Dependancy v Addiction

[akb]

From what I understand, dependency on a drug means you can't suddenly stop taking it without getting withdrawal symptoms, but the dosage remains constant and presumably effective. Addiction is the same except that you have to keep raising the dosage to get the same effect

Is this correct?

Benzos are known to be addictive. But is it possible to be on a constant effective dose without needing to increase after a certain period? Typically, how long is a benzo effective for? After a while, does placebo effect set in?

Thanks for replies in advance. I know PDU will be able to offer some insight

[panic_down_under]

Addiction is the same except that you have to keep raising the dosage to get the same effect

That is only one part of it, and a minor one. The main ones are:

: Loss of control over taking the drug

: Compulsion - getting and using the drug becomes the most import thing in the person's life, crowding out relationships and activities that were once important to them. Getting the next hit becomes all consuming

: Consequences - continuing using the drug despite it causing problems in relationships, with physical or mental health, legally, or with work


Benzos are known to be addictive.

Most don't in fact become addicted to benzodiazepines, not needing either to increase the dose over time, take less over time is much more common, nor being unable to control their intake.

OTOH, aspirin can be truly addictive with people being unable to stop taking it even when doing so will lead to certain death, as this study (http://www.gastrojournal.org/article/S0016-5085(98)70307-5/fulltext) demonstrates. Very few taking BZDs would continue if the med caused serious physical injury requiring surgery, or threatened life, as those patient's did. This has become such an issue that the gastroenterology associations in most countries discourage members from repairing aspirin induced ulceration until the patient is able to demonstrate they have overcome their addiction.

NOTE: this doesn't mean aspirin should never be used. Those taking it occasionally for pain relief will never run into problems, but long term daily use may become problematic for a few.


But is it possible to be on a constant effective dose without needing to increase after a certain period?

As per above, most do not need to keep increasing their BZD dose. Tvete IF (https://www.ncbi.nlm.nih.gov/pubmed/26683285), 2015, found 2.3% escallated their BZD intake over a 5 year period with those on shorter acting BZDs at most risk. Even the harshest BZD critics acknowledge tolerance/dose escalation is uncommon. According to an article -Benzodiazepines on trial (http://www.benzo.org.uk/tyrer1.htm) -on a certain well known anti BZD site, [i]"The typical pattern of a drug dependence syndrome, with drug seeking behaviour, rapid tolerance, and escalation of dosage, is rare (according to Marks's calculations, one in every 5 million patient months "at risk")". To put that into perspective, if all 314 million Americans took BZDs for 10 years, about 7,500 would develop tolerance. I think that is probably very conservative with the true figure being at least 10 times higher, but even at 100 times it would still not be a major issue.

[akb]

Hi PDU

thats interesting and informative

so why do you read so often that benzos are 'only for short term relief of anxiety'? is this misinformation, or fear of a benzo being used as a recreational abuse drug? does the efficacity of benzos not decrease over time? can drinking alcohol while on them diminish their efficacity?

thanks

akb

[panic_down_under]

so why do you read so often that benzos are 'only for short term relief of anxiety'? is this misinformation,

It is to some extent. BZDs have been much demonised in recent years, especially in Britain. That said, I do think antidepressants and antihistamine sedatives such as mirtazapine are the better option...provided they work. Unfortunately, about a third don't respond to them. The same is true for therapy, with a considerable overlap in those failing to benefit from either. For them, BZDs are, imho, a better option than antipsychotics, or spending their lives in fear.


or fear of a benzo being used as a recreational abuse drug?

There are few who only abuse BZDs. Mostly they are used to ease the withdrawal from other illicit drugs, or moderate their side-effects.


does the efficacity of benzos not decrease over time?

In most cases, no.


can drinking alcohol while on them diminish their efficacity?

Yes, both by a direct drug-drug interaction, and also by exacerbating anxiety. While alcohol is by far the most (self)prescribed anti anxiety and depression drug, it actually makes both worse. Anxiety/depression and alcohol feed off each other frequently causing both to spiral out of control.

Drinking while on BZDs is also potentially very dangerous as both drugs suppress the brainstem which, among other things, produces the breathing reflex. Taking both can trigger a synergistic effect which greatly increases the risk of falling asleep and asphyxiating. And if that gives anyone an unfortunate idea, there is a substantial risk of surviving but with debilitating brain damage! :ohmy:

[akb]

Hi PDU

Thanks for your explanations, which pretty much concur with my own experiences and what I've been told by psychs and pharmacists in different countries.

The asphyxiation thing actually happened to me, I'd wake up in the night unable to breath. I put it down to house dust at the time. Haven't touched alcohol for over a year now but ironically not out of choice.

My final benzo question is, do they make you feel miserable? Its already established that they affect the efficacity of ADs. My psych made me come off xanax (cold turkey) when he put me on venlafaxine, for the above reason. He also said it was OK to drink a little alcohol to take the edge off.

[panic_down_under]

My final benzo question is, do they make you feel miserable?

They may do. BZDs are CNS depressants which can sometimes trigger depression.



My psych made me come off xanax (cold turkey) when he put me on venlafaxine, for the above reason.

I find it interesting that venlafaxine is considered a better choice than the supposedly "addicting" BZDs when it can be one of the two hardest antidepressants to quit. For some more difficult that the BZDs! Jumping from the frying pan into the fire comes to mind. :weep:


He also said it was OK to drink a little alcohol to take the edge off.

I'll give him credit for knowing BZDs reduce antidepressant efficacy, though I suspect he doesn't really understand why. But he loses a lot of points for insisting you quit Xanax cold-turkey as inflicting such misery is psychologically, and potentially physically, harmful and it wasn't really necessary anyway. And he loses even more for recommending alcohol.

BZDs reduce the effectiveness of antidepressants by blocking hippocampal neurogenesis which is what creates their therapeutic response (see: Boldrini M (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/), 2014; Nochi R (https://www.ncbi.nlm.nih.gov/pubmed/23963779), 2013; Sun Y (https://www.ncbi.nlm.nih.gov/pubmed/23639432), 2013; Wu X (http://www.biologicalpsychiatryjournal.com/article/S0006-3223(09)00106-1/abstract), 2009; Stefovska VG (https://www.ncbi.nlm.nih.gov/pubmed/18991352), 2008). So does alcohol, with even moderate drinking reducing (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568748/) hippocampus neurogenesis by nearly half (see also: Morris SA (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861155/), 2010; Crews FT (https://pubs.niaaa.nih.gov/publications/arh27-2/197-204.htm), 2003).

[akb]

Hi PDU

Yep I agree. Because I was seeing psychs in 2 different countries, the one who took me off the xanax wasnt listening when I told him Id been taking for a year. The ensuing nightmare was indescribably awful.

Im slowly and successfully weaning off pregabalin now. Then Ill get off the klonopin. Ill be asking your advice on which AD to switch Cymbalta with at a later date. You actually mentioned Lexapro or a TCC in another thread, it was imapramine or chlorepramine. But I havent got there yet.

Btw, I took lofepramine for 5 years and got off it completely for a year. Then got ill again, retook it, and it didnt work. Psych said "Its working but you dont notice it"

any comments?

akb

---------- Post added at 07:35 ---------- Previous post was at 06:54 ----------

And one final (I think) question

Is it ok to take benzos when starting a new AD if a spike in anxiety is one of the new AD side effects? Or better to rough it until it kicks in?

[panic_down_under]

Btw, I took lofepramine for 5 years and got off it completely for a year. Then got ill again, retook it, and it didnt work. Psych said "Its working but you dont notice it"

It happens. Why is still a mystery. Did you take up to the maximum recommended 210mg/day for at least 2 months?


Is it ok to take benzos when starting a new AD if a spike in anxiety is one of the new AD side effects? Or better to rough it until it kicks in?

Take the BZD. Better to delay kick-in a little than not being able to stay on the AD.

[akb]

Yep, took max for 5 months. Then tofranil which didnt do it, paxil 2 weeks couldnt handle, ended up on venlafaxine.

Now been 16 years on SNRI and Cymbalta pooped out ages ago.