Re: Long term dependency on benzo's, do benefits outweigh the risk?

[jm1953]

Hello members:

I posted this in long-term survivors, perhaps it should be in treatment and side effects, or even mental  health.  Have to let the moderators figure that out.  Just figured this issue may go hand and hand with us long-termers.

In addition to the antiretrovirals I have been taking for AIDS since 1996, my HIV physician added an anti-depressant and clonazepam 1mg three times a day since 2000.  He recently bumped me up to Clonazepam 2mg three times a day about a month ago because of a bunch of extra stress I have been going through.  He also added Alprazolam Xanax 1mg twice a day PRN which I haven't started taking.

In addition I take Ambien CR nightly for sleep for three months instead of PRN which I guess also can be addictive.

After recently visiting a benzo withdrawl site, I don't think I ever knew what I was in for.  Withdrawing from clonazepam especially at a high dosage of 1 mg or 2mg three times a day for years can be a serious and life threatening if not done correctly according to what I have read.  I have even joined a forum concerning this out of suddenly feeling controlled by these substances.

I guess my question to my long-term buddies in this forum, should I really be concerned about this in light of all the other physical issues we are all dealing with from the virus, like taking all the pills we have to take daily to keep the virus under control, then more for the side effects?  And all the stress involved in our lives also to compound everything?  Maybe I shouldn't worry about it and just go on taking these as prescribed.  Perhaps what my doc says is true, the benefits outweigh the risks.

Just wondering what you might do in my shoes.   I don't know if I can detox on my own, and I don't know if I can live without anti anxiety meds because of the way my life is right now.

Thanks for any input,

Hugs,

Jeff

[Miss Philicia]

I'm confused.  Are you saying you take just 2 mg of klonopin/day, or 2 mg three time a day (total of 6 mg)?  You seem to say both up above.

Just 2 mg/day isn't that high and you should be able to slowly ween off of it if/when you decide to do so.  6 mg/day is fairly high, though I've heard of people on that amount.

So you're "dependent" on them -- you're dependent on HAART too.

[darkerpozz]

Hey, I feel for you because I too have been on HART and antidepressants for ten years and I just don't like the way I am feeling any longer but I feel struck with the antidepressants due to the withdrawals being severe and my depression is severe and I don't know if I can literally live without them. As far as ambien, I am going in to my doc Monday and telling him I would rather be addicted than have the pathetic sleep habits of present. I don't sleep until exhausted and body shuts it down. I have tried ambien and slept like a normal person but doc said they were addictive. I have come to the conclusion you must do whatever gives YOU the gretaest peace of mind nobody lives in your shoes but you and your sanity and peace of mind are yours. I hear withrawals from antidepressants is harsh but unless you MUST take care of you first.   Mark

[jm1953]

I'm confused.  Are you saying you take just 2 mg of klonopin/day, or 2 mg three time a day (total of 6 mg)?  You seem to say both up above.

Just 2 mg/day isn't that high and you should be able to slowly ween off of it if/when you decide to do so.  6 mg/day is fairly high, though I've heard of people on that amount.

So you're "dependent" on them -- you're dependent on HAART too.
/quote]
Thanks Miss P for asking clarification.  I re modified the post to be a little more concise.  To answer your question I have been taking clonazepam 1mg three times a day daily since 2000.  And recently have been bumped up to clonazepam  2mg three times daily because life has been extremely stressful at present.  He also added Alprazolam 1 mg xanax twice daily to the mix to be taken PRN.

And you have a good point, I am dependent on HAART so I guess I may be making a big deal out of nothing.

[BT65]

Jm, I was strung out on benzos for years.  And the dose had to keep going higher, and I had to switch a couple times, because of the tolerance the body builds to them.  And, after long-term use, they can have the opposite effect on you-you can get residual anxiety because they're no longer working.  Dependence on benzos, and HAART are two different things.  The body won't go through severe withdrawals from discontinuing HAART; your health will decline, but for obvious reasons. 

I went through Ativan, Xanax and Valium.  Tried Klonopin, but they never did a thing for me.  I got the dosage up very high, because, like I said, the body builds a pretty good tolerance when they're used regularly.  And when I came off of them, I went cold turkey.  I don't necessarily recommend this, but it was something I needed to do.  I knew I could develop excuse after excuse to stay on them if I would have tapered off.  Of course, at the same time I cold-turkied off two powerful opiates and an amphetamine along with giving up the benzos.  It can be done, it's just a bit traumatic.  I've developed other ways of dealing with anxiety, rather than being dependent on a pill for it for the rest of my life.  I mean, treating anxiety, and treating HIV are two different things.  I strongly believe in using benzos for short periods of time after a traumatic event.  I don't agree with their long term use.  I know I'll probably get bashed for saying that, but that's how I feel.  But, I have an addictive personality, so things like these are bad news for me.

I don't like to tell people what to do in these situations, because I think everyone has to make up their own mind.  I got too dependent on the benzos (along with other things), and they caused me a myriad of problems.  Good luck with whatever you decide to do. 

[Miss Philicia]

Well, the key with benzos is not for them to get to such a high dosage.  No offense to Betty, but if someone has had a history of drug abuse most prescribing doctors will not allow someone to either be on benzos or they would not allow you to get to such a high dose.  Benzos get a bad name due to how doctors are using them, not so much the drug itself.  And patients will also do a lot to manipulate the doctor to give them more.  Let's keep this in mind when discussing these meds.

Jeff, are you also in cognitive behavioral therapy while on these meds.  You state you've had to increase you benzo use due to "stress" but if you've been on them for almost a decade I would think you've been in CBT sessions to manage anxiety and not depend so much on medication, or at least you should be.

I've been on benzos, and went up to higher doses, and then slowly weaned myself off of them without all of the hand wringing I see on a lot of internet web sites.  Maybe they've just not effected me like they do some people in terms of withdrawal.  I would never recommend going off of these cold turkey.

[BT65]

Well, the key with benzos is not for them to get to such a high dosage.  No offense to Betty, but if someone has had a history of drug abuse most prescribing doctors will not allow someone to either be on benzos or they would not allow you to get to such a high dose.  Benzos get a bad name due to how doctors are using them, not so much the drug itself.  And patients will also do a lot to manipulate the doctor to give them more.  Let's keep this in mind when discussing these meds.

Then there are doctors who just don't give a damn.  The doctor (psychiatrist) I was seeing was also prescribing the opiates, the amphetamine, and had me on high doses of hormones and thyroid (yes, all prescribed by a psychiatrist).  He got so bad, Medicare and Medicaid quit paying for him. 

But anyway, I've been told by psychologists, and M.D.'s that benzos should be used short-term, lot long-term, due to their possibility of dependency.  Whether someone's an addict or not, the body does get dependent on certain medications.  And yeah jm, I'm a recovering addict.  I also know a couple people who aren't addicts, and have gotten hooked on different meds; one benzos, the other pain meds.  It's just something the body can get used to, thus developing a tolerance as it sounds you've done.  I mean, it's really up to you of course.  I totally agree with Philicia about the CBT.  Good luck whatever you decide to do.

[Miss Philicia]

Well you'll never get me disagreeing with that one -- lots of incompetents out there writing prescriptions, and part of the problem is dividing the task of therapy from the one dispensing the medications which became mainstreamed with HMO's decades ago.  I lucked out 10 years ago by starting with someone that did both tasks for me.  But yes, meds are really only an ideal solution for a short time -- maybe the first year or two and without getting the dosing up so high like what we're discussing, and certainly not with multiple layers of drugs.

But it's hard to talk about anything other than generalizations with the OP Jeff as I'm not sitting in the room with him, and don't know the background of his issues unless I missed an older thread where he discussed it all.

[jm1953]

Miss P and BT65:

Of course you both bring up excellent points.  And thanks for caring enough to respond.

Part of the problem I believe is my needing to change therapists because of moving out of the area, or they no longer took my insurance.  I saw a tremendous one while living in Hawaii from 2000-2006.  During that time I didn't seem as dependent on my anti anxiety meds as she got me involved in pursuing writing, volunteerism, and creative endeavors.  She and I did a lot of work together.  After I found it necessary to move back to the mainland I started over with another psychologist who I liked very much.  And again we had a great experience and I felt I was making progress.  But unfortunately there was a hitch where he could no longer take my insurance.  Once again I felt abandoned as I had established a good working relationship with my counselor.  So I have been seeing a new psychologist he referred me to in the same behavioral group, but one who has a completely different spin on things.  I thought he was great at first, and then found he may not be the right fit for me.  During this transition my life began spiraling down hill with family and health problems.

To compound that, my primary HIV physician has moved his practice three times in the past year, and seems not as focused as he usually is.  Stressed and distracted.  I have been thinking it time to start looking for a new doctor as I'm not sure why his practice is always in such disarray. 

Of course a lot of what I'm talking about sounds like blame and excuses, I guess typical of an addict, but I have really noticed a huge difference in my emotional well being and treatment the past three months, not for the better, thus the increase in dosages.

I do see a psychiatrist very infrequently, who basically is one who assesses and then dispenses meds.  He is overseeing the anti-depressant I am on, however, does not concur with my taking clonazepam, nor knows I have been prescribed Xanax.  My primary wants control over these substances for some reason.

I hear what you both are saying, and feel I need to make an appointment with my psychiatrist and let HIM make all my psychotrophic medication decisions.  He works in the same group as my past and current counselor so he has access to my case, history, and progress.  As far as my current counselor goes, I was going to ask him to refer me to another my last session because I didn't feel we had the right fit, but miraculously we made huge progress that hour and I decided to stay with him for a while longer.

So as you can see, things are kind of a result of circumstance and transition;  changing counselors, doctors, fighting amongst the family, health issues, and of course the old HIV.  You guys have given me a good kick in the behind to do something about it, and I really appreciate your concern.

You and other members have really helped me since I joined the forum, and it is a connection I very much needed.

Thank you,

Hugs,

Jeff

[Tempeboy]

Hey jm,

The length of time taking benzo's can influence the 'chemical' dependence that develops.  The key is hooking up with a prescriber that you feel comfortable with who can help you gradually wean off.  The key is to do so slowly and under supervision - possibly over 3 months or even more.

Long term benzo use can contribute to depression, changes in sleep and low mood.  People often feel better in these area's when they stop.

Some of the modern antidepressants and antipsychotics are excellent for depression either ongoingly or as needed.

[jm1953]

Tempeboy:

Thanks for the tip.  There seem to be so many rules of thumb out there.  Especially among the doctors prescribing.  Wonder why they keep prescribing knowing we will eventually become dependent upon them.  Nothing has ever been said to me about this from any of the professionals I've seen except that my psychologist does not usually prescribe them.  On the other hand, my HIV doc totally believes in clonazepam who is the one who writes the prescriptions.

[BT65]

Jm, I don't think what you're saying sounds like excuses.  I mean, you asked, so obviously you're concerned about your benzo use.  Not all doctors seem to be familiar with the possibility of dependence on these meds; you have to find one who is.  And yeah, I would definitely tell your psychiatrist about your benzo use, and see what he says. 

Sometimes we have to cycle through quite a few counselors before we find the right one.  You have a right to have one who gives you good solutions to your problems, and helps you with those solutions.  Good luck, and let us know what happens.

[smalltown66]

Hey Jeff,

I too have the anxiety issues you have ( add another of our similar complaints to the list) and I too often question whether it is beneficial to keep taking the benzos. Like everyone else has said it is very important to take a slow approach at coming off of them if that would become your decision.

I have had a couple conversations with my PCP and my psychiatrist and they both do not seem overly concerned at this time with me taking the lower doses of the benzos. I take 1mg twice daily of Ativan . I have not had any flack from my insurance or my doctors either one. Most good doctors recognize when someone is going to abuse these drugs and they will discourage it and help you to come off of them slowly. i also take Ambien CR to help with sleep. We all know that these drugs are addictive but as several others have said your doctor will consider whether he thinks you could develop a problem. But I do think it is natural to worry about the addictive affects. I too have read that benzos can worsen depression and sleep problems. I just think it a issue of just making the most informed decision you can make, and as you stated in your message often the benefits of certain meds do offset the risks. Hope you find your answer.

Smalltown

[jm1953]

Smalltown,

It is interesting we have yet one more thing in common.  I think your advice makes sense.  I see my Primary Physician tomorrow who dispenses the Clonazepam and Ambiem CR.  We've already discussed the Ambien dependency issue and he'd rather see me get sleep than not.  The benefits outweigh the risks in this case.  I plan on talking with him about the Clonazepam and see if he may want to defer treatment with that to my psychiatrist.  I kind of doubt it because he is one who really believes in quality of life for his patients and is willing to do whatever it takes to achieve that.   My psychiatrist treats some HIV patients but basically does not prescribe benzo's because of the dependency issues, but also doesn't see all we are going through like my primary does. 

None the less, I'm going to have an appointment with my psychiatrist, state my concerns, and then they can duke it out and come to a decision if it comes to that point.  I'll go along with whatever they decide.

Let's put it this way, with all the other problems we have physically going on, kidneys, blood disorders, skin problems, arthritis and etc.  I don't put this situation too terribly high on the list.  However, if the medication is making things worse we'll go from there.

Will be in touch, and take good care,

jm

[jm1953]

I saw my HIV physician today.  I asked him about my possibly stopping clonazepam or tapering off because of dependency.   My physician subscribes to quality of life especially for his long term patients.  Due to my anxiety, panic attacks and such, he feels the benefits outweigh the risks and wants me to continue clonazepam.  My dose has been lowered to 1mg three times a day. 

He was certainly open to my starting tapering if I wanted.... but the withdrawals could cause even more problems than I had before, and can last a long time.  I figure I don't want to spend months to a year having terrible days, when at this point, it is anyone's guess what us long termers life span will be.  Rather work on improving my quality of life and strive for happiness instead of dealing with withdrawal.   That is my position right now.  As we all know this being an individual disease, what's right for one might not be for another.  It all depends on the circumstances and history of the patient.

Just thought I'd follow up.

jm

[Miss Philicia]

Hmm.  Frankly if I was up to the dose you were I'd taper off more slowly than chopping off 3 mg/day all at once. Just be careful and if you end up totally miserable you might want to decrease over a span of several months and do it in 1 mg increments.  I'm kind of surprised your doctor wanted to do it this way.

[BT65]

When I quit that variety of meds I was on, I was in bed for 3 days, and I was on heavy doses of benzos for years (10+).  That was the length of the physical withdrawal.  I'm not saying you should do this, Jm.  I agree, what doesn't work for some can work for someone else.  Good luck with whatever you decide to do.

[jm1953]

Thanks for your concern.  My doctor had just bumped me up to 2mg three times a day about a month ago from one mg a day.  I discussed my concern, frankly based on some of the discussions on this forum, so he agreed to lower it.  Hopefully there will be no significant withdrawal tapering back down to 1 mg three times a day after taking the higher dose of 2mg three times a day for three to four weeks. 

You raise a good point though.  I will call him tomorrow.  Again, another reason I appreciate the information I get from members like yourselves on this forum.

Thanks again....

JM