KLONOPIN OR BUSPAR ?

[lebonvin]

Hi Ian

Point taken but I still ain't convinced. I wanna read more but that scientific stuff is too hard for me to take in

Just to make sure we never misunderstood - I'm saying that an anti-anxiety dose of a benzo last max 2 months, but your saying it last longer than that?

A question I was gonna ask you anyway so I'll ask here.

If your starting an AD for the first time, how long should you wait before giving up on it if it don't work?

If your switching from a SSRI to a new SSRI or in my case a SNRI to a new SNRI, how long?

If changing class of AD, how long?

Thanks

[panic_down_under]

Just to make sure we never misunderstood - I'm saying that an anti-anxiety dose of a benzo last max 2 months, but your saying it last longer than that?

Yes. Years. Though it depends on the BZD. The short acting ones such as alprazolam (Xanax) tend to poop out much sooner than the longer acting diazepam, clonazepam and chlordiazepoxide.

Something to contemplate. BZDs work because our brains have BZD binding sites. These haven't been in our brains since the dawn of humanity just waiting for us to develop the drugs. They are there because there are small amounts of benzodiazepine compounds in most of the things we eat, particularly diazepam and lorazepam and their respective metabolites, originating in plants and flowing up the food chain. My guess is that benzodiazepines are a plant poison to which animal life, Homo sapiens included, have become so adapted to that we can no longer function without them. If you could eat a natural BZD free diet you would die a pretty horrific, seizure racked death. Fortunately, natural BZDs are so ubiquitous that this is impossible.

While the quantities we get from food are small, they are not insignificant. Natural BZD levels can reach pharmaceutical levels in patients with some liver diseases ¹. So high in fact that medical intervention may be required ². If tolerance was as big an issue as you believe then we would be having to constantly increase our dietary intake to maintain the status quo or succumb to terrible bouts of anxiety and convulsions.

If your starting an AD for the first time, how long should you wait before giving up on it if it don't work?

Well, you can't really claim an AD doesn't work until you've been on the highest recommended dose for 8-12 weeks as some people, e.g. me, only respond to near, at, or over the maximum, but that's a long wait. More practically if there are no hints of a positive response after 8-12 weeks at a more typical therapeutic dose for that med then the odds aren't good.

If your switching from a SSRI to a new SSRI or in my case a SNRI to a new SNRI, how long?

Assuming it is an overnight, or short cross-taper switch from the typical therapeutic dose, to the equivalent of the new one then 5-8 weeks. If it is stopping drug A before beginning drug B then it's effectively the same as starting from square one. The only time this is essential is when switching to/from a MAOI class AD, but most GPs and many psychiatrists, ime, insist on changing ADs that way, presumably because they don't know any better, through fear of serotonin syndrome, or simply a lack of confidence.

If changing class of AD, how long?

This is trickier because effective dose equivalents can be much less certain so more playing around with doses may be required, however, 5-8 weeks plus the adjustment time.



References:

[1]
Baraldi M, Avallone R, Corsi L, et al (2000)
Endogenous benzodiazepines.
Therapie Jan-Feb;55(1):143-6 (Abstract)

[2]
Zeneroli ML, Venturini I, Stefanelli S, et al, (1997) Antibacterial activity of rifaximin reduces the levels of benzodiazepine-like compounds in patients with liver cirrhosis. Pharmacol Res , Jun;35(6):557-60 (Abstract)
[Note: no benzodiazepine synthesizing gut flora has ever been isolated despite much searching and they almost certainly don't exist in humans, and rifaximin probably reduces BZD by improving liver function, not killing such flora as the authors propose]