83 thoughts on “Prolonged Withdrawal– Will It Ever End?

  • October 8, 2012 at 10:58 am

    I think a retraction should be made for the disparaging remarks made regarding ( ) qualifications.

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    • October 8, 2012 at 1:18 pm

      I hear the person’s name referenced in some of the most ridiculous discussions, on message boards where patients engage in unguided self-treatment that usually ends poorly. But I have not read the recommendations myself, and so I should have withheld comment.

      Reply
  • October 8, 2012 at 10:41 pm

    Of course you don’t know what you’re talking about, but I suppose a scientist has a hard time believing they’re wrong.
    People who take benzos long term don’t go through a “few weeks of insomnia and then return to normal”. It is a horrific four years and counting experience of body twisting pain and fear I’ve been in. You get better eventually, but if you think it isn’t that big of a deal take it for a year and see what happens when it’s gone. It’s harmless after all right?

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    • October 8, 2012 at 11:26 pm

      I have no problem admitting when I’m wrong, honest. i just did so a few hours ago, in fact, if you notice the earlier comment. But why the hostility?

      There are other reasons for negative attitudes besides once taking benzodiazepines.

      Just sayin’….

      Reply
  • October 9, 2012 at 12:51 pm

    The physiological change occurring to the neurons is downregulation or desensitization. This is not damage, strictly speaking, as downregulation and upregulation of receptors are natural regulatory processes.However, some researchers believe the application of chronic medication to the receptors goes beyond their ability to adapt and chronic downregulation is not a benign condition.It is thought in benzo, antidepressant, and other neuroactive drug withdrawal that some people suffer prolonged withdrawal syndrome because the receptors (GABA in the case of benzos; serotonin etc. in antidepressants) are slow to upregulate in the absence of the drug.The downregulated receptors cannot contribute feedback to the body’s various checks and balances, which keep hormonal systems coordinated. The disturbed homeostasis in the nervous system may be self-perpetuating (example: Harvey, 2003), lasting for years.Symptoms tend to lessen over time, but can be distressing, debilitating, or even disabling.Prolonged withdrawal syndrome is a condition of autonomic nervous system dysregulation rather than physiological damage. This is why neurological or endocrinological tests, to which some people resort in desperation, usually are negative.Anyone addressing the issue of prolonged withdrawal syndrome should be aware that prolonged withdrawal symptoms generally arise from autonomic dysfunction.I do appreciate, Dr. Junig, your warnings about alternative medicine and supplement cures.From what I’ve seen in 8 years studying withdrawal syndrome, alternative, naturopathic, and orthomolecular practitioners don’t have any greater understanding of withdrawal symptoms or prolonged withdrawal syndrome than conventional medicine.They also tend to attribute the symptoms to a neurotransmitter imbalance or try to treat it as relapse or emergence of a psychiatric disorder, which may cause further harm to a destabilized nervous system.

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    • October 9, 2012 at 8:06 pm

      Thank you for your thoughtful comment. I mostly agree with you. The issue becomes, in my opinion, what ‘some researchers believe’ vs. what some researchers have been able to show, or not show, through objective observation.

      As I mentioned, I see many people with complaints of lifelong withdrawal, from opioids or from benzos. But both of those substances alter the subjective experience of the user forever; people who have been on daily benzos seem, in many cases, to see ‘anxiety’ as a symptom, whereas the rest of us see ‘anxiety’ as a normal human condition. I’m not talking about panic attacks, but about the ‘anxiety’ that comes when interacting with others, hosting a party, etc. Some people turn beet red in front of groups, and feel like hiding in a hole— but if they never met a psychiatrist they see themselves as someone in need of practice in social situations– NOT as a person with a ‘disorder.’ If that same person spent a year medicating that shyness with Xanax, then stopped the Xanax, the shyness would likely be as bad as ever, as the person never learned to deal with that situation…. and that person might say that since the benzos, they never felt ‘normal’ again. If unchallenged, that person might start talking about the damage done to his/her GABA receptors– all of this in a person who others would just consider to be shy, with perfectly normal receptors.

      I try my best to keep an open mind, and at least consider the idea that the person has some type of chronic receptor problem– just in case I find a way to fix it. But I’ve seen some people in that group who eventually dropped the ‘I’m damaged’ claim, and started challenging himself with toastmasters, community theater, working out, etc— and the symptoms eventually disappeared. That doesn’t prove my point, I realize– but it supports my point.

      People who talk of neurotransmitter imbalances are, essentially, making things up as they go along. The problem is that such a story sounds SO good, to a person who is looking for a reason to blame their neurochemistry– rather than make the difficult changes in behavior.

      Finally, I hear you about the autonomic imbalances, but there is a big chicken/egg dilemma, since people with severe fear or anxiety are going to have altered autonomics– and vice versa. I don’t know how we tell if the altered autonomics are the problem, or rather are just one more symptom.

      J

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      • October 9, 2012 at 9:14 pm

        Good points, and perhaps applicable to people who had pre-existing severe anxiety issues.However, prolonged withdrawal syndrome can occur in people who did not have those pre-existing conditions; for example, women who take antidepressants for hot flashes.There is a qualitative difference between the anxiety one might face in public speaking, and the bone-shaking “anxiety” of withdrawal syndrome.There are no terms to describe the subjective sense of a dysregulated nervous system; your patients may use “anxiety” or other common diagnosis-type words to communicate with you.If you suggest to your patients they are suffering from garden-variety anxiety, and they stubbornly resist this suggestion, they may be trying to communicate their reality to you.As for what experts have been able to prove — they’ve been able to prove precious little about subjective states, period. However, I give more credence to those who put time and thought into understanding adverse effects of psychiatric drugs, since there’s no (pharma) money in it and patient safety is the central concern.Conversely, there’s plenty of $$$$ motivation to deny and even cover up adverse effects such as prolonged withdrawal syndromes. Patients suffering from them find very little support anywhere in medicine, and they get very weary of implications they are deluded. I speak from personal experience.

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      • October 10, 2012 at 12:55 am

        I understand your points. Please realize that in my weekly radio show, I spend about 15 minutes of the hour each week condemning wht modern psychiatry has become—- the 15 minute ‘med check’, where people barely have time to state their symptoms, let alone discuss the qualitative differences beteen different anxiety states. My practice is a bit unique; I have no appointments shorter than 30 minutes, and many of my patients choose to meet for an hour– sometimes for psychotherapy, but many times because is simply takes at least that long to discuss these issues. I’ll spend the hour, simply trying to understand what, exactly, a patient means by ‘racing thoughts’– a phrase that in fast-track practices often results in a diagnosis of bipolar!

        As you likely know, it is notoriously unreliable to ask what a patient’s anxiety USED to be like. People have selective recall, colored by current experience and also, I think unconsciously, but their motivations with the current appointment. I hear often the comment, ‘but doc, I didn’t have any symptoms before I went on the medications.’ That statement always begs the question– then why did you see a psychiatrist in the first place, or try all of the medications that you now believe caused all of your problems?

        interesting discussion—- I truly do my best to ‘get it right’, and that takes a lot more time than the typical psychiatrist appointment…. and that’s a shame.

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      • September 20, 2013 at 3:55 pm

        http://en.wikipedia.org/wiki/Kindling_%28substance_withdrawal%29

        Kindling, it gets worse. Permanet CNS damage and brain damage can be done. it can take years to withdraw and it can be hell. for some it is easier, I don’t know why.

        xanax or buspar can cause dystonia, that’s permanet brain and body damage.

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      • September 20, 2013 at 4:58 pm

        This phenomenon is most-associated with alcohol or benzos…. but I see a similar kindling effect to opioid withdrawal as well.

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      • October 30, 2013 at 5:27 pm

        Regarding benzo withdrawal as well as some SSRI withdrawal…There’s zero argument when we are seeing thousands of people who took them for “trouble sleeping” and after they come off the drug, they lost their job, are anti social, have panic attacks, severe anxiety, dizziness, bloated stomach, memory problems, morning adrenaline rushes, insane irrational fear, depression, debilitating fatigue, sensitivity to caffeine, intolerance to certain foods, etc… etc… etc… Someone’s ‘new-found’ inability to consume caffeine or certain foods b/c they cause anxiety or strange feelings is a physiological response to ‘something’ in the nervous system being off kilter. These people would welcome their “trouble sleeping” issue back if they knew this was a possibility. I know not everyone will get a bad withdrawal, but I have seen plenty in the protracted group and they have tried SSRI’s, supplements, and other things only to find out that TIME was the healer.

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      • October 24, 2018 at 9:42 pm

        Exactly. It took years and after many forced psych meds with no improvement, I finally found the info and support groups I needed on the internet (Doc kept saying stay off the internet!) Twenty mg of Ativan taken over a year was enough to cause down regulation. Ten years later, having kindled several times using Ativan to cope with side effects of Remeron, Zoloft, Prozac, Trintellix, Ability, Pristiq, etc., began an eighth month taper off one mg. Thirty seven months off and unable to look after myself seventy percent of the time. My doc gave me Ativan for insomnia caused by menopause instead of HRT. Ten years of my life stolen and it’s not over!

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      • May 18, 2019 at 11:13 am

        Wow! I thought it was just me! Remeron 28 yrs. However my story is as follows I just took my last Mirtazapine dose on March 18, and I still feel sick. I have been going out of my mind, thinking by now I should be feeling better, however not so. Tophat hits it dead on.. Exactly what I am going thru..panic attacks, anxiety, racing heart, gi problems, new found sensitivity foods etc you name it! I have also under gone blood tests, hospital for racing heart. Stress test , blood work all test are normal. I am thinking why am I still feeling this way and then I search the web read this post and am floored, that other people are experiencing these symptoms and that these symptoms can last for years and years! Some days I feel Alright and some days, others symptoms are so horrible! Yes it’s that bad!

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  • October 10, 2012 at 12:41 pm

    Dr. Junig, I can tell you are one of the better psychiatrists who tries to get it right. (I’ve sent you a message through your Web site.)Allow me to caution: When a patient says ‘but doc, I didn’t have any symptoms before I went on the medications,’ they may very well be reporting accurately.Psychiatric drugs have many paradoxical adverse effects which doctors misinterpret as patients balking at treatment. They then urge patients to stay on the medications regardless of the adverse effects, which become imprinted, if you will, on the patient’s nervous system and persist even when the drug is discontinued.Antidepressants in particular not infrequently generate anxiety and sleep disruption. Many doctors prescribe benzos to counter these adverse effects.(They sometimes misdiagnose the adverse effects as “unmasking” of bipolar disorder — calling for even more polypharmacy.)I wouldn’t be a bit surprised if you see a lot of people who became dependent on benzos in this way.It’s very unfortunate for doctors as well as patients that the adverse effects of psychiatric drugs have been obscured by pharma influence. This has reduced the quality of clinical care and tarnished psychiatry.If your patients say a symptom arose AFTER they were treated with psychiatric drugs, I suggest you give more credence to that, rather than rationalizing the complaint away.Patients ask for psychiatric drugs, unnecessarily, for many reasons: They are influenced by advertising, by peer pressure, and by a cultural climate that identifies any personal lagging as a psychiatric disorder requiring drug treatment.A patient might go to a GP, mention having some anxiety before a big presentation, the GP whips out a prescription pad, and presto — you have someone who was talking about a normal emotional state chronically taking a benzo or an antidepressant or maybe both, with all their adverse effects.It’s entirely possible your patient did not have serious problems before the drugs and developed them afterwards.

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    • October 10, 2012 at 1:34 pm

      Thank you for your comment. I understand, and hope that I am always keeping multiple interpretations open for endless consideration. My point is just that many people dread the initial appointment with a psychiatrist. Going to see a stranger, opening old wounds, opening the wallet to spend much-needed money, and just taking the time for an appointment is often a big hurdle…. a hurdle not taken without some significant motivating symptoms. People with no psychiatric symptoms rarely, I would guess, schedule and keep appointments with psychiatrists…. so it is not likely that a person ‘felt fine before starting any medication.’

      That is NOT to say that people don’t get worse on many medications, particularly benzodiazepines. If you missed my link, please check out my post about that class of medications here. You will understand why I ALWAYS urge people to avoid that type of medication– except for either rare intermittent use, or for short-term (1-2 weeks) after a significant trauma.

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  • October 10, 2012 at 1:53 pm

    I’ve heard that from other psychiatrists, too — that people wouldn’t visit them unless there was really something wrong.

    My point is that the “something” is often not at the level of a psychiatric diagnosis. For example, I don’t know if you’ve had the pleasure of working at a corporate job. Stress is common in those environments. People feel pushed to keep up with others; they’re always afraid of falling short.

    Given our medication-centered culture, people do start to worry about something being very wrong with them when they don’t so easily adapt to those pressured environments. It really doesn’t take much to send someone to a psychiatrist for what they think will be a silver bullet for all their problems.

    Psychiatrists hugely underestimate the cultural influences on behavior when it comes to asking for psychiatric drugs. And once a patient gets a diagnosis pinned on — or is told he or she is suffering from a genuine chemical imbalance — you have someone convinced they need psychiatric care.

    So, I have to challenge the assumption that nobody goes to a psychiatrist unless there’s a real psychiatric disorder involved.

    All that stuff you read about an overmedicated or overdiagnosed society is true. It’s happening on the doorstep of your office and your colleagues’, not someone else’s.

    (Sorry, I’ve included line breaks in my posts, but the PsychCentral software isn’t publishing them.)

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    • October 10, 2012 at 2:33 pm

      I completely agree with you. Note that I wrote ‘symptoms’, not ‘psychiatric disorder.’ I always feel better after an appointment where I stopped a medication— and I have a number of patients who see me for the reason you describe– who take no medication at all, but are seeking an objective observer/listener.

      Reply
  • October 11, 2012 at 11:43 am

    You say “So if I’m correct, why do some people experience symptoms like yours for years after stopping benzodiazepines?

    I suspect that in some people, psychological symptoms and physical or emotional feelings become ‘imprinted’ on the brain, as memories that play back over and over in response to certain cues, until they are replaced by other memories and imprinting”

    Basically it appears you are making a statement that even the physical symptoms are basically “in our heads”. So when someone experiences Tinnitus as a result of an overrapid taper and that same Tinnitus is with that individual for years following the abrupt w/d, it’s simply a memory “imprinted” on the brain?

    Or a person experiences pain and burning of the extremities for years following a slow taper from benzos, a condition that was not pre-exisiting prior to benzo use which was originally prescribed for insomnia, are you suggesting that this too is a memory “imprinted” on the brain?

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    • October 11, 2012 at 1:16 pm

      I think you are making a mistake by equating imprinting in the brain with the phrase ‘being in our heads’– a phrase that has been used dismissively, that vaguely refers to imaginary symptoms. We know that imprinting occurs continuously and constantly, with every part of the human experience—- I am just suggesting that PERHAPS somatic feelings become imprinted as well.

      As for the pain and burning that you describe, I pride myself on taking the time required to figure things out… and I am certainly in no position to make a diagnosis based on where I’m sitting.

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  • October 12, 2012 at 8:00 am

    I had posted last night, I don’t know why it didn’t go through. Before I started taking benzos I wasn’t mentally well. I had been in a car accident and had a hard time coping with the reality of many situations which occurred with that. Then in 2009 my oldest daughter got in a horrific car accident which nearly claimed her life. When I finally could see her, she looked like an angel on one side but I noticed her bp wa 220/180. I then walked to the otherside of her to whisper her name in her ear. I then saw that her head was cut off on the left side and fear gripped every muscle I had! I passed out and they were going to admit me. Instead they signed me in and gave me a shot of ativan so I could stay with my daughter. They wrote me out a script and I was able to handle this situation without the nauseousgrueling and head spinning. She needed me there. She was in a coma for three weeks and then she was taking to Spaulding hospital for intense therapy. When she got out, she had physical and mental impairments. Although she has made great strides will always have brain damage. Now a few months on the ( 5 months at that point ), I wanted to be off of them.I tried c/t and landed in a mental institute where I was layer told that I would most likely be on them for life. So I left the hospital with more medicine than when I came in ( no anti depressants). I wasn’t satisfied with this and threw the medicine away. I didn’t sleep for 17 days straight and landed in the hospital for an irregular heart rhythm. I was young and fit, how could this be?? I had to go back on the ativan. My life became a horror after this. I was having w/d while on the medication, and so they kept increasing the dose. They then switched me to klonapins and started me 5 mgs a day, which that soon kept escalating. My tolerance to these pills were off the chart and I was now in deep depression. I took more and more because I had hit the max dosage of 10 mgs a day. So now I was running out. This was the first time I had a seizure, but many would follow. From September 2011 until present, I’ve been in rehab 14 times, and lost count of my hospital stays. When trying to be admitted to one of the best rehabs in New England, I was turned away as being high risk. My gp knows I have been wanting to get off of these pills, so decided to put me on a fast taper (6 weeks). My mind could not handle it, and I did not want my children to see me dead one day. They saved my life by calling 911 a few times for me. I think they wanted to now get rid of the problem ( me ). I’ve had to resort to so many other ways to try to a semi steady tapering. I have cut down to a comfortable 4 mgs a day of ativan, and will hopefully be able to do this on my own and with the help of a benzo group I was lucky enough to find on Facebook. Please explain to me why I’ve been borderline with ms, and lupus? I don’t have either one. My hands curl in and they ruled out arthritis. I constantly jerk. I have had to receive blood a couple of times because my platelettes were low. I have never had any of these problems until I started benzos. Yes agrophobia is very scary to the least!! I don’t like to leave my house, but hate being here as well. I used to live outside! I have always hated being an indoor girl! Living is very hard!! Wish it were just in my mind! I’ve taken cbt three times! I have all the booklets from Sunday-Saturday. If there were another way, I would want to take it! As for me, I now live in a prison! Thank you for your time!

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    • October 12, 2012 at 10:35 am

      Thank you for your comment. I believe you; your symptoms are not rare, which is why I took on this issue with my post.

      I can’t say it enough though, apparently– the ‘in my head’ thing is a phrase I did not use, and would not use. ‘Imprinting’ or memory or post-synaptic potentiation– whatever one chooses to call it– is a real, structural phenomenon. My point has been that there is no evidence for long-term change at the RECEPTOR level, so we have to look elsewhere, if we are to help people in your situation.

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      • October 12, 2012 at 11:11 am

        Sorry, and yes, an imprint, or whatever it is called. You’re right, and actually those words fit!! Good luck and again Thank You! I read your link on benzos, and believe that you do understand how dangerous it can be!! Keep up the good work!!

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      • October 12, 2012 at 12:59 pm

        Yes, there is evidence for long-term change at the receptor level, in rodent studies.

        For example, Harvey, 2003 Neurobiology of Antidepressant Withdrawal (and other work by Harvey).

        There are other studies that indicate some degree of permanent downregulation may occur, I’ll have to look them up

        There are no longitudinal neurobiological studies of prolonged withdrawal syndrome, if that’s what you mean, Dr. Junig. Because there is a vacuum in neurobiological evidence — it hasn’t been studied!!!!!! — your default logic that the cause is psychological, memory-driven, learned, or PTSD is faulty.

        (Psychiatric drug withdrawal overall is poorly studied, due to drug company influence, and the received wisdom is highly questionable.)

        Even if receptors eventually re-adapt, the cascade of dysregulation throughout the autonomic nervous system can persist.

        The receptors are taken out of the equation. As the organism attempts to maintain a sometimes dysfunctional homeostasis and return to normal, symptoms will come in waves “out of the blue.”

        Perhaps you’ve heard your patients say this?

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      • October 12, 2012 at 1:40 pm

        The full citation: Neurobiology of antidepressant withdrawal: implications for the longitudinal outcome of depression. [Review] [132 refs] Harvey BH. McEwen BS. Stein DJ. Biological Psychiatry. 54(10):1105-17, 2003 Nov 15.

        To quote the last line of the abstract– i.e. where authors typically summarize the content of the study: this article proposes a preliminary molecular perspective and hypothesis on the neuronal implications of adherence to and discontinuation of antidepressant medication. Later, in the discussion: acute antidepressant withdrawal in patients receiving chronic treatment, particularly of short half-life compounds, is associated with increased stress system activity involving the hypothalamic-pituitary growth axis and the sympathetic nervous system, specifically elevations in plasma insulin-like growth factor-1 (IGF-1) and heart rate. The latter reflect stress-related dysfunction of the hypothalamic-pituitary-adrenal and growth axes that are features of depression

        I have the full text of that article, and other articles by Harvey. In NONE of them does he conduct, or even refer to long-term studies. I’ll send you the actual paper if you like; he refers to changes in the receptor complex caused by stress hormones, when antidepressants are discontinued– but the process he describes occurs over hours and days. There is nothing new or surprising in that data; there is nothing to suggest that the effect is permanent.

        Of course, my post was not even about antidepressant (SSRI) withdrawal— which is what Harvey wrote about ten years ago. I described benzodiazepine withdrawal. SSRIs affect serotonin reuptake; Benzodiazepines act at the GABA complex. They are about as related as the heart and the kidneys both having blood flowing through them!

        The article by Harvey, if anything, supports my post; he refers to changes in ‘plasticity’, which is just another way of saying ‘imprinting’, which was my choice of words.

        Finally, you are quoting Harvey, it appears, to bash SSRIs… and that’s fine… but the Harvey paper that you listed focuses on inappropriate CESSATION of SSRIs. He describes the severe changes that occur in hypocampal neurons during depression, and argues that people are taken OFF antidepressants when they should stay ON them. He describes the neuroprotective effects of antidepressants, if anything.

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  • October 12, 2012 at 8:12 am

    I do also applaud that your trying to help! I know that in my last post I was asking you why about the the borderline ms/lupus and I don’t expect you to answer that. I am just nearly trying to figure this out myself. I am still hoping for that silver bullet!! Have a great day!

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  • October 12, 2012 at 12:27 pm

    One thing you should understand Dr. Junig is that the so-called benzo support forums operate as cults. They bash psychiatry. They attack doctors (including threatening them with violence – a most famous benzo site had “cartoons” of Dr. Leo Sternbach being boiled in oil for the “crime” of discovering diazepam). They tell strangers to stop taking their medications. The benzo forums have many of same goals as Scientology and its front group CCHR. There have been at least nine suicides related to these groups telling people to stop taking their physician prescribed medications.

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    • October 12, 2012 at 1:43 pm

      Thanks– yes, I am aware… what is frustrating is that people will cite articles out of context, or cite a title that sound frightening, without understanding how the study fits into the thousand of other studies in the same field. The best part of my academic appointment is access to online databases, where I can look up studies like the Harvey citation in about 3 minutes. I always read the references that are thrown at me— and the experience usually leaves me shaking my head.

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      • October 12, 2012 at 1:57 pm

        One of the professors they venerate suggested “they” wanted to put Valium in the drinking water of the major industrialized nations. She wasn’t making a joke!

        What ones sees at these sites is anti-vaccine talk, promotion of kook cures (like sweat lodges), rejection of Western medicine, etc. Cyberchondria is rampant among the poor souls that get sucked into the sites.

        Two people I knew personally killed themselves after being indoctrinated in this anti-psychiatry movement.

        I am not kidding.

        I have seen the forums tell people NOT to go to the ER.

        Doctors need to speak out about this and warn their colleagues and patients to beware of these sites. The people there – acting as zealots on a mission -actually believe they know more than doctors.

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      • October 12, 2012 at 4:27 pm

        This has been a long day… I’ve been typing here during my dictation time, so I’ll be in the office late tonight!

        I want to post everything that people say– with a couple exceptions that I’ve described before. I do not have the anonymity of those who comment, and so I am not willing to post comments that attack me, or my practice, on a personal level. If a person writes something really interesting, but then adds ‘I am glad I’m not YOUR patient,’ I’m sorry— I draw the line there. The people who comment don’t know me, or my practice style. I know how strong my efforts are, to find ways to help my patients; personal attacks are not fair.

        If ANYONE wants to have their comment posted, please avoid personal attacks. If people stick to the subject matter and leave me out of it, I’ll post it– although I may make a RESPECTFUL comment in return, if I disagree.

        As for the post by ‘Mike’, I would not include it if he was breaking the anonymity of someone else. But the fact that my post got cited somewhere, setting off a firestorm, is worth noting. If nothing else, it speaks to the number of people who are not finding help through traditional medical channels.

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      • October 13, 2012 at 7:36 am

        Dr Junig, further to my post above I would like to add I am greatful for you taking the time to post here, even though I do not fully agree with you I admire the fact that you are taking the time to talk. We may both learn from each other.

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  • October 12, 2012 at 1:03 pm

    “My point has been that there is no evidence for long-term change at the RECEPTOR level, so we have to look elsewhere”

    There is no evidence because there has been little to no research. If it IS something going on at the receptor level, then moving on to something else is not going to solve the problem. Those of us going through this know that something is wrong that wasn’t wrong before. The physical sensations we experience and the anxiety is not the same, it’s not related to the original causes that brought us to take the medication.
    It’s very difficult for a person like me to read that the symptoms I am experiencing are due to a “memory imprint.” I have gone through enough and am neurotic enough to feel pretty in tune with what my body is telling me and right now it’s telling me there is something wrong with my central nervous system. And doesn’t it seem plausible that a drug that effects one of the two primary neurotransmitters in the CNS could create, by its absence, the physical and mental issues that are reported? If we can’t agree on the cause, we can’t agree on the treatment.

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    • October 12, 2012 at 1:45 pm

      Gosh– there is so much research…. I just did a database search for studies about benzodiazepine withdrawal, and there are 1530 from the last 10 years. Understand that a single paper, describing a study, takes years of research.

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  • October 12, 2012 at 1:10 pm

    Hi Dr. J. The OP and other responders are from a web forum called BenzoBuddies. Here is the link where they are discussing your responses

    http://www.benzobuddies.org/forum/index.php

    under : Cold Turkey, Detox & Rapid Withdrawal

    take care, TikkiB

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  • October 12, 2012 at 1:55 pm

    I’m not a member of benzo buddies. I’m not a member of a cult. I’ve been suffering with often crippling physical and emotional problems since SLOWLY TAPERING off valium for more than six months. People who complain of benzo withdrawal are frequently condescended to and dismissed because of their history with anxiety. The same is being done here by some commentors trying to make us sound like quacks.

    Also, it would be helpful if you could provide a solid example of thorough research that would cast doubt on the damaged neuroreceptor theory.

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    • October 12, 2012 at 2:16 pm

      I’ll see what I can do about the research…. but understand how things work, when it comes to scientific study. A paper that describes no change from baseline in the study group is not likely to be written, or published.

      To get a sense of the research being done at any moment I encourage readers to go to ‘clinicaltrials.gov’ and type in any keyword. Realize that the things that come up are only current, or recently closed trials– and they are only trials paid for by the Feds. Much research occurs through private funding through endowments, or by pharma; those are not included at the .gov site.

      I certainly do not want to dismiss anyone. I realize that people have the symptoms you describe.

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      • October 12, 2012 at 2:19 pm

        I appreciate that you are open to a discussion and are being very responsive. Thanks!

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  • October 12, 2012 at 2:03 pm

    I used Xanax for only one month, 3 times a day. Had paradoxical reaction or real fast tolerance and was cold turkeyed by my Dr. Have had various symtoms for now 5 years with the first 3 being hell. Have resurgence of symtoms after taking only one percocet from Dr for a sinus headache, there has to be some damage somewhere from this. It is not a psychologic problem the physical symtpoms are real and are hell. The Med community should acknowledge us the small but significant group of people who have been adversley affected by the Benzo class of drug. Peace.

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    • October 12, 2012 at 2:11 pm

      I reject a dichotomy between ‘psychological’ and ‘physical’. I have written about the problems with benzodiazepines (the link is in my original post); that article was passed around a number of doctor forums, where the points I made were endorsed over and over.

      Reply
  • October 12, 2012 at 4:05 pm

    Dr. Junig, as much as I respect you and your decision to look deeper into this subject, I hope it’s with an open mind. I remember when my daughter was in Spaulding hospital, the Dr there explained to me that even though technology has made great triumphs and the mri are fantastic at seeing the many more things than ever before, but that the brain is to complex for anyone to still fully understand. He was very straight with me and could tell me many things that had happened to my daughter. For instance, that about %80 of her nerve endings were damaged and at most would heal upto %80. He said it was like shaking baby syndrome. He then told me the front part of her brain had severe damage. She has short term memory loss ( which is very true and she does ),. Her blood vessels had expanded which raises her risks of stroke and clotting. Then he said that ” nobody knows how her outcome will be because there is still so much hidden in the brain that we still don’t understand. A few days after that, there was a story on Good Morning America which involved a man who was in a coma state for over twenty years and how his mother never gave up on him. She believed that he did understand her but was unable to express it. The Drs kept telling her he was brain dead and finally one,,,, just one Dr believed her! It was true what she said, and they were finally able to communicate with him through squeezing of his hand. He’s out of a coma and is living with tbi, but I just found it fascinating that everyone thought he was brain dead but wasn’t. So, I believe in science, but if science cannot prove an existence of sx even when the patient says it does, should we conclude that science is right? I’m definitely not in any form of cult, I’m not dumb from the use of benzos, and I actually try to keep positive!! What I have gone through has been horrifying and not just an imprint of who I was. I know who I was and I try to keep an open mind about what you believe could be happening. I’m just curious, are you trying to understand this dependency, or prove you theory? Please know that I’m not trying to be disrespectful. I guess what I was hoping for is that you be the one to believe us. Though you can’t see something, it doesn’t mean it doesn’t exist. Being someone who has studied science, you should know that. Thank you for your time!

    Reply
  • October 12, 2012 at 6:25 pm

    Dr JUNIG, thankyou for taking the time to post, although I must say you have got it wrong. Your theory may be somewhat correct for those that had a pre existing condition of anxiety depression or other illness before the offending medication, but what about those wo took AD’s or benzos for reason other than psyhcological. A person with no history of anxiety or depression or somatic symptoms ends up a basket case after a period of time on the meds or most common during rapid withdrawal. I have been a sufferer of protracted withdrawal for over 5 years. I agree that we need to keep going as best we can and to cotinue to challange ourselves during this illness and not crawl into a hole. Although the strength needed is enormous. You are wrong to think or suggest in protracted withdrawal syndrome that the psychological is the cause for the physical symptoms, in my experience and also from the words of hundreds of sufferes I have spoken with – it is the physical that impacts on the psychological. Although I do agree that there are people that the reverse applies. You are correct that thoughts will impact on the physical sensations although you are wrong that thoughts are the cause of the sensations. My impression is that nobody can give an absulate cause of this illness, I assume until somebody conducts a microscopic autopsy on a protracted suffers brain and body we will never know.

    Reply
    • October 12, 2012 at 6:38 pm

      Thank you for your thoughts. I would not go so far as to call my thoughts on the issue a ‘theory’; I’m reporting on symptoms that I see, and musing about the science. Understand that I do not see the difference between ‘physical and psychological’ that you, and others, keep referring to. I am assuming that if a person is having symptoms, something is occurring to cause those symptoms. People have put words in my mouth here, and I suspect at another web site.

      It is not whether one impacts the other; both are one and the same.

      Reply
      • October 12, 2012 at 6:57 pm

        This is a very interesting aspect of withdrawal syndrome, one researchers would do well to study in order to find out what biochemistry does influence thoughts and emotions.People experiencing prolonged withdrawal syndrome often say they experience intense symptoms *independent* of whatever thoughts or feelings they might have at the time.They describe symptoms “coming out of the blue” or as “spontaneous.” One can be having a lovely day, and suddenly be hit with a surge of symptoms so strong it feels like a heart attack or stroke.The internal sense of these waves of symptoms is that they arise from something physical rather than mental. If intense waves of “anxiety” or “depression” are involved, they were not preceded by any conscious thought. (Again, there is a limitation of language here, as “anxiety” and “depression” cannot begin to describe the unprecedented suddenness and intensity of these feelings.)Sometimes the symptoms are physical, but of the type that won’t appear on any test, such as migraine, dizziness, parasthesia, and so forth — as is true of autonomic instability in general.Let’s say these symptoms are indicative of autonomic dysfunction, Dr. Junig. How would this fit into what you see as an indivisible union of the physical and psychological?

        Reply
  • October 12, 2012 at 7:47 pm

    Thank you for opening this dialogue Dr. Junig and for all your thoughtful responses. There is so much I’d like to tell you about what we go thru but really there are no words to describe the relentless torture of living in a body whose nervous system is completely fried (probably not a medical term). The hardest part is being denied that anything is wrong by doctors. There has been no validation for myself and many others coming from a medical professional. I wanted to speak to the hostility by a previous poster and help you understand where they are coming from.

    Chances are strong that this person has been fighting for their life for years on end and has lost all his relationships, his job, his savings and most of all his health. He parks the responsiblity for this upon the shoulders of the medical professionals who recommend these drugs and then have no clue how to safely get someone off them when they realize how harmed they are by the drugs.

    I echo the direct request of Altostrata (above) that you Please, Dr. Junig, help educate your colleagues about the need for tapering tailored to individual tolerance. I would go further to request that you also help spread the word of how extremely dangerous all benzodiazepines and sleeping pills are when prescribed for longer than 1 to 2 weeks.

    Reply
    • October 12, 2012 at 10:20 pm

      I have removed a few of the more heated comments, some as requested by the writer and some at my discretion. I am not trying to hide or censor anything. I left a sampling that covers all that was discussed– but removed the more heated ones.

      Wow– what a day. Watch for my next post– about the weather!

      Reply
  • October 13, 2012 at 7:24 am

    Dr Junig, This is in no way an attack on you, this is just a ridicules suggestion, and it is made through frustration. I have heard many times from doctors and psychiatrists that benzos are safe and withdrawal is not that bad at all. I assume you are a researcher..why not get first hand experience in what his hell is really like. Are you able to take 3 mgs of clonazepam per day for lets say 3 to 4 months and then withdraw rapidly without risking seizure…lets say a withdrawal over a period of 3 weeks. This I’m sure will give you a feeling of what this hell is like. And also give you an insight on how much of it is psychological driven. If you are not a depressed or anxious person I guess you should not have any problems if you are correct. I know this is a stupid suggestion, but you will never know what people like myself are experiencing. It is just to hard to verbalize or descibe fully without giving a doctor the impression that this is a psychological driven illness. Perhaps this anolagy may help you understand….hold your hand over a burning candle at a point that it hurts alot but you can keep it there without burning your skin off. You will notice that your thoughts and mood will change with the pain. If you had to live like this for days,weeks or months on end you will become at the very least depressed and at the worst suicidal. You do not need to have been a depressed person before hand.

    Reply
    • October 13, 2012 at 12:19 pm

      5years, why don’t you take a few minutes to read Dr. Junig’s (MD) personal story on the home page, before you pass judgement that he does not have”first hand experience of what his hell is like” This could provide some insight for you.Thanks, Tikki

      Reply
      • October 13, 2012 at 4:38 pm

        Thanks Tikki! Yes… I’m not any different from anyone else.

        Reply
      • October 13, 2012 at 6:54 pm

        Thanks Tikki, I have not read his story yet although I am now familiar with some of it, and your are absolutely right.

        Reply
  • April 6, 2013 at 2:44 am

    I’m sorry if people scared you off! Yes you will heal!! You are a scientist and so you already know all about thedown regulations of Gaba. Someone once poor
    said it to me like this, ” it’s like a house that’s been destroyed. While your brain heals it’s rebuilding each room into a far more beautiful one! It hurts and takes time to complete each one, but when it’s finished, it will have been worth it”! I believe that also! We will appreciate and live lifemore abundantly!!

    Reply
  • October 31, 2013 at 3:46 pm

    So what you are trying to tell me is that 34 months after my last dose of clonazepam my cognitive issues such as problems following lists or written instructions, reduced ability to think creatively and abstractly, poor focus and concentration (that only appeared after I stopped the benzo) are a result of memories that were imprinted in my brain earlier in withdrawal?

    I don’t pretend to have all the answers and I’m not a doctor but that doesn’t even sound plausible to me.

    Reply
    • October 31, 2013 at 4:23 pm

      You must recognize by now, after your frustration with the medical system, that whatever is going on with your health has no ‘plausible’ explanation. I suspect, though, that someone trained in neuroscience and medicine will have a better likelihood of coming up with a plausible theory, than someone without that training.

      Millions (literally) of people have started and stopped benzodiazepines who have no complaints of ‘problems following lists or written instructions, reduced ability to think creatively and abstractly, poor focus and concentration.’ Your theory is that there is something special about YOUR brain, causing you to have a different experience that other humans. Yes– there are enough people with symptoms like yours to fill a web forum or two—- but among the 200 million people in this country alone, there are large groups of people complaining of pretty much any symptom you can imagine. That’s human nature.

      The idea that you, and perhaps another 0.1% of the population (that’s generous), have something different about your brain that made it respond in the way you describe, is not plausible to me.

      On the other hand, conditioning is a universal phenomenon– in almost all animal life. Conditioning is why you find your way home at the end of the day. I am confident I could ride a bike today, even though I haven’t been on one in 25 years; that’s the power of conditioning.

      The first issue in your case is distinguishing whether you truly HAVE ‘trouble following lists or written instructions, reduced ability to think creatively and abstractly, poor focus and concentration’– or if instead you only THINK you do. If you want to know the answer to that question, see a neuropsychologist and go through the battery of tests that determine those things. But if you do that, be prepared to accept the likely answer– that you are normal in all of those things.

      If you DO have those problems, then you have to consider a mechanism— and a reason why you are uniquely effected. You also have to rule out other reasons…. for example, something must have been a problem for you, for you to start benzos in the first place. Either you had anxiety, or you had an addictive nature that caused you to take them. How do you know that one of those things– things that were present BEFORE the benzos– didn’t progress to your current problems?

      I suspect that neuropsych tests would be normal. I say that because I’ve seen testing on people with similar complaints, and they are usually normal— no matter how intense the testing. I suspect that the problem is more of perception. Some people pay a lot of attention to how they ‘think’ or how they ‘feel’; other people just live and act and rarely focus on those things. Taking benzos, I believe, tends to make people more aware of how they ‘feel’ (which actually makes their anxiety worse– but that is a different issue).

      Of course, I have never met you, and I have never pretended to have all the answers either– even in people I DO meet. I’m just trying to use my experience and education to be helpful. Hopefully that’s plausible enough for you….

      Reply
  • October 31, 2013 at 5:32 pm

    You have a medical degree….you got me there. But I have something you don’t have, and that is firsthand, personal, one on one experience with a powerful psychoactive medication that has destroyed thousands of lives, including mine. You might suspect that you are better qualified to tell me that what I am experiencing is psychological but I suspect that your theory would be a little different if you were the one who was living with this condition.

    There are quite a few more than a “handful” of people complaining about the same or very similar problems. There have been numerous studies done over the years, books have been written on the subject, and there is even legislation that is being passed in the UK where they seem to have a little better grasp on the dangers of these drugs.

    Why aren’t there books or scientific studies or internet forums popping up with patients reporting multi-year, debilitating withdrawal from asprin? Because benzos can make you sick sick sick for years and asprin doesn’t do that. But of course the standard answer from the medical community is that people who take benzodiazepines are prone to mental issues or addiction. Never mind the fact that you could have been put on these drugs for sleep or other non psych issues and still end up with the same symptoms or that the dozens of withdrawal symptoms you experience can be physical in nature or completely unrelated to your original condition.

    I can only hope for your sake that you never have the misfortune to find yourself with a debilitating medical condition that was brought on by a prescription drug, just to be marginalized by society as some kind of drug addict or told by the medical community that it is impossible for you to have physiological damage x number of months or years later and that you must have a mental issue that needs to be addressed.

    I say this because it really, really sucks to be told that it’s just your “perception” when you wake up feeling sicker than you ever thought imaginable, unable to work because one of the prerequisites of running a business is that you can at least follow basic written directions.

    Trust me, you don’t ever want to be in my shoes.

    Reply
  • November 1, 2013 at 12:02 am

    How can the following statement hold water? “Your theory is that there is something special about YOUR brain, causing you to have a different experience that other humans. The idea that you, and perhaps another 0.1% of the population (that’s generous), have something different about your brain that made it respond in the way you describe, is not plausible to me.” So you are saying that EVERY HUMAN BRAIN should respond EXACTLY the same to substances? How can such a generalization be stated in confidence? If this were true, we would have one anti depressant and we could guarantee it would work on everyone. How come there are 100 to choose from and some don’t do anything while others are very effective in lifting mood/anxiety? I don’t know what the % of people who experience protracted withdrawal from benzos is but it must be very very small, I’m not doubting that. I do know that there are many studies showing that 50+% individuals who attempt to come off of benzos get symptoms. How long the symptoms last is a mystery. I’ve also seen a ton of people who used benzos for a sleep aid and now they have anxiety, panic attacks, agoraphobia, among many other symptoms that were not present prior to taking the drug. How can someone say that the drug didn’t cause these problems when the problems are byproducts of insufficient GABA, too much GLUTAMATE, and/or an out of whack nervous system. All of which the benzo affected. Myself and many other have EXACTLY the same symptoms and we all took the exact same drug long term and developed the symptoms after taking it. I was a caffeine junky and now if I have coffee, it gives me an anxious feeling for hours and I am non functional until I sleep it off. I was about 8-10 months off of xanax and after having sex I couldn’t sleep and I would have SEVERE anxiety & one led to a horror of mental fear and panic attack. This happened every single time after sex, I tried 3 separate times to confirm the correlation. It seems that any type of adrenaline or physical stress will bring about uncomfortable symptoms. At 18 months off the drug, still can’t work out for more than a few minutes. My throat gets tight and I feel an anxiety build the more I try. I have no idea why, but yet again, it’s a physical response I’m getting. Myself and many others would also get a “morning adrenaline” rush, upon wakening it felt like someone injected you with adrenaline, fear, and anxiety. That too went away magically over months. These are “automatic” body functions, there is ZERO response to stimuli or threatening situation to cause it. The body must be in a severe state for a long time for some people. My question is what is the fix for this? My back story is that I had one panic attack and months later I was an idiot and got talked in to go talking to someone about it to resolve what caused it which was a shitty job & a break up with a girlfriend. After starting the drugs they gave me is when I was out of work for weeks on end and began becoming non functional. I NEVER went into a dr’s office to get help because I was not functional on a daily basis. I BECAME non functional BECAUSE I took the drugs.

    Reply
  • November 1, 2013 at 10:25 am

    I was about to post apologizing for misspelling Dr Junig’s last name but it appears my comment was removed entirely.

    It’s probably likely that this comment will be taken down as well, but perhaps Dr Junig will read it before he does and refer to the links below if he’s still interested in trying to help:

    http://tinyurl.com/l4cakbm

    http://psychcentral.com/blog/archives/2010/07/28/withdrawing-from-psychiatric-medications/

    (That is a link to the article from which I quoted in the comment that was taken down.)

    Reply
    • November 1, 2013 at 2:06 pm

      I removed your post, GJM, because you wrote inaccurate information about my background. You suggested that I was biased toward psychiatry. Actually, my PhD in neuroscience was centered on neurochemistry, but included neurophysiology and neuroanatomical study. My bias is toward the scientific method, and disproving the null hypothesis. My medical degree was followed by training in anesthesia, critical care, and pain treatment. I worked in that field for 10 years. I completed training in psychiatry in 2006. I can assure you that I’m not prone to ‘psychobabble’ or ‘jujitsu’ or whatever you called it in your original post.

      The links above are consistent with everything I’ve ever said about benzos. Realize, of course, that neither is peer-reviewed research; both are simply general opinions. Dr. Grohol talks about tapering meds for a period of time, even up to months; that is a far cry from saying that withdrawal symptoms will last for months. His point is that by tapering slowly, a patient avoids withdrawal.

      The other ‘tiny url’ is even more consistent with what I’ve said. He says ‘The broad range of psychiatric symptoms could be the result of agitated depression, generalized anxiety disorder, panic disorder, partial complex seizures, and schizophrenia.’ It is only a non-peer-reviewed book with one person’s opinion, so who cares…. but his point is more consistent with mine, than with the flurry of comments that have appeared in the past couple days. He didn’t write that benzo withdrawal CAUSES those things; he writes that benzo withdrawal general lasts a couple weeks, and that some people complain of a longer withdrawal syndrome—- and goes on to say that there is no real evidence for such a syndrome, so it may be that the people are having OTHER psychiatric disorders that they are BLAMING on benzos.
      Gosh– I was even more respectful of your claims than that book is!

      Reply
  • November 1, 2013 at 11:29 am

    I respect the “addiction” point of view, I know there are many people out there that are trying to get help. I was not an abuser of the drug, I am a very conservative person by nature. I had one panic attack due to a new job & a very hard break up. Weeks/months after the attack I was fine UNTIL like an idiot I went to see a psychiatrist b/c I was talked into it by my family. They said I needed drugs and again I believed the ‘authorities’ After taking Buspare,Zoloft,Klonopin I was out of work for days/weeks feeling sick/anxious/dizzy/etc…! How come I never missed a day of work before taking these meds!?!? Then weeks after stopping those due to the side effects, a new dr gave me Xanax for the “symptoms.” After taking it for a few weeks daily I started getting stomach bloating, throat tightness, depression, anger, and SEVERE panic attacks that prompted me to call 911 and go to the ER multiple times. All of these are typical side effects of xanax IN THE LITERATURE! And the dr dismissed these as “anxiety” – THAT is a joke. Benzos are physically addictive so everyone who takes them for more than 2-3 weeks is “physically” addicted. You could have a seizure or die if you stop taking it and my dr NEVER told me that! Here is a pretty good explanation by a Dr. of the reason why prescribing benzos long term is no good >>>> http://www.youtube.com/watch?v=Z_nFpzZxPoQ

    Reply
    • November 1, 2013 at 12:41 pm

      Google ‘things I hate about benzos’. Benzos are not meant to be long-term meds– and I work as hard as anyone to get that point across.

      I suggest that you approach your problems logically— as I described. Have neuropsych testing done, and if there is a problem, I’ll help take a look at it. You are repeating yourself.

      Reply
      • November 1, 2013 at 4:35 pm

        Dr Junig, I read your post about “Why I hate Benzos” and I thank you for that. I wish more Dr’s were informed. Your line here describes what happened to myself as well as thousands others: ” Benzos turn manageable anxiety into an anxiety disorder.”

        Reply
  • November 1, 2013 at 2:09 pm

    There have been studies done that concluded that benzos can indeed cause long term cognitive impairment. They are also linked to a higher incidence of dementia later in life.

    It doesn’t take a degree in neuroscience to realize that these drugs can and do cause serious long term problems for some people that go well beyond some kind of PTSD memory imprinting thing.

    Reply
      • November 1, 2013 at 3:55 pm

        http://www.bmj.com/content/345/bmj.e6231

        http://www.sciencedirect.com/science/article/pii/S089543560100453X

        http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=283284

        http://www.ncbi.nlm.nih.gov/pubmed/19546656?dopt=Abstract&access_num=19546656&link_type=MED

        http://www.ncbi.nlm.nih.gov/pubmed/1978465

        http://www.ncbi.nlm.nih.gov/pubmed/7892364

        http://www.benzos.une.edu/documents/benzowithdrawalmetaanalysis.pdf

        “Results of the meta-analyses indicated that long-term benzodiazepine users
        do show recovery of function in many areas after withdrawal. However, there remains a significant
        impairment in most areas of cognition in comparison to controls or normative data. The findings of this study highlight the problems associated with long-term benzodiazepine therapy and suggest that previous benzodiazepine users would be likely to experience the benefit of improved cognitive functioning after withdrawal. However, the reviewed data did not support full restitution of function, at least in the first 6 months following cessation and suggest that there may be some permanent deficits or deficits that take longer than 6 months to completely recover”

        Reply
      • November 1, 2013 at 4:35 pm

        Do you even READ those studies? Or just look at abstracts?
        The first one for example, with a headline suggesting an association between benzo use and dementia…. an ‘association’ is not ‘causation’. The study itself points out: Benzodiazepines could also be seen as an early risk marker for dementia that might highlight a particular at risk background in patients, but without playing any causal role in the occurrence of the disease. For example, persistent anxiety in middle age has been shown to be associated with a greater risk of dementia in elderly people.43 Hence, benzodiazepine use may be a marker of this scenario and might help to identify people at increased risk of, and not already on the causal pathway leading to, dementia.
        They go on to say why in their opinion, that is not the only factor— but this whole example shows how people who don’t read studies for a living do not critically evaluate them– but rather pick sentences here and there to make a point.
        The same study points out a number of limitations of the study, including selection biases.

        Of the other links, a couple of them are about the acute effects of benzodiazepines on cognition– effects that the drugs are known to cause, and in fact the reasons for their use in many cases (for example during surgery).

        A couple of the links are no longer good— so whatever list you are collecting needs to be dusted off.

        You’ve heard the phrase ‘a little knowledge is a dangerous thing…’ I am a referee for several journals, i.e. I help make decisions whether studies are published. Some journals publish good data, some worse data… but I guarantee that anyone truly respected for scientific knowledge does more than read the abstracts.

        Not impressed.

        Reply
 

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