From: sbharris@ix.netcom.com (Steven B. Harris)
Subject: Re: Aging, Klonopin & Chinese Medicine
Date: 19 Aug 1996
Newsgroups: misc.health.alternative

In <4v7bcn$q3v@newsbf02.news.aol.com> dagger123@aol.com (Dagger123)
writes:

>Is anyone familiar with prescription drug Klonopin? My 75 year old
>grandmother has been taking this and has various side effects. She is
>also visiting an accupuncturist and herbologist. Hoping to get additional
>information.


It's pretty much like Valium, Restoril, Xanax and the other related
benzodiazepine-class tranquilizers, hypnotics, muscle relaxants, and
anti-seizure medications.  It makes you sleepier, dumber, less steady,
and a lot less upset over little things.  In big doses you don't even
get upset over large things.  A few months of it, followed by cold
turkey, and you'll go into a panic attack when the morning paper doesn't
come.  Lovely and necessary stuff for some people, the devil itself for
others. How do you tell these classes of people apart?  Impossible,
without trying it on them.  Docs who tell you different are knaves or
fools.

                                            Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Benzos for boozers (was Re: Ritalin
Date: Fri, 11 Jul 1997
Newsgroups: misc.health.alternative,alt.drugs,sci.med.pharmacy,sci.med

In <slworkED2Ds0.G2A@netcom.com> slwork@netcom.com (Steve Work) writes:

>Samson (a.gn@is.a.small.insect) wrote:
>: In article <5q0f5m$346@nyx10.cs.du.edu>, anon1723@nyx10.cs.du.edu (L. T.
>: Randall) wrote:
>
>: > The main difference between alcohol and Valium is that one is liquid and
>: > the other is solid.
>
>: This _has_ to be a troll.
>
>Not necessarily, it might be someone who's a proponent of the AA recovery
>program. The above line (that drugs are "solid" alcohol) is a belief
>which is repeated over and over and over in AA literature. They stress
>avoidance of -all- mood-altering drugs as necessary to remain sober.



   They do this over and over, in an atmosphere blue with cigarette
smoke, and in rooms lined with coffee dispensors.

   Basically AA doesn't like illegal or prescription drugs.  Legal OTC
drugs other than alcohol are okay with them.  That means that highly
anxious people simply cannot stick with AA unless they are so religious
that they can get their anxieties killed that way.  Some of the people
who can't stick are people who used alcohol as "self medication" for
what was a primary global anxiety psychiatric problem to begin with
(and which of course then became worse).  Others are agnostics who
suspect that there's no gaseous vertebrate in the sky watching to make
sure Everything's Gunna Be All Right, so that dodge just doesn't work
for them.  (Marx said religion was the opiate of the masses, but it's
actually the benzodiazepine of the masses).

   AA's fine if it works for you.  It doesn't work for everyone,
because it's only designed for a certain kind of person.

                                         Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Ritalin
Date: Fri, 11 Jul 1997
Newsgroups: misc.health.alternative,alt.drugs,sci.med.pharmacy,sci.med

In <5q1nl8$omq@senator-bedfellow.MIT.EDU> shapere@athena.mit.edu (H. E.
Shapere) writes:

>>It almost seems as if there is a puritanism which makes dangerous and
>>addictive but not enjoyable drugs (like Valium and major tranquillizers)
>>acceptable but not drugs which also have `recreational' potential.
>
>This is something that I've noticed - antipsychotic drugs like Stelazine,
>Trilafon, Haldol, and Zyprexa are being prescribed a lot for anxiety,
>depression, insomnia, hypomania, and the like (in other words, for
>nonpsychotic symptoms). Is this a recent phenomenon? Do these drugs
>actually help with anything other than psychoses?
>
>It seems to me that, even though they're not addictive, these are
>dangerous drugs - they can cause tardive dyskinesia and neuroleptic
>malignant syndrome, as well as annoying side effects like Parkinsonism,
>sedation, and hypotension.
>
>-elizabeth



   For sure.   And as for Valium and other drugs not being "enjoyable,"
that depends on who you are.  Some people get as much kick from them as
anybody does any drug.  It just depends on what receptors your
dopamine/endorphine reward system is wired to.   And as for puritanism,
I think that some of these puritans with benzo-endorphine hookups must
be NY legislators and assistants, since NY did indeed decide to make
benzos require triplicate scrips.

   (For those that don't follow-- a "triplicate" is a carbon copy
sandwich-like thingy with the doctor's name embossed, which the state
provides its licensed practitioners.  Every time you write a drug with
it, one form goes to the drugstore files, one stays with the doctor for
his/her files, and one goes to the state agencies for THEIR files.
That makes it very easy to keep track of who and what.  Some states
don't use triplicates at all (Utah, for instance), and those that do
usually use them only for the most powerful narcotics (morphine),
amphetamines (Ritalin) and Cocaine.  New York is the only state that
uses them for benzodiazepines.)

                                        Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.pharmacy,sci.med.psychobiology
Subject: Re: Tylenol poisoning
Date: 13 Oct 1998 07:32:40 GMT

In <3622E0A6.83635268@nospam.com> Anonymous <anon@nospam.com> writes:

>While on the subject of benzodiazepines, I know that they are CNS
>depressants, but does this mean that they can also cause depression in
>the clinical (i.e. psychiatric) sense, or does it just mean that they
>make you sleepy and in large enough doses could cause respiratory
>depression or whatever?

    They make you sleepy, but aren't much in the way of respiratory
depressants in and of themselves (though in combination with other
depressant drugs they can add to the effect).  So far as depression
goes they are pretty neutral.  Alprazolam/Xanax in fairly high doses
has some antidepressant properties.


>If you are taking an antidepressant but are also anxious, is there any
>likelihood of the benzo counteracting the effect of the AD?

   Not much of one.  I use them both together in patients all the
time-- the benzo while we wait a month of the SSRI to get fully kicked
in.

> Another thought:  I've read that the drug
>reserpine can cause depression.  Is it considered a CNS depressant?

   No.  It causes affective depression but isn't a "CNS depressant."
Which seems odd but reflects the two completely different senses of the
word as used in medicine.  The latter term generally refers to level of
consciousness and respiratory function.  It has little or nothing to do
with with affective depression (sadness/anhedonia/phycomotor
retardation etc).

>In other words, is there any relationship between a drug being a CNS
>depressant in the hypnotic sense and causing depression in the
>psychiatric sense of the word?


    No, not really.  Though there are some drugs (most notably alcohol)
which are famous for having both actions in chronic use.


                                   Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.pharmacy,sci.med.psychobiology
Subject: Re: Benzos vs barbs as anxiolytics
Date: 14 Oct 1998 13:58:02 GMT

In <36243490.542B53DE@nospam.net> Anonymous <nospam@nospam.net> writes:

>I know that barbiturates are clearly more potent than benzos as
>hypnotics, but what about their effect in relieving anxiety? Are benzos
>any more effective in alleviating anxiety than barbiturates


   They are.  Anxiety has been defined as that emotion suppressed by
benzodiazepines.  Barbiturates so some of this, but poorly.  You CAN be
too sleepy to be really anxious.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.pharmacy,sci.med.psychobiology
Subject: Re: Tylenol poisoning
Date: 14 Oct 1998 21:12:11 GMT

In <3624E7F0.A222BC08@nospam.com> Anonymous <nospam@nospam.com> writes:

>What drugs would be used to treat agitated depression?

   The classic best ones are MAO inhibitors such as Nardil.  However,
due to safety concerns, SSRIs are generally tried first.  These days,
only the psychiatrists have much experience using MAO inhibitors.

> And is this like anxiety
>with depression?

   I would say anxious depression is a subset of the agitated sort.

>What about people whose anxiety (or fear) doesn't seem to be
>completely suppressed by benzodiazepines?.

   They aren't getting enough benzodiazepines.  With enough benzos you
can convert even small wild animals (foxes) to tame ones.  In fact,
there is a classic study along that line.


>For the past couple weeks I've been very sad and frightened and have been
>on Zoloft and clonazepam. The clonazepam helps some, but only partially.
>Are there drugs that work more specifically on fear than anxiety?

   Same thing, more or less.  Benzodiazepines are the drug of choice,
followed for chonic use by SSRIs, and MAO inhibitors.   Buspar has
effects, but they are mild and generally people who need benzos don't
get much kick from Buspar ("I get no kick from Bu-spar/  Mere alcohol
doesn't thrill me at all...").


>  I'm reproducing an article I'd saved below on fear and the
>amygdala from the London Times.  Do benzos act on the amygdala?


    Yes.  Just out of curiosity, and for my own private series-- are
you Jewish?  I have seen a very large number of Ashkenazi with terrible
anxiety-- whether genetic or cultural/environmental, I cannot, of
course, tell.  I think with some PET scanning there's a fascinating
paper to be written on the Jewish amygdala (preface by Woody Allen).
Why is New York the only state in the union where benzodiaezpines
require a triplicate prescription?  There's a story here waiting to be
told, but it'll probably take Jewish psychiatrists to tell it (I mean,
other than Freud, who on the basis of his study of mostly Viennese
Jewish women, seems to have more or less decided that anxiety was the
key to most non-schizophrenic mental illness).

                                             Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: alternatives to benzodiazepines?
Date: 18 Mar 1999 12:31:45 GMT

In <7cp7ml$285b$1@nnrp9.crl.com> rob@sun.alegria.com (Rob Lingelbach)
writes:

>What possible alternatives, pharmaceutically, are there to
>benzodiazpines, for anxiety and insomnia?  I tend to develop a
>reaction to benzodiazepines with even a small dose, and wonder what
>other possibilities I can suggest to my doctor.


Pills:

   Anxiety: Buspar, SSRI antidepressants, MAOI antidepressants, St.
John's wort.

    Insomnia: Many old nasty drugs like barbiturates, Miltown, chloral
hydrate, etc.  None of them good.  Older antihistamines, which are
safer but cause dry mouth.  Most muscle relaxants work reasonably well
(Soma is a cousin of Miltown). Tryptophan, if you can get a
prescription.  5-HTP, but has theoretical dangers.  GHB is superior,
but now illegal many places.  Alcohol, but causes depression if used
much.  Ambien, which works well but is expensive and resembles
benzodiazepines quite a bit, though technically not one.  Valerian
herb, but the stuff stinks to high heaven.  Kava kava, but too much can
be hepatotoxic.  A seizure drug called Neurontin is a pretty good sleep
agent, and not a controlled substance.  But it's expensive.  An old
antidepressant called Trazodone works well in women, but causes a rare
penile scaring problem in men.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: alternatives to benzodiazepines?
Date: 19 Mar 1999 10:33:30 GMT

In <19990318102707.20845.00000042@ng99.aol.com> fileclosed@aol.com
(Fileclosed) writes:

>Sir,
>   Could you piont me to where I could find more info on trazdone/penile
>scaring? Or elaborate a little more of these effect? I have been taking
>trazdone for a sleep aid/tension relief. I have had some odd reactions in
>my penis, sores,(non-herpetic), small nodules, that i had not attributed
>to trazdone as i didn't know of ant correlation. I would apprciat any
>info your could offer.


  The scaring happens only after an episode of priapism (an erection
which won't go away, and which isn't treated).  The penis wasn't built
to stay erect for 24 hours or more, and the blood pooling and pressures
can cause permanent damage.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: alternatives to benzodiazepines?
Date: 19 Mar 1999 11:21:13 GMT

In <36F1C8B7.BD35C702@servtech.com> Ed Mathes <emathes@servtech.com>
writes:

>Great list.  You left out amitryptline.


   Yeah.  Another geriatric habit.  We never use this drug in doses
large enough to make anybody sleepy.  Anticholinergics are anathema is
our field.



>For those Buspar folks.
>
>I have used it on patinets (I have no anxiety...right) with varying
>success. Company even developed a schedule to wean you off xanax or the
>benzo of your choice whilst starting buspar. Tried it on a patinet who
>had been using xanax for years...she is off for 4 months now.


    Lucky you.  I've never had any success with anybody who'd
previously been on benzos.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: To CBI
Date: Mon, 3 Jun 2002 18:05:28 -0600
Message-ID: <adh0jn$vp0$1@slb5.atl.mindspring.net>

"Kurt Ullman" <kurtullman@yahoo.com> wrote in message
news:BGKK8.40$xC3.6@newsread1.prod.itd.earthlink.net...
> In article <ader7c$r1h$1@slb0.atl.mindspring.net>, "Steve Harris"
> <sbharris@ix.RETICULATEDOBJECTcom.com> wrote:
>
> >ROFL.  Don't know about CBI but I personally recommend the
> >Halcion+Glenlivet Rx. You don't remember being anxious about the
> >flight. Indeed, you don't remember the flight at all...
> >
>        Can you remember to change planes?? (serious question, actually)


Yes, so long as you knew the information before you took the pills.

There been several cases where doctors taking temazepam flew to scientific
conventions where they had to give a talk, made the trip fine, found their
way to the proper hotel auditorium, gave the talk with slides, and later in
the day remembered none of it. Not the flight, not the talk. But gave
perfectly fine talks, answered questions, and had no problem with anything
but committing new information to LONG TERM memory for a bit. This seems to
happen worse to some people than others with this drug. It's the same-old
problem with drugs-- different quirks for different jerks.

Seriously, I personally gave up Halcion/triazolam after I used it for a
sleep agent in a hotel at a medical conference, and the next morning
proceeded at a mixer to introduce myself to fellow doctor/scientist, after
which I walked away, then 10 minutes later, ran into the same guy and
proceeded to try to introduce myself again. I had spaced almost the entire
conversation, but (fortunately) was able to be vaguely reminded of it. And I
committed the weird look which I received to my long term memory pretty
well, also <g>. Still, that experience was enough.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: Panic Disorder
Date: Sat, 7 Jun 2003 15:28:46 -0700
Message-ID: <bbtouu$otr$1@slb9.atl.mindspring.net>

"Colt" <PatSHorselady@yahoo.commune> wrote in message
news:3EE14A0F.29BB@yahoo.commune...
> Steve wrote:
> >
> > What is a SSRI drug?
> > Is it possible to cure it without drugs, which is what she is doing?
> >
> > Emma Chase VanCott wrote:
> >
> > > Steve <stevelee@magma.ca> wrote:
> > > > My daughter (22 years old) is suffering from Panic Disorder for
> > > > about a year and it is now affecting her university study. She has
> > > > to drop out of last semester.  What is the best way to treat the
> > > > disorder?  Is there a website dedicated to this disorder?
> > > > Many thanks.
> > >
> > > Generally, the gold standard is to take the SSRI drugs.
> > >
> > > Benzos (Xanax, Ativan, etc.) cause memory (learning) impairment. Not
> > > good for a student.
> > >
> > > Cheers,
> > >
> > > Emma
>
>
> An SSRI is a kind of anti-depressant (SSRI= Selective Serotonin Reuptake
> Inhibitor). These are pretty safe and relatively effective medications
> for depression and anxiety (depression and anxiety are biochemically
> related).  Yes, panic disorder can be successfully treated without
> medications in some cases, but if your daughter is so severely affected
> that she's had to drop out of school, she would probably benefit from
> trying medication.




COMMENT:

Yes. However SSRIs (Prozac, Paxil, Zoloft, Celexa, etc) can
have side effects, take a month to work, and thus
already-anxious people very often find every possible excuse
to keep from taking them. They are amazingly creative about
it, and I've seen lists of 10 different reasons why a
patient couldn't take 6 different SSRIs. It's not NEARLY so
bad with simple-depression, where often you don't have an
anxious component, and where there isn't a direct and
rapid-acting antidepressant drug, as there is for anxiety,
ie benzodiazepines or "benzos" for short (unless you count
heavy-duty opiates or alcohol in the susceptible as
antidepressants<g>).

So you have to ride herd on anxious souls them to keep them
from permanently taking the easy way out, which is dropping
out of life, or trying to do it all with benzos.  The best
use of /Benzos is in the first 1 or 2 months it takes the
SSRI to work, but naturally many patients find they are so
simple and rapid acting and free of dysphoria, that they
decide they want them only. Which isn't a good solution for
most people, since benzodiazepine class drugs (Valium,
Xanax, Clonepin and the like) are prone to cause tolerance,
rebound, dependence, and all the usual controlled substance
problems. They are best saved for SSRI breakthrough, and for
specific foreseen anxiety-proving situations, such as a
scheduled surgical or medical procedure, scheduled rare
social stress situation, airplane flight, or whatever.

SBH