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Re: Benzodiazepine Tolerance

Posted by PaulB on June 30, 2001, at 9:59:46

In reply to Re: Benzodiazepine Tolerance » rmshed, posted by Elizabeth on June 30, 2001, at 1:49:00

> > Paul: My experience with benzodiazepines has been fairly text book. I maxed out several years ago taking 4mg of Xanax per day. That was considered a theraputic dose for me. It was hard to taper down to 2.25 mg per day that I am on now.
>
> I guess I'm confused. *My* textbooks all say that panic and anxiety patients *don't*, as a rule, develop tolerance to benzos. But it sounds like you kept needing ever-increasing doses. Or am I reading you wrong?
>
> > I read in a book called "Anxiety and Phobia Handbook" that the tolerance may be down in the liver.
>
> I'm not convinced. Tolerance is usually thought to be centrally mediated, a result of receptor down-regulation. Also, people who are tolerant to, say, Xanax, don't have cross-tolerance to other drugs whose metabolism is mediated by the same enzymes.
>
> > I have a very low level of GABA production and that it also takes awhile for the brain to produce more GABA.
>
> Xanax doesn't increase the amount of GABA; it makes GABA more effective at what it does.
>
> > Although most of this is way over my head, I know understand about the need to increase benzodiazepines.
>
> Most anxiety patients don't need to increase their dose, actually. I never experimented with long-term round-the-clock benzo use, myself (the closest I've come was taking Klonopin for a month at 4 mg/day and taking Xanax about once or twice a week for six months or more).
>
> > If I had it to do all over again, I would try to find another drug that works with anxiety and panic disorder, my body is dependent on benzodiazepines.
>
> Dependence (the experience of withdrawal symptoms upon discontinuing benzos) is a normal response. It's not the same as tolerance, though.
>
> -elizabeth

Paul B writes > > > > > > > > > > > > > > > >

I look to benzodiazepines because I have failed to respond to SSRI's and MAOI's for anxiety and feel strongly that I would like to play by the rules rather than try other less recognised treatment that have been used with some success i.e.Gabapentin. Benzodiazepines, arguably, are second line therapy. I havent taken the plunge towards taking a benzodiazepine daily because they bother me-They completely block my ability to think clearly. I couldnt even read a book the other day and take any of it in. Yet by giving the pams a trial then I may realise that these intolerable cognitive problems as well as amnesic effects may decrease quite rapidly

Did this concern you guys/gals initially and did you find that when you started taking a benzodiazepine daily these severe cognitve defects and extreme sedation lessened quite quickly.

It was interesting to note what StJames said about a difference between tolerance occuring to the 'high' associated with benzodiazepines and the anxiolytic effects. I wouldnt call the initial benzodiazepine effects a 'high' but they are much more potent and can help with co-morbid depression too. Down the line they may very well worsen it. The anxiolytic effects may last a long time so Ive heard.


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