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Discussion Starter · #1 ·
I have some questions about benzos that I would like run by the pharmacology experts on this forum. You can skip to the last paragraph if this is too much psychobabble. There seems to be varying opinions concerning the addictive potential of the various benzos among online sources and the doctors I've had. My experience with being on nearly all of them at one time or another leads me to believe that while the effects of certain benzos may make them more desirable, and prone to abuse, the end result of daily use is an equal level of dependence, with variance in the manageability of withdrawal symptoms depending on potency and half-life.

Klonopin seems to be considered the least "addictive" by US doctors and their addiction specialist counterparts. This is in contrast to the information contained in the well known UK "Ashton Manual", which places Klonopin among the other high potency benzos as especially hard to manage vs. Valium as the least problematic. Valium seems to be the hardest to obtain from US doctors, probably due to its earlier years of being over-prescribed, eventually earning notoriety among doctors for being very addictive. Xanax is (I think) the most prescribed, yet well known to be the hardest to get off of and probably most abusable. Ativan, being frequently pushed instead, seems to have equal liability for inescapable dependence.

My benzo history (sorry its so long!):

My first psychiatrist absolutely would not give me anything but Librium after I told him of my extensive experience with non-prescribed drugs, including Valium & Xanax. My next doctor was a GP, he did not like the idea of constant Librium at all, instead giving me prn Ativan. This abrupt switch threw me into bouts of extreme withdrawal in between doses which I did not know what to attribute to at the time. Scared, I quite all meds for about 8 months until I moved to another city and began to experience problems with anxiety again. My next psychiatrist wanted to give me Xanax, which I did not want for long term therapy. He refused Valium, saying it is "the most addictive of all the benzos" and instead gave me Klonopin - lots of it. I was reffered to a "better" doctor by a therapist. He had no problem switching me from Klonopin to Valium, after complaining how Klonopin at an effective dosage caused me too much cognitive impairment and dullness of mood. I didn't directly ask for Valium, I just refused Ativan and knew by process of elimination he would land on it. Remarkably, he stated that he was "unaware of any subjective differences between benzos". I myself eventually initiated a taper off Valium in favor of very occasional Xanax, or so I thought. He cut off all benzos and left me on only my old, pooped-out antidepressants & Zyprexa - yuck. That trickster, after years of playing with the whole pharmacy, was done with his experiments. Recenly I visited a that plain old GP again. After briefly discussing my history of benzo use, and eventual taper off Valium, he offered me "a few". I asked for something that "didn't last so long". He told me the problem with that is the shorter acting benzos are too addictive. THIS IS THE SAME GUY GAVE ME ATIVAN IN PREFERENCE TO LIBRIUM! He gave me an inadequate dosage of Xanax, no refills. He also gave me Effexor which was supposed to leave me with no need for Xanax (yeah, right) - this was a complete disaster! I ended up taking more Xanax that I planned to manage and recover from the Effexor trial. I am still reeling from that experience and now in need of an actual psychiatrist who will prescribe benzos responsibly as I don't expect a solution from more of the usual suspect antidepressants alone for my anxiety.

The second paragraph of this post mainly concerns withdrawal & the various benzos. It is not as hard for me to understand whats going on there. I am trying to understand what exactly goes on during the path to dependence, how it may vary among benzos, and most importantly how to avoid it. I'll start with the questions that are at the top of my head:

Is there something inherent the pharmacology of benzos that makes some more pleasurable and reinforcing than the others or is this purely subjective? If so what exactly is going on biologically (other than the obvious -- potency, half life, slope of time to start / time to wear off)? Is there something unique about Xanax (my current benzo of choice) that would make it especially traumatic to the GABA system, causing a more viscious rebound-redose cycle or long term GABA imbalance?

Thanks for reading! :blah
 

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Is there something inherent the pharmacology of benzos that makes some more pleasurable and reinforcing than the others or is this purely subjective? If so what exactly is going on biologically (other than the obvious -- potency, half life, slope of time to start / time to wear off)?
My impression was that the shorter the time is from dose to peak effects, the more reinforcing it is. Other factors include benzo half-life and accumulation rate -- if it accumulates greatly and has a long half-life (like Valium), individual doses can be smaller and a more constant effect is achieved rather than massive spikes after every dose. I'm sure there are other factors too, such as the individual pharmacology of each benzo (e.g. which GABA subunits/subtypes they act upon).

A highly reinforcing & addictive benzo would have a short half-life, rapid onset of effects and low accumulation in the body.

How long did you try the antidepressant(s) for, by the way?
 

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Yes, there are a number of studies demonstrating that the perception of potency of any psychotropic drug is largely affected by how quickly the effects peak.

Think of it as that whole frog in boiling water thing. You drop a frog in boiling water, it's going to jump out, but dropping it in lukewarm water and slowly bringing it to a boil, it's not going to take as much notice of it.

Drugs with a shorter half-life are also seen as more "addictive" because the withdrawal symptoms are more severe, as the drugs clears the body at a much faster rate. This is why if you're tapering off a drug with a very short half-life, it's usually advisable to switch to something with equivalent effects but a much longer half-life, and taper off of that instead.
 

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Discussion Starter · #4 ·
How long did you try the antidepressant(s) for, by the way?
Since the beginning, about 4-5 years total. I've tried every SSRI, Wellbutrin, and Effexor. The only time I've been on them without a benzo was after the Valium taper - Wellbutrin-Celexa combo. I stopped taking them soon after. Celexa/Lexapro have never done much for me, and Wellbutrin completely stopped working. I feel no better or worse without them.

I would like to see if I can make the transition to ADs alone, because I do feel I need some med support to achieve healthier daily mental status. It is likely that I haven't given my brain a fair chance to completely recover from those years of benzos, and its hard to tell exactly where my current anxiety issues are coming from - rebound from current non-daily use or varying levels due to relative amount of recent social exposure vs. isolation.

And there is also the Zyprexa factor. That helped me calm down and worry less (GAD symptoms). No longer experiencing actual psychosis, I stopped - and still am fighting insomnia which I choose over weight gain and mental impairment.

I'm currently considering Mirtazapine, perhaps adding an SSRI and or Wellbutrin at some point. It depends on what my future doctor is willing to try.
 
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