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Dr. Bob is Robert Hsiung, MD,
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Posted by Fred23 on February 24, 2005, at 18:59:56
http://www.nytimes.com/2005/02/22/health/psychology/22benz.html
February 22, 2005
A Host of Anxiety Drugs, Begat by Valium
By NICHOLAS BAKALARAmong famous inventors, Leo H. Sternbach may not immediately leap to mind.
But this May in Akron, Ohio, Dr. Sternbach, who is 96, will be inducted into the National Inventors Hall of Fame. He holds more than 240 patents, but perhaps his most famous invention, in collaboration with colleagues, is a chemical compound called diazepam, better known by its brand name, Valium.
One of the earliest benzodiazepines, Valium was approved by the Food and Drug Administration in 1963 as a treatment for anxiety, and it would become not only the country's best-selling drug, but an American cultural icon.
Referred to knowingly in Woody Allen movies, enshrined as "Mother's Little Helper" in the Rolling Stones song, condemned as poisonous in best-selling books, Valium reached the height of its popularity in 1978, a year when Americans consumed 2.3 billion of the little yellow pills.
But by the 1980's its reputation for creating abuse and withdrawal problems was well known, and the new selective serotonin reuptake inhibitors like Prozac were widely considered better treatments for anxiety and panic disorders.
Still, the benzodiazepines - there are now more than a dozen others available besides Valium - never disappeared. They are still widely prescribed and, in the view of many doctors, extremely effective in treating not only anxiety and panic disorder, but bipolar illness, insomnia, catatonia and alcohol and drug withdrawal.
"The key is to use them correctly," said Dr. Eric Hollander, director of clinical psychopharmacology at Mount Sinai School of Medicine in New York.
Using them correctly is not so simple. Benzodiazepines cause sedation, which can be either therapeutic or a side effect, depending on the patient's ailment. Dr. Steven Roose, professor of clinical psychiatry at Columbia University, said that for anxiety the "S.S.R.I.'s are still the first-line treatment, but they can initially cause an exaggeration of anxiety symptoms."
"Pretreating with benzos can prevent this," Dr. Roose continued, citing Ativan, which "can be used for the sleep problems that S.S.R.I.'s can cause, although it should be used only for a brief term."
The use of benzodiazepines in drug withdrawal may seem paradoxical, since they can be addictive themselves.
But the newer longer-acting benzodiazepines like Klonopin may have fewer withdrawal problems than the older drugs because they are metabolized more slowly and leave the body gradually.
Even though they don't usually induce euphoria, benzopiazepines can become street drugs of abuse for their sedating effect, and some cocaine users like them to "chill out."
The benzodiazepines can also impair motor function, especially during the first weeks of treatment, and cause temporary memory impairment. The drugs do not help with depression, so those with both anxiety and depression, a common combination, may be better off with the double effect of the S.S.R.I.'s.
People who use alcohol as self-medication for anxiety are not good candidates for benzodiazepines, which can be deadly when combined with drinking.
Perhaps most notoriously, there is the danger of addiction, but some believe that may be exaggerated.
"My view is that the risk of dependency and tolerance is overblown," said Dr. Michael Craig Miller, assistant professor of psychiatry at Harvard and editor in chief of The Harvard Mental Health Letter. "People being treated for anxiety are not looking for a high; they're looking for relief from their anxiety symptoms, and if benzos give it to them, that's good."
Copyright 2005 The New York Times Company
Posted by Colleen D. on February 24, 2005, at 19:55:34
In reply to A Host of Anxiety Drugs, Begat by Valium (NY Times, posted by Fred23 on February 24, 2005, at 18:59:56
Posted by Phillipa on February 24, 2005, at 20:03:02
In reply to A Host of Anxiety Drugs, Begat by Valium (NY Times, posted by Fred23 on February 24, 2005, at 18:59:56
Exactly what I've said in all my Threads. If anxiety is your main problem you will only take enough of the drug to eliminate your anxiety. Untreated, it leads to depression. Valium is longer acting than klonopin and a taper is used in getting off of alchohol and xanax as examples. Stop the offending substance, and start valium. Increase it as needed till a level is established that is tolerable. The offending drug is being eliminated by the body. Then slowly begin tapering the valium down. Fondly, Phillipa
Posted by Nixon on February 24, 2005, at 20:30:16
In reply to A Host of Anxiety Drugs, Begat by Valium (NY Times, posted by Fred23 on February 24, 2005, at 18:59:56
Hi,
An interesting article. I can't believe the author left out perhaps the most important detail of all, Leo Sternbach discovered Librium long before valium was synthesized. The compound for librium was almost accidentally thrown out in 1957 by an assistant of Sternbach. benzo.org.uk has the whole Librium story which makes for interesting reading. You can also just search the web for 'Who discovered Librium'. Valium may have sold better but Librium was the first benzo of all. Nice article though. JN
Posted by Phillipa on February 24, 2005, at 20:44:45
In reply to Re: A Host of Anxiety Drugs, Beg by Librium (NY T » Fred23, posted by Nixon on February 24, 2005, at 20:30:16
I remember librium. Way back in the 70's when I had my first panic attack they started me on valium. I can't remember exactly what happened, but i suspect I was not responging. So, they switched me to librium. It didn't work as well for me. That was probably when they switched me back to valium and added 450mg of meprobomate. This worked for me and I was able, over a course of time to eliminate the meprobomate, and then cut down on valium a little at a time until I was only on 5mg a day. Fondly, Phillipa
Posted by Nixon on February 25, 2005, at 17:08:13
In reply to Re: A Host of Anxiety Drugs, Beg by Librium (NY T » Nixon, posted by Phillipa on February 24, 2005, at 20:44:45
Phillipa,
That's interesting. How is valium working for you now and how much do you take? JN
Posted by Phillipa on February 25, 2005, at 17:38:18
In reply to Re: A Host of Anxiety Drugs, Beg by Librium (NY T » Phillipa, posted by Nixon on February 25, 2005, at 17:08:13
At the moment, I am taking 5mg in the am and l0mg in the pm along with l5mg of remeron and chloral hydrate. I see the pdoc on Monday and have to tell her that I am taking an extra 5mg at bedtime from an old script. Others here, have suggested that I eliminate the chloral hydrate, as you develop tolerance after taking it for long periods, and increase the valium. I hope the pdoc will agree. I would also like to try Luvox again for my OCD. Of course, maybe this would decrease if my anxiety also decreased. Fondly, Phillipa
Posted by Nixon on February 25, 2005, at 18:08:31
In reply to Re: A Host of Anxiety Drugs, Beg by Librium (NY T » Nixon, posted by Phillipa on February 25, 2005, at 17:38:18
> At the moment, I am taking 5mg in the am and l0mg in the pm along with l5mg of remeron and chloral hydrate. I see the pdoc on Monday and have to tell her that I am taking an extra 5mg at bedtime from an old script. Others here, have suggested that I eliminate the chloral hydrate, as you develop tolerance after taking it for long periods, and increase the valium. I hope the pdoc will agree. I would also like to try Luvox again for my OCD. Of course, maybe this would decrease if my anxiety also decreased. Fondly, Phillipa
Maybe an increase in Valium will help. I think the luvox will help. I took Luvox about 5 years ago for around 6 months and it was positive. As for chloral hydrate the posters might have a point. The Luvox makes sense not just to decrease anxiety but in the reverse limiting obsessing about how much anxiety you may have. That concept may have substance, provided that thinking about anxiety which leads to physical symptoms is a problem for you. Remeron works well for my anxiety, as an adjunct. JN
Posted by Phillipa on February 25, 2005, at 18:19:03
In reply to Re: A Host of Anxiety Drugs, Beg by Librium (NY T » Phillipa, posted by Nixon on February 25, 2005, at 18:08:31
Makes sense to me. Thanks for your caring input. Fondly, Phillipa
Posted by SLS on February 26, 2005, at 7:04:05
In reply to Re: A Host of Anxiety Drugs, Begat by Valium (NY Times » Fred23, posted by Phillipa on February 24, 2005, at 20:03:02
> But the newer longer-acting benzodiazepines like Klonopin may have fewer withdrawal problems than the older drugs because they are metabolized more slowly and leave the body gradually.
This is a very simplistic "guess" on the part of the author as it relates to the degree of difficulty discontinuing a drug. There are other properties of these drugs that factor into it. Buspar is an anxiolytic that has a very short half-life, yet is almost entirely without withdrawal symptoms. Getting off Dalmane, a benzodiazepine with a very long half-life, can be hell to get off of.
- Scott
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