DO BENZODIAZEPINES AFFECT YOUR BODY? 3. HOW QUICKLY CAN I BECOME ADDICTED TO A BENZODIAZEPINE? 4. WHAT ARE THE DOSE EQUIVALENCIES AMONG VARIOUS BENZODIAZEPINES? 5. WHAT IS A "HALF-LIFE", AND HOW IS THE CONCEPT IMPORTANT TO BENZODIAZEPINE DEPENDENCE? 6. WHAT DOES "TOLERANCE" MEAN? 7. IF MY DOCTOR HAS PRESCRIBED A BENZODIAZEPINE AND INSTRUCTED ME TO TAKE IT FOR A MEDICAL AND/OR PSYCHOLOGICAL REASON, IS THERE ANY REASON I SHOULD DISREGARD MY DOCTOR'S ADVICE AND DISCONTINUE THE BENZODIAZEPINE? 8. WHAT IS BENZODIAZEPINE WITHDRAWAL SYNDROME? 9. WHAT ARE THE SYMPTOMS OF BENZODIAZEPINE WITHDRAWAL? 10. I AM EXPERIENCING ONE OR MORE OF THE SYMPTOMS LISTED ABOVE, BUT I HAVE NOT BEGUN TAPERING MY BENZODIAZEPINE. IS IT POSSIBLE THAT THE SYMPTOMS ARE NOT RELATED TO BENZODIAZEPINE USE, OR COULD I ALREADY HAVE STARTED WITHDRAWAL WITHOUT EVEN TAPERING? 11. WHAT FACTORS DETERMINE HOW SEVERE MY WITHDRAWAL WILL BE? 12. IF I DISCONTINUE MY BENZODIAZEPINE, WON'T THE UNDERLYING CONDITION THAT MY DOCTOR PRESCRIBED THE BENZODIAZEPINE FOR RETURN? 13. I HAVE DECIDED TO DISCONTINUE THE USE OF MY BENZODIAZEPINE. WHAT ARE THE FIRST STEPS I SHOULD TAKE? 14. IS COLD TURKEY (ABRUPT, TOTAL DISCONTINUANCE OF THE DRUG) AN ACCEPTABLE METHOD FOR DETOXING FROM A BENZODIAZEPINE? 15. OK, IF I AM GOING TO TAPER MY BENZODIAZEPINE, HOW SHOULD I STRUCTURE THE TAPER? 16. SHOULD I SWITCH TO ANOTHER BENZODIAZEPINE SUCH AS VALIUM BEFORE TAPERING? 17. MY DOCTOR HAS ASKED ME TO SWITCH TO A DRUG CALLED "PHENOBARBITOL" FOR DETOXIFICATION? IS THIS A GOOD IDEA? 18. SHOULD I CONSIDER GOING INTO AN IN-PATIENT DRUG REHABILITATION FACILITY OR DETOX CENTER TO GET OFF MY BENZODIAZEPINE? 19. WHAT IS THE LENGTH OF THE WITHDRAWAL PROCESS? 20. IS IT OK FOR ME TO SOMETIMES "CHEAT" DURING MY TAPER AND TAKE A LITTLE MORE OF MY BENZODIAZEPINE IF I HAVE TO GO THROUGH A STRESSFUL EVENT? 21. WILL I NEED TO QUIT WORK OR GIVE UP OTHER IMPORTANT ASPECTS OF MY LIFE DURING BENZODIAZEPINE WITHDRAWAL? 22. MY DOCTOR HAS PRESCRIBED AN ANTI-DEPRESSANT TO TAKE DURING MY WITHDRAWAL. IS THAT A GOOD THING TO DO? 23. ARE THERE ANY OTHER DRUGS BESIDES ANTI-DEPRESSANTS TO CONSIDER USING DURING BENZODIAZEPINE WITHDRAWAL? 24. ARE THERE ANY PARTICULAR DRUGS A DOCTOR MIGHT PRESCRIBE THAT DEFINITELY DO NOT HELP WITHDRAWAL? 25. WHAT ABOUT HERBS AND OTHER HOMEOPATHIC REMEDIES - DO ANY OF THOSE HELP THE WITHDRAWAL SYMPTOMS? 26. WHAT ABOUT USING CAFFEINE DURING WITHDRAWAL? 27. WHAT ABOUT EATING SUGAR DURING WITHDRAWAL? 28. WHAT ABOUT CONSUMING ALCOHOL DURING WITHDRAWAL? 29. WHAT FOODS SHOULD I EAT (OR AVOID) DURING WITHDRAWAL? 30. I SMOKE CIGARETTES, SOULD I QUIT DURING WITHDRAWAL? 31. SHOULD I EXERCISE DURING BENZODIAZEPINE WITHDRAWAL? 32. I HAVE TERRIBLE INSOMNIA DURING MY WITHDRAWAL. SHOULD I TAKE SOMETHING TO HELP ME SLEEP? 33. WHAT CAN I TAKE FOR PAIN MANAGEMENT DURING WITHDRAWAL? 34. ARE THERE ANY PARTICULAR DRUGS THAT ARE KNOWN TO COMPLICATE WITHDRAWAL? 35. I AM WELL INTO MY TAPER, AND MY SYMPTOMS ARE EITHER NO BETTER OR ARE WORSE. WHEN CAN I EXPECT MY SYMPTOMS TO GET BETTER? 36. I HAVE COMPLETED MY TAPER, AND HAVE FELT MUCH BETTER FOR A WHILE, BUT NOW I FEEL WORSE AGAIN. WHY? 37. WHAT IS PROTRACTED WITHDRAWAL SYNDROME? 38. SHOULD I USE A 12 STEP PROGRAM LIKE NARCOTICS ANONYMOUS TO HELP ME RECOVER FROM MY BENZODIAZEPINE ADDICTION? 39. WHO IS DR. HEATHER ASHTON? 40. WHAT IS BENZO@EGROUPS.COM? 41. ARE THERE ANY OTHER RESOURCES THAT WOULD BE HELPFUL TO ME IN UNDERSTANDING BENZODIAZEPINE DEPENDENCY AND WITHDRAWAL? 1. WHAT IS A BENZODIAZEPINE? Benzodiazepines are a large class of commonly prescribed tranquilizers, otherwise referred to as central nervous system (CNS) depressants. They include alprazolam (Xanax), bromazepam (Lexotan), chlordiazepoxide (Librium/Nova-Pam), clonazepam (Klonopin/Rivotril), clorazepate (Tranxene), diazepam (Valium/D-Pam/Pro-Pam), estazolam, flunitrazepam (Rohypnol), flurazepam (Dalmane), halazepam, ketazolam, loprazolam (Dormonoct), lorazepam (Ativan), nitrazepam (Mogadon, Insoma, Nitrados), oxazepam (Serax, Serapax, Seranid, Benzotran), trazepam, tuazepam, temazepam (Euhypnos, Normison, Sompam), triazolam (Halcion, Hypam, Tricam). There may be others as well. All benzodiazepines have five primary effects. They are: A. Hypnotic (tending to make you sleepy); B. Anxiolytic (tending to reduce anxiety/produce relaxation); C. Anti-seizure (tending to reduce the probability of having seizures and convulsions); D. Muscle relaxant (tending to reduce muscle tension and associated pain); E. Amnesic (tending to disrupt both long and short term memory). There may be secondary effects as well. Different benzodiazepines exhibit these primary effects to varying degrees. For example, diazepam (Valium) is a relatively powerful hypnotic (sleep inducer), whereas the more modern benzodiazepines such as alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin), are less powerful hypnotics, but are very powerful anxiolytics. Do not assume that because one benzodiazepine makes you sleepier than another that this benzodiazepine is more potent than those which do not produce sleepiness to the same degree. Often, the reverse is true. Benzodiazepines have been referred to as being part of a larger class of drugs known as "minor tranquilizers". As applied to benzodiazepines, this is almost certainly a misnomer, and the label has fallen into relative disuse in the past ten years. However, you may encounter this term from time to time. Benzodiazepines are most commonly prescribed for anxiety conditions, especially panic disorder (PD) and generalized anxiety disorder (GAD). They are also sometimes prescribed for seizure disorders. Klonopin, for example, is often prescribed for epilepsy. Benzodiazepines are also prescribed for insomnia and other sleep problems, such as restless leg syndrome (RLS). Benzodiazepines are also occasionally prescribed as muscle relaxants. By far the most common benzodiazepines prescribed today are Valium, Xanax, Ativan and Klonopin. Probably over 95% of the over 450 members of benzo@egroups.com (see below) are using or have used one or more of those four drugs. Valium is particularly common in the British Isles. Valium has become less common in the United States over the past 15 years, while Xanax and Klonopin have experienced increased popularity in the United States over this time. In certain Latin American countries, it appears that the drug Lexotan (bromazepam) is very popular. All benzodiazepines can cause physical dependency, otherwise commonly known as addiction. 2. HOW DO BENZODIAZEPINES AFFECT YOUR BODY? Benzodiazepines are general central nervous system (CNS) depressants. They are all very similar chemically. Specifically, they all bind directly to and act upon your GABA-A receptor sites in your brain. There are also recognized subclasses of GABA-A receptors that different benzodiazepines act upon to varying degrees. Those sites respond to the neurotransmitter GABA (gamma-aminobutyric acid). The effect of benzodiazepines in binding to and acting upon your GABA-A receptor sites is to potentiate (heighten) the effect of GABA. GABA suppresses the action of wide variety of other neurotransmitters and neural activity including, for example, the action of norepinephrine (noradrenaline). The mechanism of action of GABA is to send negatively charged chloride ions into your brain cells, making those cells resistant to the effects of neurotransmitters such as seratonin and norepinephrine that cause excitation. GABA will perform this function with or without stimulation from a benzodiazepine, but where a benzodiazepine binds to a GABA receptor site, the action is heightened. This mechanism of action is what produces the primary effects of this class of drugs. (See above.)

Posted by: RUNVS May 2, 2006, 11:00 AM

Contrary to a popular misconception (which was reinforced by some erroneous language in the prior version of this FAQ), benzodiazepines do not actually increase the organic synthesis of GABA. As stated, they heighten the action of existing GABA. Actually, benzodiazepines can, over time, decrease the synthesis of GABA in certain areas of your brain. This is one of numerous theories attempting to explain the occurrence of "paradoxical" symptoms (See below). 3. HOW QUICKLY CAN I BECOME ADDICTED TO A BENZODIAZEPINE? The time it takes to form a physical dependency on a given benzodiazepine varies widely. The following variables may play a role: the size of your dose, the regularity with which you consume your dose, and most importantly, your personal body chemistry. People have been known to form dependencies in as little as 14 days of regular use at therapeutic dose levels. Your probability of forming some degree of dependency is significant, probably at least 50%, by the time you have been using them daily for 6 months. After a year of continuous use, it is highly likely that you have formed a dependency. It is unclear whether certain benzodiazepines are associated with a more rapid onset of dependency than others. 4. WHAT ARE THE DOSE EQUIVALENCIES AMONG VARIOUS BENZODIAZEPINES? There are no clearly definitive equivalencies for various benzodiazepines. This author has personally seen at least a dozen different benzodiazepine equivalency charts and no two are alike. The table below has been chosen because it reflects the clinical experience of Dr. Ashton in having detoxed over 300 people from benzodiazepines by use of a Valium substitution method (See below). Alprazolam 0.5 Bromazepam 6 Chlordiazepoxide 25 Clonazepam 0.5 Clorazepate 15 Diazepam 10 Estazolam 1 Flurazepam 15 Halazepam 20 Ketazolam 15 Lorazepam 1 Nitrazepam 10 Oxazepam 30 Prazepam 20 Quazepam 20 Temazepam 20 Triazolam 0.5 Thus, 1 mg. of alprazolam (Xanax) or clonazepam (Klonopin) is the equivalent of 20 mg. of Valium; 1 mg. of lorazepam (Ativan) is the equivalent of 10 mg. of Valium. These dose equivalencies are important for a number of reasons, the most significant of which is the issue of switching to a different benzodiazepine such as Valium prior to tapering (see below). These figures are taken from Dr. Ashton's (see below) papers and several other sources. A similar (though not identical) equivalency table can be found at http://uhs.bsd.uchicago.edu/~bhsiung/tips/bzd.html. There is some disagreement in the medical profession about these equivalencies. You may find a doctor who will want to switch you from Xanax to Valium at a 1 mg. to 10 mg. equivalency. This is a recipe for a very difficult cross-over withdrawal. Whatever the precise therapeutic dose equivalencies, the above equivalencies should be observed in switching from one benzodiazepine to another for purposes of detoxification. (See below.) 5. WHAT IS A "HALF-LIFE", AND HOW IS THE CONCEPT IMPORTANT TO BENZODIAZEPINE DEPENDENCE? Half-life is a numerical expression of how long it takes for a drug to leave your body. Technically, the "half-life," expressed as a range, is the time it takes for half of the amount consumed to be eliminated from your body, and so on. There is some controversy as to how long benzodiazepines may actually remain in your body after you have discontinued them entirely. Benzodiazepines are fat soluble and can persist in fatty tissues. However, benzodiazepines no longer show up in blood screenings beyond 30 days after discontinuance. This either means they are totally eliminated by that time, or that they persist in amounts too small to have any long term effect. The importance of half-life is that a longer half-life generally makes for an easier withdrawal because your blood levels remain relatively constant, as opposed to the up and down roller coaster that you experience with short half life benzodiazepines. Furthermore, longer half-life benzodiazepines require less dose micro-management. For example, Valium can be taken once every 12 hours, or in some cases, once every 24 hours. Xanax, however, must be taken once every 4-6 hours to maintain constant blood levels. This is a practical impossibility for some people. The following is a list of benzodiazepines with their corresponding half-lives, expressed as a range in hours: Alprazolam 9 - 20 Bromazepam 8 - 30 Chlordiazepoxide 24 - 100 Clonazepam 19 - 60 Clorazepate 1.3 - 120 Diazepam 30 - 200 Estazolam 8 - 24 Flurazepam 40 - 250 Halazepam 30 - 96 Ketazolam 30 - 200 Lorazepam 8 - 24 Nitrazepam 15 - 48 Oxazepam 3 - 25 Prazepam 30 - 100 Quazepam 39 - 120 Temazepam 3 - 25 Triazolam 1.5 - 5 There is a misconception that longer half-life benzodiazepines prolong the withdrawal recovery process by remaining in your bodily tissues for longer. However, there is no evidence that longer half-life benzodiazepines are any greater risk for Protracted Benzodiazepine Withdrawal Syndrome (see below) than shorter half-life benzodiazepines. This method of using a longer half-life equivalent is well understood in addiction medicine circles, and is employed with other classes of drugs as well. For example, people who are experiencing withdrawal symptoms from an anti-depressant such as Paxil are often given Prozac as a substitute for purposes of detoxification, because Prozac has a longer half-life. Perhaps a more typical example is the use of the drug Methadone in heroin detoxification which is employed in part because of its relatively long half-life. 6. WHAT DOES "TOLERANCE" MEAN? Tolerance is the process by which the receptors in your brain become habituated to the action of a drug. When tolerance is reached, more of the drug is required to achieve the same effect. With benzodiazepines, and probably with many other classes of drugs as well, tolerance is virtually always associated with some degree of physical dependence. If you find that you are experiencing tolerance, this is a clear warning sign that you may have formed a dependency.

Posted by: RUNVS May 2, 2006, 11:01 AM

7. IF MY DOCTOR HAS PRESCRIBED A BENZODIAZEPINE AND INSTRUCTED ME TO TAKE IT FOR A MEDICAL AND/OR PSYCHOLOGICAL REASON, IS THERE ANY REASON I SHOULD DISREGARD MY DOCTOR'S ADVISE AND DISCONTINUE THE BENZODIAZEPINE? Yes, there may be. Unfortunately, there are many well-intended physicians who simply do not understand the seriousness of long-term benzodiazepine use. Regular benzodiazepine use almost always causes some degree of deterioration in cognitive functioning, which progresses with continued use. Long term benzodiazepine use also causes lethargy, decreased energy levels that result in impairment in work productivity and disinclination towards exercise. Furthermore, benzodiazepines, and all other classes of sedatives, frequently cause and/or worsen depression. This is why people are often given anti-depressants after being given a benzodiazepine for anxiety. Anti-depressants, though therapeutically effective for many people, have their own complications and potential for dependency. (See below) Benzodiazepines can also cause what is sometimes referred to as a "flat affect" or "emotional blunting," in which the user's ability to experience powerful emotions is impaired. Long-term benzodiazepine users often describe their experience as "sleepwalking through life." Benzodiazepine use can also cause what is called "paradoxical" symptoms in a minority of users. Paradoxical symptoms are contrary to the intended therapeutic purpose, including outbursts of rage, increased anxiety, and sleeplessness. Paradoxical symptoms can be caused by the drug's interaction with the psychological makeup of the user, or may be a biological reaction to use of the drug that people sometimes refer to as "toxicity." Paradoxical symptoms are sometimes mistaken for withdrawal, and vice versa. The above effects occur to varying degrees, depending on the individual. Some individuals may not experience certain of the effects at all. However, one effect is common to virtually all users: a physical dependency will eventually form. Benzodiazepine dependency is particularly serious as the withdrawal syndrome (see below) can be extremely difficult and protracted. Furthermore, the development of tolerance often makes long term use non-feasible, and detoxification becomes a necessary eventuality. Benzodiazepines are often misprescribed for conditions to which they are not appropriate, such as depression. Furthermore, they are often prescribed for anxiety conditions for which the individual could be treated effectively with a less addictive drug or with other therapeutic techniques. There are, however, legitimate therapeutic benefits for benzodiazepines, particularly if they are used in the short term (no more than 2 weeks of continuous use), or for situational anxiety/panic (for example, one dose of Xanax per month as the need arises.) Furthermore, many users of benzodiazepines, including some who have used them regularly for more than a year, are able to discontinue them with little difficulty. Nothing in this F.A.Q. is to be construed as advising any individual to ignore the advice of his or her physician. Decisions regarding the use or discontinuance of any benzodiazepine should be made in consultation with a physician. However, in this area you must also undertake considerable self-education in addition to listening carefully to your doctor's advice. Fortunately, there are many available resources to accomplish that (see below). Where a doctor does not appear to be up to date with current medical literature regarding benzodiazepine dependency and the withdrawal syndrome, seeking a second and third medical opinion can be a desirable option. 8. WHAT IS BENZODIAZEPINE WITHDRAWAL SYNDROME? Benzodiazepine withdrawal syndrome is believed to be caused by a dampening of the action of GABA as neuroadaptivity causes GABA to become dependent on stimulation from the benzodiazepine to initiate its primary action. In other words, when you have become dependent upon a benzodiazepine, your GABA is unable to perform its natural action without the presence of the benzodiazepine. This results in a wide variety of over-activity in different areas of your brain, causing a vast and diffuse array of symptoms. These symptoms are believed to be various manifestations of neurological over-excitation as the cells in your brain become especially sensitive to the action of excitatory neurotransmitters. The most extreme manifestation of this over-excitation a seizure event. Benzodiazepine withdrawal syndrome is noted both for its relative severity and, in some cases, its lengthy duration, as compared to withdrawal from other classes of drugs. Withdrawal either occurs through the development of tolerance without an attendant increase in dose, or through a decrease in dosage below your "tolerance point". Your tolerance point is the dose point below which the functioning of your receptors becomes impaired due to a deficiency in stimulation from the drug. Your tolerance point may be lower than your actual dosage, such that you can sometimes cut your dose by some amount without experiencing withdrawal symptoms. However, this does not mean that you will not experience withdrawal symptoms by cutting the dose further. Generally, a drug's withdrawal syndrome is the mirror opposite of its primary effects. Thus, for benzodiazepines, you can expect sleeplessness (the mirror of its hypnotic effect), anxiety (the mirror of its anxiolytic effect), muscle tension/pain (the mirror of its muscle relaxant effect), and seizures in rare cases (the mirror of its anti-seizure effect). The only exception is that benzodiazepine withdrawal syndrome does not "mirror" the amnesic effect. To the contrary, the withdrawal syndrome often results in increased impairment of memory and cognitive functioning. However, in all cases, after detoxification is complete and withdrawal is in total remission, cognitive functioning will gradually return to the level that it was at before you began using the drug. For a more complete list of symptoms, see below.

Posted by: RUNVS May 2, 2006, 11:02 AM

9. WHAT ARE THE SYMPTOMS OF BENZODIAZEPINE WITHDRAWAL? The following is a list of symptoms reported by enough individuals that they are statistically likely to be legitimate withdrawal symptoms. Keep in mind that there are a wide variety of other symptoms that have been reported that may be legitimate withdrawal symptoms as well, but have not been reported by enough individuals to be statistically significant. The determination of statistical significance is not based on hard data, but on the observations of this author in reading through thousands of posts from people in withdrawal, as well as several books and articles on the subject. This list is broken down into psychological and physical symptoms. The double asterisk indicates symptoms that occur to some degree or another, at one time or another, in virtually every person experiencing benzodiazepine withdrawal. Single asterisk are symptoms that are common, and occur in most people. Others are symptoms that are common enough to be verifiable withdrawal symptoms, but probably occur in a minority of cases. Psychological symptoms: anxiety** (including panic attacks), depression**, insomnia*, derealization/depersonalization* (feelings of unreality/detachment from self), abnormal sensitivity sensory stimuli* (such as loud noise or bright light), obsessive negative thoughts*, (particularly of a violent and/or sexual nature) rapid mood changes* (including especially outbursts of anger or rage), phobias* (especially agoraphobia and fear of insanity), dysphoria* (loss of capacity to enjoy life; possibility a combination of depression, anxiety, and derealization/depersonalization), impairment of cognitive functioning*, suicidal thoughts*, nightmares, hallucinations, psychosis, pill cravings. Note that it is far more common to fear psychosis than it is to actually experience it. Physical Symptoms: muscle tension/pain**, joint pain*, tinnitus*, headaches*, shaking/tremors*, blurred vision* (and other complications related to the eyes), itchy skin* (including sensations of insects crawling on skin), gastrointestinal discomfort*, electric shock sensations*, paresthesia* (numbness and pins and needles, especially in extremities), fatigue*, weakness in the extremities (particularly the legs)*, feelings of inner vibrations* (especially in the torso), sweating, fluctuations in body temperature, difficulty in swallowing, loss of appetite, "flu like" symptoms, fasciculations (muscle twitching), metallic taste in mouth, nausea, extreme thirst (including dry mouth and increased frequency of urination), sexual dysfunction (or occasional increase in libido), heart palpitations, dizziness, vertigo, breathlessness. Here is a site with a far more comprehensive list of possible symptoms: members.dencity.com/BenzoBusters/index.html. Here, I have cited only the ones most commonly reported. 10. I AM EXPERIENCING ONE OR MORE OF THE SYMPTOMS LISTED ABOVE, BUT I HAVE NOT BEGUN TAPERING MY BENZODIAZEPINE. IS IT POSSIBLE THAT THE SYMPTOMS ARE NOT RELATED TO BENZODIAZEPINE USE, OR COULD I ALREADY HAVE STARTED WITHDRAWAL WITHOUT EVEN TAPERING? You are probably experiencing tolerance withdrawal. When you reach tolerance, your brain needs more of the drug to stimulate the active of GABA, and you begin to experience withdrawal symptoms. Some people find that no matter how much they increase their dose, they are unable to obtain complete relief. This may be caused by a fast, upward tolerance spiral, or by toxicity (see above). Detoxification is necessary where this occurs. Some people mistakenly form a belief that the drug has "quit working" to alleviate their anxiety disorder when in fact they are experiencing anxiety brought on by tolerance withdrawal. Unfortunately, physicians will sometimes reinforce this misperception and advise you to increase your dose as a result. 11. WHAT FACTORS DETERMINE HOW SEVERE MY WITHDRAWAL WILL BE? It is impossible to predict how severe your particular withdrawal will be, or which of the 30 or so common symptoms you are likely to experience. However, predictors of severity include duration of use, dosage, type of benzodiazepine, age, your personal body chemistry, and your method of detoxification. It is unclear which, if any, of these factors relate to the duration of your withdrawal syndrome as opposed to the severity. The data regarding factors correlating to duration is less conclusive than the data correlating to severity. There is some evidence that the more modern, high potency benzodiazepines, especially Xanax, Klonopin, and Ativan may be associated with more severe withdrawal syndromes. However, this evidence remains anecdotal. Keep in mind that there is wide variation from the above generalizations. For example, one person may take a low dose of a benzodiazepine for a short period of time, and have a very severe withdrawal phase. Another individual may take a high dose of the same drug for much longer, and experience very manageable withdrawal symptoms. Furthermore, an individual Valium user may have a harder time than an individual Xanax user. These variables are only very general predictors.

Posted by: RUNVS May 2, 2006, 11:03 AM

12. IF I DISCONTINUE MY BENZODIAZEPINE, WON'T THE UNDERLYING CONDITION THAT MY DOCTOR PRESCRIBED THE BENZODIAZEPINE FOR RETURN? It may or may not. It depends on what your underlying problem was, and what post-withdrawal measures you take to manage the condition, if necessary. Sometimes, the underlying problem is simply "gone" by the time you have detoxified yourself from a benzodiazepine. Many physical and psychological conditions are a transitory response to a temporary condition in your life, such as a traumatic event. Often, people take habit forming drugs such as benzodiazepines to alleviate the symptoms of these transitory conditions, and continue taking them long after the condition would have gone away on its own. Other conditions are less transitory, such as chronic, long term panic disorder (PD). However, it is important to bear in mind that there are other treatments for these conditions, both of a pharmacological and a non-pharmacological nature. Anxiety and stress can be managed in a variety of different ways that are not as harmful to your body as benzodiazepines. There is an ongoing debate in the medical profession as to whether there is a narrow class of individuals with long-term, chronic panic disorder (PD) who are justified in taking benzodiazepines for life. This F.A.Q is for informative purposes only, and will not take a position on this controversial issue. Often, when people complete their benzodiazepine detoxification, they find an emergence of an underlying psychological problem that was masked by the benzodiazepine use for many years. People also often feel the resurfacing of emotions that may have been suppressed for a long time. Thus, there is sometimes a period of difficult adjustment even after the withdrawal symptoms subside. However, people often find the end result of this period of adjustment to be very rewarding. 13. I HAVE DECIDED TO DISCONTINUE THE USE OF MY BENZODIAZEPINE. WHAT ARE THE FIRST STEPS I SHOULD TAKE? Your first step is to educate yourself. That means reading this F.A.Q. and seeking out many of the resources referred to herein. Your second step is to see a doctor who understands the seriousness of benzodiazepine dependency, and be as well armed with information as possible going into that visit. Your third step is to approach your detoxification with a clear plan in mind, to set goals for yourself, and to begin the withdrawal process with confidence. Do not listen to horror stories from others who have had unusually bad experiences in withdrawal. Everyone's experience is different, and many people are able to withdraw with very manageable symptoms. 14. IS COLD TURKEY (ABRUPT, TOTAL DISCONTINUANCE OF THE DRUG) AN ACCEPTABLE METHOD FOR DETOXING FROM A BENZODIAZEPINE? No. There is nearly complete uniformity of opinion both in the medical profession and in the benzodiazepine recovery community that cold turkey is a dangerous and unacceptable method of detoxification. Cold turkey withdrawal may cause seizures, and is also associated with a higher probability of withdrawal psychosis. Seizures are almost non-existent in those employing a taper method, with the limited exception of people who have taken a benzodiazepine for a seizure disorder. Furthermore, psychosis is rare in those who taper their benzodiazepine slowly. There is a misconception that cold turkey withdrawal, though it may cause more severe symptoms, will bring about a faster remission of symptoms. This is the idea that a slow taper "prolongs the agony of withdrawal". This notion is almost certainly false. In fact, there is some anecdotal evidence that cold turkey withdrawal may lengthen the course of the withdrawal syndrome, and may even cause Protracted Withdrawal Syndrome (see below). 15. OK, IF I AM GOING TO TAPER MY BENZODIAZEPINE, HOW SHOULD I STRUCTURE THE TAPER? There are two very general rules, and one exception to the rule that is discussed below. The first rule is, the slower the taper, the milder the withdrawal symptoms. The second rule is, the smaller the cuts you are able to make, the milder the withdrawal symptoms. These are related, though separate, issues. For example, you might decide to cut your dose by 1/4 mg. every month, or in the alternative, cut your dose by 1/8 mg. every two weeks. Either way, you are tapering at the same rate. In this author's opinion, the second option is a far superior method of tapering. Any cut is a shock to your brain and body. Cold turkey is the largest cut of all. It is a spontaneous, total deprivation of your dependent substance. The shock caused by cold turkey withdrawal is such that even after resumption of your drug at the previous dose, it may take weeks or months to "stabilize", and in some cases, you may never stabilize from a cold turkey withdrawal until after you have completed your taper. This logic further extends to the size of your cuts. The smaller the cuts you make, the less the shock to your system, and the less pronounced the withdrawal symptoms triggered by the cut. It is not recommended that any individual cut represent more than 10% of your total dose at a given time. Thus, it is preferable to make smaller and smaller cuts as you go, though this can be very difficult as you approach the end of your taper. Always make the smallest cuts possible. That means taking the smallest dose size available and splitting it into 4 pieces, which can be done easily with or without a razor blade. For example, with Valium, you can split the smallest (2 mg.) tablet into 4 .5 mg. pieces. With Klonopin, you can split the smallest (.5 mg.) tablet into 4 pieces of .125 or 1/8th mg. If you are on a high dose and feel that you are able to taper rapidly at first because you are above your tolerance point (see above), space your cuts close together (no closer than 1 cut every 3 days), but make the smallest cuts possible. If or when you begin to feel withdrawal symptoms, you can start to space your cuts further apart (up to about 4 weeks). Generally, the higher potency benzodiazepines such as Xanax, Klonopin, and Ativan force you to make larger cuts (see below), and therefore you must space your cuts at least 3 weeks apart toward the end of your taper. Of course, even where you are able to make very small cuts with lower potency benzodiazepines such as Valium, you can make these small cuts relatively far apart if this is your most comfortable method of detoxification. There is a method of tapering that involves mixing the drug with either water or a dry carrier like sugar to produce a "titration" which allows for very minute reductions, such as 1% every other day. This method has been employed with success by some people. In England, doctors have created a liquid titration kit to assist users in withdrawing comfortably. There is some promise that this method can substantially diminish, if not eliminate, the withdrawal syndrome. Unfortunately, these titration kits are not available in North America. If you are unable to use a titration method, you may wish to consider switching to Valium, assuming, of course, that you are not already using that particular benzodiazepine. (See below) This method has been used with success, particularly in England, for many years.

Posted by: RUNVS May 2, 2006, 11:04 AM

Dr. Heather Ashton has detailed taper schedules available that are based on switching to Valium. (Also see below.) There seems to be a limited exception to the slow taper rule where people find that they have a "toxic" reaction to taking the benzodiazepine (see "paradoxical symptoms" above). There is a tricky distinction between toxic symptoms and withdrawal symptoms. The usual way to tell the difference is to try increasing your dose. If the symptoms reduce or stay the same, your symptoms are likely attributable to withdrawal. If your symptoms increase, you may be experiencing toxicity, and should probably consider a faster taper (6 to 8 weeks). However, do not make a hasty decision to taper fast. Make certain that you are experiencing toxicity first. Generally speaking, your symptoms are far more likely to be related to withdrawal than toxicity. One cause of toxicity may be the taking of more than one psychoactive drug simultaneously. For example, taking a benzodiazepine with an anti-depressant and a narcotic (pain killer). 16. SHOULD I SWITCH TO ANOTHER BENZODIAZEPINE SUCH AS VALIUM BEFORE TAPERING? Keep in mind that some people feel that switching to Valium is not for everyone; and many have tapered their drug of dependency and have recovered very well. However, if you are considering this alternative, there are three reasons that are often cited for switching to Valium for purposes of detoxification. First, Valium has a far longer half-life than most other benzodiazepines. (See above). This allows for a steady, smooth reduction in dose over time. It also permits you to take your dose less often. In some cases, you can take your entire daily dosage before bedtime. This reduces problems of micro-managing your dose by taking another pill every few hours. It also can aid in sleep, which can be a large issue during withdrawal. Second, Valium is low in potency relative to most other benzodiazepines and comes in tablets of 2 mg., 5 mg. and 10 mg. As a practical matter, you can make cuts as small as .5 mg. This is the equivalent of somewhere between 1/20th and 1/40th mg. of Xanax or Klonopin. Given the importance of making the smallest cuts possible, particularly as you approach the end of your taper, this is a very large benefit. Finally, Dr. Ashton and some others believe that the more modern, high potency benzodiazepines such as Xanax, Klonopin, and Ativan tend to produce more difficult withdrawal syndromes. So far the evidence of this is anecdotal, meaning that it is based on clinical observation and patient self-reports. There do not appear to be any studies that conclusively correlate severity of withdrawal with type of benzodiazepine. If you do decide to switch to Valium, it is important that you have an idea of what to expect. First of all, because each benzodiazepine has a unique chemical composition, one benzodiazepine will not completely cover the withdrawal syndrome of another. Medical literature indicates that lower potency benzodiazepines cover fewer subclasses of GABA-A receptors (see above) than the modern, high potency benzodiazepines such as Xanax and Klonopin. This is why it is important to observe the proper dose equivalencies. (See above.) These are special equivalencies for purposes of switching to Valium, and are sometimes called "loading doses" or "suppression doses." The consequence of taking a loading dose is that although your withdrawal symptoms may be suppressed very well, you might also experience the side effect of over sedation. This is particularly so as Valium is a more potent sleep agent than most high potency benzodiazepines even at the equivalent therapeutic dose, and these equivalencies are probably well above the therapeutic dose equivalencies. However, most benzodiazepine users rapidly develop a tolerance to the sleep inducing (hypnotic) effects of benzodiazepines, so that it is likely that this over-sedation will recede within the first few weeks. Because it is important to manage this problem of over sedation and to avoid cross-over withdrawal symptoms, it is a very good practice to use a gradual dose substitution method rather than simply discontinue your drug of dependency and begin taking Valium at the full equivalency dose. Depending on the size of your dose, the period of dose substitution may be anywhere from 3 weeks to about 3 months.

Posted by: RUNVS May 2, 2006, 11:05 AM

During this period of dose substitution, sometimes cuts to your total dose are made, and other times, slight increases are made. If you experience extreme over-sedation and no withdrawal symptoms, that is a sign that the equivalency dose is too high for you, and you may wish make a small cut in your total dose as you cross-over. If, on the other hand, you begin to experience heightened withdrawal symptoms during cross-over, you may wish to make a small increase in your dose during cross-over. Because the proper equivalencies vary from person to person, the cross-over process can be a matter of trial and error. However, it is important to understand that the end result of switching to Valium should be that you are relatively stable after the switch is complete, meaning that you are experiencing either no withdrawal or very mild withdrawal symptoms. Dr. Ashton has circulated detailed protocols based upon switching to Valium and explaining the method in detail. (See above and below.) Librium is another long acting benzodiazepine that is sometimes (but rarely) used as a substitute. This author has insufficient information regarding the effectiveness of Librium substitution to provide a meaningful comment at this time. It is not necessary to switch from Librium to Valium. Librium should be tapered directly, although there is a problem in that it comes only in 5 mg. capsules in North America. Ideally, for Librium detoxification, the capsule should be opened and the contents halved to make 2.5 mg. cuts. Of course, if it possible to make even smaller cuts, that is most preferable. 17. MY DOCTOR HAS ASKED ME TO SWITCH TO A DRUG CALLED "PHENOBARBITOL" FOR DETOX? IS THIS A GOOD IDEA? Some doctors, particularly in the United States, use a detoxification method of switching the patient to phenobarbitol, then tapering the phenobarbitol, usually over a period of 2 to 6 weeks. Phenobarbitol is a long acting barbiturate (another class of sedatives). It acts upon many of the same GABA-A receptors as benzodiazepines, but binds to the receptors at a different location. Phenobarbitol is very cross-tolerant with the benzodiazepine class, and if taken in a proper "loading dose" (see above) will probably suppress withdrawal symptoms fairly well. Phenobarbitol detoxification is "medically safe," in that Phenobarbitol is a potent anti-seizure agent so that you will likely not have any risk of seizures with this method. Phenobarbitol also has a very long half-life, similar to that of Valium, and can be broken down into very small cuts. The equivalency is 3 mg. of Phenobarbitol to 1 mg. of Valium. Reported results from Phenobarbitol substitution are mixed but inconclusive due to the small number of people at benzo@egroups.com who have experienced this method. Doctors using this method generally observe the practice of using a heavy "loading dose," but they usually do not employ a gradual dose substitution method. More importantly, when this method is used, the detoxification is usually done very rapidly (e.g. 4-6 weeks). The problem with Phenobarbitol detoxification may not be so much the use of Phenobarbitol itself as the rapidity of the taper that is usually employed. Where information is discovered related to the effectiveness of Phenobarbitol using a slow taper method, this F.A.Q. will be revised to reflect that information. 18. SHOULD I CONSIDER GOING INTO AN IN-PATIENT DRUG REHABILITATION FACILITY OR DETOX CENTER TO GET OFF MY BENZODIAZEPINE? Only in a relatively small percentage of cases do people have successful experiences detoxing from benzodiazepines on an in-patient basis. The problems with detoxification centers are multi-fold. First and foremost, detox facilities are geared towards treating drug abuse behaviors, not providing support for withdrawal. The facilities often do not understand the necessity of tapering your benzodiazepine slowly. Often, they will require you to taper over a 3-6 week period. Some will even take you off your benzodiazepine over a one week period with a Valium or phenobarbitol substitute. These facilities usually will not keep you in-patient for more than about 6 weeks. The result is that you may end up being detoxed in an overly rapid fashion, while receiving classes on drug abuse but no specific support for managing withdrawal. The experience after leaving the facility can often be very rough, as you may be left in a state of fairly intense withdrawal that can persist for a long while. In short, people with benzodiazepine dependencies often feel worse after they leave these facilities than before then entered. Clinical experience suggests that benzodiazepine detoxification works best where the patient controls his or her own taper schedule in conjunction with the advise of a physician knowledgeable about benzodiazepine dependency. Detoxification centers, even where they might permit a relatively slow taper, will usually take the control of the process away from the patient and force the patient into a rigid protocol. However, detox centers should be considered in two circumstances. First, if you have a problem abusing benzodiazepines either alone or in combination with other drugs, an in-patient setting is often appropriate to enforce the discipline of tapering the drug, and to educate you on how to avoid drug abuse. (But see the discussion on 12 step programs below.) If you feel that you lack the necessary self-discipline to taper yourself slowly and gradually and have no spouse or other caretaker who will manage your taper for you, you may wish to consider a facility. Second, in the rare circumstance where your withdrawal syndrome is so severe that you are unable to take care of yourself and you have no live-in spouse or other caretaker, you may wish to consider the in-patient option. Before choosing a detox facility, you should call at least five different facilities and make, at a minimum, the following inquiries: a. Will they permit you to taper your benzodiazepine slowly? b. Do they have staff who have direct experience with patients in benzodiazepine withdrawal? c. Do they have an in-house psychiatrist and/or psychologist to provide support? If the answer to these questions is yes, yes, and yes, the chances are that you have found the best possible detox facility. However, it is still inadvisable to detox yourself on an in-patient basis unless you are in either of the two circumstances discussed above.

Posted by: RUNVS May 2, 2006, 11:07 AM

19. WHAT IS THE LENGTH OF THE WITHDRAWAL PROCESS? It varies tremendously. For people with mild dependencies, the withdrawal process typically encompasses 1-4 weeks of symptoms. This generally applies to most, but not all, people who have used a benzodiazepine for less than six months. It also applies to a percentage of people who have used a benzodiazepine for more than one year. For people with severe dependencies, 6 to 18 months total recovery time, including the taper process, is typical. Generally, one may expect 6 months to a year of diminishing symptoms after a taper is complete. There is also an uncommon phenomenon called Protracted Withdrawal Syndrome (see below). 20. IS IT OK FOR ME TO SOMETIMES "CHEAT" DURING MY TAPER AND TAKE A LITTLE MORE OF MY BENZODIAZEPINE IF I HAVE TO GO THROUGH A STRESSFUL EVENT? This is strictly a matter of opinion. In the opinion of this author, anyone detoxing from benzodiazepines who has a history of abuse should avoid the temptation to temporarily increase the dose at all costs, unless it is to avoid seizures or psychosis. If one has poor self-discipline, giving in on a single occasion to increase the dose in order to better cope with some stressful event may lead to a pattern of "giving in" which will ultimately lead to total relapse. If confronted with a stressful event, my advice is avoid the stressful event if possible. If not, make sure a supportive individual is there with you and tough it out. If, however, you are among the majority who have no history of abuse and have never abused your benzodiazepine, it is probably not harmful to do this on rare occasions, e.g. if you must attend a wedding or funeral or are forced to attend a function in a crowded public place where you have some fear of crowds and/or public places. If you have demonstrated self-discipline in your taper, you can probably get away with increasing your dose for one day on rare occasions, e.g. a few times during your taper. As clarification, it is always acceptable to "go sideways," (stay at the same dose as opposed to cutting) for a while in order to stabilize where your symptoms are particularly severe. This is different than the issue of increasing your dose to cope with stressful events. Finally, if you feel that you must increase your dose a little to stabilize yourself because you have tapered too quickly, do so. However, the better solution is to avoid tapering too quickly in the first place. (See above.) 21. WILL I NEED TO QUIT WORK OR GIVE UP OTHER IMPORTANT ASPECTS OF MY LIFE DURING BENZODIAZEPINE WITHDRAWAL? Going through withdrawal while managing the demands of everyday life is a difficult balancing act. It cannot be emphasized strongly enough the extent to which stress can worsen your withdrawal symptoms. That means stress related to jobs, relationships, or anything else. The key is that you need to understand going into your withdrawal process is that you will have to make adjustments in your life, including your level of activity and the types of activities in which you engage. The amount of adjustment will depend on the severity of your withdrawal on the one hand, and the stress level brought on by the activities on the other. Some people can work through withdrawal; others cannot. Some people quit their jobs, some take leaves of absence, some work through it with considerable difficulty, and still others work through it with mild difficulty. While in withdrawal, the best advice is to reduce your stress by the maximum amount that is feasible given the demands of your life. What that means will vary tremendously from one case to the next. 22. MY DOCTOR HAS PRESCRIBED AN ANTI-DEPRESSANT TO TAKE DURING MY WITHDRAWAL. IS THAT A GOOD THING TO DO? Maybe. Most doctors who prescribe anti-depressants for benzodiazepine withdrawal, or for any other purpose, will prescribe one of the modern class of SSRIs (Selective Serotonin Reuptake Inhibitors) that includes Prozac, Paxil, Zoloft, Celexa, and Serzone. Or they sometimes prescribe one of two even more recently developed drugs: Effexor and Wellbutrin. Doctors often prescribe these particular drugs because, in addition to their anti-depressant properties, they are recognized as anxiolytics (anti-anxiety agents). Ironically, all of these drugs are known to heighten anxiety and agitation, though this side effect often diminishes after the first few weeks of use. Even the SSRI's such as Paxil and Zoloft which are thought to have a primary sedative effect often cause heightened anxiety when you are in withdrawal. This heightened anxiety may be one reason that people in benzodiazepine withdrawal often discontinue the use of these drugs after a short period of time. Among those who have taken anti-depressants for long periods of time during withdrawal, the experiences are mixed. Some seem to benefit, others do not. Still others feel that their symptoms are worsened. Generally, due to the potential for creating complications of your other withdrawal symptoms, anti-depressants should only be taken where you are suicidally depressed. That does not mean that you are simply pondering or even obsessing about suicide. It means that you feel that, barring some kind of pharmacological intervention, you *will* do something self-destructive. Otherwise, anti-depressants should generally be avoided during withdrawal. Another issue is that most anti-depressants are documented to be addictive to varying degrees and, in fact, there is some evidence that the withdrawal syndrome can be very pronounced and similar to benzodiazepine withdrawal (though not nearly as protracted) in some cases of long term use. There are a few scattered reports of people who have benefited from the use of an earlier class of anti-depressants known as "tricyclics." One of these is Doxepin, which has a primary sedative effect as opposed to the stimulant effect of the SSRIs. Tricyclics also have their own set of complications and side effects. Consult your physician and check the written warnings for tricyclics to make sure that you do not have any of a number of medical conditions that may be complicated by the use of tricyclics. As with SSRI's, some are known to cause primarily sedation, where others are known to have stimulant properties. The best advice with anti-depressants or any other prescribed adjunct drug is to proceed with caution. If you decide to take an anti-depressant, you may want to start at a very low dose to see how well you tolerate the drug before increasing to the dose recommended by your physician. 23. ARE THERE ANY OTHER DRUGS BESIDES ANTI-DEPRESSANTS TO CONSIDER USING DURING BENZODIAZEPINE WITHDRAWAL? Yes. There are several. And your doctor may suggest one or more. Again, the best advice is to proceed with caution and carefully research any new drug you are considering. A few are mentioned below. Tegretol (carbomazepine): an anti-seizure drug. Some studies have shown this drug to be effective in reducing certain physical withdrawal symptoms. Others have shown it to be ineffective. Testimonials regarding the use of Tegretol are mixed. Neurontin: primarily a pain medication, neurontin has been implicated as alleviating certain physical withdrawal symptoms. Testimonials are mixed and too few for reliable generalization. Beta blockers (e.g. Inderal): beta blockers help with heart palpitations, hypertension, as well as shakes/tremors. Some beta blockers cross the blood/brain barrier, and may be mildly addictive, though the official medical literature states that they are non-addictive. However, that same literature also recommends that they not be discontinued abruptly. Do not take a beta blocker unless you are seriously troubled by any of the above-mentioned symptoms. Even then, you should either take them at the lowest dose possible, or take them situationally (as the symptom emerges). Beta blockers do not directly reduce anxiety, but they can alleviate some of the physical symptoms associated with panic attacks, which may indirectly help to reduce the associated anxiety level.

Posted by: RUNVS May 2, 2006, 11:07 AM

24. ARE THERE ANY PARTICULAR DRUGS A DOCTOR MIGHT PRESCRIBE THAT DEFINITELY DO NOT HELP WITHDRAWAL? Yes. Buspar, a commonly prescribed anti-anxiety agent, is virtually certain to be totally ineffective in alleviating withdrawal symptoms. This conclusion is supported by studies. Furthermore, this author has never heard a single testimonial from anyone who claims to have benefited from this particular drug in withdrawal. 25. WHAT ABOUT HERBS AND OTHER HOMEOPATHIC REMEDIES - DO ANY OF THOSE HELP THE WITHDRAWAL SYMPTOMS? Maybe. Everyone's experience is different. Acupuncture, massage therapy and chiropractic have been commented on, but there is little conclusive data as to their effectiveness in relieving withdrawal symptoms. As for herbal remedies, all of the following have been mentioned as helpful to one person or another: valerian, kava kava, st. john's wort, 5htp, SAMe, melatonin, GABA, chamomile, and Rescue Remedy****. With very few exceptions, the majority of these have been found to be helpful in only a few cases, and several people have felt that their withdrawal symptoms were heightened by taking one or more of these substances. Of the entire group mentioned, only two have been singled out by a fairly large number of people as especially helpful: chamomile tea and Rescue Remedy****. Keep in mind that even those herbal substances which you find helpful may only work where your symptoms are relatively mild. For example, chamomile tea might relieve mild agitation, but is very unlikely to bring you out of a full blown panic attack. However, there are breathing and relaxation methods that can help to alleviate panic attacks. Kava is noted as creating more adverse reactions than some of these other substances, and is probably the least recommended of the group for experimentation. However, all herbal drugs have been noted by one person or another as producing unpleasant side effects or as simply being ineffective. Herbal drugs are generally not regulated and there are occasional reports of these substances containing toxins, though these occurrences are becoming particularly rare in industrialized countries in recent years due to heightened media scrutiny of homeopathic drugs. It is also important to understand that herbal medicines are drugs. These plants contain organic, bioactive substances that cross the blood brain barrier and act upon your brain just as synthetic drugs do. In fact, many pharmaceuticals are synthesized versions of bioactive substances naturally occurring in plants and animals. The only difference is, you get a much higher purity of the substance in synthetic form than you would in organic form. Because herbs are drugs, they can also have toxic and deleterious effects. Fortunately, most herbal medicines are low enough in potency that they are well tolerated and non-addictive. However, it is important to start at a low dose and pay close attention to your body's reaction to the use of an herbal medicine just as it is with a synthetic one. Generally speaking, you will have a strong sense of how well you are tolerating a particular substance shortly after you beginning taking it, often after the very first dose. This FAQ does not recommend, negatively or positively, the use of herbal remedies for anxiety disorders such as GAD or PD. This FAQ is about benzodiazepine dependency and withdrawal, not about alternative treatments for anxiety disorders. The only opinion intimated herein is that some people may experience some relief from certain herbal remedies during the withdrawal process. Many, if not most, others, experience no relief at all. In general, herbal medicines are safer to experiment with during withdrawal than are synthetic ones. Therefore, you may wish to consider these possibilities before trying another potentially addictive synthetic drug. However, keep in mind that even if you experience some form of relief from an herbal remedy, there are no panaceas for benzodiazepine withdrawal syndrome, and only time will ultimately produce total recovery. 26. WHAT ABOUT USING CAFFEINE DURING WITHDRAWAL? You should *totally* abstain from the use of caffeine during benzodiazepine withdrawal. It is a stimulant and is known to worsen withdrawal symptoms. If you use caffeine to ward off migraine headaches, try to find another remedy that does not contain caffeine. You should refrain from the use of all other stimulants as well. For example, do not use "non drowsy decongestants" that contain the drug "pseudophedrine." That is a stimulant that will likely cause heightened agitation, which is the last thing you need during withdrawal. 27. WHAT ABOUT EATING SUGAR DURING WITHDRAWAL? There is considerable anecdotal evidence in the form of testimonials from people in withdrawal that sugar can exacerbate withdrawal symptoms. Shirley Trickett, in her book Freeing Yourself From Tranquilizers, indicates that benzodiazepine withdrawal causes hypoglycemia. This is one theory as to why sugar may cause problems during withdrawal. Another is that sugar may stimulate the production of adrenaline. In much the same way that it may cause hyperactivity in children, it can cause heightened agitation during withdrawal. Whatever the reason, there is substantial anecdotal evidence that consuming sweets, particularly in large quantities, can greatly complicate withdrawal. 28. WHAT ABOUT CONSUMING ALCOHOL DURING WITHDRAWAL? Alcohol consumption, even in relatively small amounts, is not advised during benzodiazepine withdrawal. Many people report that alcohol, a sedative that should cause a reduction in anxiety, actually heightens withdrawal symptoms, particularly those of derealization and depersonalization. Even if you find that alcohol has a calming effect on withdrawal symptoms, regular alcohol use creates a toxicity that will almost certainly prolong your recovery process. And even if you are able to successfully withdraw from benzodiazepines while consuming alcohol on a regular basis, which is unlikely, you will have probably substituted one addiction for another. 29. WHAT FOODS SHOULD I EAT (OR AVOID) DURING WITHDRAWAL? First of all, you should probably drink lots of liquid, perhaps double your ordinary intake. Some people feel that this may hasten the recovery process. The evidence of this is inconclusive. However, drinking large quantities of liquids helps to flush toxins from your system and is a generally good for digestion. Even if it provides no specific relief in withdrawal, it is generally a healthy practice. As for food, there are various theories about what should and should not be consumed. Some people develop fixations about their diets during withdrawal, associating a new withdrawal symptom with whatever food they consumed most recently, and concluding that this food is something to be avoided during withdrawal. Shirley Trickett (see above), in her book Freeing Yourself From Tranquilizers, recommends a hypoglycemic diet. This consists of eating three small meals per day, and having at least 2-3 snacks spaced out between the meals. The regimen consists of roughly equal parts complex carbohydrates, protein, and fat, with very little or no sugar intake. Whatever diet you decide is appropriate, the most important consideration during withdrawal is that it is a healthy diet. While the evidence regarding the effect of one particular food versus another is not conclusive, there is strong evidence that a healthy diet makes for an easier withdrawal. Another way of looking at it is in the converse: when you eat junk, your body rebels and causes you to experience discomfort. While this is true even when you are not in withdrawal, it is true more so in withdrawal because your body is already in a state of trauma. That trauma is virtually certain to be compounded by an unhealthy diet. There are a wide variety of opinions about proper diet and nutrition during withdrawal, and to discuss all of them is outside the scope of this F.A.Q. If you are interested in eliciting opinions on this subject, inquire to benzo@egroups.com wherein you will find no shortage of ideas on the subject.

Posted by: RUNVS May 2, 2006, 11:08 AM

30. I SMOKE CIGARETTES. SHOULD I QUIT DURING WITHDRAWAL? Nicotine, the primary drug contained in tobacco, is an addictive sedative drug like benzodiazepines, although it is vastly different in its chemical structure and mechanism of action. Unlike benzodiazepines, the primary symptom of Nicotine withdrawal is a craving for the drug. However, other symptoms, especially agitation and insomnia, have been noted as Nicotine withdrawal symptoms. Therefore, it is inadvisable to withdraw from Nicotine while you are in the process of benzodiazepine detoxification. If you plan to quit smoking (which is always a good idea for health reasons), it is preferable that you accomplish this before you begin benzodiazepine detoxification. Failing that, you should wait until you have fully recovered from benzodiazepine withdrawal before discontinuing cigarettes. The only exception to this guideline is where you are carrying a child. In that circumstance, it is critical that you quit smoking immediately. Benzodiazepine detoxification should also be accomplished during pregnancy, as there is clear medical evidence that a child born of a benzodiazepine dependent parent may experience symptoms consistent with benzodiazepine withdrawal. Where you are dependent on a benzodiazepine and carrying a child, a more rapid taper schedule that is generally desirable may be advisable. Detoxification during pregnancy, as in all other situations, should be done with close consultation with a physician who is knowledgeable regarding benzodiazepine dependency. 31. SHOULD I EXERCISE DURING BENZODIAZEPINE WITHDRAWAL? Yes. Aerobic exercise has consistently been found in studies to reduce both anxiety and depression. Some people believe that aerobic exercise may even shorten the course of withdrawal. Strenuous aerobic exercise is often difficult for people in withdrawal, as it causes an influx of adrenaline that can heighten withdrawal symptoms. In some cases, people have reported experiencing panic attacks after intensive exercise. Where you are unable to engage in vigorous exercise, it is recommended that you engage in as much low impact aerobic exercise as possible. Brisk walking is a good form of aerobic exercise that some people have reported as having an immediate, calming effect. Relatively non-strenuous swimming is also a good option. 32. I HAVE TERRIBLE INSOMNIA DURING MY WITHDRAWAL. SHOULD I TAKE SOMETHING TO HELP ME SLEEP? Opinions vary on the subject. While it should not slow your recovery process to take an over-the-counter drug with sedative properties, some people feel that taking virtually any other drug makes their withdrawal symptoms worse. Many others, however, have found that various synthetic and organic drugs are helpful as sleep aids. These include, but are not limited to, antihistamines (such as Benadryl), Dramamine, valerian root, 5Htp, chamomile, warm milk, and melatonin. It is important to be cautious regarding your decision to ingest any psychoactive chemicals, be they organic or synthetic, during withdrawal. Therefore, it is prudent to avoid taking sleep aids if you are suffering from only mild insomnia. If, however, your insomnia is severe, as it often can be during certain stages of withdrawal, you may wish to consider taking one or more sleeping aids, particularly as serious sleep deprivation may worsen withdrawal symptoms. It should go without saying that you cannot take a different benzodiazepine for sleep. That might be effective in inducing sleep, but it is the equivalent of increasing your dose and reversing your recovery process. The same holds true to varying degrees for barbiturates, alcohol, opiates and narcotics. You should also avoid the drug Ambien, a sedative not technically in the benzodiazepine class, but very similar chemically. Any of the above-mentioned over-the-counter sleep aids or herbal sedatives may be useful. However, it has often been observed that tolerance to the sleep effects of these substances, including for example melatonin, can develop rapidly. It is therefore recommended that you alternate more than one sleep remedy, so that no one remedy is employed more than 2 or 3 times per week. It is important to note that virtually all tranquillizers, including antihistamines, can produce paradoxical symptoms of agitation and heightened insomnia for some users. If you feel that any substance you are consuming as a sleep aid is making your withdrawal symptoms worse, discontinue that substance immediately. 32. WHAT CAN I TAKE FOR PAIN MANAGEMENT DURING WITHDRAWAL? Many people experience muscle and joint pain during withdrawal. This can occur to varying degrees. Only a very small fraction of people have reported bad reactions to over-the-counter pain relievers. These should be used as a first resort. Do not use prescription pain relievers unless your pain is extremely debilitating. 34. ARE THERE ANY PARTICULAR DRUGS THAT ARE KNOWN TO COMPLICATE WITHDRAWAL? There is some evidence that antibiotics can complicate withdrawal. However, it is not recommended that you refrain from taking antibiotics where they are prescribed by a doctor for a potentially serious condition. Some people have actually refused to take antibiotics for pneumonia while in withdrawal. Be advised that if you choose to make this kind of decision, you do so at your own risk. There are undoubtedly other drugs that may complicate withdrawal as well. Be cautious, but also be sensible about health problems you may have that are unrelated to withdrawal. 35. I AM WELL INTO MY TAPER, AND MY SYMPTOMS ARE EITHER NO BETTER OR ARE WORSE. WHEN CAN I EXPECT MY SYMPTOMS TO GET BETTER? There is no way to tell. Sometimes, people's symptoms begin to diminish before their taper is complete; sometimes shortly after the taper is complete; sometimes quite a while after the taper is complete. The important thing to remember is that in all cases the healing process is moving forward, whether it is immediately apparent or not, and that you will eventually begin to feel better. 36. I HAVE COMPLETED MY TAPER, AND HAVE FELT MUCH BETTER FOR A WHILE, BUT NOW I FEEL WORSE AGAIN. WHY? This is a typical experience. Benzodiazepine withdrawal recovery occurs in fits and starts. The fact that you have experienced relief for a time means that you will experience it again. As time goes on, generally these recurring episodes are spaced further apart, and are less in intensity. Benzodiazepine withdrawal leaves you vulnerable to stress for quite a long time even after you are almost totally healed. It is often reported that people who have felt withdrawal free for six months have had sudden, intense withdrawal episodes brought on by traumatic or stressful events. It is probably helpful to get counseling if you continue to have ongoing anxiety issues long after your taper is complete. This does not mean that you are not still experiencing withdrawal. It means that the purpose of detoxifying yourself in the first place was to find alternative, less toxic methods of managing anxiety problems.

Posted by: RUNVS May 2, 2006, 11:09 AM

37. WHAT IS PROTRACTED WITHDRAWAL SYNDROME? Protracted With Syndrome (PWS) is not a phenomenon with a single, unitary definition. Many people who have no experience with benzodiazepine dependency, which includes almost half of the medical community, do not recognize any form of withdrawal syndrome as persisting beyond about 30 days. Part of the problem is that the average physician sees very few people with serious benzodiazepine dependency, and when they do, the symptoms are often misinterpreted or misdiagnosed. Another problem is that statistics actually show that, indeed, about 70% of people with a benzodiazepine dependency are able to complete withdrawal in less than a month. However, it is important to understand that this statistic takes into account large numbers of people who have used a benzodiazepine for only a few weeks or months. For people who have used benzodiazepines for years, a 6 to 18 month course of withdrawal is actually the norm. For doctors who have not seen significant numbers of people in this circumstance, that scenario is viewed as "protracted," because withdrawal syndromes rarely persist more than 30 days for virtually every other class of drug. What those few doctors and recovering victims who truly understand benzodiazepine dependence know is that the 6 to 18 month scenario is just a typical outcome for any serious dependency. In those circles, PWS is roughly defined as significant, debilitating, and continuous (not minor or occasionally occurring) symptoms persisting beyond about one year after total cessation of the drug. One of the true ironies here is that just as there is debate among the truly ignorant as to whether the very common 6 to 18 month scenario exists, there is also a debate among people in recovery and addiction medicine circles as to whether true PWS (beyond about 18 months) is a real phenomenon. Most people in these circles believe it is. However, some would attribute symptoms several years out to a re-emergence of an underlying condition, to some other undiagnosed medical or psychiatric condition, or to psychosomatic complaints. Dr. Ashton and others believe that PWS is a real phenomenon. What causes it is at this point is unknown. However, there are two things to keep in mind about PWS. First, even if you are in the category of people with a serious dependency, the statistical likelihood of you experiencing PWS is quite small, probably less than 1 in 10. If you are two years out and have occasional, mild symptoms, that is not PWS. It is typical. If you have significant, debilitating symptoms beyond a year, that is PWS and it is atypical but not unheard of. However, the second thing to keep in mind is that there is no evidence that benzodiazepine withdrawal syndrome can ever be permanent. Even in the rare cases that symptoms persist for years, they gradually diminish over time until they are gone. As you taper, do not concern yourself with whether or not you will experience PWS. You probably will not. And even if you do, that is something to manage if or when you get there. 38. SHOULD I USE A 12 STEP PROGRAM LIKE NARCOTICS ANONYMOUS TO HELP ME RECOVER FROM MY BENZODIAZEPINE ADDICTION? This is a personal choice, and opinions vary considerably in the benzodiazepine recovery community. In fact, the issue has been debated on the benzo@egroups.com (see below) more than once. Some feel that most people who have a benzodiazepine dependency are not drug abusers. Rather, they are people who have taken a medication according to their doctor's instructions for a specific medical and/or psychological condition, have never exceeded the recommended dosage, have never experienced a "high" or intoxication from the drug, and have never experienced a specific craving for the drug. This is where the term "accidental addict" is rooted. Often, people who fit this mold feel that 12 step programs such as NA are not a proper fit for them, because those programs are aimed at conditioning people to avoid abuse type behaviors. People with a benzodiazepine dependency are often seeking support and guidance on how to manage their withdrawal syndrome, not training on how to avoid drug abuse. Still others not only feel that these types of programs have helped them, but feel that they would not be alive today without them. It is important to note that a sizable percentage of benzodiazepine dependents do exhibit patterns of abuse. The clearest sign is taking dosages far in excess of what your doctor has prescribed, and/or having a history of abusing other drugs in the past or simultaneously with your benzodiazepine. 12 step programs may be a better fit for people in that category. One factor that many have found helpful in the withdrawal process is spirituality, e.g. a connection with some form of Higher Power(s). Some have found that 12 step programs help them understand the importance of spirituality. Others have found their own spirituality without the assistance of any such program.

Posted by: RUNVS May 7, 2006, 6:16 PM

bump

Posted by: RUNVS June 2, 2006, 1:55 PM

They talk about benzos on the Radio Great stuff to listen to. http://www.anniearmenlive.org/benzos.htm#HELP

Posted by: RUNVS June 12, 2006, 12:28 AM

bump

Posted by: RUNVS July 4, 2006, 9:33 AM

:)

Posted by: RUNVS July 8, 2006, 4:12 AM

A visual animation on how benzos work with gaba receptors http://www.sciencemuseum.org.uk/exhibitions/brain/images/1-1-4-1-5-3-0-0-0-0-0.swf sciencemuseum.org.uk

Posted by: great info August 29, 2006, 10:36 AM

great info

Posted by: runvs September 23, 2006, 1:08 AM

I'm 14 months off of ativan and still feel very disabled. This benzo stuff is very serious and can make you very sick for a long time. Please Remember This Warning Now if you read this thread you can't say you didn't know.

Posted by: RUNVS February 28, 2007, 7:08 AM

Some more good info here about benzos http://benzowithdrawal.com/

Posted by: kee kee March 11, 2007, 4:56 PM

Thats a lot of cutting and pasting...whew...good info though I suppose. Thank god that I never became addicted to anything but pain pills...I hated pills until I got addicted to perc and oxy's. I detest pills to this day...all of them. I have ativan prescribed to me for withdrawal and noticed how uneasy I felt only after about a 10 day run! As long as there is breath in my body I will never mess with drugs again! I hate hate hate them.

Posted by: Aarniek@aol.com May 24, 2017, 12:14 PM

After 55 months off and still unable to walk from crippling muscle tension,today I was hit with the most intense symptoms yet,including severe convulsions ! Anyone else have anything like that happen and if so how long did it last ,plus did you find anything to help ?

Posted by: ergo June 6, 2017, 11:27 AM

If you want help getting off benzo or sleep med like Ambien or Lunesta - you can get a lot of help at benzobuddies.org DO NOT COLD TURKEY OFF A BENZO!