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These are short stories detailing personal experiences or interesting news stories on a variety of health topics that you feel may be helpful or inspirational to others. Our community will vote on the stories using one of the following 3 criteria - Heartfelt, Informative or Motivational. Stories with most votes rise to the top of the home pageTags are short descriptive words or labels that you add to your story to make it easier to find laterThe more tags you add, the easier it would be for others to find.
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You can see a list of all your tags in My Tags section of your My Home section. Xanax, one of the most commonly prescribed medications in the country, has been associated with confusion, paranoia, depression, hostility and forgetfulness while a person is taking it. Sudden withdrawal from such antianxiety agents can be living hell for some people. We have received letters from readers reporting nerves "jumping," muscle twitching, feelings of disorientation, fear, insomnia, anxiety, agitation and even seizure
The Xanax Studies
On reading Upjohn's eight-page advertisements in psychiatric journals about its FDA studies, I was struck by something odd. At the top left of one page is a statement that drug evaluations were made at "weeks 1, 2, 3, 4, 6, and 8 of therapy." This gave the immediate impression that Xanax must have been proven effective at eight weeks. But the chart beneath this statement records only the first four weeks. Nowhere in the advertisement is there any discussion of the results after the full eight weeks. Then, at the bottom of the page, there is this explanation: "Because of the high rate of placebo dropouts, week 4 (the last evaluation point where the majority of patients remained in the placebo treatment group) was considered the study 'end point' for efficacy analyses."
In other words, Upjohn was counting only the first four weeks of the study and discarding the final results at eight weeks. Why would Upjohn want to do this?
I was shocked at what I found when I studied the original research report. By the end of the eight weeks, the sugar-pill patients were doing about as well as the drug patients. Indeed, the placebo patients were far better off, because they did not suffer the severe withdrawal and rebound reactions, including an increase in anxiety and in phobic responses, plus a 350 percent greater number of panic attacks.
In an unusually negative reaction to a highly touted study, an international group of eleven psychiatrists and psychologists, led by Isaac M. Marks from the Institute of Psychiatry in London, wrote a two-page letter in the July 1989 Archives of General Psychiatry criticizing and largely dismissing the Xanax study. They point out that "at the last week after taper [drug withdrawal], patients receiving alprazolam were in a worse state than patients receiving placebo, in terms of panic (350% worse, in table I of the article by Pecknold et al.), phobias and Hamilton anxiety (other measures were not reported)."
In summary, the FDA Xanax study really shows that most patients were better off if they had never taken the drug. None of this is obvious in reading the actual study by James C. Ballenger and his colleagues. In the introductory abstract, no mention is made of Xanax's effect beyond four weeks. And yet the abstract describes the drug as an unqualified success.
Faced with their own negative results, the Xanax investigators came up with statistical manipulations to show how the data really should have - but didn't - come out at eight weeks; but apparently they were embarrassed by these efforts, and they limited the summary and conclusion of their report to data from the first four weeks. As noted, the drug company, with whom they were working closely, followed suit.
In their lengthy critique of the study in the Archives of General Psychiatry, Marks and his colleagues point out that a few weeks of relief is hardly worth the consequences of withdrawal and worsening symptoms, especially when the patients had been suffering from anxiety problems for an average of nearly nine years.
Furthermore, they point out that any hoped-for benefit must be balanced against known and unknown dangers of long-term use, including the possibility (see above) of brain shrinkage from chronic benzodiazepine use.
Marks and his colleagues summarize, "The unqualified conclusions about efficacy based solely on short-term partial gains in a chronic condition seems biased and arguable."
More Problems with the Xanax Study
As discussed in chapter 8, most people think that FDA drug trials extend for many months or years rather than a few weeks. According to Ballenger and his colleagues, most psychiatrists were giving Xanax for a period of three months to a year before tapering or discontinuing it. Yet Upjohn itself limited its data analysis on efficacy to a mere four weeks. It merits reemphasis: FDA approval does not mean that the drug has been tested with controlled studies for anywhere near the length of time that it typically is prescribed by doctors.
The size of the sample is also a problem, especially in regard to testing for negative side effects. While most people think that FDA-approved drugs have been tested on thousands or tens of thousands of patients, the actual sample size is described in Upjohn advertisements as "more than 500 patients." In fact, only 226 patients took Xanax for the length of the main study. That is hardly a sufficient number to test for relatively infrequent but potentially serious side effects. For example, a side effect that causes death in 0.5 percent of drug patients could easily escape showing up in such a small sample, but it would kill five thousand of the first one million people to take the drug. And, of course, a side effect that doesn't appear until after eight weeks would be missed completely.
Xanax's addictive effects became a serious problem even during short, eight-week trials. J. C. Pecknold and his associates found that even a gradual four-week period of withdrawal did not prevent a "worsening of symptoms" and that "some, in fact most, patients experienced relapse." Thirty-five percent of the patients had "mild to moderate" withdrawal symptoms. Thus after only two months of treatment, a large percentage of the patients were becoming addicted to the drug.
The warning given by Upjohn for Xanax in the 1991 PDR states: "If benzodiazepines are used in large doses and/or for extended periods of time, they may produce habituation and emotional and physical dependence." However, the data actually indicate that physical dependence very frequently develops without "large doses" and before "extended" periods of treatment. Furthermore, there is no hint in the PDR that Xanax is especially addictive.
Writing in The New Harvard Guide to Psychiatry, George Vaillant indicates that the public is unaware of the addictive qualities of minor tranquilizers, including Xanax: "Contrary to popular belief, physical dependence on diazepam (Valium), chlordiazepoxide (Librium) and especially alprazolam (Xanax) does occur" (p. 711). Because the public is relatively ignorant of the problem and because Xanax is "especially" likely to addict, Upjohn should have made the danger as emphatically clear as possible.
Pecknold and his colleagues recommend that treatment with Xanax be routinely extended for six months, to be followed by very slow withdrawal. This adds up to a minimum period of treatment approaching one year. In short, the authors recommend many months of treatment for a drug whose beneficial effect over a placebo was shown to decline to nothing at eight weeks! Furthermore, as Pecknold and associates admit, the increased length of treatment could be expected to worsen the addiction and withdrawal problems. A genuine concern for the patients should have led these investigators to the opposite recommendation: that in order to avoid withdrawal and addiction, the drug should be used for very short periods of time (such as a few days) or not at all.
PROTOCOL FOR TREATMENT OF XANAX WITHDRAWAL
By: Ronald A. Gershman, M.D.
PLEASE NOTE THAT WE DO NOT HAVE A DATE FOR THIS ARTICLE
BUT THERE IS VERY VALUABLE INFORMATION IN IT.
ADDITIONAL DUE DILIGENCE SHOULD ALWAYS BE DONE TO TRY TO CONFIRM RESEARCH
SUCH AS THE FOLLOWING EVEN THOUGH THE DOCTOR
APPARENTLY PRACTICED AT CEDAR SINAI HOSPITAL IN LOS ANGELES
BACKGROUND
Xanax is a triazolobenzodiazepine that is very similar to other benzodiazepines
in most of its properties, but does have some properties that distinguish it from
the group in general, which are specifically its anti-panic and
anti-depressant properties. As an anxiolytic or anti-anxiety agent,
it functions more or less indistinguishably from other benzodiazepines.
In that capacity, it is a relatively short-acting anti-anxiety agent
with a half life of somewhere between 8 and 12 hours.
Xanax, when administered on a regular basis, will produce physiological dependence
with a severe withdrawal syndrome that relates to both dose and duration of usage,
with duration being more important than actual dosage.
Higher doses will produce more rapid physiologic addiction than lower doses,
but severe levels of physical addiction can occur in
even the low therapeutic range of dosaging at 1 mg. or 2 mg. per day.
Average length of time necessary to occur to the extent that the patient will
clinically experience clearly noticeable symptoms of withdrawal is
approximately four to six months at dosages between 2 mg. to 4 mg.
If there is a history of addiction to benzodiazepines, an addiction can occur
much more rapidly over a shorter period of time,
with a more intense withdrawal.
Since Xanax is a relatively short-acting agent, the symptoms of withdrawal have
a relatively rapid onset and rapidly accelerate, producing
severe dysphoria and symptoms of withdrawal in the patient beginning at
approximately six hours from the last dose and generally peaking at
approximately 24 to 72 hours after discontinuation.
What has become clinically apparent with Xanax which appears to be somewhat different
than the other benzodiazepines is that the patients ability to
self-detox or be able to be gradually tapered off of the medication is markedly more difficult.
Thusly, once the physiologic dependence has occurred with Xanax,
the ability of the patient to discontinue use successfully on their own is quite low,
and m
Question(s): Written by: Prof. Heather Ashton, University of Newcastle, Department of Neurology, Neurobiology & Psychiatry First version: 26 Nov 2006. Latest revision: 18 Jul 2007.
Why should you come off benzodiazepines? How difficult is withdrawal from Xanax, Valium, Rohypnol and other benzodiazepines? What are the symptoms of Xanax/Valium/Rohyponol/Oxazepam withdrawal? Answer: Long-term use of benzodiazepines can give rise to many unwanted effects, including poor memory and cognition, emotional blunting, depression, increasing anxiety, physical symptoms and dependence. All benzodiazepines can produce these effects whether taken as sleeping pills or anti-anxiety drugs. Furthermore, the evidence suggests that benzodiazepines are no longer effective after a few weeks or months of regular use. They lose much of their efficacy because of the development of tolerance. When tolerance develops, "withdrawal" symptoms can appear even though the user continues to take the drug. Thus the symptoms suffered by many long-term users are a mixture of adverse effects of the drugs and "withdrawal" effects due to tolerance. The Committee on Safety of Medicines and the Royal College of Psychiatrists in the UK concluded in various statements (1988 and 1992) that benzodiazepines are unsuitable for long-term use and that they should in general be prescribed for periods of 2-4 weeks only. In addition, clinical experience shows that most long-term benzodiazepine users actually feel better after coming off the drugs. Many users have remarked that it was not until they came off their drugs that they realised they had been operating below par for all the years they had been taking them. It was as though a net curtain or veil had been lifted from their eyes: slowly, sometimes suddenly, colours became brighter, grass greener, mind clearer, fears vanished, mood lifted, and physical vigour returned. Thus there are good reasons for long-term users to stop their benzodiazepines if they feel unhappy about the medication. Many people are frightened of withdrawal, but reports of having to "go through hell" can be greatly exaggerated. With a sufficiently gradual and individualised tapering schedule, as outlined below, withdrawal can be quite tolerable, even easy, especially when the user understands the cause and nature of any symptoms that do arise and is therefore not afraid. Many "withdrawal symptoms" are simply due to fear of withdrawal (or even fear of that fear). People who have had bad experiences have usually been withdrawn too quickly (often by doctors!) and without any explanation of the symptoms. At the other extreme, some people can stop their benzodiazepines with no symptoms at all: according to some authorities, this figure may be as high as 50% even after a year of chronic usage. Even if this figure is correct (which is arguable) it is unwise to stop benzodiazepines suddenly. The advantages of discontinuing benzodiazepines do not necessarily mean that every long-term user should withdraw. Nobody should be forced or persuaded to withdraw against his or her will. In fact, people who are unwillingly pushed into withdrawal often do badly. On the other hand, the chances of success are very high for those sufficiently motivated. As mentioned before, almost anyone who really wants to come off can come off benzodiazepines. The option is up to you. More informationStepwise dose reducal plan Articles about benzodiazepines Types of withdrawal symptoms Articles about benzodiazepines Articles about psychiatric drugs Pages of interest from other web sites(will open in a new window or tab)A detailed plan for Benzodiazepam withdrawal
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2 Years, 8 months, 1 Week, 4 days ago
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