Long term effect on benzos and dose

[konings]

I take only 5mg valium daily or the xanax equivalent. Does this small a dose qualify for long terms effects of benzos at all? (the xanax equivalent is 0.25mg).

[Wooster]

Hi konings,

 

I think this is a challenging question to answer because each person has a different response to medications based on their individual physiology.

 

I'm sure there must be *some* research on the dose and length of time using benzos related to level of cognitive impairment. However, in my 5 minute internet search, nothing jumped out at me.

[Brokendishes]

I'm not a doctor...I just have been on Xanax for several years now... I'm not at a maximum dose, but it's more than what I would want to be on in a perfect world.  I don't know how long it takes or how much it takes to become physically addicted. I take my meds as I'm supposed to and would only take an extra .25mg if I had a death in the family or something that bad...

 

I can tell you that the memory loss is a fact...I don't know if it's reversable.   I notice I am more forgetful than before--I used to have a razor-sharp mind, but now things are cloudy--different things happening, what day, little bits and pieces just aren't there... My husband will bring up something from a fight 6 months ago--I can't remember it...I can vaguely recall a fight but not any specific details... In a way it's a good thing because I can't obsess over some comment or some incident that pissed me off--but it also bothers me that it takes me a second more now to recall a name or something like that... I'm sure part of it is stress, but I can definitely tell it's the Xanax too... Plus when you're on them, during the phase where the dose is peaking, I find that I can't collect my thoughts properly to 'fight back' or be really precise, if that makes sense?  Once the dose peaks and my levels are evened off, I can go back to zinging one-liners and being witty on demand.lol

 

I hear that they slow your motor reflexes too but I don't think it's true...I'm just calmer, like in heavy traffic, and can react as quickly as before, just without my heart popping out of my chest or my eyes shooting out on stalks.lol

 

The memory loss is a bit bothersome at times, but unless I was living on a nice tranquil island somewhere, I'll take a little brain fog over a total mental breakdown any day.

[crtclms]

Brokendishes, you don't get addicted due to the amount of a med you take. Addiction is a psychological and physiolgical (I can't spell) problem where a person goes seeking out a  med, and needs higher and higher doses of it to achieve the same effect. I think what we are talking about here is dependence. I just don't want you to think you can suddenly become a raging addict if your pdoc suggests a .25 rise in your dosage.

 

Anyway, someone can probably explain addiction better than I, but I don't think this is the problem in this case.

[socialpanda]

This is an interesting topic. I've done a lot of research of primary literature, and the major meta-analysis that report cognitive deficits in long term users had an average of a 17 mg dose across studies (as measured in valium dosing, the specific benzos varied and thus the dosing did, but were all averaged to that dose) which is clearly higher. Also I think the length of use average was somewhere around 9 years (with 1-34 range). This makes me think that a lot of the negative effects might be slightly overblown for someone taking a 5 mg dose (hopefully) in the short term.

 

HOWEVER, that said they did report significant cognitive deficits, basically on every possible test of cognition, with a variety of kinds of memory, critical reasoning, analysis, general intelligence, reaction time, etc... and a follow-up meta-analysis found improvements, but still significant problems on all of these tests after an average (across studies) of 6 months washout.

 

I think at the end of the day benzo brain damage works the same way as most other drugs that have that potential (alcohol, marijuana, MDMA, psychedelics, whatever) in that if you are using a low-medium dose, and are using it for short term, or PRN, you really shouldn't get too antsy, particularly if it manifests a tangible benefit for you. In cases of larger dosing and longer term usage, the benefits can still outweigh the cost, but in that case it becomes more of a personal decision.

[HAL9000]

So its like a glass of wine for dinner every once in a while vrs a 12+ pack of beer every night?   I totally get the need for Benzos but I'm surprised about daily users.  I thought that was what the Doctors want to avoid?   Buspar is supposed to be non addictive.  There are some others which I can't remember but wouldn't those be a good main daily thing? 

 

I'm curious why drugs (in general - Lipitor, Blood Pressure pills etc) seem to follow a trend with the patient.  Humm..  Not saying this well.   Is there any truth that some folks just need larger doses in general? 

 

*And I should add that I'm not talking about stepping up a dose over 5 or 10 years because it starts to be less effective.  The example would be BP is high so try minimum dose lets say 2mg.   No (or slight effect) so go to 5mg.   Still not really doing it so you go 10, 40mg (Which lets say is the Max sized tablet)  and its there that it works.  And for me it seems to be the SOP.   Which is maybe why I want to ask to go up from 4 mg PRN to 10  or 6 or whatever the change rate is supposed to be.

 

Is it how well your liver is working?  And a question I didn't think about tiill now but does needing high doses of everything mean your Liver is super great or its about to fail.

[San]

crtclms has a very good point.

 

5mg of valium is quite a low dose. It has a longer half life of the benzos. (Xanax, I believe, is the shortest) I've been on benzos for 11 years (ativan, valium, xanax and currently klonopin) at high doses, low doses, etc. I haven't noticed anything terribly awry. I function much better with them because without them I'd be shaking under my blankets.

 

Addiction is a complex topic. Some people are more prone to it than others. I generally pair addiction and abuse together, but that's my view, it's not necessarily correct or true.

[crtclms]

So its like a glass of wine for dinner every once in a while vrs a 12+ pack of beer every night?   I totally get the need for Benzos but I'm surprised about daily users.  I thought that was what the Doctors want to avoid?   Buspar is supposed to be non addictive.  There are some others which I can't remember but wouldn't those be a good main daily thing? 

 

I'm curious why drugs (in general - Lipitor, Blood Pressure pills etc) seem to follow a trend with the patient.  Humm..  Not saying this well.   Is there any truth that some folks just need larger doses in general? 

 

Benzos are used daily for GAD relatively often. Some pdocs will only use them short term, but some use them as long as they feel is appropriate. My pdoc put me on Xanax 2mg/day, with 1mg PRN in 2006, and that is the dose I have remained at. Most pdocs prefer clonezapam for long term treatment of anxiety, it has a longer half life, and is less prone to abuse. But I had a paradoxical reaction, and would fly into rages.

 

My dad had patients with GAD on as much as 6mg a day. Because I have been very compliant, and usually have more than half my prns left at the end of the month, my pdoc (and my dad) think it is an appropriate treatment. I also took a CBT class, but that is more for on-the-spot anxiety, not for maintaining daily equilibrium.

 

Buspar doesn't work for that many people, it is just that for those for whom it does work, it works well. For me, it was like taking sugar pills with side effects. I can't take SSRIs because they make me wacko. I've tried propranolol and atenolol, and had different, but equally bad side-effects. I guess AAPs are used for anxiety, but I don't know how widespread that was in 2006 (it could have been widespread, I just hadn't heard of it).

 

TheSystem, I believe ativan is actually the fastest acting, with the shortest half life. That is what my husbands epilepsy doctors give him for seizures. Well these days, I am shoving them in his mouth *after* seizures, to calm him down when he is in a fugue state, but that is also an appropriate use. He usually stops wandering around about 5 minutes after I manage to get one into him, and goes to bed.

 

I know next to nothing about valium and librium, so they could be fast, too.

[HAL9000]

How fast meds act is an interesting question.  I had some major surgery (Major ouch) and took some low dose narcotics.  They took about 15 minutes (Guessing) and would last about 3 hours.   I would be really interested if 15 minutes is what to expect with most drugs?   I've heard Xanax and Ativan work in a minute or two.  Never tried them (Would prefer not to)

[melissaw72]

How fast meds act is an interesting question.  I had some major surgery (Major ouch) and took some low dose narcotics.  They took about 15 minutes (Guessing) and would last about 3 hours.   I would be really interested if 15 minutes is what to expect with most drugs?   I've heard Xanax and Ativan work in a minute or two.  Never tried them (Would prefer not to)

 

If you put xanax under your tongue, it works instantly (either the regular pill, or the ODTs -- both can go under your tongue, but ODTs work better and taste better).  If you swallow xanax, it takes (took me) about 25 minutes to feel an effect.  I am currently on xanax 1.5 mg as needed every day, the ODTs.  My tolerance level doesn't build with it.  1.5 mg/day has been enough for awhile.  But some people do have high tolerance levels of it.

 

For me, narcotics acted fast, within 15-20 minutes, and lasted awhile.  But the longer I took them the less effective they became; tolerance level built up.  I eventually stopped those though.

[Wooster]

It depends on where it gets absorbed and how quickly the medicine moves into the bloodstream.

 

One of the things I remember from my wilderness first responder class is that antihistamines take about 15 minutes to be absorbed, so you'd better have a second dose of epinephrine available because a shot from an epi pen tends to only last about 10 minutes in most people... leaving about 5 tense minutes waiting for the antihistamine to kick in.